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Adrenocortical Insufficiency (Addison’s Disease)

results when adrenal cortex function is inadequate to meet thepatient’s need for cortical hormones.

Autoimmune or idiopathic atrophy of the adrenal gland

is responsible for 80% of cases.

Tuberculosis and histoplasmosis

most common infections that destroy adrenal gland tissue

tuberculosis

should be considered in the diagnostic workup because of its increasingincidence

Inadequate secretion of ACTH from the pituitary gland

also results inadrenal gland also results in adrenal insufficiency because of decreased stimulation of the adrenal cortex.

Therapeutic use of corticosteroid

is the most common cause of adrenocortical insufficiency.

addisonian crisis

With disease progression and acute hypotension, the patient develop

addisonian crisis

characterized by cyanosis and the classic sign of circulatory shock; pallor, apprehension, rapid respirations, and low blood pressure.

dexamethasone suppression test

s the most widely used screening test for diagnosis of pituitary and adrenal causes of Cushing’s syndrome.

Measurement of plasma ACTH by radioimmunoassay

is used in conjunction with the high-dose suppression test to distinguish pituitary tumors from ectopic sites of ACTH production as the cause of Cushing’s syndrome.

transsphenoidal hypophysectomy

Surgical removal of the tumor by ____, is a treatmentof choice and has a 90% success rate for Cushing’s

Adrenalectomy

is the treatment of choice in patients with primary adrenal hypertrophy.

Temporary replacement therapy

with hydrocortisone may be necessary for several months until the adrenal glands begin to respond normally to the body’s needs. If both adrenal glands have been removed (adrenalectomy, bilateral), lifetime replacement of adrenal cortex hormones is necessary

Adrenal enzyme inhibitors

may be used to reduce hyperadrenalism if the syndrome is caused by ectopic ACTH secretion by a tumor that cannot be eradicated.

Addison’s Disease

results when adrenal cortex funstion is inadequate to meet the patient's need for cortical hormones.

Autoimmune or idiopathic atrophy of the adrenal glands

is responsible for 80% of cases for Addison’s disease.

• CBC

• Serum Electrolytes

• Urine

• ACTH Administration

Assessment and Diagnostic Findings of Addison’s Disease

Metyrapone/Cosyntropin

• ACTH Administration

  • what med?

• Hydrocortisone

• Vasopressin

• IV Fluid

• Antibiotics

Medical Management for Addison’s disease

1. Addisonian Crisis

2. Restoring the Fluid Balance

3. Improving Activty Intolerance

Nursing Management for Addison’s Disease

Cushing's syndrome

results from excessive, rather han deficient, adrenocortical activity.

excessive administration of corticosteroids of ACTH or from hyperplasia

The Cushing’s syndrome may result from

• Transsphenoidal hypophysectomy

• Radiation of the pituitary Gland

• Adrenalectomy

• Adrenal Cortex Hormones

• Temporary Replacement Steroids Therap

• Adrenal enzyme inhibitors

Surgical Management for Cushing’s

Hyperthyroidism

Overactive thyroid, Low TSH, Increased T3 and T4

• .Graves Disease

• Thyroiditis

• Toxic Nodular goiter

Types of Hyperthyroidism

1. Total Thyroidectomy

2. Lobectomy or Hemithyroidectom

3. Near-total thyroidectomy

4. Isthniset

Management (Surgical) for idk basta

• Synthetic Levothyroxine

Management (Medication) for Hypothyroidism

Hyperthyroidism

is second to diabetes mellitus as the most prevalent endocrine disease

Grave's disease

The most common type of hyperthyroidism

Grave's disease

resulting from excessive production of thyroid hormones brought about by abnormal thyroid gland stimulation by circulating antibodies

emotional shock, stress, or an infection

Grave's disease may occur following an

Thyroiditis and excessive ingestion of thyroid hormone

common causes of hyperthyroidism

inflammation

resulting from irradiation of the thyroid or destruction of thyroid tissue by a tumor (cancer) may also cause an excessive thyroid hormone release.

thyrotoxicosis

Clients with fully-developed hyperthyroidism demonstrate a distinct group of manifestations.

Ophthalmopathy

Eye manifestations of hyperthyroidism, e.g., exophthalmos (bulging eyes), producing a startled facial expression and may be irreversible despite treatment.

Exophthalmos

Bulging eyes seen in hyperthyroidism.

Heat Intolerance

Poor tolerance to heat and excessive sweating seen in hyperthyroidism.

Fine Tremor of the Hands

Slight shaking of the hands observed in hyperthyroidism.

Progressive Weight Loss

Occurs despite increased appetite and dietary intake in hyperthyroidism.

Diarrhea

Bowel Function Changes associated with hyperthyroidism.

Osteoporosis

Particularly in females, associated with hyperthyroidism and fractures.

Myocardial Hypertrophy and Heart Failure (Decompensation)

May occur with severe and untreated hyperthyroidism, especially among elderly clients.

Emaciation, Severe Nervousness, Delirium, Disorientation

Possible outcomes in untreated, advanced hyperthyroidism.

• Presence of symptoms

• Elevated serum T4

• Increased ¹²³I or ¹²⁵I uptake by the thyroid over 50%

Diagnosis in advanced cases is based on:

Irradiation via radioisotope

Most common treatment for elderly clients

• Irradiation via radioisotope

• Antithyroid medications

The two types of pharmacotherapy used totreathyperthyroidism and control excessive thyroid activity include

antithyroid medications

hinder the synthesis of thyroid hormones andother agents to control hyperthyroidism’s manifestations.

bruit

indicating increased blood flow through the thyroid gland.

bruit, tenderness, enlargement, and nodularity

abnormal findings

Serum immunoassay

for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) are the most commonly used tests.

TSH concentration measurement

is the single best thyroid function screening test among clients for its high sensitivity and specificity (> 95%).

TSH concentration measurement

This test detects small serum TSH alterations permitting the possibility of distinguishing subclinical thyroid disorder from euthyroid condition among Clients having high or low normal values.

serum free thyroxine (FT4)

is the most widely-used test confirming an abnormal TSH.

serum free thyroxine (FT4)

free (unbound) thyroxine (the only metabolically active fraction of T4) is directly measured.

0.9 to 1.7ng/dL

Serum FT4 normally ranges from

T3 resin uptake test

an indirect measure of unsaturated thyroxine-binding globulin (TBG) determining the amount of thyroid hormone bound to TBG, including the number of available binding sites.

radioactive iodine uptake test

he rate of iodine uptake by the thyroid gland is also measured through the

radioactive iodine uptake test

This test is done via the administration of iodine-123 or another radionuclide to the client, and using a scintillation counter, the amount of gamma rays released from the breakdown of iodine-123 in the thyroid is detected and counted, revealing the proportion of the administered dose present in the thyroid gland at a specific time after its administration.

fine-needle aspiration biopsy

When malignancy is suspected, this done using a small- gauge needle to sample the thyroid tissue for laboratory examination.

thyroid scan

involving a scintillation detector or gamma camera moves back and forth across the area to be studied in a series of parallel tracks, making a visual image of radioactivity distribution in the area being scanned. This diagnostic procedure helps determine the thyroid gland’s location, size, shape, and anatomic function, especially with enlarged thyroid tissue.

Irradiation via radioisotope

its destructive effects on the thyroid gland

• Propylthiouracil (PTU / Propacil)

• Methimazole (Tapazole)

Common Antithyroid Medications

Antithyroid medications

are utilized to inhibit one or more stages in thyroid hormonesynthesis (e.g., PTU) or hormone release (e.g., sodium iodide, potassiumiodide).

Iodine or iodide compounds

are also used to manage hyperthyroidism. Some of these compounds decrease the amount of thyroid hormones released from the thyroid gland and reduce the thyroid gland’s vascularity and size.

beta-adrenergic blocking agents

is an essential component of treatment, particularly in controlling the sympathetic effects associated with hyperthyroidism. For instance, propranolol (Inderal) controls nervousness, tachycardia, tremor, anxiety, and heat intolerance. Its use continues until the value of free T4 normalizes and the TSH level approaches normal.

Propranolol (Inderal)

Beta-Adrenergic Blocking Agents example