MIDTERM EXAM 3RD YEAR

Endocrine Glands

Ductless glands that release hormones directly into the bloodstream

Hypothalamus

Controls pituitary gland; secretes releasing hormones; maintains homeostasis

Anterior Pituitary Hormones

GH, PRL, ACTH, TSH, LH, FSH, MSH

Posterior Pituitary Hormones

Stores and secretes ADH and Oxytocin from hypothalamus

Primary Endocrine Disorder

Problem originates in the gland itself

Secondary Endocrine Disorder

Problem is in the pituitary or hypothalamus

GH Hypersecretion

Gigantism in children, Acromegaly in adults

GH Hyposecretion

Dwarfism

Prolactin Hypersecretion

Galactorrhea

Prolactin Hyposecretion

Absence of milk during lactation

ACTH Hypersecretion

Cushing’s Syndrome

ACTH Hyposecretion

Addison’s Disease

TSH Hypersecretion

Hyperthyroidism

TSH Hyposecretion

Hypothyroidism

FSH/LH Hypersecretion

Precocious puberty

FSH/LH Hyposecretion

Infertility, impotence, no ovulation

MSH Hypersecretion

Bronze skin appearance

MSH Hyposecretion

Albinism

ADH Hypersecretion

SIADH - water retention

ADH Hyposecretion

Diabetes Insipidus - water loss

Oxytocin

Stimulates uterine contraction and milk ejection

Alpha cells

Secrete glucagon - increases blood glucose

Beta cells

Secrete insulin - decreases blood glucose

Delta cells

Secrete somatostatin - inhibits other hormones

Diabetes Mellitus

Chronic metabolic disorder with hyperglycemia

Type 1 DM

Autoimmune, no insulin, common in children, prone to DKA

Type 2 DM

Insulin resistance or deficiency, common in obese adults, prone to HHNKS

3 P's of DM

Polyuria, Polydipsia, Polyphagia

Macroangiopathy

Affects brain, heart, peripheral arteries

Microangiopathy

Affects kidneys (nephropathy), eyes (retinopathy)

Random Blood Sugar (RBS)

≥200 mg/dL with symptoms = DM

Fasting Blood Sugar (FBS)

126 mg/dL = DM

Postprandial Blood Sugar

≥200 mg/dL = DM

HbA1c

7% indicates poor glucose control

Type 1 DM Management

Diet, exercise, insulin

Type 2 DM Management

Diet, exercise, oral hypoglycemics, insulin if needed

Rapid-acting Insulin

Onset: 5 mins, Peak: 30–60 mins, Duration: 2–4 hrs

Short-acting Insulin

Onset: 30–60 mins, Peak: 2–4 hrs, Duration: 6–8 hrs

Intermediate Insulin

Onset: 1–2 hrs, Peak: 6–12 hrs, Duration: 18–24 hrs

Long-acting Insulin

Onset: 5–8 hrs, Duration: 24 hrs

Lipodystrophy

Fat loss or buildup from repeated insulin injections

Somogyi Phenomenon

Rebound hyperglycemia after night hypoglycemia

OHA Precaution

Avoid alcohol with sulfonylureas - causes vomiting

Hypoglycemia

<60 mg/dL; caused by insulin OD, missed meals, exercise

Hypoglycemia Management

Simple sugar PO or D50 IV push

ADH (Antidiuretic Hormone)

Regulates water balance by promoting reabsorption of water in kidneys

SIADH

Pathologic high levels of ADH despite normal plasma osmolality and volume

Key Signs of SIADH

Hyponatremia, concentrated urine, low serum osmolality, water retention

SIADH Labs

Findings: Serum Na

SIADH Management

Fluid restriction, monitor neuro status, seizure precautions, 3% NSS for severe cases

Diabetes Insipidus

Low or absent ADH, causing excessive water loss through dilute urine

Types of DI

Central (CDI), Nephrogenic (NDI), Dipsogenic, Gestational

DI Causes

Head trauma, brain tumors, CNS infections, pituitary surgery, meds like Dilantin or alcohol

DI Manifestations

Polyuria, polydipsia, dehydration, low urine specific gravity, hypernatremia

DI Labs

Findings: Serum Na >145, Serum Osmo >295, Urine Osmo <300, SpG <1.005

Water Deprivation Test

Used to diagnose DI; positive if urine remains dilute despite dehydration

Nephrogenic vs Central DI

Test with DDAVP; ↑ urine osmo in central DI, little/no change in nephrogenic

DI Treatment

DDAVP for CDI, HCTZ + low sodium diet for NDI, D5W for fluid replacement

Thyroid Hormones

T3 (metabolism, growth), T4 (heat production), Calcitonin (↓ calcium)

Hyperthyroidism

Excess thyroid hormones (T3/T4), often autoimmune (Graves)

Thyroid Storm

Acute, life-threatening hyperthyroid crisis due to stress or surgery

Hyperthyroid Signs

Restlessness, tachycardia, weight loss, heat intolerance, exophthalmos

Hyperthyroid Diet

High calorie, high protein, avoid stimulants, replace fluids

Hyperthyroid Drugs

Beta-blockers, iodine preps, PTU, methimazole, steroids

Hyperthyroid Surgery Care

Post-op: semi-Fowler's, trach set ready, ice collar, check for tetany

Hypothyroidism

Low thyroid hormone; causes include Hashimoto's, surgery, radiation

Myxedema

Severe hypothyroidism in adults; coma if untreated

Hypothyroid Signs

Bradycardia, cold intolerance, fatigue, hoarse voice, dry skin

Hypothyroid Diet

Low calorie, high fiber to manage obesity and constipation

Hypothyroid Drugs

Levothyroxine, cytomel; start low and go slow

Thyroid Function Tests

T3/T4 levels, RAIU scan, thyroid scan, FNB, BMR

RAIU Test

High uptake = hyperthyroidism, low uptake = hypothyroidism

Aldosterone

Promotes sodium & water retention, potassium excretion

Cortisol

Regulates stress, metabolism, and immune function

Androgens

Main source of male hormones in females

Addison’s Disease

Hypofunction of adrenal cortex; ↓cortisol, aldosterone, and sex hormones

Addison’s Disease Symptoms

Fatigue, weight loss, hypotension, bronzed skin, hypoglycemia

Addison's Lab Findings

Low cortisol, hyponatremia, hyperkalemia, hypoglycemia, acidosis

Addison’s Nursing Care

Hormone replacement, rest, high sugar-salt-protein diet

Cushing’s Syndrome

Hyperfunction of adrenal cortex; ↑cortisol, aldosterone, and sex hormones

Cushing’s Symptoms

Moon face, buffalo hump, striae, hirsutism, obesity, mood swings

Cushing's Labs

High cortisol, hypernatremia, hypokalemia, hyperglycemia

Cushing’s Meds

Mitotane, Mifepristone, Ketoconazole, Metyrapone, insulin

Cushing’s Nursing Care

Monitor BP/weight, low sodium-calorie diet, prepare for surgery

Hyperaldosteronism (Conn’s Syndrome)

Excess aldosterone secretion, often from adrenal tumor

Hyperaldosteronism Symptoms

Hypertension, headache, muscle weakness, hypokalemia

Hyperaldosteronism Labs

↓K+, alkalosis, high urinary aldosterone

Hyperaldosteronism Nursing Care

Spironolactone, K+ supplements, sodium restriction, prep for surgery

Pheochromocytoma

Tumor of adrenal medulla causing excess epinephrine/norepinephrine

Pheochromocytoma Symptoms

Severe headache, palpitations, sweating, hypertension, tachycardia

Pheochromocytoma Labs

↑Catecholamines, VMA, blood sugar, glycosuria, tumor on x-ray

Pheochromocytoma Nursing Care

Monitor BP, control hypertension, high-calorie diet, avoid stimulants