Assessment and Management of Patients with Endocrine Disorders 2,3

Assessment and Management of Patients with Endocrine Disorders

Overview

• Prepared by Prof. Zeinab Al-Wahsh for Spring 2024-2025 Lectures 2-3

Endocrine Glands

• Endocrine glands release hormones (chemical messengers) into the bloodstream to various organs and tissues.

• Example: Pancreas secretes insulin; Thyroid gland regulates chemical activity levels via pituitary instructions.

Pituitary Gland

Location and Structure

• Size: About the size of a pea (1.27 cm in diameter).

• Often called the master gland.

• Located on the inferior aspect of the brain, with anterior and posterior lobes.

• Controlled by the hypothalamus.

Disorders of the Pituitary Gland

Acromegaly

• Occurrence: About 6 in every 100,000 adults.

• Cause: Abnormal growth hormone (GH) production after normal growth.

• Typically caused by a benign tumor in the pituitary gland.

• Risk factors: Prior history of a pituitary tumor.

Hyperpituitarism - Acromegaly

• Elevated secretion of anterior pituitary hormones leading to excessive GH.

• Causes include:

  • Pituitary or hypothalamus malfunction.

  • Primary adenoma of hormone-secreting cells.

  • Lack of feedback from target gland.

• Two types:

  • Acromegaly: occurs in adulthood.

  • Gigantism: occurs in childhood with extreme height.

Assessment of Acromegaly

• Symptoms include:

  • Enlarged hands and feet.

  • Visual problems, headaches.

  • Oily skin, hyperglycemia, jaw protrusion, joint pain.

  • Menstrual disturbances, impotence.

Complications of Acromegaly

• May include:

  • Hypo-pituitarism, high blood pressure, glucose intolerance, diabetes.

  • Cardiovascular disease, carpal tunnel syndrome, sleep apnea, arthritis.

  • Other complications include uterine fibroids and vision abnormalities.

Diagnosis & Tests for Acromegaly

• High levels of growth hormone and IGF-1.

• Spine x-ray shows abnormal bone growth.

• MRI or CT might reveal pituitary tumors.

Management of Acromegaly

• Provide emotional support and encourage expression of feelings.

• Frequent skin care and interventions for joint pain.

• Prepare client for radiation therapy or hypophysectomy if needed.

Simmonds' Disease (Panhypopituitarism)

• No hormones from anterior pituitary lobes due to various causes (tumors, surgery, etc.).

• Leads to atrophy of several organs including heart, kidneys, and adrenal glands.

• Symptoms include impotence, extreme weight loss, hypometabolism, amenorrhea.

• Treatment involves hormone replacement therapy (HRT).

Diabetes Insipidus (DI)

• Overview: Water metabolism issue due to ADH deficiency.

• Classification includes primary neurogenic, secondary neurogenic, nephrogenic, and drug-related.

• Symptoms of DI:

  • Polyuria (excessive urination), polydipsia (excessive thirst).

  • Dehydration, dry skin, headache.

Addison's Disease

• Condition involves hypo-secretion of adrenal cortex hormones, commonly due to autoimmune destruction.

• Symptoms include weakness, GI disturbances, bronze pigmentation, electrolyte imbalances (hyperkalemia).

• Treatment involves monitoring vital signs, maintaining fluid/electrolyte balance, and educating on lifelong corticosteroid use.

Cushing's Syndrome

• Caused by increased ACTH from tumors.

• Symptoms: central obesity, hypertension, moon face, and muscle weakness.

• Treatment may involve adrenalectomy and the need for lifelong steroid supplementation post-surgery.

Hypothyroidism & Myxedema

• Myxedema: severe hypothyroid state often caused by Hashimoto's thyroiditis.

• Symptoms: lethargy, cold intolerance, weight gain, dry skin.

• Diagnosis includes T4 test, high TSH in primary cases, and thyroid function tests.

Graves' Disease (Hyperthyroidism)

• Caused by hyper-secretion of thyroid hormone leading to increased metabolism.

• Symptoms include exophthalmos, increased appetite, nervousness.

• Diagnosis includes decreased TSH and elevated T3/T4 levels.

• Treatment may involve medication, radioactive iodine, or surgery.

Parathyroid Disorders

Hypoparathyroidism

• Caused by decreased parathyroid hormone, typically after thyroid surgery.

• Symptoms: hypocalcemia, tingling, cramps, tetany.

Hyperparathyroidism

• Caused by increased parathyroid hormone.

• Symptoms: bone deformities, fractures, elevated calcium levels.

• Management includes monitoring electrolytes and potential surgical intervention.