210 metabolism

Study Guide on Endocrine Disorders

Adrenocortical Dysfunction

Adrenal Insufficiency

  • Definition: Insufficient secretion of adrenal cortex hormones (mineralocorticoids, glucocorticoids, and androgens).

  • Types:

    • Primary (Addison’s Disease):

      • Hyposecretion of adrenal cortex hormones.

      • Causes: Adrenalectomy, autoimmune destruction, tuberculosis (TB), metastatic carcinoma.

    • Secondary:

      • Hyposecretion of ACTH from the pituitary gland.

      • Causes: Abrupt discontinuation of corticosteroid therapy, pituitary dysfunction.

  • Manifestations (acute or chronic): Hyperpigmentation (bronzed skin), weight loss, hypotension, hyponatremia, hypoglycemia, fatigue, hyperkalemia.

Addisonian Crisis

  • Definition: Life-threatening condition due to acute adrenal insufficiency.

  • Etiology: Infection, stress, trauma, abrupt withdrawal of corticosteroids.

  • Manifestations: Severe abdominal, lower back, or leg pain; severe vomiting; diarrhea; dehydration; loss of consciousness; low BP; dysrhythmias.

  • Treatment: High-dose hydrocortisone, fluids with dextrose.

Cushing’s Syndrome

  • Pathophysiology: Overproduction of cortisol by the adrenal cortex.

  • Causes: Adenoma, prolonged steroid use, ACTH secreting tumor.

  • Manifestations: Buffalo hump, moon face, truncal obesity, fluid retention, muscle wasting, hypertension.

  • Diagnostic Tests: ↑ Glucose, sodium; ↓ Potassium, calcium; ↑ Cortisol in saliva.

  • Treatment: Adenoma removal, medications like Ketoconazole, fluid/sodium restriction.

Pituitary Dysfunction Disorders

Hyperpituitarism

  • Pathophysiology: Oversecretion of pituitary hormones.

  • Causes: Pituitary tumor or tissue hyperplasia.

  • Manifestations: Acromegaly, sexual dysfunction, increased ICP.

Hypopituitarism

  • Pathophysiology: Deficiency of one or more pituitary hormones; can lead to diabetes insipidus.

  • Causes: Pituitary tumor, congenital defect, trauma.

  • Manifestations: Decreased sexual function, adrenal insufficiency, polydipsia, polyuria.

Thyroid Disorders

Hyperthyroidism

  • Pathophysiology: Overproduction of T3 & T4.

  • Causes: Graves' disease, toxic nodular goiter.

  • Manifestations: Increased appetite, weight loss, heat intolerance, exophthalmos.

  • Diagnostic Tests: ↑ T3 and T4, variable TSH levels.

  • Complications: Heart failure, thyroid storm.

Hypothyroidism

  • Pathophysiology: Decreased production of T3 & T4.

  • Causes: Underactive thyroid, Hashimoto’s disease.

  • Manifestations: Weight gain, cold sensitivity, dry skin, myxedema.

  • Diagnostic Tests: ↓ T3 and T4; TSH may vary.

  • Complications: Myxedema coma.

Nursing Care Interventions

  • Monitor vital signs, glucose levels.

  • Manage fluid intake/output.

  • Educate on diet (high-calorie/high-protein for hyperthyroidism; low-calorie/high-fiber for hypothyroidism).