ENDOCRINE DISORDERS

PITUITARY GLAND DISORDER

1. Hypopituitarism / Myxedema

• Pathophysiology:

  • Hyposecretion of one or more pituitary hormones caused by:

    • Tumors, trauma, encephalitis, autoimmunity, or stroke.

    • Destruction of the anterior lobe of the pituitary gland and effects of radiation therapy to head and neck.

  • Can lead to coma and death if missing hormones are not replaced.

  • Inadequate secretion of TSH, common in older women (e.g., Hashimoto's Thyroiditis).

  • Thyroid deficiency present at birth is termed cretinism.

  • Myxedema can arise from the accumulation of mucopolysaccharides, describing severe symptoms of hypothyroidism.

2. Clinical Manifestation

• Extreme fatigue

• Alopecia: hair loss, brittle nails, dry skin, numbness/tingling in fingers

• Husky voice and hoarseness

• Menstrual disturbances and loss of libido

• Weight gain

• Thickened skin

• Sensation of cold

• Slowed speech, enlarged tongue, hands, and feet

• Constipation

3. Pharmacologic Therapy

• Hormone replacement therapy

• Synthetic levothyroxine (e.g., Synthroid, Levothroid)

• Avoid external heat to prevent vascular collapse

• Administer concentrated glucose for hypoglycemia

4. Therapy and Interventions

• Radione therapy, surgery, and antithyroid drugs as treatment options

• Nursing interventions:

  • Monitor vital signs and neurological status

  • Provide emotional support and client education

  • Encourage expression of feelings about body image

5. Hyperpituitarism (Acromegaly/Gigantism)

Gigantism

• Occurs before epiphyseal closure (before 21 years) affecting long bones

Acromegaly

• Develops after epiphyseal closure (after 35 years) with increased GH

• Pathophysiology: Hypersecretion of growth hormone, often due to pituitary tumors.

• Signs and Symptoms:

  • Large hands and feet, thickened jaw, arthritic changes

  • Oily skin, hypertension, organomegaly, and hyperglycemia

• Medications:

  • GH antagonists: Bromocriptine (Parlodel), Sandostatin (Octreotide)

• Interventions:

  • Laser or cryosurgery, hypophysectomy, and monitoring for post-surgical complications.

6. Diabetes Insipidus

• Pathophysiology:

  • Decreased release of ADH from the posterior pituitary leads to reduced fluid absorption in the kidneys, resulting in polyuria (4 to 10 L daily).

• Assessment:

  • Fluid volume deficit symptoms like hypovolemia, decreased blood pressure.

• Interventions:

  • Administer Desmopressin (DDAVP) to increase tubular water reabsorption, monitor vital signs.

  • Signs of complications: Hypernatremia (increased sodium level), resulting in irritability, weakness, and possible seizures.

ADRENAL GLAND DISORDER

1. Addison’s Disease

• Pathophysiology:

  • Autoimmune or idiopathic atrophy leading to hyposecretion of adrenal cortex hormones (glucocorticoids, mineralocorticoids, and androgens).

  • Decreased ACTH levels, often due to therapeutic corticosteroid use.

• Signs and Symptoms:

  • Lethargy, weight loss, dark hyperpigmentation, hypotension, muscle weakness, anorexia, low blood glucose, low serum sodium, high serum potassium.

2. Addisonian Crisis

• Signs:

  • Cyanosis, headache, nausea, abdominal pain, diarrhea, confusion, restlessness.

• Medications:

  • Glucocorticoid and mineralocorticoid replacement.

• Management:

  • Administer fluids and corticosteroids in a recumbent position with legs elevated; IV hydrocortisone with normal saline.

• Nursing Management:

  • Monitor vital signs and electrolytes, educate about lifelong adherence to medication, and assess skin color/turgor.

3. Cushing’s Syndrome/Disease

• Pathophysiology:

  • Excess cortisol production due to adrenal or pituitary tumors or prolonged glucocorticoid therapy; more prevalent in women aged 20 to 40.

• Clinical Manifestations:

  • Central-type obesity, buffalo hump, thin fragility of skin, glucose intolerance, sleep disturbances, excessive protein loss with muscle wasting, sodium and water retention (hypertension, heart failure), moon facies.

• Assessment:

  • Overnight dexamethasone suppression test, 24-hour urinary free cortisol, CT/MRI scans.

• Medications:

  • Ketoconazole, Mitotane.

• Interventions:

  • Monitor glucose/electrolytes, prepare for surgical interventions, encourage rest and activity, maintain skin integrity.

THYROID GLAND DISORDER

1. Hypothyroidism

• Pathophysiology:

  • Hyposecretion of thyroid hormones (T3, T4) resulting in decreased metabolism.

• Signs and Symptoms:

  • Lethargy, weight gain, bradycardia, constipation, myxedema.

• Medications:

  • Levothyroxine sodium.

• Interventions:

  • Monitor vital signs, educate about medication adherence and dietary adjustments; avoid sedatives and opioids.

• Myxedema Coma:

  • Severe condition with signs like hypotension, bradycardia, hypothermia, and a risk for respiratory failure.

  • Interventions:

    • Maintain airway, IV fluids, levothyroxine administration, monitor blood pressure and electrolytes.

2. Hyperthyroidism (Graves' Disease)

• Pathophysiology:

  • Hypersecretion of thyroid hormones increasing metabolic rate.

• Signs and Symptoms:

  • Weight loss, tachycardia, heat intolerance, exophthalmos.

• Medications:

  • Methimazole, Propylthiouracil, beta-blockers.

• Interventions:

  • Administer antithyroid drugs, prepare for thyroidectomy, monitor daily weight, maintain cool environment, and provide a high-calorie diet.

3. Thyroid Storm

• Signs:

  • Fever, tachycardia, nausea, vomiting, agitation, confusion, seizures.

• Interventions:

  • Maintain airway, administer antithyroid medications, monitor vital signs and for dysrhythmias, use cooling blankets.

• Thyroidectomy:

  • Removal of thyroid glands indicated for persistent hyperthyroidism.

• Pre-operative/ Post-operative Interventions:

  • Monitor vitals/electrolytes, assess for hyperglycemia, and precautions for respiratory distress and potential hypocalcemia.

PARATHYROID GLAND DISORDER

1. Hypoparathyroidism

• Pathophysiology:

  • Hyposecretion of parathyroid hormone leading to hypocalcemia.

• Signs and Symptoms:

  • Muscle cramps, tetany, numbness, Trousseau's and Chvostek’s signs, hypotension, anxiety.

• Medications:

  • Calcium and Vitamin D supplements to enhance calcium absorption.

• Interventions:

  • Administer calcium, initiate seizure precautions, and administer a high-calcium, low-phosphorus diet.

2. Hyperparathyroidism

• Pathophysiology:

  • Hypersecretion of PTH leading to hypercalcemia.

• Signs and Symptoms:

  • Fatigue, weakness, renal stones, skeletal pain, nausea/vomiting, and hypertension.

• Medications:

  • Calcitonin, Bisphosphonates, Furosemide.

• Interventions:

  • Monitor calcium levels, encourage fluid intake, and administer medications.

• Parathyroidectomy:

  • Removal of one or more parathyroid glands with pre- and post-operative interventions for electrolyte balance and potential complications.

DIABETES MELLITUS

• Diabetes is a group of metabolic diseases characterized by hyperglycemia due to defects in insulin secretion/action.

• Types:

  • Type 1: Autonomic destruction of beta cells leads to insulin deficiency.

  • Type 2: Insulin resistance with relative deficiency; progresses to increased blood sugar levels leading to organ/tissue damage.

• Clinical Manifestations:

  • Polyuria, polydipsia, polyphagia, fatigue, vision changes, dry skin, slow wound healing.

• Assessment and Diagnosis:

  • Blood glucose levels:

    • Fasting Plasma Glucose ≥ 126 mg/dL

    • Random Plasma Glucose ≥ 200 mg/dL

• Medications and Interventions:

  • Type 1: Insulin therapy; Type 2: oral medications (e.g., Metformin).

  • Monitor blood glucose, ensure proper administration, encourage diet/exercise.

  • Educate patients on signs of hypoglycemia/hyperglycemia and complications.