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Endocrine System
Nursing
71
Medical
Undergraduate 4
11/16/2008

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Term
Anterior Pituitary Hormones
Definition
TSH-thyroid-stimulating hormone;
ACTH-adrenocorticotropic hormone or corticotropin;
LH-luteinizing hormone;
FSH-follicle-stimulating hormone;
PRL-prolactin;
GH-growth hormone;
MSH-melanocyte-stimulating hormone;
Term
Posterior Pituitary Hormones
Definition
Vasopressin or ADH: antidiuretic hormone-promotes water reabsorption

oxytocin: stimulates uterine contractions and ejection of breast milk
Term
Hypopituitarism
Definition
Usually one hormone is markedly decreased and the others somewhat decreased.
Term
Deficiencies of what hormones are the most life threatening?
Definition
Deficiencies of ACTH and TSH are the most life threatening.
Term
Panhypopituitarism
Definition
extremely rare for the anterior pituitary to stop making all hormones
Term
Hypopituitarism
Definition
Hypopituitarism may be caused by tumors of the pituitary gland or hypothalamus, head trauma, brain tumor, radiation, brain surgery, stroke, or infections of the brain and the tissues that support the brain. Occasionally, hypopituitarism is due to uncommon immune system or metabolic diseases such as sarcoidosis, histiocytosis X, and hemochromatosis.
Term
What accounts for 25-30% of pituitary adenomas
Definition
prolactinomas--removal of this is one of the most common neurological surgeries
Term
Signs and symptoms of Anterior hypopituitarism
Definition
Signs and symptoms depend on the cause and the hormone affected.
fatigue ,weakness, sensitivity to cold,
decreased appetite weight loss abdominal pain,
low blood pressure,headache, visual disturbances,
loss of armpit or pubic hair
in women: cessation of menstrual periods, infertility, or failure to lactate
in men: decreased libido, loss of body or facial hair
**REMEMBER THIS IS INSIDIOUS--it creeps up on you!
Term
Hypopituitarism: Diagnosis
Definition
cranial CT scan or cranial MRI, revealing a tumor or abnormal mass in the pituitary gland;
Blood levels of serum luteinizing hormone (LH), serum follicle stimulating hormone (FSH), or serum thyroid stimulating hormone (TSH), decreased or normal;
serum testosterone serum estradiol (estrogen), serum cortisol, serum ACTH, levels, decreased;
T4 (thyroid hormone), decreased;
serum growth hormone (GH), decreased;
Term
Stimulation testing
Definition
injecting agents that are known to stimulate secretion of specific pituitary hormones and then measuring the response;
if an agent is injected and you get a correct response, you know it's a production problem; if it's injected and don't get a correct response, it's a receptor problem
Term
Hypopituitarism: Treatment
Definition
Removal of pituitary tumor;
Replacement of deficient hormones;
watch for halo sign to make sure there is no CSF leakage;
more severe HA when raised up head of bed, so they'll want to lay back down
Term
Hyperpituitarism
Definition
Over secretion of hormones due to pituitary tumors or hyperplasia;
Benign adenomas are the most common;
If the tumor gets large enough it presses on brain tissue and causes visual changes, headache and signs of increased intracranial pressure
Term
Growth Hormone Hypersecretion before puberty
Definition
leads to gigantism.
Usually caused by a pituitary tumor.
Causes organ overgrowth and pressure on pituitary and brain tissue.
Term
Growth Hormone Hypersecretion after puberty
Definition
causes Acromegaly
Onset is insidious--slowly
An incidence of 3-4 cases per million people per year and a prevalence of 40-70 cases per million population.
This happens more commonly than giantism
After a prolactinoma, these growth hormone tumors are the most common
Remember it’s also happen internally—not just externally
Term
Acromegaly: mortality rate and most common cause of death
Definition
The mortality rate is 2-3 times that of the general population; The most common cause of death is cardiovascular and pulmonary complications.
Term
Treatment of Acromegaly
Definition
Successful treatment, with normalization of GH levels, may be associated with a return to normal life expectancy; bone doesn’t return to normal, but prevents further damage
Term
does acromegaly happen more in men or women
Definition
men
Term
Acromegaly: signs and symptoms
Definition
Changes in appearance: thick oily skin, increased lip and nose size, protrusion of the lower jaw, increased head size, and increase head, hands and feet.
Joint enlargement with pain, kyphosis, and barrel chest.
Excessive sweating, hyperglycemia.
Airway narrowing, enlarged heart lung and liver.**
Term
Acromegaly: testing
Definition
Serum GH levels: Inability to suppress serum GH during an oral glucose tolerance test (OGTT) is the criterion standard for diagnosing GH excess.
Serum IGF-1 concentrations
Serum insulin like growth factor-binding protein-3 levels
CT or MRI
Term
Acromegaly: Medical treatment
Definition
Somatostatin analogs (Octreotide):adverse effects are nausea, abdominal pain, diarrhea, and increased incidence of gallstones, reduce effects of cyclosporine; drugs are insulin, oral hypoglycemics, beta-blockers, and calcium channel blockers.;
Dopamine agonists (eg, bromocriptine):Adverse effects include nausea, vomiting, abdominal pain, arrhythmias, nasal stuffiness, orthostatic hypotension, sleep disturbances, and fatigue; caution in renal or hepatic disease
Term
Surgical Treatment of Acromegaly
Definition
Surgical removal of tumor.
Post op: Usually in neuro-ICU first 24 hr
Monitor: vitals, vision, mental status, level of consciousness;
Watch for “halo sign” for CNS fluid leakage
Term
Acromegaly: Post surgery teaching
Definition
Pt to report post nasal drip. Avoid coughing, sneezing or blowing the nose early after surgery as it can cause increase pressure and CSF leakage.; watch for halo sign
Term
Posterior Pituitary Hypofunction causes...
Definition
Diabetes Insipidus
Term
Diabetes Insipidus
Definition
A water metabolism problem caused by an ADH deficiency or an inability of the kidneys to respond to ADH
Term
Key Features of Diabetes Insipidus
Definition
Inability to concentrate urine leads to polyuria with excessive fluid loss and dehydration, dilute urine, increased thirst, hypotension, tachycardia, irritability, decreased LOC, lethargy and coma; there will be a rise hemoglobin and hematocrit and BUN
Term
What is the greatest danger for patients with Diabetes Insipidus?
Definition
The greatest danger for these pts is dehydration! b/c they’re going to completely dry out
Term
Diabetes Insipidus: Assessment
Definition
24 hour I & O: Urine output must exceed 4 L to diagnosis diabetes insipidus.; 24 hr. urine output will usually be between 4 and 30 L/day.;
"water deprivation" or dehydration test: measure urine output, specific gravity, osmolarity and weight hourly.;
CT or MRI scans
Term
What happens if you withhold water from pts with diabetes insipidus?
Definition
they will continue to put out huge amounts of water; the body isn't saving itself/conserving what they need
Term
Treatment of diabetes insipidus
Definition
Oral chlopropamide (Diabinese)(can cause hypoglycemia;
Vasopressin nasal sprays;
Daily weights;
Drink fluids equal to urine output;
Wear med alert
Hormone treatment is lifelong!!!
Term
SIADH: Posterior Pituitary Hyperfunction
Definition
syndrome of inappropriate antidiuretic hormone- too much vasopressin (ADH) is put out even when plasma osmolarity is low--drowning b/c not putting any fluids out!
Term
Causes of SIADH
Definition
Malignancies Pulmonary: pneumonia/pneumothorax;
CNS: trauma, infection, strokes;
Drugs: opioids, general anesthesia
Term
What is the most important electrolyte to watch?
Definition
Sodium-it can get below 115 mEq/L
Term
What does SIADH cause?
Definition
GI disturbances: N/V, loss of appetite
Water retention, hyponatremia (especially if Na fall below 115 mEq/L) and fluid shifts leads to lethargy, headaches delirium, decreased LOC, seizures and coma.
Decreased tendon reflexes, tachycardia and hypothermia.
Term
Why do you need to watch their BP continuously even if they're on anti-HTN meds?
Definition
because their BP will continually increase even with medication
Term
SIADH: Treatment/Monitoring
Definition
Fluid restriction- As low as 500 mL/24 hr;
I & O, daily weights- weight gain of 2 lbs per day troubling, 1 Kg wt. = 1 L fluid.;
Diuretics- may cause more Na loss;
Use saline in all IVs- hypertonic saline is rarely used because it can cause fluid shifts and heart failure;
Demeclyocycline (Declomycin)-rarely used (don't take with antiacids or milk
Term
Adrenal cortex produces what?
Definition
cortisol, aldosterone, and androgens
Term
what does the adrenal medulla produce?
Definition
norepinephrine and epinephrine
Term
Adrenal Hypofunction: ADDISON'S Disease
Definition
also called adrenal insufficiency, or hypocortisolism.;
May result from inadequate ACTH through the hypothalamic-pituitary control system or dysfunction of adrenal gland tissue.
Term
Primary Causes of adrenal hypofunction
Definition
affects about 1 in 100,000 people;
About 70 percent of reported cases of Addison's disease are caused by autoimmune disorders: tuberculosis, AIDS, hemorrhage, metastatic cancer
Term
Secondary Causes of adrenal hypofunction
Definition
Pituitary tumors, high dose pituitary radiation, or an abrupt stop of long term glucocorticoid therapy; these will cause probs but won’t affect aldosterone output; more common than primary
Term
Adrenal Hypofunction: Key features
Definition
Usually begins gradually: chronic, worsening fatigue, muscle weakness, joint pain, loss of appetite, wt. loss, N/V, diarrhea, salt cravings.;
Irritability and depression;
Anemia, orthostatic hypotension,hypoglycemia, hyponatremia, hypercalcemia and hyperkalemia
Term
Addisonian Crisis: Life threatening event--What can cause it?
Definition
Usually when someone with adrenal insufficiency experiences a stressor such as surgery, severe infection, or trauma
Term
Addisonian Crisis: Life threatening event--what can it lead to?
Definition
to severe hypotension, hyponatremia and hyperkalemia: weakness, confusion, cardiac arrhythmias,shock, coma
Term
Adrenal Hypofunction: Testing for Primary
Definition
low serum cortisol, low blood glucose, hyponatremia, hyperkalemia, increased BUN, (elevated eosinophils and ACTH in primary disease).
Term
Adrenal Hypofunction: Testing for Secondary
Definition
Secondary disease also has low serum ACTH, ACTH stimulation test results in increased cortisol levels
Term
Other Adrenal testing
Definition
CT, MRI, skull X-ray, or angiography to detect tumors or atrophy.;
Urinary testing for glucocorticoid metabolite 17-hydroxycortico-steroid
Term
Nursing Interventions for Adrenal Hypofunction
Definition
Maintain fluid balance-daily wt., I & O;
Monitor for cardiac problems;
Manage electrolyte imbalances;
Monitor for and manage hypoglycemia;
Administer gluccocorticoids and aldosterone as ordered.(may carry dexamethanon pen);
Teach patient to wear medic alert, hormonal replacement is lifelong and what to do incase of sick days of stressors.
Term
Adrenal Hyperfunction: Hypersecretion of the adrenal gland results in:
Definition
Hypercorticalism: Cushing’s syndrome, Cushing’s Disease (also known as Hyperadrenocorticism);
Hyperaldosteronism;
Excessive androgen production
Term
Hypercorticalism: Cushing's Disease
Definition
Caused by endogenous cortisol secretion by pituitary or adrenal adenomas or lung, GI or pancreatic malignancies
Term
Hypercorticalism: Cushing’s syndrome
Definition
Caused by administration of Glucocorticoids or ACTH as an anti-inflammatory in treatment of asthma, transplants, autoimmune diseases or allergic responses.
Term
Manifestations of Cushing’s
Definition
Fat redistribution and weight gain: moon face, buffalo hump, obesity;
Muscular atrophy, thin skin, striae;
Increased risk for infections
Osteoporosis with spontaneous fracture;
Hypertension, increased risk for DVT, edema, bruising.;
Sleep disturbances, decreased memory.
Weakness, fatigue;
Increased glucose and possible DM;
Changes in menses, libido and secondary sex characteristics.


See chart 66-13
Term
Cushing’s: Diagnostic Assessment
Definition
Elevated plasma cortisol levels- try and get the sample at the same time each day as levels normally fluctuate;
ACTH levels may be elevated;
Increased glucose, and sodium;
Decreased serum calcium and potassium and lymphocyte count;
also causes increased WBCs--don't be alarmed, but do notify dr.;
Urine for free cortisol and metabolites- Done as a 24 hr. collection. Urine Ca+, K+, and glucose will be elevated.;
Dexamethasone suppression tests for Cushing’s disease.;
In normal subjects giving dexamethasone will suppress cortisol secretion.
Term
Radiologic exams for Cushing's
Definition
X-rays of skull, chest and abdomen.;
Angiography;
Nuclear scans;
CT scans;
MRI;
Ultrasonography
Term
Nonsurgical Management of Cushing's
Definition
Treat the clinical manifestations such as: hypernatremia, hypokalemia, hyperglycemia and hypertension.;
Protect from injury: falls, fractures and skin tears.;
Prevent infection;
Provide education;
Term
Surgical Management of Cushing's
Definition
Removal of pituitary adenoma-Most common cause of Cushing's.; Surgical cure rate of 85-90%;
Will need replacement steroids;
Adrenalectomy- Usually done laproscopically; Will need lifelong steroid replacement
Term
Surgical Management of Cushing's: Pre operative
Definition
Pre Op: Correct electrolyte imbalances and monitor for dysrhytmias
Term
Surgical Management of Cushing's: Post-Op
Definition
Monitor vitals and I&O, Monitor urine output, daily wt. and electrolyte levels; Pt. may need immediate glucocorticoid replacement therapy
Term
Hyperaldosteronism
Definition
Excessive secretion of aldosterone
Term
What is hyperaldosteronism usually caused by?
Definition
adrenal adenoma
Term
What does excess aldosterone lead to?
Definition
Na+ retention and K+ and hydrogen ion loss
Term
Symptoms of hyperaldosteronism
Definition
high BP***; HA, muscle weakness, fatigue, intermittent paralysis, numbness and nocturia; also, watch for signs of K+ depletion such as numbness and tingling
Term
Hyperaldosteronism: signs and test
Definition
Low serum potassium level;
Abdominal CT scan that shows adrenal mass;
Elevated plasma and urine aldosterone levels;
Low plasma renin activity;
ECG that shows abnormalities associated with low potassium levels
Term
Hyperaldosteronism: Interventions
Definition
Surgical removal of adenoma: surgery is not done until potassium levels are normal.;
Spironolactone (Aldactone): potassium sparing diuretic. (will need liver tests b/c it's hard on liver)
Watch for hyperkalemia. Avoid K+ supplements. Teach patient signs of hyponatremia such as dry mouth or lethargy.
Term
What type of replacement therapy will be needed if only one adrenal gland is removed?
Definition
Will need temporary replacement therapy, but it will eventually compensate
Term
Pheochromocytoma
Definition
a tumor of the adrenal gland that causes excess release of epinephrine and norepinephrine
Term
What does a pheochromocytoma cause?
Definition
Causes sporadic attacks of sympathetic stimulation lasting minutes to hours.
Term
Pheochromocytoma: signs and symptoms
Definition
Severe headache;
Palpitations;
Rapid heart rate;
Sweating – can be profuse;
Flushing / heat intolerence;
Chest pain ;
Abdominal pain –may cause nausea and vomiting;
Nervousness/ Irritability ;
Decreased appetite /Loss of weight
Term
What should you NOT do in pts with pheochromocytoma?
Definition
DO NOT palpate the abdomen in these patients as it can cause a sudden release of catacholamines and cause a hypertensive crisis.
Also, tricyclics, glucagons and foods with tyramine can also cause a HTN crisis
Term
Diagnosis of Pheochromocytoma
Definition
Adrenal biopsy;
An MRI or CT of abdomen that shows adrenal mass;
24 hr. urine collection for VMA (vanilylmandelic acid), metanephrine and catecholamines;
Clonidine suppression test (Clonidine reduces the catecholemine levels in normal people, but will remain same in people with pheochromocytoma
Term
Pheochromocytoma: Interventions
Definition
Surgical removal of the tumor is the main treatment.;
Monitor and stabilize blood pressure before and after surgery.; Start with alpha blockers and then beta blockers.;
Do not palpate the abdomen.;
Provide adequate hydration and nutrition.
Term
What could happen if a beta blocker is used before alpha blockade is achieved? (Pheochromocytoma)
Definition
may cause a rebound in BP
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