disorders and tests of the endocrine system

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inspection of endocrine system

mood, neck, eyes, posture, amount and placement of body fat, skin and hair texture and moisture, skin color changes

palpation of endocrine system

thyroid is the only gland that can be palpated, not done with hyperthyroidism, skin turgor

TSH test

increased levels with hypothyroidism and decreased levels in hyperthyroidism

Calcium test

decreased in hypothyroidism

Growth hormone test

increased in acromegaly, decreased in dwarfism

ADH test

decreased in diabetes insipidus and increased in SIADH

Cortisol test

increased in cushings syndrome and decreased in addison's disease

Fasting Plasma Glucose

increased with physical and psycological stress, increased in illness and DM, decreased with hypoglycemia

Oral glucose tolerance test

hour intervals to check blood sugars and urine dipstick to look for glucose after drinking a glucose drink

Post Prandial Glucose test

drawn 2-4 hrs after a pt eats

Hgb A1c

normal is between 7-8 percent, tracks blood sugar for past 90 days to see how well person is doing with control of DM

nuclear scans

to check thyroid gland for tumors or nodules, inject radioactive dye and scan thyroid, look for hot spots (good) or cold spots which are often malignant

ultrasound

done on thyroid and parathyroid to find tumors

Diabetes Insipidus

caused by a deficiency of ADH, usually from a (brain)tumor or head trauma (neurogenic), use vasopressin (DDAVP) to treat

S/S of DI

polyuria 3-15L of urine per day, dehydration symptoms, polydypsia, high plasma osmolality, low urine concentration.......evaluation: water deprivation test

SIADH(syndrome of inappropriate antidiuretic hormone)

increase in ADH causing fluid overload can be caused by cancer, meds, head trauma, or brain surgery

S/S of SIADH

weight gain, edematous (renal water retention), hyponatremia, thirst, lethargy, impaired taste, dyspnea on exertion, nausea, vomiting, sz, coma

Tx of SIADH

fluid restriction, correct hyponatremia, diuretics, monitor sodium and potassium levels and lung sounds

Dwarfism

lack of GH caused by genetics or pituitary disorders often caused by infections and malnutrition in childhood

Acromegaly

excess GH (IN ADULTS)caused by disfunction of pituitary gland, will have a large physical appearance: enlarged hands, feet, skull. Risk for diabetes, hypertension, heart disease

Hypophysectomy

removal of the pituitary gland

post op care for pituitary surgery

neuro checks, urine specific gravity test, don't remove nasal packing, can't brush teeth, monitor drainage for glucose

pre op care for pituitary surgery

neuro checks, teach pt methods of coughing and sneezing more softer, don't strain when having a BM

Ablation Therapy

a Tx for hyperthyroidism using radioactive iodine

exophthalmos

bulging eyes--> hyperthyroidism, grave's disease

tetany

continuous tonic spasm of a muscle caused from deficiency of calcium, vit D, and alkalosis

Anosmia

absense of the sense of smell

Hypothyroidism

decreased function of the thyroid T3 and T4 are lacking
dry, flaky skin, cold intolerance, decreased appetite, reduced HR and BP, weight gain, lethargy

Myxedema

hypothyroidism in adults: increased sensitivity to cold, fatigue, weight gain, thin brittle hair and fingernails, slow speech, decreased sense of taste and smell

Cretanism

hypothyroidism in children

Tx for hypothyroidism

Synthroid, monitor TSH, T3, T4

Hyperthyroidism

excess of thyroid hormone T3 and T4

Thyroid storm (or crisis)

TSH, T3, and T4 are very high, emergency,
can occur after surgery or spontaneously. hyperthermia, tachycardia, agitation, delerium, NVD

Tx for thyroid storm

PTU (propyithiouracil) :(O2, ASA, beta blockers, ablation therapy)

Goiter

enlarged thyroid gland because of lack of Iodine, can occur in hypo and hyper

Tx of goiter

add iodine, thyroidectomy, have tracheotomy kit at bedside

Hypoparathyroidism

decrease PTH, decrease calcium, can be caused from accidental removal of the parathyroid when removing the thyroid

Tx of hypoparathyroidism

IV, calcium gluconate, high calcium diet and vit. D, monitor for kidney stones

Hyperparathyroidism

increased PTH, increased calcium, usually caused by benign tumors, can be hereditary, seen also in chronic kidney disease

Tx of hyperparathyroidism

IV NS, diuretics, fosamax, parathyroidectomy, trach at bedside

Pheochromacytoma

rare tumor of the adrenal medulla causing an increased secretion of epinephrine and norepinephrine

Tx of pheochromacytoma

surgical removal of 1 or both adrenal glands

Addisons disease

Primary adrenal insufficiency (autoimmune) causing decreased production of cortisol and aldosterone causing hyponatremia, hyperkalemia, hypoglycemia, weakness and fatigue, increased pigmentation in creases of hands, fingers, elbows, knees

Tx of addisons

steroids for life, monitor I&O, BG, sodium, keep away from illness, increased cortisol during stress

Cushings disease

Pituitary tumor is most common cause, also steroid use: increased ACTH, results in increased cortisol. Supraclavicular fat pad front and back (buffalo hump), moon face, truncal obesity, easy bruising, hyperglycemia, muscle wasting, weakness, hypertension, increased body hair, osteoporosis

Tx of cushings

removal of adrenal glands and/or pituitary glands, decrease steroids

Chvostex sign

tap facial nerve in front of the ear if positive you will see a spasm in the face, used to check for tetany

Truousseau sign

put BP cuff on arm, pump it up, if positive there will be a spasm in arm, used to check for tetany

Adrenocortical hormones

cortisone, prednisone, decadron, used to reduce inflammation

anterior pituitary hormones

corticotropin, used to treat adrenal insufficiency caused from injury to the pituitary gland, IM for 21 days

post. pituitary hormones

vasopressin, used for diabetes insipidus

thyroid replacements

levothyroxine - synthroid, liotrix

antithyroid products

logols iodine, tapazole, PTU

logols iodine

used to destroy part of the thyroid gland

tapazole

blocks function of T3 and T4, usually used on children and young adults

PTU

given 10-14 days before thyroid surgery to calm the thyroid down so they don't over produce hormones during surgery

DI: insufficiency of ADH due to:

Neurogenic: Insufficient amounts of ADH (brain surgery, brain tumor, surgery, infection)
Nephrogenic: Inadequate response by kidney to ADH -(can be caused by genetic condition or other disorders)
Psychogenic: not same as DI, but same symptoms, take in large amounts of fluids and develop resistance to ADH

Treatment for nephrogenic DI

Thiazide diuretics

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