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58 terms

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