patho pharm II -exam 2 - Endocrine Disorders 9 points

• Syndrome of Inappropriate ADH
• Overproduction of ADH secretion without normal stimuli.

• Ectopic ADH= Not from the pituitary
• Usual sources are cancer cells- (Small cell adenocarcinoma is most common) 

• Less common causes:
• CNS disorders (brain tumor)
• Pulmonary disorders (pneumonia, TB)
• Drugs (Chemo)
• psychosis, myxedema

SIADH results in inappropriate reabsorption of water at distal tubules leading to water overload  or intoxication. 

• 1. Decreased urine output
• 2. Edema - Water intoxication
• 3. Hyponatremia- serum/ Hypernatremia- urine
• 4. Hyposmolality- serum/ hyperosmolality -urine
• 5. Fatigue, confusion, convulsions - twitches
• 6. Anorexia, Abd cramps, N/V
• 7. Dyspnea, HTN

Serum= Hyponatremia (dilutional), Hyposmolality

Urine= Hypernatremia, Hyperosmolality, High urine specific gravity

• Fluid volume excess
• 1. Correct causitive problem- if possible
• 2. Monitor of electrolyte/osmolality 
• 3. Fluid restricion (<800-1000cc/day)
• 4. Diuretics
• 5. Sodium replacement - Hypertonic saline IV
• 6. Pharm- lithium, demeclocycline interfere w. ADH action, Dilantin interfere w. ADH release

** Assess CNS changes, distention, BP, HR, UO, I&O

Deficient ADH secretion

Diabetest insipidus makes the body unable to conserve water resulting in large volume diuresis  and tissue dehydration. 

• Neurogenic: insufficient amounts of ADH
•      - idiopathic
•      - posttraumatic 
•      - post-surgical

Other uncommon types: nephrogenic: insuff response of kidneys to adh; and Psychogenic (rare): compulsive water drinking

Lesions of the hypothalamus, pituitary stalk, posterior pituitary. 

• May develop due to:
• *brain tumor or head trauma
• *cerebral -aneurysms, thrombosis, infetions 
• *Immunologic disorders

• Excretion of large amounts of dilute urine --> 
• Inrease in serum osmolality --> Hypernatremia --> Dehydration --> Polydipsia 

• Polyuria, Polydipsia, Nocturia 
• Dehydration
• Hypernatremia - blood
• Hyperosmolality - blood/ hyposmolality - urine
• Tachycardia
• Hypotension

Serum = hyperosmolality, hypernatremia

Urine= low specific gravity, hyposmolality, hyponatremia. 

• ^{(Fluid volume deficit)}
• 1. Administer hypotonic fluids (0.45 NS).. or oral 40-50 glasses/day (9-10 L)
• 2. ADH replacement- Synthetic vasopressin (DDAVP) or drugs that potentiate endogenous ADH
• 3.Monitor: I&O, daily wt, urine specific gravity measures, VS OFTEN
• 4. Provide Skin and oral care

• Abnormal ADH production= 
• 1. SIADH
• 2. Diabetes Insipidus

Late onset overproduction of growth hormone 

Early onset overproduction of growth hormone. 

• 1. Bony proliferation
• 2. Peripheral nerve entrapment
• 3. Insulin resistance
• 4. HTN and heart failure

• Enlarged jaw, forehead, hands, feet and tongue
• Increased sebaceous and sweat glands
• Barrel chest
• Weakness, muscular atrophy, footdrop, and sensory changes in the hands.

Surgical removal or radiation of tumor (the cause)

• ◦Affects growth and maturation of tissues
• ◦Helps regulate serum calcium

• Types:
•  ◦Thyroxine (T4) and Triiodothyronine (T3)
• ◦Calcitonin - affects serum calcium levels

• Hyperthyroidism:
•     1. Graves disease
•     2. Nodular Thyroid Disease
•     3. Thyrotoxic Crisis (aka thyroid storm)

• Hypothyroidism:
•     1. Primary
•     2. Hashimoto
•     3. Myxedema

Thyroid Cancer

Familial auto-immune disorder that causes hyperthyroidism because of negative feedback.

*Generalized acceleration of body processes

Thyroid autoantibodies (TSI) stimulate thyroid gland --> also decreases thyroid regulators TSH and TRH --> Hyperthyroidism

• Hyperthyroidism
• Goiter (visible enlargement of thyroid gland)
• Opthalmopathy (eye disease)
• Dermopathy (skin disease)

• Drugs to suppress thyroid activity (PTU)
• Radioactive Iodine
• Surgery (thyroidectomy) 

• 1. Fine hair/Hair loss
• 2. Exopthalmos - bulging eyes , Goiter 
• 3. Sweating
• 4. Tachycardia, HTN
• 5. Weight loss with INCREASED appetite
• 6. Decreased libido and irregular menstration 
• 7. Tremors, Muscle wasting
• 8. decreased attention span, nervousness, insomnia

Goiter , Visible enlargement of the thyroid gland due to hyperthyroidism 

• Normal increases in TH (puberty, pregnancy)
• Iodine deficiency
• Viral Infection
• Immunologic disorder

• "Thyroid Storm" 
• -Under-treated hyperthyroidism
• -Excessive stress
• - Infection
• -Pulmonary or cardiac disorders
• -Inadequate treatment for thyroid surgery

• Hyperthermia
• Tachycardia, Hypertension
• Heart failure (High output)
• Agitation
• Delirium
• Hyperglycemia
• N & V, Diarrhea, Dehydration

• Propylthiouracil (PTU) -(Thyroid antagonist)
• ◦Inhibits synthesis of T3 and T4
• ◦Inhibits iodine uptake in thyroid gland

Prognosis: Fatal within 48 hours if untreated.

= Everything slows down. 

• 1. Primary hypothyroidism – Decrease in amount of circulating TH
• ◦Etiology: Non-bacterial inflammation, Viral infection, Thyroidectomy, Toxic effect of medications (Lithium, Amiodarone), Age

• 2. Hashimoto Disease (Autoimmune Thyroiditis)
• ◦Synthesis of thyroid hormone decreased
• ◦Etiology: thyroid antibodies and infiltrating lymphocytes destroy thyroid tissue, Genetic disposition

Myxedema - occurs secondary to altered composition of dermis and other tissues, and edema. 

Clinical manifestations: Non-pitting edema, especially around eyes, Thickening of  tongue, Hoarseness

Labs: Hyponatremia, Hypoglycemia, anemia, bradycardia, decreased o2, increased CO2 and pH

• Symptoms are proportional to degree of TH deficiency
• All body systems affected
• - Decreased metabolic rate
• - Goiter may develop (Decreased TH à Increased TSH à Hypertrophy of thyroid cells àGoiter)
• -Myxedema
• **LOOK UP- Tissues become water logged due to separation connective tissue by increased amounts of protein and mucopolysaccharides (p. 637).

Risk factor: Ionizing radiation (Chernobyl – 1986)

• Diagnosis
• ◦Thyroid nodule on palpation
• ◦Needle aspiration of nodule

• Treatment
• ◦Near-total thyroidectomy
• ◦Total thyroidectomy
• ◦Post-op radio-active iodine
• ◦Levothyroxine

= Cushings syndrome: exaggerated actions of gluticosteroids cause excessive secretion of cotisol from adrenal cortex

• 1. Adrenal Tumor
• 2. Corticosteroid medications such as prednisone, solu-medrol 

• Weight gain (fat redist./water retention)
• Moon Face
• Buffalo hump (kyphosis)
• Truncal Obesity (wt in abdomen) 
• Glucose intolerance (Hyperglycemia)
• Muscle wasting (protein catabolism)
• Osteoporosis (protein wasting)- fractures, reduced height
• Renal stones (HYPERCALCEMIA)
• Collagen loss- fragile skin and capillaries, easy bruise, striae
• Hyperpigmentation
• HTN
• Immunosuppression- Poor wound healing
• Mood changes
• Elevated androgens (Sx in women)- facial hair, acne, irreg . 

• Complicated and challenging!
• Labs: Hyperglycemia*, Glycosuria, Hypokalemia, Metabolic alkalosis
• Elevated serum ACTH & cortisol levels
• MRIs, etc.

• = Addison's Disease 
• Hyposecretion of cortisal from adrenal cortex

• autoimmunity
• genetics
• exogenous glucocorticosteroids
• ACTH hyposecretion

• (due to low cortisol & aldosterone)
• Weakness and fatigue
• GI dist- pain, diarrhea, anorexia
• Hypoglycemia
• Hyponatremia
• Hyperpigmentation with areas of vitiligo -loss of pigment
• Hypotention 
• Confusion
• Decreased tolerance of stress

• Hypoglycemia, Hyperkalemia, Hyponatremia
• decreased cortisol in blood and urine
• Altered ACTH levels