- Usually affects target organs
- Often Excess GH
- - Giantism (Childhood)
- - Acromegally (Adulthood)
Caused by Hyperpituitarism and excess GH in early childhood
- Hyperpituitarism and excess GH in Adulthood (usually between 30-40 y.o.)
- Sx: Spade-Shaped hands and feet, prominant supraorbital ridge, large nose/jaw, separated or lacking teeth, sexual dysfunction, HTN, visual feild deffects, peripheral neuropathy, abnormal glucose
- Rare, usually from tumor/trauma
- Usually non-specific but can be target organs
- Tx c sergery, radiation therapy, hormone therapy
- Can be ACTH, TSH, GH, Gonadotrophin
- Anterior Pituitary Problem
- Acute: Fatigue, N/V, Dizziness, Circulatory Collapse
- Chronic: Tiredness, Pallor, Wt.Loss, Anorexia, Hypoglycemia
- Anterior Pituitary Problem
- bradycardia, constipation, slow mentation, hair loss, hoarsness, wt. gain, cold intoleerance
- ANterior Pituitary Problem
- loss of libido, infertility, amenorrhea, osteoporosis
- Anterior Pituitary Problem
- Decreased muscle mass and strength, decreased quality of life, increased central obesity, premature artherosclerosis
Disfunction in the POSTERIOR pituitary causes an excess of ADH leading to the kidneys retaining water. This retention of water leads to a decrease in urine output.
A dysfunction in the POSTERIOR pituitary leads to deficient ADH production which causes an increase in dilute urine output. Due to the increased dilute urine output there is hyponatremia causing uncontrolable thirst. There is poor skin turgor, hyerthermia, tachycardia, dry mucosa, hypotension, coma, yearning for ice water.
- Sx: goiter, exophthalamos, warm/moist/flushed skin, hair loss, weight loss with increased apetite
- -Graves Dz
- Tx: Block the effects, stop the over secreation with medications or sergery, RAI
- Nrs: Teach about RAI, artificial tears, dark glasses, increased caloric intake, decrease caffeine intake, limit activity
- Sx: Cold intolerance, weight gain, cold/dry/course skin, decreased pulse below 75 bpm, hoarsness, deafness, myxedema.
- Tx: Thyroid hormone replacement, NO sedatives, OTC meds MUST be checked with Dr.
- Nrs: Low cal diet, temp control environment, prevent constipation.
- Cause: Adenoma, Carcinoma, Trauma, Chronic Kidney Dz
- Sx: Peptic Ulcers from stress, ectopic calcifications, neuropathies, weakness, stones, bone pain.
- Tx: Surgery, NO thiazides, phosphorus supplements
- Nrs: Ambulation, avoid immobility, monitor for tetany (if Ca+ drops too low)
- Sx: Tingling/burning in digits, muscle ache/cramping, twitching or spasms of muscles (usually mouth), Painful menstruation, brittle nals, patchy hairloss, thinning eyebrows, dry/course skin
- Tx: increase Ca+ in diet, decrease phosphorus in diet, med alert wristband
- Nrs: watch for tetany, seizure precautions, cardiac monitoring
- Increased cortisol usually related to petuitary adenoma
- Sx: buffalo hump, thin skin, cataracts, thin limbs, poor wound healing, moon face, HTN, easy bruising, increased adb. fat, decreased lymphocytes
- Tx: surgery
- Nrs: I&O, cough, deep breathing, limit stress
- All 3 steroids decreased, autoimmune, generally in patients with immune problems
- Adrenocortical insufficiency--- primary
- Causes: Adenoma or hyperplasia
- Sx: Na+ retention K+ excretion, HTN, dysrhythmias, glucose intolerance, alkalosis, tetany
- Tx: adrenalectomy, antiHTN, K-sparing diuretics
- Response to extraadrenal stimulus= renal artery stenosis, tumors
- Tx: ance inhibitors
- Most common adrenal problem
- -Tumors might be bilateral, 10% are malignant
- Sx: Severe HTN, headaches, tachycardial, sweating
- Tx: Surgery, symptomatic blocking agents to decrease BP
- Sx: asymetrical pain and stiffness in joins after rest, crepitation, dislocation, nodes, sitting and rising problems due to fluid
- Tx: first acetaminophen and topicals, then NSAIDs and steroids. Narcs generally do not help joint pain
- Nrs: Cold/heat packs to decrease swelling and increase circulation, weight loss, exercize, Tx pain, avoid repetative movements, surgery
- Chronic, systemic, recurrent inflammation of joints
- Sx: bilateral, symmetric joint stiffness, swelling, fibrosis, deformities, subluxation, rheumatic nodules, vasculitis.
- Tx: NSAIDs, DMARDs, biological response modifiers
- Nrs: Relaxation, balanced nutrition, joint-protection, splints, body alignment, exercise.
Systemic Lupus Erythematosus
- Multisystem chronic inflammation from problems with immune regulation.
- Sx: variable with no pattern
- -- wt. loss, fatigue, swelling joints, erythematous, butterfly rash, sun sensitivity, increased susceptability to infection, behavioral changes.
- Tx: NSAIDs, antimalarials (Quinalone), steroids, immunosuppressants.
- NRS: heat, exercize, stress menagement, emotional support, skin protection from breakdown.
- C- calcinosis (Ca+ deposits on skin often = open wounds)
- R- raynauds
- E- esophageal dysfunction (acid reflux and decreased motility)
- S- Sclerodactyly (Thick, tight, syran-wrap skin)
- T- Telargiectasia (dilation of capillaries= red marks on skin)
- Tx: antacids, PT, anti-inflammatories
- Nrs: No finger sticks, no barefoot, diet, emotional support.
Chronic head aches, generalized muscle pain, sleep disorders, cognitive/memory impairment, morning stiffness, vision problems, twitches, cold symptoms.
- Acute arthritis associated with increased levels of uric acid. Urate crystals in joints cause inflammation.
- Tx: colchicine (acute Tx), NSAIDs, Allopurinol (Chronic Tx)
- decreased bone density, risk for fractures
- Nurse: increade Ca+ and vitamin D, weight bearing exercises
Rapid bone loss often seen in cancers
Infection of bone
Inadequate mineralization, deficient vitamin D, kidney disorders
- Rheumatic; Inflammation of striated myscle with weakness and atrophy especially in proxmial muscles.
- Sx: Rash, periorbital edema, polyarthalgia, polyarthritis, raynauds.
- Tx: Steroids and immunosuppressives
- Nrs: PT, nutrition (swallowing problems)
- Proximal muscle stiffness, weakness and aching (neck, shoulder, pelvic muscles)
- Sx: low fever, weight loss, anorexia, depression, lasts months to years, possible blindness
- Tx: Steroids and NSAIDs
- Inflammation of exocrine glands
- Tx: Artificial Tears and Saliva
- Nrs: Foods with fiber are hard to swallow due to lack of saliva and so you might see diarrhea. Risk for choking.