Endocrine Hyper and Hypo

  1. Panhypopituitarism
    rare decreased production of all anterior pituitary hormones
  2. Hypothyroidism S&S?
    • Extreme
    • fatigue
    • Thin hair or hair loss
    • Weight Gain
    • Dull appearance
    • Thick lips
    • Addition S&S:Brittle nails, Dry Skin, Constipation, Numbness & tingling of fingers, Decreased libido, Irritable, Cool extremities
  3. TSH levels are high but T3 & T4 levels are low?
    Anticipation of administering?
    • Hypothyroidism
    • Administer: Thyroid replacement-levothyroxine
  4. Hypoparathyroidism S&S?
    • —Mild tingling or numbness around the mouth or in hands/feet— 
    • Severe muscle cramps— 
    • Carpopedal spasms— 
    • Seizures— 
    • Irritability
    • —Clouded concentration— 
    • Psychosis
    • Causes a decrease in serum calcium due to lack of PTH
  5. Treatment for Hypoparathyroidism?
    • Treat for risk of injury: fall precaution, seizure precaution.
    • —Administer IV calcium—
    • Administer Calcitrol to correct Vit D deficiency
    • —Provide diet high in Calcium but low in Phosphorus—
    • Provide Mg supplement
    • —Provide oral suction for airway clearance
  6. Addisons Disease?
    Adrenal hypofunction:
  7. Adrenal Hypofunction S&S?
    • Loss of Aldosterone
    • K, Na, water imbalance
    • hypovolemia: decrease in BP
    • Hyperkalemia: Metabolic acidosis and dysrhythmias
    • Hyponatremia: AMS
    • Hypoglycemia
  8. Loss of cortisol due to hypofunctioning adrenal gland?
    • decrease in gluconeogenesis + depletion of glycogen stores=hypoglycemia and all the symptoms that accompany Low BG.
    • shaking, sweating,anxious, irritable, weakness, tachycardia, dizziness, headache, impaired vision.
  9. Treatment for hypothyroidism?
    • Monitor for respiratory deficiencies: O2, caution with opioids or CNS depressants 
    • Monitor for cardiac output: —Administer hormone replacement—
    • Administer stool softener &/or stimulant laxative to prevent Valsalva maneuver
    • —Monitor for chronic anemia: H/H, MCV, TIBC, MCHC
    • Monitor for Hypothermia: warm blankets
    • Monitor for imbalanced nutrition and constipation: stool softeners, education,
  10. Serum lab values thyroid disorders?
    • TA-Thyroid autoimmune 
    • TSH: Thyroid Stimulating Hormone-released by anterior pituitary gland
    • T4: Thyroxine
    • T3: Triiodothronine Both of these are created by the thyroid and synthesized from iodine and tryosine(amino acid)
  11. Hypoparathyroidism also causes what to calcium?
    Hypocalcemia: think twitchy
  12. Parathyroid controls calcium and phosphate. What does an increase or decrease of PTH cause?
    • PTH causes calcium and phosphorous to be resorbed from the bones and increases serum concentration in the blood. Also responsible for calcium absorption through the intestines.
    • High amounts of PTH: Hypercalcemia and hypophophatemia
    • Low amounts of PTH: Hypocalcemia and hyperphosphatemia
  13. Primary causes of hypoparathyroidism?
    • Congenital Albright Hereditary Osteodystrophy
    • Cancers of thyroid
  14. Secondary causes of PTH deficiency?
    • Autoimmune disorder that attacks parathyroid glands
    • Malnutrition causing parathyroid to work harder leading to hyperparathyroidism.
  15. Chevosteks sign?
    tapping of temporal nerve below the zygomatic arch causes a twitching of the lip and facial spasms. Not the best indicator of hypoparathyroidism
  16. Calcium sensing receptor
    CaSR found in parathyroid glands, brain, bones, heart and kidneys.
  17. Foods rich in calcium and vitamin D for hypoparathyroidism?
    • Vitamin D: Milk, fortified orange juice, egg yolk, fish, fortified rice
    • Calcium: Milk, fortified beverages, cheese, Beans, almonds. Green leafy vegetables,Nuts, Salmon, sardines, Tofu, apricots
    • Any enriched or fortified foods may have increase in calcium or vitamin D.
  18. High amounts of TSH being excreted by the pituitary gland may cause?
    Goiters= an enlarged thyroid. Typically benign and caused due to the thyroid not producing enough TH
  19. Adrenal hypofunction triad symptoms?
    • Hypoglycemia
    • Hyperkalemia
    • Hyponatremia
  20. Loss of aldosterone and cortisol=?
    Adrenal crisis: Leads to hypovolemic shock due to excess excretion of fluids.
  21. ACTH?
    • Adrenocorticotropic hormone released by the anterior pituitary gland that causes the adrenal glands to secrete cortisol.
    • Cortisol is needed to manage fight/flight response, blood sugar levels, gluconeogenesis= fat, protein, carb metabolism to manage BG, immune response, BP, Heart and blood vessel tone and contractions, and CNS activation.
  22. Cortisol is released by? and does what?
    • is released by the cortex of the adrenal glands in response to ACTH.
    • and is needed to manage fight/flight response, blood sugar levels, gluconeogenesis= fat, protein, carb metabolism to manage BG, immune response, BP, Heart and blood vessel tone and contractions, and CNS activation.
  23. Treatment for adrenal hypofunction?
    • Monitor I & O at risk for falls.
    • Monitor for decreased cardiac output: Administer corticosteroid replacement
    • —Drugs to increase BP
    • —Position in recumbent position—
    • Monitor K+ level
  24. Too little ADH?
    Polydipsia=leads to dilute urine and the blood will become more concentrated due to a decrease in ECF.
  25. Dilute urine=diabetes insipidus
    Posterior pituitary gland produces insufficient ADH, hence the kidneys make a lot of urine.
  26. Osmolality changes with a decrease in ADH?
    Normal range: 275-295 is based on (Na, Glucose, BUN)
    • Na (2x Na level)+ (glucose/18) + (BUN/3)= normal range of 275-295. 
    • Serum osmolality of blood.
  27. Stimulated by the hypothalamus=Anterior pituitary vs posterior pituitary hormones.
    • Anterior: Adrenocorticotrophic hormone (ACTH) Thyroid-stimulating hormone (TSH) Luteinising hormone (LH) Follicle-stimulating hormone (FSH) Prolactin (PRL) Growth hormone (GH) Melanocyte-stimulating hormone (MSH)
    • Posterior: Anti-diuretic hormone (ADH) Oxytocin
  28. Diabetes insipidus due to too little ADH?
    • Excessive thirst
    • dilute urine <1.005
    • dry mucous membranes
    • rapid heart rate
    • electrolyte imbalance
    • unintended weight loss
    • fever
    • fatigue
  29. Nursing care for Low ADH?
    • Monitor I & O
    • Monitor labs for serum hemoconcentration
    • vasopressin may be administered when there is a lack from adrenal glands.
  30. TSH levels are low and T3 and T3 levels are High?
  31. Hyperthyroidism S&S? Hyperactive metabolism
    • Hallmark=heat intolerance
    • diaphoresis
    • hunger with weight loss
    • Palpitations
    • Vision changes=Double Vision-diplopia
    • exopthalmos
    • Malaise
    • Goiter development
  32. Exopthalmos?
    Eyes protruding
  33. Thyroid storm? GRAVES disease-too much Thyroid hormone. 
    • Fever, Tachycardia, increased BP, Gi distress, anxiety, tremors
    • causes by a TA disorder, TSI (thyroid stimulating immunoglobulin) created by B lymphocytes. attaches to TSH and causes overproduction of Thyroid Hormone
  34. Treatment for Hyperthyroidism?
    • Beta-adrenergic blocking drugs (Inderal) to relieve tachycardia, palpitations, anxiety, diaphoresis
    • Provide oxygen for high metabolic demands
    • Provide hi calorie diet
    • Ensure the environment is calm; limit visitors
    • Monitor and treat hyperthermia
    • —radioactive iodine I131 or anti-thyroid drugs or surgical removal of goiter
    • SE: abd cramps, bleeding gums, bone pain, leukemia, Cx pain, dry mucous membranes, infertility.
  35. Radioactive iodine I 131?
    Used for treating a hyperactive thyroid. Quickly absorbed by the thyroid and causes a hypothyroid which is more easily manageable.
  36. Hyperparathyroiditis?
    • May be caused by chronic RF
    • phosphorus retention and calcium loss cause the parathyroid gland to react by stimulating bone release of calcium.
  37. Hypercalcemia due to hyperparathyroidism?
    Too much PTH leads to resorption of bone.
    • Bone pain &rickets
    • kidney stones
    • pathologic bone fractures
    • muscle weakness
    • peptic ulcer disease
    • fatigue
    • volume depletion 
    • submental  disturbances.
  38. High levels of calcium result from a hyperparathyroid? which causes?
    High amounts of PTH and leads to renal calculi.
  39. Treatment for Hyperparathyroidism?
    • treat acute pain due to kidney stone formation if applicable.
    • IV fluids/lasix to excrete calcium
    • calcitonin 
    • surgery to remove parathyroid is also common treatment
    • risk for pathologic fractures-ambulate to stimulate bone deposition, monitor labs and teach about medications.
  40. Cushings syndrome for andrenal hyperfunction?
    increase in cortisol, aldosterone, androgens.
  41. Increased cortisol due to cushings causes fat distribution changes?
    • Moon face
    • buffalo hump
    • weight gain
    • muscle wasting
  42. Increased cortisol production leads to? adrenal hyperfunction
    • Decrease in sleep and more fatigue
    • increased glucose
    • mood swings
    • bone density loss-osteoporosis
    • decreased immune system masking signs of infection
  43. Increased aldosterone due to adrenal hyperfunction?
    can be caused by cushings, adrenal adenoma and pregnancy
    • Na+ and water rentention
    • BP increase and weight gain, edema
    • decrease in K+ leads to metabolic alkalosis
    • Increase Sodium, Glucose and decrease Potassium.
  44. Hirsutism?
    Male characteristics on a female due to an increase of androgens-hyperfunctioning adrenal gland.
  45. Treatment for adrenal hyperfunction?
    • Monitor for increased  BP, weight
    • Monitor E&F
    • Monitor for risk of infection-temp, labs, skin assessments.
    • Beta blockers may be used as well to counteract the effects of the catacholamines
  46. SIADH? Syndrome of inappropriate secretion of antiduretic hormone (ADH)
    • Low blood sodium caused by excess production of ADH leading to water retention leading to:
    • dilutional hypoatremia
    • decrease in sodium and decrease in serum osmolality: Dilute blood.
  47. SIADH causes urine osmolality to?
    • Increase in specific gravity (urine osmolality) which makes the urine more concentrated.
    • >1.026
  48. Etiology of SIADH?
    • Head injury: especially subarachnoid hemorrhage
    • Lung cancer: especially small cell lung cancer
    • Infections: brain abscess, pneumonia, lung abscess.
    • Drugs: Chlorpropamide (sulfonylurea) Type 2 diabetic, Clofibrate (lipid lowering) cholesterol, SSRIs (anti-depressant), Cyclophosphamide (Cytoxan) chemomed, lithium (mood stabilizer in manic/depressive)
  49. S&S of SIADH?
    • water retention-fluid overload
    • Low sodium levels
    • low serum osmolality
    • High urine osmolality-high specific gravity
    • decreased LOC
    • cerebral edema due to excess water-hypotonic (Wii contest)
    • headache
    • psychosis
  50. Treatment for SIADH?
    • Monitor I & O: Hypertonic fluids, diuretics, restrict water intake, Conivaptin blocks receptors of ADH in euvolemic hyponatremia
    • Risk for falls: Neuro checks, alarms, reorrient, ambulate
  51. Adrenal glands are responsible for which hormones?
    Cortisol, aldosterone, epinephrine, norepinephrine, steroids, androgens.
  52. ADH puts water into urine which effects?
    • Urine osmolality or specific gravity. 
    • Too little ADH: Urine is dilute
    • Too much ADH: Urine is concentrated.
  53. What are catecholamines?
    Epi and norepinephrine
  54. effects of calcitonin in blood ?
    • Inhibits Ca2+ absorption by the intestine
    • Inhibits osteoclast activity in bones
    • Stimulates osteoblastic activity in bones. Inhibits renal tubular cell reabsorption of Ca2+ allowing it to be excreted in the urine
  55. Treatment for adrenal hypofunction
    • Treat with D5NS or D10+NS
    • replacement of cortisol
  56. Plasma & urinary catecholamine levels are ordered.  The nurse expects to see:
    Increased epinephrine & norepinephrine levels with Increased BP & HR
  57. Dexamethasone suppression test distinguishes between adrenal hyperplasia & adrenal tumor.
    • Dexamethasone is a synthetic steroid that suppresses secretion of ACTH. 
    • Draw blood sample at baseline.
    • 2.Administer dexamethasone @ bedtime.
    • 3.Redraw blood sample next am. 
    • 4.If cortisol levels are NOT suppressed, suspect adrenal adenoma.
  58. Dexamethasone suppression test indications
    Detect adrenal hyperfunction (give cortisol)  Detect adrenal hypofunction (give ACTH)
  59. synthetic steroid use-roid rage
    Many harmful effects-tumors, cancers, organ failure, weak tendons, severe acne, may cause hirsutism in women along with irregular menstrual cycle.
  60. Hashimoto disease?
    Causes a condition called hypothyroidism due to a TA reaction. Antithyroid antibodies (antiperoxidase)  and lymphocytes. Destroys essential enzyme responsible for T3 (triiodothyronine) and T4(thyroxine) production and causes thyroid tissue scarring
  61. Too much ADH: Would you expect the heart rate to increase or decrease?
    Fluid overload/ higher volume. Increased HR
  62. Too much ADH: Would the urine be dilute or concentrated? What does this due to specific gravity
    • Concentrated due to very little water being excreted by kidneys.
    • High specific gravity due to concentration
  63. Rationale for treatment for too much ADH
    • Fluid restriction: Will concentrate sodium/normalize sodium level
    • Diuretics: Pull off excess fluid; excrete water 
    • Hypertonic saline IV fluid (3%): Increase osmolality; prevent cerebral edema 
    • Fall precautions: LOC decreased with low sodium; muscle weakness
  64. Manifestations of dehydration due to DI?
    • Cardiac: Rapid heart rate, hypotension, decreased CO, weak pulses, electrolyte imbalance
    • Renal/urinary: polyuria, low urine specific gravity, dilute Cardinal symptoms 
    • Integumentary: dry, poor tugor, dry mucous membranes, fever 
    • Neuro: Lethargy, alt LOC, HA, increased thirst
    • BUN will be High along with the blood having false result of an increase in H/H. Urine specific gravity will be low due to Dilution.
  65. Cretinism-Congenital hypothyroidism Image Upload 1
    • condition of stunted body growth and impaired mental development. 
    • Treatment must be started within the first 6 weeks of life. Thyroid replacement cures condition and allow for normal development
  66. Relaxation
    Image Upload 2
  67. ACTH
    • Target: Adrenals 
    • Stimulates the adrenal gland to produce a hormone called cortisol. ACTH is also known as corticotrophin.
  68. TSH
    • Target: Thyroid 
    • Stimulates the thyroid gland to secrete its own hormone, which is called thyroxine. TSH is also known as thyrotrophin.
  69. Negative feed back loop
    Used to help regulate the body and maintain homeostasis. prevents excessive secretion of hormones in the endocrine system. Example: if serum calcium levels fall, PTH is released; PTH causes an increase in serum calcium, which provides feedback to the parathyroid glands to shut off PTH secretion.
  70. Hypothalamus and it's role with TSH?
    Hypothalamus secretes releasing hormones such as TRH and this stimulates the release of TSH in the anterior pituitary gland causing the thyroid to release TH
  71. pituitary gland is known as the?
    Master gland due to it's responsibility with releasing many endogenous hormones. Works with the hypothalamus to control hormone release and relies on negative feedback loop.
  72. TA Thyroid antibodies (serum)
    Negative to 1:20 assesses for autoimmune disease of thyroid. Graves/ Hashimoto
  73. Thyroid stimulating hormone (TSH) (serum)
    • 0.35-5.5 ulU (microinternational unit/ml), Less than 3ng/ml
    • secreted by anterior pituitary gland, in response to thyroid releasing hormone from hypothalamus. Stimulates release of thyroxine (T4). Dependent on the negative feed back system.
  74. Thyroxine (T4) serum
    • 4.5-11.5 mcg/dL
    • Main hormone secreted by thyroid and is at least 25 times more concentrated than triiodothyronine (T3).
  75. Triiodothyronine (T3) serum
    • 80-200ng/dl
    • more short acting and more potent than thyroxine.
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Endocrine Hyper and Hypo