Endocrine Disorders Part 2: Endocrine assessment Part 2

Somatostation (bone & muscle), Corticotropin releasing hormone (adrenal cortex), Vaspressin (kidney), Growth hormone-releasing hormone (bone & muscle), Gonadotropin releasing hormone (ovaries & testes), Oxytocin (uterus, mammory), Thyrtropin releasing hormone (thyroid)

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Secretes many hormones that target other tissues and endocrine glands, Connected by nerve fibers and the hypophyseal stalk

Hormones vasopressin/anti-diuretic hormone ADH, and oxytocin are made in the hypothalamus but stored in the POSTERIOR pituitary

Growth hormone (GH), Thyrotropin (thyroid-stimulating hormone TSH), Corticotropin (Adrenocorticotropic hormone ACTH), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Melanocyte-stimulating hormone (MSH), Prolactin (PRL)

ADH (vasopressin)), Oxytocin

Reduced liver production of somatomedins leads to:, :Causes growth pattern changes, :Increases rate of bone destruction, Results in osteoporosis & ⬆️risk for bone fractures

Gonadotropins are Luteinizing hormone LH and follicale stimulating hormone FSH, -Men: testicular failure & ⬇️testosterone, ⬇️ libido, -Women: ovarian failure, amenorrhea, infertility, ⬇️libido, (Watch for opposite sex characteristics facial hair on women, breasts on men etc.)

They cause a decrease in secretion of vital hormones from the thyroid & adrenal glands, TSH, Adrenocorticotropic hormone (ACTH)

Decrease thyroid hormone levels, Weight gain, Cold intolerance, Alopecia, Hirsutism, ⬇️Cognition, Lethargy

Decrease serum cortisol levels, Malaise/lethargy, Headache, Pale skin, Anorexia, Hypoglycemia, Hyponatremia, Hypotension

Primary v secondary, Benign or malignant tumors of pituitary, Malnutrtition & rapid loss of body fat, Shock or severe hypotension - Leads to hypoxia, infarction, & ⬇️ hormone secretion, Head trauma, Brain tumors, Infections/inflammatory causes (meningitis, malaria, fungal), Radiation/surgery of head/brain, Late stage HIV, Postpartum hemorrhage (Sheehan syndrome)

Reduction in specific pituitary hormones causes changes in target organ function and appearance

Changes in secondary sex characteristics, Men: facial/body hair loss, low libido, impotence, Women: low libido, amenorrhea, painful intercourse, infertility, breast atrophy, decreased axillary/pubic hair

Blurred double vision, Peripheral changes, Headaches, Limited eye movements

Lab testing will vary depending on the problem, CT, MRI, to evaluate sella turcica, pituitary itself, Angiogram to r/o aneurysm/vascular issues

Gonadotropin deficiency: Men: androgens (testosterone) SEs: baldness, acne, gynecomastia, enlarged prostate, Gonadotropin deficiency: Women: Hormone replacement therapy (HRT) SEs: HTN, blood clots, Growth hormone deficiency: SQ injections of humone growth hormone (hGH), TSH deficiency: tx depends on cause, ACTH: may need hydrocortisone or prednisolone (depends on causes, symptoms, and labs)

Ok great thanks!, I like to answer the question and then read the question with it like a statement or sentence to make sure I read it all right and it does help me catch those key words sometimes!

Hormone over-secretion from anterior pituitary tumors or tissue overgrowth (hyperplasia), Tumors usually are benign adenomas, Compresses brain tissue & causes neuro & endocrine changes, Most common in cells that produce PRL, GH, ACTH, Prolactin adenomas are the most common type: Excessive PRL inhibits gonadotropins -leading to galactorrhea (abnormal discharge of breast milk), amenorrhea, infertility

Results in acromegaly, Gradual onset, Early treatment is essential, Enlargement of face, hands, and feet, Enlargemnt of heart, liver, and lungs, Predisposed to hyperglycemia

Results in overstimulated adrenal cortex, Causes excess production of glucocorticoids, Mineralocorticoidd, & androgens, Cushing’s Syndrome is hypercortisolism can result from ACTH excess

Age, gender, family, history, Changes in hat, ring, glove, shoe size, Change in facial features over time?, Fatigue?, Back/joint pain (GH bone changes), Headache, vision changes, Sexual dysfunction (PRL ⬆️):⬇️ libido, infertility, impotence, Weight gain/weight loss

Hyperpituitarism can be causes by multiple endocrine neoplasia, Inactivation of a suppressor gene: MEN1, Autosomal dominant, Benign tumor of pituitary, parathyroid, glands, or pancreas, Causes ⬆️production of GH = acromegaly, Ask about parents having a tumor of the pituitary, pancreas, or parathyroid glands

Testing orders will vary depending on symptoms/hormone involved, Specific hormone lab levels, Suppression testing, CT/MRI for tumor diagnosis

Growth hormone antagonists which include:, :bromocriptine mesylate (Parlodel) PO, :lanreotide (Somatuline Depot) SQ, :octreotide (Sandostatin) SQ, :pegvisomant (Somavert) SQ, These are given either with surgery or when someone is contraindicated for surgery. Keep in mind surgery or gamma knife takes time to work which is why these meds are used. Meds do have SEs some worse than others

1.25mg-2.5mg/day PO, ***Nursing starter alert!** Bromocriptine can cause cardiac dysrythmias, coronary artery spasms, and CSF leak. Pt should immediately report chest pain, dizziness, nasal discharge, Should also not be used in pregnancy

90 mg sq every 4 weeks fr 3 months first, Then adjust dose response

100-500 mcg SQ TID, Dose adjustment needed for elderly

40 mg SQ loading dose, Then 10 mg/day SQ

Does not immediately reduce pituitary hormone excess, May take months to years, Not used to manage acromegaly

Hypophysectomy is the most common, ⬇️ Hormone levels, relieves headaches & sexual dysfunction

Nasal packing & mustache dressing, No coughing/ sneezing/ blowing nose/ bending forward

Transsphenoidal (through sphenoid sinus) approach, Ensoscopic trans nasal approach, Craniotomy if tumor cannot be reached by one of the other options

Neuro, vision, mental status monitoring very important!, Montior for diabetes insipidus, Post-nasal drip/excessive swallowing = CSF leaks (makes halo on dressing hence importance of mustache dressing), Headache/fever/neck rigidity = infection = meningitis, Symptomatic care, Replacement hormones & glucocorticoids for LIFE!!!

Neuro status x24 hrs; then Q4, Fluid balance (output v intake), Nasal drip pad

Deep breathing exercise (without the cough don’t want them coughing!), Prevent constipation (no straining), No coughing/blowing nose/ sneezing, No teeth-brushing x 2 wks (floss/mouthwash only, No bending at waist, Self-administration of life long medications, Report any return of symptoms

LARGE volume water loss caused by either 1 or 2, 1: ADH deficiency, 2: Inability of kidneys to respond to ADH, Very high urine output, Low urine specific gravity, Dehydration, Hypotension, Increased plasma osmo, & electrolyte levels increased (^sodium) (volume loss increases blood concentration), Increased thirst, Urine output does not decrease when fluid intake increase

Fluid losses will chang blood and urine tests, Urine output may be 4-30 L/day!, Urine dilute with low specific gravity & osmolarity

CV: Hypotension, tachycardia,, CV: Weak pulses, hemoconcentration, Kidney/urinary: ⬆️urine output, Kidney/urinary: Dilute with ⬇️ specific gravity, Skin: Poor turgor, Skin: Dry mucous membranes, Neuro: Decreased cognition, irritability, Neuro: ⬆️ thirst and ataxia

Symptoms are related to dehydration, Ask about: ⬆️Urination and ⬆️thirst, : Recent surgery, : Head trauma, : Drugs i.e. lithium, Poor skin turgor, dry/cracked mucous membranes

Focuses on symptom control with drug therapy:, -Desmopressin (DDVAP, Stimate) oral or intranasal, -Does/frequency depends on response, -May be given IV or IM for severe hydration, SE: Intranasal: mucous membrane ulceration, allergy, sensation of chest tightness, and lung inhalation of spray, *** Nursing safety alert!** IV desmopressin in 10 X stronger than the oral form!

Detect dehydration early & manage hydration status is the goal, Accurate I&O & urine specific gravity, Daily weights

Fluid intake should match output, Life-long drug therapy required (with permenant DI), Dose adjustments required based on symptoms, Drugs cause water retention (teach s/s of overload), Daily weights: same scale/sametime/ same clothes (report any 1 kg/2.2 lb gain, 911 or ER for s/s of water toxicity -Headache, confusion, nausea, vomitting, Medical alert bracelet

Urine output volume decreased; urine specific gravity increased

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Schwartz-Bartter syndrome, Over-secretion of ADH (vasopressin):, -Even when plasma osmolarity is low or normal, -Result: water retention & fluid overload, -Dilutional hyponatremia

Many causes, Malignancies, Pulmonary disorders, CNS disorders, Drugs

Ask about medical conditions that may cause SIADH, Symptoms related to water retention & sodium dilution:, -GI: N/V, loss of appetite, weight gain, -Neuro: Lethergy, headaches, hostility,disorientation, changes in LOC, decreased, responsiveness, seizures, coma, -Vitals: bounding pulse, hypothermia

Restricting fluid:, -Essential to prevent further dilution of plasma, -May be as low as 500-1000ml/24hrs, -Measure I&O, daily weights, -Provide mouth care

Promote water excretion without sodium loss, Tolvaptan (Samsca) PO (also used for PKD), Conavatptan (Vaprisol) IV infusion, **Nursing safety priority!** Tolvaptan and conavaptan given only in hospital setting to closely monitor for serum sodium increases and central nervous system complications

Replace lost sodium:, -Hypertonic salin used when sodium is very low, -3% sodium chloride, —3% given with caution may promote HF, —Monitor for increased in fluid overload q2hrs, —-Bounding pulse, neck vein distention, crackles, dyspnea, peripheral edema, ⬇️urine output