N326 Endocrine Disorders Endocrine System: example of how it works - releasing factor goes to the anterior pituitary which releases ACTH into the blood which goes to the adrenal cortex and the adrenal cortex releases cortisol Endocrine Glands: secrete hormones which regulate various functions throughout the body, examples: pituitary gland, thyroid and parathyroid, adrenal glands, pancreas, ovaries (female), testes (male)The hypothalamus and the pituitary in the brain control the normal secretion of thyroid hormones whichin turn controls metabolism. Growth Hormone (GH) - Gigantism - Excessive GH in children- Acromegaly - Excessive GH in adultsGrowth Hormone Excess- Tufted or clubbed fingertips- Enlargement of hands and feet- Joint pain, from mild to severe- Soft tissues of the face and jaw thicken- Hirsutism - excessive hairiness - May result in speech difficulties- Sleep apnea (due to pharyngeal soft tissue growth)- Diabetic and CV complications may be permanent.Nursing Diagnoses: GH ↑- Insomnia, related to soft tissue swelling- Disturbed body image, related to enlargement of hands, feet, enlargement of bony and soft tissue on face and head- Chronic pain, related to enlargement of bones and cartilageHyper-pituitary or Acromegaly- Diagnosis – increased serum somatotropin (GH), X-rays, MRI, physical exam, oral glucose challenge test – level does not decrease - Complications – increased ICP with enlarged tumor, increased blood sugar- Clinical Manifestations – enlarged pituitary gland, headache, visual disturbances, slanting forehead, coarse facial features, protruding jaw, increased BP, increased CHF, menstrual changes,sleep apnea, hypertrophy of soft tissue such as Tongue, skin, and visceral organs, enlargement ofthe small bones in the hands and feet Growth Hormone Deficit - Truncal obesity- Decreased muscle mass - Reduced strength, Decreased energy- Flat affect- Depression- Treatment - Hormone replacement therapy (Somatropin)SIADH: Syndrome of Inappropriate Antidiuretic Hormone- Excessive serum ADHo Water Intoxicationo Cellular edemao Dilutional hyponatremia- Feedback mechanism does not work on Posterior PituitarySIADH- Assessment - FVE: ↑BP; crackles in lung fields; JVD; taut skin; I > O- Clinical Manifestations: headache; fatigue; anorexia; nausea; muscle aches- Treatment - Restore normal fluid volume & osmolality; fluid restrictionDiabetes Insipidus- Deficient ADH production or secretiono Hypothalamus malfunction o Medications (lithium)o Excessive water intake caused by thirst center lesion- Fluid & electrolyte imbalances related to ↑urine output & increased plasma osmolality- Characterized by polydipsia & polyuria- Severe fluid volume deficit manifests in weight loss, constipation, poor tissue turgor, hypotension & shock- History of head injury, pituitary tumor, or craniotomy - S/S: Up to 20 L of urine per day, decreased specific gravity, decreased osmolarity, hypovolemia, increased thirst, tachycardia, decreased BP- Nursing Care: monitor fluids, replace fluids, check neurological status, check vital signs, check mucous membranes- Treat with: vasopressin, DDAVP Goiter- Goiter is an enlargement of your thyroid gland — a small, butterfly-shaped gland weighing less than an ounce, located just below your Adam's apple.- Hormones produced by your thyroid gland regulate all aspects of your metabolism, from the rateat which your heart beats to the speed at which you burn calories.- Although generally not uncomfortable, goiter can interfere with swallowing or breathing. - Goiters are more common in women and older adults.- A rounded neck was considered to be a sign of great beauty during the late Renaissance.- It occurred regularly in parts of the world where iodine supplies were insufficient for normal thyroid function.- The possible causes are numerous - In the past, the most common cause of goiter was a shortage of iodine in the diet in areas where the soil was deficient in iodine. Without enough dietary iodine, your thyroid can't make and release enough of the two essential iodine-containing hormones. - Goiter became rare in the United States after iodized salt was introduced. - Found in Graves’ disease (hyperthyroidism)- In some parts of the world, however, goiter is still common because of iodine deficiency.- Treatment for goiter depends on the size of the enlargement, signs and symptoms, and the underlying cause.Goiter Manifestations- Enlargement of thyroid gland, resulting in swelling of neck - A tight feeling in throat - Coughing - Difficulty swallowing - Difficulty breathing - May experience other signs and symptoms depending on the underlying cause of the goiter- Thyroid ultrasound uses high frequency sound waves to make a picture of the thyroid gland Hyperthyroidism - A sustained increase in synthesis and release of thyroid hormones by thyroid gland- Occurs more often in women- Highest frequency in 20- to 40-year-olds- Most common form - Graves’ disease- Other causes: Thyroiditis, Toxic nodular goiter, Exogenous iodine excess, Pituitary tumors, Thyroid cancer- Thyrotoxicosis - Physiologic effects/clinical syndrome of hypermetabolism resulting from increased circulating levels of T3, T4- Hyperthyroidism and thyrotoxicosis usually occur together as Graves’ diseaseGraves’ disease- Autoimmune disease of unknown etiologyo Diffuse thyroid enlargement o Excessive thyroid hormone secretion- Precipitating factorso Insufficient iodine supplyo Infectiono Stressful life events interacting with genetic factors- Accounts for 75% of cases of hyperthyroidism- Antibodies are developed to TSH receptoro Leads to clinical manifestations of thyrotoxicosis o May progress to destruction of thyroid tissue causing hypothyroidism- Graves’ disease is a common cause of hyperthyroidism, an over-production of thyroid hormone, which causes enlargement of the thyroid and other symptoms such as exophthalmos, heat intolerance, and anxiety Clinical Manifestations Hyperthyroidism- Related to effect of thyroid hormone excesso ↑ Metabolismo ↑ Tissue sensitivity to stimulation by sympathetic nervous system- Ophthalmopathyo Abnormal eye appearance or functiono Exophthalmos - Protrusion of eyeballs from the orbits, Impaired drainage from orbit, Increased fat and edema in retro-orbital tissues, Seen in 20% to 40% of patientsClinical