Nursing 3366 Pathologic Processes: Implications for Nursing Lecture Notes: Disorders of the Endocrine System, Part IObjectives /outcomes for this subject ( some of these are in Part I and some in Part II )DESCRIBE/DISCUSS/IDENTIFY:1. key aspects of normal endocrine function, especially feedback systems and influences on other body systems.2. pathophysiology of select derangements of endocrine glands, including:- hyperthyroidism & hypothyroidism - calcium movement problems caused by disorders of calcitonin and PTH - hormonally-related bone disorders such as osteopenia & osteoporosis caused by aboveproblems, as well as menopause.- diabetes mellitus. - Cushing’s syndrome & Addison’s disease 3. signs and symptoms related to above pathological conditions, including the significance of diagnostic test results used to evaluate and monitor endocrine function, such as TSH, T4, T3, cortisol, blood sugar, and glycosylated hemoglobin.4. basic treatment modalities related to altered endocrine conditions.Outline for endocrine system disorders:I. Disorders of the Pituitary GlandA. Diabetes insipidus (DI)B. Syndrome of inappropriate ADH (SIADH) II. Disorders of ThyroidA. OverviewB. HypothyroidismC. HyperthyroidismIII. Disorders of Calcium MovementA. Basics of calcium and calcium movementB. Disorders caused by calcium movement alterationsC. Bringing it all together_IV. Disorders of Adrenals V. Disorders of Endocrine PancreasKey points about the endocrine system in general (read this brief A&P before class):1. the endocrine system is dependent on negative feedback systems, that is:a. a HIGH blood level of a circulating hormone (a hormone is basically a chemical messenger) will automatically suppress the gland that secreted it and/or other glands in the feedback loop, thus decreasing secretion of that hormone.b. a LOW blood level of a circulating hormone will automatically stimulate the glandthat secreted it and/or other glands in the feedback loop.. the result is that there will be MORE of the hormone in circulation. 2. most endocrine disorders are problems of either hyposecretion or hypersecretionI. Disorders of the Pituitary GlandA. Overview1explaining negative feedback simplistically: low triggers high; high triggers low. will be on test 4will be on final exam (25% of final)FYI: “pituita” came from Latin for phlegm (mucus); they used to believe that the pituitary gland made phlegm;“hypohysis”—Latin for “growth attached under”—comes from fact that pituitary gland is attached under hypothalamus in brain1. pituitary gland is also known as hypophysis, located in brain near base of skull2. known as master gland because it secretes many important hormones that govern other glands (including these that we will talk about in our 2 endocrine lectures): (see Prep 10 & pic in book, pg 459)a. antidiuretic hormone (ADH)b. thyroid-stimulating hormone (TSH) (will talk about thyroid in later section of notes)c. adrenocorticotropic hormone (ACTH)—will talk about this more in Endo IIB. ADH problems (undersecretion and oversecretion)1. diabetes insipidus (DI) [undersecretion]a. nomenclature of DI: diabetes means “to pass too much urine;” insipidus means “flavorless” (refers to the fact that the urine has no color because it isvery dilute)b. etiology & mechanisms of DI:1) renal-related etiology: —“sick” kidneys often have a decreased response of renal tubules to ADH2) CNS-related etiologies:a) a lesion such as a pituitary tumor causes the gland to diminish its secretion of ADH b) acute abnormality in the brain such as head injury or other causes of cerebral edema & IICP in the brain can put pressure on the pituitary gland & cause it to diminish ADH secretion3) whatever the etiology, without the influence of ADH, you won’t “hold onto” water effectively --water will indiscriminately flow from the peritubular capillaries of the kidneys into the tubules and becomes very dilute urine4) S&S (in this general order):a) you void huge amounts (___________________) of dilute urine b) this makes you thirsty, so you drink water, but it just flows right out no matter how much you drink.c) this translates eventually to your blood compartment having less water  concentration increaseshigher serum osmolality  since the blood now has a higher osmolality than the next door tissue compartment (all over the body), water will be PULLED INTO the blood compartment (and constantly “peed out”) leaving the tissue cells dehydrated & shrunkend) so you have S&S of dehydration eventually, which include __________________________________________ & ____________________________________________5) domino effect is T to B: since the plasma compartment (ie, the blood all over the body) 2A&P review: ADH(antidiuretic hormone) secretion is a normal process that the body uses to compensate for (“fix”) low fluid volume: when the pituitary detects that circulating fluid volume is low, (the body has a high osmolality or high blood concentration) it secretes ADH ADH “tells” kidneys to “hangonto” water by decreasing urineoutput fluids are conserved and fluid volumeSummary of not enough ADH : A person drinks H2O, but there is less ADH to tell the kidneys to “hold on” to the H20 H2O goes directly out into urine without being concentrated by kidneyspolyuria thirst more water is drunk goes straight out into urine thirst….etc…--ultimately, no matter how much you drink, you get dehydrated.2. syndrome of inappropriate antidiuretic hormone (SIADH) [oversecretion]a. SIADH can be triggered by many events:1) ectopically-produced (ectopic = “outside usual”) ADH such as from small-cell bronchogenic cancer2) various drugs that effect the brain, especially general anesthetics(SIADH sometimes seen in post-op recovery period).3) trauma to brain such as brain tumors, head injury, etc. (swelling of brain puts pressure on pituitary gland, but can be in opposite way than DI; in SIADH there is OVERsecretion of ADH.)b. mechanism of action & S&S1) characterized by abnormally high levels of ADH: you “hold onto” watertoo much by abnormally decreasing urination results in increasedvascular fluid volume essentially means that water has beenadded to the blood = diluted plasma compartment & lower serum osmolality small amounts highly concentrated urine. 2) S&S include a) decreased urine output (_____________________) becauseyour body is