endocrine disorders and management final

8/19/2019 Endocrine Disorders and Management Final

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Prepared by: Zyrine M. Salomon,R.N

Assessment and Management of

Patients with Endocrine Disorders

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Definition of HormonesChemical messengers of the body

Act on specific target cells

Regulated by negatie feedbac!

"oo much hormone, then hormone release reduced

"oo little hormone, then hormone release increased

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#ypothalamus

Posterior Pituitary

Anterior Pituitary

"hyroid

Parathyroids

Adrenals

Pancreatic islets

$aries and testes

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Glands of the Endocrine

System

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Hypothalamus

Sits bet%een the cerebrum and brainstem

#ouses the pituitary gland and hypothalamus

Regulates:

"emperature&luid olume

'ro%th

Pain and pleasure response#unger and thirst

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Hypothalamus Hormones

Releasing and inhibiting hormones

Corticotropin(releasing hormone

"hyrotropin(releasing hormone

'ro%th hormone(releasing hormone

'onadotropin(releasing hormone

Somatostatin()(inhibits '# and "S#

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Pituitary Gland

Sits beneath the hypothalamus

"ermed the *master gland+

iided into:

Anterior Pituitary 'landPosterior Pituitary 'land

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Anterior Pituitary Gland

Promotes gro%th

Stimulates the secretion of si- hormones

Controls pigmentation of the s!in

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Anterior Pituitary Gland

Hormones

'ro%th #ormone((Adrenocorticotropic hormone

"hyroid stimulating hormone

&ollicle stimulating hormoneoary in female,

sperm in males

/uteini0ing hormonecorpus luteum in females,

secretion of testosterone in males

Prolactinprepares female breasts for lactation

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Actions of the major hormones of the anterior pituitary.

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Posterior Pituitary Hormones

Antidiuretic #ormone

$-ytocincontraction of uterus, mil! e1ection

from breasts

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Adrenal orte!

Mineralocorticoidaldosterone. Affects sodium

absorption, loss of potassium by !idney

'lucocorticoidscortisol. Affects metabolism,regulates blood sugar leels, affects gro%th, anti(

inflammatory action, decreases effects of stress

Adrenal androgensdehydroepiandrosterone and

androstenedione. Conerted to testosterone in the

periphery.

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Adrenal Medulla

2pinephrine and norepinephrine

sere as neurotransmitters for sympathetic system

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"hyroid Gland

3utterfly shaped

Sits on either side of the trachea

#as t%o lobes connected %ith an isthmus

&unctions in the presence of iodineStimulates the secretion of three hormones

4noled %ith metabolic rate management and

serum calcium leels

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"hyroid

&ollicular cells e-cretion of triiodothyronine 5"67and thyro-ine 5"874ncrease 3MR, increase bone

and calcium turnoer, increase response to

catecholamines, need for fetal '9

"hyroid C cellscalcitonin. /o%ers blood calcium

and phosphate leels

3MR: 3asal Metabolic Rate

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Parathyroid Glands

2mbedded %ithin the posterior lobes of the thyroidgland

Secretion of one hormone

Maintenance of serum calcium leels

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Pancreas

/ocated behind the stomach bet%een the spleenand duodenum

#as t%o ma1or functions

igestie en0ymes

Releases t%o hormones: insulin and glucagon

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Pancreatic Hormones

4nsulin ( a hormone made by the pancreas that allo%s your body touse sugar 5glucose7 from carbohydrates in the food that you eat for

energy or to store glucose for future use. 4nsulin helps !eeps your

blood sugar leel from getting too high 5hyperglycemia7 or too lo%

5hypoglycemia7.

'lucagon stimulates glycogenolysis and

glyconeogenesis

Somatostatin decreases intestinal absorption of

glucose

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#nsulin

Produced by the 3eta cells in the islets of/angerhans

Regulates blood glucose leels

Mechanisms

2ases the actie transport of glucose into muscle and

fat cells

&acilitates fat formation

4nhibits the brea!do%n and moement of stored fat

#elps %ith protein synthesis

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(continued' Action of insulin and glucagon on $lood glucose le%els. &(' Low $lood

glucose is raised $y glucagon release.

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Glucagon

Produced by the alpha cells in the islets of /angerhans

'lucagon released %hen blood glucose falls belo% ;

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Glucagon

Preents blood glucose from decreasing belo% acertain leel

&unctions:

Ma!es ne% glucose

Conerts glycogen into glucose in the lier and

muscles

Preents e-cess glucose brea!do%n

ecreases glucose o-idation and increases blood

glucose

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Adrenal Glands

Pyramid(shaped organs that sit on top of the!idneys

2ach has t%o parts:

$uter Corte-

4nner Medulla

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Adrenal orte!

Secretion of t%o hormones'lucocorticoids: cortisol

Mineralocortocoids: aldosterone

4noled %ith blood glucose leel, anti(

inflammatory response, blood olume, and

electrolyte maintenance

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Adrenal Medulla

Secretion of t%o hormones

2pinephrine

Norepinephrine

4noled %ith the stress response

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)%aries

2strogenProgesteroneinportant in menstrual

cycle,=maintains pregnancy,

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"estes

Androgens, testosteronesecondary se-ualcharacteristics, sperm production

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"hymus

Releases thymosin and thymopoietinAffects maturation of " lymphocetes

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Pineal

MelatoninAffects sleep, fertility and aging

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Prostaglandins

>or! locallyReleased by plasma cells

Affect fertility, blood clotting, body temperature

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M?@22MA C$MA

occasionally called my!edema

crisis* is a rare life+threatening

clinical condition that represents

se%ere hypothyroidism with

physiological DE .compensation

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The condition usually occurs inpatients with long-standing,undiagnosed hypothyroidism and isusually precipitated by infection,cerebrovascular disease, heart failure,trauma, or drug therapy. Patients withmyxedema coma are generallyseverely-ill with signicant

hypothermia and depressed mentalstatus.

M,-EDEMA )MA

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MANAGEMENT:

Air%ay management

( Mechanical ventilation is commonly required during

the first 6!"# hours, $ut some %atients require

%rolonged res%iratory su%%ort for as long as 2! &ee's.

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ADRENAL CRISIS


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ADRENAL CRISIS

also 'no&n as (ddisonian crisis and

acute adrenal insufficiency, a medical

emergency and %otentially life!threatening

situation requiring immediate emergency

treatment. )t is a constellation of sym%tomsthat indicate severe adrenal insufficiency

caused $y insufficient levels of the hormone

cortisol.

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auses* incidence* and ris

factors/(drenal crisis occurs if the adrenal gland is

deteriorating *(ddison+s disease, %rimary adrenal

insufficiency, if there is %ituitary gland in-ury

*secondary adrenal insufficiency, or if adrenal

insufficiency is not adequately treated.is' factors for adrenal crisis include %hysical stress

such as infection, dehydration, trauma, or surgery,

adrenal gland or %ituitary gland in-ury, and ending

treatment &ith steroids such as %rednisone orhydrocortisone too early.

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MANIFESTATIONS:eadache, Profound &ea'ness, atigue

lo&, sluggish movement, ausea and 3omiting

4o& $lood %ressure, 5ehydration

igh fever, ha'ing chills, onfusion or coma

a%id heart rate, 7oint %ain, ($dominal %ain

8nintentional &eight loss

a%id res%iratory rate *see tachy%nea

8nusual and ecessive s&eating on face and/or %alms

'in rash or lesions may $e %resent

lan' %ain

4oss of a%%etite

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;mergency Management for (ddisonian risisMaintain air&ay, $reathing, and circulation in %atients &ith

adrenal crisis.

8se coma %rotocol *ie, glucose, thiamine, naloone.

8se aggressive volume re%lacement thera%y *detrose 5


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Emergency Management for Addisonian risis

8se detrose


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Emergency Management for Addisonian risis

Bnce the %atient sta$iliCes, usually $y the second day,

the corticosteroid dose may $e reduced and thenta%ered. Bral maintenance can usually $e achieved $y

the fourth or fifth day.

(l&ays treat the underlying %ro$lem that %reci%itated

the crisis. )nfectious etiologies commonly %reci%itateadrenal crisis. ecognition and treatment of causative

factors are crucial as%ects of managing adrenal

hy%ofunction.

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( t $l hi h i hi$it th ff t f d li


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• (eta $locers* which inhi$it the effect of adrenaline,

re!"# $% &'!r e)r# *e)#$%+ 're "'-"& )%. -$# "e

/'re e#) *"'er )"' e" ee *"''. ee" 'e%

)%. re")e. *& "'-$%+ #e re"e)e '/ ) )r#$!")re%&e /r' $.%e& E)"e '/ *e#) *"'er $%"!.e

)#e%'"'" (Te%'r$%, e#'r'"'" (L're'r, T'r'" )%.

r'r)%'"'" (I%.er)", I%%'r)% S$.e e//e# )& $%"!.e

/)#$+!e, !e# #'), e).)e, .$$%e,'%#$)#$'%, .$)rre), $rre+!")r e)r#*e)#, .$//$!"#&

*re)#$%+ )%. -e""$%+ $% #e "$*

• )ther medications #)# "'-er *"''. re!re )& *e

rer$*e. $/ *"''. re!re $ %'# #)*$"$e. -$# )")*"'er )%. *e#) *"'er

Surgery


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Surgery

•#n most cases* the entire adrenal gland with a pheochromocytoma

is remo%ed with laparoscopic* or minimally in%asi%e* surgery.

Surgeon will mae a few small openings through which he or sheinserts wand+lie de%ices e4uipped with %ideo cameras and small

tools.

•"he remaining healthy adrenal gland carries out the functions

normally performed $y two* and $lood pressure usually returns tonormal. #n some unusual situations* such as when the other

adrenal gland has already $een remo%ed* a surgery may $e

considered to e!tract only the tumor and spare some of the healthy

tissue.

•#f a tumor is cancerous &malignant'* surgery may $e effecti%e only

if the tumor and any metastasi5ed tissues are isolated. Howe%er*

e%en if all of the cancerous tissues are not remo%ed* surgery may

limit hormone production and pro%ide some control of $lood

pressure.


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;ERGLCEMIA


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;ERGLCEMIA

a term referring to high blood glucose leels ( the

condition that often leads to a diagnosis of diabetes.

igh $lood glucose levels are the defining feature of

dia$etes, $ut once the disease is diagnosed,

hy%erglycemia is a signal of %oor control over the

condition.

y%erglycemia is defined $y certain high levels of $lood

glucose@

asting levels greater than A.0 mmol/4 *126 mg/d4

:&o!hours %ost%randial *after a meal levels greater than

11.0 mmol/4 *200 mg/d4.

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:hirst and hunger

5ry mouthrequent urination, %articularly at night

:iredness

ecurrent infections, such as thrush

Eeight loss

3ision $lurring.

Symptoms of hyperglycemia/

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C)!e '/ &er+"&e$):

;ating more or eercising less than usual

)nsufficient amount of insulin treatment *more

commonly in cases of ty%e 1 dia$etes

)nsulin resistance in ty%e 2 dia$etes

Psychological and emotional stress:he Fda&n %henomenonF or Fda&n effectF ! an early

morning hormone surge.

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Emergency treatment for se%ere

hyperglycemia

&luid replacement. (dminister fluids — either orally

or through intravenously — until %atient is rehydrated.

:he fluids re%lace those lost through ecessive

urination, as &ell as hel% dilute the ecess sugar in the

$lood.

2lectrolyte replacement. ;lectrolytes are minerals in

the $lood that are necessary for the tissues to function

%ro%erly. :he a$sence of insulin can lo&er the level of

several electrolytes in the $lood.

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Thank You !!

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Never Stop Learning,because life never

stops teaching…- Zyrine Salomon

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endocrine disorders and management final

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