Chapter 79 Endocrine Disorders

The Endocrine System Endocrine system Regulates nearly all body processes Endocrine glands Groups of cells that produce chemical substances called hormones Endocrine disorders Caused by overproduction or underproduction of specific hormones

Major Endocrine Glands Anterior pituitary – CT , MRI and Pet Scans Posterior pituitary Thyroid- table 79-2-about of iodine uptake; hold certain drugs before test ie BC, ASA, coagulants 1wk Parathyroid Adrenal medulla Adrenal cortex Pancreatic islets Testes Ovaries

Diagnostic Tests Pituitary function tests Thyroid function tests Laboratory tests Radiographic evaluations Thyroid scan (radioscan)-Hyperthyroid diagnosis Radioactive iodine uptake (RAIU)-have u ate shellfish within one week? Thyroid ultrasound (thyroid echogram)

Diagnostic Tests (cont’d) Parathyroid function tests Laboratory tests, ultrasound, magnetic resonance imaging (MRI), thallium scan, and fine-needle biopsy. Adrenal function tests The most diagnostic urine test of the adrenal medulla function is the urinary metanephrine Laboratory tests: Blood tests, urine tests Radiographic evaluations Adrenal angiogram or venogram-cath insertion and contrast medium injected General pancreatic function tests

Diagnostic Tests (cont’d) Tests for diabetes mellitus –how high is too high for glucose? Blood tests Fasting plasma glucose Oral glucose tolerance test Glycosylated hemoglobin Estimated average glucose Glycemic index- which type of food is most likely to increase blood glucose? Urine tests Keto-Diastix test

Common Medical and Surgical Treatments Surgical treatment in pituitary or thyroid disorders Removal of the affected gland Diabetes mellitus Cannot be treated with surgery Pancreatic or cellular transplants have had some success in reversing the symptoms.

Nursing Process Data collection Planning and implementation Evaluation

Pituitary Gland Disorders Disorders of the anterior lobe Gigantism = over production of STH and acromegaly Disorders of the posterior lobe Syndrome of inappropriate antidiuretic hormone (SIADH) Diabetes insipidus- monitor vasopressin Pituitary neoplasms Hypophysectomy

Question Is the following statement true or false? Diabetes insipidus is a disease that results from overproduction of the antidiuretic hormone.

Answer False Diabetes insipidus is a disease that results from underproduction of antidiuretic hormone (ADH or vasopressin). Primary nephrogenic insipidus is caused by kidney dysfunction due to a deficiency in ADH or to a lesion in the midbrain. Secondary central diabetes insipidus results from a tumor in the gland itself or pressure in the pituitary area from head trauma, infection, or other tumors.

Thyroid Gland Disorders Hyperthyroidism Overproduction of T4, increase in metabolic rate Graves’ disease or exophthalmic or toxic diffuse goiter Weight loss Hypothyroidism Deficiency of T4, decrease in metabolic rate Congenital hypothyroidism, myxedema Hashimoto’s thyroiditis Weight gain

Thyroid Gland Disorders (cont’d) Simple goiter or colloid goiter Thyroid neoplasms Simple cyst, semisolid cyst Thyroidectomy Subtotal thyroidectomy, total thyroidectomy Postoperative complications Tetany, Chvostek’s sign and Trousseau’s sign, thyroid crisis

Question Is the following statement true or false? A nurse should ensure that following a thyroidectomy, an endotracheal tube is available in the client’s room.

Answer True The nurse should ensure that an endotracheal tube is available in the client’s room, both preoperatively and postoperatively, because swelling may obstruct the airway, causing respiratory distress. In this event, an endotracheal tube is inserted, and the client is taken to the operating room for tracheostomy. Internal hemorrhage and edema following thyroidectomy are postoperative threats.

Parathyroid Gland Disorders Hyperparathyroidism Excess of PTH that causes blood calcium levels to rise, resulting in calcium depletion in bones (osteomalacia) Hypoparathyroidism Deficiency of PTH from lowered production of the hormone Consequent reduction in the amount of calcium available to the body and an accumulation of phosphorus in the blood

Adrenal Gland Disorders Cushing’s syndrome (hyperadrenalism) Hypokalemia, hypernatremia, hyperglycemia Primary aldosteronism Addison’s disease Destruction or degeneration of the adrenal cortex Addisonian crisis Adrenal neoplasms Pheochromocytoma- HTN

Question Is the following statement true or false? When caring for a client with Addison’s disease, the nurse should increase the client’s water intake.

Answer False Because this client is dehydrated, fluid replacement is key, but because sodium loss results from previous hormone imbalance, sodium also must be replaced in the diet. Increased sodium will aid in fluid retention without excess fluid intake. Water intake is thus restricted as excess water overloads the system.

Pancreatic Endocrine Disorders Diabetes mellitus Type 1, insulin-dependent diabetes mellitus (IDDM); or juvenile diabetes – most likely the diagnosis will be accompanied by DKA Type 2 non–insulin-dependent diabetes mellitus (NIDDM); or adult-onset diabetes Gestational diabetes mellitus (GDM) Prediabetes Impaired glucose homeostasis (IGH), impaired fasting glucose (IFG), impaired glucose tolerance (IGT)

Type 1 and Type 2 Diabetes Mellitus Age of onset Under 30 years Over 30 years Classic symptoms Nearly always present Usually not present Hereditary factors Occasionally present Usually present Weight Normal or underweight Usually overweight Ketoacidosis Susceptible Not susceptible Usual treatment Insulin, meal plan, exercise Meal plan, exercise, oral medications or insulin

Question Is the following statement true or false? In type 2 diabetes, insulin deficiency is absolute.

Answer False In type 1 diabetes, insulin deficiency is absolute; insulin injections are necessary for survival. In type 2 diabetes, insulin deficiency ranges from insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance.

Insulin Goal of insulin therapy To mimic the body’s natural levels of insulin Types of insulin Ultra-rapid, short-acting regular insulin Rapid, short-acting, regular human insulin Neutral protamine Hagedorn (NPH) insulin Long-acting insulin Use, care, and storage

Other Medications Pramlintide (Symlin) Injected at meal times to improve average blood glucose levels (HA1C or eAG). It cannot be combined with insulin. Insulin coverage Insulin pumps Oral diabetes medications Pancreas transplantation

Complications of Diabetes Mellitus Hypoglycemic reaction, hyperglycemia Nonketotic hyperosmolar state Infections Surgical complications Macrovascular complications Microvascular complications Nephropathy and retinopathy Neuropathy

Question Is the following statement true or false? A client with hypoglycemic reaction should have chocolate bars to increase the glucose level in his body.

Answer False Avoid chocolate bars and whole milk as treatment for a hypoglycemic reaction because the high fat content prevents quick release of glucose.

Long-Term Management of Diabetes Mellitus Client teaching Physician contact Glucose monitoring Meal planning Lifestyle factors Smoking Insulin injection Alternative forms of insulin administration

Long-Term Management of Diabetes Mellitus (Cont’d) Hypoglycemia and hyperglycemia Sexuality Exposure to cold Vision impairment Dental examination Foot care Traveling Identification

Mixing Insulins

Glucagon…..

End of Presentation