1. Chapter 79 Endocrine Disorders

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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.

8. Nursing Process
Data collection
Planning and implementation
Evaluation

9. 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

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

11. 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.

12. 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

13. 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

14. 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.

15. 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.

16. 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

17. 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

18. 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.

19. 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.

20. 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)

21. 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

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

23. 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.

24. 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

25. 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

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

27. 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.

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

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

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

31. Mixing Insulins

32. Glucagon…..

33. End of Presentation