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93 Cards in this Set
- Front
- Back
What are the five functions of the endocrine system
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1) Differentiate reproductive and CNS in fetus
2)Stimulation of growth and dev in childhood and adolescence 3)Coordinate reproductive system 4) Homeostasis 5) Initiate corrective and adaptive responses |
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Definition of Autocrine
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Within Cells
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Definition of Paracrine
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Local cells
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Definition of Endocrine
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Remote Cells
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Release of hormones regulated by
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Chemical factors (blood sugar ex)
Endocrine factors Neural Control |
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Characteristics of Endocrine organs
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Ductless glands that secrete their substances directly into the blood
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Two important groups of hormones from the Hypothalamus
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Releasing hormones
Inhibiting hormones |
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Pituitary gland
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Pea size gland, located under the hypothalamus
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Anterior Pituitary
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Accounts for 80% of the gland by weight.
Growth hormone Prolactin - stimulates breast development necessary for lactation |
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Posterior Pituitary
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Composed of nerve tissue and is essentially an extension of the hypothalamus
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Antidiuretic Hormone
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Secreted by posterior pituitary
regulates fluid volume by stimulating reabsorption of water in the renal tubules (vassopressin) |
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Oxytocin
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Secreted by the Posterior Pituitary
Stimulates ejection of milk into mammary glands and contraction of uterine smooth muscle (later is regulated by positive feedback) |
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Iodine
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Necessary for the synthesis of thyroid hormones
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Thyroxine (T4)
Triiodothronine (T3) |
The two major thyroid hormones that affect metabolic rate, caloric requirements, oxygen consumption, carbohydrate and lipid metabolism, growth and development, and brain functions
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Calcitonin
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Produced by the thyroid in response to high levels of circulating Calcium
Inhibits calcium resorption (loss); increases storage in boon, and increases excretion |
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Parathyroid glands
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small, oval structures, usually arranged in pairs behind each thyroid lobe
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Parathyroid hormone
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PTH- regulates the blood level of calcium
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Adrenal medulla hormones
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catecholamines- norepinephrine and epinephrine (essential for the body's response to stress)
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Adrenal Cortex
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Outer part of the adrenal gland that secretes more than 50 steroid hormones classified as either: glucocorticoids, mineralocorticoids, and androgens. (cholesterol is precursor)
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Corticosteroid
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Any of the hormones synthesized by the adrenal cortex
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Cortisol
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Most abundant and potent glucocorticoid
Regulates blood glucose Antiinflammatory Stress response |
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Aldosterone
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Potent mineralocorticoid that maintains extracellular fluid volume.
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Adrenal androgens
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Secreted in small amounts by the adrenal cortex
Stimulate pubic and axillary hair growth and sex drive in females (converted to estrogen) |
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The most common non-specific symptoms of endocrine disorders
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Fatigue and depression
Often accompanied by changes in energy, alertness, sleep patterns, mood, affect, weight, skin, hair, and sexual function |
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Acromegaly
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Excessive secretion of GH in adults= overgrowth of the bones and soft tissues
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What causes overproduction of GH
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Almost always caused by a benign pituitary tumor
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Syndrome of Inappropriate antidiuretic hormone (SIADH)
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Overproduction or oversecretion of ADH
Fluid retention (low output and weight gain); Dilutional hyponatremia (Serum NA <134 mEq/l or serum osmolarity < 280 mOsm/kg), concentrated urine |
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Diabetes Insipidus
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Decreased production or secretion of ADH
Characterized by increased thirst (polydipsia) and increased urination (polyuria) the primary characteristic of DI, may exhibit hypovolemic symptoms |
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Goiter
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Hypertrophy and enlargement of the thyroid gland caused by excess TSH stimulation
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Hashimotos thyroiditis
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Chronic autoimmune disease in which thyroid tissue is replaced by lymphocytes and fibrous tissue. Most commone cause of goiterous hypothyroidism.
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Cause of acute Thyroditis
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Bacterial or fungal infection
Have an abrupt onset and the thyroid gland is painful |
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Thyrotoxicosis
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Refers to the physiologic effects or clinical syndrome that results from excess circulating levels of T3 and/or T4
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Graves Disease
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The most common form of hyperthyroidism (75%)
Autoimmune disease Manifestations include: increased metabolism, goiter, increased sensitivity to sympathetic nervous system Exophthalmos- protrusion of the eyeballs |
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Thyrotoxic crisis
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Also called thyroid storm
Acute, rare condition in which all hyperthyroid manifestations are heightened Caused by stressors in a patient with prexisting hyperthyroidism |
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Iodine therapy
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In large doses rapidly inhibits synthesis of T3 and T4, and blocks their release into circulation
Decreases the vascularity of the thyroid gland, making surgery safer and easier |
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Nursing interventions of hyperthyroidism
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Related to increased metabolic state (increase nutrition) and to counteract stimulation of sympathetic nervous system (calming interventions)
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Hypothyroidism
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One of the most common medical disorders in the US
Generally effects people over the age of 65 |
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Most common cause of hypothyroidism worldwide
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Iodine deficiency
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Cretinism
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Thyroid hormone deficiency during fetal or early neonatal life.
All infants in the US are screened for |
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Clinical manifestations of hypothyroidism
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Fatigue, lethargy, mental changes (impaired memory, slowed speech, somnolence, etc...), long periods of stage altered sleep
Decreased cardiac output and contractility, anemia |
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Myxedema
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Occurs in patients with severe long-standing hypothyroidism
Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues causes facies: puffiness, periorbital edema, and masklike affect |
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Nursing management of hypothyroidism
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Low-cal diet
Assess for weight gain, mental changes, iodine containing meds, bradycardia, dry, thick cold skin, thick brittle nails, parasthesia, and muscular aches and pains Meds (synthroid) |
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Hyperparathyroidism
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Oversecretion of PTH, associated with increased serum calcium levels and low PO4
Most common cause is benign tumor (primary) Chronic renal failure (secondary) loos of feedback loop (transplant): tertiary |
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Clinical manifestations of hyperparathyroidism
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weakness. loss of appetitie, constipation, increased need for sleep, emotional disorders, and shortened attention span
Major signs: osteoporosis, fractures, and kidney stones. |
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Post op complications for hyperparathyroidism
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Major complications associated with hemorrhage and fluid and electrolyte disturbances
Tetany- condition of neuromuscular hyperexcitability associated with sudden decrease in calcium levels |
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Cause of acute Thyroditis
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Bacterial or fungal infection
Have an abrupt onset and the thyroid gland is painful |
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Thyrotoxicosis
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Refers to the physiologic effects or clinical syndrome that results from excess circulating levels of T3 and/or T4
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Graves Disease
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The most common form of hyperthyroidism (75%)
Autoimmune disease Manifestations include: increased metabolism, goiter, increased sensitivity to sympathetic nervous system Exophthalmos- protrusion of the eyeballs |
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Thyrotoxic crisis
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Also called thyroid storm
Acute, rare condition in which all hyperthyroid manifestations are heightened (severe tachycardia, temp > 105) Caused by stressors in a patient with prexisting hyperthyroidism |
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Iodine therapy
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In large doses rapidly inhibits synthesis of T3 and T4, and blocks their release into circulation
Decreases the vascularity of the thyroid gland, making surgery safer and easier |
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Cushing Syndrome
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Spectrum of clinical abnormalities caused by an excess of corticosteroids, paticularly glucocorticoids
Exogenous= corticosteroids (prednisone) Endogenous= adrenocorticotropic hormone (ACTH), secreting tumor |
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Clinical manifestations of Cushing syndrome
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Truncal obesity
Moonface Purplish red striae Histruism in females Menstrual disorders Impaired skin integrity |
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Diagnose Cushing syndrome
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24 hour urine collection for free cortisol
50-100 mcg/day in adults indicates Cushing |
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Surgery on the adrenal glands
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Poses risk because they are highly vascular (hemorrhage)
Can release large amounts of hormones= BP, fluid and electrolyte imbalances |
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Addison's disease
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Hypofunction of the adrenal cortex causes reduction of all three clases of adrenal corticosteroids
Most common cause is an autoimmune response, usually not noticed until 90% of cortex is destroyed |
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Manifestations of Addison's disease
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Very slow onset: weakness, fatigue, weight loss, and anorexia, skin hyperpigmentation
Severe insufficiency can lead to hypotension, tachycardia, dehydration, hyponatremia, etc... possible shock |
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Acute nursing intervention for Addison's disease
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Assess vital signs every 30 minutes to 4 hours depending on instability
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Interventions for Addison's disease
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Unable to tolerate stress= need to manage via medications and techniques
Patient should carry an emergency kit at all times |
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Effects of corticosteroid therapy
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Antiinflammatory action
Immunosuppression Maintenance of normal BP Carbohydrates and protein metabolism= can lead to glucose intolerance |
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Hyperaldosteronism
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sodium retention and K+ and H+ secretion leads to hypertension and hypokalemic alkalosis
Clincal signs: hypertension and headache, weakness and fatigue that can lead to tetany. |
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Pheochromocytoma
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Rare condition characterized by a tumor of the adrenal medulla that produces excessive catecholamines
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Clinical manifestations of pheochromocytoma
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Severe, episodic hypertension accompanied by severe, pounding headache, tachycardia with palpitations, profuse sweating, and unexplained abdominal or chest pain
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Thyroiditis
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Inflammatory process with different causes and different treatments.
Recovery in weeks or months. |
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Nodules
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Hard painless nodules (around the thyroid) are bad
Evaluate with radiologic testing US, CT, MRI, FNA, thyroid scan |
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FNA
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Fine needle aspiration
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"Hot" nodules
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Thyroid takes in iodine in a radioactive scan = benign
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"Cold" nodules
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Thyroid does not take in radioactive scan = malignant
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Hyperthyroidism diagnostics
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Decreased TSH, increased free T4
RAIU helps differentiate between Graves or thyroiditis |
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Hyperthyroidism treatments
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Medications: antithyroid drugs (PTU, Tapazole) not curative.
Beta blockers-slow down metabolism Large doses of Iodine Radioactive iodine therapy subtotal thyroidectomy |
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Nursing care for thyroid disorders
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HOB up, no flexion, tingling, pain meds, diet, trach tray, O2, suction equip, etc.
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Goitrogens
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substances that suppress the function of the thyroid gland by interfering with iodine uptake, which can, as a result, cause an enlargement of the thyroid (patients should avoid)
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Treatment of hyperparathyroid
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Surgery: endoscopic approach with autotransplantation in upper arem
Nursing care: avoid immobility |
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Hypoparathyroidism
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Rare, iatrogenic, cause is usually due to decreased parathyroid hormone
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Symptoms of hypoparathyroidism
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Decreased calcium level, tingling of the lips, parasthesias, respiratory diffuculty
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Nursing care of hypoparathyroidism
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Calcium infusion, Vitamin D replacement, lifelong tx
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Hormones of the anterior pituitary
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TSH
ALTH FSH (follicle stimulating hormone) LH (leutinizing hormone) GH Prolactin |
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Why would you ask about "Ring, hat, and shoe size."?
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Assess for growth hormone excess (photos also helpful)
Oral glucose challenge test is the definitive diagnostic |
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Clinical manifestations of growth hormone excess
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Enlargement of the hands and feet. Thickening of the face.
sleep apnea Signs of diabetes mellitus Cardiomegaly HTN Visual difficulties Headache |
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Surgical care for growth hormone excess
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Transphenoidal approach- up through the nose (94% effective)
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Radiation therapy for growth hormone excess
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Procedure where radiation is delivered to specific areas ( nursing: vitals, neurochecks, seizures, headaches, pin discomfort) If surgery was not completely successful
Usually end up with hypo function and have to give drugs to replace (sandostatin, dostinex, somaver) |
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Why do you have to send clear nasal drainage to the lab following surgery for growth hormone excess?
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To check for cerebrospinal fluid
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Preop instructions following surgery for growth hormone excess
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Antibiotics, nose drops
Avoid coughing, sneezing, valsava maneuver in order to prevent CSF leak No teethbrushing for 10 days |
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Possible complications following transphenoidal or radiosurgery for growth hormone excess?
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Diabetes insipidus, caused by cerebral edema
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Most frequent pituitary tumors?
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Prolactinomas (prolactin-secreting adenoma)
Ovulatory and menstural problems, decreased libido, headache, visual impairment, and lactation |
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What are the most common hormone deficiencies associated with hypopituitarism?
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GH
FSH LH |
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Characteristics of Diabetes Insipidus
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"High and dry"
Decreased ADH Increased urination and thirst (polydipsia) Nocturia Dehydration Hypernatremia (150 mEq/l or greater) Urine specific gravity < 1.005 Elevated serum osmolarity > 300mOsm/kg decreased urine osmolarity |
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Serum osmolarity
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Tells how much water is on board, the "thickness or concentration of the solution
The higher the serum osmolarity, the less fluid on board |
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Characteristic of SIADH
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"low and wet"
Increased ADH Decreased urine output Hypertension Weight gain and fluid retention Hyponatremia (130mEq/l or less) Urine sg > 1.030 Decreased serum osmolarity < 280 mOsm/kg Increased urine osmolarity |
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Water deprivation test
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Used to differentiate causes of polyuria, including:
Central DI Nephrogenic DI SIADH Psychogenic polydipsia Adminster ADH, only in central DI does urine osmolarity increase |
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Patient teaching with water deprivation
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Severe dehydration may occur
Test is 6 hours long Assess urine Administer 5 units of ADH |
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Thyroid scan
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Take radioactive isotopes, and scan for hot and cold nodules: cold nodules malignant
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Radioactive iodine uptake (RAIU)
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Measures thyroid activity, iodine is administered and then the uptake is measured with a scanner.
2-4 hour 3-19% (normal) 24 hours 11-30% (normal) |
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When do you take a cortisol sample?
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Morning: cortisol has a diurnal variation, levels higher in the morning.
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