endocrine

• pituitary


  master endocrine gland

  - anterior and posterior pituitary
• anterior pituitary


  FLAT PEG

  Follicle stimulating hormone (FSH)

  lutenising hormone ( LH)

  acth ( adrenocorticotrophic hormone)

  thyroid stimulating hormone( TSH)

  prolactin ( P)

  endorphins ( E)

  growth hormone ( G)
• posterior pituitary


  anti- oxidant

  ADH and Oxytocin
• hypopituitarism


  - decrease in the one or more pituitary hormones

  - manifestation based on which hormone is deficient

  - fixed with surgery, radiation, hormone replacement
• selective hypopituitarism


  deficiency of one pituitary hormone
• panhypopituitarism


  deficiency of all pituitary hormones
• hyperpituitarism


  -overactivity of pituitary hormones

  - tumors can be causes

  management aimed oto decrease

  - fixed with surgery. radiation
• pituitary surgery


  Transsphenoidal hypophysectomy
• transsphenoidal hypophysectomy


  monitor for meningitis, CSF, ICP, diabetes insipidus, a
• S/S of a CSF leak

  -HALO SIGN in drainage (clear in center, yellow on edges)

  -sweet-tasting drainage

  -clear drainage from the nose

  -headache
• S/S of meningitis


  - stiff neck

  - headache

  -fever

  - irritability
• S/S of ICP


  - headache

  -nausea/ vomiting
• post-op care for a hypophysectomy

  - neuro exam for ICP

  - mouth care- dry mouth

  - no swimming

  - no activities that increase ICP

  - I & O drainage

  - desmopressin or vasopressin ( ADH meds)

  - increase HOB, increases ventilation, decrease drainage and ICP

  -NO NSAIDS
• activities that increase ICP


  - bending at waist

  - straining in the BR

  - coughing/ sneezing

  - blowing your nose

  -heavy lifting
• meds for diabetes insipidus

  - vasopressin

  - desmopresssin
• SIADH


  -syndrome of inappropriate antidiuretic hormone

  -too much ADH is being held on to meaning too much fluid retention, not enough being excreated
• DI


  - lack of ADH

  - too much diuresis
• SIADH S/S

  - fluid retention

  - concentrated urine

  - increase BP (too much fluid)

  - increased urine specific gravity

  - decreased urine output

  - diluted hyponatremia
• DI S/S

  -fluid loss

  - decreased BP

  -increased urine output

  - diluted urine

  - dehydration

  - hypernatremia

  -tachycardia
• SIADH treatment


  - hypertonic solution bc of hyponatremia

  - fluid restriction

  - diuretic antagonists

  - monitor urine and blood studies

  - monitor neuro status, I & Os, weight, seizure precautions bc of low sodium
• DI treatment


  Give ADH (PItressin or vasopressin)

  Give fluids to increase Intravascular volume

  monitor UOP

  *monitor fo ischemia, neuro status, dehydration
• adrenal cortex hormones


  3 S' ( steriods)

  sugar- glucocorticoids

  salt- mineralcorticoids

  sex- androgens
• hyperaldosteronism (CONN"S SYNDROME)


  excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium
• hyperaldosterone manifestations


  hypertension and hypokalemia due to too much water retention
• hyperaldosterone treatment


  aldactone( gets rid of water and keeps potassium)

  adrenelectomy
• cushing syndrome

  hypersecretion of cortisol (hydrocortisone) by the adrenal gland
• Cushing syndrome S/S`

  -moon face

  -hypokalemia

  -hyperglycemia

  -fluid over load

  -purple striae

  - fat pad

  -hirsutism

  
• cushing syndrome treatment


  - fluid

  - avoid food w/ sodium and sugar raising foods

  -I & Os, daily weights

  -monitor labs
• Addison's disease

  - LOW AMOUNT OF STEROIDS

  
• ADDISONS DISEAS S/S


  - SMALL, SKINNY, WEAK

  -Double P's- hyperpigmentation, hyperkalemia

  - low BP

  -hypoglycemic

  -low sodium

  -amenorrhea
• adrenal crisis


  give kayexalate- to lower potassium levels

  - Iv fluids

  - steriods and glucose
• patient teaching for addisions disease


  - wear medical bracelet

  - increase foods in calcium and vitamin D

  - limit potassium intake

  -steroid meds
• phenochromocytoma


  tumor of the adrenal medulla
• Phenochromocytoma S/S


  Palpitations

  Headache

  Episodic sweating

  hypertension

  hyperglycemia
• phenochromocytoma treatment


  - elevate HOB

  -calm environment

  -CHECK BP/ HR!!!

  -if bilateral adrenalectomy, monitor for adrenal insufficiency
• parathyroid disorder


  hyperparathyroid

  hypoparathyroidism
• TSH and T4T3 level


  - negative feed back loop

  - inverse relationship
• thyroid testing


  ultrasound, biopsy, physical exam, thyroid uptake and scan
• hyperthroidism


  too much t3 and t4 levels

  -weight loss

  - diarrhea

  -heat intolerance

  - insomnia

  -exopthalamos
• exophathalmos


  -bulging eyes in graves disease

  - can causes diplopia

  -tepeeza drug