Endocrine

Disorders
STUDY GUIDE FOR NURSING STUDENTS

Hormonal Symphony
Body's Regulatory
Ensemble

FAMZ NURSING NOTES

Endocrine system overview

Diabetes
Insulin types

Hyperlycemia

Hypoglycemia

Hyperthyroidism

Hypothyroidism

Hyperparathyroidism

Hypoparathyroidism

Addison's disease

Neuropathy
Pheochromocytoma
Adrenal Gland Disorders
Cushing Syndrome
SIADH versus DI

FAMZ NURSING NOTES

The endocrine system is a complex network of glands and organs in the
human body that produce and secrete hormones. These hormones are
chemical messengers that travel through the bloodstream to various target
tissues or organs, where they regulate and control many physiological
processes.
Endocrine systems, also referred to as
hormone systems, that control many
important functions in the body. These
include the hypothalamus, pituitary
gland, pineal gland, thyroid gland,
parathyroid glands, adrenal glands,
pancreas, and the reproductive organs
(ovaries in females and testes in males).

The major glands of the endocrine system include:

Pituitary gland: Located at the base of the brain, it is

often referred to as the "master gland" because it controls
the functions of other endocrine glands. It produces
hormones that regulate growth, reproduction, and the
function of other glands.

Thyroid gland: Found in the neck, it produces hormones

that regulate metabolism, growth, and development.
These hormones are involved in controlling the rate at
which the body uses energy.

Parathyroid glands: There are four small parathyroid

glands located near the thyroid gland. They secrete
parathyroid hormone, which helps regulate calcium and
phosphate levels in the body. These yellow dots
represent parathyroid gland.
 Adrenal glands: Situated on top of the kidneys, these
glands produce hormones such as cortisol, which helps
regulate stress response and metabolism, and adrenaline,
which is involved in the "fight or flight" response.

Pancreas: This gland is located behind the stomach and

plays a crucial role in regulating blood sugar levels. It
produces insulin and glucagon, which help control
glucose metabolism.

Gonads: These are the reproductive glands, including the

testes in males and the ovaries in females. They produce
hormones, such as testosterone and estrogen, which are
involved in sexual development and reproductive
functions.

Pineal gland: Located in the brain, it produces the

hormone melatonin, which helps regulate sleep-wake
cycles.

Hypothalamus: It serves as a vital link between the

nervous system and the endocrine system. The
hypothalamus plays a crucial role in regulating
numerous physiological processes and maintaining
homeostasis in the body.

The hormones secreted by these glands have widespread effects on various

bodily functions, including growth and development, metabolism,
reproduction, response to stress, regulation of electrolyte balance, and
immune system function.
Overall, the endocrine system works in conjunction with the nervous
system to maintain homeostasis and coordinate the activities of different
organs and tissues throughout the body.
 What does the endocrine system do?
Your endocrine system continuously monitors the amount of hormones in
your blood. Hormones deliver their messages by locking into the cells they
target so they can relay the message.

The pituitary gland senses when your hormone levels rise, and tells other
glands to stop producing and releasing hormones. When hormone levels
dip below a certain point, the pituitary gland can instruct other glands to
produce and release more. This process, called homeostasis, works
similarly to the thermostat in your house. Hormones affect nearly every
process in your body, including:
Metabolism (the way you break down food and get energy from
nutrients).
Growth and development.
Emotions and mood.
Fertility and sexual function.
Sleep.
Blood pressure.

Sometimes glands produce too much or not enough of a hormone. This

imbalance can cause health problems, such as weight gain, high blood
pressure and changes in sleep, mood and behavior. Many things can affect
how your body creates and releases hormones. Illness, stress and certain
medications can cause a hormone imbalance.

How can I keep my endocrine system healthy?

Your endocrine system needs the same things the rest of your body needs
to stay healthy. You should exercise, eat right and see your healthcare
provider regularly.
If you have a family history of diabetes, thyroid disorders or PCOS, talk to
your provider. Managing these conditions can help you avoid a hormone
imbalance that can lead to health problems.
 Endocrine System
HYPOTHALAMUS
connects the nervous system and
endocrine system; controls hormones
from the central nervous sytem

PITUITARY GLAND
monitors and regulates growth
PINEAL GLAND
hormones; also controls
reproductive glands produces melatonin
that regulates sleep

THYROID
regulates metabolism
and use of energy

ADRENAL GLAND
PANCREAS
produces hormones
that help regulate produces hormones
metabolism and other that regulate blood
body functions glucose

AR
ONVFEM Y TESTIS
ALES) (IN MALES
)
(I

produces estrogen
that controls female produces testosterone
puberty and that controls male
progesterone that puberty and ability to
manages fertility produce sperm
Diabetes is a condition that happens when your blood sugar (glucose) is too
high. It develops when your pancreas doesn’t make enough insulin or any
at all, or when your body isn’t responding to the effects of insulin properly.
Diabetes affects people of all ages.
When a person has diabetes, their body either doesn't produce enough
insulin or is unable to effectively use the insulin it produces. This leads to
an accumulation of glucose in the bloodstream, causing high blood sugar
levels. Over time, persistently high blood sugar levels can lead to various
health complications.
Two major types of diabetes are discussed below:

TYPE 1 DIABETES
Type 1 diabetes, also known as juvenile diabetes or insulin-dependent
diabetes, is a chronic autoimmune condition characterized by the
pancreas producing little to no insulin. Insulin is a hormone responsible
for regulating blood sugar levels, allowing glucose to enter cells and
provide energy.
This type of diabetes occurs when the immune system mistakenly
attacks and destroys the insulin-producing cells in the pancreas. As a
result, the body is unable to produce enough insulin, or in some cases, no
insulin at all. People with type 1 diabetes require lifelong insulin therapy
to regulate their blood sugar levels.

Symptoms of Type 1 Diabetes

In people with type 1 diabetes, the onset of symptoms can be very
sudden, while in type 2 diabetes, they tend to come about more
gradually, and sometimes there are no signs at all.
Symptoms of type 1 diabetes:
Frequent urination Blurred vision
Increased thirst and hunger Slow-healing wounds
Unexplained weight loss Recurring infections
Fatigue and weakness
 Symptoms of Type 1 Diabetes

Treatment:
Management of type 1 diabetes revolves around maintaining blood sugar
levels within a target range to prevent complications. Treatment
typically involves a combination of:

Insulin Therapy:
Since the body doesn't produce enough insulin, individuals with type 1
diabetes need to administer insulin via injections or an insulin pump.
Insulin helps regulate blood sugar levels and allows cells to utilize
glucose for energy.

Blood sugar monitoring:

Regularly checking blood sugar levels with a glucose meter helps
individuals make informed decisions about insulin dosage, diet, and
physical activity.

Healthy eating:
Following a balanced diet, counting carbohydrates, and managing portion
sizes are essential. Consistency in meal timing is also important for
insulin management.
 Regular exercise:
Engaging in physical activity helps lower blood sugar levels, improves
insulin sensitivity, and promotes overall health. However, adjustments
may be needed to insulin dosage and food intake to prevent
hypoglycemia during exercise.

Continuous glucose monitoring (CGM):

CGM systems provide real-time information on blood sugar levels,
helping individuals track trends and make timely adjustments to their
insulin regimen.

Complications

Poorly managed type 1 diabetes can lead to various long-term

complications, including:

Cardiovascular diseases
Kidney damage (diabetic nephropathy)
Nerve damage (neuropathy)
Eye problems (diabetic retinopathy)
Foot problems and amputations
Skin conditions
Mental health issues

It's important for individuals with type 1 diabetes to work closely with
healthcare professionals, including endocrinologists and certified diabetes
educators, to develop a personalized treatment plan and effectively
manage their condition. Ongoing education, support from loved ones, and
regular medical check-ups are crucial for living a healthy life with type 1
diabetes.
 TYPE 2 DIABETES
This type of diabetes is characterized by insulin resistance. In this
condition, the body's cells become less responsive to the effects of insulin,
leading to elevated blood sugar levels. Over time, the pancreas may also
produce less insulin. It is often associated with poor diet, lack of physical
activity, and excess body weight.

In other words, the most common type of diabetes, type 2 diabetes is

diagnosed when your blood sugar (also called blood glucose) is persistently
elevated above the normal range over a long period of time. At the same
time, your body either doesn't use insulin properly or doesn't make
enough insulin. Our bodies need insulin to move glucose into cells so it can
be used for energy.

Symptoms of Type 2 Diabetes

In type 2 diabetes, symptoms may tend to come about more gradually, and
sometimes there are no signs at all.
Symptoms of type 2 diabetes:

Increased frequency
and volume of
urination
Increased hunger
Tingling, numbness,
or pain in the feet or
hands
Sores, cuts, and
bruises that are slow
to heal
Fatigue
Blurry vision
Sudden weight loss
 Treatment:
Managing type 2 diabetes often involves a combination of lifestyle
modifications, oral medications, and, in some cases, insulin therapy. Here
are some key aspects of treatment:

Healthy eating
A well-balanced diet focusing on whole foods, high-fiber carbohydrates,
lean proteins, and healthy fats is crucial. Portion control and monitoring
carbohydrate intake help manage blood sugar levels.

Regular physical activity

Engaging in regular exercise, such as brisk walking, cycling, or swimming,
helps improve insulin sensitivity, lowers blood sugar levels, and promotes
weight management.

Medications
Depending on individual needs, healthcare providers may prescribe oral
medications to help control blood sugar levels. These medications work in
various ways, such as stimulating insulin production, reducing glucose
production in the liver, or improving insulin sensitivity.

Blood sugar monitoring

Regularly monitoring blood sugar levels using a glucose meter helps
individuals understand how their diet, exercise, and medications affect
their glucose levels.
 TYPE 1 vs TYPE 2
DIABETES
TYPE 1 TYPE 2
Can be prevented
Cannot prevented or through lifestyle
Symptoms
cured include thirst, modifications
frequent
The body does not create urination and The body does not create
enough insulin blurry vision enough insulin or
Requires healthy develops insulin
Causes are unknown lifestyle, and
resistance
but genetics may play a medication
Causes include genetics,
role Can cause
serious aging, inactivity,
Requires insulin health obesity, and more
issues
injections for life Requires insulin as
needed, injected or oral

Type 1 diabetes is an autoimmune condition that typically requires insulin

therapy, whereas type 2 diabetes is influenced by various factors including
lifestyle choices, and may be managed initially with lifestyle modifications
and oral medications.

Consulting with healthcare professionals is essential to determine the

appropriate treatment plan based on the specific type of diabetes an
individual has.

Both types of diabetes can lead to various long-term complications if not

properly managed. These complications include cardiovascular diseases,
kidney damage, nerve damage, eye problems, foot problems, and skin
conditions.
Insulin is a hormone produced by the beta cells of the pancreas. It plays a
crucial role in regulating blood sugar levels and allowing cells to use
glucose for energy. Insulin acts as a key that unlocks the cells, enabling
glucose to enter and be utilized.

TYPES OF INSULIN
There are several types of insulin available, which differ in their onset,
peak, and duration of action. The main types of insulin include:

Rapid-acting insulin: This type of insulin begins to work within 15

minutes after injection and reaches its peak effect within 1 to 2 hours. It
typically lasts for around 3 to 4 hours. Rapid-acting insulin is commonly
used before meals to control the rise in blood sugar that occurs after
eating. Examples include insulin lispro, insulin aspart, and insulin
glulisine.

Short-acting insulin: Also known as regular or

neutral insulin, this type starts working within 30
minutes after injection, peaks in 2 to 4 hours, and
generally lasts for about 6 to 8 hours. It is typically
taken before meals to control blood sugar levels.
Short-acting insulin can also be administered
intravenously in hospital settings. Regular insulin is
an example of short-acting insulin.

Intermediate-acting insulin: Intermediate-acting insulin has a slower

onset of action compared to rapid-acting or short-acting insulin. It
begins working within 2 to 4 hours, peaks in 4 to 8 hours, and lasts for
approximately 12 to 16 hours. This type of insulin helps maintain blood
sugar control between meals and overnight. NPH insulin (neutral
protamine Hagedorn) is an example of intermediate-acting insulin.
 Long-acting insulin: Long-acting insulin provides a more consistent
release of insulin over an extended period. It typically starts working
several hours after injection, has no pronounced peak, and can last for
up to 24 hours or even longer. Long-acting insulin helps maintain
baseline insulin levels throughout the day and night. Examples include
insulin glargine, insulin detemir, and insulin degludec.

Premixed insulin: Premixed insulin formulations combine

intermediate-acting insulin with either rapid-acting or short-acting
insulin in specific ratios. These pre-mixed insulin options offer the
convenience of both basal (background) and prandial (mealtime) insulin
in a single injection. They are typically taken before meals and provide
coverage for both immediate and long-lasting blood sugar control.

FUNCTIONS OF INSULIN
Glucose Regulation
Insulin is responsible for maintaining blood sugar levels within a narrow
range. When blood sugar levels rise after a meal, the pancreas releases
insulin into the bloodstream to facilitate the uptake of glucose by cells,
thereby lowering blood sugar levels.

Storage of Excess Glucose

Insulin helps store excess glucose in the liver and muscle cells in the form
of glycogen. This stored glucose can be released when the body needs
additional energy, such as between meals or during physical activity.

Inhibition of Glucose Production

Insulin prevents the liver from producing excessive glucose, thereby
maintaining stable blood sugar levels. It inhibits the breakdown of glycogen
into glucose and suppresses the production of glucose from other sources.
Hyperglycemia refers to high blood sugar levels, typically defined as having
a fasting blood glucose level above 126 milligrams per deciliter (mg/dL) or a
random blood glucose level above 200 mg/dL. It is commonly associated
with diabetes, both type 1 and type 2, but can also occur due to other factors
or medical conditions.

Causes of Hyperglycemia
Diabetes
In people with diabetes, hyperglycemia can occur due to inadequate insulin
production (type 1 diabetes) or insulin resistance (type 2 diabetes).

Insufficient Insulin
Skipping or inadequate doses of insulin or oral diabetes medications can
lead to high blood sugar levels.

Unhealthy Eating Habits

Consuming excessive carbohydrates or sugary foods without proper
insulin management can cause hyperglycemia.

Lack of Physical Activity

Physical activity helps regulate blood sugar levels. Insufficient exercise can
contribute to elevated blood sugar.

Stress
Hormonal changes caused by stress can affect blood sugar
regulation and lead to hyperglycemia.

Illness or Infection
Infections, particularly in people with diabetes, can cause
temporary spikes in blood sugar levels.
Hypoglycemia, also known as low blood sugar, is a medical condition
characterized by a decrease in the concentration of glucose (sugar) in the
blood. Glucose is the primary source of energy for the body's cells,
particularly the brain, so maintaining an appropriate blood sugar level is
crucial for normal bodily functions.

Causes of Hypoglycemia
Diabetes
People with diabetes who use insulin or certain oral medications to manage
their blood sugar levels may experience hypoglycemia if their medications
or insulin dosages are not properly adjusted.

Skipping or Delaying Meals

When you go for an extended period without eating, especially if you have
diabetes, your blood sugar can drop too low.

Excessive alcohol consumption

Consuming excessive carbohydrates or sugary foods without proper
insulin management can cause hyperglycemia.

Certain medications
Some medications, such as those used to treat diabetes, can cause
hypoglycemia as a side effect.

Medical conditions
Certain medical conditions, such as hormonal disorders, liver or kidney disease,
and tumors, can lead to hypoglycemia.
 Symptoms of Hyperglycemia and Hypoglycemia

If left untreated, severe hypoglycemia can lead to loss of consciousness,

seizures, and in rare cases, even death. It is important for individuals with
diabetes or those at risk for hypoglycemia to be aware of the symptoms and
take appropriate actions to raise their blood sugar levels, such as
consuming glucose tablets, fruit juice, or other sources of fast-acting
carbohydrates.

If you suspect you have hypoglycemia or hyperglycemia, it is essential to

consult with a healthcare professional for proper diagnosis and guidance on
managing your blood sugar levels effectively.
 COMPARISON BETWEEN HYPERGLYCEMIA &
HYPOGLYCEMIA
HYPERGLYCEMIA HYPOGLYCEMIA
Hyperglycemia refers to
Hypoglycemia refers to low
high blood sugar levels,
blood sugar levels, usually
typically defined as a blood
defined as a blood glucose
glucose concentration
concentration below
above normal ranges (e.g.,
normal ranges (e.g., below
fasting blood sugar level
70 mg/dL).
above 126 mg/dL )

Causes of hyperglycemia Causes of hypoglycemia

include insufficient insulin include excessive insulin
production or action, or medication dosage,
unhealthy eating habits, delayed or skipped meals,
lack of physical activity, increased physical activity
stress, illness, or certain without adequate food
medications. intake.

Symptoms of hypoglycemia
Symptoms of
can vary but may include
hyperglycemia may include
shakiness, dizziness,
excessive thirst, frequent
sweating, confusion,
urination, fatigue, blurred
weakness, headache,
vision, dry mouth, and slow
hunger, and rapid
wound healing.
heartbeat.

Treatment typically Treatment typically

involves adjusting insulin involves consuming a
or medication doses, source of fast-acting
following a healthy diet, carbohydrates, such as
increasing physical activity, glucose tablets, fruit juice,
and closely monitoring or candy, to raise blood
blood sugar levels. sugar levels quickly.
Hyperthyroidism is a medical condition characterized by excessive
production of thyroid hormones by the thyroid gland. The thyroid gland,
located in the front of the neck, produces hormones that regulate various
bodily functions, including metabolism.
In other words, Hyperthyroidism is a condition in which your thyroid
creates and releases more hormones than you need. This is also called
overactive thyroid. The main hormones your thyroid makes include
triiodothyronine (T3) and thyroxine (T4).

What does my thyroid do?

Located at the front of your neck, the thyroid is a butterfly-shaped gland.
Glands are organs that can be found all over your body. Some of your
glands create and release hormones — substances that help your body
function and grow.
The thyroid gland plays a big part in
many of your body’s main functions,
including:
Regulating your body
temperature.
Controlling your heart rate.
Controlling your metabolism (the
process that transforms the food
you put in your body into energy
that helps your body function).
When your thyroid gland is working
correctly, your body is in balance, and
all of your systems function properly.
If your thyroid stops working the way
it’s meant to creating too much or too
little thyroid hormones it can impact
your entire body.
 Normal Thyroid Hyperthyroidism

Symptoms of Hyperthyroidism
There are many symptoms of hyperthyroidism, and they can impact your
entire body. You may experience some of these symptoms and not others,
or many of them at the same time. Symptoms of hyperthyroidism can
include:
Rapid heartbeat.
Feeling shaky and/or nervous.
Weight loss.
Increased appetite.
Diarrhea and more frequent bowel movements.
Vision changes.
Thin, warm and moist skin.
Menstrual changes.
Intolerance to heat and excessive sweating.
Sleep issues.
Swelling and enlargement of the neck from an enlarged thyroid gland
(goiter).
Hair loss and change in hair texture (brittle).
Bulging of the eyes.
Muscle weakness.
 RAPID HEARTBEAT

What causes Hyperthyroidism?

Medical conditions and situations that can cause hyperthyroidism include:
Graves’ disease
In this disorder, your immune system attacks your thyroid. This makes
your thyroid create too much thyroid hormone. Graves’ disease is a
hereditary condition. Graves’ disease is the most common cause of
hyperthyroidism, making up about 85% of cases.
Thyroid nodules
A thyroid nodule is a lump or growth of cells in your thyroid gland. They
can produce more hormones than your body needs. Thyroid nodules are
rarely cancerous.
 Thyroiditis
Thyroiditis is inflammation of your thyroid gland, which may be painful or
painless (silent). It may happen within a year of delivering a baby
(postpartum thyroiditis). After you experience thyroiditis, your thyroid
may be unable to recover, which would lead to hypothyroidism.

Consuming excess iodine

If you’re at risk for hyperthyroidism and consume too much iodine
(through your diet or medications), it can cause your thyroid to produce
more thyroid hormone. Iodine is a mineral that your thyroid uses to create
thyroid hormone. Receiving intravenous iodinated contrast (iodine “dye”)
may also cause hyperthyroidism. Amiodarone, a medication that contains a
high amount of iodine, may also cause hyperthyroidism.

Treatments for Hyperthyroidism

The treatments for hyperthyroidism include medicines, radioiodine
therapy, and thyroid surgery:
Medicines for hyperthyroidism includes Antithyroid medicines,
which cause your thyroid to make less thyroid hormone. You
probably need to take the medicines for 1 to 2 years and Beta blocker
medicines, which can reduce symptoms such as tremors, rapid
heartbeat, and nervousness. They work quickly and can help you feel
better until other treatments take effect.
Radioiodine therapy is a common and effective treatment for
hyperthyroidism. It involves taking radioactive iodine by mouth as a
capsule or liquid. This slowly destroys the cells of the thyroid gland
that produce thyroid hormone.
Surgery to remove part or most of the thyroid gland is done in rare
cases. It might be an option for people with large goiters or pregnant
women who cannot take antithyroid medicines.
Hypothyroidism is a medical condition characterized
by an underactive thyroid gland, which fails to
produce enough thyroid hormones to meet the body's
needs. The thyroid gland, located in the front of the
neck, plays a crucial role in regulating various
metabolic processes in the body.
Thyroid hormones, primarily thyroxine (T4) and
triiodothyronine (T3), are responsible for controlling
metabolism, energy production, growth, and the
functioning of various organs and systems. When the
thyroid gland doesn't produce enough hormones, it
can lead to a wide range of symptoms and health
issues.

What causes Hypothyroidism?

Hypothyroidism can have various causes, including:

Autoimmune thyroiditis (Hashimoto's thyroiditis)

This is the most common cause of hypothyroidism. It occurs when the
body's immune system mistakenly attacks the thyroid gland, leading to
inflammation and gradual destruction of thyroid tissue.

Surgical removal of the thyroid gland

If the thyroid gland is partially or completely removed due to conditions
like thyroid cancer or large goiters, it can result in hypothyroidism. In
such cases, lifelong hormone replacement therapy is necessary.
 Radiation therapy
Radiation therapy for certain types of cancers, particularly when aimed at
the neck area, can damage the thyroid gland and impair its hormone
production.

Medications
Some medications can interfere with thyroid hormone production or
disrupt the conversion of T4 to T3, leading to hypothyroidism. Examples
include certain chemotherapy drugs, lithium (used for bipolar disorder),
and amiodarone (used for heart rhythm problems).

Radioactive iodine therapy

This treatment is often used for hyperthyroidism (overactive thyroid) and
involves the administration of radioactive iodine to destroy or reduce the
activity of the thyroid gland. As a side effect, this can lead to
hypothyroidism.

Different Stages Of Thyroid Gland

These pictures will help you better understand different stages of thyroid
gland damage.

Healthy Thyroiditis Thyroid Nodules

Thyroiditis is swelling (inflammation) (A thyroid nodule is an unusual lump
Thyroid of the thyroid gland. (growth) of cells on your thyroid gland)
 Symptoms of Hypothyroidism
1. Fatigue: Feeling excessively tired, lacking energy, and experiencing a
general sense of weakness or sluggishness.
2. Weight gain: Unexplained weight gain or difficulty losing weight
despite maintaining a healthy diet and exercise routine.
3. Constipation: Sluggish bowel movements, infrequent stools, and
difficulty passing stool.
4. Sensitivity to cold: Feeling cold more easily than others, even in
normal or warm temperatures.
5. Decreased heart rate: A slower heart rate (bradycardia) and low blood
pressure may be observed.
6. Hair and nail changes: Hair loss, thinning hair, brittle nails, and slow
hair growth are common. Hair may become coarse and dry.
7. Menstrual irregularities: Changes in menstrual cycle length, heavier or
irregular periods, or even cessation of menstruation (amenorrhea).
8. Dry skin: Skin may become dry, rough, and itchy. It may also appear
pale and feel cool to the touch.
Hyperparathyroidism is when your parathyroid glands create high
amounts of parathyroid hormone in the bloodstream. These glands,
located behind the thyroid at the bottom of your neck, are about the size
of a grain of rice.
Hyperparathyroidism is a medical condition characterized by overactivity
of the parathyroid glands, which are four small glands located behind the
thyroid gland in the neck. These glands are responsible for regulating
calcium levels in the body.

The parathyroid hormone produced by the thyroid

glands helps maintain the right balance of calcium in the
bloodstream and in tissues that depend on calcium for
proper functioning. This is especially important for
nerve and muscle function, as well as bone health.

Types Of Hyperparathyroidism
There are two types of hyperparathyroidism. Primary and Secondary

Primary Hyperparathyroidism
In primary hyperparathyroidism, an enlargement of one or more of the
parathyroid glands causes overproduction of parathyroid hormone. This
causes high calcium levels in the blood, which can cause a variety of health
problems. Surgery is the most common treatment for primary
hyperparathyroidism. Primary hyperparathyroidism occurs because of a
problem with one or more of the four parathyroid glands:
A noncancerous growth (adenoma) on a gland is the most common
cause.
Enlargement (hyperplasia) of two or more parathyroid glands accounts
for most other cases.
A cancerous tumor is a very rare cause of primary
hyperparathyroidism.
 Secondary hyperparathyroidism
Secondary hyperparathyroidism is the result of another condition that
lowers the blood calcium, which then affects the gland's function. This
causes your parathyroid glands to overwork and produce high amounts of
parathyroid hormone to maintain or restore the calcium level to the
standard range. Factors that may result in secondary
hyperparathyroidism include:
Severe calcium deficiency: Your body may not get enough calcium
from your diet, often because your digestive system doesn't absorb the
calcium from food. This is common after intestinal surgery, including
weight loss surgery.

Severe vitamin D deficiency: Vitamin D helps maintain appropriate

calcium levels in the blood. It also helps your digestive system absorb
calcium from your food. Your body produces vitamin D when your
skin is exposed to sunlight. You also get some vitamin D in food. If you
don't get enough vitamin D, then calcium levels may drop.

Chronic kidney failure: Your kidneys convert vitamin D into a form

that your body can use. If your kidneys work poorly, usable vitamin D
may decrease and calcium levels drop. This causes parathyroid
hormone levels to go up. Chronic kidney failure is the most common
cause of secondary hyperparathyroidism.

In some people with long-term secondary hyperparathyroidism, usually

from end-stage kidney disease, the parathyroid glands enlarge. They begin
to release parathyroid hormone on their own. The hormone level doesn't
go down with medical treatment and the blood calcium becomes too high.
This is called tertiary hyperparathyroidism, and people with this condition
may require surgery to remove parathyroid tissue.
 Hyperparathyroidism Preventions

Preventing hyperparathyroidism involves maintaining good overall health

and addressing certain risk factors. While it may not be possible to
completely prevent the condition, the following measures can help reduce
the risk or minimize the impact of hyperparathyroidism:

Stay hydrated:
Proper hydration is important for kidney function and can help prevent
the formation of kidney stones, which can be associated with
hyperparathyroidism.

Quit smoking
Smoking has been associated with numerous health problems, including
bone loss and increased risk of fractures. If you smoke, quitting can have
significant benefits for your overall health and may help reduce the risk of
hyperparathyroidism.

Regular health check-ups

Attend routine medical check-ups and screenings to monitor your overall
health. This can help detect any abnormalities or early signs of
hyperparathyroidism, allowing for timely intervention.
Hypoparathyroidism is a rare medical condition characterized by
insufficient production or inadequate function of the parathyroid
hormone (PTH) by the parathyroid glands. The parathyroid glands are four
small glands located near the thyroid gland in the neck. They play a crucial
role in regulating calcium and phosphorus levels in the body.
Hypoparathyroidism is usually a chronic (lifelong) condition, but it can be
temporary.

What are parathyroid glands?

Most people have four pea-sized parathyroid glands located behind their
thyroid gland — the butterfly-shaped gland in your neck. Like your
thyroid, your parathyroid glands are part of your endocrine system.
Sometimes your parathyroid glands are located along your esophagus or
in your chest. These are known as ectopic (in an abnormal place)
parathyroid glands.
Your parathyroid glands are in charge of controlling the amount of
calcium in your blood by producing parathyroid hormone (PTH). Too little
PTH results in low amounts of calcium in your blood (hypocalcemia), and
too much PTH causes high amounts of calcium in your blood
(hypercalcemia). PTH also helps control the levels of phosphorus and
vitamin D in your blood and bones.
 Causes of Hypoparathyroidism
Hypoparathyroidism can be caused by several factors, including:

1. Congenital: Some individuals are born with underdeveloped or

missing parathyroid glands, leading to congenital
hypoparathyroidism.
2. Autoimmune disorders: Certain autoimmune conditions, such as
autoimmune polyglandular syndrome type 1 or type 2, can damage the
parathyroid glands.
3. Surgery or neck trauma: Damage to the parathyroid glands during
neck surgery or accidental injury can result in hypoparathyroidism.
4. Radiation therapy: Radiation treatment to the neck or head region for
cancer may affect the parathyroid glands.
5. Idiopathic: In some cases, the cause of hypoparathyroidism remains
unknown.
 Treatment For Hyperparathyroidism and
Hypoparathyroidism
The treatment for hyperparathyroidism and hypoparathyroidism differs
due to the opposite nature of these conditions. Let's discuss the treatment
options for each:

Medications may be Since hypoparathyroidism

prescribed to manage leads to low levels of calcium
symptoms and reduce in the blood, calcium
complications associated supplements are typically
with hyperparathyroidism. prescribed to maintain
These may include normal calcium levels. These
bisphosphonates, which help supplements may need to be
prevent bone loss, or taken several times a day
calcimimetics, which can and are often combined with
lower parathyroid hormone vitamin D supplements.
(PTH) levels.
Vitamin D is necessary for
The primary treatment for the absorption of calcium.
hyperparathyroidism is Therefore, vitamin D
surgical removal of the supplements are often
abnormal parathyroid gland prescribed along with
or glands causing the calcium to ensure adequate
overproduction of PTH. This calcium absorption.
procedure, called a
parathyroidectomy, is Regular blood tests are
usually recommended if the necessary to monitor
condition is severe or calcium and PTH levels.
causing complications. Dosages of calcium and
vitamin D supplements or
other medications may need
to be adjusted based on these
results.
Addison's disease, also known as primary adrenal insufficiency, is a rare but
potentially life-threatening condition that occurs when the adrenal glands,
which are located above the kidneys, do not produce enough of certain
hormones. These hormones are essential for maintaining normal bodily
functions, such as regulating blood pressure, managing stress, and
balancing electrolytes.

In most cases, Addison's disease is caused by an autoimmune disorder,

where the body's immune system mistakenly attacks and damages the
adrenal glands. Other causes of the condition include infections, such as
tuberculosis, cancer, or certain medications.
 Causes
The most common cause of Addison's disease is an autoimmune
disorder, which occurs when the immune system mistakenly attacks
the body's own tissues. In this case, the immune system attacks the
adrenal glands and damages them, causing them to produce
insufficient amounts of cortisol and aldosterone. Other causes of
Addison's disease include infections such as tuberculosis, fungal
infections, and certain cancers that can affect the adrenal glands.

Symptoms
The symptoms of Addison's disease can be vague and may develop
slowly over time, making it difficult to diagnose. Some people with
Addison's disease may not show any symptoms until the condition has
progressed significantly.
The most common symptoms of Addison's disease include:

1. Extreme fatigue and weakness, which may worsen over time

2. Weight loss and decreased appetite
3. Low blood pressure, which can cause dizziness or fainting
4. Salt cravings
5. Nausea, vomiting, and diarrhea
6. Abdominal pain
7. Muscle or joint pain
8. Hyperpigmentation, which is a darkening of the skin
9. Irritability and depression
10. Loss of body hair, especially on the arms and legs
11. Women may experience irregular periods or absence of periods
 Diagnosis
Addison's disease is diagnosed
through a physical exam, medical
history, and blood tests. The blood
tests are used to check for low
levels of cortisol and aldosterone in
the blood. A diagnosis may also be
confirmed with an ACTH
stimulation test, which measures
the ability of the adrenal glands to
produce cortisol in response to a
hormone called ACTH. Other
diagnostic tests may include
imaging tests such as CT scans or
MRI scans of the adrenal glands.

Treatment
The main treatment for Addison's disease is hormone replacement
therapy. This involves taking medications to replace the hormones
that the adrenal glands are not producing. The medications usually
include cortisol and aldosterone. Cortisol is typically given in pill
form and taken several times a day. Aldosterone may be given in
pill form or as a nasal spray. The dosage of the medications may
need to be adjusted over time, and regular blood tests are needed to
monitor hormone levels. In some cases, people with Addison's
disease may need to take additional medications to manage other
symptoms or complications.
 Prevention
There is no known way to prevent Addison's disease. However,
managing any underlying autoimmune disorders or infections may
help reduce the risk of developing the condition. It is also
important for people with Addison's disease to manage their
condition carefully and follow their doctor's instructions regarding
medication dosages and management of symptoms.

Types
There are two types of Addison's disease: primary and secondary.
Primary Addison's disease is caused by damage to the adrenal
glands themselves, while secondary Addison's disease is caused by
a problem with the pituitary gland or hypothalamus, which can
affect the production of ACTH. Secondary Addison's disease is less
common than primary Addison's disease.

Primary Addison's Secondary Addison's

Disease Disease
This type of Addison's disease This type of Addison's disease
is caused by damage to the is caused by a problem with the
adrenal glands themselves. The pituitary gland or
most common cause of hypothalamus, which can
primary Addison's disease is an affect the production of
autoimmune disorder, in which adrenocorticotropic hormone
the body's immune system (ACTH). ACTH is a hormone
attacks the adrenal glands, that stimulates the adrenal
causing them to become glands to produce cortisol and
damaged and unable to aldosterone. If the pituitary
produce sufficient amounts of gland or hypothalamus is
cortisol and aldosterone. damaged or not functioning
Other causes of primary properly, it may not produce
Addison's disease include enough ACTH, which can lead to
infections, such as a decrease in cortisol and
tuberculosis or fungal aldosterone production from
infections, as well as cancer the adrenal glands. Causes of
that affects the adrenal secondary Addison's disease can
glands. Primary Addison's include tumors, infections,
disease is typically diagnosed radiation therapy, or
when the adrenal glands have autoimmune disorders.
lost at least 90% of their Secondary Addison's disease is
function. less common than primary
Addison's disease.

The symptoms of primary and secondary Addison's disease are

usually similar, but secondary Addison's disease may also be
accompanied by other symptoms related to the underlying condition
that is causing the problem with the pituitary gland or hypothalamus.
Treatment for both types of Addison's disease involves
hormone replacement therapy, which replaces the cortisol and
aldosterone that the adrenal glands are not producing. The
dosage of the medications may need to be adjusted over time,
and regular blood tests are needed to monitor hormone levels.
In some cases, people with Addison's disease may need to take
additional medications to manage other symptoms or
complications.

Conclusion
Overall, the management and treatment of Addison's disease depend
on the individual's specific circumstances, the severity of the
condition, and any underlying causes or complications. Regular
medical check-ups and close monitoring of symptoms and hormone
levels are crucial for managing the condition effectively.

Complications
If left untreated, Addison's disease can lead to severe complications,
such as adrenal crisis, which is a life-threatening condition
Neuropathy is a general term that refers to any disease or dysfunction of the
nervous system, particularly the peripheral nervous system (PNS), which
connects the brain and spinal cord to the rest of the body. This condition
can affect the nerves that control various functions, including movement,
sensation, and organ function. Neuropathy can result from various causes,
such as injury, infections, toxins, metabolic disorders, autoimmune
disorders, and certain medications. Symptoms of neuropathy can include
numbness, tingling, pain, muscle weakness, and loss of coordination,
depending on the type and severity of the condition.

Symptoms
The symptoms of neuropathy can vary widely depending on the type of
nerves affected and the severity of the condition. Some common symptoms
include:
Tingling or burning sensation in the hands or feet
Numbness or loss of sensation in the hands or feet
Muscle weakness or atrophy
Pain or cramps in the muscles
Loss of coordination or balance
 Difficulty with fine motor skills, such as buttoning clothes or
writing
Autonomic symptoms, such as excessive sweating, dizziness, or
digestive issues
Causes
Neuropathy can be caused by a variety of factors, including:

Diabetes: This is the most common cause of neuropathy in the United

States, and is typically caused by high blood sugar levels that damage
the nerves.

Autoimmune disorders: Conditions such as rheumatoid arthritis, lupus,

and Guillain-Barre syndrome can cause neuropathy by attacking the
body's own nerves.

Infections: Viral or bacterial infections, such as shingles or Lyme

disease, can cause neuropathy.

Trauma: Injuries to the nerves, such as those caused by car accidents or

sports injuries, can cause neuropathy.

Exposure to toxins: Chemicals such as alcohol, drugs, and certain

medications can damage the nerves and cause neuropathy.

Genetics: Some forms of neuropathy are inherited and run in families.

 Diagnosis
The diagnosis of neuropathy typically involves a thorough medical history
and physical exam, as well as various tests such as:

Nerve conduction studies: These tests measure the speed and strength of
electrical signals traveling along the nerves.

Electromyography (EMG): This test measures the electrical activity of the

muscles and can help determine if the neuropathy is affecting the
muscles.

Blood tests: These tests can help identify underlying conditions that may
be causing the neuropathy.

Imaging tests: CT or MRI scans may be used to look for structural

abnormalities or tumors that may be compressing the nerves.

Migraine: Migraine is a neurological disorder characterized by recurrent

headaches that are moderate to severe in intensity and often
accompanied by other symptoms such as nausea, vomiting, and
sensitivity to light and sound.

Chronic obstructive pulmonary disease (COPD): COPD is a chronic lung

disease that makes it difficult to breathe. The condition is often caused
by long-term exposure to irritants such as cigarette smoke or air
pollution.
 Treatment
The treatment of neuropathy depends on the underlying cause and severity
of the condition. Some common treatments include:

Medications: Pain relievers, anti-inflammatory drugs, and certain

antidepressants or anticonvulsants may be prescribed to help manage
pain and other symptoms.

Physical therapy: Exercises and other physical therapies can help

improve muscle strength and coordination, as well as reduce pain.

Transcutaneous electrical nerve stimulation (TENS): This therapy uses a

small electrical current to stimulate the nerves and reduce pain.

Surgery: In some cases, surgery may be necessary to relieve pressure on

the nerves or repair damage to the nerves.

Prevention
While it may not be possible to prevent all forms of neuropathy, there are
some steps that can be taken to reduce the risk of developing the condition.
These include:

Maintaining good control of blood sugar levels if you have diabetes

Avoiding exposure to toxins or chemicals that can damage the nerves

Wearing protective gear during sports or other physical activities to

reduce the risk of injuries

Managing underlying conditions that can cause neuropathy, such as

autoimmune disorders or infections
Pheochromocytoma is a rare type of tumor that develops in the adrenal
glands. These glands are located on top of the kidneys and produce
hormones that regulate various functions in the body, including the "fight
or flight" response to stress. Pheochromocytomas are typically benign,
meaning they are not cancerous, but in some cases, they can be malignant
and spread to other parts of the body.
Pheochromocytomas develop from chromaffin cells, which are specialized
cells in the adrenal glands that produce hormones such as adrenaline and
noradrenaline. These hormones play a key role in regulating blood pressure,
heart rate, and other physiological responses to stress.

Causes
Pheochromocytoma is believed to be caused by genetic mutations that
occur in the cells of the adrenal gland. These mutations can cause the cells
to grow and divide uncontrollably, forming a tumor. While most cases of
pheochromocytoma are sporadic, meaning they occur for unknown reasons,
some cases are associated with inherited genetic syndromes such as
multiple endocrine neoplasia (MEN) type 2, von Hippel-Lindau disease, and
neurofibromatosis type 1.
 Symptoms
The symptoms of pheochromocytoma are caused by the excessive
production of adrenaline and noradrenaline, which are hormones produced
by the adrenal gland. These hormones can cause the following symptoms:

High blood pressure (hypertension): This is the most common symptom

of pheochromocytoma, and it can be severe and difficult to control with
medication.

Rapid heart rate (tachycardia): This is another common symptom and

can be accompanied by palpitations (a feeling of skipped or extra
heartbeats).

Headaches: These can be severe and may be located in the temples or

back of the head.

Sweating: This can be excessive and may occur at any time, even during
sleep.

Tremors: These can be fine or coarse and may affect the hands or other
parts of the body.

Anxiety: This can be severe and may be accompanied by panic attacks.

Weight loss: This can occur even with a normal appetite.

Palpitations: These are a sensation of racing or pounding heartbeats.

Flushing: This is a sudden reddening of the skin, usually on the face or

neck.

Chest pain: This can be due to increased heart rate or high blood
pressure.
 Diagnosis
The diagnosis of pheochromocytoma involves several tests, including:

Blood tests: These may include measurements of catecholamines

(adrenal hormones) and their metabolites, such as metanephrines and
normetanephrines.

Urine tests: A 24-hour urine test may be used to measure levels of

catecholamines and their metabolites. This test may be more sensitive
than blood tests.

Imaging tests: CT or MRI scans of the adrenal gland may be used to

identify the tumor and determine its size and location. Other imaging
tests, such as MIBG scans or PET scans, may also be used.

Genetic testing: This may be recommended for people with a family

history of pheochromocytoma or certain genetic syndromes.

Treatment
The primary treatment for pheochromocytoma is surgery to remove the
tumor. This is typically done through an open or laparoscopic approach,
depending on the size and location of the tumor. Prior to surgery,
medications may be given to control blood pressure and heart rate. If
surgery is not an option, other treatments may be used, such as radiation
therapy, chemotherapy, or targeted therapy.
Adrenal gland disorders are problems that arise in one or both adrenal
glands. These are a set of paired organs located on the top of each kidney.
The adrenal glands are responsible for making several hormones and
catecholamines (i.e., adrenaline). Each adrenal is composed of two parts: the
inner portion, called the adrenal medulla, and the outer portion called the
adrenal cortex. The cortex is further divided into 3 layers or zones. Each
layer of the adrenal cortex and the adrenal medulla produce a different
hormone.

The adrenal cortex produces

Mineralocorticoids/Aldosterone: helps regulate sodium and potassium

handling in the kidney which affects blood pressure and fluid volume
Glucocorticoids/Cortisol: responsible for aiding in glucose metabolism, the
inflammatory and immune response to illness or injury, and maintenance
of blood pressure and cardiac output
Adrenal Androgens: includes DHEA-sulfate, DHEA, testosterone, and
androstenedione, all of which contribute to the development of male
characteristics in men; they have a lesser role in women, they contribute to
libido and serve as a precursor to estrogen
What are common types of adrenal disorders?

There are different conditions related to your adrenal glands. Some of the
most common include:
Addison’s disease, also called adrenal insufficiency. In this disorder,
you don’t produce enough cortisol and/or aldosterone.
Cushing’s syndrome. In this disorder, your levels of cortisol are too
high. This term can be applied when large doses of steroids are given
to treat certain medical conditions.
Congenital adrenal hyperplasia. This term refers to genetic condition
in which your adrenal glands are not able to make cortisol well. As a
result ACTH is elevated. Depending on the defect higher levels of male
hormone might be made.
Adrenal gland suppression. This is a type of adrenal insufficiency that
is related to outside sources of cortisol or related synthetic hormones
such as prednisone or dexamethasone.
Hyperaldosteronism. If you have this condition, your body produces
too much aldosterone which can lead to blood pressure elevation and
potassium loss.
Virilization. This condition happens when your body produces too
much of the male sex hormones and is only apparent in females or
boys before puberty.
There are also conditions of the adrenal glands related to growths
(tumors). These include:
Adrenal gland tumors. Tumors can disrupt hormone output, but are
usually noncancerous.
Adrenocortical carcinoma. This rare condition refers to cancer forming
in the adrenal gland’s outer layer.
Pheochromocytoma. If you have this condition, your glands make too
much epinephrine and norepinephrine which can raise blood pressure
or make your heart race.
Pituitary tumors. Abnormal growth on the pituitary gland can cause
adrenal gland conditions by disrupting the amount of hormones made
by the adrenal glands. ACTH producing tumors cause Cushing’s
disease. If tumors are large enough, they may press on the normal
pituitary cells and cause deficiency of ACTH and secondary adrenal
insufficiency.
 What are the symptoms of adrenal disorders?
The symptoms of adrenal disorders vary depending on which hormones
are involved. Many of the symptoms of adrenal disorders are similar to
those of other illnesses.
Symptoms of high levels of cortisone (Cushing’s disease) include:
Upper body obesity, while arms and legs stay thinner. (A common trait
called a Buffalo hump refers to a lump in between the shoulders.)
Being tired and confused.
Developing high blood pressure and diabetes.
Skin that bruises easily.
Wide purplish streak marks on the abdominal skin.
Symptoms of high levels of aldosterone include:
High blood pressure.
Low potassium levels.
Weakness.
Pain and spasms in your muscles.
Symptoms of high levels of male sex hormones are only apparent in
females or in young boys before puberty. These include:
Growing facial hair and or balding.
v
Developing acne.
Having a deeper voice.
Becoming more muscular.
Developing a greater sex drive.
Developing masculine traits is called virilization.

What causes adrenal disorders?

Adrenal gland disorders are caused by problems with the glands
themselves that cause overproduction or underproduction of hormones.
They are also caused by problems in other glands, such as the pituitary
gland. Genetics can also play a part in certain adrenal disorders. In many
cases, no one really knows why the disorders develop.
Primary adrenal insufficiency is most often caused when your immune
system attacks your healthy adrenal glands by mistake. Other causes may
include: Cancer. Fungal infections.
Cushing syndrome, also called hypercortisolism, is a set of symptoms
resulting from exposure to high levels of the stress hormone cortisol.
Cortisol, a hormone in the body that is typically produced in response to
stress, helps regulate blood pressure and blood sugar, reduce inflammation,
and metabolize food.
Cortisol production and
release is stimulated by a
series of hormone
interactions. First, the
hypothalamus secretes
corticotropin-releasing
hormone, known as CRH.
CRH stimulates the
anterior pituitary gland to
produce
adrenocorticotropic hormone (ACTH). Ultimately, ACTH signals cortisol
production of the adrenal glands, which are small glands located on top of
each kidney.
 Signs and Symptoms
Most early signs and symptoms of Cushing
syndrome are general and non-specific,
including fatigue, diabetes, high blood
pressure, and depression. Over time, most
individuals with undiagnosed Cushing
syndrome develop weight gain, leading to
obesity with characteristic features, such as a
moon face (i.e., a rounded face shape), a
buffalo hump (i.e., a bump behind the
shoulders), and thin extremities. The skin
may become more frail, leading to easy
bruising and stretch marks. Individuals
assigned female at birth who are
experiencing Cushing syndrome commonly
present with decreased libido; menstrual
changes; and hirsutism, or thick hair growth
in unexpected areas, such as on the face or
back. Rarely, individuals may also experience
proximal myopathy, or muscle weakness, in
the legs and arms, which may be evidenced
by difficulty standing up or climbing stairs.

What causes Cushing syndrome?

There are many potential causes of Cushing syndrome. The most common
cause is long-term use of glucocorticoids to treat inflammatory disorders,
like asthma, rheumatoid arthritis, or lupus. Glucocorticoids resemble
cortisol and, thus, can be utilized in the body as excess cortisol. Less
frequently, Cushing syndrome may develop due to a tumor that affects the
hormones involved in stimulating cortisol production. Pituitary tumors that
produce ACTH in excess, as seen in Cushing disease, are the most common
tumor type. Sometimes, ectopic ACTH-producing tumors (i.e. tumors that
secrete ACTH outside of the pituitary gland) may occur, such as in the lungs
or pancreas, and are often cancerous. Cushing syndrome can rarely be
caused by an adrenal tumor, which is typically benign, or non-cancerous.
 DIAGNOSIS AND TESTS
When your healthcare provider suspects hypercortisolism, there are certain
guidelines they may follow. They’ll ask questions, look at your medical
history, perform a physical examination and then conduct some laboratory
tests. They’ll likely continue to monitor you over time.
Cushing syndrome can sometimes be difficult to diagnose. If you tell your
provider you have fatigue and weight gain, they might not immediately
think of Cushing syndrome. These types of symptoms are common to many
different kinds of diseases.
Cushing syndrome is also sometimes mistaken for polycystic ovary
syndrome or metabolic syndrome. Your healthcare provider will have to go
through a process of elimination to rule out other conditions.

What tests will be done to diagnose Cushing syndrome?

Your healthcare provider is likely to request some of the following tests:
24-hour urinary cortisol test
This test measures the amount of cortisol in micrograms (mcg) in your
urine. Your healthcare provider will have you collect your urine (pee) over a
period of 24 hours.
Midnight salivary cortisol test
Typically, cortisol levels are very low late at night. This test checks cortisol
levels between 11 p.m. and 12 a.m. If you have Cushing syndrome, your
cortisol levels will be unusually high during that hour.
Low-dose dexamethasone suppression test
Dexamethasone is a cortisol-like drug. For this test, you take one milligram
(mg) of the drug by mouth at night and then measure cortisol levels between
8 a.m. and 9 a.m. This blood test determines if the adrenal glands responded
to the dexamethasone by suppressing the amount of cortisol they secrete. If
you have Cushing syndrome, your cortisol levels will remain high.
Blood test
A blood test will measure the ACTH levels in your blood. An adrenal tumor
might be there if the levels are low. If the levels are normal or high, there
could be a pituitary or ectopic tumor.
High-dose dexamethasone suppression test
This test is like the low-dose dexamethasone suppression test, but the
dosage is 8 milligrams instead of one. A provider will typically perform
this test after the low-dose test shows high levels of cortisol in the
morning and when blood tests show high ACTH in the blood. This test can
determine the source of Cushing syndrome, since it can tell the difference
between a pituitary adenoma (Cushing disease) and a tumor elsewhere in
your body (such as your lungs).
CAT scan (CT scan) or MRI abdomen
Your provider may perform a CT scan or MRI to look for a tumor in your
adrenal glands. The provider can do these scans with or without IV
contrast. The tests are very sensitive at identifying adrenal tumors.
Magnetic resonance imaging (MRI) pituitary
An MRI will take a picture of your pituitary gland to see if there’s a tumor.
In some cases, the MRI won’t provide a perfect diagnosis. Fifty percent of
those with Cushing syndrome will have a “normal” MRI and 10% will have
tumors unrelated to the syndrome.
Bilateral inferior petrosal sinus sampling (BIPPS)
This test finds the source of ACTH secretion. ACTH and other pituitary
hormones go into the bloodstream from the pituitary gland. An
experienced interventional radiologist will go through two veins known as
the inferior petrosal sinuses. This test has a 95% to 98% accuracy rate.
CT scan chest
If your provider suspects an ectopic tumor, they’ll order a CT chest to
look for possible lung cancer.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and
diabetes insipidus (DI) are two disorders that are challenging to understand
and often get confused. These complex conditions centered on the activity
of antidiuretic hormone (ADH) require immediate attention and treatment.

Antidiuretic hormone, or arginine vasopressin (AVP), is released by the

pituitary gland in response to changes in volume, blood pressure and
plasma osmolality. A key regulator of water absorption in the kidneys, ADH
plays opposing roles in SIADH and DI. To put it simply, SIADH is exactly
what it states, an inappropriate secretion of ADH. Too much ADH prevents
the production of urine and leads to the retention of excess water in the
body, hyponatremia, and hypo-osmolality (Lippincott Advisor, 2021a).
SIADH may be caused by a central nervous system (CNS) disorder, cancer,
mesothelioma, cardiopulmonary disorders such as asthma, atelectasis,
myocardial infarction, vascular diseases, multiple sclerosis, Guillain-Barre
syndrome, porphyria, myxedema, and psychosis. Complications are
significant and include water intoxication, cerebral edema, noncardiogenic
pulmonary edema, heart failure, seizures, coma, and death (Lippincott
Advisor, 2021a).
 The effect is reversed in diabetes insipidus. There are two types of DI:
central (also known as pituitary, neurogenic or neurohypophyseal) and
nephrogenic. In central DI, either the hypothalamus does not produce
enough ADH, or the pituitary gland does not secrete enough ADH. Without
vasopressin, filtered water is excreted in the urine instead of being
reabsorbed. In nephrogenic DI, ADH production and secretion are normal,
but the kidneys are resistant to the anti-diuretic effects of the hormone.
The result in both subtypes is polyuria, greater than 3L/24 hours in adults
and greater than 2L/24 hours in children. In severe cases of DI, 24-hour
urine output can reach up to 10-20 L/day. These conditions may be caused
by damage to the hypothalamus or pituitary gland, central nervous system
malformation, certain drugs, kidney diseases, and genetic defects. Major
complications of DI include hypovolemia, hyperosmolality, circulatory
collapse, CNS changes, loss of consciousness, bladder distention and
hydronephrosis (Lippincott Advisor, 2021b). Since SIADH results in the
retention of water, remember “SI” for “soaked inside.” For DI, excess fluid
leaves the body, therefore think “dry inside.” Here’s a table outlining the
main differences between SIADH and DI.
Impaired AVP
secretion or
response results in
impaired renal
concentration and
is termed diabetes
insipidus (DI).
Hyponatremia that
results from AVP
production in the
absence of an
osmotic or
hemodynamic
stimulus is termed
syndrome of
inappropriate
antidiuretic
hormone secretion
(SIADH).
 SIADH versus DI
Major Differences
SIADH DI
“Soaked Inside” “Dry Inside”
Too much ADH prevents Not enough ADH or
ADH
the production of urine resistance to ADH leads
and leads to the retention to increased urine output
of excess water in the and dehydration.
body.

Clinical Dilutional Hypernatremia

hyponatremia Polyuria (more than
Manifestations
Moderate (Na+ 120- 3L/24 hours)
129 mEq/L) Polydipsia (extreme
Severe (Na+ < 120 thirst)
mEq/L) Nocturia
Poor concentration Urine osmolality less
Speech difficulties than serum
Dizziness, gait osmolality
disturbance Dehydration
Confusion, Tachycardia
forgetfulness Hypotension
Sluggish deep tendon Hypothermia
reflexes Weight loss
Tremor and asterixis Weakness, fatigue
Weight gain Irritability
Cheyne-Stokes Dry skin and mucous
respirations (with membranes
severe or rapid onset)
Seizure
Cerebral edema
Coma
 Major Differences
SIADH DI
“Soaked Inside” “Dry Inside”
Treat underlying Treat underlying
Key
condition cause
Treatment
Prevent further IV fluids, (dextrose 5%
Strategies decrease in Na+ water or hypo-
concentration, correct osmolar IV) based on
hyponatremia osmolality
SLOWLY Central DI:Administer
Fluid restriction 500 to desmopressin
1,500 mL/day (DDAVP)
Loop diuretics Carbamazepine to
(furosemide for fluid help release ADH
overload) Nephrogenic
3% sodium chloride DI:Thiazide diuretic
infusion if sodium less and/or amiloride
than 120 mEq/L or Low sodium, low-
acute seizures protein diet
Vasopressin receptor Prostaglandin
antagonists synthesis inhibitors
Institute seizure (indomethacin)
precautions

Monitoring
Monitoring will be similar for both SIADH and DI with a few differences. For
both conditions, be sure to closely monitor vital signs, intake and output, as
well as daily weight. Assess urine and serum electrolyte levels, particularly
sodium, and observe for changes in neurologic status and level of
consciousness. It is important to assess cardiac rate and rhythm, heart and
lung sounds and evaluate your patient’s response to treatment. For DI, also
check the blood urea nitrogen level, urine specific gravity and osmolality,
and the 24-hour urine volume per your institution policies. In addition, for
DI patients it is critical to monitor for signs and symptoms of hypovolemic
shock.