Endocrine Test #1 Review

 Diabetes Insipidus – hyposecretion: ADH (not enough ADH)

o Dry inside: urinate a lot
o Adverse effect – dehydration d/t electrolyte imbalance
o Specific gravity – low (< 1.005 – normal range is 1.005 – 1.030)
o Causes:
 Tumor
 Head trauma
 Surgery – craniotomy
 stroke
 Certain drugs
 Cancer
o S/S:
 polyuria
 dehydration
 low BP
 excretes large amounts of diluted urine
 nocturia (3-20 L of urine)
 tachycardia
 decreased skin turgor
 headache
 muscle pain & weakness
 postural hypotension
 mucus membranes dry
 mental status changes
o Treatment:
 hypotonic IV solution (high amounts of sodium chloride –
needs frequently monitoring)
 ADH replacement: Vasopressin and Desmopressin (DDAVP –
potin vasoconstrictor) - increase BP
 Adequate fluids
o Nursing management:
 Monitor fluids and electrolytes
 Monitor weights
 Monitor I & O’s
 Monitor skin integrity
 Administer IV Hypotonic Saline

 SIADH – hypersecretion: too much ADH

o SIADH is often of non-endocrine origin
o Causes:
 NS disorders – stroke, head injury, brain surgery, tumor
 HIV
 Pulmonary disease: TB and severe pneumonia
 Medications:
 Vincristine
 Phenothiazines
 Antidepressants
 Thiazide diuretics
 Anticonvulsants
 Antidiabetic drugs
 Nicotine
o S/S:
 weight gain without edema
 fluid volume overload
 low urinary output of concentrated urine
 hypertension
 tachycardia
 nausea & vomiting
 Hyponatremia
 Muscle cramps
 Brain swelling
 Death
o Low BUN, Hemoglobin & Hematocrit, Creatinine levels, CAT Scan
or MRI for underlying cause to locate and eliminate tumor
o Patient may be on fluid restriction (no water pitcher or ice chips)
o Treatment:
 Hypertonic IV solution (3%)
 Lasix, IV Vaprisil
 Implement seizure precautions
 Elevate HOB to promote venous return
 Restrict fluid intake
 Administer loop diuretics – Furosemide
 Administer Vasopressin
o Nursing management:
 Monitor BP & Pulse
 Monitor serum sodium levels
 Initiate seizure precautions
 Restrict fluid intake (no water pitcher or ice chips)
 Monitor weights
 Elevate HOB
  Administer medications as prescribed
 Monitor signs of edema
 Monitor mental status

 Acromegaly – too much growth hormone in an adult

o Long bones grows wider
o Bones increase in size, enlargement of facial features, hands,
and feet
o Internal organs and glands enlarge
o Excess GH can be caused by pituitary hyperplasia (benign tumor)
o s/s develop very slowly, and disorder may be present for many
years before it is recognized
 change in ring or shoe size
 nose, jaw, brow, hands, and feet enlarges
 teeth may be displaced, or dentures may no longer fit
 tongue becomes thick causing dysphasia
 sleep apnea may develop
o if tumor is the cause:
 visual disturbances
 headaches
 diabetes mellitus may develop
o with treatment, soft tissues reduce in size, but bone growth is
permanent
o CT scan or MRI are done to locate pituitary tumor
o Treatment: medications to block GH or hypophysectomy,
radiation
 Medications: Lanreotide (can treat GH disorder), Octreotide
(can lower excess levels of GH), and Cabergoline (can
lower high levels of Prolactin hormone in blood)

 Dwarfism – GH is deficient in childhood

o Causes:
 Tumors
 Surgery
 Hereditary
 Malnutrition
 Neglect/severe emotional stress
 Trauma to the pituitary gland or Hypothalamus
o S/S:
 Children may grow to only 3-4 ft in height, but have normal
body proportions
  Sexual maturation may be slowed (related to involvement
of additional pituitary hormones)
 Fatigue
 Weakness
 Excess body fat
 Decreased muscle and bone mass
 Sexual dysfunction
 High cholesterol
 Increased risk for cardiovascular and cerebrovascular
disease
 Headaches
 Mental slowness
 Psychological disturbances may also occur. (ALL THESE
SIGNS AND SYMPTOMS CAN LEAD TO DECREASED
QUALITY OF LIFE)
o GH levels in the blood can be measured by a routine lab test, but
the results may be unreliable because GH is not evenly secreted
over the course of the day
o A more reliable test for GH stimulation is induced Hypoglycemia
o Treatment: administration of GH or Somatropin (GH can now be
made in the lab use recombinant DNA and can administered
SubQ), and surgery may be indicated if a tumor is the cause
o Nursing management: approach the patient with respect while
asking the client, if the diagnosis is new, the patient may need to
learn to self-administer Somatropin

 Hypothyroidism – hyposecretion of TH (thyroid hormone) –

NOT ENOUGH IDODINE
o Thyroid gland produces T3, T4, and Calcitonin – the body needs
IODINE to make these hormones
o Not enough energy
o Causes:
 Hashimoto’s Disease (Most common)
 Autoimmune disease
 Thyroiditis
 Thyroidectomy
 Anti-thyroid medications
 Pituitary hormone
 Affects women more often than men
o LAB VALUES:  T3 & T4 &  TSH
o S/S:
  No energy
 Fatigue
 No expressions
 Weight gain
 Cold
 Oligomenorrhea
 Slurred speech
 Dry skin
 Coarse hair
 Bradycardia
 Decreased GI function (constipation)
 Decreased blood sugar (hypoglycemia)
o Life-threatening complication: Myxedema Coma
 This occurs in patients with long-standing, untreated
hypothyroidism and can be triggered by stress (infection,
trauma, or exposure to cold) leading to:
 decreased mental status
 hypothermia
 decrease respiratory rate
 non-pitting edema of the face, hands, and feet
 lethargy
 blood glucose drops
 cardiac output drops (which can reduce perfusion of
kidneys)
 death can occur because of heart or respiratory failure
o Treatment of Myxedema:
 Intubation
 Mechanical ventilation
 Slowly rewarmed with blankets
 IV fluids
 IV Levothyroxine (Synthroid)
 Underlying cause is treated
o Treatment for Hypothyroidism:
 Oral thyroid replacement such as Levothyroxine (Synthroid)
o Nursing management:
 Monitor if patient is feeling fatigue
 Monitor HR
 Monitor daily weights
 Monitor if patient is feeling cold
 Monitor patient for constipation (diet: high fiber diet and
increase fluids)
 Monitor for SOB
  Check vital signs
 Check patient for dry skin and hair
 Observe patient for mental dullness or for memory loss in
older adults
 Diet: low calorie and high fiber diet
 Educate patient on medication compliance – Levothyroxine
is to be taken for a life-time
 Hyperthyroidism – hypersecretion of TH (thyroid hormone) –
TOO MUCH IODINE
o Too much energy
o Causes:
 Graves Disease (most common)
 Too much iodine
 Toxic nodular goiter
 Hypothyroidism (because of long-term disease or as a
result of treatment)
 Thyroid replacement medication (toxicity)
o LAB VALUES:  T3 & T4 &  TSH
o S/S:
 Exophthalmos (bulging eyes)
 Hyper-excitable
 Nervous/tremors
 Irritable
 Low attention span
 Increased appetite
 Weight loss
 Hair loss
 Tachycardia
 Goiter (enlarged thyroid)
 Hot
 Increased blood pressure
 Increased GI function (diarrhea)
 Oligomenorrhea
 Palpitations
o Life-threatening complication: thyroid storm (thyrotoxic
crisis)
 This occurs in hyperthyroid patients who are untreated or
who develop another illness or stressor. It also may occur
after thyroid surgery in patients who have been
inadequately prepared with antithyroid medication. S/S
include:
 Tachycardia
  High fever
 Extreme hypertension (with eventual heart failure and
hypotension)
 Dehydration
 Restlessness
 Delirium
 Coma
 Thyroid storm can result in death in as little as 2 hours if
untreated
o Treatment: If thyroid storm occurs, treatment is first directed
toward relieving the life-threatening symptoms.
 Acetaminophen is given for the fever
 Aspirin is avoided because it binds with the same serum
protein as T4 and it frees T4 into the circulation
 IV fluids and a cooling blanket may be ordered to cool the
patient
 Propranolol is given for tachycardia and symptom control
 Oxygen is administered and HOB is elevated because the
high metabolic rate requires more oxygen
 Once symptoms are controlled and the patient is safe, the
underlying thyroid problem is treated
o A radioactive iodine uptake test or a thyroid scan can be done to
determine hyperactivity of the gland, or the locate a
nodule/tumor.
o Thyroid-stimulating immunoglobulin is present in Graves’s
Disease
o Nursing management for thyroid storm:
 Maintain patent airway
 Cooling blankets
 Medications: antithyroid medications, beta blockers,
glucocorticoids, nonsalicylate pyrectics
o Treatment for hyperthyroidism:
 Methimazole (Tapzole) inhibits TH, but may take several
months to be effective and must be continued for 12-18
months
 Beta blockers relieve sympathetic NS symptoms
 Calcium and Vitamin D are given to protect bones
 Radioactive Iodine (RAI) may be used to destroy a portion
of the thyroid gland (patient takes 1 oral dose of RAI)
 Sometimes medications or RAI alone can control
hyperthyroidism; however, if this does not occur, surgery is
planned
 Adequate preparation of the patient is important because a
euthyroid (normal, healthy thyroid) state helps prevent a
post-op thyroid storm
 Thyroidectomy – full or partial to continue to secrete some
hormone (following surgery the patient will likely become
hypothyroid and will require thyroid replacement hormone:
levothyroxine)
o Nursing management:
 Monitor BP & Pulse
 Obtain daily weights
 Administer medications as prescribed
 Diet: high calorie diet
 Educate patient on medication compliance
 Educate patient to avoid stimulants

 Hypoparathyroidism – hyposecretion of PTH (parathyroid

hormone) - The parathyroid gland produces and secretes PTH which
controls the levels of calcium in the blood
o  Calcium &  Phosphorus
o Causes:
 Can occur due to the accidental removal of the
parathyroid: thyroidectomy, parathyroidectomy, or radical
neck dissection
 Genetic predisposition
 Exposure to radiation
 Magnesium depletion
o S/S: calcium plays an important role in nerve cell stability;
hypocalcemia causes neuromuscular irritability
 Positive Trousseau’s sign (carpal spasm caused by inflating
a blood pressure cuff) – (SAME S/S OF HYPOCALCEMIA)
 Positive Chvostek’s sign (contraction of facial muscles with
a light tap over the facial nerve)
 Hypocalcemia
 Hyperphosphatemia
 Hypotension
 Tetany
 Muscle cramps/spasms, and twitching
 Anxiety
 Irritability
 Depression
 Numbness & tingling of the fingers, tongue, and lips
 o Chronic hypocalcemia can lead to:
 Lethargy
 Calcification in the brain leading to psychosis
 Cataracts
 Convulsions
o Lab tests show decreased serum calcium and PTH levels and
increased serum phosphorus, an ECG is done to evaluate cardiac
function, and radiographs show bone changes
o Treatment:
 IV calcium gluconate (acute cases of hypoparathyroidism)
 Vitamin D and oral calcium supplements
 Magnesium is given if hypomagnesemia is present
o Nursing management:
 Monitor BP & P
 Monitor calcium and phosphorus levels
 Administer medications as prescribed
 Diet: high calcium, low phosphorus
 Seizure precautions (hypocalcemia)

 Hyperparathyroidism – hypersecretion of PTH

o  Calcium &  Phosphorus
o Causes:
 Primary cause: tumor or hyperplasia of the parathyroid
 secondary cause: chronic kidney failure
o S/S:
 Stones:
 kidney stones (increased calcium)
 Bones:
 skeletal pain
 pathological fractures from bone deformities
 Abdominal moans:
 Nausea
 Vomiting
 Abdominal pain
 Peptic ulcers
 Weight loss/anorexia
 Constipation
 Psychic groans:
 Mental irritability
 Confusion
 depression
  hypercalcemia
 hypophosphatemia
 cardiac dysrhythmias
 hypertension
 increased urination
 fatigue
o severe hypercalcemia:
 coma
 cardiac arrest
o Lab tests include serum calcium, phosphorus, and PTH levels,
radiographs or bone density test may show decreased bone
density, 24-hour urine test might be used to test how much
calcium is being excreted in the urine, and an ultrasound may be
used to help locate the parathyroid glands if surgical removal is
planned
o Treatment:
 Cinacalcet (Sensipar) – a newer drug that acts like calcium
in the blood, fooling the parathyroid glands into reducing
PTH secretion
 IV normal saline (in acute hypercalcemia)
 Furosemide (Lasix)
 Bisphosphonates (alendronate/Fosamax) or Calcitonin
(Fortical) – may be given to prevent calcium release from
bones (Oral or IV)
 Phosphates
 Parathyroidectomy – if possible, some parathyroid tissue is
left intact to secrete PTH
o Nursing management:
 Monitor BP
 Monitor calcium and phosphorus levels
 Increase fluid intake
 Promote body alignment
 Promote safety precautions
 Administer medications as prescribed
 Diet: high fiber and moderate calcium
 Pre and post-op care for parathyroidectomy

 Cushing’s Disease/Syndrome – hypersecretion of ACTH; way

to remember: “they have a cushion”
o Disorder of the adrenal cortex – retains sodium and water and
loses potassium
o Related to hyperthyroidism
o Increased steroids
o Causes:
 Pituitary tumors
 Females
 Overuse of cortisol medications
o S/S:
 Moon face
 Buffalo hump
 Truncal obesity with thin extremities
 Weight gain
 Hypertension
 Muscle wasting
 Hirsutism – masculine characteristics
 Supraclavicular fat pads
 Slow wound healing
 Red cheeks
 Thinning hair
 Ecchymoses (easy bruising)
 Striae
 Pathologic fractures
 Osteoporosis
 Pendulous abdomen (hanging downwards of the abdomen
over the pelvis)
 Hyperglycemia (high blood sugar)
 Hypernatremia (high sodium)
 Hypocalcemia (low calcium)
 Hypokalemia (low potassium)
o Plasma, urine cortisol, and plasma ACTH are measured, 24-hour
urine test for cortisol may be collected, a dexamethasone
suppression test may be done, and serum potassium is
measured
o Treatment:
 Ketoconazole – can block production of adrenal steroids
 Administer chemotherapeutic agents if adrenal tumor is
present
 Adrenalectomy – requires lifelong glucocorticoid
replacement
 Avoid infection
o Nursing management:
 Monitor BP
 Monitor daily weights
  Monitor I & O’s
 Monitor electrolyte levels
 Monitor glucose levels
 Administer medications as prescribed
 Prepare patient for adrenalectomy if applicable

 Addison’s Disease – hyposecretion of ACTH; way to

remember: “we need to add some”
o Disorder of the adrenal cortex – retains sodium and water and
loses potassium
o Related to hypothyroidism
o Decreased steroids
o Causes:
 Autoimmune disease
 Surgical removal of both adrenal glands
 Infarction of adrenal glands (injury or necrosis of the glands
due to inadequate blood supply)
 Infection of the adrenal glands
 TB
 Cytomegalovirus
 Bacterial infections
 AIDS
 Cancer
 Pituitary or Hypothalamus problems
 Abruptly stopping steroids
o S/S:
 Fatigue
 weakness
 Nausea & vomiting
 Diarrhea
 Weight loss / anorexia
 Lethargy
 Hypotension
 tachycardia
 Hypovolemia
 Confusion
 psychosis
 Hyperpigmentation of the skin
 Vitiligo – white areas of depigmentation
 Decreased body hair
 Hyperkalemia
  Hypercalcemia
 Hyponatremia
 Hypoglycemia
o Life-threatening complication: Addisonian Crisis
 This occurs when patients are exposed to stress (infection,
trauma, or psychological pressure) the body may be unable
to respond normally with secretion of additional cortisol,
and an adrenal crisis can occur. This can lead to:
 Profound fatigue
 Dehydration
 Renal failure
 Vascular collapse
 Hyponatremia
 Hyperkalemia
 Profound hypotension
 Tachycardia
 Cardiac arrhythmias
 Severe hypoglycemia
 Coma
 Death
o Treatment for Addisonian Crisis:
 Rapidly restoring fluid volume and cortisol levels
 IV fluids (containing glucose)
 Large doses of IV glucocorticoids (Hydrocortisone) are
administered
 Electrolytes are replaced as needed
 The cause of the crisis is identified and treatment
o Serum, urine cortisol, blood glucose levels, BUN, and hematocrit
levels are measured, an ACTH stimulation test helps determine
whether adrenal glands are functioning, serum sodium and
potassium levels are monitored, and a CT scan or MRI may be
done to evaluate the size of the adrenal glands or the locate a
pituitary tumor.
o Treatment for Addison’s Disease:
 Administer mineralocorticoid and/or glucocorticoids
(Hydrocortisone, Prednisone, and Cortisone)
 Diet: high in protein and carbs
 Administer Vasopressin
o Nursing management:
 Monitor BP
 Monitor daily weights
 Monitor I & O’s
  Monitor electrolyte level
 Monitor glucose levels
 Administer medications as prescribed

 Pheochromocytoma – Rare tumor on the adrenal gland that

secretes excessive amounts of epinephrine and
norepinephrine
o Adrenal medulla disorder
o Too much adrenaline is released from the adrenal gland
o Causes:
 Family history that makes patient prone to developing the
tumor
o S/S:
 Hypertension (severe)
 Headache
 Heat (excessive sweating)
 Hypermetabolism
 Hyperglycemia
 Tachycardia
 Palpations
 Tremor
 Diaphoresis
 Feelings of apprehension
 Intermittent unstable hypertension
o Patients with a suspected Pheochromocytoma will have a 24-hr
urine test for metanephrines and vanillylmandelic acid (VMA), a
blood test for metanephrines may be done, and if the results are
elevated a CT scan or MRI is done to locate the tumor
o Treatment:
 Adrenalectomy (if tumor is present) of one or both adrenal
glands
 Administer anti-hypertensives
 Diet: high in calories, vitamins, and minerals
 Foods high in tyramine (aged cheeses, beer, wine,
chocolate, etc.) should be avoided because they can
exacerbate symptoms
o Nursing management:
 AVOID STIMULI – it may cause a hypertensive crisis
 Educate patient to not smoke, drink caffeine, or change
positions suddenly
 Promote rest and calm environment
 If adrenalectomy is done, patient is at risk for unstable
blood pressure and hypoglycemia – monitor vital signs and
blood glucose
 If both adrenal glands were removed, the patient will
require lifelong replacement hormone therapy