D2 Endocrine

8/13/2019 D2 Endocrine

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Disorders of the

Endocrine SystemDisorders of the Endocrine System

Growth Hormone ADH


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Growth Hormone

stimulates cell growth in puberty increases height and weight duringpuberty


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Notes secreted by anterior pituitary gland


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Acromegaly

Hypersecretion of Growth Hormone develops during adulthood epiphyseal plates close by adulthood long bones cannot increase

bone plates are already formed


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Notes

Explain that this is affected by the pituitary gland. Usuallyfrom a tumor,

also called somatropin (gh) irreversible long bones have already developed so height is not affected.

growth plates at long ends of bones have already matured.causes facial features, jaw, hands, feet to widen and enlarge

see page 489 in book


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Figure 11 6

Right: Coarse facial features typical of acromegaly. Left: Patients faceseveral years before she developed the pituitary tumor.


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Notes

The photograph on the left represents theindividual prior to the diagnosis ofacromegaly. The physiological impact of the

disease is apparent in the photograph on theright side.


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Acromegaly

Acr/o means extremity megaly means enlargement


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Acromegaly large hands and feet enlarged forehead and protruding jaw

may take 10-15 years to manifest

enlarged tongue


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Notes

hypertrophy of vocal cords cause deepening

voice enlargement of heart, liver and spleen

muscle weakness can develop joints may become stiff, painful

females may have amenorrhea


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Diagnosis

lab tests may show increased serumGH

Pituitary gland enlargement shown on MRI CT scan


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Notes

oral glucose challenge test concentration is

abnormally high, normally this falls oral intake should be restricted prior to test for 8 hours. MRI and CT scan may show tumor


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Treatment of Acromegaly

Radiation therapy

medications to suppress GH secretion

transsphenoidal hypophysectomy surgical removal of the pituitary glandthrough the roof of the mouth


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Notes

medications used are Dostinex

and Sandostatin


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Gigantism

Caused by hypersecretion of growthhormone during childhood and puberty

Causes all bones and tissues to growcontinuously

Becomes abnormally tall


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Notes

if GH occurs in child before closure of

epiphyses there is an overgrowth of long bones

great height

and

increased

muscle

development

life expectancy is shortened


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Dwarfism

Hyposecretion of Growth Hormoneduring childhood and puberty

lack of growth and short stature butwith normal body portions


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Notes

sexual development is normal but delayed

may produce normal offspring normal intelligence

if dwarfism is caused by tumor, surgery is usually indicated


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Antidiuretic hormone

also called vasopressin

causes kidneys to conserve water bydecreasing amount of urine produced


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Notes

also causes vasoconstriction of the arterioles of the body which increases blood pressure.

moves water from renal tubules into the blood decreases urine volume and keeps blood pressure and blood

volume normal

anti=against dia=completely through ur/o urine, urinary stystem

etic=pertaining to


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Diabetes Insipidus

Caused by damage to posteriorpituitary gland

Hyposecretion of antidiuretic hormone(ADH)

excessive amounts of urine (polyuria)


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Notes

Caused by problems with posterior pituitary

gland.. may have 5-15 LITERS a day of urine. diabetes=like a sieve or siphon

inspidus=tasteless

brain injury, neuro problems, intracranialhemorrhage, infarct, meningitis,


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Diabetes Insipidus

symptoms

weakness, thirst

increased intake of fluids(polydipsia)

very pale urine


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Notes

electrolyte imbalances

large urine output 520 l per day normal is 1500 2000 per day

severe hydration hypernatremia

may lead to hypovolemic shock, tachycardia, tachypnea, hypotension


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Treatment of DiabetesInsipidus

IV fluids

ADH replacement therapy

Pitressin or Desmopressin (DDAVP)


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Notes

urine specific gravity drops below 1.003. NA

increases to above 145. eliminate caffeine,


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Diabetes Insipidus Associated with head trauma, brain tumors,

central nervous system infections, cranial surgery

Severe fluid volume deficit Symptoms- Marked Polyuria (2 to 20L/day, Intense

Polydipsia (may drink 4 to 20L/day). Dilute urine

with low specific gravity (1.001 1.005),Hypernatremia,

May lead to s/sx of hypovolemic shock (ALOC,tachycardia, tachypnea and hypotension)

Treatment of underlying cause; maintain fluidbalance


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Notes

Clinical symptoms include polyuria and polydipsia. Tx: Synthetic preparations of ADH are administered with

nasal sprays or IM. Insipidus means tasteless, reflecting the condition of dilute

urine as opposed to mellitus meaning sweet or honey,

reflecting the sugar content of urine in DM The term Diabetes comes from the Greek Diabainein,

meaning to pass through.

Both DI and DM are characterized by polyuria.


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Diabetes InsipidusDiagnosis

Urine specific gravity and ADHmeasurement

Fluid deprivation test- test how wellpituitary is producing ADH

CT scan Radiographic evaluation of the sella

turcica


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Notes

sella turcica is the bony cup that the pituitary

gland sits in, in the brain.


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Diabetes Insipidus ADH/DDAVP/Vasopressin Eliminate coffee, tea and other beverages

containing caffeine d/t possible diuretic

effect Patient is at risk for severe dehydration

and severe hypernatremia if intakecannot match urinary losses.


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Diabetes Insipidus

Assess for s/sx of dehydration (dry oral mucousmembranes, poor skin turgor, soft eyeballs, low BP, rapidpulse)

Monitor I/O Daily weights Instruct to wear medic-alert jewelry stating diagnosis of

diabetes insipidus

Dependent on medication for the rest of their lives.


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SIADH syndrome of inappropriate antidiuretic

hormone

hypersecretion of ADH. water retention, hyponatremia, hyposmolarity

(excess dilution of blood)

concentrated urine, decreased urine output


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Notes

emphasis on too much ADH vs too little ADH

decreased urine volume, kidneys reabsorb morewater, expand fluid volume fluid overload occurs


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Treatment of SIADH Correct underlying cause surgery to remove tumor from posterior

pituitary gland

Lasix and fluid restriction. possible IV hypertonic infusion (3%

NS)


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Two types of DiabetesMellitus

Diabetes I

Juvenile Onset

Insulin Dependent


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Diabetes MellitusType II Adult onset non-insulin dependent

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