Endocrine Abnormalites
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Transcript of Endocrine Abnormalites
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1212 SECTION 10 Problems Related to Regulatory and Reproductive Mechanisms
DIAGNOSTIC STUDIES OF ENDOCRINE SYSTEM
Accurately performed laboratory tests and radiologic examina-tions contribute to the diagnosis of an endocrine problem. Lab-oratory tests usually involve blood and urine testing. Ultrasound may be used as a screening tool to localize endocrine growths such as thyroid nodules. Radiologic tests include regular x-ray, computed tomography (CT), and magnetic resonance imaging (MRI). With all diagnostic testing, you are responsible for explaining the procedure to the patient and caregiver. Diagnos-tic studies common to the endocrine system are presented in Table 48-8.
Laboratory StudiesLaboratory studies used to diagnose endocrine problems may include direct measurement of the hormone level, or they may involve an indirect indication of gland function by evaluat-ing blood or urine components affected by the hormone (e.g., electrolytes).
Hormones with fairly constant basal levels (e.g., T4) require only a single measurement. Notation of sample time on the laboratory slip and sample is important for hormones with cir-cadian or sleep-related secretion (e.g., cortisol). Evaluation of other hormones may require multiple blood samplings such as in suppression tests (e.g., dexamethasone) and stimulation tests
FINDING DESCRIPTION POSSIBLE ETIOLOGY AND SIGNIFICANCECardiovascularChest pain Angina caused by increased metabolic demands HyperthyroidismDysrhythmias Tachycardia, atrial fibrillation Hypothyroidism, hyperthyroidism, pheochromocytomaHypertension Elevated blood pressure caused by increased
metabolic demands and catecholaminesHyperthyroidism, pheochromocytoma, Cushing syndrome
MusculoskeletalChanges in muscular
strength or muscle massGeneralized weakness and/or fatigue Common symptoms associated with many endocrine problems,
including pituitary, thyroid, parathyroid, and adrenal dysfunctions; diabetes mellitus; diabetes insipidus
Decreased muscle mass Specifically seen in those with growth hormone deficiency and in Cushing syndrome secondary to protein wasting
Enlargement of bones and cartilage
Coarsening of facial features; increases in size of hands and feet over a period of several years
Gradual enlargement and thickening of bony tissue occurs with growth hormone excess in adults as seen in acromegaly
NutritionChanges in weight Weight loss Hyperthyroidism caused by increases in metabolism, diabetic
ketoacidosisAltered glucose levels Weight gain Hypothyroidism, Cushing syndrome
Increased serum glucose Diabetes mellitus, Cushing syndrome, growth hormone excess
NeurologicLethargy State of mental sluggishness or somnolence HypothyroidismTetany Intermittent involuntary muscle spasms usually
involving the extremitiesSevere calcium deficiency that can occur with hypoparathyroidism
Seizure Sudden involuntary contraction of muscles Consequence of a pituitary tumor; fluid and electrolyte imbalance associated with excessive ADH secretion; complications of diabetes mellitus; severe hypothyroidism
Increased deep tendon reflexes
Hyperreflexia Hyperthyroidism, hypoparathyroidism
GastrointestinalConstipation Passage of infrequent hard stools Hypothyroidism; hyperparathyroidism caused by calcium
imbalances
ReproductiveChanges in reproductive
functionMenstrual irregularities, decreased libido,
decreased fertility, impotenceReproductive function is significantly affected by various endocrine
abnormalities, including pituitary hypofunction, growth hormone excess, thyroid dysfunction, and adrenocortical dysfunction
OtherPolyuria Excessive urinary output Diabetes mellitus (secondary to hyperglycemia) or diabetes
insipidus (associated with decreased ADH)Polydipsia Excessive thirst Extreme water losses in diabetes mellitus (with severe
hyperglycemia) and diabetes insipidus, dehydrationDecreased urine output ADH leads to reabsorption of water from kidney
tubulesSyndrome of inappropriate antidiuretic hormone (SIADH)
Thermoregulation Cold insensitivity Hypothyroidism caused by a slowing of metabolic processesHeat intolerance Hyperthyroidism caused by excessive metabolism
ADH, Antidiuretic hormone.
TABLE 48-7 COMMON ASSESSMENT ABNORMALITIEScontdEndocrine System