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NRS 212-Acute I

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Rebecca McCay

on 1 June 2015

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Transcript of NRS 212-Acute I

Acute Alterations in the Endocrine System
NRS 212-Acute I
Adrenal Disorders
Endocrine Glands
Disorders of the Thyroid
Hypothyroidism vs. Hyperthyroidism
Disorders of the Parathyroid
Pituitary Disorders
Pituitary Gland:
Your pituitary gland is a pea-sized gland at the base of your brain. The pituitary is the "master control gland" - it makes hormones that affect growth and the functions of other glands in the body.

With pituitary disorders, you often have too much or too little of one of your hormones. Injuries can cause pituitary disorders, but the most common cause is a pituitary tumor.
The following hormones are made in the
anterior pituitary gland:

Prolactin
- Stimulates breast milk production after childbirth. It also affects sex hormone levels from ovaries in women and from testes in men, as well as fertility.

Growth hormone (GH)
- Stimulates growth in childhood and is important for maintaining a healthy body composition and well-being in adults. Important for maintaining muscle mass and bone mass.

Adrenocorticotropin (ACTH)
- Stimulates the production of cortisol by the adrenal glands. Cortisol, a "stress hormone," is vital to our survival. Helps maintain BP and blood glucose levels--produced in larger amounts when we’re under stress (illness or injury).

Thyroid-stimulating hormone (TSH)
- Stimulates the thyroid gland to produce thyroid hormones, which regulate the body's metabolism, energy balance, growth, and nervous system activity.

Luteinizing hormone (LH)
- Stimulates testosterone production in men and ovulation in women.

Follicle-stimulating hormone (FSH)
- Promotes sperm production in men and stimulates the ovaries to produce estrogen and develop eggs in women.
Review:
The following hormones are stored in the posterior pituitary gland:

Antidiuretic hormone (ADH) - Also called vasopressin, regulates water balance in the body. It conserves body water by reducing the amount of water lost in urine.

Oxytocin – Oxytocin causes milk to flow from the breasts in breastfeeding women, and may also help labor to progress.



The most frequent type of pituitary disorder is a pituitary
glandtumor
(fairly common in adults). They are not brain tumors and are almost always benign (cancerous tumors of this sort are extremely rare).
There are two types of tumors—secretory and non-secretory. Secretory tumors produce too much of a hormone normally made by the pituitary, and non-secretory tumors do not.

The problems caused by pituitary tumors fall into three general categories:
Hypersecretion: Too much--caused by a secretory pituitary tumor.
Hyposecretion: Too little of any hormone in the body can be caused by a large pituitary tumor, which interferes with the pituitary gland’s ability to produce hormones--can also result from surgery or radiation of a tumor.
Tumor mass effects: As a pituitary tumor grows and presses against the pituitary gland or other areas in the brain, it may cause headaches, vision problems, or other health effects.

Injuries, certain medications, bleeding inside or close to the pituitary, and other conditions can also affect the pituitary gland. Loss of normal pituitary function also can occur after major head trauma.

Treatment may include tumor removal and
hypophysectomy
(removal of the hypophysis or pituitary gland).
Pituitary Tumors
Review:
Diagnostics
ACTH
levels in the blood are measured to help detect, diagnose, and monitor conditions associated with excessive or deficient cortisol in the body. Conditions include:

Cushing disease:
excess
cortisol that is due to an ACTH-producing tumor in the pituitary gland (usually a benign tumor)
Cushing syndrome:

refers to the symptoms and signs associated with excess cortisol.
Addison disease:

(primary adrenal insufficiency) decreased cortisol production due to adrenal gland damage
Secondary adrenal insufficiency:
decreased cortisol production because of pituitary dysfunction
Hypopituitarism:

pituitary dysfunction or damage that leads to decreased (or no) hormone production by the pituitary, including ACTH production


Both
ACTH and cortisol can help to differentiate among some of these conditions because the level of ACTH normally changes in the opposite direction to the level of cortisol.
ACTH
FSH
In both women and men, the
FSH
test may be used with other hormone tests such as

LH
, testosterone, estradiol, and/or progesterone to help:
Determine the cause of infertility
Diagnose conditions associated with dysfunction of the ovaries or testicles
Aid in the diagnosis of pituitary or hypothalamus disorders, which can affect
FSH
production
Women
-
Investigation of menstrual irregularities
Predicting onset/confirmation of menopause
Men
- Help determine the reason for a low sperm count.
Children
-FSH and LH used to help diagnose delayed or precocious (early) puberty.
GH
Used to identify GH deficiency and to help evaluate pituitary gland function, usually as a follow-up to other abnormal pituitary hormone test results.

Used to detect excess GH and to help diagnose and monitor the treatment of
acromegaly
(excess GH causing bone size to increase) and
gigantism
.

Low GH may lead to decreased bone strength and fractures.

Because GH is released in pulses, a single measurement of the blood level is not normally clinically useful. Therefore, testing for the suppression or stimulation of growth hormone release from the pituitary is usually done.

GH stimulation tests help to diagnose GH deficiency and hypopituitarism.

A GH suppression test and insulin-like-growth-factor-1 (IGF)-testing can also be used to monitor treatment of a GH-producing pituitary tumor.
LH
LH
- Hormone associated with reproduction and ovulation in women and testosterone production in men.

LH
is often used in conjunction with other tests (FSH, testosterone, estradiol and progesterone):

In the workup of infertility:
Aids in diagnosis of pituitary disorders that affect
LH
production
Helps diagnose conditions R/T dysfunction of the ovaries or testicles
In women, LH levels are useful for:
Investigation of menstrual irregularities
Evaluate
LH
levels during the menstrual cycle; multiple urine
LH
tests may be ordered for this purpose. These
LH
"spot tests" can be performed at home and used to detect the surge in
LH
that indicates that ovulation will occur in the next 1-2 days. The tests can help determine when a woman is likely to be the most fertile.
In children, FSH
and
LH
are used to diagnose delayed and precocious (early) puberty
MRI of Head
Review:
Adrenal glands:
Small glands on top of each kidney. Produce hormones that you can't live without, including sex hormones and cortisol.
Cortisol
helps you respond to stress and has many other important functions.

Adrenal gland disorders:
Glands make too much or not enough hormones.
Cushing's syndrome:
Too much cortisol
Addison's diseas
e:
T
oo little. Some people are born unable to make enough cortisol.

Causes of adrenal gland disorders:
Genetic mutations
Tumors including
pheochromocytomas
Infections
A problem in another gland, such as the pituitary, which helps to regulate the adrenal gland
Certain medicines
Treatment depends on which problem you have. Surgery or medicines can treat many adrenal gland disorders.
Diagnostics:
Cushing's Syndrome
One or more of the three screening tests:
Screens for elevated cortisol levels in saliva
24 hour urine cortisol test (elevation)
Dexamethasone suppression test- Elevation will be noted with cortisol production.
Hallmark signs of Cushing's syndrome (too much cortisol):
A fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin.
Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, diabetes.
Treatment: Aimed @ cause
Reducing corticosteriod use
Surgery (if tumor)
Radiation (Pituitary tumor)
Medications to control excessive cortisol
production (ketoconazole)
Addison's Disease:
Diagnostics:
Cortisol Levels
ACTH levels
ACTH stimulation test: An hour-long test, IV administration of synthetic ACTH, blood levels of various hormones before and after ACTH administration to determine if adrenal insufficiency

(lack of cortisol) exists.
Signs/Symptoms:
Usually develop slowly, often over several months, and may include:
Muscle weakness and fatigue
Weight loss and decreased appetite
Darkening of your skin (hyperpigmentation)
Low blood pressure, even fainting
Salt craving
Low blood sugar (hypoglycemia)
Nausea, diarrhea or vomiting
Muscle or joint pains
Irritability
Depression
Body hair loss or sexual dysfunction in women
Acute adrenal failure (
Addisonian Crisis
=Pain in low back, legs, abdomen, severe vomiting/diahrrea/dehydration, low BP, LOC, hyperkalemia)
Treatment:
ACTH and/or Cortisol replacement therapy
Monitoring/correction of fluids/electrolytes
Hyperaldosteronism
Blood and urine tests to check for high levels of
Aldosterone
and low levels of
Potassium
.
CT scan of Abdomen
: Noncancerous tumors or abnormal growth of the adrenal glands
Treatment:
Surgical excision of the affected adrenal gland (A period of hypoadrenalism can occur producing clinically significant hyponatremia and hyperkalemia-Monitor and correct as needed. Once the potassium level is stable, Na restriction and po KCL supplements may be used as effectively as, or in addition to, potassium-sparing
diuretics.


Spironolactone
is the most effective drug for controlling the effects of hyperaldosteronism, though it may interfere with the progression of puberty.
Laparoscopic Retroperitoneal Adrenalectomy
Laparocopic Transsphenoidal Hypophysectomy
Why is this important to know?
What should I watch for?
What should I teach the patient to avoid?
Full transcript