Endocrine System

Question 1

Addison’s Disease

Answer 1

• Low cortisol, lack of aldosterone by the adrenal gland
• Assess blood pressure (low) and heart rhythm (high)
• Presentation:
  hyperpigmentation
  weak
  craves salty food
  hypoglycemic

-Addisonian Crisis:
similar to signs of shock
tachycardia
hypotension
pallor
tachypnea
hyponatremia
hyperkalemia

-Treatment:
avoid caffeine
avoid alcohol
high protein
high carbs
lifelong steroid treatment
normal cortisol levels: 5-25

Question 2

Cushing’s Disease and Syndrome

Answer 2

• High cortisol due to hypersecretion of glucocorticosteroids

-Presentation
osteoporosis
upper body obesity and thin extremeties
amenorrhea
elevated triglycerides and hypertension
increased thirst and urination
hypernatremia

-Dexamesthasone test (9-10 hour test) if cortisol is suppressed it indicates pituitary axis is working normally

-Medications:
metyrapone
aminoglutethimide
mitotane
ketoconazole

Question 3

Diabetes Insipidus

Answer 3

-low ADH = high urine output
-increase fluids

-Presentations:
decreased urine specific gravity (diluted urine, <1.005)
decreased urine osmolarity
increased sodium
polyuria, polydipsia
tachycardic and dehydrated
weak pulses
hypotension

-treatment:
vasopressin (ADH)

Question 4

SIADH

Answer 4

• High ADH = low urine output
  -restrict fluids to 500 - 1,000 mL per day

-Presentations:
increased urine specific gravity (>1.030)
decreased sodium
confused
seizures
weakness
anorexia, nasuea, vomiting (from low sodium)
weight gain

Question 5

Hypoglycemia vs Hyperglycemia

Answer 5

-Hypoglycemia:
sweating
tachycardia
tremors
palpitations
hunger
anxiety

-Hyperglycemia:
warm skin
rapid respirations
changes in mental status

Question 6

DKA

Answer 6

• elevated BUN (>20), creatinine(>1.5), specific gravity (>1.030)
• blood sugar 300-800 (less than 300 is an improvement)
• common for type I diabetes
• caused by missed dose of insulin, infection, untreated diabetes
• polyuria, polydipsia, polyphagia
• metabolic acidosis with ketonuria
• kussmaul’s respirations
• treat with IV fluids 0.9% IV fluids followed by 0.45%, followed by D5W once blood glucose is <250. Secondly, treat with insulin at 0.1mg/kr/hr (regular insulin is the only one that can be given IV). check glucose hourly
• monitor K+

Question 7

HHS

Answer 7

• high urine specific gravity, high BUN,
• hypotension, tachycardic
• administer fluids as you would with DKA
• blood sugar >600

Question 8

Thyroid Storm

Answer 8

• Individual’s heart rate, blood pressure, and body temperature can soar to dangerously high levels.
• can happen after thyroidectomy, monitor temp.