Diabetes Insipidus
- related to what hormone imbalance
- what happens?
- Undersecretion of ADH
- cannot hold onto water
DI
Etiology
- Renal
- CNS
-“sick” kidneys cause decreased response of renal tubules to ADH
- pituitary lesion/tumor causes diminished ADH production
- head injury puts pressure on pituitary
DI
4 S&S
- Dilute urine in excess (Polyuria)
- Excessive thirst
- Dehydrated cells due to polyuria - high serum Osmo
(T to B) - Dehydration - dry mucous membranes & poor skin turgor
SIADH
Which hormone imbalance?
What overall effect?
Oversecretion of ADH
“Hold onto” water
SIADH
Etiology (3)
- Ectopically produced ADH by small cell cancer(outside usual)
- General anesthetic reactions
- Brain trauma that puts pressure on pituitary
SIADH
S&S (3)
- oliguria (decreased urine output)
- Low serum osmo (B to T)
- Peripheral and pulmonary edema (pitting skin, crackles in lungs)
HYPERthyroidism
Etiology
MOST common cause
Excess T3 & T4 production
Graves Disease (autoimmune disorder and where antibodies attack TSH receptors on thyroid by mimicking TSH, causing over secretion)
HYPERthyroidism
S&S
- Labs
- CV
- GI
- High serum T4; low serum TSH
- tachycardia
- increased appetite w/ diarrhea
HYPERthyroidism
S&S
- Hair
- appearance (2)
- body changes
- Sensitive hair follicles
- alopecia - Exophthalamus (bulging eyed from fat tissues behind eyes)
- Goiter caused by overactive T4 cells
- Fatigue & weight loss
- High body temp & heat intolerance
- Flushed skin w/ excessive sweating
HYPERthyroidism
-Extreme State
S&S
- neuro
- circulatory
- other
Thyrotoxic Crisis
“Thyroid storm”
- Extreme restlessness, agitation, delirium, seizures, coma
- Tachycardia, HF, shock
- Diaphoresis, hyperthermia (103-105 F)
HYPERthyroidism
Dx
(2)
- Antithyroid meds to inhibit thyroid hormone production
2. Surgery - thyroidectomy
HYPOthyroidism
-Hormone imbalance?
Undersecretion of T3 & T4
HYPOthyroidism
Etiology (5)
Loss of function thyroid tissue by:
- Congenital defect
- Removal or destruction of tissue
- Hashimoto’s thyroiditis
- Iodide deficiency
- Overactive antithyroid drugs
Hashimoto’s Thyroiditis
Autoimmune disorder
-thyroid tissue slowly replaced by lymphocytes & scar tissue
Cretinism
Congenital HYPOthyroidism w/ stunted mental & physical growth caused by lack of iodide in Mother’s diet in utero
HYPOthyroidism
S&S
LABS
Low serum T4; high serum TSH
HYPOthyroidism
S&S
(8)
- neuro
- circulatory
- pulmonary
- GI
- hair
- skin
- other (3)
- Confusion, memory loss, depression
- Anemia, bradycardia, decreased CO
- Dyspnea, hypoventilation, CO2 retention
- Decreased appetite, constipated
- Dry, brittle hair. Alopecia
- Myxdema, dry and coarse skin
- Goiter
- compensatory response to create more T4, scar tissue in HT - Weight gain
- decreased body temp & cold intolerance
Calcitonin & PTH
-Functions
- Calcitonin secreted by thyroid gland and moved calcium from blood into bone
- PTH secreted by parathyroid and stims resorption of calcium from bone to blood
How does PTH move CA from bone to blood?
Stims osteoclastic activity
Calcitonin & PTH
Relationship
Negative Feedback:
- hypocalcemia increases PTH secretion and suppresses calcitonin
- hypercalcemia increases calcitonin and decreases PTH
Osteoporosis
- Etiology
- Tx
- sequela
‘Porous Bone’
- Dramatic bone density decreases due to increased osteoclastic activity
- Age related (Women over Men)
- Bone breakage
Osteopenia
Moderate decrease in bone density.
** The rest is same as Osteoporosis**
Osteoporosis/-penia
Dx
- Surgery for bone breakages
- Rx to decrease osteoclastic activity (nasal calcitonin and biphosphonates - Fosamax)
Other CA related problems (3)
- Electrical: hyper/hypo polarization of cells affects RMP
- Clotting issues due to hypocalcemia
- Kidney Stones
Hyerglycemia
stimulates secretion of insulin, activates glycogenesis to store unneeded glycogen.
HYPOglycemia
secretion of counterregulatory hormones.
When one doesn’t eat GH is released from pituitary gland and glucagon released from the pancreas and stimulated glycogenesis and g
Cushing’s Syndrome
-Imbalance
hypercortisolism and hyperaldosteronism
Cushing’s Syndrome
-Etiology (3)
- Pathologic oversecretion of adrenocorticopathic hormone (ACTH) from the pituitary gland
- adrenal cortex tumor
- Hyperadosteronism by adrenal cortex
Cushing’s Syndrome
-S&S
Physical Appearance (lipids)
abnormal breakdown of adipose tissue deposits:
- truncal obesity
- moon face
- buffalo hump
- High levels of LDL & artherosclerosis risk
Cushing’s Syndrome
-Muscles
- Weakness & Wasting (thin arms and legs)
- short stature
- weakened collagen fibers = skin tears= purple striae
Cushing’s Syndrome
Tx
- decrease steroids if possible.
- remove cause of exogenous cortisol hypersecretion
- drugs that block the effect of aldosterone
Addison’s Disease
Overview
hypocortisolism and hypoaldosteronism
Addison’s Disease
-S&S
hypoglycemia
anorexia
body can’t hang on to water
decreased bloodvolume
Addisonian crisis
Severe hypotension due to fluid loss
Addison’s Disease
tX
prednisone, aldosterone, fluids, high NaCl diet
Diabetes Mellitus
Type 1
- Juvenile Onset
- TOTAL lack of insulin secretion
Diabetes Mellitus
Type 2
Adult onset
- abnormally low insulin production
- impaired insulin utilization
Type I
Sequela
hyperglycemia due to glucose not getting into cells. Stims Gluconeogenesis = high ketones in blood
Type I DM
Extreme State: DKA
Diabetic Ketoacidosis
- Metabolic acidosis, Kussmaul respirations, can progress to diabetic coma
- Give insulin
Type II DM
S&S
- obesity
- hyperglycemia, hyperinsulinemia
- pancreatic overdrive = decreased insulin secretion
- fatigue, mild polydipsia, polyuria
Type II DM
Extreme State - HHNKS
Hyperglycemic-hyperosmolar-nonketotic syndrome
- VERY high serum osmo, extreme polyuria, extreme dehydration
- can progress to diabetic coma
Type II DM
tX (4)
- weight loss
- oral medications
- insulin
- IV fluids for HHNKS
Type I & II DM
S&S
(6)
- macroangiopathy - due to glucose txicity
- microangiopathy - damage to small vessels
- peripheral neuropathy
- autonomic neuropathy (autonomic system nerve damage)
- Bladder control
- Silent MI
Hypoglycemia
Weakness, fatigue, apathy, confusion, shakiness, irritability, and swearing
Hypoglycemia
Extreme State
Hypoglycemic shock or coma and seizures
Hypoglycemia
tX
OJ, sugar, or cracker.
IV glucose od IM orsubQ glucagon