Endocrine and Hepatic Disorders

1. Endocrine and Hepatic Disorders Diana Blum MSN Metropolitan Community College Nursing 2150

2. Endrocrine glands • Pituitary gland • Adrenal gland • Thyroid gland • Islets cells of the pancreas • Parathyroid glands • Gonads

3. Hormones and Target tissue • Hormones-Natural chemicals that exert their effects of a specific tissue • Target tissue-usually located at a distance from the endocrine gland with no direct connection between the endocrine gland and the target tissue. • Endocrine glands are “ductless glands”

4. Neuroendorcrine Regulation • The primary function of the endocrine glands is to regulation of overall body function. • The body must maintain a homoeostatis to respond to environmental changes. • Temperature regulation • Serum sodium levels

5. Lock and Key As hormones travel through the body, they can only recognize their target tissue. Each receptor site type is specific to only one hormone Only the correct hormone can connect to the correct receptor Once the hormone binds to the site the target tissue will change the tissues activity

6. Disorders of the endorcrine system are related to either excess or deficiency of a specific hormone or to a defect at its receptor site. • Onset • Slow or insidious • Abrupt or life threatening

7. Negative Feedback Control Mechanism Hormone secretion is dependant on the need of the body for the final action of that hormone When the body moves away from homeostatis a specific change or action is required or a response is needed to correct the change Supply and demand

8. Parathyroid • Parathyoid hormone • Adrenal Cortex • Glucocorticoid • Mineralacorticoids

9. Testes • testosterone • Ovary • Estrogen • Progesterone

10. Pancreas • Insulin • Glucagon • somatostatin

11. Glands

12. Hypothalamus • Small area of nerve and glandular tissue located beneath thalamus on each side of third ventricle of the brain • Shares a small closed circulatory system with anterior pituitary • Known as hypothalamic-hypophysial portal system • Hormones can travel directly to anterior pituitary

13. Hypothalamus • corticotropin-releasing hormone • Thyrotropin releasing hormone • Gonadotropin releasing hormone • Growth hormone releasing hormone • Growth inhibiting hormone • Prolactin inhibiting hormone • Melanocyte inhibiting hormone

14. Pituitary gland • Located at base of brain in a valley of the sphenoid bone called sella turcica • PEA SIZED • The hypothalamus and pituitary work together. The hormones of posterior pituitary are produced in hypothalamus and are sent through portal system • The hormones are stored in nerve endings of posterior pituitary and arereleased into blood when needed

15. The pituitary gland is responsible for many hormones and subsequent target tissues and actions

16. Anterior pituitary • Thyroid stimulating hormone • Adrenocorticotropic hormone • Luteinizing hormone • Follicile stimulating hormone • Growth hormone • Melanocyte stimulating hormone

17. Posterior pituitary • Vasopressin • Oxytocin • Triiosothyronine (T3) • Thyroxine (T4) • Calcitonin

18. Patho • Adenohypophysis-controls growth, metabolic activity and sexual development. GH, PROLACTIN, TSH, AdrenoCorticoTropin (ACTH), FSH, LH, MSH Disorders arise when the anterior pituitary does not work effectively or when the hypothalamus is not work effectively. (Primary pituitary dysfunction vs. secondary pituitary dysfunction)

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20. Disorders of the Anterior Pituitary Hypopituitarism Hyperpituitarism

21. Hypopituitarism • Deficiency in one or more hormones • In rare cases, panhypopituitarism is present (Decreased hormone production from the anterior pituitary) • Deficiencies in ACTH and TSH are most life threatening as they correspond to vital hormones from adrenal gland and thyroid gland. The other hormones from the gonads LH and FSH interfere with sexual reproduction

22. Clinical Manifestations • GH • Decreased bone density • Fractures • Decreased muscle strength

23. Clinical Manifestations • Gonadotropins-women • Amenorrhea • Anovulation • Low estrogen levels • Breast atrophy • Decreased libido • Gonadotropins-male • Decreased facial hair • Reduced muscle mass • Impotence • Decreased body hair • Loss of bone density

24. Clinical Manifestations • Thyroid stimulating hormone (TSH) • Weight gain • Intolerance to cold • Menstrual abnormalities • Slow cognition • lethargy

25. Clinical Manifestations • Andrenocorticotropin-ACTH • Decreased serum cortisol levels • Pale sallow skin • Headache • Hypoglycemia • hyponatremia

26. Diagnositics • Stimulation test • Usually involve injecting agents that are known to stimulate secretion of specific pituitary hormones • Skull x ray • CT scan • MRI

27. Interventions for hypopituitarism • Replacement of deficient hormone • Androgens • Women will be given combination of estrogen and progesterone • Gonadatropin releasing hormone and human gonadatropin are used to stimulate ovulation

28. Hyperpituitarism Oversecretion usually caused by pituitary tumor or hyperplasia Rare Can cause gigantism or acromegaly

29. Gigantism-onset of GH hypersecretion occurs before puberty

30. Agromegaly • Andre the GIANT stood 7 feet tall and died at 46. He did not treat his disease. Excessive secretion of GH occurs after puberty

31. Clinical manifestations • Facial feature abnormalities • Proganthism • Changes to vision • Organmegaly • Hypertension • Dysphagia • Deepened voice

32. Diagnostics • Laboratory blood draw to determine which hormone is excessively secreting. • CT scan • MRI • Suppression test

33. Non surgical management • Drug therapy • Dopamine agonist • Parlodel • Dostinex • Both of these drugs stimulate the production of dopamine and inhibit the release of GH and PRL

34. Somatostatin analogues • Octreotide-inhibits GH release • Somavert-growth hormone blocker

35. Radiation therapy • Takes a long time to be effective • Not immediate is acute situations • Side effects • Optic nerve damage

36. TransSphenoidalhypophysectomy • Surgery through nose into sphenoid sinus cavity • Monitor neurologic status • Monitor fluid balance (transient diabetes insipidus) • Instruct client not to sneeze, cough, blow nose • Encourage deep breathing exercises • Monitor pad for nasal drainage (test for glucose) • Instruct patient to use dental floss and oral rinse. Brushing teeth is not permitted for at least 10 days post op

38. Surgical Management of Hyperpituitarism • Preop • Education, education education Operative Use of a microscope makes incision in upper lip graft taken from thigh to prevent leak in CSF

39. Postoperative- Vital signs and: • Monitor neurologic status • Monitor fluid balance (transient diabetes insipidus) • Instruct client not to sneeze, cough, blow nose. • Encourage deep breathing exercises • Monitor pad for nasal drip • Instruct patient to use dental floss and oral rinse. Brushing teeth is not permitted.ita

40. Disorders of the Posterior Pituitary • Diabetes insipidus • Syndrome of Inappropriate Antidiuretic hormone

41. Three types of DI • Nephrogenic-inherited • Primary-defect in the hypothalamus or pituitary gland • Drug related-Lithium

42. Key features • Hypotension • Decreased pulse pressure • Tachycardia • Increased Hbg,hct and BUN • Increased UOP • Poor skin turgor • Irritablilty • Decreased coginition • Hyperthermia • Lethargy leading to coma • Excessive thirst • Decreased urine specific gravity

43. Nursing interventions • Primary management is with medications. • Lypressin • DDAVP • Pitressin • Diabinese

44. SIADH • ECF expands • Decreased sodium levels • supplement diet with sodium and potassium at home • Diuretics may be used to decrease volume • Fluid restriction

45. Nursing diagnosis Fluid volume excessrelated to compromised regulatory mechanism and intravenous overload. Altered thought processrelated to cerebral edema

46. SIADH Case study- 77 year old female is taken to the ER for a fall at home. Assesment reveals Awake, alert and oriented Complains of pain to right hip. She has a history of hypertension and asthma. EKG shows NSR CBC wbc 9.4 rbc 3.9 hgb 12.1 hct 39.0 • BMP • Glucose 92 • BUN 18 • Cr 1.1 • NA 130 • K 4.2 • CO2 37 • Cl 97 • Pulse ox 94% on RA • VS 98.6, 84, 18, 156/93

47. On admission to ICU • Na 116 • K 3.5 • Cl 86 • BUN 9 • Cr .8 • Glucose 126 • Hgb 9.1 • Hct 27 • Serum Osmolality 243 • Urine Osmolality 541

48. Ms. Mills still remains confused but her respiratory status has improved. • Twenty four hours later her lab shows • Na 132 • K 3.2 • Cl 98 • Serum osmolality 275 • Urine osmolality 400 • At this time her IV solution is changed to D5 NS at 50 ml/hr. She is weaned off the oxygen and is alert awake and oriented. • Vitals show 99.2 100 20 130/78

49. Discuss two other sodium disorders that must be differientaited from SIADH? • Why are elderly more prone? • What are factors that contributed to the development of SIADH in Ms. Mills

50. Parathyroid gland • Consists of four small glands located on the back of thyroid gland • Chief cell of this gland production and secretion of PTH • Regulates calcium and phosphorus metabolism by acting on bone, kidneys and intestinal tract • Serum calcium is major controlling factor of PTH (Parathyoid hormone)