Endocrine Problems Debra Conroy-Mccue RN DNP Dr. Angela D. Banks, RN, PhD Thyroid • • • • Metabolism Regulate Temperature Stimulates SNS HR Brain and growth development • Fertility • Regulates TSH Hyperthyroidism • Thyrotoxicosis • Graves disease –Changes in behavior –Insomnia –Restlessness –Irritability –Palpitations –Wt loss –Heat intolerance Diagnostic Labs Elevated T3 & T4 Decreased TSH Exophthalmos Pharmacological Management Anti-thyroid drugs • Propylthiouracil (PTU) • Iodine preparations • Beta-adrenergic blocking drugs – Lithium Hypothyroidism • Hashimotos’s thyroiditis • Decreased metabolic rate – – – – Extreme fatigue Wt. gain Bradycardia Cold intolerance • Myxedema Diagnostic Labs : Decreased T3 T4 Increased TSH Goiter Pharmacological Treatment of Hypothyroidism • Levothyroxine (Synthroid) Hypothalamus Anterior Pituitary Neuroendocrine system Disorders of Anterior Pituitary Gland • Primary pituitary dysfunction • Secondary pituitary dysfunction • Pituitary hypofunction • Pituitary hyperfunction Cause of Hypopituitarism • Benign or malignant tumors • Anorexia nervosa • Shock or severe hypotension • Sheehan s syndrome postpartum hemorrhage Patient Assessment Management of Hypopituitarism • • • • Replacement of deficient hormones Androgen (Testosterone) Most effective route is Intramuscular Continues until virilization occurs Acromegaly • Growth hormone hypersecretion after puberty • Most common cause is pituitary adenoma • Prolactin secreting tumors Gigantism Pharmacological Treatment Parlodel Dostinex Permax Sandostatin Somavert • Stimulate dopamine receptors • Inhibit the release of many pituitary hormones • Growth hormone • Prolactin Surgical Management Transphenoidal Postoperative Care • • • • • • Monitor neurologic response Assess for postnasal drip HOB elevated Assess nasal drainage Avoid bending Avoid strain at stool Diabetes Insipidus Pharmacological Treatment Desmopressin acetate (DDAVP) Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) • Vasopressin is secreted even when plasma osmolarity is low or normal. • Feedback mechanisms do not function properly • Water is retained, resulting in hyponatremia Medical Problems & SIADH Recent head trauma Cerebrovascular disease Tuberculosis or other pulmonary disease Cancer Nursing Interventions • • • • Fluid restriction Diuretics Hypertonic saline Demeclocycline (Declomycin) • Neurologic assessment