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Impairment of the Endocrine Gland - Coggle Diagram
Impairment of the Endocrine Gland
Too much hormone
Syndrome of Inappropriate Antidiuretic Hormone (SIADH): excessive ADH
Diagnostic Criteria: serum sodium <135 mEq/L, plasma osmolality <280 mOsm/kg, low urine volume, high sodium content in urine, absence of renal/adrenal/thyroid abnormalities
Clinical Manifestation: due to hyponatremia
Between sodium levels of 115-120 mEq/L: anoreia, nausea, vomiting, headache, irritability, disorientation, muscle cramps, and weakness
Sodium levels below 110 mEq/L: psychosis, gait disturbances, seizures, or coma
Low and concentrated urine output
Treatment: water restriction for mild hyponatremia, hypertonic IV solutions for severe hyponatremia with AMS, medications to block effects of ADH or to increase urine output
Hyperthyroidism: excessive thyroid hormone
Diagnostic Criteria: physical exam, elevated T3 and T4 serum levels, and serum TSH level are screening tools. To diagnose- serum thyroxine level and uptake of radioactive iodine by thyroid
Treatment: medications to block thyroid hormone production, shrinkage of thyroid gland by radioactive iodine, or surgical removal of the thyroid gland that may require lifetime use of oral thyroid hormone replacement therapy
Clinical Manifestation: weight loss, agitation, restlessness, sweating, heat intolerance, diarrhea, tachycardia, palpitations, tremors, fine hair, oily skin, irregular menstrual cycle, weakness
Goiter: enlarged thyroid gland
Exophthalmos: protrusion of eyes
Cushing Syndrome: excessive ACTH and cortisol hormone
Diagnostic Criteria: 24-hour urine collection to determine cortisol excretion, imaging to locate tumors that is causing excess hormone secretion
Treatment: surgery/radiation to remove/shrink tumors, corticosteroid medication to prevent adrenal crisis
Clinical Manifestation (due to prolonged exposure to glucocorticoids): stretch marks due to truncal obesity, extremity weakness and muscle wasting, thin skin, osteoporosis, suppressed inflammation and immune responses (more infections, skin ulcers, and poor wound healing), DM diagnosis due to glucose intolerance, and behavioral changes (euphoria to minor emotional disturbances to psychosis)
Moon face and buffalo hump appearance due to changes in fat metabolism
Due to excessive aldosterone (hypertension and hyperkalemia) or due to excessive androgen (hirsutism, which is excessive body and facial hair in women)
Hormone may be produced ectopically due to a tumor
Too little hormone
Diabetes Insipidus: deficiency of ADH
Diagnostic Criteria: serum hyperosmolality, low specific gravity <1.005, low ADH levels
Treatment: drink fluids to replace excessive loss or administer IV fluids for those with inadequate thirst
Clinical Manifestation: polyuria, excessive thirst, diluted urine, severe dehydration
Hypothyroidism: deficiency of thyroid hormone
Diagnostic Criteria: sensitive TSH assay, free T4, total T4 and T3 uptake, thyroid autoantibodies, antithyroglobulin test
Treatment: lifetime thyroid hormone replacement therapy (levothyroxine, which is synthetic T4)
Clinical Manifestation: fatigue, cold intolerance, weakness, weight gain, dry skin, coarse hair, constipation, lethargy, impaired reproduction, impaired memory
Myxedema: edematous tissue of the face, mucous membranes, hands, and feet
Addison Disease: deficiency of ACTH
Diagnostic Criteria: hyponatremia, hyperkalemia, depressed corticosteroid levels even after administration of ACTH
Treatment: temporary isotonic IV fluid with hydrocortisone sodium succinate or phosphate to improve blood pressure, lifetime oral replacement of glucocorticoid/mineralocorticoid hormones, increased salt intake during hot weather
Clinical Manifestation
With deficient mineralocorticoids: dehydration, hyponatremia, hyperkalemia
With deficient androgens: sparse axillary and pubic hair in women
With deficient glucocorticoid: hypoglycemia, weakness, poor stress response, fatigue, anorexia, nausea, vomiting, weight loss, personality changes
Receptor binding is impaired