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Altered Hormonal and Metabolic Function (Diabetes Insipidus (DI) # # #…
Altered Hormonal and Metabolic Function
Diabetes Insipidus (DI)
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There is not enough ADH which causes the body not to be able to concentrate or retain water
Caused by
Insufficient production of ADH, inadequate kidney response to the presence of ADH, and large amounts of fluid that then decreases ADH levels
Manifestations
Polyuria and excessive thirst
Loss of fluids
Severe dehydration
Shock or death
Diagnostic criteria
Patient history
Recent cranial surgery
Physical examination
Signs of dehydration and enlargement of the bladder
Urine-specific gravity
1.005 or less
Treatment
More fluids, IV hydration, and desmopressin
Hyperthyroidism
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Excessive thyroid hormone
Caused by
Graves disease
Manifestations
Weight loss, restlessness, sweating, diarrhea, tachycardia, tremors, and weakness
Excessive metabolic rate of the body, enlargement of the thyroid gland, and protrusion of the eyes
Diagnostic criteria
Patient history
Family history of autoimmune disease, thyroid disease, or emigration from an iodine-deficient location
Physical examination
Enlargement of the thyroid gland and protrusion of the eyes
Measurement of serum TSH levels
Confirm with serum free thyroxine
TSH levels are suppressed due to negative feedback loop
Treatment
Main goal is to reduce thyroid hormone level
Gland destruction, medication, or surgically
Hypothyroidism
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Deficient thyroid hormone
Caused by
Autoimmunity, iodine deficiency, and surgical removal of the thyroid gland
Manifestations
Fatigue, weakness, weight gain, constipation, and impaired memory
Diagnostic criteria
Patient history and physical examination
Thyroid autoantibodies and antithyroglobulin test
Treatment
Main goal is to replace the deficient hormones of TSH, T4, and T3 levels
Thyroid hormone replacement therapy
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
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Excessive production and release of ADH
Cause by
Tumor
Manifestations
Decreased urine output, anorexia, vomiting, headaches, and weakness
Diagnostic criteria
Based off of laboratory findings
Hyponatremia (serum sodium less than 135 mEq/L
Hypotonicity (plasma osmolality less than 280 mOsm/kg
Decreased urine volume and high concentration of urine
Treatment
Main focus is to remove the cause (tumor) and medication is removing the tumor does not help improve urine output
Mild symptoms of hyponatremia: fluid restriction
Severe hyponatremia: isotonic or hypertonic saline
Cushing Syndrome
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Prolonged exposure to high levels of endogenous or exogenous glucocorticoids
Caused by
Long term use of corticosteroid medications, tumors or the pituitary gland, and ectopic production of ACTH or CRH from a distant tumor
Manifestations
Obesity, weakness, skin becomes thin, osteoporosis, ulcers, diabetes mellitus, hirsutism, and psychosis
Diagnostic criteria
24 hour urine collection
Detects high levels of cortisol
Imaging studies
This helps locate tumors that may be secreting more ACTH or cortisol
Treatment
Main goal is to remove what is causing the high levels of hormones
Surgery or radiation
Corticosteroid medication
Addison Disease
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Acute ACTH deficiency
Caused by
Lack of ACTH production from the pituitary
Manifestations
Depends on the levels of a hormone
Glucocorticoids
Hypoglycemia, weakness, weight loss, fatigue, and anorexia
Mineralocorticoids
Dehydration, fatigue, shock, hypotension, hyperkalemia, and hyponatremia
Androgens
Sparse axillary and pubic hair in women
Treatment
Isotonic IV fluid replacement
Oral replacement of glucocoticoid and mineralocorticoid hormones
Diagnostic criteria
Laboratory analysis of electrolyte levels
Shows hyponatremia and hyperkalemia
Impairment of the hypothalamic-pituitary axis
Impairment of the endocrine gland
Too much or not enough hormone produced and secreted
Impairment of hormone metabolism and elimination