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Altered Hormonal and Metabolic Function (Syndrome of Inappropriate…
Altered Hormonal and Metabolic Function
Syndrome of Inappropriate Antidiuretic Hormone Secretion
Alteration
: excessive production and release of ADH (despite changes in serum osmolality and blood volume.)
Most common cause
is a tumor
Clinical Manifestations:
hypotonic hyponatremia, decreased/concentrated urine, anorexia, nausea, vomiting, headache, irritability, disorientation, muscle cramps, and weakness, psychosis, gait disturbances, seizures, or coma.
Diagnostic Criteria
: Hyponatremia (Na<135mEq/L), Hypotonicity (osmolality < 280mOsm/Kg), decreased urine output, concentrated urine, etc.
Treatment
: remove cause of SIADH (water restriction, IV isotonic or hypertonic saline administration, etc.
Diabetes Insipidus
Alteration
: insufficient ADH that prevents the body from concentrating or retaining water OR inadequate kidney response to ADH, OR overhydration that decreases ADH levels.
Most common cause
is impairment of hypothalamic osmoreceptors after trauma or surgery.
Clinical Manifestations:
polyuria (large volume urine output), excessive thirst, serum hyperosmolality severe dehydration, shock, and death.
Diagnostic Criteria
: patient history, physical examination, urine specific-gravity < 1.005, urine osmolality < 200mOsm/kg.
Treatment:
hydration, IV hydration, and desmopressin.
Cushing Syndrome
Alteration
: prolonged exposure to elevated levels of endogenous or exogenous glucocorticoids.
Major Causes
: long term use of corticosteroid medications, pituitary gland tumors, adrenal gland tumors, or ectopic productive on ACTH or CRH from distant tumors.
Clinical Manifestations:
metabolic alterations, excessive circulating glucose, glucose intolerance, suppression of the inflammatory and immune reponse, behavioral changes, obesity, extremity weakness, thin skin, osteoporosis, increased infections, etc.
Diagnostic Criteria:
elevation in urine and imagine studies to locate tumors.
Treatment
: remove the cause of excess hormone production, corticosteroid medications, etc.
Hypothyroidism
Alteration
: deficient thyroid hormoneAcquired hypothyroidism can result from deficient thyroid hormone synthesis, destruction of the thyroid gland, or impaired TSH.TRH secretion.
Common causes
of acquired hypothyroidism: autoimmunity, iodine deficiency, surgical removal, radiation therapy, medications, and genetic defects.
Clinical Manifestations
: fatigue, cold intolerance, weakness, weight gain, dry skin, coarse hair, constipation, lethargy, impaired reproduction, impaired memory, goiter, myxedema, etc.
Diagnostic Criteria
: patient history and physical examination. Lab tests for TSH levels, free T4/total T4/ total T3 uptake, thyroid autoantibodies, and antithyroglobluin.
Treatment
: replace deficient hormones to normalize TSH, T4 and T3 levels. Thyroid hormone replacement therapy with levothyroxine or other drugs.
Hyperthyroidism
Alteration
: excessive thyroid hormone because of excessive stimulation of the thyroid gland, diseases of the thyroid gland, or excess production of TSH by a pituitary adenoma
Most common cause
is Grave’s disease, an excessive stimulation of the thyroid gland.
Clinical Manifestations
: goiter, exophthalmos, excessive metabolic rate of the body (weight loss, agitation, restlessness, sweating, etc.)
Diagnostic Criteria
: patient history and physical examination (goiter, exophthalmos, etc.), serum-free thyroxine levels, elevated levels of serum T3 and T4, and increased uptake of radioactive iodine by the thyroid gland.
Treatment
: reduce thyroid hormone levels through gland destruction via radioactive iodine, medications that block thyroid hormone production or surgical removal of the gland.
Addison Disease
Alteration
: acute ACTH deficiency from lack of CRH or ACTH, or adrenal cortex hormones.
Cause
: autoimmune destruction of the layers of the adrenal cortex is most common cause for Addison Disease specifically.
Clinical Manifestations
: hyperpigmentation of skin and mucous membranes, hypoglycemia, personality changes, dehydration, hyponatremia, hyperkalemia, etc.
Diagnostic Criteria
: clinical presentation, hyponatremia and hyperkalemia lab results, low corticosteroid levels in the serum after administration of ACTH.
Treatment
: isotonic IV fluid replacement, hydrocortisone sodium succinate, oral glucocorticoid and mineralocorticoid hormones, increased salt intake in hot weather, etc