Altered Hormonal or Metabolic function can lead to
Syndrome of Inappropriate Antidiuretic Hormone Secretion.
Cushing syndrome
Hyperthyroidism
Diabetes Insipidus
Hyopthyroidism
Addisons Disease
Impaired Hypothalamic-Pituitary Axis
Impaired Endocrine Gland
Decreased or Increased horomone production/secretion
The Gland is not producing active hormone
Target cell unresponsive
Negative feedback loop impaired
Hormone is being produced ectopically
Manifests decreased/concentrated urine output, hypotonic hypothermia nausea vomiting headach, weakness, muscle cramping, seizure/psychosis/coma
Diagnosed by serum sodium <135mEq/L
Plasma osmolality < 280 mOsm/kg
Decreased urine volume and no renal abnormalities
Treated by water restriction, removing the cause, isotonic/hypertonic saline IV (hyponatremia) with altered mental status,
water intoxication
Manifestations
excessive thirst
low specific gravity urine/diluted
polyuria: increased urine output
Severe dehydration, loss of fluid=serum hyperosomolality
Diagnosed by
physical exam:dehydration, enlarged bladder
Serum Solute/ Urine Osomolality <200mOsm/kg
specific gravity of urine <1.005
Treated with
Staying hydrated
IV hydration with hypotonic solution
pharmacologic treatement: desmopressin (antiduretics)
Manifestations include fatigue, cold intolerance, weight gain, dry skin/coarse hair, impaired reproduction, impaired memory, goiter; swelling of the tissues of face, hands, feet, and mucous membranes
Diagnosis
Treatments
Manifests as
Treatment
Diagnosis
Diagnosis
Treatment
Manifestations include stimulation of skin melanocytes causing darkening of skin/mucous membranes
Treatment
Manifestations metabolic alterations, glucose intolerance, suppression of immune/inflammatory response, impaired stress response, obestity of trunk, face, upperback "moon face" excess circulating glucsose
Diagnosis
agitation, restlessness, sweating
diarrhea, palpitations, tremors
Weight loss, fine hair, weakness
Protrusion of the eyeballs (exophthalmos)
physical exam: history of autoimmune/thyroid disease
protrusion of the eyes and measurement of thyroxine (TSH suppressed)
increased uptake of radioactive iodine by thyroid gland
Pharmacology blocking thyroid hormone
surgical removal of the gland
reduce hormone levels
Thyroid hormones decreased, TSH often elevated
Lab studies of TSH T4, Total T2/T3, thyroid autoantibodies, and antithyroglobulin.
history/physical,
24 hour urine collection (cortisol secretion), Imaging studies to locate a potential tumor that may be secreting ACTH or cortisol.
Corticosteroid medications
Removing source of hormone production: Surgery/Radiation
Lab studies: hyponatremia, hyperkalemia
Physical Examination
Corticosteroid levels remain depressed even after ACTH administration
Actue: IV of isotonic, Hydrocortisone sodium succinate or phophate infusion/tapering.
Hormone replacement therapy
Hirsutism: excessve body hair, facial hair, pubic/axillary hair growth changes
Graves Disease
Hormone replacement therapy
Diet changes: Increase nature iodine