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Hormonal and Metabolic Dysfunction (Inappropriate ADH Secretion…
Hormonal and Metabolic Dysfunction
Inappropriate ADH Secretion
ADH controls fluid balance by regulating reabsorption of water by the kidneys
Manifestations
Decreased and Concentrated Urine Output
Symptoms DO NOT manifest until serum sodium is 115-120 mEq/L
N/V
Anorexia
Headache
Disorientation
Diagnosis
hyponatremia ( Na <135 mEq/L)
#
hypotonicity (osmolality <280 mOsm/kg)
decreased UOP
highly concentrated urine w/ high Na content
absence of renal, adrenal, or thyroid abnormalities
Treatment
Fluid restriction
IV isotonic or hypertonic saline
Diabetes Insipidus
Insufficient ADH that results in the inability of the body to concentrate or retain water
Manifestations
Depend of severity
Polyuria
polydipsia
severe dehydration and serum hyperosmolality
Diagnosis
H&P
Signs of dehydration
Enlargement of bladder
lab measurements of serum solute concentration
Treatment
Hydration
IV
PO
DDAVP
Hyperthyroidism
Excessive thyroid hormone
Manifestations
Weight loss
Agitation
Restlessness
Sweating
Development of Goiter
Exophthalmos (protrusion of the eyeballs)
Diagnosis
Family hx of autoimmune disease, thyroid disease
Enlarged and slightly firm thyroid gland
Measurement of serum TSH levels
#
Treatment
Goal is to reduce thyroid hormone levels
Gland destruction via radioactive iodine
Ablation of thyroid gland
Cushing Syndrome
Prolonged exposure to elevated levels of endogenous or exogenous glucocorticoids
Manifestations
Glucose intolerance
Suppression of inflammatory and immune responses
behavioral changes
Obesity of trunk, face and upper back
Hirsutism (excessive body and facial hair)
Diagnosis
24 hr urine collection where elevations in cortisol excretion are noted
Imaging studies to locate tumors excreting excess ACTH or cortisol
Treatment
Surgery or radiation to remove tumors
Corticosteroid
Hypothyroidism
Deficient Thyroid Hormone
Manifestations
Gradual
Fatigue
Weight gain
Cold intolerance
Dry Skin
Myxedema (boggy, nonpitting edematous tissue)
Diagnosis
TSH assay
H&P
#
Treatment
Thyroid hormone replacement therapy
Addison Disease
ACTH deficiency; presents when 90% or more of the adrenal cortices are destroyed or nonfunctional
Manifestations
Skin Melanocytes
Results in hyper pigmentation or darkening of skin and mucous membranes
Diagnosis
Laboratory analysis
hyponatremia
hyperkalemia
serum corticosteroid levels
Treatment
Isotonic IVF replacement along w/ hydrocortisone sodium succinate or phosphate
Oral replacement of glucocorticoid and mineralcorticoid hormones
Increased salt intake in hot weather
Caden Smith