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Disorders of altered hormonal & metabolic regulation (Cushings (Cause:…
Disorders of altered hormonal & metabolic regulation
Addisons
Adrenal hormone deficiency
Cause: destroyed pituitary gland, destruction of adrenal cortex
Increased ACTH to combat
CM: CMs of low glucocorticoids, mineral corticosteroids & androgens High ACTH causes hyperpigmentation. Hypotension, shock
Dx: lab tests revealing hyponaturemia & hypokalemia. Low serum corticosteroids even after ACTH administration
Tx: IV w/ isotonic saline & hydrocortisone sodium succinate or phosphate to increase BP. Oral gluco & mineralocorticoids for life. High sodium diet in heat
Thyroid disorders
Hypothyroidism
5x greater risk after 80
Cause: congenital or acquired
Acquired: autoimmune (hashimotos), destruction of thyroid, surgery, no hormone secretion, genetics, Sx
CM: tired, cold, weak, weight gain, constipation, impaired memory, myxedema
Dx: sensitive TSH assay, free T4, total T4, T3 uptake, thyroid auto antibodies & antithyroglobulin. Low serum thyroid hormones, increased TSH
Tx: levothyroxine
Hyperthyroidism
Cause: excessive stimulation or disease of thryoid. Increased TSH in pituitary, expectorants, seaweed, autoimmune (graves)
CM: weight loss, hot, agitation, diarrhea , tachycardia, tremor, brittle hair, oily skin, altered men’s traction, weakness, goiter & exophthalmus
Dx: from iodine deficient area, firm thyroid gland, high serum free T4 , increased uptake of radioactive iodine
Tx: gland destruction via radioactive iodine , methimazole or PTU (Rx), Sx removal of thyroid
Women
Gradual onset
Temp, hair, weight, skin, mental , bowel
Cushings
Cause: prednisone, tumor on pituitary, adrenal gland, or ectopic
CM: metabolic alterations , increased glucose (DM), decreased immunity, behavioral changes, obesity of trunk, face & upper back (moon face), muscle weakness & wasting, atrophic & thin skin, osteoporosis
Tx: tumor removal via radiation or Sx. Gradual removal of corticosteroids
Dx: 24hr urine collection showing high cortisol, imaging studies for tumor. Possibility of false positive
Prolonged exposure to glucocorticoids
Syndrome of Innapropriate ADH Hormone secretion SIADH)
Excess production & release of ADH w/o stimuli
Cause: tumor secretion ectopic ADH
Dx: hyponaturemia , hypotonicity, low urine output
H2O restriction or hypotonic IV , tumor removal
CM: hyponaturemia, increased urine concentration, low urine output, anorexia, nausea, vomiting , headache, irritabiltiy, disorientation , muscle cramps, weakness. Eventual psychosis, seizures, coma
Diabetes Insipidus (DI)
Cause: decreased production in hypothalamus or decreased secretion in pituitary , inadequate kidney response to ADH (nephrogenic DI), large fluid intake
CM: polyuria , extreme thirst, hyperosmolality, shock , dehydration
Low ADH- no H20 retention
Dx: patient he, large bladder, specific gravity < 1.005
Tx: hypotonic IV , desmopressin (ADH) (DDAVP)