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Altered Hormonal and Metabolic Function (Damage to Metabolism - caused by…
Altered Hormonal and Metabolic Function
Damage to Hypothalamic-Pituitary Axis
- usually due to infection, inflammation, tumors, degeneration, hypoxia, hemorrhage or genetic defects
Diagnostic Criteria
- clinical presentation and lab analysis of electrolyte levels that show either hyponatremia and hyperkalemia. Corticosteriod levels are also measured.
Treatment
- acute treatment includes IV isotonic fluids, hydrocortisone sodium succinate, oral glucocorticoid and mineralocorticoid hormone replacements, increased salt intake
Clinical manifestations
- hyperpigmination due to elevated skin melanocytes, depending on hormones, hypoglycemia, weakness, fatigue, anorexia, nausea, vomiting, weight loss, personality changes, dehydration, hyponatremia, shock, sparse axillary,
Example
- Addison Disease
Damage to Feedback Mechanisms
- caused by ectopically produced hormone, tumors, and more
Diagnostic Criteria**
Diagnostic Criteria**- patient history, physical exam, measurment of TSH level, confirmed through serum-free thyroxine measurement, T3 and T4 level test
Treatment
- radioactive iodine to reduce levels, medication to block production and in extreme cases surgical removal
Clinical manifestations
- enlarged thyroid, weight loss, agitation, restlessness, sweating, heat intolerance, diarrhea, tachycardia, palpitations, tremors, fine hair, oily skin, irregular menstruation, and weakness
Damage to Metabolism
- caused by excess circulating hormone from inability to metabolize
Diagnostic Criteria
- 24 hour urine collection testing for cortisol, imaging studies to locate potential tumors
Treatment
- removing excess hormones, surgery or radiation may be needed to remove tumor, corticosteroid medications
Clinical manifestations
- metabolic alterations, suppression of inflammatory and immune responses, behavior changes, impaired stress response, obesity of trunk, face and upper back, weakness, muscle wasting, strophic and thin skin, osteoporosis, diabetes, mood changes
Example
- Hyperthyroidism
Example
- Cushing syndrome
Damage to Cell Receptors
- caused by decreased receptor number, lack of receptor sensitivity, antibodies present, tumor present
Diagnostic Criteria
- patient history and exam, may show recent surgery or trauma, physical signs of dehydration or enlarged bladder, serum solute concentration test, ADH level test and urine-specific gravity test done
Treatment
- hydration, IV fluid if needed, pharmacologic treatment with an anti diuretic, ect.
Clinical manifestations
- polyuria, excessive thirst, diluted urine, hyperosmolality, severe dehydration, shock and death could occur
Example
- Diabetes Insipidus
Damage to Elimination Mechanisms
- caused by excess circulating hormone from inability to eliminate
Diagnostic Criteria
- hyponatremia, hypotonicity, decreased urine volume, concentrated urine with sodium, absence of renal adrenal or thyroid abnormalities
Treatment
- removing cause, water restriction, isotonic or hypertonic saline IV administration, medication to block ADH and increase urine output
Clinical manifestations
- decreased and concentrated urine output, anorexia, nausea, vomiting, headache, irritability, disorientation, muscle cramps and weakness
Example
- Syndrome of Inappropriate Anti-diuretic Hormone Secretion
Damage to Endocrine Glands
- due to genetic defects, autoimmune conditions, degeneration, atrophy, infection, inflammation, neoplastic growths, hypoxia, radiation and other medications or injury
Diagnostic Criteria
- based on patient history and physical exam, TSH sensitivity assay done, free T4, total T4 and T3 uptake tests done, thyroid auto-antibodies and antithyroglobuliln test toconfirm
Treatment
- hormone replacement therapy and clinical signs and symptoms management
Clinical manifestations
- fatigue, cold intolerance, weakness, weight gain, dry skin, coarse hair, constipation, lethargy, impaired reproduction and memory
Example
- Hypothyroidism