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Altered Hormonal and Metabolic function - Coggle Diagram
Altered Hormonal and Metabolic function
Syndrome of inappropriate antidiuretic hormone secretion
clinical manifestations include decreased and concentrated urine output, depends on serum sodium level, significant if <115 mEq/L. rapid onset shows anorexia, nausea, vomiting, headache, irritability, disorientation, muscle cramps, weakness.
condition of excessive ADH production and release, resisting changes to serum osmolality and blood volume
most commonly caused by tumor that is secreting ectopic ADH, diagnosing criteria includes finding hyponatremia, hypotonicity, decreased urine volume, highly concentrated urine with a high sodium content, and absence of renal, adrenal and thyroid abnormalities
treatment includes medication to block ADH affects or increase urine output, or having saline administered intravenously if removal of ADH-stimulus is not possible
Diabetes Insipidus
condition of insufficient ADH, body can't retain water, due to inadequate kidney response to ADH and insufficient production of ADH by the hypothalamus, ineffective secretion by posterior pituitary, or ingestion or large fluid volumes.
clinical manifestations include polyuria, excessive thirst, severe dehydration, serum hyperosmolality, urine has low specific gravity
diagnostic criteria includes patient history of recent head trauma or brain tumor removal, physical examination to detect dehydration, lab measures of serum solute concentration, ADH levels, and urine-specific gravity of 1.005 or less will confirm the diagnosis
treatment includes staying hydrated, such as IV hydration with a hypotonic solution. medications include a vasopressin analog to act as a antidiuretic.
Hyperthyroidism
state of excessive thyroid hormone, resulting from excessive stimulation to thyroid gland due to disease or excessive TSH production by pituitary adenoma
clinical manifestations related to thyroid gland enlargement and excessive metabolic rate of body. weight loss, heat intolerance, sweating, restlessness, agitation, tachycardia, irregular menstrual cycle and weakness are common. Goiters develop as well as exophthalmos (like in Graves disease)
diagnostic criteria based on patient history and physical examination, often finding and enlarged and firm thyroid gland and eye protrusion. history of autoimmune or thyroid disease is prevalent.
treatment includes medications to reduce thyroid hormone levels via gland destruction using radioactive iodine, or that block thyroid hormone production. surgery is less common. Full removal requires life-long oral hormone replacement therapy.
Hypothyroidism
state of deficient thyroid hormone, can be congenital or acquired, may lead to cretinism if not treated. may result from deficient thyroid hormone synthesis, destruction of gland, or impaired TSH or TRH secretion
clinical manifestations are gradual, include fatigue, cold intolerance weakness, weight gain, coarse hair, constipation, impaired memory and reproduction. goiter may be present as the gland enlarges.
diagnostic criteria based on patient history and physical examination, but mostly lab tests including TSH assay, free T4, total T4, T3 uptake, thyroid autoantibodies and antithyroglobulin tests used to confirm.
treatment works to replace the deficient hormone by normalizing TSH, T4 and T3 using medications like Levothyroxine and Synthroid
Cushing Syndrome
condition of prolonged exposure to elevated endo- or exogenous glucocorticoids. 4 processes that contribute: long term administration of medications like prednisone, tumors of pituitary gland that stimulate excess ACTH, adrenal gland tumors, ectopic production of ACTH or CRH from tumor
clinical manifestations include hirsutism, physical changes like changes in fat metabolism leading to obesity, behavioral changes, impaired stress response, suppression of inflammatory and immune responses
diagnostic criteria based on 24-hour urine collection to detect elevations in cortisol. imagine studies used to locate tumors that are secreting excess ACTH
treatment is focused on removing the cause of excess hormone production, surgery or radiation to remove tumors, corticosteroid medications may supplement during acute illness
Addison Disease
characterized as acute ACTH deficiency, may lead to hypotension, shock and death. commonly caused by autoimmune destruction of the layers of adrenal cortex.
clinical manifestations are based on which hormone is deficient in the body. androgen deficiency= less body hair in women, mineralcorticoids= dehydration, hyponatremia, hyperkalemia, hypotension. glucocorticoids= hypoglycemia, personality changes, hypoglycemia
diagnostic criteria includes clinical presentation and lab values showing hyponatremia and hyperkalemia. serum corticosteroid levels will show depressed corticosteroid levels after ACTH administration.
treatment includes isotonic IV infusion with hydrocortisone sodium succinate or phosphate to improve blood pressure, oral glucocorticoids are supplemented to replace hydrocortisone IV for remainder of life. if Addison's is caused by TB bacteria, antibiotics are needed.