Altered Hormonal and Metabolic Functions
Damage to HPA
Damage to Feedback Mechanisms
Damage to Endocrine Glands #
Damage to Cell Receptors
hyperpituitariarism
hypopituitariarism
Addison Disease
Hypothyroidism
Diabetes Insipidus (DI)
Cushing Syndrome
Hyperthyroidism
SIADH
SIADH
Addison Disease
severe dehydration
excessive thirst
polyuria
anorexia, NV
pyschosis, gait disturbances (Na <110meq/L)
decreased/concentrated urine
Diagnostics
hypotonicity
hyponatremia
Tx
IV hypertonic solution
fluid restriction
Diagnostics
bladder enlargement
urine osmolality <200, urine-specific gravity of 1.005 or less
recent cranial surgery/head trauma
Tx
Desmopressin (DDAVP)
hypotonic IVF
Hypothyroidism #**
Hyperthyroidism #
fatigue, cold intolerance, wt gain
tumor common cause
goiter, myxedema
cretinism
Diagnostics
free T4, total T4, T3 uptake
thyroid antibodies
↑ TSH, serum thyroid decreased
Levothyroxine
wt loss, agitation, sweating
thyrotoxic crisis, thyrotoxicosis
Graves Dx
Diagnostics
↓ TSH
family hx
eye protrusion
enlarged/firm thyroid
Tx
radioactive iodine
beta-blockers
full thyroid ablation
Cushing Syndrome #
hirsutism
thin/atrophic skin
trunk obesity, moon face, buffalo hump
↑ BG
Diagnostics
imaging
24-hr urine w/↑ cortisol
Tx
corticosteriods
surgery/radistion
hyperpigmentation skin
↓ gluoco/mineral corticoids, androgens
hypoglycemia, vomiting
sparse public/axillary hair women
dehydration, hyonatremia
Tx
high Na diet
lifetime steroids
isotonic IVF w/hydrocortisone
tumors that may be producing ↑ ACTH/cortisol
Damage to Metabolism & Elimination