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Altered Hormonal and Metabolic Function - Coggle Diagram
Altered Hormonal and Metabolic Function
Cushing syndrome
diagnostic criteria
i. 24 hour urine collection to see if there is an elevation in cortisol levels
ii. Imaging studies to locate tumors
treatment modalities
i. focus on removing the cause of excess hormone production
ii. corticosteroid medications
clinical manifestations
i. excess secretion of glucocorticoids leading to:
ii. Obesity of the face and posterior neck and back
iii. Protein degradations
iv. Atrophic and thin skin
v. Osteoporosis
vi. Suppression of the inflammatory and immune responses leading to increased infections, skin ulcerations and poor wound healing
vii. Glucose intolerance
viii. Alterations in behavior
ii. Obesity of the face and posterior neck and back
iii. Protein degradations
iv. Atrophic and thin skin
v. Osteoporosis
vi. Suppression of the inflammatory and immune responses leading to increased infections, skin ulcerations and poor wound healing
vii. Glucose intolerance
viii. Alterations in behavior
hypothyroidism
diagnostic criteria
i. patient history
ii. physical examination
iii. laboratory testing for TSH
treatment modalities
i. focus on replacing the deficient hormone with goals of normalizing TSH T4 and T3 and alleviations of clinical signs and symptoms
ii. lifelong thyroid hormone replacement therapy
iii. levothyroxine
clinical manifestations
i. gradual
ii. fatigue
iii. cold intolerance
iv. weakness
v. weight gain
vi. dry skin
vii. coarse hair
viii. constipation
ix. lethargy
x. impaired reproduction
xi. impaired memory
xii. Goiter
xiii. dietary iodine deficiency
xiv. myxedema
syndrome of inappropriate antidiuretic hormone secretion
related to hypotonic hyponatremia
symptoms
depends on the serum sodium level
rate of onset
including examples such as
a. anorexia
b. nausea
c. vomiting
d. headache
e. irritability
f. disorientation
g. muscle cramps
h. weakness
Significant symptoms manifest after serum sodium is less that 115 to 120 mEq/L
include a decreased and concentrated urine output
diagnostic criteria
i. hyponatremia
ii. hypotonicity
iii. decreased urine volume
iv. highly concentrated urine with a high sodium content
v. absence of renal, adrenal or thyroid abnormalities
treatment modalities
i. removing the causative agent, if possible
ii. mild symptoms of hyponatremia
water restriction
iii. severe hyponatremia (altered mental status)
isotonic or hypertonic saline via IV administration
iv. medications to block the effects of ADH or increase urine output, if removing the causative agent is not possible
hyperthyroidism
diagnostic criteria
i. patient history
ii. physical examination, enlarged thyroid gland or protrusion of eyes
iii. family history of autoimmune disease, thyroid disease or emigration from an iodine-deficient location
iv. screenings of TSH levels
treatment modalities
i. centered around reducing thyroid hormone levels through gland destruction via radioactive iodine, medications blocking thyroid hormone production or surgical removal
ii. full ablation of thyroid glands (require oral thyroid hormone replacement therapy for life)
clinical manifestations
i. related to enlargement of thyroid gland and excessive metabolic rate of the body
ii. weight loss
iii. agitation
iv. restlessness
v. sweating
vi. heat intolerance
vii. diarrhea
viii. tachycardia
ix. palpitations
x. tremors
xi. fine hair
xii. oily skin
xiii. irregular menstrual cycle in women
xiv. development of goiter
xv. exophthalmos
Addison Disease
diagnostic criteria
i. based on clinical presentation
ii. laboratory analysis of electrolyte levels (signifying hyponatremia and hypokalemia)
iii. corticosteroid serum levels measured (signifying depressed levels after ACTH administration)
treatment modalities
i. for acute illness
isotonic IV replacement with hydrocortisone sodium succinate or phosphate
ii. long-term
once tapered off of IV fluids, oral glucocorticoid and mineralocorticoid hormones are takensalt intake may need to increase in hot weather (excepted Addison caused by TB)
clinical manifestations
i. insufficient levels of some steroid hormones
ii. elevations in ACTH levels
iii. hyperpigmentation or darkening of skin and mucous membranes
diabetes insipidus
i. patient history
ii. physical examination (to look at previous cranial surgery)
iii. laboratory assessments of serum solute concentration, ADH levels, and urine-specific gravity
i. fluid replenishment
ii. IV hydration with hypotonic solution
iii. Pharmacologic intervention like desmopressin, synthetic vasopressin or analog
clinical manifestations
i. depend on severity
ii. loss of ADH or inadequate kidney response to ADH results in polyuria and excessive thirst
iii. loss of fluids leads to serum hyperosmolality and severe dehydration
iv. shock and death occur if untreated