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Altered hormonal and metabolic function - Coggle Diagram
Altered hormonal and metabolic function
Syndrome of Inappropriate Antidiuretic Hormone Secretion
condition of excessive production and release of ADH despite changes in serum osmolality and blood volume
ADH levels increase with certain medications and stressful stimuli like trauma, exposure to temperature extremes, pain conditions, surgery, or infection
most common cause is a tumor, secreting ectopic ADH
Diagnosis:
Hyponatremia, hypotonicity, decreased urine volume, highly concentrated urine with a high sodium content, absence of renal, adrenal, or thyroid abnormalities
Manifestations:
decreased and concentrated urine output, severity depends on serum sodium level and the rate of onset
rapid onset of hyponatremia leads to more severe- anorexia, nausea, vomiting, headache, irritability, disorientation, muscle cramps, and weakness
serum sodium level drops below- psychosis, gait disturbances, seizures, or coma
Treatment:
focus on removing the cause of if possible
mild hyponatremia- water restriction
severe hyponatremia- isotonic or supertonic saline administered intravenously
Diabetes Insipidus
Diagnosis:
patient history and physical examination
having recent surgery removing tumor of brain or head trauma, detect signs of dehydration and possible enlargement of bladder, ADH levels and urine-specific gravity lab tests
Manifestations:
loss of ADH or inadequate kidney response- polyuria and excessive thirst, urine is hgihly dilute with a low specific gravity... leads to serum hyperosmolality and severe dehydration, possible shock and death
condition of insufficient ADH that results in the inability to concentrate or retain water
Treatment:
hydration, IV hydration with a hypotonic solution, desmopressin, synthesis vasopressin analog
impairment of hypothalamic osmoreceptors after trauma or surgery to region at or near hypothalamus
Hyperthyroidism
results from excessive stimulation to the thyroid gland, diseases of the thyroid gland, or excess production of TSH by a pituitary adenoma
Diagnosis:
patient history and physical examination
family history of autoimmune disease, thyroid disease, or emigration from iodine-deficient location
enlarged and slightly firm thyroid gland, protrusion of the eyes
measurement of serum-free thyroxine, uptake of radioactive iodine by thyroid gland
Manifestations:
weight loss, agitation, restlessness, sweating, heat intolerance, diarrhea, tachycardia, palpitations, tremors, fine hair, oily skin, irregular menstrual cycle in women, and weakness; development of goiter, exophthalmos
Treatment:
Reducing thyroid hormone levels through gland destruction via radioactive iodine, medications blocking thyroid hormone production, or surgical removal of all or part of gland
cough expectorants, health food supplements that contain seaweed, and iodinated contrast dyes
Grave's Disease
Hypothyroidism
deficient thyroid hormone; congenital or acquired
Diagnosis:
Patient history and physical examination done
Laboratory tests looking at TSH, free T4, total T4, T3 uptake, thyroid autoantibodies, and antithyroglobulin that will help diagnose as well as confirm the cause
Manifestations:
gradual, fatigue, cold intolerance, weakness, weight gain, dry skin, coarse hair, constipation, lethargy, impaired reproduction, and impaired memory, or goiter
boggy, nonpitting, edematous tissues especially of the face and mucous membranes, hands, and feet
Treatment:
focus on replacing deficient hormone with goals of normalization of TSH,T4, and T3 levels, along wit alleviation of clinical manifestations
lifelong thyroid hormone replacement therapy initiated and increased until levels and improvements are achieved; Levothyroxine
deficient thyroid hormone synthesis, destruction of thyroid gland, or impaired TSH or TRH secretion
Cushing Syndrome
long-term administration of corticosteroid medications
tumors of pituitary gland stimulate excess ACTH production
tumors of the adrenal gland stimulate excess cortisol production
ectopic production of ACTH or CRH from a tumor at distant site
Manifestations:
excess secretion of glucocorticoids result in metabolic alteration, excessive circulating glucose and subsequent glucose intolerance, suppression of inflammatory and immune responses, behavioral changes, and an impaired stress response
obesity of the trunk, face, and upper back, protein degradation resulting in extremity weakness and muscle wasting, skin becomes atrophic and thin, bones exhibit osteoporosis, increased infections, skin ulcerations, and poor wound healing, diabetes mellitus, excessive body and facial hair, or changes in patterns of hair growth
prolonged exposure to elevated levels of endogenous or exogenous glucocorticoids
Diagnosis:
based on 24-hour urine collection where elevations in cortisol excretion are noted
imaging studies done to locate tumors that may be secreting excess ACTH or cortisol
Treatment
:
focus is on removing cause of excess hormone production
surgery or radiation, corticosteroid medication may be needed at first and then must be gradually withdrawn
Addison Disease
Manifestations:
based on insufficient levels of steroid hormones
Glucocorticoids- hypoglycemia, weakness, poor stress response, fatigue, anorexia, nausea, vomiting, weight loss, personality changes
Mineralocorticoids- dehydration, hyponatremia, hyperkalemia, hypotension, weakness, fatigue, shock
Androgens- sparse axillary and pubic hair in women
adrenal cortical insufficiency results from lack of CRH or ACTH, or lack of secretion of hormones from the adrenal cortex
typically presents when 90% or more of the adrenal cortices are destroyed or nonfunctional
autoimmune destruction of the adrenal cortex is the most common cause
Diagnosis:
based on clinical presentation and laboratory analysis of electrolyte levels, whether they show hyponatremia or hyperkalemia
measurement of serum corticosteroid levels, that will show corticosteroid levels that remain depressed after administration of ACTH
Treatment:
isotonic IV fluid replacement is infused with hydrocortisone sodium succinate or phosphate, once tapered off, oral replacement of glucocorticoid and mineralocorticoid hormones will proceed for remainder of life, increased salt intake in hot weather
caused by tuberculosis- treat with antibiotics with no further lifelong replacement needed
SIADH is excessive production and release of ADH vs Diabetes Insipidus is insufficient ADH
Hyperthyroidism is the excessive stimulation of the thyroid gland, whereas hypothyroidism is deficient in thyroid hormone productions