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Altered Hormonal and Metabolic Regulation - Coggle Diagram
Altered Hormonal and Metabolic Regulation
Alteration in Elimination
Diabetes Insipidus
Insufficient ADH resulting in inability to retain or concentrate water
Manifestations
Polyuria
Highly dilute urine
Excessive Thirst
Shock, Death
Serum hyperosmolality
Diagnostic Criteria
H&P for recent cranial surgeries
Bladder enlargement
Signs of Dehydration
Lab values
Urine-sp gravity 1.005 or less
Low ADH levels
Urine osmoliity less than 200 mOsm/kg
Treatment
Hydration/Fluid Replacement
Desmopressin (DDAVP)
IV Hypotonic Solution
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
Diagnostic Criteria
Decrease Urine Volume
Highly concentrated urine with high sodium content
Hyponatremia
Hypotonicity
Renal, Adrenal, and Thyroid Abnormalities ruled out
Treatment
Water Restriction
IV Isotonic or Hypertonic Saline, if severe hyponatremia
Excessive production and release of ADH
Manifestations
Disorientation
Muscle Cramping and Weakness
Psychosis, Gait Disturbances, Seizures, Coma
Anorexia
Nausea/Vomiting
Unknown Tumor secreting ectopic ADH
Impairment of Hypothalamus-Pituitary Axis
Cushing Syndrome
Treatment
Removal of Tumor
Surgical
Radiation
Corticoteroids
Prevention of acute adrenal crisis
Excessive ACTH Production
Prolonged exposure to endogenous or exogenous cortisol
Manifestations
Obsesity in trunk, face, and upper back
Moon Face, Buffalo Hump
Abdominal stretch marks; Thin and Atrophic Skin
Osteoporosis
Behavioral Changes
Psychosis
Euphoria
Diagnostic Criteria
Elevated cortical levels in blood, urine, saliva
CT or MRI of adrenal or pituitary gland
Hyperthyroidism
State of excessive thyroid hormone
Overstimulation of thyroid gland
Diagnostic Criteria
Physical Examination
Lab Values
Elevated T3 and T4 serum levels
Elevated FT4 levels
Treatment
Radioactive Iodine
Surgical Removal of all/part of Thyroid Gland
Manifestations
Goiter
Oily Skin, Irregular Menstrual Cycles in Women
Exophthalmos
Graves' disease
Weight loss, tachycardia, tremors, palpitations
Impairment of Endocrine Gland
Addison Disease
Treatment
Isotonic IV Fluid Replacement with Hydrocortisone Sodium Succinate
Oral replacement of Glucocorticoid and Mineralocorticoid hormones
Increased sodium intake, if hot weather
Manifestations
Dependent upon Deficient Hormone
Glucocorticoids
Hypoglycemia, Weakness, Fatigue
Nausea/Vomiting, Weight loss, Personality Changes
Mineralocoticoids
Hyponatremia, Hyperkalemia
Androgen
Sparse axillary and Pubic Hair in Women
Diagnostic Criteria
Depressed Corticosteroid Levels after ACTH administration
Adrenal and Cortisol Insufficieny
Hypothyroidism
Diagnostic Criteria
Lab Values
Elevated TSH
Decreased FT4
Decreased T3 and T4 levels
Treatment
Lifelong Thyroid Hormone Replacement Therapy
Levothyroxine
State of deficient thyroid hormone
Manifestations
Myxedema
Fatigue, Cold Intolerance, Weakness
Weight Gain
Dry skin, Coarse Hair, Impaired Reproduction
Excess Hormone Secretion
Ectopic Hormone Production
Impaired Negative Feedback Loop