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Hormonal and Metabolic Dysfunction, Alyssa Vasquez …
Hormonal and Metabolic Dysfunction
Syndrome of Inappropriate Antidiuretic Hormone Syndrome (SIADH)
The clinical manifestations for SIADH are related to hypotonic hyponatremia and include a decreased and concentrated urine output. The symptoms for a rapid onset could include anorexia, nausea, vomiting, or headache, as well as muscle cramps. The symptoms for a sodium low level could include psychosis, gait disturbances, seizures, or coma.
The diagnostic criteria for SIADH are serum sodium < 135mEq/L (hyponatremia), plasma osmolarity < 280 mOsm/kg (hypotonicity), decreased urine volume, high concentrated urine with high sodium content, and the absence of renal, adrenal, or thyroid abnormalities.
The treatment for SIADH focuses on removing the cause of the disease if possible. Medications may be administered to block the effects of ADH or to increase urine output if removing the cause is not feasible.
Diabetes Insipidus (DI)
The clinical manifestations for DI depend on the severity of the DI. Loss of ADH or inadequate kidney response to ADH results in polyuria and excessive thirst. Loss of fluids leads to serum hyperosmolarity and severe dehydration, shock and death can occur if untreated.
The diagnostic criteria for DI is made through carful patient history and physical examination. Lab measurement of serum solute concentration, ADH levels, and urine specific gravity is used to confirm the diagnosis. Which is a urine specific gravity of 1.005 or less and a urine osmolarity less than 200 mOsm/kg are often found in DI.
The treatment for DI is hydration, being hydrated is important for this diagnosis. IV hydration with hypotonic solution is required. Pharmacologic treatment may include the use of desmopressin, a synthetic vasopressin analog, which acts as a potent antidiuretic.
Hyperthyroidism (Graves Disease)
The clinical manifestations for hyperthyroidism are related to enlargement of the thyroid gland and the excessive metabolic rate of the body. Weight loss, agitation, restlessness, sweating, heat intolerance, diarrhea, tachycardia, palpitations, tremors, fine hair, oily skin, and irregular menstrual cycle are common findings for hyperthyroidism.
The diagnostic criteria for hyperthyroidism is based on the patients history and physical examination. The patient history may be significant for a family history of autoimmune disease, thyroid disease, or emigration from an iodine-deficient location.
The treatment for hyperthyroidism measures are based on reducing thyroid hormone levels through gland destruction via radioactive iodine, medications that block thyroid hormone production, or less commonly surgical removal of all part of the gland.
Hypothyroidism
The clinical manifestations for hypothyroidism are often gradual and include fatigue, cold intolerance, weakness, weight gain, dry skin, coarse hair, constipation, lethargy, impaired reproduction, and impaired memory. Goiter may also be present.
The diagnostic criteria is based on the patients history and physical examination. Lab studies include the sensitive TSH assay, free T4, total T4, and T3 uptake, thyroid autoantibodies, and antithyroglobin tests to confirm the diagnose and provide evidence as to causality.
The treatment for hypothyroidism focuses on replacing the deficient hormone with the goals of normalization of TSH, T4, and T3 levels, along with alleviation of the clinical signs and symptoms. The most common drug used to treat hypothyroidism is levothyroxine, which is a synthetic form of T4.
Cushing Disease
The clinical manifestations for cushing disease are excess secretion of glucocorticoids can result in metabolic alterations, excessive circulating glucose and subsequent glucose intolerance, suppression of the inflammatory and immune responses, behavioral changes, and impaired stress response.
The diagnostic criteria for cushing disease is often based on a twenty four hour urine collection. False-positive tests may result in those with obesity, alcoholism, chronic renal failure, anorexia, or bulimia (these all raise cortisol secretion).
The treatment for cushing disease is focused on removing the cause of excess hormone production. Surgery or radiation may be needed to remove tumors, and corticosteroid medications may be needed to avert an adrenal crisis during acute illness.
Addison Disease
The clinical manifestations for addison disease are based on insufficient levels of the steroid hormones. Elevations in ACTH levels stimulate skin melanocytes, resulting in hyperpigmentation, or darkening of the skin and mucous membrane.
The treatment for addison disease IV fluid replacement is infused along with hydrocortisone sodium succinate or phosphate. Treatment of the bacteria with antibiotics is required since tuberculosis bacteria can destroy the adrenal gland.
The diagnostic criteria for addison disease is based on the clinical presentation and lab analysis of electrolyte levels demonstrating hyponatremia and hyperkalemia.
Alyssa Vasquez BIOL.219- Sec 1 July 4, 2023