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Altered Hormonal & Metabolic Function - Coggle Diagram
Altered Hormonal & Metabolic Function
Impairment of Hypothalamic-Pituitary Axis
Diabetes Insipidus
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Damage to the hypothalamus or posterior pituitary
↓ ADH secretion
Kidneys cannot reabsorb water in collecting ducts
Excessive water loss
Dehydration
Causes
Tumors
Head trauma
Infection
Pituitary surgery
Damage to hypothalamus or posterior pituitary
Clinical Manifestations
Dehydration
Polydipsia
Polyuria
Hypernatremia
Diagnosis
Water deprivation test
Serum osmolality ↑
Urine osmolality ↓
Treatment
Fluid replacement
Desmopressin
ADH replacement
Endocrine Gland Dysfunction
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Hypothyroidism
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Causes
Hashimoto Thyroiditis
Thyroid Destruction
Radiation
Thyroidectomy
Thyroid gland dysfunction
↓ T3/T4 production
↓ Cellular metabolism
Clinical Manifestations
Fatigue
Weight gain
Cold intolerance
Constipation
Dry skin
Diagnosis
↑ TSH
↓ T4
Treatment
Levothyroxine
Hyperthyroidism
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Causes
Graves disease
Toxic multinodular goiter
Thyroid adenoma
Excess thyroid hormone production
↑ metabolic rate
Excessive sympathetic stimulation
Clinical Manifestations
Weight loss
Heat intolerance
Tachycardia
Anxiety
Tremor
Diagnosis
↓ TSH
↑ T3/T4
Treatment
Methimazole
Radioactive iodine
Thyroidectomy
Addison Disease
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Causes
Autoimmune adrenal destruction
Infection
Hemorrhage
Metastatic cancer
Adrenal cortex destruction
↓ cortisol
↓ aldosterone
Impaired stress response and sodium retention
Clinical Manifestations
Fatigue
Weight loss
Hypotension
Hyperpigmentation
Hyponatremia
Diagnosis
ACTH stimulation test
↓ Cortisol
↑ ACTH
Treatment
Glucocorticoid replacement
Mineralocorticoid replacement
Too Much Hormone Production
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Cushing Syndrome
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↑ Cortisol
↑ gluconeogenesis
Protein breakdown
Fat redistribution
Causes
Pituitary adenoma (Cushing)
Adrenal tumor
Excess corticosteroid use
Clinical Manifestations
Hyperglycemia
Truncal obesity
Moon face
Hypertension
Muscle wasting
Treatment
Remove tumor
Cortisol-lowering medications
Reduce steroid use if applicable
Diagnosis
Serum cortisol levels
24 hr urine cortisol
Dexamethasone suppression test
Too Little Hormone Production
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Insufficient Hormone Secretion
Inadequate target-cell stimulation
Decreased physiologic function
SEE
Diabetes insipidus (↓ ADH)
Hypothyroidism (↓ T3/T4)
Addison Disease (↓ Cortisol/Aldosterone)
Receptor Binding Defect
Hormone present but cannot bind receptor
Not primary mechanism in the six clinical models
Ectopic Hormone Production
SIADH (Syndrome of Inappropriate ADH Secretion)
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Causes
Small-cell lung cancer
CNS injury
Pulmonary disease
Medications
↑ ADH secretion
Excessive water reabsorption
Dilutional hyponatremia
Cerebral edema
Clinical Manifestations
Weight gain
Headache
Confusion
Seizures
Hyponatremia
Diagnosis
↓ Serum osmolality
↑ Urine osmolality
Serum sodium levels
Treatment
Fluid restriction
Hypertonic saline
Vasopressin antagonists
Treat underlying cause
Feedback Dysfunction
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SEE
Cushing Syndrome
Excess cortisol
Feedback regulation disrupted
Continued cortisol excess
SIADH
ADH secretion continues despite low serum osmolality
Feedback regulation ineffective
Target Cell Response Defects
Hormone binds receptor but intracellular signaling fails
Receptor is activated, but cell cannot carry out instructions
Not primary mechanism in the six clinical models
Causes
Enzyme defects
Protein defects
Intracellular signaling abnormalities
Is Hormone Metabolism and Elimination Impaired?
Causes
Liver disease
Kidney disease
Impaired hormone breakdown
Hormone accumulation
Prolonged hormone effects
Clinical manifestations depend on hormone affected
Treatment
Treat liver/kidney disease