NURSING MANAGEMENT OF PATIENT WITH

METABOLIC AND ENDOCRINE DISORDERS

• Endocrine system terminology

• Endocrine

• Exocrine

• Hormone

• Target organ

• Hypersecretion

• hyposecretion

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 • Pituitary grand diseases

• Hyperpituitarism
hyperpituitarism of growth hormone (GH) by the
pituitary

• Gigantism
—GH hyper secretion during puberty and growth
years

• Person is very tall , proportioned normally

• Acromegaly
—GH Hypersecretion during adulthood
dis guring overgrowth of bones & soft tissues

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• HYPERPITUITARISM:

• Other aspects:
—Gigantism:
fairly abrupt onset
non-life threatening
growth upto 6 inches/yr
—Agromegaly:
.Gradual onset
.Decrease life expectancy
.Headache, sinus problems, skin
changes, parethesias, joint pain, visual
disorders

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 • Hypopituitarism

• De ciency of any or all of the pituitary

hormones

• Usually involve GH and gonadotropin

—LH, FSH, prolactin, oxytocin

• Less commonly involved:

—ACTH and TSH

• Panhypopituitarism:
— All hormones are de cient

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 • Hypopituitarism

• S/S: varies with hormone de ciency and age of disease onset .

• —In childhood: S/S are dwar sm and delayed development of

secondary sexual characteristics
—In adults: S/S are amenorrhea, infertility, lowering of
testosterone levels, libidy, hair loss.
— ACTH & TSH de ciency;

• general

• s/s : fatigue, pallor, anorexia, poor stress response

• Hypopituitarism

• Treatment : hormone replacement

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 • DIABETES INSIPIDUS

• Hyposecretion of vasopressin
—ADH(antidiuretic hormone)

• S/S: extreme polyuria, thirst, very dilute urine

produced, leads to dehydration

• Etiology: anything that destroys the pituitary or

idiopathic

• Treatement: uid replacement, hormone

replacement(tablet, nasal spray)

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• THYROID GLAND DISEASES

• Goiter
-enlargement or hyperplasia of thyroid
gland

• Simple goitre
-goitre not caused by infection, tumour,
other hypo-or hyperthyroid condition
-more common in females
-sporadic and endemic types

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 • GOITER

• Sporadic type
-ingestion of certain foods, drugs
(goitrogens)

• Endemic type
-diet de ciency of iodine

• Etiology: hyperplasia due to inability to

make su cient T3 and T4, compensation

• Treatment :T3 and T4 or iodine

replacements, surgery,dietery,changes

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 • THYROIDITIS

• In ammation of thyroid glands

• Females more than males

• Etiology & types

• Autoimmune
.Antibodies to thyroid hormones
.Myxedema, grave’s disease

• Subacute granulomatous
.follows an infection (mumps, in uence, adenovirus)

• Miscellaneous
.Bacterial infections (TB, syphilis, suppurative)

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 • Thyroiditis

• S/S: may have no symptoms or thyroid

enlargement, pain and dysphagia

• Autoimmune thyroiditis=most common

type, common in females

• Treatment varies with type:

—hormone replacement, steroid,
antibiotics, anti-in ammatories, pain
meds

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 • GRAVE’S DISEASE

• Hyperthyroidism
—grave’s disease is most common hyperthyroid
disease

• Hypersecretion of T3 and T4

• May cause thyrotoxicosis

—di use e ect, multiple symptoms

• Females mostly, 30-40 YOA

• ETIOLIGY :
—genetic or immunologic

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• GRAVE’S DISEASE

• Treatment:
—Varies with disease severity & patient
age —
Antithyroid drugs, surgery, radioactive
iodine therapy

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• Hypothyroidism

• Hypo secretion of thyroid hormones

• More common in women, esp. ovr 40 YOA

• Two versions
cretinism
congenital form
Myxoedema
starts in childhood or adulthood

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 • Hypothyroidism

• Etiology:
—Dietery metabolic, iatrogenic, congenital,
in ammatory, chronic autoimmune

• S/S
—children: growth retardation, delayed sexual
development, impaired intelligence
—adults: cold intolerance, fatigue, constipation,
weight gain, anorexia, dry skin, brittle hair &
nails, cardiomegaly, myxoedema coma

• Treatment: Hormone replacement meds

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 • Parathyroid diseases

• A ects women more than men(2:1)

• Excessive secretion of PTH by gland

causes abnormalities of calcium (Ca++)
and phosphates(P04-)

• EFFECTS :

• -Hypercalcemia (most important e ect)

• -Hypophosphatemia

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 • HYPERPARATHYROIDISM / HYPERCALCEMIA

• Primary disease: parathyroid adenoma

• Secondary disease: chronic RF, calcium

de cient diet, calcium malabsorption

• any condition that tends to reduce circulating

levels of calcium

• S/S: many patients are asymptomatic

—brittle bones, arthralgia, calcium renal
stones, polyuria, nausea, vomiting, fatigue,
muscle weakness or atrophy, cardiac
arrythmias
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 • Hyperparathyroidism

• Treatment:
— Surgical removal of glands (s)
— Increasing uid & sodium intake
— Meds that increase calcium excretion
— Treatment varies with the etiology,
primary or secondary
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• HYPOPARATHYROIDISM

• Under section of PTH by gland

—Hypocalcemia
—Excessive calcium deposition into bones

• Etiology: iatrogenic (surgical) or inherited

• S/S: parenthesis of extremeties, muscle

cramps(tetany), depression, irritability,
laryngospasm, seizures, brittle nails, hair
loss

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 • Hypoparathyroidism

• Treatment:
vitamin D and calcium supplements
periodic lab tests to determine serum
levels
— high calcium, low phosphorous diet

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• Adrenal Disease

• Cushing’s syndrome:
—Hypersecretion of hormones by the adrenal
cortex

• — cortisol excess
—more common in women
—may be due to:
Over secretion of ACTH
Benign or malignant neoplasm of adrenal cortex
iatrogenic (prolonged steroid treatment)

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 • Cushing’s Disease

• S/S:
—“moon faces”, truncal obesity with thin limbs
“bu alo hump”, decreased glucose tolerance,
muscle weakness, hypertension, anxiety,
depression

• Treatment:
—Surgery for tumor removal, drug or radiation
to decrease ACTH SECRETION

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 • Other Adrenal Diseases

• Addisson’s disease
—Hypo secretion of adrenal cortex hormones
—decreased ability to handle physiological stress
—low BP , increased

• Pheochromocytoma
-tumour of adrenal medulla
-secretes catecholamines
.Epinephrine
.norepinephrine
.like SNS, increase blood pressure, heart rate ,
skin ushing.

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 • DIABETES MELLITUS

• Chronic carbohydrate metabolism disorder

due to insulin de ciency or inadequate
insulin utilisation by cells

• Insulin
—pancreatic endocrine secretion
(hormone)
— Made by islet of Langerhans
— Lower serum glucose level
— Allows cellular uptake and use of
glucose

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• Diabetes mellitus (DM)

• Disorder characterised by:

— Hyperglycaemia
— Ketosis (ketones in the blood)
— Acidosis.

• (excess hydrogen ions in the blood )

• Ketoacidosis

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