DISORDERS OF THE THYROID GLAND cells.

The disease usually results in a decline in

hormone production (hypothyroidism).
THYROID HORMONES
Sarcoidosis
• T3—Triiodothyronine--metabolism, growth
development • is an inflammatory disease in which the immune
• T4—Tetraiodothyronine or Thyroxine ○ catabolism, system overreacts, causing clusters of inflamed
body heat production tissue called "granulomas" to form in different organs
• Thyrocalcitonin ○ Involves Ca²⁺ deposits into of the body.
thebones regulates serum Ca²⁺ • Sarcoidosis most commonly affects the lungs and
lymph nodes, and thyroid gland but it can also affect
the eyes, skin, heart and nervous system.
I¹⁻ → oxidized → plasma iodide
+ 6. Decreased thyroid hormones (T3 and T4)
thyroglobulin ← tyrosine
• therefore slow basal metabolic rate (BMR):
Iodine— • decręasęd BMR affects lipid metabolism, increases
chỏlęsterol and triglyceride levels, and affeçts RBC
• essential element for the production of T3 and T4 production, leading to anemia and folate deficiencies.
• Comes from the ingested iodine in the diet,
• Iodine is oxidized to plasma iodide. 7. Hypothyroidism also commonly occurs in patients with
• Plasma iodide will enter the thyroid gland by active previous hyperthyroidism that has been treated with
transport radioiodine or antithyroid medications or thyroidectomy.

Sources of Iodine CLINICAL FINDINGS

• Fish (such as cod and tuna), seaweed, shrimp, and • Dull mental process
other seafood, which are generally rich in iodine. • Apathy
• Dairy products (such as milk, yogurt, and cheese) and • Lethargic
eggs, which are also good sources of iodine. • Poor memory/attention span
• Iodized salt • Increased sleeping (14-16hrs)

Plasma iodide

• is combined with tyrosine [amino acid derived from

the diet] to produce thyroglobulin
• Thyroglobulin is a stored form of thyroid hormones in
thyroid gland And thyroglobulin is Released into the
blood stream in the form of T3 and T4
• Therefore, protein is essential in the diet.

DISORDERS OF THE THYROID GLAND

HYPOTHYROIDISM- Deficiency of thyroid hormones

Etiology and pathophysiology Classified according to time of life when it

occurs:
1. Deficient hormone
synthesis a. Cretinism: Congenital Hypothyroidism
2. Congenital thyroid defects hypothyroidism found at birth
3. Prenatal and postnatal
In Congenital Hypothyroidism- Permanent
iodine deficiencies
retardation occurs if not treated within first six
4. Autoimmune diseases
weeks of life with thyroid hormones
that causes
hypothyroidism (e.g., • Detection is done
Hashimoto disease, through newborn metabolic
sarcoidosis) screening [blood test] at 24
48 hours of life
Hashimoto's disease is an
autoimmune disorder that can Signs & Symptoms for
cause hypothyroidism, or Cretinism
underactive thyroid.
• PROLONGED
Jaundice (2 weeks or more)
Poor feeding,
• lethargy.
• constipation, bradycardia,
• Respiratory difficulty.
• hoarse cry weight over 4kg
• dwarfism ,
• LARGE fontanels

Wide Anterior Fontanel

• The fontanelle allows skull to deform during birth to

ease its passage through birth canal and for
expansion of brain after birth.
• Definition: enlarged fontanelles are larger than
• In Hashimoto's disease, the immune-system cells expected soft spots for age of a baby.
lead to the death of the thyroid's hormone producing
Management for cretinism: Clinical findings for hypothyroidism

• Lifelong therapy • Decreased libido,

• Thyroid hormones • difficulty becoming pregnant,
• changes in menses (women);
b. Lymphocytic thyroiditis: (a painless lymphotic • impotence (men)
thyroiditis{inflammation of the thyroid gland}) • intolerance to cold
• Lack of facial expression;
• Occurs most often after 6 years of age and peaks • weight gain;
during adolescence; • constipation;
• generally self-limiting • subnormal temperature and
• pulse rate;
• dry, brittle hair and nails;
• pale, dry, coarse skin;
• enlarged tongue;
• hoarseness;
• thinning of lateral
• eyebrows;
• loss of scalp, axilla, and
• pubic hair;
• diminished hearing;
• anemia;
• periorbital edema

c. Myexedema -hypothyroidism in adults

Myxedema coma

• is a rare and extreme complication of hypothyroidism

• It affects with multiple organ abnormalities associated
with altered sensorium,
• it can be fatal.
• Hypothyroid patients exhibit multiple physiologic
alterations to compensate for the deficiency of thyroid
hormone
• is most severe degree of hypothyroidism & a
potentially fatal endocrine emergency exhibited by the
ff:
▪ hypothermia,
▪ bradycardia,
▪ hypoventilation,
▪ progressive loss of consciousness;
▪ precipitated by severe physiologic
stress;

Severe hypothyroidism can be precipitated by the following:

• illness,
• withdrawal of thyroid meds,
• anesthesia,
• sedatives,
• surgery,
• hypothermia,
• STRESS
dx for hypothyroidism
MANAGEMENT
• Decreased serum T3 and T4 levels
• Patent airway • Increased TSH levels as the
• Replace fluids with IV NSSS o Hypothalamus and anterior pituitary gland
• Give levothyroxine sodium IV make stimulatory hormones (TSH) as a
• Give glucose, corticosteroids IV compensation
• Check temp, BP, LOC, hourly • Decreased radioiodine uptake
• Check blood sugar levels • Elevated Serum Lipid, Cholesterol and Protein levels
• Aspiration precautions,
Interventions for hypothyroidism
• keep warm
1. Lifelong Hormone Replacement of Thyroid hormones:
Classification according to causes:
• levothyroxine (Synthroid;Eltroxin);most comon
• Primary—result from the failure of the thyroid gland to secrete • liothyronine (Cytomel);
T3 and T4 • liotrix (Thyrolar)
2. Maintenance of vital functions
• Secondary—result from the failure of the anterior pituitary 3. Screening every 5 years after age 35 for thyroid
gland to secrete thyroid-stimulating hormone hormone status
4. Instruct client
• Tertiary—result from the failure of the hypothalamus to • Modify outdoor activities in cold weather; wear
release thyroid-releasing hormone adequate clothing because of sensitivity to cold
environments
 • Use moisturizers for dry skin
• Restrict calories, cholesterol, and fat in diet to
prevent weight gain
• Diet: iodized salt
• Avoid constipation (e.g., increase fluid intake and
fiber in diet)
• Teach to seek medical supervision regularly
ASIN LAW
• The Act for Salt Iodization Nationwide (ASIN LAW), or
the Republic Act 8172, is the requirement of the
addition of iodine to salt intended for the animal and
human consumption in order to eliminate
micronutrient malnutrition in the country.
• The Act was approved on December 20, 1995 by
former President Fidel V. Ramos
HYPERTHYROIDISM (GRAVES DISEASE,
THYROTOXICOSIS)
• Is a metabolic imbalance resulting from excessive
thyroid hormone production.
• Most common form of hyperthyroidism is GRAVE’S
DISEASE
• Common in women and peak age occurs between 30
– 40 yrs
• Decrease TSH
• Radioactive Thyroid Scan wound indicate an
increased Iodine uptake & (hot spots in the thyroid
gland)
• Tachycardia in EcG
Thyroid Storm, (also called thyroid crisis and thyrotoxic
crisis)
• happens when the thyroid gland releases a large
amount of thyroid hormone in a short amount of time.
• It's a rare complication of hyperthyroidism.
• Thyroid storm is a medical emergency and is life-
threatening condition.
• hypermetabolism occurs and may lead to heart failure
• usually precipitated by a severe physiologic or
psychologic stress (e.g., manipulation of gland during
thyroid surgery,
• radioactive iodine therapy that releases thyroid
hormone into bloodstream
Risks for Thyroid Storm, Thyroid Crisis
• Infection,

Etiology and pathophysiology of HYPERTHYROIDISM

1. Excessive concentration of thyroid hormones in blood

as result of thyroid disease or increased levels of TSH
that leads to hypermetabolic state
2. Autoimmune process autoantibodies mimic the TSH
leading to a hypersecretion of the thyroid hormones
3. Toxic nodular goiter. • surgery,
4. Exposure to iodine • radioactive iodine
5. TSH secreting pituitary tumor
▪ Assessment:
6. Thyroiditis – inflammation of the thyroid gland
• Tachycardia (> 130), Hypertension
• Increased temp, agitation/anxiety
• N/V,
• diarrhea

Management for Thyroid Storm,Thyroid Crisis

• propylthiouracil (PTU) large doses then

SSKI(saturated sol of potassium iodide)
• Hypothermia blanket,
• acetaminophen
• Propranolol (Inderal) and digoxin IV
• O2,
• fluids

Therapeutic interventions for hyperthyroidism

Basic concept to remember in hyperthyroidism 1. Antithyroid medications:

“Everything is high, fast and wet” • propylthiouracil (PTU), methimazole
(Tapazole);
Clinical findings for hyperthyroidism
block synthesis of thyroid hormones
• polyphagia,
• emotional lability (mood swings), 2. Antithyroid medications:
• apprehension, heat intolerance • iodine (potassium or kalium iodide SSKI-
• Weight loss, saturated sol of potassium iodide));
• loose stools,
• tremors, This medications reduce vascularity of thyroid gland
• hyperactive reflexes, 3. Radioactive iodine: 131T (atomic cocktail);
• restlessness,
• diaphoresis, destroys thyroid gland cells, thereby decreasing production of
• insomnia, thyroid hormone
• exophthalmos, corneal ulceration,
• increased systolic blood pressure, temperature, pulse 4. Medications to relieve clinical findings related to
rate, and respiration increased metabolic rate:
• adrenergic blocking agents
Diagnostic tests:
For treatment of HPN & arrythmia (Carvedilol)
Serum thyroid function test:
5. Graves’ ophthalmopathy:
• Increased T3 levels (NV:60-181 ng/dl) • prednisone to reduce inflammation behind
• Increased T4 levels (NV: : 4.5 – 10.9 mcg/dl) the eye
 • orbital decompression to reduce abnormal
protrusion of the eyeball (exophthalmos);
• various procedures to correct vision or
protect eye, (e.g., eye drops, patches, tinted
eyeglasses, elevation of head of bed, cool
compresses to eyes
6. Well-balanced, high-calorie diet with vitamin and
mineral supplements, low fiber diet if with diarrhea
• Avoid stimulants like caffeine Fluid
replacement for diarrhea
7. Surgical intervention: subtotal or total thyroidectomy;
1. Establish climate for uninterrupted rest (e.g.,
decreased stimulation, prescribed medications);
provide relaxing, calm environment
2. Protect from stress-producing situations
3. Keep room cool
4. Provide care before thyroidectomy
a) Teach importance of taking prescribed antithyroid
medications to achieve euthyroid state
b) Teach deep-breathing exercises and use of
hands to support neck to avoid strain on suture
line after surgery
5. Provide care after thyroidectomy
• Observe for clinical findings of respiratory distress
and laryngeal stridor caused by tracheal edema;
• explain a sore throat when swallowing is expected;
• keep tracheotomy set available
• Assess for hoarseness which may result from
endotracheal intubation or laryngeal nerve damage
• Maintain in semi-Fowler position to reduce edema at
surgical site
CARE AFTER THYROIDECTOMY
• Observe for hemorrhage at operative site and back of
neck and shoulders
• Observe for thyrotoxicosis (e.g., high temperature,
tachycardia, irritability, delirium, coma)
• Notify health care provider immediately if clinical
findings of thyrotoxicosis occur;
• administer propranolol (Inderal), iodine,
propylthiouracil (PTU), and steroids as prescribed
• Observe for signs of tetany (e.g., numbness or
twitching of extremities, spasm of glottis, positive
Chvostek and Trousseau signs)
Tetany is a symptom that involves involuntary muscle
contractions and overly stimulated peripheral nerves.
It's caused by electrolyte imbalances — most often
low blood calcium levels.
o because hypocalcemia can occur after
accidental trauma or removal of parathyroid
glands;
o give calcium gluconate or calcium chloride
(IV) as prescribed if tetany occurs
Trousseau signs
• is carpal spasm which indicates hypocalcemia
• This is done by compression of the brachial artery
with BP cuff for 3 minutes is done to assess for
trousseaus signs
6. Teachings regarding Radioactive iodine therapy
a. Client is mildly radioactive and should follow radiation
precautions as advised (usually 7 days)
(1) Increase clear fluid intake
(2) Void hourly during first 8 to 12 hours
(3) Flush toilet twice after use
(4) Ensure thorough hand hygiene
(5) Avoid contact with children; avoid close prolonged contact
or sleeping with another person
(6) Do not share dishes, utensils, food, or drink with another;
avoid kissing and sexual contact until permitted
b. Hospitalization in isolation may be required for several days
if larger dose is used
c. Clinical findings of hyperthyroidism may take 3 to 4 weeks to
subside
7. Teach client the importance of taking antithyroid
medications regularly and to observe for adverse
effects
• Hypothyroidism occurs as result of treatment
• Hyperthyroidism occurs as result of
thyrotoxicosis or overmedication with thyroid
hormone replacement therapy
HYPERTHYROIDISM
Hypothyroidism may result from therapy
(e.g., radioactive iodine-RADIATION DESTRROYS THE
THYROID GLAND, thyroidectomy); and thyroid hormones
levothyroxine (Synthroid)
8. Instruct client to comply with periodic T3, T4, TSH
studies to monitor hormone levels
DISORDERS OF THE PARATHYROID GLAND
HYPOPARATHYROIDISM- Decreased ParaThyroid hormone
level resulting in hypocalcemia
Parathyroid hormone (PTH) is a hormone released by the
parathyroid glands to control calcium levels in the blood.
• It also controls phosphorus and vitamin D levels.
• If your body has too much or too little parathyroid
hormone, it can cause symptoms related to abnormal
blood calcium levels
Etiology for HYPOPARATHYROIDISM
• Insufficient amount of parathormone after thyroid
surgery because removal of the parathyroid tissue,
• parathyroid surgery, or radiation therapy of neck
• As level of parathormone drops, serum calcium level
also drops, causing clinical findings of tetany; when
the ca level dec, serum phosphate level inc
• Etiology in children is Unknown
Clinical manisfestations of hypoparathyroidism
• Decreased serum calcium and parathormone levels;
• elevated serum phosphate level
 • photophobia,
• irritability,
• dyspnea,
• Stridor and wheezing from laryngeal spasm;
• tremors;

ASSESSMENT of Hypoparathyroidism

• Mild tingling and numbness around the face &

extremities
• Severe muscle cramps,
• carpopedal spasms,
• Seizures

Signs of tetany:
6. Aluminum hydroxide: to decrease
• Cardiac dysrhythmias absorption of phosphorus from the GI tract
• Dysphagia
Nursing responsibilities:
+CHVOSTEK’S SIGN:
• Observe for respiratory distress;
• twitching of mouth, • have emergency equipment
nose and eye in available for tracheostomy and mechanical
response to tapping ventilation
near the angle of the • Reduce environmental stimuli
jaw • Maintain seizure precautions

+TROUSSEAU’S SIGN:

• carpopedal spasm induced by application of BP cuff

• Provide dietary instruction (e.g., elimination of milk,

cheese, and egg yolks because of high phosphorus
content;
• encourage inclusion of dietary sources of calcium that
are low in phosphorus)
DX for hypoparathyroidism • Teach clinical findings of hypocalcemia and
hypercalcemia; instruct to contact health care provider
• X-ray examination reveals increased bone density immediately if either occurs
• CT scan
• Dec Serum Ca, Mg, Vit D HYPERPARATHYROIDISM
• Inc Serum phosphate
• Occurs when there is Hyperfunction of parathyroid
• Cardiac dysrhythmias,
glands;
• alkalosis,
• hypertrophy and hyperplasia of glands
• cataracts if disease is chronic
• Primary etiology : is usually caused by adenoma;
Therapeutic interventions • Secondary etiology: Radiation, Vit D def, Chronic
Renal Failure with hypocalcemia
1. Calcium chloride or calcium gluconate given IV for • Occurs because of the Increased reabsorption of
emergency treatment of tetany calcium and excretion of phosphorus by kidneys
2. Calcium salts administered orally: • Demineralization of bone occurs if dietary intake is not
o calcium carbonate (TUMS, CalPlus, Caltrate, enough to meet calcium levels demanded by high
Os-Cal 500), levels of parathormone
o calcium gluconate (Kalcinate);
o calcium citrate (Citracal, CalCitrate 250) ASSESSMENT

Calcium 0.5-2G daily (Oral), 10% (IV) 1. Hypercalcemia

3. Vitamin D:
• Dihydrotachysterol (Hytakerol),
• Ergocalciferol (Calciferol)
o to increase absorption of calcium from the GI
tract
o Recommended dose: VIT D: calcitriol
(Rocaltrol)
▪ Ergocalciferol daily: 50,000–
400,000 U
4. Parathormone injections
5. High-calcium, low phosphate diet
 2. Hypophosphatemia <2.5mg/dl • Surgical excision of parathyroid tumor:
parathyroidectomy
Phosphate is a charged particle that contains the mineral • Restriction of dietary calcium intake
phosphorus and it is needed for several important bodily • Limit high calcium
functions, including: foods
• High fluids (oral, IV)
• Building and repairing your bones and teeth.
• Encourage mobility
• Helping your nerves function.
• Assess skeletal
• Making your muscles contract
involvement (pain)
The body needs vitamin D in order to absorb phosphate. • Assess renal
involvement
• The kidneys help control the levels of phosphate in • Acid-ash diet, I and O
your blood by filtering out extra phosphate and • Furosemide (Lasix) to increase renal excretion of
eliminating it through your urine (pee). calcium
• the kidneys can also reabsorb phosphate instead of • Dialysis,
filtering it out if you have low phosphate levels. • Pharmacology to decrease calcium level: gallium
(Ganite), calcitonin (Miacalcin)
• Calcimimetics: cinacalcet (Sensipar) This tricks
parathyroid glands into releasing less parathyroid
hormone
• Hormone replacement therapy for postmenopausal
women with osteoporosis; may help bones retain
calcium
• Calcium & vit d supplement
• Bisphosphonates: alendronate (Fosamax),
ibandronate (Boniva), risedronate (Actonel) this help
prevent loss of calcium from bones

After parathyroidectomy for parathyroid hyperplasia:

Other Assessments for Primary Hyperparathyroidism
• autotransplant of a segment of parathyroid gland is
• Renal calculi/stones, placed in forearm or neck to prevent
• repeated UTI’s, hypoparathyroidism
• azotemia
• Anorexia, DISORDERS OF THE ADRENAL GLAND Two distinct parts
• N/V, of the arenal gland:
• constipation
• ADRENAL CORTEX
• Lethargy,
• ADRENAL MEDULLA
• stupor, psychosis

Diagnostics for Primary Hyperparathyroidism:

• Elevated Serum PTH--Normal 50-330 pg/ml

• Elevated Serum calcium :--normal range: 9-
10.5mg/dL
• Decreased Serum phosphate:--Normal 3.0-4.5mg/dL
• X-ray: demineralized bone

Other Clinical findings

• apathy,
• fatigue,
• muscular weakness,
• emotional irritability,
• deep bone pain (if demineralization occurs),
• backaches
• bone cysts,
• pathologic fractures
• Renal damage,
• pyelonephritis,
• polyuria,
• constipation
• Cardiac dysrhythmias

Therapeutic interventions for hyperparathyroidism

 • Increased Melanocyte Stimulating Hormone
o Tan complexion
o Bronze skin

Manifestations Of Adrenocortical Insufficiency

(Addison’s disease)

for the adrenal cortex the hormones secreted are  aldosterone – hypotension, weight loss, weakness
glucocorticoids, mineralocoricoids, sex hormones,  cortisol - hypoglycemia
• androgen - Φ
• Remember the 3 sss, sex hormone, sugar and • Loss of axillary and pubic hair
sodium (salt)
• Then the adrenal medulla secretes adrenaline and
noradrenaline that is needed for the fight & flight
responses

Inner—adrenal medulla

• Epinephrine or adrenaline [derived from the word

adrenergic]—both dilator and constrictor
o Norepinephrine or noradrenaline—only
vasodilation
• Dilate coronary artery
o Increase myocardial blood flow or perfusion
o Increase myocardial contraction Diagnostics for Adrenocortical Insufficiency (Addison's
▪ Increase pulse rate disease
▪ Tachycardia
• Dilate pulmonary blood vessel • ACTH stimulation test using cosyntropin or Cortrosyn
o Relaxation of smooth muscle of bronchi and stimulation test
bronchioles o Fast: 6 hrs before test
o Bronchial dilation • Cortisol levels
o Increase rate and depth of respiration
▪ Tachypnea or hyperpnea A cortisol test
• Constrict peripheral arterioles
o Increase peripheral resistance • shows whether a person has high or low levels of
▪ Increase BP or hypertension cortisol, which may indicate an adrenal disorder.
o Decrease blood supply to skin and mucous • A normal cortisol value in a blood sample taken at 8
membrane a.m. is 5 to 25 mcg/dL.
▪ Pallor • But results can vary widely, depending on the time of
o Glycogenolysis—breakdown of glycogen to the test and the other factors that affect cortisol levels.
glucose in the liver
Management for Adrenocortical Insufficiency (Addison's
▪ Hyperglycemia disease)
ADRENAL CORTEX Maintenance
Hyposecretion
• High carbo, protein diet, dec K+
1. Addison’s Disease • Monitor infection
• Increase sodium: 4-6 gm/day
Hypersecretion • Monitor BP. I & O, weight, bed rest
• Steroid hormone replacement
2. Cushing’s Disease
3. Conn’s Disease (Primary Aldosteronism) Steroid Therapy

ADRENAL MEDULLA Glucocorticoids (given 2/3 dose AM, 1/3 PM)

Hypersecretion • Cortisone acetate (Cortone Acetate)

• Hydrocortisone (Solu-
4. Pheochromocytoma Cortef, Cortaid, Corticaine)
• Dexamethasone
Addison’s Disease (Adrenocortical
(Decadron)
Insufficiency)--Chronic deficiency of
• Prednisone
adrenal cortex hormones
(Deltasone, Meticor
▪Causes for Addison’s Disease :
Mineralocorticods: Give in
• Autoimmune (atrophy of the AM
adrenal gland)
• Flurocortisone 0.05 - 0.1 mg Pi
• Bilateral adrenalectomy
• Sudden cessation of
• Give with meals because steroids are gastric
exogenous hormone
irritant
Hypoactive adrenal cortex and • Give with antacids
Decreased SSS hormones therefore • Report: signs of infection, because steroids
dec sss hormone: suppress immune response
o wt gain (5 lb/wk) bec of fluid & Na retention
• Hypoglycemia • Monitor: I&0,
• Decrease BP • Monitor potassium levels, steroids excrete potassium
• Hyponatremia (possibility of Hypokalemia), Hyperglycemia: monitor
• Hypovolemia blood & urine sugar hypertension,
• Hyperkalemia • Cushing syndrome
• Dysrhythmia • Medic-Alert bracelet, emergency kit.
 • Increase capillary fragility
• Patient is prone to Ecchymosis
o Therefore avoid any form of skin trauma or
injury
• Patients are also prone to Osteoporosis with
prolonged use of steroid
o Therefore increase calcium in the diet

When is steroid best taken?

• In the morning
• it mimics the timing of your body's own production of
cortisone
• Taking your dose of prednisone too late in the
evening may cause difficulty sleeping.
• Cortisol as nature's built-in alarm system
• Cortisol is a steroid hormone, in the glucocorticoid Adrenal Crisis- Worst form of Addison's Disease (hypotension,
class of hormones. When used as a medication, it is shock)
known as hydrocortisone. It is produced in many
animals, mainly by the zona fasciculata of the adrenal Addisonian crisis (acute adrenal insufficiency)
cortex in the adrenal gland. It is produced in other
• Can be precipitated by stresses (e.g.. pregnancy,
tissues in lower quantities
surgery, infection, dehydration, emotional turmoil);
Nrsg Considerations when on steroids therapy: • fatal if not treated
• Sudden decline in steroid level
• Taper the dose when withdrawing steroid o Severe hypoglycemia
o Example: o Severe hypotension
▪ Prednisolone 5mg, 4tab, TID, for 5 o Severe hypovolemia
days, then o Cardiac Arrest
▪ Prednisolone 5mg, Ztab, BID, for 3 • Management
days, then o ABC
▪ Prednisolone 2mg, 1tab, OD, for 3 o IV fluid replacement
days o Monitor blood Na, K, & sugar
o To avoid Addisonian Crisis o IV steroid immediately
o Supportive management
Surg Tx: (Adrenalectomy)
Management:
Preop
• Identify cause
• Check glucose and K* levels o Reverse shock,
• Vitamins and proteins for tissue repair o Restore bld circ,
• Asepsis o VS closely
o Antibiotics if infection
Post-op
• Dexamethasone: 5-10 mg IV stat
• Give IV steroids as prescribed • For Na and K imb replacements
• Monitor BP, I and O and electrolytes • -Glucagon for hypoglycemia
• Teach: Steroid replacement (bilateral), s/s of Adrenal
2. Cushing's Disease
crisis
• Hyperactive adrenal cortex
Addison's Disease (PRIMARY ADRENAL INSUFFICIENCY)
• Increased SSS hormones
• is a medical emergency caused by a lack of cortisol. • Excess cortex hormones:
• autoimmune destruction of cortex or idiopathic o Corticosteroids
atrophy o Glucocorticoids, mineralocorticoids,
• Associated with endocrine disorders, o androgen
• And can be caused by sudden cessation of
s/s Cushing's Disease
glucocorticoids, adrenalectomy, tuberculosis,
acquired immunodeficiency syndrome (AIDS) • Moon facis
• Virilism or
masculinization
• Hirsutism
• Enlargement of the
clitoris
• Buffalo hump
• Hypernatremia,
hypokalemia

Edema to Anasarca

What is anasarca?

• Anasarca is the gross and

generalized edema of the
body tissues with profound
subcutaneous swelling due
to accumulation of excess
fluid in the body tissue.
• Anasarca is not a disease
itself but it is a symptom of
an underlying condition
Cushing's Syndrome Interventions:

Risk factors: • Spironolactone

• Surgical removal
• Pituitary tumor (Inc ACTH)
• Adrenal cortex tumor
• Long term steroid use
• -Common: women (20-40
yrs)

DX:

• Inc serum na, K,

hyperglycemia
• Dexamethasone suppression
test
• Increased cortisol levels in
plasma & urine
• CT scan, MRI

Management:

• Diet: high protein, potassium

• Restrict NA, water intake,
• Monitor F/E
• Promote home safety: fractures
• Adrenal cytotoxic meds/cortisol inhbitors:
o Mitotane (Lysodren) & Metyrapone
• Radiation therapy: to dec sec of cortical hormones
• Hypophysectomy,
• Adrenalectomy
• Hormone replacement post surgery
The Renin- Angiotensin-Aldosterone
System (RAAS) is a hormone system within the body that is
essential for the regulation of blood pressure and fluid balance.
The system is mainly comprised of the three hormones renin,
angiotensin II and aldosterone. Primarily it is regulated by the
rate of renal blood flow.

Adenoma of the Adrenal Glands

3. Crohn's Disease

ALDOSTERONE -functions by : sodium and water

reabsorption

4. Pheochromocytoma

Adenoma of the adrenal medulla

SNS hyperactivity: 5 H's

• Hypertension
• Headache Adrenal Medulla Disorder:
• Hyperhidrosis
• Benign tumor (10% bilateral)
• Hypermetabolism
• Inc. epinephrine
PRIMARY ALDOSTERONISM o Vasoconstriction, Inc BP
(CONN'S SYNDROME) o ↑ cardiac output
o ↑ Blood glucose (glycogenolysis)
PRIMARY ALDOSTERONISM (CONN'S SYNDROME
Manifestations for Pheochromocytoma
• -Excessive secretion of aldosterone which is a
mineralocorticoid that is secreted in response to • Hypertension
renin-angiotensin system and ACTH: • Headache,
• causes kidneys to retain sodium and excrete • Tachycardia, angina
potassium and hydrogen • Hyperhidrosis
• Hypermetabolism
Causes: • Hyperglycemia

• adenoma of adrenal cortex; D× tests: Urinary vanillylmandelic (VMA)

• hyperplasia or carcinoma of the adrenal cortex
Vanilly|mandelic Acid (VMA)
Symptoms:
• Done to evaluate the level of catecholamines in the
• Hypertension blood and in the urine
• Hypokalemia, hypernatremia • VMA is the byproduct of catecholamines.
• Muscle weakness, Cramping
 • For 48 hours, avoid foods rich in amines,
caffeine, vanilla or licorice.
• For 2 weeks, avoid meds especially
Acetylsalicylic Acid.
• . Avoid excessive exercise and stress
before the 24-hour urine collection.
• Normal Value:
o Blood: 0.2-0.9 mg%
o Urine: 0.2-7 mg/24hrs

Other Dx tests for Pheochromocytoma:

• CT Scan, MRI: tumor

• Total Plasma Catecholamine
Concentration
• Total plasma epinephrine
o Patient to rest for 30 minutes.
o Insert a butterfly needle.
o Blood extraction after 30 minutes.
o Normal Values
o Epinephrine: 100 pg/ml (590 pmol/L)
o Norepinephrine: 100-550
pg/ml (590-3,240pmol/L)

Clonidine Suppression Test

• Clonidine (Catapres) intake- adrenergic

blocker suppressing the release of
catecholamines
• . Normal Values
o After 2 to 3 hours, total plasma
catecholamine value decreases

Management:

• Dec stimulants, quiet environment, BP/pulse

monitoring
• Avoid abdominal palpation
• Beta blocker
• Adrenalectomy
• Beta-Adrenergic blocker to Dec HR
• Nadolol (Corgard), Propranolol (Inderal)
• Metoprolol (Lopressor), Timolol (Blocadren), Atenolol
(Tenormin)
• Teach:
o Check Pulse, postural hypotension
• Do not stop meds
- May mask hypoglycemia symptoms