ENDOCRINE SYSTEM DISCONTINUE - TAPER DO NOT WITHDRAW ABRUPTLY

PITUITARY GLAND- MASTER GLAND-

Anterior and posterior PG- GLUCORTICOIDS
-AFFECT MOOD,
Hormones -CAUSE IMMMUNOSUPPRESION - RISK FOR INFECTION/ AFFECT MOOD
Anterior -BREAK DOWN FATS AND PROTEINS
1.-Growth Hormone -INHIBITS INSULIN- HYPERGLYCEMIA
2. -TSH (Thyroid Stimulating Hormone) - Thyroid Gland
3. -Prolactin - Mammary Gland (production of milk) MINEROLOCORTICOIDS- ALDOSTERONE
-Adrenal Cortex RETENTION OF SODIUM AND WATER
4. FSH, LH EXCRETION OF POTASSIUM

Posterior/ PPG( Store and release) - release hormones - Hypothalamus SEX HORMONES
1. Oxytocin TESTOSTERON0 ESTROGEN NAD PROGESTERONE
2. Vasopressin (Anti-Diuretic Hormone)
Adeenocortical Insufficiency - not enough steroids
-Decreased glucocorticoids
ADRENAL GLAND Fatigue, weightloss, hypoglycemia, confusion
-located at TOP OF YOUR KIDNEYS
-INNER PART -ADRENAL MEDULLA -Decrease mineralocorticoids
-OUTER PART- ADRENAL CORTEX - loss of sodium and water- hyponatremic, fluid volume deficit, retention of potassium -hypekalemic
Hyperkalemia
ADRENAL CORTEX ST Depression Tall Peaked T waves PR Interval prolonged
- Zona Glomerulata - Mineralocorticoids (Salt) - Aldosterone- FX: Sodium Reabsorption (na filter sa Hypokalemia
kidney-renal tubules - need sa body- go back sa blood stream)/ ma release pag decrease ang BP and low ang U wave (prominent) ST depression T-wave depression
blood volume.(Saka sodium, ubos potassium) -Decreased sex hormones
- Zona fasciculata - Glucocorticoids - (Sugar) - Cortisol- FX: Primary stress Hormone ( cortisol also
promotes Gluconeogenesis - production/ formation of glucose from new sources (fats/proteins)- ADRENAL CRISIS
HYPERGLYCEMIA ( Increase Cortisol - Hyperglycemia) -fever, syncope, convulsions, hypoglycemia, hyponatremia, severe vomitting and diarrhea
- Zona Reticularis- Androgens (Sex Hormones)-
Hypovolemic shock - decrease volume , increase sodium
ADRENAL MEDULLA Cardiogenic shock - increase potassium, increase reactivity, pasmodic hyperactivity
-Cathecholamines -Norepinephrine/ Epinephrine- Mimics SNS - Sympathetic Nervous System -stress taas kaayo.

Adrenal Cortex Hormones Seizure - manifestation of a neurologic disorder

- Epilepsy - repeated seizure due to an illness, no neurologic disorder.
Increase SSS- Cushings Disease - HYPERGLYCEMIA
Decrease SSS - Addisons Disease - INFECTION
= risk for infection (Increase/Decrease) NATURAL CORTICOSTERIODS

LONG TERM CORTICOSTEROIDS THERAPY

-RISK FOR OSTEOPOROSIS / hyperkalemia
- Gastric Irritant- take with meals/ risk for infection/
ADDISON’S DISEASE RENAL SYSTEM
TREATMENT ANTI-DIURETIC HORMONE = ADH- water reabsorption
-THINK SHOCK!
-IV Fluid Administration 1. -DI (Diabetic Insipidus)- not enough
-Increased Sodium Intake -polyuria
-I/O
-Daily Weight 2. SIADH - too much
-Replace Steroids
Prednisone ADH
Fluorocortisone - secreted from the pituitary gland- transphenoid transectomy- CSF leakage - naay glucose/ HALO’s signs
(mag gamit ug gauze, ang center naay blood, naay clear liquid sa palibot sa circle- possible CSF leakage
CUSHING’S DISEASE -pituitary glans is in the brain between in your eyeballs
-Excess of steroids: Body has too much glucocorticoids, minerolocorticoids, and sex hormones - be on look out for these issues
-craniotomy, head injury, sinus injury
Glucorcorticoids
-immunosuppression Causes- anti-diuresi- holding on to water
-Hyperglycemia -Increased ADH- increased water
-Mood Alteration ANTIDIURETIC HORMONE ADH = VASOPRESSIN
- Fat redistribution ( excess glucocorticoids cause lipolysis of extremities and lipogenesis in the trunk
-Excess of steroids: Body has too much glucocorticoids, mineralocorticoids and sex hormones There is NOT ENOUGH ADH in the body
Mineralocorticoids -0.5ml/kg /hour
-Fluid retention -withouht ADH to tell the body to hold on to water, the kidneys produce HUGE amounts of urine
-Sodium retention
- Potassium Excretion This leads to fluid volume deficit.
Sex Hormones = HYPOTENSION
-Oily skin/acne =HYPOVELEMIA
-Moon faced = AT RISK FOR HYPOVOLEMIC SHOCK
-Buffalo
DIABETIC INSIPIDUS
-Memory focus and lack of concentration, dry mouth ( polydipsia), and excessive thirst ( ), rapid heart rate, low
blood pressure, muscle cramps, lightheadedness, headaches, dry eyes, weight loss, large amounts of urine
Laboratory values
- URINE- DILUTE
= Decreased USG
=Decreased Urine osmolality
-BLOOD = CONCENTRATED
= Increased Serum Na
=Increased Serum osmololality
=Serum Hct> 40%
- Monitor Neuro Status
- Replace Fluids
-Monitor hourly UOP
-Replace Volume + MIVF
-Vasopressin - DDAVP = Vasopressin/ Desmopressin
Brain sensitive to sodium DI SIADH
If Hyponatremia= risk for cerebral edema DECREASED ADH INCRASED ADH
FLUID VOLUME DEFICIT FLUID VOLUME EXCESS
Heart sensitive to potassium Increased Serum Osmolality (275-295 mOsm/kg of Decreased
If Hypokalemia = risk for MI water)
Increased Serum Sodium ( 135-145 mg/dL) Decreased
SIADH Decreased Urine specific gravity (1.010- 1.030) Increased
-Urine output= concentrated Decreased Urine Osmolality (200-800 mOsm/kg of Increased
- The body is making too much ADH water)
-with too much antidiuresis, the kidneys stops excreting water and HOLD on to it. Medication: Vasopressin, DDAVF, Desmopressin Medication: AVP Antagonist- vaptan , tolvaptan
-Decreased UOP
- Retention of water in the intravascular space
ONLY water is retained = no sodium.
Dilutional Hyponatremia- diluted water- diluted blood in the vascular space THYROID HORMONE (T3 & T4)
Weight Gain HYPERTHYROIDISM
No peripheral edema -NOT ENOUGH THYROID HORMONE
Anorexia -severe form -Myxedema Coma - children( Cretinism)
Nausea HYPERTHYROIDISM (GRAVES DISEASE)
Vomitting -TOO MYCH THYROID HORMONE
Dilutional Hyponatremia -Auto immune by nature
=Irritability, confusion and hallucinations , seizures (Na <125 ), limit stimulus of the patient.
Laboratory Values =HYPOTHALAMUS - Thyro Thropic Hormone/ thyroid Releasing Hormone - APG ( Anterior Parathyroid Gland)-
TSH (Thyroid Stimulating Hormone) - Thyroid Gland = T3 ( Triiodothyronine, T4 Thyroxine , Calcitonin =
URINE= CONCENTRATED ( Increased Heat Production, Increased metabolism, hyperdefecation,
Decreased UOP, Increased urine osmolality, Increased urine specific gravity, Increased urine sodium
BLOOD= DILUTE Regulation of Calcium
Increased blood volume, decresed blood osmolality, HYPONATREMIA, anemia = Hypocalemia= triggers Parathyroid Gland- release of PTH
Tolvaptan- medication Functions:
Treatment -Bone= promotes bone resoprtion, osteoclasts activity (Ca+ moves from bone to blood)
-Monitor Serum Sodium -Kidney = promotes Ca+ reabsorption (nibalik sa blood stream)= Increased excretion of Phosphorus , activates
-Sodium Replacement Vitamin D absoption ( ma absorbed with Liver)
-Seizure precautions -Small Intestine = absorption of Ca+ with help of Vitamin D.
-fluid restriction -Masobra PTH- Hypercalcemia= shoots up= too much break down of calcium
-hypertonic saline
Hypercalcemia - triggers Thyroid Gland to release Calcitonin- (Fxns: Inihibits Osteoclasts activity,inhibits Ca+
reabsorption from the kidneys.
THYROID HORMONE PARATHYROID HORMONE (PTH)
-Produce by the thyroid gland -HYPOPARATHYROIDISM
-There are two types : T3, and T4 -NOT ENOUGH
-Thyroid Hormones - energy HYPERTHYROIDISM
-They are controlled by a negative feedback loop ( antagonist stimulus) e.g. TSH , T3 and T4 -TOO MUCH
-Thyroid Stimulaitng Hormone (TSH) controls the release of T3 and T4
-Secreted by the Parathyroid glands
- Low T3 and T4 causes High TSH -Causes
-High T3 and T4 causes low TSH

Positive feedback- strengthen stimulus HYPOPARATHYROIDISM

Negative Feedback - antagonist stimulus -The Parathyroid glands do not secrete enough PTH
= Increased PTH = Increased Calcium
HYPERTHYROIDSIM - There are LOW SERUM CALCIUM LEVELS
- Low Serum calcium level cause high serum phosphorus levels

THYOIAMIDES - PROPHYLTHIOURACIL (PTH) = effects: increased salivation
- Methimazole (Monitor for Agranulocytosis)= Risk for infection - report to physician if nag fever or nag sore
throat.
Beta-Blockers- targets beta 1 and beta 2, given if di sya asthmatic- For patient who have SNS symtoms,
Increased HR, Arrythmias, to control symtoms of SNS symptoms- block ang gibuhat na symptoms ni thyroid
hormone.
CNS - seizures, calcifications, Parkinsonisms or dytonia (Intention Tremor, Nystagmus -Multiple Sclerosis)
CVS- Cardiac arrhythmias, hypocalcemia-associated dilated cardiomyopathy
Renal - Nephrocalcinosis, Kidney Stones, Chronic Kidney disease
Peripheral Nervous System- paresthesia, muscle cramp, tetany
Neuro- Symptoms of anxiety and depression
Opthalmologic - Cataracts, Papillidoma
Dental Systems - Altered tooth morphology

IODINE COMPOUNDS Treat: Fix the electrolyte imbalance

Lugol solutions- iodine compound, SSKI(saturated solution of Potassium Iodide - mixed with juice or - Calcium replacement and Phosphorus Binders
milk and drink with straw- decrease size and vascularity of the thyroid effects Phophorus binder
= calcium based- calcium carbonate
=Metal- based = aluminum hydroxide gel (amfo gel)
pre-op = SSKI and Lugols solution =Calcium Free/ Metal free = Sevelamer
Semi fowlers
Damage nerve- horsenss HYPERPARATHYROIDISM
Tetany- tingling finger finger -AT RISK FOR OSTEOPOROSIS
Laryngospasm- trach set - sobra calcium = at risk for kidney Stones
-hallmark- stridor and IV calcium gluconate -
-
HYPERMAGNESEMIA -
DTR (Deep Tendon Reflex)
RR (Decreased) Musculoskeletal
Oliguria (Decreased 100) Digestive System
Pressure ( Decreased BP) Nervous System
Treatment
-Biphosphonates
-Alendronate/ fosamax
- inihibits bone reabsorption ( mu taas samot ang Ca+ sa blood )
-
-Partial Parathyroidim
-There are 4 parathyroid glands, taking out 2 can decrease OTH secretion

INSULIN
Exocrine fx: lipase, amylase, tripsine
Endocrine fx: insulin, glucagon
DM, DKA, HNNS = NOT ENOUGH INSULIN
HYPOGLYCEMIA = TOO MUCH INSULIN

ISLET OF LANGERHANDS
INSULIN = BETA CELLS
GLUCAGON = ALPHA CELLS

DM, DKA, HNNS

DM and DKA= at risk for dehydration / Difference: ketones
HNNS= hyperglycemia
= metabolic acidosis = kaussmauls / acitone/ fruity breath
pH - ubos, HCO2/ BC03 - ubos
Fully compensated =
Partially compensated = abnormal tanan
Uncompensated = either HCO3 ug Pc02 ang normal wala naningkamot