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Definition and Types DIABETES INSIPIDUS Diabetes insipidus is a disorder of the posterior lobe of the pituitary gland characterized

by a deficiency of antidiuretic hormone (ADH), or vasopressin. Great thirst (polydipsia) and large volumes of dilute urine characterize the disorder Types: Nephrogenic DI

Risk Factors and Causes head trauma brain tumor inflammation surgical ablation or irradiation of the pituitary gland

Diagnostic Test fluid deprivation test Urinalysis MRI Genetic Screening

Common Complications Electrolyte imbalance Dehydration Water intoxication

Management Maintain fluid & electrolyte balance Monitor VS and observe for sign of dehydration and hypovolemia Administer hormone replacement as ordered: a. Vasopressin IM injection b. Lypressin nasal spray Provide client teaching and discharge planning concerning lifelong hormone replacement Weigh daily

Pathophysiology: Failure of the renal tubules to respond to ADH Renal tubules excrete excessive amount of water in the urine caused by insufficient ADH Inherited or idiopathic malfunction Caused by trauma,tumors,infection and surgery

Neurogenic DI

Primary DI

Secondary DI

Definition and Types Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Excessive amount of serum ADH resulting in water intoxication and hyponatremia (dilutional hyponatremia) Types: Acute Chronic

Risk Factors and Causes SIADH is often of nonendocrine origin; patients with bronchogenic carcinoma in which malignant lung cells synthesize and release ADH Hypersecretion of ADH by the hypothalamus from head injury, brain surgery, tumor, and infection Pathophysiology: Malfunction of the usual feedback mechanism Failure to decrease posterior pituitary secretions of ADH with decreased onmolality High levels of ADH Renal absorption of H2O & suppression of renninangiotensin mechanism Renal excretion of sodium (hyponatremia)

Diagnostic Test Serum chemistry panel Sodium level Osmolality Blood urea nitrogen and creatinine levels Uric acid level Potassium level Albumin level Cortisol Thyroidstimulating hormone and free T4

Common Complications Hyponatremia

Management Limit fluid intake Monitor urine osmolality Monitor serum electrolytes,hematocrit, BUN and sodium Supplement sodium intake Administer diuretics as ordered Weigh daily

Definition and Types Gigantism is a very rare condition that occurs during childhood, in which there is extreme bone, muscle and organ growth

Risk Factors and Causes overproduction of growth hormone (GH) inherited or genetic syndromes (multiple endocrine neoplasia and McCuneAlbright syndrome) Pathophysiology: benign pituitary tumors Pressure on the pituitary gland overproduction of GH Abnormal bone, muscle and organ growth

Diagnostic Test GH stimulation tests GH suppression Blood test CT scan MRI

Common Complications high blood pressure severe headaches sleep apnea diabetes diminished vision heart failure

Management Surgery : Transphenoidal resection Radiation : Conventional radiation Stereotactic radiosurgery, ex: gamma knife Medical: *Somatostatin analogues: Octreotide (Sandostatin)

Nursing Management: Assess the body changes of the patient. Give psychological support. Assess the sensory perception status of the patient

Lanreotide *Depot somatostatin analogues: Sandostatin LAR SR-lanreotide *Dopamine agonists: Bromocriptine Cabergoline *GH receptor antagonists: Pegvisomant

Definition and Types Hyperthyroidism Excessive secretion of thyroid hormone from the thyroid gland

Risk Factors and Causes Inherited or idiopathic malfunction Pathophysiology: Excess thyroid hormone secretion Increased basal metabolic rate Increased cardiovascular function Increased gastrointestinal function Increased neuromuscular function

Diagnostic Test Thyroid-stimulating hormone (TSH) Iodine thyroid scan

Common Complications Heart problems Brittle bones Eye problems

Management Medical: Radioactive iodine Anti-thyroid medspropylthiouracil and methimazole (Tapazole) Beta blockers

Xray Red, swollen skin Ct scan Thyrotoxic crisis

Surgery : Thyroidectomy Eye muscle surgery Orbital decompression surgery Nursing management: Monitor vital signs Weigh daily Provide for periods of uninterrupted rest Provide a cool environment Encourage quiet, relaxing diversional activities Observe for and prevent complications