ENDOCRINE DISORDERS

1. PITUITARY DISORDERS
A. SIADH
B. Diabetes Insipidus
C. Acromegaly
D. Pituitary Dwarfism
E. Precocious Puberty

SIADH

HIGH secretion of ADH

Fluid retention

Less than 280 osmolality

Hyponatremia Muscle cramps

Increased weight 2kg a day

Decreased urine output

Urine Specific Gravity > 1.025

HTN

TREATMENT FOR SIADH:

Correction of fluid retention

HOB lower than 10 degrees.

NURSING MANAGEMENT FOR SIADH

Teach patient NOT to restrict sodium

Ice chips, sugarless gum and hard candies are options for
patient with increased thirst.

II.

DIABETES INSIPIDUS
Low secretion of ADH (Vasopressin)
increased urine output
dehydration
HYPERNATREMIA
Hypotension
Low specific gravity (< 1.005) and high serum osmolality
( > 295)
Water deprivation test to confirm DX
Treatment:
i. Vasopressin and DESMIPRESSIN administration (longterm therapy)
ii. Thiazide diuretic

III.

ACROMEAGLY
HIGH secretion of GROWTH HORMONE usually because of a
tumor on the pituitary (Adenoma)
Thickening of bone and tissue
Enlargement of HANDS and FEET
DX: GH and Glucose Tolerance Test Keep glucagon by the
bed for induce hypoglycemia
TX: Sx to remove pituitary tumor
i. Hypophysectomy: LIFETIME hormone replacement
ii. Post op pt after Transphenoidal Hypophysectomy
Since sx is done through the nose, monitor for CSF
leakage and send off any clear liquid off to the lab.
1. DO NOT BRUSH TEETH FOR 10 DAYS POSTOPERATIVE
2. Monitor for DIABETES INSIPIDUS because
patient can no longer produce ADH
MONITOR URINE OUTPUT CLOSELY.

IV.

PITUITARY DWARFISM
LOW GROWTH HORMONE
Usually stop growing around 2-3 years old
2

TX with GH supplement only as a CHILD.

V.

PRECOCIOUS PUBERTY

Caused by Gonadotropin-releasing hormone (GnRH) by the

hypothalamus
Causes girls to start period very early, pubic and axillary hair to
grow.
Know it is usually in children that are 6-8 is age.

2. THYROID DISORDERS
1.
2.
3.
4.

Goiter
Thyroid Nodules/ Thyroid Cancer
Thyroiditis
Hyperthyroidism
Thyroid Storm
Thyroidectomy
5. Hypothyroidism
Myxedema

I.

GOITER
Enlarged thyroid gland
Most commonly seen with Graves Disease
Can be seen with both HYPO and HYPER-thyroidism
Toxic-Goiter Thyroid produces excess Thyroid Hormone
Non-ToxicThyroid produces normal levels of Thyroid Hormone
DO NOT palpate because it could cause a thyroid storm and
it could be released and cause increase HR, HTN, etc.
A lack of IODINE is the most common cause of this
worldwide (Not in the USA because ionized salt additive)

THYROID NODULES/CANCER

A. NODULE

Palpable nodules on thyroid can be either malignant or benign.

B. THYROID NODULE
3

 Most common type of endocrine carcinoma

DX: US, CT, MRI, needle biopsy
1. HOT nodules: almost always benign
2. COLD nodules: HIGH risk of being malignant.

TX: Removal of tumor, all or part of the thyroid hormone

replacement necessary, and radiation therapy.

C. THYROIDITIS
Inflammation of the thyroid
Subacute granulomatous thyroiditis: caused by viral infection
Acute thyroiditis: caused by bacterial or fungal infection
Chronic autoimmune thyroiditis (Hashimotos thyroiditis): a chronic
autoimmune disease. Thyroid tissue is replaced by lymphocytes
and fibrous tissue. This patient is at risk for other autoimmune
disorders.
1. This is chronic, will be on Synthroid for the rest of their life
D. HYPERTHYROIDISM
2nd most prevalent endocrine disorder behind DM.
EXCESS secretion of Thyroid Hormone
Thyroid storm (Thyrotoxicosis)
i. Can be a medical emergency
Grave Disease: attaches to the receptors and antibodies and a
constant TSH stimulation.
o Toxic Nodular goiters: cause hyperthyroidism independent
of TSH stimulation
Primary Hyperthyroidism: This means that this is the actual GLAND
itself but if its SECONDARY its the hypothalamus.
Keep room warm cool, heat intolerant
Keep them in a quiet environment b/c of their high vitals
They will have a LOW TSH but high T4& T3
Keep HOB elevated and cant close their eyes because of bulging
eyes, can put a patch.
E. THYROID STORM
Thyrotoxic crisis (Thyroid storm) is a acute condition in which all
thyroid manifestations are heightened.
Life threatening emergency
Stressors occur to patient with history of hyperthyroidism
4

 Heart and nerve tissues more sensitive to SNS activation

Care is directed at managing respiratory distress, fever reduction,
fluid replacement, eliminating stressors