Assessment and Management of Patients with Endocrine Disorders

Posted by e-Medical PPT Friday, August 31, 2012
Disorders of the Pituitary
Pituitary Tumors
Eosinophilic tumors may result in gigantism or in acromegaly.  May suffer from severe headaches, visual disturbances, decalcification of the bone, endocrine disturbances
Basophilic tumors may cause Cushing’s syndrome w/features of hyperadrenalism, truncal obesity, amenorrhea, osteoporosis
Chromophobic tumors—90% of pituitary tumors. Present with lowered BMR, obesity, somnolence, scant hair, low body temp, headaches, visual changes
Growth hormone deficiency in childhood will result in primary dwarfism.

Diabetes Insipidus
Deficiency of ADH
Excessive thirst, large volumes of dilute urine
Can occur secondary to brain tumors, head trauma, infections of the CNS, and surgical ablation or radiation
Nephrogenic DI—relates to failure of the renal tubules to respond to ADH. Can be related to hypokalemia, hypercalcemia and to medications (lithium demeocycline)

Excessive ADH secretion
Retain fluids and develop a dilutional hyponatremia
Often non-endocrine in origin—such as bronchogenic carcinoma

Most common cause is Hashimoto’s thyroiditis
Common in those previously treated for hyperthyroidism
Atrophy of gland with aging
Medications like lithium, iodine compounds, antithyroid meds can cause
Radiation treatments to head and neck
Infiltrative diseases like amyloidosis, scleroderma
Iodine deficiency and excess
Hypothalamic or pituitary abnormality
More common in women, especially over age 50

From mild symptoms to myxedema
Myxedema –accumulation of mucopolysaccharides in sc and interstitial tissues. Is the extreme form of hypothyroidism. Can progress to shock.
S/S—fatigue, hair loss, dry skin, brittle nails, numbness and tingling of the fingers, amenorrhea, weight gain, decreased heart rate and temperature, lassitude, cognitive changes, elevated cholesterol levels, constipation, hypotension

Extreme form is Grave’s disease
Caused by thyroiditis, excessive amount thyroid hormone, abnormal output by immunoglobulins
Is more common in women

Parathyroid Glands
May be asymptomatic
Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension and cardiac dysrhythmias
Excess calcium in the brain can lead to psychoses
Renal lithiasis can lead to renal damage and even failure
Demineralization of bones with back and joint pain, pain on weight bearing, pathologic fractures
Peptic ulcers and pancreatitis can also occur
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