ENDOCRINE CONDITIONS – MEDICAL-SURGICAL / ADULT
HEALTH NURSING
Definitions • Pathophysiology • Diagnostics • Management • Complications
Course: Adult Health Nursing (MedSurg Nursing) - Endocrine conditions
Primary Reference: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing,
Latest Edition, ATI Book: Unit 12, pg 843-911
Study Program: Nursing / Medicine / Clinical Health Sciences
Document Type: Course Summary & Exam Revision Notes
Level: Undergraduate
Pathophysiology of secretions
ADH and Oxytocin are made & secreted by hypothalamus, then they go to the
Posterior Pituitary gland for storage, then come down and act on particular organs (eg
uterus, kidney)
The secretion of the hormones that come from the anterior P. gland is controlled by
the releasing factors that come from the hypothalamus
ADH/ vasopressin is stimulated by the increase in blood osmolality or by a decrease
in the blood pressure. ADH retains more fluid, osmolality goes down; to increase BP=
we hold on to fluid and constriction to increase BP
Oxytocin stimulates uterine contractions and milk secretion
1. PITUITARY DISORDERS
Anterior Pituitary Gland Hypothesis
Anterior stimulate: FSH, LH, prolactin, ACTH, TSH, GH-(somatotropin)
Hyper: Cushing syndrome(ACTH), gigantism(GH) acromegaly(GH)
Hypo: Dwarfism(GH)
Panhypopituitarism - Hyposecretion of all the anterior P. gland hormones. ( Loss of
the stimulating hormones leading to shrinking of the target organs )
Posterior Pituitary Gland Hypothesis
Posterior stimulate: ADH/ vasopressin, Oxytocin
Hyper: SIADH
Hypo: DI - most common condition R/T decrease in vasopressin
A. Diabetes Insipidus (DI)
Definition
Disorder of the pituitary gland caused by deficiency of ADH characterized by excess
thirst and passage of large volume of (up to 15 quarts/day) diluted colourless urine,
dry hands, and constipation
Causes
Head Trauma
Brain tumor
Surgical interventions r/t P. gland
1
, Infections of CNS (meningitis, encephalitis, TB)
Nephrogenic
Failure of the renal tubules to respond to ADH.
Drug-Induced: Lithium, Declomycin
Types
1. Central, caused by drugs (ethanol, opiate antagonist, phenytoin) or disease (trauma,
infection, neoplasms) affecting the hypothalamus or pituitary gland
2. Nephrogenic, an X -linked congenital or tubulointestinal nephraopathies
3. Psychogenic, caused by beer or water potomania
Pathophysiology
Central DI: ↓ ADH production
Nephrogenic DI: kidneys unresponsive to ADH
Leads to polyuria → dehydration → hypernatremia
Clinical manifestations
Polyuria
Nocturia
Severe dehydration
Wt. loss.
Polydipsia
Hypotension
Tachycardia
Lethargy
Muscle cramps
Headaches
Diagnostics
Urine output > 5 L to 20 L/day
History of fluid intake of 5L to 20 L/day
Hypernatremia in those who are unable to access water
Elevated BUN/ Creatinine levels
Serum osmolality > 290 mOsm/kg
Urine specific gravity < 1.005
Water deprivation test
Management ( Replace ADH, fluids, and correct underlying pathology )
Correct underlying cause
Hypotonic IV fluids
Desmopressin (DDAVP)-synthetic vasopressin
Diabinese-chlorpropamide/thiazide diuretics-potentiate the action of vasopressin:
Used in mild disease, milder disease process
Nephrogenic: Thiazide diuretics, ibuprofen, aspirin,indomethacin(prostaglandin
inhibitors), Na restriction
In case of emergency for serum Na+ > 150 give 50% of the calculated volume during
the first 12-24 hour period
Exam tip: Have enough ADH= don't give more; how can we make kidneys more
sensitive to ADH we already have in body
2
HEALTH NURSING
Definitions • Pathophysiology • Diagnostics • Management • Complications
Course: Adult Health Nursing (MedSurg Nursing) - Endocrine conditions
Primary Reference: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing,
Latest Edition, ATI Book: Unit 12, pg 843-911
Study Program: Nursing / Medicine / Clinical Health Sciences
Document Type: Course Summary & Exam Revision Notes
Level: Undergraduate
Pathophysiology of secretions
ADH and Oxytocin are made & secreted by hypothalamus, then they go to the
Posterior Pituitary gland for storage, then come down and act on particular organs (eg
uterus, kidney)
The secretion of the hormones that come from the anterior P. gland is controlled by
the releasing factors that come from the hypothalamus
ADH/ vasopressin is stimulated by the increase in blood osmolality or by a decrease
in the blood pressure. ADH retains more fluid, osmolality goes down; to increase BP=
we hold on to fluid and constriction to increase BP
Oxytocin stimulates uterine contractions and milk secretion
1. PITUITARY DISORDERS
Anterior Pituitary Gland Hypothesis
Anterior stimulate: FSH, LH, prolactin, ACTH, TSH, GH-(somatotropin)
Hyper: Cushing syndrome(ACTH), gigantism(GH) acromegaly(GH)
Hypo: Dwarfism(GH)
Panhypopituitarism - Hyposecretion of all the anterior P. gland hormones. ( Loss of
the stimulating hormones leading to shrinking of the target organs )
Posterior Pituitary Gland Hypothesis
Posterior stimulate: ADH/ vasopressin, Oxytocin
Hyper: SIADH
Hypo: DI - most common condition R/T decrease in vasopressin
A. Diabetes Insipidus (DI)
Definition
Disorder of the pituitary gland caused by deficiency of ADH characterized by excess
thirst and passage of large volume of (up to 15 quarts/day) diluted colourless urine,
dry hands, and constipation
Causes
Head Trauma
Brain tumor
Surgical interventions r/t P. gland
1
, Infections of CNS (meningitis, encephalitis, TB)
Nephrogenic
Failure of the renal tubules to respond to ADH.
Drug-Induced: Lithium, Declomycin
Types
1. Central, caused by drugs (ethanol, opiate antagonist, phenytoin) or disease (trauma,
infection, neoplasms) affecting the hypothalamus or pituitary gland
2. Nephrogenic, an X -linked congenital or tubulointestinal nephraopathies
3. Psychogenic, caused by beer or water potomania
Pathophysiology
Central DI: ↓ ADH production
Nephrogenic DI: kidneys unresponsive to ADH
Leads to polyuria → dehydration → hypernatremia
Clinical manifestations
Polyuria
Nocturia
Severe dehydration
Wt. loss.
Polydipsia
Hypotension
Tachycardia
Lethargy
Muscle cramps
Headaches
Diagnostics
Urine output > 5 L to 20 L/day
History of fluid intake of 5L to 20 L/day
Hypernatremia in those who are unable to access water
Elevated BUN/ Creatinine levels
Serum osmolality > 290 mOsm/kg
Urine specific gravity < 1.005
Water deprivation test
Management ( Replace ADH, fluids, and correct underlying pathology )
Correct underlying cause
Hypotonic IV fluids
Desmopressin (DDAVP)-synthetic vasopressin
Diabinese-chlorpropamide/thiazide diuretics-potentiate the action of vasopressin:
Used in mild disease, milder disease process
Nephrogenic: Thiazide diuretics, ibuprofen, aspirin,indomethacin(prostaglandin
inhibitors), Na restriction
In case of emergency for serum Na+ > 150 give 50% of the calculated volume during
the first 12-24 hour period
Exam tip: Have enough ADH= don't give more; how can we make kidneys more
sensitive to ADH we already have in body
2
