Endocrine Archer Review NCLEX Crash Course

Endocrine Archer Review Crash Course Welcome! ● If you have a question please enter it in the chat! I will do my best to answer questions as we go, but if I miss one will always circle back to you! ● We will be taking two 10 minute breaks during the class ● Handouts & powerpoint slides are located in the ‘Handouts’ section of your GoToWebinar control panel. You can download and print them from here! ● If you have any technical issues or questions about streaming, handouts, etc. please email Hormone - Glucocorticoids, mineralocorticoids, and sex hormones…. STEROIDS Not enough steroids → Addison’s disease Too many steroids → Cushing's disease Steroids ● Produced by the adrenal cortex ● Glucocorticoids ○ Affect mood ○ Cause immunosuppression ○ Breakdown fats & proteins ○ Inhibit insulin ● Mineralocorticoids - aldosterone ○ Retention of sodium and water ○ Excretion of potassium ● Sex hormones - testosterone, estrogen, progesterone Addison’s Disease What is Addison’s Disease ● Adrenocortical insufficiency - not enough steroids ● Decreased glucocorticoids ○ Fatigue ○ Weight loss ○ Hypoglycemia ○ Confusion ● Decreased mineralocorticoids ○ Loss of sodium and water → hyponatremic, fluid volume deficit ○ Retention of potassium → hyperkalemic ○ Hypotension ● Decreased sex hormones Assessment Treatment ● Think SHOCK! ○ IV fluid administration ○ Increased sodium intake ● I&O ● Daily weight ● Replace steroids ○ Prednisolone ○ Fludrocordisone NCLEX Question A nurse knows that in the event of an Addisonian crisis, it is most appropriate to administer which of the following medications intravenously? a. Insulin b. Normal saline solution c. dextrose 5% in water d. dextrose 5% in half-normal saline solution Answer: B One problem of a client in the Addisonian crisis is hyponatremia. The nurse should, therefore, anticipate administering the standard saline solution. Glucose, vasopressors, and hydrocortisone are also used to treat the Addisonian crisis. It would be inappropriate to administer insulin, dextrose 5% in water, or dextrose 5% in half-normal saline solution for this client. The correct answer is option B, while options A, C, and D are incorrect. Cushing’s Disease What is Cushing’s Disease? ● Excess of steroids ● Body has too much glucocorticoids, mineralocorticoids and sex hormones ○ Glucocorticoids ■ Immunosuppression ■ Hyperglycemia ■ Mood alteration ■ Fat redistribution (excess glucocorticoids cause lipolysis of extremities and lipogenesis in the trunk) ○ Mineralocorticoids ■ Fluid retention ■ Sodium retention ■ Potassium excretion ○ Sex hormones ■ Oily skin/acne Assessment ● Think extremities ● Moon faced ● Truncal obesity ● Buffalo hump ● Hyperglycemia ● Immunosuppressed ● CHF ● Weight gain ● Fluid volume excess Treatment ● Adrenalectomy ○ Remove the glands secreting the excess hormones ○ Can remove one or both ● Avoid infection ○ Patient is immunosuppressed ○ Hand washing ○ Limiting visitors NCLEX Question Your client is a patient with low potassium levels and accelerated hypertension. The physician has listed the cause as "hyperaldosteronism." Which of the following endocrine disorders cause an increased amount of aldosterone? Select all that apply. A. Cushing’s disease B. Addison’s disease C. Crohn's disease D. Pheochromocytoma Answer: A Cushing's disease (Choice A) is caused by an increased secretion of adrenocorticotropic hormone (ACTH) from the pituitary gland. Increased ACTH causes increased stimulation and hyperplasia of the adrenal cortex. This leads to increased levels of both glucocorticoids(cortisol) and mineralocorticoids(aldosterone). The physician may order ACTH and Cortisol levels to establish the diagnosis of Cushing's disease. Clinical symptoms include abdominal obesity, moon facies, neck hump, abdominal striae, increased blood glucose, secondary diabetes, hypertension, and Hypokalemia. Other manifestations include Osteoporosis and increased risk of fractures. Clients are prone to increased risk of infections because excess steroids (cortisol) cause immunosuppression. Choice B is incorrect. Addison's disease is autoimmune destruction of the adrenal cortex. The resulting adrenal insufficiency would cause low levels of cortisol and aldosterone. There is a reflex increase in ACTH due to feedback from the Adrenal gland. Clinical manifestations of Addison's disease include fatigue, diarrhea, hyperpigmentation, and hypotension (opposite of hyperaldosteronism). Hypoaldosteronism can be associated with hyperkalemia (elevated potassium levels), hyponatremia (low sodium levels), and mild metabolic acidosis. Choice C is incorrect. Crohn's disease is a GI disorder involving inflammation of the digestive tract. It does not cause increased aldosterone. Choice D is incorrect. Pheochromocytoma is a tumor of Adrenal Medulla. Since medulla produces catecholamines, cancer involving this area is associated with high levels of Adrenaline and Nor-adrenaline. Adrenal medulla does not produce aldosterone. Therefore, secondary refractory hypertension in Pheochromocytoma is mediated by Catecholamine excess, not by aldosterone excess. Hormone - Antidiuretic hormone (ADH) Not enough ADH → DI Too much ADH → SIADH Antidiuretic Hormone ● Secreted from the pituitary gland ● Pituitary gland is in the brain, between your eyeballs ● Be on the lookout for these issues if a patient had: ○ Craniotomy ○ Head injury ○ Sinus surgery ● Causes anti - diuresis - holding on to WATER ○ Only water is retained, so sodium! ○ Increased ADH → increased water ● Antidiuretic hormone = ADH = Vasopressin