HYPOPITUITARISM HYPERPITUITARISM

- Hyposecretion of one or more of the - Hypersecretion of growth hormone

pituitary hormones

Caused by: tumors, trauma, encephalitis, Caused by: pituitary tumors

autoimmunity, or stroke Leads to: acromegaly and Cushing’s disease

Hormones most often affected: growth hormone

(GH) and gonadotropic hormones

Sx & S: Sx & S:
a. Mild to moderate obesity (GH, TSH) a. Large hands and feet
b. Reduced cardiac output (GH, ADH) b. Thickening and protrusion of jaw
c. Infertility, sexual dysfunction (gonadotropins, c. Arthritic changes and joint pain
ACTH) d. Visual disturbances
d. Fatigue, low blood pressure (TSH, ADH, ACTH, e. Diaphoresis
GH) f. Oily, rough skin
e. Tumors of the pituitary also may cause g. Organomegaly
headaches and visual defects (pituitary is located h. Hypertension
near the optic nerve). i. Dysphagia
j. Deepening of the voice

Interventions: Interventions:
- hormone replacement - frequent skin care.
- Client education regarding signs and - radiation of the pituitary gland
symptoms of hypofunction and - hypophysectomy if planned
hyperfunction related to insufficient or
excess hormone replacement
HYPOPHYSECTOMY (PITUITARY ADENECTOMY, TRANSSPHENOIDAL PITUITARY SURGERY)
- Removal of a pituitary tumor via craniotomy or a transsphenoidal

Complications (craniotomy): increased intracranial pressure, bleeding, meningitis, and

hypopituitarism.

Complications (transsphenoidal): cerebrospinal fluid leak, infection, and hypopituitarism.

DIABETES INSIPIDUS SYNDROME OF INAPPROPRIATE ANTIDIURETIC

HORMONE SECRETION (SIADH)
- Hyposecretion of ADH - Excess ADH is released
Caused by: stroke or trauma, or may be Caused by: trauma, stroke, malignancies (often in
idiopathic the lungs or pancreas), medications, and stress.
Results in: water intoxication and hyponatremia.

Sx & S: Sx & S:
a. Excretion of large amounts of dilute urine a. Signs of fluid volume overload
b. Polydipsia
c. Dehydration (decreased skin turgor and dry b. Changes in level of consciousness and mental
mucous membranes) status changes
d. Inability to concentrate urine c. Weight gain
e. Low urinary specific gravity, 1.006 or lower d. Hypertension
f. Fatigue e. Tachycardia
g. Muscle pain and weakness f. Anorexia, nausea, and vomiting
h. Headache g. Hyponatremia
i. Postural hypotension that may progress to
vascular collapse without rehydration
j. Tachycardia

Interventions: Interventions:
- avoid foods or liquids that produce - Restrict fluid intake as prescribed.
diuresis. - Administer diuretics and IV fluids (usually
- . Vasopressin tannate (Pitressin) or normal saline or hypertonic saline)
desmopressin acetate (DDAVP, Stimate, - Medications that inhibit ADH-induced
Minirin)- ADH deficiency is severe or water reabsorption and produce water
chronic. diuresis may be prescribed.

ADDISON’S DISEASE CUSHING’S DISEASE AND CUSHING’S SYNDROME

(HYPERCORTISOLISM)
- Hyposecretion of adrenal cortex - Hypersecretion of glucocorticoids
hormones (glucocorticoids and
mineralocorticoids) Disease- abnormally increased secretion
(endogenous) of cortisol, caused by increased
amounts of ACTH secreted by the pituitary gland.

Syndrome- chronic and excessive production of

cortisol by the adrenal cortex or by the
administration of glucocorticoids in large doses
for several weeks or longer

Sx & S: Sx & S:
a. Lethargy, fatigue, and muscle weakness a. Generalized muscle wasting and
b. Gastrointestinal disturbances weakness
c. Weight loss b. Moon face, buffalo hump
d. Menstrual changes in women; c. Truncal obesity with thin extremities,
impotence in men supraclavicular fat pads; weight gain
e. Hypoglycemia, hyponatremia d. Hirsutism (masculine characteristics in
f. Hyperkalemia, hypercalcemia females)
g. Hypotension e. Hyperglycemia, hypernatremia
h. Hyperpigmentation of skin (bronzed) f. Hypokalemia, hypocalcemia
with primary disease g. Hypertension
h. Fragile skin that easily bruises
i. Reddish-purple striae on the abdomen
and upper thighs
Interventions: Interventions:
- Administer glucocorticoid or - Administer chemotherapeutic agents as
mineralocorticoid prescribed for inoperable adrenal
- Avoid individuals with an infection. tumors.
- High protein and high carbohydrate, - Adrenalectomy if results from an
normal sodium intake adrenal adenoma; glucocorticoid
- Avoid strenuous exercise and stressful replacement may be required following
situations. adrenalectomy.
- lifelong glucocorticoid therapy
- Avoid over-the-counter medications.

HYPOTHYROIDISM HYPERTHYROIDISM
- Hyposecretion of thyroid hormones T3 - hypersecretion of thyroid hormones (T3
and T4 and T4 )
- decreased rate of body metabolism - increased rate of body metabolism
- Graves’ disease

Sx & S: Sx & S: (thyrotoxicosis.)

a. Lethargy and fatigue a. Personality changes such as irritability,
b. Weakness, muscle aches, paresthesias agitation, and mood swings
c. Intolerance to cold b. Nervousness and fine tremors of the
d. Weight gain hands
e. Dry skin and hair and loss of body hair c. Heat intolerance
f. Bradycardia d. Weight loss
g. Constipation e. Smooth, soft skin and hair
h. Generalized puffiness and edema around f. Palpitations, cardiac dysrhythmias, such
the eyes and face (myxedema) as tachycardia or atrial fibrillation
i. Forgetfulness and loss of memory g. Diarrhea
j. Menstrual disturbances h. Protruding eyeballs (exophthalmos) may
k. Cardiac enlargement, tendency to be present
develop heart failure Goiter may or may i. Diaphoresis
not be present j. Hypertension
k. Enlarged thyroid gland (goiter)

Interventions: Interventions:
- thyroid replacement; levothyroxine - high-calorie diet.
sodium (Synthroid) - Administer antithyroid medications
- low-calorie, low-cholesterol, low– (propylthiouracil, PTU)
saturated fat diet. - propranolol (Inderal) for tachycardia
- roughage and fluids to prevent -
constipation
- warm environment
- Avoid sedatives and opioid analgesics
 MYXEDEMA COMA THYROID STORM
- persistently low thyroid production. - acute and life-threatening;
uncontrollable hyperthyroidism.
Sx & S: Sx & S:
a. Hypotension a. Elevated temperature (fever)
b. Bradycardia b. Tachycardia
c. Hypothermia c. Systolic hypertension
d. Hyponatremia d. Nausea, vomiting, and diarrhea
e. Hypoglycemia e. Agitation, tremors, anxiety
f. Generalized edema f. Irritability, agitation, restlessness, confusion,
g. Respiratory failure and seizures as the condition progresses
h. Coma g. Delirium and coma

Interventions: Interventions:
- Administer IV fluids (normal or - Antithyroid medications, β-blockers,
hypertonic saline) glucocorticoids, and iodides- Prevent
- Administer levothyroxine sodium occurrence in surgery
- glucose intravenously - Nonsalicylate antipyretics
- corticosteroids - cooling blanket
-

SIGNS OF TETANY
■ Cardiac dysrhythmias
■ Carpopedal spasm
■ Dysphagia
■ Muscle and abdominal cramps
■ Numbness and tingling of the face and extremities
■ Positive Chvostek’s sign
■ Positive Trousseau’s sign
■ Visual disturbances (photophobia)
■ Wheezing and dyspnea (bronchospasm, laryngospasm)
■ Seizures

HYPOPARATHYROIDISM HYPERPARATHYROIDISM
- hyposecretion of parathyroid hormone - hypersecretion of parathyroid hormone
- Can occur following thyroidectomy

Sx & S: Sx & S:
a. Hypocalcemia and hyperphosphatemia a. Hypercalcemia and hypophosphatemia
b. Numbness and tingling in the face b. Fatigue and muscle weakness
c. Muscle cramps and cramps in the abdomen or c. Skeletal pain and tenderness
in the extremities d. Bone deformities that result in pathological
d. Positive Trousseau’s sign or Chvostek’s sign fractures
e. Signs of overt tetany, such as bronchospasm, e. Anorexia, nausea, vomiting, epigastric pain
laryngospasm, carpopedal spasm, dysphagia, f. Weight loss
photophobia, cardiac dysrhythmias, seizures g. Constipation
f. Hypotension h. Hypertension
g. Anxiety, irritability, depression i. Cardiac dysrhythmias
j. Renal stones

Interventions: Interventions:
- seizure precautions - Encourage fluid intake.
- tracheotomy set, oxygen, and suctioning - furosemide (Lasix)
equipment at the bedside. - normal saline
- administer calcium gluconate - phosphates
intravenously for hypocalcemia. - calcitonin (Fortical; Miacalcin)
- high-calcium, low-phosphorus diet - parathyroidectomy
- vitamin D supplements
-

HYPOGLYCEMIA
- occurs when the blood glucose level falls below 70 mg/dL or when the blood glucose level
drops rapidly from an elevated level.
- too much insulin or oral hypoglycemic agents, too little food, or excessive activity.

Sx &S:
Mild Interventions:
■ Hunger - Give 10 to 15 g of a fast-acting simple
■ Nervousness carbohydrate
■ Palpitations ■ Commercially prepared glucose tablets
■ Sweating ■ 6 to 10 Life Savers or hard candy
■ Tachycardia ■ 4 tsp of sugar
■ Tremor ■ 4 sugar cubes
■ 1 Tbsp of honey or syrup
■ ½ cup of fruit juice or regular (nondiet)
soft drink
■ 8 oz low-fat milk
■ 6 saltine crackers
■ 3 graham crackers
- Retest the blood glucose level in 15 minutes
- Snack containing protein and carbohydrates,
such as low-fat milk or cheese and crackers-
once symptoms resolves
Moderate Interventions:
■ Confusion - 15 to 30 g of a fast-acting simple
■ Double vision carbohydrate.
■ Drowsiness - additional food such as low-fat milk or
■ Emotional changes cheese and crackers after 10 to 15
■ Headache minutes.
■ Impaired coordination
■ Inability to concentrate
■ Irrational or combative behavior
■ Light headedness
■ Numbness of the lips and tongue
■ Slurred speech

Severe Interventions:
■ Difficulty arousing - injection of glucagon is administered
■ Disoriented behavior subcutaneously or intramuscularly.
■ Loss of consciousness - second dose in 10 minutes if the client
■ Seizures remains unconscious.
-

DKA HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC

SYNDROME (HHNS)
- life-threatening complication of type 1 - Extreme hyperglycemia occurs without
diabetes mellitus ketosis or acidosis
- most often in individuals with type 2
diabetes mellitus

Sx & S: Sx & S:
a. hyperglycemia a. Altered central nervous system function
b. dehydration with neurologic symptoms
c. ketosis b. Dehydration or electrolyte loss: Same as
d. acidosis for DKA
e. Ketosis: Kussmaul’s respiration
f. “fruity” breath
g. Nausea
h. abdominal pain
i. Altered central nervous system function
with neurologic symptoms
j. Dehydration or electrolyte loss: Polyuria,
polydipsia, weight loss, dry skin, sunken
eyes, soft eyeballs, lethargy, coma

Laboratory Findings: Laboratory Findings:

Serum glucose : > 300 mg/dL (16.7 mmol/L) > 800 mg/dL (44.5 mmol/L)
Serum ketones Positive at 1:2 dilution Negative
Serum pH < 7.35 > 7.4
Serum HCO3 < 15 mEq/L > 20 mEq/L
Serum Na Low, normal, or high Normal or low
Serum K Normal; elevated with acidosis, low Normal or low
following dehydration Elevated
BUN > 20 mg/dL; elevated because of Elevated
dehydration
Creatinine > 1.5 mg/dL; elevated because of
dehydration
Urine ketones Positive Negative

Interventions: Interventions:
- rapid IV infusions of 0.9% or 0.45% - Insulin plays a less critical role
normal saline (NS) - fluid replacement, correction of
- dextrose is added to IV fluids when the electrolyte imbalances, and insulin
blood glucose level reaches 250 to 300 administration
mg/dL. - similar to that for DKA
- insulin administered intravenously
- short-duration insulin only
- IV bolus dose of insulin (usually 5 to 10
units)