Transcript File - Medical Assisting SPSCC

11
Lecture Notes
Endocrine System
Diseases and Disorders
Classroom Activity to Accompany
Diseases of the Human Body
Fifth Edition
Carol D. Tamparo
Marcia A. Lewis
Copyright © 2011 by F.A. Davis Company. All rights
reserved. This product is protected by copyright. No part
of it may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic,
mechanical, photocopying, recording, or otherwise—
without written permission from the publisher.
To keep a lamp burning, we have to
keep putting oil in it.
—Mother Teresa
3
Common Signs and Symptoms of
Endocrine System Diseases and
Disorders
•
•
•
•
•
•
•
•
•
•
•
Mental abnormalities
Unusual change in energy level
Changes in skin, nails, or hair
Muscle atrophy
Growth abnormalities
Polyuria or polydipsia
Cold/heat intolerance
Unusual weight gain or loss
Nausea and vomiting
Irregular menstruation
Erectile dysfunction
4
Hyperpituitarism
• Description
• Hypersecretion of human growth hormone (hGH)
by the anterior pituitary gland
• Giantism results from hypersecretion of hGH
during the growing years
• Acromegaly results from hypersecretion of hGH
in adulthood
5
Hyperpituitarism
• Etiology
• Benign slowing growing adenoma in the
pituitary gland
• Adenoma releases high levels of hGH
• May also be genetic
6
Hyperpituitarism
• Signs and symptoms
• Excessive growth of the long bones in
giantism
• Abrupt increases in height
• Gradual deformation of facial features in
acromegaly
• Enlargement of hands, feet, head, and tongue
• Sweating, chronic sinus congestion, weakness,
joint pain, numbness or tingling
7
Hyperpituitarism
• Diagnostic procedures
• Clinical picture
• Glucose tolerance test
• MRI and CT scans
• Bone x-rays
MRI=magnetic resonance imaging; CT=computed tomography.
8
Hyperpituitarism
• Treatment
• Surgical management of pituitary tumors
• Radiation to reduce or destroy tumor
• Medication to stop hGH production
9
Hyperpituitarism
Complementary therapy
• None indicated
Client communication
• Explain nature of hormone hypersecretion
• Monitor replacement therapy
10
Hyperpituitarism
• Prognosis
• Dependent on how the condition has
advanced
• For giantism prognosis is good
• Advanced acromegaly causes serious
complications
• Prevention
• None known
11
Hyperpituitarism
• What gland produces hGH?
1. Thyroid
2. Pituitary
3. Parathyroid
4. Adrenal
12
Hypopituitarism
• Description
• Commonly, gonadotropin and hGH are
deficient in anterior pituitary
• Complex disorder causes metabolic
dysfunction, sexual immaturity, growth
retardation in childhood
• Can result in hyposecretion of essential
“target gland” hormones
13
Hypopituitarism
• Etiology
• Pituitary or hypothalamus tumors
• Congenital defect
• Pituitary vascular diseases
• Iatrogenic
14
Hypopituitarism
• Signs and symptoms
• Depend upon age of client, deficient hormones
• May be dwarfism in children
• Slow emergence of secondary sexual
characteristics
• Amenorrhea
• Infertility
• Decreased libido
• Loss of body hair in adults
• Fatigue, weakness, anorexia
15
Hypopituitarism
• Diagnostic procedures
• Clinical history
• Laboratory tests to measure pituitary and
“target” gland hormone levels will confirm
diagnosis
• CT scan, MRI to pinpoint tumors or lesions
16
Hypopituitarism
• Treatment
• Hormone replacement therapy with constant
monitoring of levels
• Surgical management of pituitary tumors
17
Hypopituitarism
Complementary therapy
• Manage stress, maintain appropriate weight, eat
healthy food, limit fat intake
Client communication
• Explain nature of hormone deficits
• Monitor replacement therapy
18
Hypopituitarism
• Prognosis
• Good with hormone replacement
• Total loss of all hormonal secretions from
anterior pituitary can be fatal
• Prevention
• None known
19
Diabetes Insipidus
• Description
• Kidneys are unable to conserve water
• Insufficient secretion of vasopressin by the posterior
pituitary gland
• Failure of the kidney to respond to vasopressin
• Affects men more than women; usually starts in
childhood
20
Diabetes Insipidus
• Etiology
• Tumors
• Hypophysectomy
• Skull fracture
• Infection
• Idiopathic
21
Diabetes Insipidus
• Signs and symptoms
• Polyuria (4 to 16 liters of urine in 24 hours)
• Polydipsia
• Dehydration, weakness, mental confusion
• Diagnostic procedures
• UA
• Dehydration test to rule out other diseases
UA=urine analysis.
22
Diabetes Insipidus
• Treatment
• Increased fluid intake
• Hormone replacement therapy
23
Diabetes Insipidus
Complementary therapy
• None
Client communication
• Monitor proper fluid balance, weight gain,
and recurrence of polyuria
24
Diabetes Insipidus
• Prognosis
• Depends upon underlying cause, success of
treatment
• Normal life with vasopressin replacement
therapy
• Prevention
• None known
25
Diabetes Insipidus
• Which hormone is deficient in diabetes
insipidus?
1. hGH
2. Thyroxine
3. Prolactin
4. Vasopressin
26
Simple Goiter
• Description
• Enlarged thyroid not caused by infection or
neoplasm
• Endemic or sporadic
• More common in women
• Thyroid enlarges when it cannot secrete
enough of thyroid hormones T3, T4
27
Simple Goiter
• Etiology
• Endemic goiter result of insufficient intake of
iodine
• Sporadic goiter follows ingestion of certain
drugs or foods
• Usually occurs in females over age 40 with a
family history
• May be idiopathic
28
Simple Goiter
• Signs and symptoms
• May appear as small nodule or large, swollen mass
at front of neck
• Diagnostic procedures
• Rule out other diseases
• Enlarged thyroid gland with T3, T4 levels normal by
radioimmunoassay test
• Biopsy of the nodule
29
Simple Goiter
• Treatment
• Reduce goiter size
• Dietary supplements of iodine
• Hormone replacement therapy
• Excision, if quite large, followed by lifelong
hormone replacement
30
Simple Goiter
Complementary therapy
• Nutritional supplements
• Avoid such goitrogenic foods as cabbage,
spinach, peanuts, soybeans, peaches
Client communication
• Use iodized salt
• Teach clients how to monitor progressive thyroid
enlargement
31
Simple Goiter
• Prognosis
• Good with successful treatment
• Hormone replacement therapy may be
necessary
• Prevention
• Adequate dietary intake of iodine
32
Hyperthyroidism
(Graves Disease)
• Description
• Oversecretion of thyroid hormones causes
goiter, ophthalmopathy, dermopathy,
thyrotoxicosis
• Affects women more than men
33
Hyperthyroidism
(Graves Disease)
• Etiology
• Oversecretion of thyroid hormones
influences metabolism of cells throughout
body
• Graves may be genetic but more likely
autoimmune
34
Hyperthyroidism
(Graves Disease)
• Signs and symptoms
•
•
•
•
•
•
•
•
Goiter
Exophthalmos that may interfere with eye blinking
Thickened patches of skin on feet or legs
Nervousness, anxiety
Loss of sleep
Excessive perspiration, heat intolerance
Muscle wasting, bone decalcification
Cardiac problems
35
Hyperthyroidism
(Graves Disease)
• Diagnostic procedures
• Physical manifestation of disease
• Radioimmunoassay to confirm increased
levels of T3 and T4; nuclear thyroid scan
• Blood tests showing high levels of antithyroid
immunoglobulins
36
Hyperthyroidism
(Graves Disease)
• Treatment
• Dependent upon client’s age, sex, severity of
disease
• Goal: to block thyroid hormone production
with surgery or radioactive iodine therapy
• Short-term use of iodide compounds
37
Hyperthyroidism
(Graves Disease)
Complementary therapy
• Same as for goiter
• Cool compresses and eye drops for exophthalmos
• Hydrocortisone creams for dermopathy
Client communication
• Teach clients to recognize symptoms of hypothyroidism that may
result from drug therapy
• Drug and iodide compound therapy require monitoring
38
Hyperthyroidism
(Graves Disease)
• Prognosis
• Varies; if treatment results in disease remission,
prognosis is good
• Potentially fatal complication thyroid storm (medical
emergency) that results from severe thyrotoxicosis
• Prevention
• None known
39
Hypothyroidism
(Cretinism, Myxedema)
• Description
• Undersecretion of thyroid hormones
• Cretinism result of congenital deficiency of
hormones
• Myxedema result of deficiency of hormones
in childhood or adulthood
• Affects women more than men
40
Hypothyroidism
(Cretinism, Myxedema)
• Etiology
• Insufficiency or loss of thyroid tissue
• Iatrogenic due to surgery, radioactive iodine therapy
or congenital abnormality
• Common causes are inflammation and chronic
autoimmune and Hashimoto thyroiditis
• Dietary or metabolic iodine deficiencies
41
Hypothyroidism
(Cretinism, Myxedema)
• Signs and symptoms
• In neonate constipation and feeding
problems
• Brain and skeleton fail to develop
• Retarded growth, impaired intelligence,
delayed secondary sexual characteristics
42
Hypothyroidism
(Cretinism, Myxedema)
• Signs and symptoms (cont.)
• In children, there may be a hoarse cry, sleeping too
much, feeding problems; in adults, symptoms
insidious
• Fatigue, constipation, intolerance to cold, muscle cramps
• Later symptoms include mental clouding, diminished
appetite and weight gain, dry skin, brittle hair and nails
43
Hypothyroidism
(Cretinism, Myxedema)
• Diagnostic procedures
• Radioimmunoassay reveals decreased
levels of T3, T4, and elevated TSH
• Thyroid scan shows diminished iodine
uptake
• High cholesterol, alkaline phosphates,
triglycerides
44
Hypothyroidism
(Cretinism, Myxedema)
• Treatment
• Lifelong hormone replacement therapy
• Infants should begin as soon as possible
45
Hypothyroidism
(Cretinism, Myxedema)
Complementary Therapy
• None
Client Communication
• Hormone replacement therapy needs
continued monitoring throughout client’s
life
46
Hypothyroidism
(Cretinism, Myxedema)
• Prognosis
• Good with successful replacement therapy
• Myxedema coma is a life-threatening complication
• Prevention
• Only hypothyroidism due to dietary deficiency,
radiation, or surgical removal of the thyroid, and
drug-induced forms are preventable
47
Hypothyroidism
(Cretinism, Myxedema)
• Cretinism is the result of ____ deficiency
of thyroid hormones?
1. congenital
2. adult
3. iatrogenic
4. secondary
48
Hyperparathyroidism
(Hypercalcemia)
• Description
• General disorder of calcium, phosphorus
metabolism
• High levels of PTH cause
hypophosphatemia, hypercalcemia
• Affects women twice as much as men
PTH = parathyroid hormone.
49
Hyperparathyroidism
(Hypercalcemia)
• Etiology
• Excessive secretion of PTH
• Primary cause is adenoma of a parathyroid gland
• Secondary causes include chronic renal failure,
dietary insufficiency of calcium or Vitamin D,
tuberculosis, and sarcoidosis
50
Hyperparathyroidism
(Hypercalcemia)
• Signs and symptoms
•
•
•
•
•
•
•
•
Gradual onset
Clients may remain asymptomatic
Weak, brittle bones
Joint pain
Kidney stones
Polyuria
CNS disturbances
CNS = central nervous system.
Chronic fatigue
51
Hyperparathyroidism
(Hypercalcemia)
• Diagnostic procedures
• Radioimmunoassay reveals increased serum
PTH
• 24-hour urine shows calcium excretion
• Bone mineral density test
• CT scan of bone
52
Hyperparathyroidism
(Hypercalcemia)
• Treatment
• Varies with etiology
• Goal is to reduce levels of circulating calcium
• Surgery and/or drug therapy
53
Hyperparathyroidism
(Hypercalcemia)
Complementary therapy
• Monitor calcium and vitamin D supplements
• Avoid smoking
Client communication
• Teach client about disease and its treatment
• Stress importance of follow-up care
54
Hyperparathyroidism
(Hypercalcemia)
• Prognosis
• Good with successful treatment
• Complications include organ damage, coma,
cardiac arrest from severe hypercalcemia
• Prevention
• None known
55
Cushing Disease
• Description
• Hypersecretion of the adrenal cortex of the
adrenal glands resulting in production of
excess cortisol
• More common in females
56
Diabetes Mellitus
• Description
• Chronic disorder of carbohydrate
metabolism, the result of insufficient or
inadequate use of insulin
• Causes hyperglycemia, diabetic ketoacidosis
57
Diabetes Mellitus
• Description
• Four types
• Immune-mediated type 1 diabetes: abrupt onset;
occurs prior to age 30; complete absence of
insulin secretion
• Type 2 diabetes: gradual onset; most common
form; occurs after age of 40; pancreas has some
insulin-secreting ability
58
Diabetes Mellitus
• Description (cont.)
• Gestational diabetes (GDM): develops during
pregnancy; resolves after delivery; increased risk
to type 2 diabetes later
• Other types of diabetes: caused by pancreatic
dysfunction as the result of drugs, chemicals,
infections
59
Diabetes Mellitus
• Etiology
• Cause of types 1 and 2 diabetes are unknown
• Type 1 may be autoimmune disorder; type 2 may be
genetic
• Type 2 risk factors are obesity, sedentary lifestyle,
family member with diabetes
• Other types of diabetes are related to specific
conditions
60
Diabetes Mellitus
• Signs and symptoms
• Polyuria
• Glycosuria
• Polydipsia
• Weight loss; polyphagia
61
Diabetes Mellitus
• Signs and symptoms (cont.)
• Type 1
• Ketoacidosis
• Type 2
• May have hard-to-heal infections, blurred vision
• Muscle weakness, fatigue
• Often asymptomatic
62
Diabetes Mellitus
• Diagnostic procedures
• Presenting symptoms
• Hemoglobin A1C
• Random blood glucose test
• Fasting blood glucose test
63
Diabetes Mellitus
• Treatment
• Diet and exercise helpful for most forms
• Type 1 = glucose monitoring and insulin
management
• Type 2 = diet; may require insulin therapy
• Self-management of disease important
64
Diabetes Mellitus
Complementary therapy
• Diet high in complex carbohydrates, fiber, and
whole grains
• Exercise
Client communication
• Teach clients how to monitor blood sugar levels
• Advise clients to pay special attention to their
teeth and feet
65
Diabetes Mellitus
• Prognosis
• With early diagnosis, successful treatment, few
complications, prognosis is good
• Complications can be acute, resulting in diabetic
coma or insulin shock; both are life threatening
• Complications may come late in disease process,
affecting nearly every body organ
66
Diabetes Mellitus
• Prevention
• None known
• Persons at risk should carefully manage their
weight, diet; get plenty of exercise
67
Diabetes Mellitus
• Type 1 diabetes is the result of ____ not
being produced by the pancreas.
1. calcium
2. glucagon
3. hGH
4. insulin
68
Credits
Publisher: Margaret Biblis
Acquisitions Editor: Andy McPhee
Developmental Editors: Yvonne Gillam, Julie Munden
Backgrounds: Joseph John Clark, Jr.
Production Manager: Sam Rondinelli
Senior Developmental Editor, Electronic Publishing: Kirk Pedrick
Electronic Publishing: Frank Musick
The publisher is not responsible for errors of omission or for consequences from application of information in this presentation, and
makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should be applied by the
reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each
situation.
69