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8/4/2019 Endocrine Lymphatic and Immune Disorders
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Disorders -
Endocrine/Lymphatic/Immune
Systems
Compiled by Sen.T/Sr. Navuta
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Disorders of the Endocrine System
May be related to either anexcess or a deficiency of aspecific hormone
May be related to a defect at itsreceptor site
Onset of an Endocrine Disordercan be either slow and insidiousor abrupt and life-threatening
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Laboratory Testing for Endocrine
Functioning
Radioimmunoassay: competitive bindingassay test in which radioactively labeledamounts of hormones compete with
unlabeled hormones from plasma orserum for antibody binding sites.
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Urine Testing: measures hormone levelsand metabolites of specific hormones in
urine Usually done in a 24 hour urine collection
to better reflect the functioning of a gland
such as adrenal gland Certain hormones may require addition of
additives to the collection container
No unnecessary medications should beused by client during collection process
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24 Hour Urine Collection
Test starts when client first arises andurinates
The first specimen is discarded but time is
noted - (first specimen is not collectedbecause it is hard to tell how long it has beenin bladder)
Client adds all urine voided after that first
discarded specimen during next 24 hours Some hospital labs may have it put on ice
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Glucose Testing
Can be done via finger stick or
venous puncture
Glycosylated hemoglobin (HbA1c)value reveals the average bloodglucose level over a period of 2-3
months
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Radiographic Examinations Anterior, posterior and lateral skull x-ray
studies may be used to visualize sellaturcica (an indentation of sphenoid bonewhich houses the pituitary gland)
Erosion of this structure indicates invasionof the wall from an abnormal growth
CT and MRI scans can show extent of
growth or location of a tumor buried withinpituitary
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Radiographic Examinations
Size and shape of other glands andnearby structures may be visualizedby use of a contrast media
Angiography and Venography mayreveal structural abnormalities inblood vessels and ultrasonography of
thyroid gland can indicate whethernodules or masses are solid or cystic
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Pituitary Hypofunction
Caused by a deficiency of one or
more anterior pituitary hormones
Results in metabolic abnormalitiesand sexual dysfunction
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Pituitary Hypofunction
Interventions focus on replacement ofdeficient hormones to treat delayed
puberty
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Testosterone therapy is initiated withhigh-dose testosterone derivativesand continued until virilization isachieved (deepened voice, increased
chest, facial, pubic and axillary hairgrowth)
Dose is then decreased, but therapy
continues throughout lifetime
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Androgen therapy is avoided in men with
prostate cancer
Male fertility may be decreased and/ordepleted due to testosterone therapy
Side effects include: gynecomastia (male breasts)
baldness
prostatic hypertrophy
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Women may be treated with a combination of
estrogen & progesterone administered attheir menstrual cycle
The risk for hypertension or thrombosis is
increased with estrogen therapy especiallyif the woman smokes
Female fertility may be decreased andmedications are needed to induce ovulation
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Growth Hormone Deficiency changes tissue growth
patterns indirectly In children, GH deficiency leads to short stature &
other manifestations of growth retardation
GH deficiency in adults produces no obvious
anatomic changes - does increase rate of bonedestructive activity leading to thinner, more fragilebones
Adult clients may be treated with injections of GH,
although this treatment is rare
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Pituitary Hyperfunction
A condition of hormone oversecretion that occurswhen client has pituitary tumors or hyperplasias
Tumors usually arise from:
somatotropic cells (growth hormone) lactotropic cells (prolactin)
corticotropic cells (adrenocorticotrophic hormone)
Can also be caused by hypothalmic dysfunction
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Adenomas can develop in clients without afamily history or as part of a syndrome knownas multiple endocrine neoplasia
Multiple endocrine neoplasia is a familialdisorder inherited as an autosomal dominanttrait may include parathyroid and pancreatic
tumors
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Benign epithelial tumor, which is classified bysize, degree of invasiveness and hormonesecreted
As it grows, it compresses brain tissue
causing neurologic symptoms, as well asendrocrine symptoms (i.e. visual changes,headache and increased ICP)
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Prolactin secreting tumors are most commonof the Pituitary Adenomas
Produces excessiveprolactin inhibitingsecretion of gonadal steroids and
gonadotropins in men Men (gynecomastia due to low levels of
testosterone & muscle weakness)
Women (no production of breast milk, nomenses)
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Overproduction of Growth Hormone
Results in gigantism or acromegaly
Onset may be gradual, slow progression, andchanges may remain unnoticed for years
before diagnosis
Early detection and treatment is essential toprevent irreverible changes in the soft
tissues, such as those of the face, hands,feet and skin
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Enlarged hands and feet in an adult are anindicator of growth hormone excess
Although some changes are reversible after
treatment for overproduction of growthhormone, skeletal changes are permanent
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Gigantism
Onset of Growth Hormone Hypersecretionoccurs before puberty causing rapidproportional growth in the length of all bones
Back pain and arthralgias (joint pain) may besymptoms in response to bone changes
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Gigantism
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Acromegaly
Occurs after puberty and produces increasedskeletal thickness, hypertrophy of the skinand enlargement of many visceral organs
such as liver and heart.
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Acromegaly
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Acromegaly
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Cushings Disease
Caused by hypersecretion of Adrenocorticotrophichormone (ACTH)
Results in overstimulationof Adrenal Cortex
producing excessive amounts of glucocorticoids,mineralcorticoids and androgens
Clients have alterations of nitrogen, carbohydrateand mineral metabolism
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Cushings Disease
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Posterior Pituitary
Disorders of posterior pituitary are directlyrelated to a deficiency or excess of hormoneVasopressin (antidiuretic hormone - ADH)
Two disorders associated with ADHdeficiency or ADH excess are: Diabetes Insipidus
Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
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Diabetes Insipidus
Two clinical manifestations/signs that alertyou to possible endocrine disorder would be:
increased thirst
increased urination
Diabetes Insipidus is a disorder of watermetabolism caused by a deficiencyof ADH
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Diabetes Insipidus
Source of ADH insufficiency is caused eitherby: decrease in ADH synthesis
inability of kidneys to respond appropriately toADH
ADH deficiency results in excretion of largevolumes of dilute urine called polyuria
Hypernatremia is a potential problem
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Diabetes Insipidus
Dehydration caused by massivediuresiscaused by polyuria results in an increase inplasma osmolality causing thirst
However, if thirst mechanism is inadequate orabsent, or if person is unable to obtain water,dehydration becomes moresevere
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Types of Diabetes Insipidus
Nephrogenic diabetes insipidus is an inheriteddisorder where the renal tubules do not respond tothe action of ADH.
This results in inadequatewater reabsorption by
kidney Urine output is then increased and specific gravity is
decreased.
With effective treatment, urine output is effectively
decreased and specific gravity is increased
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Primary Diabetes Insipidus: caused by a
defect in Hypothalmus or Pituitary Glandresulting in a lackof ADH production orrelease
Secondary Diabetes Insipidus: resultsfrom tumors within/adjacent to hypothalmusor pituitary gland, head trauma, infectiousprocesses, surgical procedures or metastatic
tumors.
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Drug-related Diabetes Insipidus : causedby administration of lithium carbonate ordemeclocycline as these drugs can
interfere with kidneys response to ADH.
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Clinical Manifestations of Diabetes
Insipidus
Loss of free water produces expectedchanges in blood and urine tests
Initial step in diagnosis is to measure a 24
hour fluid I&O. Urine output during thisperiod must be more than 4 liters fordiagnosis. However, it may vary from 4-30
liters in a day
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Insipidus vs. Mellitus
Diabetes Mellitusis endocrine problemcaused by a decreased sensitivity of insulinreceptors to presence of insulin
Diabetes Insipidusis endocrine problemcaused by an insufficiency of AntidiureticHormone (ADH)
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Drug Therapy for Diabetes Insipidus
Client with permanent Diabetes Insipidus requireslife-long vasopressin therapy
Client is instructed to recognize poluria and
polydipsia signals for another dose of medication All clients taking vasopressin need to record daily
weights to identify weight gains
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Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)
Occurs when vasopressin (ADH) is secretedwhen plasma osmolarity is low or normal
Decrease in plasma osmolarity normally
inhibits ADH production and secretion In SIADH, the feedback mechanisms that
regulate ADH do not function properly ADHcontinues to be released even when plasma
is hyposmolar
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As a result of ADH secretion, water is
retained, resulting in: dilutional hyponatremia
expansion of the extracellular fluid volume
Pulmonary disorders (including Emphysema &other chronic lung diseases) can cause SIADHeither by causing increased secretion of ADHor ectopic synthesis of ADH.
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Adrenal Gland Hypofunction
Addisons Disease is caused by an insufficiency of
adrenocortical steroids causing problems throughloss of mineralocorticoid (aldosterone) andglucocorticoid (cortisol) action
Reducedaldosterone secretion causes potassium,sodium and water imbalances:
Hyperkalemia
Hyponatremia Hypovolemia
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Lower adrenal andogen levels result in
decreased/loss of body/axillary/pubic hair(esp. in women) because adrenals producemost of androgrens in females
Excessive production of melanocyte-stimulating hormone increases pigmentationof skin and causes darkening of skin
It can cause vitiligopatchy areas ofdepigmentation of skin
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Acute Adrenal Insufficiency
Called Addisonian crisis a life-threateningevent in which physiologic need forglucocorticoid and mineralocorticoid
hormones is greater than the available supply Usually occurs in response to a stressful
event (surgery, trauma, severe infection)
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Hormone Replacement
Glucocorticoid and mineralocorticoiddeficiencies are completely corrected byreplacement therapy
Drug regimen is divided into thirds 2/3given in morning and 1/3 given in lateafternoon to mimic normal adrenal hormone
secretion rhythm
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Additional mineralocorticoid hormone may beneeded (such as Florinef) to maintain correctelectrolyte balance (esp. Na and Kcl)
Adjustments may be needed in hot weather
to compensate for sodium loss due toexcessive perspiration
Salt restriction or diuretic therapy should not
be started withoutconsidering whether itmight precipitate an adrenal crisis
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Endocrine Disorders: Thyroid,
Parathyroid and Pancreas
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Graves Disease
(Hyperthyroidism)
Also known as Toxic Diffuse Goiter
Autoimmune disorder antibodies orimmunoglobulins are made and attach to
thyroid stimulating hormone (TSH) receptorsites on thyroid tissue
Thyroid gland increases in size and
overproduces thyroid hormones
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Presentation:
Goiter (enlargement of the thyroid gland)
Exophthalmos (abnormal protrusion of the eyes
giving a wide-eyed startled look) Pretibial myxedema (dry, waxy swelling of the
front surfaces of the lower legs)
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Graves Disease
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Clients may have excessive tearing,
bloodshot eye appearance or have sensitivityto light.
Fine, soft, silky hair and smooth, moist skin
are common with hyperthyroidism. Emotional lability (mood instability) is often
experienced. Client may also appear
extremely restless, irritable and fatigued.
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Extremity muscle weakness, hyperactivedeep tendon reflexes or tremors
Not all clients with goiter have
hyperthyroidism A hallmark assessment finding: heat
intolerance
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Hypothyroidism
Decreased metabolism from low levels ofthyroid hormones
Can occur at any time throughout life span;
however most often occurs in womenbetween ages 30-60. Women are affected 7-10 times more than men
Link between diabetes mellitus and
development of hypothyroidism has beenestablished
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Most tissues and organs are affected by lowmetabolic rate
Cellular energy production is decreased and
many metabolites build up (compounds ofprotein and sugars)
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Cellular energy is decreased and metabolites buildup inside of cells, which increases mucous andwater, thus forming cellular edema and changesorgan texture.
Cellular edema is called myxedema because it isNOT formed from water alone. Nonpitting edemaforms everywhere
Myxedema coma is rare serious complication
M d
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Myxedema
H h idi
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Hypothyroidism
Client reports more time sleeping (14 -16 hrsper day)
Generalized weakness, anorexia, muscle
aches and paresthesias Constipation is common, as is cold
intolerance
Women have difficulty getting pregnant or
changes in menses; Men have problems withimpotence and fertility
H h idi
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Hyperparathyroidism
Primary hyperparathyroidism results when 1or more parathyroid glands does not respondto normal feedback of serum calcium
In 80-85% of cases, cause is benign tumor in1 parathyroid gland
H h idi
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Hyperparathyroidism
Client may develop renal calculi (kidney stones) anddeposits of calcium in soft tissue of kidney
Pathologic fractures, bone cysts and osteoporosis iscaused due to increased rate of bone destruction(osteoclastia)
Anorexia, nausea, vomiting, epigastric pain,constipation and weight loss are common when
serum calcium levels are high
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Peptic ulcer disease can result from elevatedserum gastrin levels (hypergastrinemia)caused by hypercalcemia.
Fatigue and lethargy may be present and willbecome more severe as calcium levels rise
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Disorders of the Lymphatic System
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El h ti i
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Elephantiasis
Immune System Disorders
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Immune System Disorders
Hypersensitivity
Autoimmune Disease
Immunodeficiency Diseases
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Type II (antibody-dependant cytotoxic)- as intransfusion reaction.
Type III (immune complex)- large antibody-antigen complexes that get trapped under the tunic
interna of blood vessels and cause inflammation. Type IV (delayed)- occur 12 to 72 hours after
exposure. Delay commonly associated with traveltime to lymph nodes. Cosmetics and poison ivy
hapten commonly do this.
Autoimmune Diseases
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Autoimmune Diseases
Failure of the immune system to distinguish self fromforeign antigens.
Immune systems produces antibodies against bodies
own tissues.
Causes:
- Cross reactivity fight against a foreign antigenleds to antibodies that attack self.
- Abnormal exposure to self-antigens in the blood
- Changes in the structure of self-antigens
Immunodeficiency Diseases
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Immunodeficiency Diseases
SCID Severe combined immunodeficiency disease
- congenital deficiency of both T and B cells.
- susceptible to opportunistic infections.
- Bubble babies
AIDS Acquired
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AIDS AcquiredImmunodeficiency diseases
Acquired after birth, likeHIV.
HIV targets helper T cells Without these cells, all 3
immune responses arehampered.
Most patients with AIDS
die of opportunisiticinfections.
HIV virus
T torial Q estions
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Tutorial Questions
Discuss the following conditions
- Diabetes Mellitus
- Goiter
- Cushings Syndrome
- Pancreatitis
- HIV/AIDS
- Systemic Lupus Erythmatosus
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The End