Packet 14 - Endocrine Function (4)

Question 1

Decrease in ADH/vasopressin levels.

a. ) Graves Disease
b. ) Syndrome of Inappropriate ADH (SIADH)
c. ) Goiter
d. ) Hashimoto Thyroiditis
e. ) Diabetes Insipidus

Answer 1

Diabetes Insipidus

Decrease in ADH / Vasopressin levels

P/C Factors:

1. Central / Neurogenic Type (r/t defect in synthesis/release of ADH).
   
   • Head injury
   • Surgery near hypothalamus or pituitary
2. Nephrogenic Type (r/t impaired kidney response to ADH).
   
   • Genetic defect
   • Electrolyte disorders
   • Certain drugs

Assessment Findings:

• Polyuria (dehydration).
• Polydipsia (excessive thirst).
• NPO patients at risk for hypernatremia.

Question 2

This type of Diabetes insipidus is related to a defect in the synthesis/release of ADH caused by either a head injury or surgery near the hypothalamus or pituitary.

a. ) Central / Neurogenic type
b. ) Nephrogenic type

Answer 2

Central / Neurogenic type

Diabetes Insipidus

Decrease in ADH / Vasopressin levels

P/C Factors:

1. Central / Neurogenic Type (r/t defect in synthesis/release of ADH).
   
   • Head injury
   • Surgery near hypothalamus or pituitary
2. Nephrogenic Type (r/t impaired kidney response to ADH).
   
   • Genetic defect
   • Electrolyte disorders
   • Certain drugs

Assessment Findings:

• Polyuria (dehydration).
• Polydipsia (excessive thirst).
• NPO patients at risk for hypernatremia.

Question 3

Enlargement of thyroid gland.

a. ) Graves Disease
b. ) Syndrome of Inappropriate ADH (SIADH)
c. ) Goiter
d. ) Hashimoto Thyroiditis
e. ) Diabetes Insipidus

Answer 3

Goiter

Enlargement of thyroid gland.

P/C Factors:

• Tumors / nodules
• Hypothyroid states → increase TSH

Question 4

Increased levels of thyroid hormone (hyperthyroidism, thyrotoxicosis).

a. ) Graves Disease
b. ) Syndrome of Inappropriate ADH (SIADH)
c. ) Goiter
d. ) Hashimoto Thyroiditis
e. ) Diabetes Insipidus

Answer 4

Graves Disease

Increased levels of thyroid hormone (hyperthyroidism, thyrotoxicosis)

P/C Factors:

• Autoimmune disorders (autoantibodies stimulate TSH receptors).
• inflammation
• tumors / cancer
• Decreased protein-binding r/t malnutrition, nephrotic syndrome, cirrhosis, some drugs → increase free hormone → increases hormone effects.
• Hypothalmic or pituitary disorders (secondary disease).
• increased intake of exogenous hormone.

Assessment Findings:

1. Thyroid Storm

Question 5

Increase in ADH/vasopressin levels.

a. ) Graves Disease
b. ) Syndrome of Inappropriate ADH (SIADH)
c. ) Goiter
d. ) Hashimoto Thyroiditis
e. ) Diabetes Insipidus

Answer 5

Syndrome of Inappropriate ADH (SIADH)

Too much ADH / Vasopressin

P/C Factors:

• Ectopic production of ADH from tumors or cancer of lungs, lymphoid tissues, prostate, pancreas, etc.
• Other intrathoracic conditions/pulmonary lesions r/t ectopic ADH produced by diseased lung tissue, or r/t increased secretion due to stress.
  
  • Ex: TB, severe pneumonia

Assessment Findings:

• Retain water.
• Decreased urine output.
• Weight gain.
• Edema and hypertension (mild).
• Hypotonic (water moves in → cellular swelling).
• Hyponatremia.
• First seen when brain cells swell.

Question 6

This type of Diabetes insipidus is related to impaired kidney response to ADH caused by a genetic defect, electrolyte disorders, or certain types of drugs.

a. ) Central / Neurogenic type
b. ) Nephrogenic type

Answer 6

Nephrogenic type

Diabetes Insipidus

Decrease in ADH / Vasopressin levels

P/C Factors:

1. Central / Neurogenic Type (r/t defect in synthesis/release of ADH).
   
   • Head injury
   • Surgery near hypothalamus or pituitary
2. Nephrogenic Type (r/t impaired kidney response to ADH).
   
   • Genetic defect
   • Electrolyte disorders
   • Certain drugs

Assessment Findings:

• Polyuria (dehydration).
• Polydipsia (excessive thirst).
• NPO patients at risk for hypernatremia.

Question 7

Decreased levels of thyroid hormone (hypothyroidism).

a. ) Graves Disease
b. ) Syndrome of Inappropriate ADH (SIADH)
c. ) Goiter
d. ) Hashimoto Thyroiditis
e. ) Diabetes Insipidus

Answer 7

Hashimoto Thyroiditis

Decreased levels of thyroid hormone (hypothyroidism)

P/C Factors:

• Congenital defects (cretinism)
• Autoimmune disease
• inflammation / infection
• iatrogenic causes
• iodine deficiency
• Hypothalmic or pituitary disorders (secondary disease).