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66 Cards in this Set
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pituitary disorders
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caused by hormone imbalance-general hypopituitrism or hyperpituitrism
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pituitary disorders-disorder related to Antidiuretic hormone imbalance-ADH
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also called arginie vasopressin AVP
is sythesized in the hypthalamus and stored and secreted by posterior pituitary gland |
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insufficent ADH disorder
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diabetes insipidus
water loss |
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excessive ADH disorder
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SIADH
water retention |
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SSX of diabetes insipidus
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poluria, polydipsia, hypoantremia, increased serum osmolality(concentrated blood) and dehydration
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SSX of SIADH
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fluid retention, weight gain, hyponatremia
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diagnostic test for diabetes insipidus
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urine specific gravity, urine and plasma osmolaity
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diagnostic test for SIADH
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serum and urine sodium and osmolaity
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therapeutic interventions for diabetes insipidus
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synthetic ADH repalcement
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therapeutic interventions for SIADH
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treat cause
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priority nursing diagnosis for diabetes insipidus
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risk for deficient fluid volume:<BR>monitor weight daily, I &amp; O, vitals, and urine specific gravity(decreased weight, output greater than intake, low BP, elevated pulse rate, and high urine specific gravity may indicate fluid deficit)
provide free access to oral fluids if the DI is not pyschogenic. If patients thirst mechanism is not intact, give patients fluids every hour encourage the Pt. to participate in maintaining intake and output records, monitoring weight and checking urine specific gravity, if able. report a drop in BP and a rising pulse to registered nurse or physcian(this may be signs of hypovolemic shock) |
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priority nursing diagnosis for SIADH
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risk for excess fluid volume
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urine specific gravity test normal ranges
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1.010 to 1.025
if less than 1.005 in diagnosing diabetes insipidus-use of reagent strip by the bedside hypovolemic shock occurs if fluid balnce is not restored signs of hypotension, weakness. poor skin turgor |
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Syndrome of Inappropiate antidiuretic hormone SIADH
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manifestations of dilutional hyponatemia:
bounding pulse elevated or normal BP muscle weakness headache personality changes nausea diarrhea convulsions coma |
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Syndrome of Inappropiate antidiuretic hormone SIADH causes
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certain lung cancers, or Hodgkin's disease may be ectopic sites of production of ADH-like substance
some drugs-tricyclic antidepressants and general anesthetics may increase ADH secretions head trauma or surgery or a brain tumor affecting pituitary function\ or complications of Diabetes Insipidus |
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nursing diagnosis for SIADH
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excess fluid volume related to compromised regulatory mechanism
monitor daily weights, I & O, vitals, urine specific gravity(elevate BP, bounding pulse and low urine specific gravity may all indicate fluid overload) maintain fluid restriction-fluids high in salt may help correct dilutional hyponatremia) promote comfort and choice during fluid restriction offer hard candy provide ice chips(100 ml of ice chips egual to 50 ml of water) provide calibrated cups report change of consciousness immediateley and monitor the Pt for seizures(these are signs of serious fluid imbalance) |
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disorder related to Growth Hormone Imbalance
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GH, also called somatotropin-responsible for normal growth of bones, cartilage and soft tissue(target organs)
GH is synthesized and secreted by the anterior pituitary gland |
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disorder related to Growth Hormone Imbalance-Dwarfism
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GH is deficent due to pituitary
most common cause worldwide is malnutrition a tumor, or failure of the pituitary to develop infection or trauma to pituitary neglect and severe emotional stress causing phychosocial dwarfism |
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SSX of Dwarfism
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children grow to only 3 to 4 feet of height but have normal body proportions
sometimes accompanied by mental retardation in adults: weakness, hypoglycemia, sexual dysfunction, skin changes and increased risk of cardiovascular disease. headaches, mental slowness, and visula disturbances may occur |
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diagnostic tests for dwarfism
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GH levels in blood are measured routine lab work
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therapeutic interventions for dwarfism
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in children administer GH
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nursing diagnosis for dwarfism
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disturbed body image R/T short statue
acceptance proveide opportunity for Pt. to verbalize feelings consult occup[ational therapist provide information about support groups |
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Acromegaly
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excess GH-rare
usually in 30's or 40's if it occurs in children it is Giantism bones increase in size in the hands, feet and facial features long bones grow in width not lenght because the epiphydeal disks are closed SC connective tissue increasess causing fleshy appearance interanl oragns and glands enlarge impaired tolerance of carbohydrates leads to elevated blood glucose |
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SSX of Acromegaly
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changes in ring or boot sizes
the nose, jaw, brow and hands and feet enlarge teeth become diplaced the tongue becomes thick-difficulty in speaking and swallowing sleep apnea verbal changes lead to kyphosis visual disturbances-tumor pressure on the optic nerve diabetes mellitus may develop due to GH increases blood glucose and causes and increase workload of the pancreas |
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diagnostic tests for Acromegaly
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serum GH levels are measured and radiographs show abnormal bone growth
large dose of glucose-glucose normally suppresses GH but if the hormone continues to be released after glucose-acromegaly is suspected MRI is done to locate pituitary tumor |
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therapeutic intervetions for Acromegaly
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aimed at cause
Parlodel or sandostatin may decrease GH levels hypophysectomy or radiation may be indicated if there is a tumor if pituitary is removed life long replacement of thyroid hormone, corticosteroids and sex hormoness is important to maintain homeostasis |
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nusring diagnosis for Acromegaly
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disturbed body image R/T canges in appearance
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hypothyroidism
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in women 30 to 60
in infants-cretinism in adult -myxedema |
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hypothyroidism occurs when?
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thyroid gland fails to produce enough TH even though there is enough TSH stimulating hormone being secreted by the pituitary
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thyroid hormone abnormalties in Hyperthyroidism
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Primary- +TH goes up -TSH is down
secondary TH is up and TSH is up |
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thyroid hormone abnormalties in hypothyroidism
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primary- TH is down and TSH is up
secondary- TH is down and TSH is down |
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etiology of hypothyroidism
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congential defect, inflammation, iodine deficiency
Hasimoto thyroiditis is an autimmune disorder-eventually distroys the thyroid tissue secondary or tertiary hypothyroidism may be caused by pituitary or hypothalamic lesion or postpartum pituitary necrosis-rare disorder in which the pituitary is destroyed following pregnancy and delivery |
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SSX of hypothyroidism
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reduced metabolic rate
cardiovascular-bradycardia, decreased cardic output, cool skin, cold intolerance neurological-lethargy, slowed movements, memory loss, confusion pulmonary- dyspnes, hypoventialation skin-cool, dry, brittle, dry hari GI-decreased appetite, weight gain, constipation, increased serum lipid levels reproduction- decreased libido, erectile dysfunction |
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SSX of Hyperthyroidism
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cardiovascular-tacycardia, palpitations, increased cardia output, warm skin, heat intolerance
neurological-fatigue, restlessness, tremor, insommia, emotional instability pulmonary-dyspnes diaphoresis;wram, moist skin; fine, soft hair GI=increased appetite, weight loss, freguent stools, decreased serum lipid levels reproductive-decreased libido, erectile desfunction, amenorrhea |
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hyperthyroidism
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usually diagnosed in young women
Graves disease is the most common cause multigoiter is more common in older women |
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hyperthyroidism
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primary-excess TH released
secondary-excess TSH from pituitary is released causing overstimulation of the thyroid gland tertiary-excess TRH from the hypothalamus high levels increase metabolic rate increase the # of beta-adrenergic receptor sites in the body, which enhances the activity of norepinephrin-flight or flight response |
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thyrotoxic crisis can result in ?
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death in 2 hours if untreated
SSX- tachycardia, high fever, hypertension(w/eventual heart failure and hypotension) dehydration, restlessness and delerium or coma |
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thyrotoxic crisis-treatment is first given to treat the life threatening symptoms
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acetaminophen-for fever(asprin is avoided becasue it binds to T4)
IV fluids and cooling blanket beta-adrenergic blocker-propranolol is given for tacycardia oxygewn is given and HOB elevated because high metabolic rate requires more oxygen after life thretening treatment is given the underlying thyroid problem is treated |
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diagnostic test for hyperthyroidism
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serum levels of T3 & T4 are elevated
TSH is low if in primary hyperthyroidism TSH is high if itis caused by pituitary thyroid scan for tumor should not be palpated- |
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nursing diagnosis for hyperthyroidism
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hyperthermia R/T hypermatabolic state
monitor temp-temp may be elevated administer analgesics applying cooling blanket-set 1 to 2 degrees below current temp and wrap extremities |
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goiter
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enlargement of the thyroid gland is enlarged in response to increased TSH levels
TSH is elevated because of low TH, iodine deficiency, pregnancy or viral, genetic or other conditions if it is caused by iodine deficiency or other enviromental factors is called an edemic goiter some food & medications are goitrogens-they interfere with the bodys use of iodine and include foods such as turnips, cabbage, broccoli, horseradish, cauliflower and carrots goitrogenic medications include propylthioureacil, sulfonamides, lithium, salicylates(asprin) goiter w/ hyperthyroidism is called a toxic goiter |
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goiter SSX
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thyroid gland is enlarged and swelling in neck
can interfere w/ breathing and swallowing |
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diagnostic test for goiter
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thyroid scan
serum T3 & T4 levels |
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therapuetic interventions for goiter
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aimed at cause
goitrogen-list of food to avoid iodine deficient-iodized salt is given synthyroid may be given to reduce TSH levels Thyroidectomy |
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nursing care for goiter
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breathing and swa;lowing assessed
stridor-if airway is obstructed stridor should be report to physcian immediately |
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cancer of the thyroid gland
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SSX:
a hard painless nodule may be palpated difficulty breathing or swallowing changes in the voice most have normal TH levels |
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diagnostic tests for cancer of thyroid
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thyroid scan
cold indicates cancer |
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nursing postoperative care for Pt. with thyroidectomy surgery
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monitor vitals, oxygen saturation, drain(if present), and dressing every 15 minutes initially progressing to every 4 hours
decresed BP w/ increased pulse should alert to possiblity of shock related to blood loss tacycardia and fever, along with mental status changes may indicate thyrotoxic crisis check back of neck for pooling of blood observe for respiratory distress, incresed resp.,rate, dyspnes, or stridor ask Pt to speak to detect horaness of the voice box which may indicate trauma to the laryngeal nerve monitor Pt serum calcium level and watch for signs of tetany(low calcium) |
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parathyroid glands
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secrete PTH in respoonse to low levels of calcium
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PTH
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raises serum levels by promoting calcium movement from bones to blood and by increasing absorption of dietary calcium
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decreased PTH is called
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hypoparathyroisism
and incresed PTH is hyperthyroidism |
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SSX of hypoparathyroisism
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tetany
neuromuscular irritability numbness of fingers and tingling perioral area muscle spasms twitching positive Chvostek's and Trousseaus' signs are early indications of tetany chvosteks-tap on Pt facial nerve just in front of ear-spasm is postive results for hypocalcemia Trousseaus-place a sphygmomanometer on Pt arm and pump it to above the Pt systolic pressure. Spasm in the thumb and fingers occur within 3 minutes if Pt has hypparathyroisism |
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diagnostic test for hypoparathyroisism
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serum PTH, calcium and phosphate
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therapeutic interventions fro hypoparathyroidism
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calcium replacement, high calcium, low phosperous diet
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nurisng priority diagnosis for parathyroidism
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risk for injusry R/T tetany
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hyperparathyroidism
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excess PTH
SSXhypercalcemia, fatigue, pathological fractures-kidney stones, cardiac dysrhythmias, gastric secretions, abdominal pain, peptic ulcer diagnostic tests-serum PTH, radiographs may show bone density, calcium and phosphate. therapuetic-calcitonin, parathyroidectomy Nursing diagnosis-risk for injury R/T to bone demineralization |
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disorders of the adrenal glands
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a rare tumor in the adrenal medulla called pheochromocytoma causes hypersecretion of epinephrine and norepinephrine
hypersecretion of cortisol from the adrenal cortex results in Cushings syndrome hypofunction of the adrenal cortex results in Addisons disease |
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SSX of Pheochromocytoma
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arises from the chromaffin cells in the adrenal medulla
exagerated fight or flight synptoms-because of norepinephrine hypertension tacycardia(HR over 100) palpitations tremors diaphorisis feelings of apprehension severe pounding HA N/V constipation glucose may increase unstable intermitent hypertension is most commone-diastolic>115-at risk for stroke, vision changes and organ damage |
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diagnostic test for Pheochromocytoma
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24 hour urine test for metanephrine and vanillylmandelic acid(VMA)
Pt should avoid caffeine and medications for 2 days before the test-if results are elevated a CT scan or MRI for location of tumor |
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interventions for Pheochromocytoma
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surgical removal of both adrenal glands-must be stabilized before surgery
alph-blocking medication(dibenzyline) dilate blood vessels to control acute hypertension beta-blocker meds may be added to block beta-adrenergic receptors in the heart and lungs to reduce fight or flight symptoms |
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adrenocortical insufficiency/addisons disease
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insufficient production of the hormones of the adrenal cortex
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adrenocortical insufficiency/addisons disease
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reduced levels of cortisol or aldosterone or both
and a deficiency in androgens may exist |
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adrenocortical insufficiency/addisons disease
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in Primary-ACTH are up in an attempt to stimulate the adrenal cortex to synthesize more hormones
secondary-deficient ACTH fails to stimulate adrenal steroid synthesis |
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adrenocortical insufficiency/addisons disease
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is thought to be autoimmune-gland destroys itselfin response to TB, fungal infection, AIDs and metastatic cancer
secondary AI-caused by dysfunction of the pituitary or hypothalamus |
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SSX of adrenocortical insufficiency/addisons disease
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hypotension-lack of aldosterone(aldosterone causes sodium and water retention) if deficient sodium and water are lost casuing tacycardia and hypotension
low cortisol levels cause hypoglycemia, weakness, fatigue, weight loss, confusion, and psychosis in primary AI-ACTH may cause hyperpigmentation of the skin-Pt is tanned or bronzed appearance coma or death if not treated |
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adrenal cortex think of salt, sugar, and sex
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aldosterone promtes salt
cortisol promotes sugar androgens-are sex hormones |