THIS versusTHAT

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SIADH DI
Syndrome of Inappropriate Diabetes Insipidus
Antidiuretic Hormone
ADH is stored in the
TOO MUCH ADH is pituitary gland and NOT ENOUGH ADH is
released = kidneys released when the body released = kidneys
retain excess water! experiences a decrease in cannot save water!
blood volume...

CAUSES CAUSES
1. Disorders of the brain → injury, tumor, 1. Damage to the hypothalamus → radiation
infection or surgery
2. Brain surgery in the hypothalamus region 2. Brain injury → ↑ICP puts pressure on the
3. Lung disease → TB, cancer pituitary gland
4. Sepsis 3. Lung disease (TB, PNA, cancer)

SYMPTOMS SYMPTOMS
SOAKED INSIDE DRY INSIDE
Low urination → the body is holding in water Polyuria → the body is releasing too much
so urine output will be reduced water so urine output will be increased
Sticky, thick urine - urine will be concentrated Diluted urine
NCLEX: HIGH SPECIFIC GRAVITY >1.030 NCLEX: LOW SPECIFIC GRAVITY <1.005
Hypoosmolality AND hyponatremia → the Hyperosmolality AND hypernatremia → you
patient is diluted! are dehydrated
Seizures! WATCH FOR: headache and Dry skin & mucous membranes - increased
confusion thirst
Severely high blood pressure Decreased blood pressure

TREATMENT TREATMENT
GOAL: Increase fluid retention and improve
GOAL: Decrease fluid retention and improve
tonicity homeostasis
tonicity homeostasis
Desmopressin/Vasopressin
Fluid restriction
THINK: This will “press” (or contract) the
Loop Diuretics
renal ducts to decrease urinary output
Correct sodium deficit:
and increase fluid in the body to balance
Give hypertonic solution → FIRST LINE TX
water and sodium
for severe hyponatremia. This will treat
Encourage fluids - drink water!
SIADH by replenishing sodium in the body
If unable to drink, administer dextrose
DO NOT give isotonic solution to patients
and normal saline slowly to avoid fluid
with hyponatremia → will worsen
volume overload or hyperglycemia
WATCH FOR: WATCH FOR:
Signs and symptoms of seizure → place the Signs and symptoms of seizure → place the
patient on seizure precautions patient on seizure precautions
Measure intake and output & DAILY WEIGHTS Measure intake and output & DAILY
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WEIGHTS
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ADDISON'S DISEASE CUSHING SYNDROME

ABSENT STEROIDS CUSHION OF STEROIDS

patho
The adrenal glands DO NOT The adrenal glands PRODUCE
patho

PRODUCE ENOUGH steroid TOO MUCH steroid hormone

hormones (cortisol and (specifically cortisol)
aldosterone)

CAUSES: “ADD” CAUSES

A - Autoimmune response → immune system MOST COMMON: CUSHION OF STEROIDS
attacks the adrenal cortex Long-term steroid use
D - Damage to the adrenal gland → infection, Tumors on the adrenal gland → this is
cancer, TB called Cushing Syndrome
D - Damage to the pituitary gland → tumors, Tumors on the pituitary gland → this is
surgery, inflammation called Cushing’s Disease

SYMPTOMS SYMPTOMS
ABSENT or LOW "CUSHION" OF STEROIDS
Low blood pressure High blood pressure
Low temperature (cold intolerance) High sodium (hypernatremia) and blood sugar
Low sodium (hyponatremia) and blood sugar High risk of infections = slow wound healing
Low mood and energy from steroid use
Loss of body hair Excess of body hair = hirsutism (“hairy suit”)
Low weight due to fluid loss Big, round abdomen = overweight
HIGH potassium (muscle spasm & peak T NCLEX: Moon face, buffalo hump
wave) Stretch marks, rosy cheeks
HIGH pigmentation

TREATMENT
TREATMENT
GOAL: Decrease excessive cortisol in the body
GOAL: Increase (ADD) deficient steroids! Exogenous: Gradually reduce steroid dosage
Lifelong steroid therapy (meds ending in to a level that will effectively control
-sone) Cushing’s syndrome and treat the disorder
Encourage increased intake of protein, carbs, it’s initially being taken for
and sodium Endogenous: Surgically remove the tumor or
Increase sodium intake in hot weather and affected gland
after exercise We must replace the hormones that are
WATCH FOR: lost with life-long steroid therapy. If left
Swelling → fluid/weight gain untreated, the patient may enter
Sepsis → due to slow wound healing Addisonian Crisis
Hyperglycemia & osteoporosis
Addisonian crisis
ADDISONIAN CRISIS
Occurs when the adrenal glands do not produce enough cortisol (Addison's disease)
OR when there is a sudden halt in cortisol (Cushing syndrome) 73
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HYPOTHYROIDISM HYPERTHYROIDISM
WHAT HAPPENS? WHAT HAPPENS?
The underproduction of the thyroid gland, causing The overactivity of the thyroid gland, causing too
not enough T3 and T4 to be produced and released much T3 and T4 to be produced and released
↓ ↓
Consequently, the pituitary gland produces more Consequently, the pituitary gland produces less TSH
TSH to stimulate the thyroid hormone production to slow down the thyroid hormone production

NOT ENOUGH T3 & T4 TOO MUCH T3 & T4

Pituitary will make more TSH to speed up Pituitary will make less TSH to slow down

↓T3, ↓T4 ↑T3, ↑T4

CAUSES ↑TSH ↓TSH CAUSES
1. HashimOtos (trick: hypOthyroidism) 1. Graves Disease (trick: graves = gains = HIGH)
2. Low dietary iodine 2. Iodine excess
3. Pituitary tumor 3. Levothyroxine excess
4. Thyroidectomy

SYMPTOMS: lOw & slOw SYMPTOMS: High & Hot

Low blood pressure High blood pressure
Low heart rate High heart rate → heart palpitations
Low respiratory rate → KEY: Keep a High temperature → hot and sweaty skin (KEY:
tracheotomy kit at the bedside!! not dry!!)
Low temperature → KEY: NO electric blankets Heat intolerance
Low energy → weak, fatigued High GI motility → diarrhea
Low GI motility → constipation → increased Grape eyes AKA Exophthalmos → KEY: use an
weight and water in the body eyepatch or tape the eyes closed when sleeping
Low mood, libido, consciousness Golf balls in the throat AKA Goiter
Slow and dry skin turgor/hair loss

DON’T FORGET ABOUT THE DIET! DON’T FORGET ABOUT THE DIET!
Because the patient exhibits an underactive Because the patient exhibits an overactive metabolism
metabolism and “low and slow” symptoms, and “high and hot” symptoms, encourage a diet that
encourage a diet: will replace the lost nutrients:
Low in calories, protein and carbohydrates High in calories, protein and carbohydrates
→ daily weights Frequent meals
Consume foods high in iodine AVOID high fiber foods, caffeine and spicy food →
this will encourage faster metabolism and worsen
IODINE: OUR KEY INGREDIENT TO MAKE T3/T4 hyperthyroidism
Increase fiber intake
Frequent rest periods → the patient
experiences decreased energy
TREATMENT
GOAL: Decrease production of T3 and T4 and symptom
control
TREATMENT 1. Antithyroid Medications
GOAL: Stops the thyroid gland from making too
GOAL: Increase production of T3 and T4 and symptom much thyroid hormone
control Propylthiouracil (PTU) → THINK: Puts the Thyroid
Because the patient is lacking appropriate production of Underground
thyroid hormone (T3 and T4) due to various causes, a Methimazole
synthetic form of thyroid hormone should be given 2. SSKI aka Potassium Iodide → Shrinks the thyroid
Levothyroxine 3. Beta Blockers → symptom control
Regulate low and slow symptoms
WATCH FOR:
74Encourage balanced diet MYXEDEMA COMA WATCH FOR:
THYROID STORM
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HYPOPARATHYROIDISM HYPERPARATHYROIDISM
WHAT HAPPENS? WHAT HAPPENS?
The underproduction of the parathyroid The overactivity of the parathyroid gland,
gland, causing not enough parathyroid causing too much parathyroid hormone to
hormone to be produced and released be produced and released
↓ ↓
Consequently, we do not have enough Consequently, we have too much calcium
calcium being absorbed in our blood absorbed in the blood!

TOO LITTLE PTH TOO MUCH PTH

PRODUCED → NOT PRODUCED →too
ENOUGH Ca+ much Ca+
absorbed in blood absorbed in blood

CAUSES CAUSES
1. Removal of or accidental injury to the 1. PRIMARY - A tumor or enlargement of one or more
parathyroid glands during surgery to the neck of the parathyroid glands causes overproduction of
2. Autoimmune conditions PTH
3. Radiation to the face or neck ↑ PTH, ↑ Ca+
4. Low magnesium levels 2. SECONDARY - Caused by a condition outside of the
parathyroid glands (kidney disease or vitamin D
deficiency)

SYMPTOMS
↓ Ca+, ↑ PTH (over time, the parathyroid gland
compensates by increasing parathyroid
hormone)
Labs: hypocalcemia & hyperphosphatemia
Parasthesia, (+) Trousseaus and Chvostek signs
Tetany: muscle twitching or cramping SYMPTOMS
Tingling, burning, twitching
“Stones, bones, abdominal groans
Seizures and psychiatric moans”
Cardiac arrhythmias Kidney stones
Brittle nails Excess urination
Osteoporosis, arthritis, bone pain
Nausea, vomiting, constipation
TREATMENT Abdominal pain
Psychosis, anxiety
GOAL: Replace what we’re missing → calcium! Lethargy, memory loss
IV calcium or magnesium..remember they’re
BFF’s!
Oral vitamin D or calcium carbonate tablets if TREATMENT
the patient is able to swallow
Encourage a diet higher in calcium and lower GOAL: Decrease production of parathyroid
in phosphorus...remember the inverse hormone
Primary - Cut out the tumor or
relationship with these two
parathyroidectomy
Monitor vital signs and EKG monitor Secondary - Treat the underlying cause
Our heart is super sensitive to changes in Educate on avoiding lithium or thiazide
calcium so this is a big one! medications
Why? These will increase calcium in the
blood and worsen our current problem
Encourage active lifestyle to facilitate bone 75
health
RNEXPLAINED

ENDOCRINE DISORDERS
CRASH COURSE

r y gland DIABETES INSIPIDUS SIADH

ta
Not enough ADH being Too much ADH being released
i
pitu

released ↓
↓ Retains excess water in the body
Loses too much water from
the body

reas
DKA HHNS
nc
Complication of T1D Complication of T2D
pa

↓ ↓
NO working insulin receptors FEW working insulin receptors
↓ ↓
s/s hyperglycemia, ketones, Does not have ketones, abd pain
abd pain, kussmaul or kussmaul respirations
respirations
nd
l gla
na
ADDISONS CUSHINGS
e
adr

Not enough cortisol & Too much cortisol being released

aldosterone being released ↓
↓ High symptoms
Low symptoms

oid
gland HYPOTHYROIDISM HYPERTHYROIDISM
r

Not enough T3/T4 produced Too much T3/T4 produced and

thy

and released released

↓ ↓
Hashimotos Graves disease
↓ ↓
Low & slow symptoms High & hot symptoms

oid gland HYPOPARATHYROIDISM HYPERPARATHYROIDISM

yr
th
para

Not enough PTH being Too much PTH being

produced produced
↓ ↓
Low calcium & high High calcium & low
phosphorus phosphorus

76
 RNEXPLAINED

ENDOCRINE DISORDERS
SIGNS AND SYMPTOMS

r y gland DIABETES INSIPIDUS SIADH

ta
Polyuria Low urination
i
pitu

Low specific gravity <1.005 High specific gravity >1.030

Hyperosmolality Hypoosmolality
Hypernatremia Hyponatremia
Dry skin/mucus membranes Seizures
Low BP Severely high BP

reas
DKA HHNS
nc
HIGH sugar (250-500+) HIGH sugar (600+)
pa

Ketones present Extreme dehydration

Acidosis >7.35 Neurologic symptoms
Dehydrated (confusion)
Kussmaul respirations NO ketones, kussmaul or abd
Abdominal pain pain!

l gland
ADDISONS CUSHINGS
na
Low blood pressure High blood pressure
e
adr

Hyponatremia, low blood sugar Hypernatremia

Low temperature/cold High blood sugar
intolerance High risk of infection
Low mood/energy Excess body hair (hirsutism)
Loss of body hair Round abdomen (overweight)
Low weight d/t fluid loss Moon face/buffalo hump
High potassium & pigmentation

gland HYPOTHYROIDISM HYPERTHYROIDISM

oid
Grape eyes (exophthalmos)
r

Low HR/BP/RR
thy

Low temperature Goiter

Low energy (fatigue, weak) High HR/BP
Slow GI (constipation) Heart palpitations
Hair loss Hot & sweaty skin
Low mood/sex drive Heat intolerance
Slow, dry skin turgor Fast metabolism (diarrhea)
Slow menstruation

oi d gland HYPOPARATHYROIDISM HYPERPARATHYROIDISM

yr
Hypocalcemia Hypercalcemia
th

Hyperphosphatemia Hypophosphatemia
para

+ Trousseau Osteoporosis
+ Chvostek Kidney stones
Tetany - muscle aches and Abdominal pain
cramps Excessive urination
Seizures Weakness, aches
Tingling, burning, twitching
77