Transcript Document
Endocrinology
Sections
Anatomy and Physiology
Endocrine Disorders and Emergencies
Anatomy & Physiology
Endocrine Glands
Have systemic effects.
Act on specific target tissues in specific ways.
May have single or multiple targets.
Disorders
Disorders result from over- or underproduction of hormone(s).
Hypothalmus
Located deep within the cerebrum.
Some cells relay messages from the autonomic nervous system to the central nervous system.
Other cells respond as gland cells to release hormones.
Posterior Pituitary
Diabetes Insipidus Oxytocin and Pregnancy
Anterior Pituitary
Thyroid Gland
Hyperthyroidism & Hypothyroidism
Parathyroid Gland
Thymus Gland
Pancreas
Combination Organ
Exocrine tissues called acini secrete digestive enzymes into the small intestine.
Endocrine tissues secrete hormones.
Glycogenolysis.
Gluconeogenesis.
Pancreas
Adrenal Gland
Adrenal Medulla
Inner segment of adrenal gland.
Closely tied to autonomic nervous system.
Adrenal Cortex
Outer layers of endocrine tissue, which secrete steroidal hormones.
Adrenal Gland
Female
Ovaries
Male
Testes
Gonads
Pineal Gland
Located in the roof of the thalamus.
Related to the body’s “biological clock.”
Implicated in Seasonal Affective Disorder.
Other Organs with Endocrine Activity
Placenta
Releases hCG throughout gestation
Digestive Tract
Gastrin and secretin
Heart
ANH
Kidneys
Renin
Endocrine Disorders and Emergencies
Disorders of the Pancreas
Disorders of the Thyroid Gland
Disorders of the Adrenal Glands
Disorders of the Pancreas
Diabetes Mellitus
Glucose Metabolism
Metabolism
• Anabolism & catabolism
Disorders of the Pancreas
Insulin is required for glucose metabolism
• Presence of enough insulin to meet cellular needs.
• Ability to bind in a manner to stimulate the cells adequately.
When unable to obtain energy from glucose, the body begins to use fatty stores.
• Ketones and ketosis.
Regulation of Blood Glucose
Hypoglycemia and hyperglycemia Role of pancreas, liver, and kidneys Osmotic diuresis and glycosuria
Diabetes Mellitus
Type I Diabetes Mellitus
Also called juvenile or insulin-dependent diabetes mellitus (IDDM).
Characterized by low production of insulin.
• Closely related to heredity.
Results in pronounced hyperglycemia.
• Symptoms of untreated Type I DM include polydipsia, polyuria, polyphagia, weight loss, and weakness.
• Untreated or noncompliant patients may progress to ketosis and diabetic ketoacidosis.
Diabetes Mellitus
Type II Diabetes Mellitus
Also called adult-onset or non-insulin-dependent diabetes mellitus (NIDDM).
Results from decreased binding of insulin to cells.
• Related to heredity and obesity.
• Accounts for 90% of all diagnosed diabetes patients.
• Less risk of fat-based metabolism.
Results in less-pronounced hyperglycemia.
• Hyperglycemic hyperosmolar nonketotic acidosis.
• Managed with dietary changes and oral drugs to stimulate insulin production and increase receptor effectiveness.
Diabetic Emergencies
Diabetic Emergencies
Blood Glucose Determination Choose a vein, and prep the site.
Blood Glucose Determination Perform the venipuncture.
Blood Glucose Determination Place a drop of blood on the reagent strip. Activate the timer.
Blood Glucose Determination Wait until the timer sounds.
Blood Glucose Determination Wipe the reagent strip.
Blood Glucose Determination Place the reagent strip in the glucometer.
Blood Glucose Determination Read the blood glucose level.
Blood Glucose Determination Administer 50% dextrose intravenously, if the blood glucose level is less than 80 mg.
Diabetic Emergencies
Diabetic Ketoacidosis
Pathophysiology
Results from the body’s change to fat metabolism.
Continuous buildup of ketones produces significant acidosis.
Signs and Symptoms
Extended period of onset (12 –24 hours).
Sweet, fruity breath odor.
Potassium-related cardiac dysrhythmias.
Kussmaul’s respiration.
Decline in mental status and coma.
Diabetic Emergencies
Assessment and Management
Focused History & Physical Exam
• Obtain SAMPLE and OPQRST histories.
• Look for medical identification.
Management
• Maintain airway and support breathing as indicated.
• Determine blood glucose level and obtain blood sample.
• If blood glucose unknown, administer 25g 50% dextrose.
• Establish IV and administer normal saline per local protocol.
• Monitor cardiac rhythm and vital signs.
• Expedite transport.
Diabetic Emergencies
Hyperglycemic Hyperosmolar Nonketotic (HHNK) Coma
Pathophysiology
Found in Type II diabetics.
Results in blood glucose levels up to 1000mg/dL.
Insulin activity prevents buildup of ketones.
Sustained hyperglycemia results in marked dehydration.
• Often related to dialysis, infection, and medications.
Very high mortality rate.
Diabetic Emergencies
Signs & Symptoms
Gradual onset over days.
Increased urination and thirst, orthostatic hypotension, and altered mental status.
Assessment & Management
Difficult to distinguish from diabetic ketoacidosis in the prehospital setting.
Treatment is identical to diabetic ketoacidosis.
Diabetic Emergencies
Hypoglycemia
Pathophysiology
True medical emergency resulting from low blood glucose levels; rarely seen outside diabetics.
By the time signs and symptoms develop, most of the body’s stores have been used.
Diabetics with kidney failure are predisposed to hypoglycemia.
Diabetic Emergencies
Signs & Symptoms
Altered mental status with rapid onset
• Frequently involves combativeness.
Diaphoresis and tachycardia Hypoglycemic seizure and coma
Assessment and Management
Focused History & Physical Exam
• Obtain SAMPLE and OPQRST histories.
• Look for medical identification.
Diabetic Emergencies
Management
• Maintain airway and support breathing as indicated.
• Determine blood glucose level and obtain blood sample.
• Establish IV access.
• If blood glucose <60mg/dL or is unknown, administer 25– 50g of 50% Dextrose IV.
• If IV cannot be established, administer 0.5–1.0mg glucagon intramuscularly.
• Monitor cardiac rhythm and vital signs.
• Expedite transport.
Disorders of the Thyroid Gland
Grave’s Disease
Pathophysiology
Probably hereditary in nature.
Autoantibodies are generated that stimulate thyroid tissue to produce excessive hormone.
Signs & Symptoms
Agitation, emotional changeability, insomnia, poor heat tolerance, weight loss, weakness, dyspnea.
Tachycardia and new-onset atrial fibrillation.
Protrusion of the eyeballs or goiters.
Disorders of the Thyroid Gland
Assessment & Management
Usually arise from cardiovascular signs/symptoms.
• Manage signs and symptoms.
Thyrotoxic Crisis (Thyroid Storm)
Pathophysiology
Life-threatening emergency, usually associated with severe physiologic stress or overdose of thyroid hormone.
Results when thyroid hormone moves from bound state to free state within the blood.
Disorders of the Thyroid Gland
Signs & Symptoms
High fever (106 º F or higher) Reflected in increased activity of sympathetic nervous system.
• Irritability, delirium or coma • Tachycardia and hypotension • Vomiting and diarrhea
Assessment and Management
Support airway, breathing, and circulation.
Monitor closely and expedite transport.
Disorders of the Thyroid Gland
Hypothyroidism and Myxedema
Pathophysiology
Can be inherited or acquired.
Chronic untreated hypothyroidism creates myxedema.
• Thickening of connective tissue in skin and other tissues.
• Infection, trauma, CNS depressents, or a cold environment can trigger progression to a myxedemic coma.
Disorders of the Thyroid Gland
Signs & Symptoms
Fatigue, slowed mental function
Cold intolerance, constipation, lethargy
Absence of emotion, thinning hair, enlarged tongue
Cool, pale doughlike skin
Coma, hypothermia, and bradycardia
Disorders of the Thyroid Gland
Assessment and Management
Focus on maintaining ABCs.
Closely monitor cardiac and pulmonary status.
Establish IV access, but limit fluids.
Expedite transport.
Disorders of the Adrenal Gland
Hyperadrenalism (Cushing’s Syndrome)
Pathophysiology
Often due to abnormalities in the anterior pituitary or adrenal cortex.
May also be due to steroid therapy for nonendocrine conditions such as COPD or asthma.
Long-term cortisol elevation causes many changes.
• Atherosclerosis, diabetes, hypertension • Increased response to catecholamines • Hypokalemia and susceptibility to infection
Disorders of the Thyroid Gland
Signs & Symptoms
Weight gain “Moon-faced” appearance
Fat accumulation on the upper back
Skin changes and delayed healing of wounds
Mood swings
Impaired memory or concentration
Disorders of the Adrenal Gland
Assessment & Management
Support ABCs.
Use caution when establishing IV access.
Report any observations indicative of Cushing’s Syndrome to the receiving facility.
Adrenal Insufficiency (Addison’s Disease)
Pathophysiology
Due to destruction of the adrenal cortex.
Often related to heredity.
Stress may trigger Addisonian crisis.
Disorders of the Adrenal Gland
May be related to steroid therapy.
• Sudden withdrawal can trigger Addisonian crisis.
Signs & Symptoms
Progressive weakness, fatigue, decreased appetite, and weight loss
Hyperpigmentation of skin and mucous membranes Vomiting or diarrhea Hypokalemia and other electrolyte disturbances Unexplained cardiovascular collapse
Disorders of the Adrenal Gland
Assessment and Management
Maintain ABCs.
Closely monitor cardiac and pulmonary status.
Obtain blood glucose level and treat for hypoglycemia if present.
Establish IV and provide aggressive fluid resuscitation.
Expedite transport.
Summary
Anatomy & Physiology
Endocrine Disorders and Emergencies