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Diabetes insipidus results from a decreased secretion or response to ADH. Diabetes
insipidus may be idiopathic or familial. This condition may be the result of lesions in the
hypothalamus or posterior pituitary. It can also result from disorders or drugs that
damage the kidneys. Manifestations include large quantities of urine with low specific
gravity, polydipsia, nocturia, dehydration, weight loss, increased serum osmolality,
elevated temperature, and electrolyte imbalances. Diagnosis is made by testing the
individual’s response to fluid deprivation and vasopressin (ADH), obtaining skull X rays
to rule out a tumor, and testing kidney function. Treatment options include
administration of IV, IM, or intranasal vasopressin or hypophysectomy of the posterior
pituitary....kat
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is the result of an increase in
ADH secretion. It can be drug-induced, a complication of central nervous system
infections or trauma, a result of pulmonary infections, or due to any number of
different tumors. The increased release of ADH causes water retention and dilutional
hyponatremia. Manifestations include fluid retention, increased urine specific gravity,
anorexia, nausea, vomiting, stomach cramps, irritability, stupor, seizures, and
decreased osmolality and serum sodium. Diagnosis is based on analysis of serum or
urine electrolytes and osmolality. Treatment is to restrict fluids and administer
hypertonic saline, diuretics, phenytoin (Dilantin), or demeclocycline (Declomycin).
KAT
Hyperthyroidism (thyrotoxicosis) is a condition that is caused by excessive amounts of
circulating thyroid hormone (T3 and T4), leading to increased metabolism. The most
common form is Graves’ disease, which is an autoimmune disorder. Autoimmune
disorders result when the body loses its capacity to differentiate the self from what is
not the self. In such cases, the immune system literally attacks the body itself by way
of antibodies.
Common manifestations include irritability, increased activity, decreased attention
span, tremors, insomnia, weight loss, increased appetite, increased growth and bone
age (children), muscle weakness, dyspnea, exophthalmos (bulging eyes), visual
disturbances, goiter, a rapid and pounding pulse, heat intolerance, and warm, flushed
skin. In addition, the thyroid gland will be so enlarged that it can be felt on palpitation;
auscultation may reveal a bruit or whistling sound that is caused by increased
circulation of blood through the gland. Diagnosis is made primarily by physical exam
and thyroid studies, although a thyroid scan may be obtained. Treatment may include
antithyroid medications (propylthiouracil), subtotal thyroidectomy, or radioactive iodine
ablation.
KAT
Tetany is yet another complication of thyroid surgery. It is caused by the accidental
removal or nicking of the parathyroid glands during thyroidectomy. Under normal
circumstances, the parathyroid glands regulate calcium balance in the body, and this
balance allows the neuromuscular system to function properly. With tetany, however,
this is not the case. The signs of tetany are as follows: • Restlessness • Irritability •
Photophobia • Muscle cramping, especially in the hands • Numbness around the
mouth, nose, and ears • Twitching, tingling, or numbness of the extremities •
Laryngospasm (advanced tetany) • Bronchospasm (advanced tetany) • Cardiac
dysrhythmias (advanced tetany) • Seizures (advanced tetany) Patients with tetany
may also exhibit electrocardiographic changes associated with hypocalcemia, such as a
prolonged S-T segment, and their serum calcium levels may be 5–6 mg/dL or less.
(Normal calcium range is 8.5–10.5 mg/dL.) In addition to these symptoms, definitive
diagnosis of tetany may be made on the basis of three positive signs: Trousseau’s sign,
Chvostek’s sign, and the peroneal sign.
KAT
Pheochromocytoma has five primary symptoms; all are related to overactivity of the
sympathetic nervous system: 1. Hypertension (sometimes orthostatic in nature) 2.
Headache (often pounding) 3. Hyperhidrosis (excessive sweating) 4. Hypermetabolism
(increased basal metabolic rate [BMR] with weight loss) 5. Hyperglycemia (increased
blood glucose) With pheochromocytoma, a patient’s systolic blood pressure can be
over 300 mm Hg and his or her diastolic blood pressure can be as high as 200 mm Hg.
This condition called malignant hypertension, and it is caused by constriction of the
blood vessels. Other cardiovascular and neurological symptoms associated with
catecholamine release include heart palpitations, tachycardia, nervousness, and visual
disturbances.
The Somogyi effect (named after the biochemist who discovered it) is a type of
rebound hyperglycemic reaction that can be caused by the presence of too much
insulin. Symptoms of this effect reflect a combination of those exhibited by people with
hypoglycemia and those exhibited by people with hyperglycemia. They include
trembling, perspiration, feelings of apprehension, and headache, especially upon
awakening; these symptoms result from increased insulin levels in the blood.
Paradoxically, the high blood glucose levels associated with the Somogyi effect are
generally inconsistent with the foregoing symptoms, although they are consistent with
what is happening in the body. The body responds to excess insulin by secreting
glucagon, epinephrine, and/or glucocorticoids; these hormones in turn stimulate the
liver to secrete glucose, thus raising a person’s blood sugar. The normal tendency for
patients experiencing the Somogyi effect is to take an extra dose of insulin to
counteract rising glucose levels; doing this, however, only serves to further elevate
blood sugar. Instead, insulin doses for individuals with the Somogyi effect are generally
tapered. Blood glucose levels for these patients must be carefully monitored, especially
at night when hypoglycemic reactions may occur.
insipidus may be idiopathic or familial. This condition may be the result of lesions in the
hypothalamus or posterior pituitary. It can also result from disorders or drugs that
damage the kidneys. Manifestations include large quantities of urine with low specific
gravity, polydipsia, nocturia, dehydration, weight loss, increased serum osmolality,
elevated temperature, and electrolyte imbalances. Diagnosis is made by testing the
individual’s response to fluid deprivation and vasopressin (ADH), obtaining skull X rays
to rule out a tumor, and testing kidney function. Treatment options include
administration of IV, IM, or intranasal vasopressin or hypophysectomy of the posterior
pituitary....kat
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is the result of an increase in
ADH secretion. It can be drug-induced, a complication of central nervous system
infections or trauma, a result of pulmonary infections, or due to any number of
different tumors. The increased release of ADH causes water retention and dilutional
hyponatremia. Manifestations include fluid retention, increased urine specific gravity,
anorexia, nausea, vomiting, stomach cramps, irritability, stupor, seizures, and
decreased osmolality and serum sodium. Diagnosis is based on analysis of serum or
urine electrolytes and osmolality. Treatment is to restrict fluids and administer
hypertonic saline, diuretics, phenytoin (Dilantin), or demeclocycline (Declomycin).
KAT
Hyperthyroidism (thyrotoxicosis) is a condition that is caused by excessive amounts of
circulating thyroid hormone (T3 and T4), leading to increased metabolism. The most
common form is Graves’ disease, which is an autoimmune disorder. Autoimmune
disorders result when the body loses its capacity to differentiate the self from what is
not the self. In such cases, the immune system literally attacks the body itself by way
of antibodies.
Common manifestations include irritability, increased activity, decreased attention
span, tremors, insomnia, weight loss, increased appetite, increased growth and bone
age (children), muscle weakness, dyspnea, exophthalmos (bulging eyes), visual
disturbances, goiter, a rapid and pounding pulse, heat intolerance, and warm, flushed
skin. In addition, the thyroid gland will be so enlarged that it can be felt on palpitation;
auscultation may reveal a bruit or whistling sound that is caused by increased
circulation of blood through the gland. Diagnosis is made primarily by physical exam
and thyroid studies, although a thyroid scan may be obtained. Treatment may include
antithyroid medications (propylthiouracil), subtotal thyroidectomy, or radioactive iodine
ablation.
KAT
Tetany is yet another complication of thyroid surgery. It is caused by the accidental
removal or nicking of the parathyroid glands during thyroidectomy. Under normal
circumstances, the parathyroid glands regulate calcium balance in the body, and this
balance allows the neuromuscular system to function properly. With tetany, however,
this is not the case. The signs of tetany are as follows: • Restlessness • Irritability •
Photophobia • Muscle cramping, especially in the hands • Numbness around the
mouth, nose, and ears • Twitching, tingling, or numbness of the extremities •
Laryngospasm (advanced tetany) • Bronchospasm (advanced tetany) • Cardiac
dysrhythmias (advanced tetany) • Seizures (advanced tetany) Patients with tetany
may also exhibit electrocardiographic changes associated with hypocalcemia, such as a
prolonged S-T segment, and their serum calcium levels may be 5–6 mg/dL or less.
(Normal calcium range is 8.5–10.5 mg/dL.) In addition to these symptoms, definitive
diagnosis of tetany may be made on the basis of three positive signs: Trousseau’s sign,
Chvostek’s sign, and the peroneal sign.
KAT
Pheochromocytoma has five primary symptoms; all are related to overactivity of the
sympathetic nervous system: 1. Hypertension (sometimes orthostatic in nature) 2.
Headache (often pounding) 3. Hyperhidrosis (excessive sweating) 4. Hypermetabolism
(increased basal metabolic rate [BMR] with weight loss) 5. Hyperglycemia (increased
blood glucose) With pheochromocytoma, a patient’s systolic blood pressure can be
over 300 mm Hg and his or her diastolic blood pressure can be as high as 200 mm Hg.
This condition called malignant hypertension, and it is caused by constriction of the
blood vessels. Other cardiovascular and neurological symptoms associated with
catecholamine release include heart palpitations, tachycardia, nervousness, and visual
disturbances.
The Somogyi effect (named after the biochemist who discovered it) is a type of
rebound hyperglycemic reaction that can be caused by the presence of too much
insulin. Symptoms of this effect reflect a combination of those exhibited by people with
hypoglycemia and those exhibited by people with hyperglycemia. They include
trembling, perspiration, feelings of apprehension, and headache, especially upon
awakening; these symptoms result from increased insulin levels in the blood.
Paradoxically, the high blood glucose levels associated with the Somogyi effect are
generally inconsistent with the foregoing symptoms, although they are consistent with
what is happening in the body. The body responds to excess insulin by secreting
glucagon, epinephrine, and/or glucocorticoids; these hormones in turn stimulate the
liver to secrete glucose, thus raising a person’s blood sugar. The normal tendency for
patients experiencing the Somogyi effect is to take an extra dose of insulin to
counteract rising glucose levels; doing this, however, only serves to further elevate
blood sugar. Instead, insulin doses for individuals with the Somogyi effect are generally
tapered. Blood glucose levels for these patients must be carefully monitored, especially
at night when hypoglycemic reactions may occur.
