NCM 116 REPORTING – GROUP 2

NUTRITIONAL – METABOLIC PATTERNS/ RESPONSES TO ALTERED ENDOCRINE

FUNCTION
1. HYPERFUNCTION
2. HYPOFUNCTION
A. THYROID GLAND
B. PARATHYROIDS
C. ADRENAL GLANDS
D. PITUITARY GLANDS
E. PANCREAS I - DM
MEMBERS;
ANCHETA, BIOLENA, PALERMO, ADRES, MANZANO

*ANCHETA

HYPERFUNCTION
Hyperfunction of endocrine glands may result from overstimulation by the pituitary
whether due to intrinsic pituitary dysfunction or overstimulation of the pituitary by the
hypothalamus. However, hyperfunction of endocrine glands is most commonly due to
hyperplasia or neoplasia of the gland itself. In some cases, cancers from other tissues can
produce hormones (ectopic hormone production).
 Hormone excess also can result from exogenous hormone administration. In some cases,
patients take nonprescription products that contain hormones and may not know or tell the
physician.
Tissue hypersensitivity to hormones can occur. Antibodies can stimulate peripheral
endocrine glands, as occurs in hyperthyroidism of Graves’ disease. Disruption of a peripheral
endocrine gland can rapidly release stored hormone (eg, thyroid hormone release in subacute
thyroiditis).
Enzyme defects in the synthesis of a peripheral endocrine hormone can result in
overproduction of hormones proximal to the block. Finally, overproduction of a hormone can
occur as an appropriate response to a disease state.

HYPOFUNCTION
Hypofunction of an endocrine gland can result from under stimulation by the pituitary
whether due to intrinsic pituitary dysfunction or under stimulation of the pituitary by the
hypothalamus.
Hypofunction originating within the peripheral gland itself can result from congenital or
acquired disorders (including autoimmune disorders, tumors, infections, vascular disorders, and
toxins).
Genetic disorders causing hypofunction can result from deletion of a gene or by
production of an abnormal hormone. A decrease in hormone production by the peripheral
endocrine gland with a resulting increase in production of pituitary regulating hormone can lead
to peripheral endocrine gland hyperplasia. For example, if synthesis of thyroid hormone is
defective, thyroid-stimulating hormone (TSH) is produced in excessive amounts, causing goiter.
Several hormones require conversion to an active form after secretion from the peripheral
endocrine gland. Certain disorders can block this step (eg, renal disease can inhibit production of
the active form of vitamin D). Antibodies to the circulating hormone or its receptor can block the
ability of the hormone to bind to its receptor.
Disease or drugs can cause increased rate of clearance of hormones. Circulating
substances may also block the function of hormones. Abnormalities of the receptor or elsewhere
in the peripheral endocrine tissue can also cause hypofunction.

*BIOLENA
THYROID GLANDS
The thyroid is a 2-inch-long, butterfly-shaped gland in the front of your neck that controls your
metabolism. It’s part of your endocrine system, which makes chemicals called hormones that
help control many of your body’s functions.
How It Works
The thyroid sits just below your voice box (larynx), near the base of your neck. Two hormones
made by the thyroid gland help regulate your metabolism -- the chemical processes in your body
that break down what you eat to make energy. They can affect how fast your heart beats, how
deep you breathe, and whether you gain or lose weight. They can also help control your body
temperature, cholesterol levels, and women’s menstrual cycles.
Doctors call these hormones T-3 and T-4 for short. The thyroid releases them into your
bloodstream, which takes them through your body. Another gland, called the pituitary gland, tells
your thyroid how much of these hormones your body needs.
When It Doesn’t Work Right
Sometimes, the thyroid gland develops a problem. It might start producing too much or too little
hormone. It might become enlarged, or it could grow lumps of extra tissue.
More than 12% of people will have some sort of problem with their thyroid during their lifetime.
Women are far more likely to have this happen than men.
Reference: Written by WebMD Editorial Contributors, 2023, What Does Your Thyroid Do?,
(https://www.webmd.com/a-to-z-guides/what-does-thyroid-do)

HYPOTHYROIDISM
DESCRIPTION:
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn’t produce
enough of certain important hormones.
Women, especially those older than age 60, are more likely to have hypothyroidism.
Hypothyroidism upsets the normal balance of chemical reactions in your body. It seldom causes
symptoms in the early stages, but, over time, untreated hypothyroidism can cause a number of
health problems, such as Obesity, joint pain, Infertility and Heart disease.

RISK FACTORS:
Although anyone can develop hypothyroidism, you’re at an increased risk if you:
• Are a woman older than age 60
• Have an autoimmune disease
• Have a close relative, such as a parent or grandparent, with an autoimmune disease

• Have been treated with radioactive iodine or anti-thyroid medications

• Received radiation to your neck or upper chest
• Have had thyroid surgery (partial thyroidectomy)
• Have been pregnant or delivered a baby within the past six months

SIGNS AND SYMPTOMS:

The signs and symptoms of hypothyroidism vary, depending on the severity of the hormone
deficiency. But in general, any problems you have tend to develop slowly, often over a number of
years.
At first, you may barely notice the symptoms of hypothyroidism, such as fatigue and weight
gain, or you may simply attribute them to getting older. But as your metabolism continues to
slow, you may develop more obvious signs and symptoms. Hypothyroidism signs and symptom
may include:
• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Unexplained weight gain
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory
When hypothyroidism isn’t treated, signs and symptoms can gradually become more severe.
Constant stimulation of your thyroid gland to release more hormones may lead to an enlarged
thyroid (Goiter). In addition, you may become more forgetful, your thought processes may slow,
or you may feel depressed.
Advanced hypothyroidism, known as myxedema, is rare, but when it occurs it can be life-
threatening. Signs and symptoms include low blood pressure, decreased breathing, decreased
body temperature, unresponsiveness and even Coma. In extreme cases, myxedema can be fatal.
Hypothyroidism in infants
Although hypothyroidism most often affects middle-aged and older women, anyone can develop
the condition, including infants. Initially, babies born without a thyroid gland or with a gland that
doesn’t work properly may have few signs and symptoms. When newborns do have problems
with hypothyroidism, they may include:
Yellowing of the skin and whites of the eyes (jaundice). In most cases, this occurs when a baby’s
liver can’t metabolize a substance called bilirubin, which normally forms when the body recycles
old or damaged red blood cells.
• Frequent choking.
• A large, protruding tongue.
• A puffy appearance to the face.
As the disease progresses, infants are likely to have trouble feeding and may fail to grow and
develop normally. They may also have:
• Constipation
• Poor muscle tone
• Excessive sleepiness
When hypothyroidism in infants isn’t treated, even mild cases can lead to severe physical and
mental retardation.

Hypothyroidism in children and teens

In general, children and teens who develop hypothyroidism have the same signs and symptoms
as adults do, but they may also experience:
• Poor growth, resulting in short stature
• Delayed development of permanent teeth
• Delayed puberty
• Poor mental development

Complications:
Untreated hypothyroidism can lead to a number of health problems:
• Goiter. Constant stimulation of your thyroid to release more hormones may cause the
gland to become larger — a condition known as a Goiter. Hashimoto thyroiditis is one of the
most common causes of a Goiter. Although generally not uncomfortable, a large Goiter can
affect your appearance and may interfere with swallowing or breathing.
• Heart problems. Hypothyroidism may also be associated with an increased risk of Heart
disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the “bad”
cholesterol — can occur in people with an underactive thyroid. Even subclinical hypothyroidism,
a more benign condition than true hypothyroidism, can cause an increase in total cholesterol
levels and impair the pumping ability of your heart. Hypothyroidism can also lead to an Enlarged
heart and Heart failure.
• Mental health issues. Depression may occur early in hypothyroidism and may become
more severe over time. Hypothyroidism can also cause slowed mental functioning.
• Peripheral neuropathy. Long-term uncontrolled hypothyroidism can cause damage to
your peripheral nerves — the nerves that carry information from your brain and spinal cord to
the rest of your body, for example your arms and legs. Signs and symptoms of Peripheral
neuropathy may include pain, numbness and tingling in the area affected by the nerve damage. It
may also cause muscle weakness or loss of muscle control.
• Myxedema. This rare, life-threatening condition is the result of long-term, undiagnosed
hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness
followed by profound lethargy and unconsciousness. A myxedema Coma may be triggered by
sedatives, infection or other stress on your body. If you have signs or symptoms of myxedema,
you need immediate emergency medical treatment.
• Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs
fertility. In addition, some of the causes of hypothyroidism — such as autoimmune disorder —
also impair fertility. Treating hypothyroidism with thyroid hormone replacement therapy may not
fully restore fertility. Other interventions may be needed, as well.
• Birth defects. Babies born to women with untreated thyroid disease may have a higher
risk of birth defects than may babies born to healthy mothers. These children are also more prone
to serious intellectual and developmental problems. Infants with untreated hypothyroidism
present at birth are at risk of serious problems with both physical and mental development. But if
this condition is diagnosed within the first few months of life, the chances of normal
development are excellent.

Hypothyroidism results when the thyroid gland fails to produce enough hormones.
Hypothyroidism may be due to a number of factors, including:
• Autoimmune disease. People who develop a particular inflammatory disorder known as
Hashimoto’s thyroiditis suffer from the most common cause of hypothyroidism. Autoimmune
disorders occur when your immune system produces antibodies that attack your own tissues.
Sometimes this process involves your thyroid gland. Scientists aren’t sure why the body
produces antibodies against itself. Some think a virus or bacterium might trigger the response,
while others believe a genetic flaw may be involved. Most likely, autoimmune diseases result
from more than one factor. But however it happens, these antibodies affect the thyroid’s ability to
produce hormones.

TESTS AND DIAGNOSIS:

Because hypothyroidism is more prevalent in older women, some doctors recommend that older
women be screened for the disorder during routine annual physical examinations. Some doctors
also recommend that pregnant women or women thinking about becoming pregnant be tested for
hypothyroidism.
In general, your doctor may test for an underactive thyroid if you’re feeling increasingly tired,
have Dry skin, Constipation and weight gain, or have had previous thyroid problems or Goiter.
• Blood tests
Diagnosis of hypothyroidism is based on your symptoms and the results of blood tests that
measure the level of TSH and sometimes the level of the thyroid hormone thyroxine (T4). A low
level of thyroxine and high level of TSH indicate an underactive thyroid. That’s because your
pituitary produces more TSH in an effort to stimulate your thyroid gland into producing more
thyroid hormone. Thyroxine (T4), the main product of the thyroid gland, may also be measured
to confirm and assess the degree of hypothyroidism.
A normal range for TSH in most laboratories is 0.4 milliunits per liter (mU/L) to 4.0 mU/L,
according to the American Thyroid Association. If your TSH is higher than 4.0 mU/L on repeat
tests, you probably have hypothyroidism. Your doctor may also order a T4 test.

MANAGEMENT:
Pharmacological Management:
Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone
levothyroxine (Levothroid, Synthroid, others). This oral medication restores adequate hormone
levels, reversing the signs and symptoms of hypothyroidism.
One to two weeks after starting treatment, you’ll notice that you’re feeling less fatigued. The
medication also gradually lowers cholesterol levels elevated by the disease and may reverse any
weight gain. Treatment with levothyroxine is usually lifelong, but because the dosage you need
may change, your doctor is likely to check your TSH level every year.
Determining proper dosage may take time
To determine the right dosage of levothyroxine initially, your doctor generally checks your level
of TSH after two to three months. Excessive amounts of the hormone can cause side effects, such
as:
• Increased appetite
• Insomnia
• Heart palpitations
• Shakiness
If you have Coronary artery disease or severe hypothyroidism, your doctor may start treatment
with a smaller amount of medication and gradually increase the dosage. Progressive hormone
replacement allows your heart to adjust to the increase in metabolism.
Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively
inexpensive. If you change brands, let your doctor know to ensure you’re still receiving the right
dosage. Also, don’t skip doses or stop taking the drug because you’re feeling better. If you do,
the symptoms of hypothyroidism will gradually return.

Proper absorption of levothyroxine

Certain medications, supplements and even some foods may affect your ability to absorb
levothyroxine. Talk to your doctor if you eat large amounts of soy products or a high-fiber diet or
you take other medications, such as:
• Iron supplements
• Cholestyramine
• Aluminum hydroxide, which is found in some antacids
• Calcium supplements
If you have subclinical hypothyroidism, discuss treatment with your doctor. For a relatively mild
increase in TSH, you probably won’t benefit from thyroid hormone therapy, and treatment could
even be harmful. On the other hand, for a higher TSH level, thyroid hormones may improve your
cholesterol level, the pumping ability of your heart and your energy level.

Alternative Medicine
Although most doctors recommend synthetic thyroxine, natural extracts containing thyroid
hormone derived from the thyroid glands of pigs are available. These products contain both
thyroxine and triiodothyronine. Synthetic thyroid medications contain thyroxine only, and the
triiodothyronine your body needs is derived from the thyroxine.
Extracts are available by prescription only and shouldn’t be confused with the glandular
concentrates sold in natural foods stores. These products aren’t regulated by the Food and Drug
Administration, and their potency and purity isn’t guaranteed.

Medical Management:
People who produce too much thyroid hormone (Hyperthyroidism) are often treated with
radioactive iodine or anti-thyroid medications to reduce and normalize their thyroid function.
However, in some cases, treatment of Hyperthyroidism can result in permanent hypothyroidism.
• Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or
halt hormone production. In that case, you’ll need to take thyroid hormone for life.
• Radiation therapy. Radiation used to treat Cancers of the head and neck can affect your
thyroid gland and may lead to hypothyroidism.
• Medications. A number of medications can contribute to hypothyroidism. One such
medication is lithium, which is used to treat certain psychiatric disorders. If you’re taking
medication, ask your doctor about its effect on your thyroid gland.
Less often, hypothyroidism may result from one of the following:
• Congenital disease. Some babies are born with a defective thyroid gland or no thyroid
gland. In most cases, the thyroid gland didn’t develop normally for unknown reasons, but some
children have an inherited form of the disorder. Often, infants with congenital hypothyroidism
appear normal at birth. That’s one reason why most states now require newborn thyroid
screening.
• Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary
gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign
Tumor of the pituitary gland.
• Pregnancy. Some women develop hypothyroidism during or after pregnancy (postpartum
hypothyroidism), often because they produce antibodies to their own thyroid gland. Left
untreated, hypothyroidism increases the risk of Miscarriage, premature delivery and
Preeclampsia — a condition that causes a significant rise in a woman’s blood pressure during the
last three months of pregnancy. It can also seriously affect the developing fetus.
• Iodine deficiency. The trace mineral iodine — found primarily in seafood, seaweed,
plants grown in iodine-rich soil and iodized salt — is essential for the production of thyroid
hormones. In some parts of the world, iodine deficiency is common, but the addition of iodine to
table salt has virtually eliminated this problem in the United States. Conversely, taking in too
much iodine can cause hypothyroidism.

Nursing Management:
• Assess client weight and appetite
• Consult with a dietitian to provide a menu for the patient (an increased fiber to counter
constipation)
• Educate the patient and family
• Encourage patient to use moisturizer if the skin is dry
• Educate patient on compliance with thyroid hormone therapy
• Encourage exercise
• Check labs for levels of thyroid hormone
• Monitor fluid intake
• Encourage patient to follow with a mental health nurse since depression is common in
hypothyroidism
Monitor for signs and symptoms of overtreatment with levothyroxine. Indications of
overtreatment mimic signs and symptoms of hyperthyroidism such as anxiety, palpitations,
tachycardia, heat intolerance, fever, excessive sweating, changes in appetite and weight loss.
Report any signs of cardiac excitability, chest pain, and dysrhythmias to the medical provider.

• Coordination of Care
Hypothyroidism affects multiple organ systems across all age groups and affects patient well-
being and ability to function on a daily basis. Treatment is with levothyroxine monotherapy
(Grade A, Best Evidence Level 1).
Effective treatment calls for a team-based and patient-centered approach. When patient
symptoms are not adequately controlled an endocrinology consult should be obtained.
Endocrinology consultation is also recommended in complex scenarios such as preconception,
pregnancy, congenital and pediatric hypothyroidism, failure of treatment, co-existing cardiac or
other endocrine disorders, difficulty in interpretation of thyroid test results, drug-induced
hypothyroidism. Other specialists that may be needed are a psychiatrist, obstetrician-
gynecologist, pediatrician, cardiologist, and intensivist.
It is helpful to work closely with a pharmacist to determine medication and food interactions, the
effect of changes in levothyroxine formulations, to investigate the causes for the requirement of
unusually high doses of levothyroxine or fluctuating TSH levels. Prompt notification of
unusually high levels of TSH by laboratory personnel, close monitoring of vital signs and mental
status by nurses can facilitate early treatment and better outcomes, especially in the inpatient
setting such as in myxedema coma. Rapid response teams can be effectively utilized when
hypothyroidism causes hemodynamic instability.

PROGNOSIS:
Without treatment, hypothyroidism may have a risk of high morbidity and mortality. It can
eventually lead to coma or even death. In children, failure to treat hypothyroidism can result in
severe mental retardation. A leading cause of death in adults is heart failure. With treatment, most
patients have a good prognosis, and the symptoms usually reverse in a few weeks or months.
Severe hypothyroidism may present as myxedema coma and is an endocrine emergency. Prompt
recognition and early treatment in the intensive care unit (ICU) are essential, and even then,
mortality reaches 25% to 60%.
UPDATES:

Nikita Patil, National Library of Medicine, 2023, Hypothyroidism

Web: https://www.ncbi.nlm.nih.gov/books/NBK568746/
PARATHYROID GLANDS
Parathyroid glands are small glands, located in the neck just behind the butterfly-shaped thyroid
gland. Two parathyroid glands lie behind each ‘wing’ of the thyroid gland (there are usually four
in total). The parathyroid glands release a hormone called parathyroid hormone (PTH). This
hormone helps to control the levels of calcium in the bloodstream. When calcium levels are low,
parathyroid hormone is released by the parathyroid glands into the blood and causes the bones to
release calcium and increase levels in the bloodstream. It also causes the kidneys to stop calcium
being lost in urine as well as stimulating the kidneys to increase vitamin D metabolism.
If someone does not take in enough calcium through their diet or does not have enough vitamin
D, circulating calcium levels fall and the parathyroid glands produce more parathyroid hormone.
This brings calcium levels in the bloodstream back up to normal.
Another method that parathyroid hormone uses to increase calcium levels in the bloodstream is
activation of vitamin D. This occurs in the kidney too; the activated vitamin D then increases
calcium absorption from the gut.
HYPOPARATHYROIDISM
DESCRIPTION
Hypoparathyroidism is an uncommon condition in which your body secretes abnormally low
levels of parathyroid hormone (PTH). PTH plays a key role in regulating and maintaining a
balance of your body’s levels of two minerals — calcium and phosphorus.
The low production of PTH in hypoparathyroidism leads to abnormally low ionized calcium
levels in your blood and bones and to an increase of serum phosphorus.
Treatment for hypoparathyroidism consists of taking supplements to normalize your calcium and
phosphorus levels. Depending on the cause of your hypoparathyroidism, you’ll likely need to
take supplements for life.

SYMPTOMS
Signs and symptoms of hypoparathyroidism can include:
• Tingling or burning (paresthesias) in your fingertips, toes and lips
• Muscle aches or cramps affecting your legs, feet, abdomen or face
• Twitching or spasms of your muscles, particularly around your mouth, but also in your
hands, arms and throat
• Fatigue or weakness
• Painful menstruation
• Patchy Hair loss, such as thinning of your eyebrows
• Dry, coarse skin
• Brittle nails
• Headaches
• Depression, mood swings
• Memory problems
• When to see a doctor
If you have any of the signs and symptoms associated with hypoparathyroidism, make an
appointment with your doctor for an evaluation. Contact your doctor immediately if you have a
seizure or have difficulty breathing, both of which can be complications of hypoparathyroidism.

RISK FACTORS
Factors that may increase your risk of developing hypoparathyroidism include:
• Recent neck surgery, particularly if the thyroid was involved
• A family history of hypoparathyroidism
• Having certain autoimmune or endocrine conditions, such as Addison’s disease — a
condition characterized by a deficit in hormone production by the adrenal glands
COMPLICATIONS
Hypoparathyroidism may result in numerous complications.
• Reversible complications
The following complications are due to low calcium levels, most of which are likely to improve
with adequate treatment:
Tetany. These cramp-like spasms of your hands and fingers may be prolonged and painful.
Tetany may also include muscle discomfort and twitches or spasms of the muscles of your face,
throat or arms. When these spasms occur in your throat, they can interfere with breathing,
creating a potential emergency.
Paresthesias. These are characterized by sensory symptoms of odd, tingling sensations or pins
and needles feelings in your lips, tongue, fingers and feet.
• Loss of consciousness with convulsions (Grand mal seizures).
• Malformation of the teeth, affecting dental enamel and roots.
• Impaired kidney function.
• Heart arrhythmias and fainting, even Heart failure.
• Irreversible complications
• Accurate diagnosis and effective treatment may prevent these complications associated
with hypoparathyroidism, but once present, they won’t improve with calcium and vitamin D
treatment:
• Stunted growth (short stature)
• Slow mental development (or mental retardation) in children
• Calcium deposits in the brain, which can cause Balance problems and seizures
• Cataracts

TESTS AND DIAGNOSIS

Medical history
A doctor who suspects hypoparathyroidism begins by taking a medical history and asking about
your symptoms, such as Muscle cramps or tingling of your toes, fingers or lips. He or she will
want to know whether you’ve had recent surgeries, particularly operations involving the thyroid
gland or your neck.
Physical exam
Next, your doctor will conduct a physical examination, looking for signs that suggest
hypoparathyroidism, such as facial muscle twitching.

Blood tests
You’ll also have blood tests, and the following findings may indicate hypoparathyroidism:
• A low blood-calcium level
• A low parathyroid hormone level
• A high blood-phosphorus level
• A low blood-magnesium level
Your doctor may also order a urine test to determine whether your body is excreting too much
calcium.
In diagnosing children, doctors check to see whether tooth development is normal and whether
they have met developmental milestones.
Your healthcare provider may have you undergo other tests to check for more serious side effects
of hypoparathyroidism, including:
• An electrocardiogram (ECG or EKG) to check for an abnormal heart rhythm.
• A computed tomography (CT) scan to check for calcium deposits in your brain.

MANAGEMENT
The goal of treatment is to relieve symptoms and to normalize levels of calcium and phosphorus
in your body. A treatment regimen typically includes:
Pharmacological Management:
• Oral calcium carbonate tablets. Oral calcium supplements can increase calcium levels in
your blood. However, at high doses, calcium supplements can cause gastrointestinal side effects,
such as Constipation, in some people.
• Vitamin D. High doses of vitamin D, generally in the form of calcitriol, can help your
body absorb calcium and eliminate phosphorus.
Some studies have shown benefits of treatment with recombinant human parathyroid hormone
(PTH), currently used to treat the bone-thinning disease Osteoporosis. However, it’s not
approved for treatment of hypoparathyroidism.
If calcium in your blood remains low despite treatment, your doctor may add a prescription
diuretic medication — specifically a thiazide diuretic such as hydrochlorothiazide or metolazone.
While some other types of diuretics (loop diuretics) decrease calcium levels in your bloodstream,
the thiazides can increase blood-calcium levels.
Most people who are treated for hypoparathyroidism can keep their symptoms under control if
they continue to receive treatment. Early diagnosis and treatment can help prevent complications
of hypoparathyroidism, some of which are permanent.

Dietary steps
Your doctor may recommend that you consult a dietitian, who is likely to advise a diet that is:
• Rich in calcium. This includes dairy products, green leafy vegetables, broccoli, kale, and
fortified orange juice and breakfast cereals.
• Low in phosphorus-rich items. This means avoiding carbonated soft drinks, which
contain phosphorus in the form of phosphoric acid, and limiting eggs and meats.

Medical Management:
Intravenous infusion
If you need immediate symptom relief, your doctor may recommend hospitalization to
administer calcium by intravenous (IV) infusion. These IV infusions may be important if you’re
having severe spasms associated with tetany. After hospital discharge, you can continue to take
calcium and vitamin D orally.
Regular monitoring
Your doctor will regularly check your blood to monitor levels of calcium and phosphorus.
Initially, these tests will probably be weekly to monthly. Eventually, you’ll need blood tests just
twice a year.
Because hypoparathyroidism is a long-lasting (chronic) disorder, treatment generally is lifelong,
as are regular blood tests to determine whether calcium in particular is at normal levels. Your
doctor will adjust your dose of supplemental calcium if your blood-calcium levels rise or fall.

Surgical Management:
Patients undergoing parathyroidectomy for parathyroid hyperplasia are at high risk of developing
permanent primary hypoparathyroidism.
Patients may be treated with an autotransplant of a segment of parathyroid gland to prevent
hypoparathyroidism. This autotransplant is usually placed subcutaneously in the forearm or in
the neck. A study by Teshima et.al. indicated that if the parathyroid glands cannot be preserved in
situ during total thyroidectomy for thyroid cancer, hypoparathyroidism can best be avoided by
autotransplantation of two or more parathyroid glands. The investigators found that 33% of the
patients in whom one parathyroid gland was autotransplanted developed permanent
hypoparathyroidism, while none of the patients in whom two or more parathyroid glands were
autotransplanted developed this condition.

PROGNOSIS
In chronic cases, lifelong calcium supplements along with calcitriol (a medication that treats low
calcium levels caused by kidney disease) are necessary. Most can live healthy, functional lives,
but some have persistent complaints that may be improved by replacing parathyroid hormone.
https://emedicine.medscape.com/article/122207-treatment?form=fpf

*PALERMO
ADRENAL GLAND DISORDERS
Are located on the top of your kidneys. Each gland is about the size of the end of your
thumb and is shaped like boomerang. The adrenal gland consists of two portions: the inner core
(medulla) and the outer layer (cortex).

MEDULLA - it produce hormones called catecolamines. The most important of these are
adrenaline (epinephrine) and noradrenaline (norepinephrine). Physical and emotional stresses
usually trigger their release. When secreted into the bloodstream, catecolamines increase your
heart rate and blood pressure and effect several other body functions.

CORTEX- it produce hormones called corticosteroids. An area of your brain called

hypothalamus and the pituitary gland control the production of these hormones.

There are three groups of corticosteroids.

 SEX- it includes male androgens and female estrogens, which affect sexual development
and reproduction. Sex hormones are also produced in larger amounts in the testicles and ovaries.
 Glucocorticoids- the cortisol family of hormones or the Glucocorticoids influence the
conversion of starchy foods into the glycogen, a stored form of blood sugar. One important
glucocorticoid is cortisol which has many functions. Among other task, it helps regulate the
immune system, helps maintain proper blood pressure and blood volume, and helps your body
deal with physical stress.

 Mineralcorticoids- are corticosteroids that control the body’s content of the mineral
sodium and potassium. Aldosterone is the main member of this group.

RISK FACTORS:
Adrenal gland disorders can have various risk factors that may increase the likelihood of
developing these conditions.
 Autoimmune Disorders: Certain autoimmune disorders, such as autoimmune Addison's
disease, increase the risk of developing adrenal gland disorders.
 Medication Use: Prolonged use of corticosteroid medications, such as prednisone, can
increase the risk of adrenal gland disorders, particularly Cushing's syndrome.
 Infections: Certain infections, such as tuberculosis or fungal infections, can affect the
adrenal glands and contribute to adrenal gland disorders, including adrenal insufficiency.
 Genetic Factors: Some adrenal gland disorders, such as congenital adrenal hyperplasia,
have a genetic component.
 Tumors: Adrenal tumors, both benign and malignant, can disrupt normal adrenal gland
function and lead to hormone imbalances. These tumors can be associated with conditions like
Cushing's syndrome, aldosteronism, or pheochromocytoma.
 Age and Gender : Some adrenal gland disorders, such as adrenal tumors or Cushing's
syndrome, may have a higher prevalence in certain age groups or genders. For example, adrenal
tumors called pheochromocytomas are more common in young adults.
 Lifestyle Factors: These may include chronic stress, smoking, excessive alcohol
consumption, and poor dietary habits. These factors merely increase the likelihood, and some
disorders can occur without any identifiable risk factors.

SIGNS AND SYMPTOMS

 Weakness, loss of consciousness and fatigue
 Weight loss and decreased appetite
 Darkening of the skin
 Lightheadedness when standing
 Diarrhea, Nausea and Vomiting
 Low blood sugar
 Joint and muscle aches
 Irritability
 Salt craving

LABORATORY AND DIAGNOSTIC

 Blood tests: Blood tests can measure the levels of hormones produced by the adrenal
glands, such as cortisol, aldosterone, and adrenal androgens.
 Urine tests: Urine tests can be used to measure the levels of certain hormones or their
metabolites, such as cortisol or catecholamines.
 ACTH stimulation test: This test measures how the adrenal glands respond to
adrenocorticotropic hormone (ACTH), which is produced by the pituitary gland. It helps
determine if the adrenal glands are functioning properly and can differentiate between primary
and secondary adrenal insufficiency.
 Imaging tests: Imaging tests, such as computed tomography (CT) scans or magnetic
resonance imaging (MRI), can provide detailed images of the adrenal glands. These tests can
help identify tumors, cysts, or other structural abnormalities in the adrenal glands.
 Dexamethasone suppression test: This test is used to evaluate cortisol production and can
help diagnose conditions like Cushing's syndrome. It involves taking a synthetic glucocorticoid
called dexamethasone and measuring cortisol levels in the blood or urine.
 Genetic testing: In certain cases, genetic testing may be recommended to identify specific
genetic mutations associated with adrenal gland disorders, such as congenital adrenal hyperplasia
or familial adrenal cancer syndromes. I

MANAGEMENT AND TREATMENT

 Pharmacological
Here are some common pharmacological treatments used for adrenal gland disorders:
 Corticosteroids: Corticosteroids, such as hydrocortisone, prednisone, or dexamethasone,
are often prescribed to replace or supplement the hormones that the adrenal glands are not
producing adequately.
 Mineralocorticoids: In cases of mineralocorticoid deficiency, medications like
fludrocortisone may be prescribed.
 Steroidogenesis inhibitors: Steroidogenesis inhibitors, such as ketoconazole or
metyrapone, are used to reduce the production of excess cortisol in conditions like Cushing's
syndrome or adrenal tumors.
 Anti-androgens: Anti-androgen medications, such as spironolactone or flutamide, may be
prescribed to block the effects of adrenal androgens in conditions like congenital adrenal
hyperplasia or adrenal tumors.
 Chemotherapy or targeted therapy: In cases of adrenal cancer or metastatic adrenal
tumors, chemotherapy or targeted therapy medications may be used to help shrink or slow down
the growth of cancer cells.

 Medical
The medical management of adrenal gland disorders involves various approaches depending
on the specific condition and its underlying cause. Here are some common medical
management strategies for adrenal gland disorders:
 Hormone replacement therapy: For adrenal insufficiency (such as Addison's disease),
hormone replacement therapy is the mainstay of treatment such as hydrocortisone, prednisone, or
dexamethasone, to replace the deficient cortisol and, if necessary, aldosterone.
 Monitoring and adjusting medication: Regular monitoring of hormone levels through
blood tests is essential to ensure that hormone replacement therapy is effectively managing
adrenal gland disorders.
 Managing complications: Adrenal gland disorders can lead to various complications, such
as electrolyte imbalances, low blood pressure, or metabolic disturbances. Medical management
involves addressing and managing these complications through appropriate interventions, such
as fluid and electrolyte replacement or blood pressure management.
 Treating underlying causes: If the adrenal gland disorder is secondary to another
condition, such as an autoimmune disease or tumor, medical management may involve treating
the underlying cause.
 Regular follow-up and monitoring: Regular follow-up visits with healthcare
professionals, including endocrinologists, are important to monitor hormone levels, adjust
medication dosages if needed, and address any new symptoms or complications.
 Lifestyle modifications: lifestyle modifications may be recommended to support adrenal
gland health. This can include stress management techniques, maintaining a balanced diet,
regular exercise, and avoiding triggers that may exacerbate symptoms.

 Nursing Mangement

 Adrenal gland function It consist of two parts: the outer adrenal cortex and the
inner adrenal medulla.
1.Adrenal Cortex: The adrenal cortex produces several hormones, including: -
Cortisol: This hormone helps regulate metabolism, immune response, blood sugar
levels, and the body's response to stress. Aldosterone: Aldosterone helps regulate
fluid balance and blood pressure by controlling the reabsorption of sodium
and the excretion of potassium in the kidneys.
2. Adrenal Medulla: The adrenal medulla produces two main hormones: - Epinephrine
(adrenaline): Epinephrine is involved in the body's "fight or flight" response and helps increase
heart rate, blood pressure, and energy availability during times of stress
or danger. - Norepinephrine (noradrenaline): Norepinephrine also plays a role in the
body's stress response and helps regulate blood pressure.

 Imaging Test

 Ultrasound: This test uses sound waves to create images of the adrenal glands. It is non-
invasive and helps visualize the size and shape of the glands.
 CT Scan: A CT scan provides detailed cross-sectional images of the adrenal glands. It
can detect and characterize adrenal masses or tumors.
 MRI: MRI uses magnetic fields and radio waves to produce detailed images of the
adrenal glands. It provides high-resolution images and helps differentiate between benign and
malignant tumors.

NURSING PRIORITIES
 Assessment and Monitoring: - Monitor vital signs, including blood pressure, heart rate,
and respiratory rate, to identify any abnormalities or changes. Assess for signs and symptoms of
adrenal crisis, such as severe fatigue, dehydration, low blood pressure, and altered mental status.
- Monitor electrolyte levels, including sodium and potassium, as imbalances can occur in certain
adrenal gland disorders. - Assess for signs of hormone imbalance, such as weight changes,
changes in hair growth, and mood disturbances.
 Medication Management: - Administer medications as prescribed, ensuring accurate
dosages and timing. - Educate the individual on the purpose, dosage, and potential side effects of
their medications. - Monitor for medication side effects and adverse reactions, such as fluid
retention or electrolyte imbalances.
 Symptom Management: - Assist with symptom management strategies, such as stress
reduction techniques and lifestyle modifications. - Provide support and education on managing
symptoms related to hormonal imbalances, such as fatigue, weight changes, and mood
disturbances. - Encourage a balanced diet and regular exercise to promote overall well-being.
 Education and Self-care: - Educate the individual about their specific adrenal gland
disorder, including its causes, symptoms, and treatment options. - Teach self-care measures, such
as proper medication administration, monitoring of symptoms, and recognizing signs of adrenal
crisis. - Provide information on the importance of regular follow-up appointments and adherence
to treatment plans.
 Emotional Support: - Provide emotional support and counseling to help individuals cope
with the challenges and emotional impact of living with an adrenal gland disorder. - Encourage
open communication and provide resources for support groups or counseling services.

PREVENTION:
The prevention of adrenal gland disorders involves various strategies here are some general
measures that may help reduce the risk:
 Manage stress: Engaging stress management techniques such as regular exercise,
practicing relaxation techniques (e.g., deep breathing, meditation), getting enough sleep, and
seeking support from loved ones or professionals can help reduce the risk of adrenal gland
disorders.
 Practice a healthy lifestyle: This includes eating a balanced diet rich in fruits, vegetables,
whole grains, and lean proteins, maintaining a healthy weight, limiting the consumption of
processed foods, sugars, and unhealthy fats, and staying hydrated.
 Avoid excessive alcohol and caffeine consumption: It's advisable to moderate alcohol
consumption and limit caffeine intake to moderate levels.
 Be cautious with medications: It's essential to use medications as prescribed by healthcare
professionals and under their guidance.
 Practice safety measures: This includes practicing good hygiene, getting vaccinated as
recommended, wearing protective gear when necessary, and following safety guidelines in
various settings.
 Genetic counseling and testing: If you have a family history of adrenal gland disorders or
certain genetic conditions, consider genetic counseling and testing to assess your risk and discuss
preventive measures. Regular check-ups with healthcare professionals, early detection, and
prompt treatment can help manage adrenal gland disorders effectively.

PROGNOSIS
 Adrenal Insufficiency: With appropriate hormone replacement therapy, the prognosis for
adrenal insufficiency is generally good.
 Cushing's Syndrome: success of treatment in addressing that cause. - Surgical removal of
adrenal tumors or pituitary tumors causing Cushing's syndrome can lead to significant
improvement or cure.
 Congenital Adrenal Hyperplasia (CAH): the effectiveness of hormone replacement
therapy. With proper management, including lifelong hormone replacement and regular
monitoring, individuals with CAH can lead healthy lives and have a good prognosis.

INTERVENTIONS:
Surgery to remove tumors in the adrenal gland or, when appropriate, surgery to remove
the one or both of the adrenal glands. Minimally invasive surgery performed through the nostrils
to remove tumors in the pituitary gland. Medication to stop the excess production of hormones.
Hormone replacement.

UPDATES:
1. "Management challenges and therapeutic advances in congenital adrenal" - A study published
in Nature discusses the emerging potential of adrenal-derived 11-oxygenated androgens as new
biomarkers for congenital adrenal hyperplasia (CAH). Traditional biomarkers are subject to
variability and are not adrenal-specific, but these new biomarkers show promise. Read more
2. "Adrenal Disease articles: The New England Journal of Medicine" - The New England
Journal of Medicine has published articles on various aspects of adrenal disease, including a case
study on tongue discoloration and its implications. Read more
3. "Overview of the 2022 WHO Classification of Adrenal Cortical" - A publication in
Springer provides an overview of the updated 2022 World Health Organization (WHO)
classification of adrenal cortical tumors. The new classification includes sections on adrenal
ectopia and its potential role in neoplastic proliferations and mimicking metastatic disease. Read
more
4. "Adrenal Disease 2022 | Endocrine Society" - The Endocrine Society has released a
thematic issue focused on adrenal disease. It features a collection of journal articles published in
2021-2022, curated based on Altmetric Attention Scores and Featured Article designations. Read
more
5. "Thematic Issue: Adrenal Disease 2022 - Oxford Academic" - Oxford Academic has a
thematic issue on adrenal disease. It explores the functioning of the hypothalamic-pituitary-
adrenal (HPA) axis and the suppression of the contralateral adrenal gland in the presence of a
functional adrenal adenoma.
Sources: MAYO CLINIC FAMILY HEALTH BOOK

*ADRES
nutritional-metabolic patterns of pituitary gland

The pituitary gland is an important endocrine gland located at the base of the brain. It plays a
crucial role in regulating various bodily functions through the release of hormones. Nutritional-
metabolic patterns of the pituitary gland refer to the specific dietary and metabolic factors that
can influence its functioning.

Proper nutrition is essential for the normal functioning of the pituitary gland. It requires a
balanced intake of essential nutrients, including vitamins, minerals, amino acids, and fatty acids,
to produce and release hormones effectively. Certain nutrients, such as iodine and iron, are
particularly important for the synthesis of specific pituitary hormones.
Additionally, the metabolic state of the body can also impact the pituitary gland. Metabolic
disorders, such as diabetes or obesity, can affect the hormonal regulation of the pituitary gland
and disrupt its normal functioning. Conversely, hormonal imbalances originating from the
pituitary gland can also contribute to metabolic abnormalities.

Overall, maintaining a healthy and balanced diet, along with proper metabolic function, is crucial
for supporting the optimal performance of the pituitary gland and ensuring overall hormonal
balance in the body.

pituitary gland response to altered endocrine function.

The pituitary gland plays a central role in the regulation of the endocrine system, which includes
various glands and organs that produce and release hormones. When there is an alteration or
dysfunction in the endocrine system, the pituitary gland responds in different ways depending on
the specific condition or hormonal imbalance. Here are a few examples:

1. Increased hormone production: If there is a deficiency or decreased production of a specific

hormone in the body, the pituitary gland may respond by increasing the production and release of
the corresponding stimulating hormone. For example, if there is a decrease in thyroid hormone
production, the pituitary gland releases more thyroid-stimulating hormone (TSH) to stimulate the
thyroid gland to produce more thyroid hormones.

2. Suppression of hormone production: In certain cases, an excess production of a hormone may

lead to negative feedback on the pituitary gland, causing it to reduce the secretion of stimulating
hormones. This helps to regulate and balance hormone levels in the body. For instance, if there is
excessive cortisol production from the adrenal glands, it can inhibit the release of
adrenocorticotropic hormone (ACTH) from the pituitary gland, which, in turn, reduces cortisol
production.

3. Enlargement or tumor formation: In some cases, chronic stimulation or dysfunction of the

pituitary gland may result in the development of an adenoma, which is a non-cancerous tumor.
These tumors can cause an enlargement of the pituitary gland and disrupt its normal hormone
production and regulation.

4. Feedback loop disruption: Alterations in endocrine function can disrupt the feedback loops
between the pituitary gland and target organs or glands. This can lead to imbalances in hormone
levels and disregulation of various bodily functions.

It is important to note that the response of the pituitary gland to altered endocrine function can
vary depending on the specific hormone involved, the underlying condition, and individual
factors. It is best to consult with a healthcare professional for a thorough evaluation and
appropriate management of any endocrine disorders.

*MANZANO
PANCREAS
• A gladular organ located in the abdomen. It makes pancreatic juices, which contain
enzymes that aid in digestion, and it produces several hormones, including insulin.
• The pancreas is tucked behind the stomach. It shaped somewhat like a tadpole- fat at one
end and slender at the other- and is around 25 cm in length.
• The pancreas has dual roles; it is an organ of the digestive system and of the hormonal
(endocrine) system.
• Once food has been mulched and partially digested by the stomach, it is pushed into the
duodenum (first part of the small intestines).
• The pancreas adds its own digestive juices and enzymes to the food, via a small duct
attached to the duodenum. This process is said to belong to the ‘exocrine pancreas’.
• The pancreas produces hormone insulin which helps to control the amount of sugar in the
blood. This is the role of the ‘endocrine pancreas’.

The exocrine pancreas

• The pancreas helps to digest foods, particularly protein. Pancreatic juices contain
enzymes that only become activated once they reach the duodenum. This is to prevent the
protein-digesting enzymes trypsin from ‘eating’ the protein based- pancreas or its duct. Other
enzymes produced by the pancreas include amylase (to break down carbohydrates) and lipase (to
break down fats). the exocrine pancreas also makes sodium bicarbonate, which helps to
neutralize the stomach acids in the food.

The endocrine pancreas

• the pancreas makes the hormone insulin, which helps to control blood sugar levels.
Insulin is manufactured by a small clump of pancreatic cells called the islets of Langerhans, so
that the sugar can pass into cells. The endocrine pancreas also makes glucagon, another hormone
involved in the regulation of blood sugar.

CAUSES:
 Several conditions can lead to acute pancreatitis:
o blockage in the bile duct caused by gallstones
o heavy alcohol use.
o Certain medicines.
o High triglyceride levels in the blood.
o High calcium levels in the blood
o Pancreas cancer
o Injuries from trauma or surgery.

 Conditions that can lead to chronic pancreatitis include:

o damage from repeated acute pancreatitis.
o Heavy alcohol use.
o Inherited genes linked to pancreatitis
o High triglyceride levels in the blood
o High calcium levels in the blood

RISK FACTORS:
o Factors the increase your risk of pancreatitis includes:
o Excessive alcohol use. Research shows that having four or five drinks a day increase the
risk of pancreatitis.
o Cigarette smoking. Compared with nonsmokers, smokers are on average three times
more likely to develop chronic pancreatitis. Quitting smoking can decrease the risk.
o Obesity. People with a body mass index of 30 or higher are at increased risk of
pancreatitis.
o Diabetes. Having diabetes increases the risk of pancreatitis.
o Family history of pancreatitis. A number of genes have been linked to chronic
pancreatitis. A family history of the disease is linked to an increased risk, especially when
combined with other risk factors.

SIGNS AND SYMPTOMS:

o Symptoms of pancreatitis may vary. Acute pancreatitis symptoms may include:
o pain in the upper belly
o pain in the upper belly that radiates to the back
o tenderness when touching the belly
o fever
o rapid pulse
o upset stomach
o vomiting
o chronic pancreatitis signs and symptoms include:
o pain in the upper belly
o belly pain that feels worse after eating
o losing weight without trying
o oily, smelly stools

COMPLICATIONS:
o Pancreatitis can cause serious complications, including:
o Kidney failure. Acute pancreatitis may result in the kidneys not filtering waste from the
blood. Artificial filtering, called dialysis, may be needed for short- term or long-term treatment.
o Breathing problems. Acute pancreatitis can cause changes in how the lungs work, causing
the level of oxygen in the blood to fall to dangerously low levels.
o Infection. Acute pancreatitis can make the pancreas vulnerable to infections. Pancreatic
infections are serious and require intensive treatment, such as surgery or other procedures to
remove the infected tissue.
o Pseudocyst. Acute and chronic pancreatitis can cause fluid and debris to collect in a
‘pocket’ in the pancreas, called pseudocyst. A large pseudocyst the ruptures can cause
complications such as internal bleeding and infection.
o Malnutrition. With both acute and chronic pancreatitis, the pancreas may not produce
enzymes for the digestive system. This can lead to malnutrition, diarrhea and weight loss.
o Diabetes. Diabetes can develop when chronic pancreatitis damages cells that produce
insulin.
o Pancreatic cancer. Long-standing inflammation in the pancreas is a risk factor for cancer
of the pancreas.
DISORDERS OF THE PANCREAS:
o Acute pancreatitis
o Chronic pancreatitis
o Pancreatic cancer
o Diabetes

ACUTE PANCREATITIS
• Acute pancreatitis is inflammation of the pancreas. This is a medical emergency and
requires prompt treatment. It occurs when the pancreas suddenly becomes inflamed- the enzymes
can’t leave the pancreas and so cause irritation and burning. Enzymes may also leech into the
abdominal cavity. The two most common causes for pancreatitis are drinking too much alcohol
(alcohol induced pancreatitis) and gallstones within the bile tubes (gallstone pancreatitis). Other
factors that may trigger acute pancreatitis include:
 Certain drugs
 Mumps
 Damage or trauma to the pancreas
 Pancreatic cancer
CHRONIC PANCREATITIS
• Chronic pancreatitis means recurring bouts of inflammation, even when known triggers
(such as alcohol) are eliminated. Alcoholics are not increased risk of developing this condition.
The relentless inflammation eventually damages or destroys part of pancreas, reducing its
function. Symptoms include digestive upsets and passing fatty, foul-smelling stools.

PANCREATITIC CANCER
• Pancreatic cancer starts in the cells of the duct and spreads into the body of the pancreas.
Nearby blood vessels and nerves may be invaded. Without treatment, this type of cancer will
spread to every abdominal organ and to other parts of the body, via the lymphatic system. The
causes are unknown, but risk factors may include:
 Cigarette smoking
 Chronic pancreatitis
 Advancing age (over 65 years)
DIABETES
• In some cases, the islets of Langerhans can’t produce enough insulin, so blood sugar
levels remain high. In other cases, insulin is produced but the body is unable to utilize it, for
reasons unknown. Complications of high blood sugar levels include:
 Kidney damage
 Eye damage
 Nerve damage
 Increase risk of stroke
 Increase risk of heart attack

DIAGNOSIS AND TEST:

Diagnosis and pancreatic problems

o Diagnostic methods depend on the disorder under investigation, but may include:
o General test- such as blood test, physical examination and x-rays
o Ultrasound- sound waves from a picture of the pancreas
o Computed tomography (CT) scan- a specialized x-ray takes three- dimensional pictures
of the pancreas
o Magnetic resonance imaging (MRI) – similar to a CT scan, but magnetism is used to
build a three-dimensional picture.
o Endoscopy- a thin telescope is inserted down the throat. This device may be used to inject
contrasting dye into the pancreatic duct prior to x-rays.
o Laparoscopy- the pancreas is examined through a slender instrument inserted into the
abdomen.
o Biopsy- a small tag of pancreatic tissue is taken out with a needle and examined in a
laboratory.

1. MANAG EMENT AND TREATMENT

MEDICAL MANAGEMENT:
o Healthcare professionals use a combination of tests and procedures to diagnose
pancreatitis:
o Blood tests: These provide clues about the immune system, pancreas, and related organs.
o Ultrasound: It can reveal gallstones in the gallbladder or inflammation of the pancreas.
o CT scan: Useful for assessing gallstones and the extent of inflammation.
o MRI: Detects irregular tissues or structures in the gallbladder, pancreas, and bile ducts.
o Endoscopic ultrasound: An ultrasound device on a small tube examines the digestive
system for inflammation, gallstones, cancer, and blockages in the pancreatic or bile ducts.
o Stool tests: Measure fat levels to assess nutrient absorption
.NURSING MANAGEMENT:
o Pancreatitis, whether acute or chronic, requires comprehensive nursing care to support
patients throughout their entire episode of care. Let’s delve into the nursing management and
treatment aspects:
1. Acute Pancreatitis:
o Nursing Priorities:
1. Pain Management: Alleviate pain and discomfort associated with pancreatitis.
2. Vital Signs Monitoring: Stabilize vital signs.
3. Intravenous (IV) Fluids: Administer fluids to maintain hydration.
4. Nutritional Support: Provide appropriate nutrition once vomiting or pain subsides.
5. Medications: Administer medications for pain control and inflammation management.
6. Enzyme Levels Monitoring: Keep track of pancreatic enzyme levels and function.
2. Chronic Pancreatitis:
o Pathophysiology:
o Self-Digestion: The pancreas’s own proteolytic enzymes, particularly trypsin, cause acute
pancreatitis.
o Mechanisms: Gallstones may enter the common bile duct, obstructing pancreatic juice
flow or causing bile reflux into the pancreatic duct.
o Activation: Powerful enzymes within the pancreas become activated, leading to
vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage.

Treatment for pancreatic problems:

 Treatment depends on the cause, but may include:
o Acute pancreatitis- hospitalization in intensive care, fasting and intravenous fluids,
surgery to remove gallstones or damaged sections of pancreas, lifestyle changes, such as
eliminating alcohol.
o Chronic pancreatitis- long-term treatment may include reducing dietary facts,
supplementing digestion with pancreatic enzyme tablets, eliminating alcohol, taking regular
insulin injections for reduced endocrine function.
o Pancreatic cancer- surgery to remove the cancer and associated tissue, radiotherapy and
chemotherapy.
o Diabetes- in some cases, diabetes can be managed with a carefully controlled diet. In
others, the person may also need to take regular medications or injections of insulin.

PREVENTION:
 Preventing pancreatitis involves adopting healthy lifestyle practices and managing
underlying risk factors. Here are some essential steps:
1. Limit Alcohol Intake:
o Excessive alcohol consumption is a significant risk factor for pancreatitis. Moderation is
key. If you drink alcohol, do so in moderation or consider abstaining altogether.
2. Maintain a Healthy Diet:
o Low-Fat Diet: High-fat diets can strain the pancreas. Opt for a diet rich in fruits,
vegetables, whole grains, and lean proteins.
o Avoid Trigger Foods: Limit foods that may exacerbate symptoms, such as spicy, greasy,
or heavily processed foods.
3. Stay Hydrated:
o Proper hydration supports overall health and helps prevent complications.
4. Manage Gallstones:
Gallstones can lead to pancreatitis. If you have gallstones, work with your healthcare provider to
manage them effectively.
5. Control Blood Sugar Levels:
o Individuals with diabetes should manage their blood sugar levels carefully to reduce the
risk of pancreatitis.
6. Quit Smoking:
o Smoking is associated with an increased risk of pancreatitis. Seek support to quit
smoking if needed.
7. Be Cautious with Medications:
o Some medications can contribute to pancreatitis. Follow your doctor’s advice and report
any adverse effects promptly.
8. Regular Exercise:
o Engage in regular physical activity to maintain overall health and prevent obesity.
9. Seek Prompt Medical Attention:
o If you experience symptoms such as severe abdominal pain, nausea, vomiting, or fever,
seek immediate medical help.
10. Follow Medical Recommendations:
o If you have a history of pancreatitis or other related conditions, adhere to your healthcare
provider’s recommendations.

PROGNOSIS:
The prognosis for pancreatic diseases varies depending on the specific condition. Let’s explore
different aspects:
1. Acute Pancreatitis:
o Most patients with acute pancreatitis can expect complete recovery. Although it can be
very serious and even life-threatening, the majority of patients recover fully.
o In most cases of acute pancreatitis, patients will be in the hospital for a few days and will
receive intravenous (IV) fluids and pain medicine.
2. Chronic Pancreatitis:
o Acute pancreatitis can become chronic if pancreatic tissue sustains damage and scarring
occurs.
o About 5% of patients need long-term treatment for chronic pancreatitis. For those
affected, this can mean a lifetime of ongoing pain, nausea, and other gastrointestinal symptoms.
o Approximately half of patients with chronic pancreatitis develop severe pain that may
require treatment with procedures such as fluid drainage, partial or complete pancreas removal,
gallstone removal, or stent placement to unblock bile or pancreatic ducts.