DRUGS AFFECTING ENDOCRINE SYSTEM

ENDOCRINE SYSTEM
ENDOCRI NE SYSTEM IS A SERIES OF GLANDS THAT PRODUCE AND
SECRETES HORMONES THAT THE BODY USES FOR A WI DE RANGE OF
F U N C T I O N . T H E S E C O N T R O L M A N Y D I F F E R E N T B O D I LY F U N C T I O N S ,
INCLUDING:

 RESPI RATION
 METABOLISM
 REPRODUCTION
 SENSORY PERCEPTION
 MOVEMENT
 SEXUAL DEVELOPMENT
 GROWTH

HORMONES ARE PRODUCED BY GLANDS AND SENT INTO THE

B L O O D S T R E A M T O T H E VA R I O U S T I S S U E S I N T H E B O D Y. T H E Y S E N D
SIGNALS TO THOSE TISSUES TO TELL THEM WHAT THEY ARE SUPPOSED
TO DO. WHEN THE GLANDS DO NOT PRODUCE THE RIGHT AMOUNT OF
HORMONES, DISEASES DEVELOP THAT CAN AFFECT MANY ASPECTS OF
LIFE. THE MAIN HORMONE PRODUCING GLANDS ARE: HYPOTHALAMUS,
P I T U I TA RY, PA R AT Y R O I D , PA N C R E A S , T H Y R O I D , A D R E N A L , P I N E A L ,
O VA R I E S , T E S T E S .
 CUSHING’S DISEASE
OVERVIEW OF THE DISEASE

Cushing’s disease is a serious of an excess of the steroid hormone cortisol in the

blood level caused by a pituitary tumor secreting adrenocorticotropic hormone
(ACTH). ACTH stimulates the adrenal glands that is located on top of the kidneys
to produce cortisol, commonly referred to as the stress hormone.

SYMPTOMS OF CUSHING’S DISEASE

• Fat redistribution with a characteristic buffalo hump
• Thin extremities
• Hypertension
• Hirsutism
• Infertility
• Amenorrhea
Although uncommon, some patient with Cushing's disease have large pituitary tumors
(macroadenomas). In addition to the severe hormonal effects related to increase blood cortisol levels,
the large tumor can compress adjacent structures leading to:
•Vision loss
•Other visual problems
•Increased compression of the normal gland can caused hormone insuffiency, called hypopituitarism.
•In men, this can lead to a low testosterone level, causing decreased sexual drive and impotence
•In some cases, there can be loss body and facial hair
•In women, this can lead to infertility

DIAGNOSIS: The early stages of cushing's disease maybe difficult to recognize, especially because
the body changes develop slowly. The diagnosis may be difficult to make because sometimes the
hormone elevation come and go. In general, the first step in making the diagnosis is establishing a
state of excessive blood cortisol.

PATHOPHYSIOLOGY OF CUSHING's DISEASE

When stimulated by ACTH, the adrenal glands secretes cortisol and other steroid hormones.
Although the adenomas of cushing's disease secrete excessive amounts of ACTH, they generally
retain some negative feedback responsiveness to high doses of glucocorticoids. However some
overlap exists in the response to negative feedback between pituitary and ectopic sources of excessive
ACTH.
DRUG OF CHOICE(DOC)
Medication can be used to control cortisol production when surgery and radiation don’t work. Medications might also be
used before surgery in people who have become very sick with Cushing’s Disease. Medications to control excessive
production of cortisol at the adrenal gland include ketoconazole, mitotane (Lysodren) and metyrapone (Metapirone)

MECHANISM OF ACTION(MOA)
Side effects from these medications may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low
potassium, and swelling. Some have more serious side effects, such as neurological side effects and liver toxicity.

MEDICAL INTERVENTION
Treating cushing's disease requires an experienced team of experts. To achieve the best outcome, you should seek treatment at
a hospital that has a dedicated pituitary tumor program. Treatment option includes surgery, medication, radiation therapy,
other treatment options.

SURGERY FOR CUSHING's DISEASE

•Surgically removing the pituitary adenoman offers the only long term cure of cushing's disease
MEDICAL THERAPY FOR CUSHING's DISEASE
•There is no effective drug that lowers ACTH production and shrinks the pituitary tumor. There are medication that inhibit
the adrenal glands production of cortisol. In some patients, these medications can effectively reduced the sypmtoms related to
excessive cortisol when:
Surgery falls to completely remove the tumor
Medication is necessary before surgery, in a patient who is very ill.
RADIATION THERAPY FOR CUSHING's DISEASE
•In some cases, surgeons may not be able to remove the tumor surgically. Radiation therapy can be very effective in
controlling the growth of these tumors. A consequence of radiation treatment is that it can cause delayed pituitary failure.
This typically occurs several years after treatment, and therefore continued long term follow up with an endocrinologist is
important. Hormone replacement is required.
NURSING INTERVENTION
•Decreasing risk of injury
Provide a protective environment to prevent falls, fractures, and other injuries to bones and soft
tissues.
•Decreasing risk of infection
Avoid unnecessary exposure to people with infection
•Preparing patient for surgery
Monitor blood glucose levels, and assess stools for to blood because diabetes mellitus and peptic
ulcer are common problems
•Encouraging rest and activity
Encouarage moderate activity to prevent complications of immobality and promote self esteem.
•Promoting skin integrity
Use meticulous skin care to avoid traumatizing fragile skin
•Improving body image
Discuss the impact that changes have had on patients self concept and relationships with others.
•Improving thought processes
Explain to patient and family the cause of emotional instability, and help them cope with mood
swings, irritability, and depression
 ADRENAL INUFFIENCY

*OVERVIEW*
Adrenal insufficiency is a disorder first described by Thomas Addison in 1855, which is characterized by deficient
production or action of glucocorticoids and/or mineralocorticoids and adrenal androgens. This life-threatening disease
may result from disorders affecting the adrenal cortex (primary), the anterior pituitary gland (secondary), or the
hypothalamus (Tertiary)

*Pathophysiology*
Adrenal insufficiency occurs when the adrenal glands fail to release adequate amounts of these hormones to meet
physiologic needs, despite release of ACTH from the pituitary. Infiltrative or autoimmune disorders are the most
common cause, but adrenal exhaustion from severe chronic illness also may occur.The adrenal glands are small organs
located on top of each kidney. They consist of an inner layer called the medulla and an outer layer called the adrenal
cortex. In the body, the hypothalamus, the pituitary glands, and the adrenal glands work together to produce
hormones that control many body systems. If any part of their signaling and feedback system is not working it can
cause major disruptions and illness within the body.

*Symptoms* The most common symptoms of adrenal insufficiency are* chronic, or long-lasting, fatigue* muscle
weakness* loss of appetite* weight loss* abdominal pain* nausea* vomiting* diarrhea* low blood pressure that drops
further when you stand up, causing dizziness or fainting*Drug of Choice* Dexamethasone provides relief for inflamed
areas of the body. It is used to treat a number of different conditions, such as inflammation (swelling), severe allergies,
adrenal problems, arthritis, asthma, blood or bone marrow problems, kidney problems, skin conditions, and flare-ups
of multiple sclerosis. Dexamethasone is a corticosteroid (cortisone-like medicine or steroid). It works on the immune
system to help relieve swelling, redness, itching, and allergic reactions. Dexamethasone Intensol may cause some
unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention
 *Mechanism of Action*
The short term effects of corticosteroids are decreased vasodilation and permeability of capillaries, as well
as decreased leukocyte migration to sites of inflammation.3 Corticosteroids binding to the glucocorticoid
receptor mediates changes in gene expression that lead to multiple downstream effects over hours to days

*Side Effects*
• blurred vision
• decrease in the amount of urine
• dizziness* fast, slow, pounding, or irregular heartbeat or pulse
• headache
• irritability
• mental depression
• mood changes
• nervousness

Less common causes of Adrenal Insufficiency are:

• cancer cells in the adrenal glands
• surgical removal of the adrenal glands to treat other conditions
• bleeding into the adrenal glands
• genetic disorders that affect the way the adrenal glands develop or function
• certain medicines, such as antifungal medicines or etomidate, a type of general anesthesia
 *Nursing Intervention*
• Assess for fatigue, sensory deficits, or muscle weakness, which may progress to paralysis
• Assess additional indicated laboratory tests.
• Assess vital signs, especially noting BP and HR for orthostatic changes.
• Assess color, concentration, and amount of urine.
• Assess skin turgor and mucous membranes for signs of dehydration.

Medical Intervention

• • Doctors will consider a person’s age and general health when determining the right treatment.
• • Hormone replacement therapy is a common form of treatment for adrenal insufficiency, which
involves replacing the hormones that the adrenal glands no longer produce, including cortisol.
• • To replace cortisol, doctors will usually prescribe hydrocortisone as a pill several times per day.
• • recommend fludrocortisone to balance minerals in the body without aldosterone.
 CARCINOID SYNDROME

 Overview
 Carcinoid syndrome occurs when a rare cancerous tumor called a carcinoid tumor secretes
certain chemicals into your bloodstream, causing a variety of signs and symptoms. A carcinoid
tumor, which is a type of neuroendocrine tumor, occurs most often in the gastrointestinal tract or
the lungs. Carcinoid syndrome typically occurs in people who have carcinoid tumors that are
advanced. Treatment for carcinoid syndrome usually involves treating the cancer. However,
because most carcinoid tumors don't cause carcinoid syndrome until they're advanced, a cure
may not be possible. Medications may be recommended to relieve your carcinoid syndrome
symptoms and make you more comfortable.
 Cancer is a general term used to describe a disturbance of cellular growth and refers to a group
of diseases and not a single disease entity. Because cancer is a cellular disease, it can arise from
any body tissue, with manifestations that result from failure to control the proliferation and
maturation of cells.There are more than 150 different types of cancer, including breast cancer,
skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. Symptoms vary
depending on the type. Cancer treatment may include chemotherapy, radiation, and/or surgery.

 Pathophysiology
 The pathophysiology of carcinoid syndrome is based on biologically active amines and peptides
entering the systemic circulation and escaping the first-pass metabolism of the liver. Usually,
these bioactive products are inactivated in the liver.
 Symptoms
The signs and symptoms of carcinoid syndrome depend on which chemicals the carcinoid tumor secretes into your
bloodstream. The most common signs and symptoms include:
1. Skin flushing- The skin on your face and upper chest feels hot and changes color — ranging from pink to
purple. Flushing episodes may last from a few minutes to a few hours or longer. Flushing may happen for no
obvious reason, though sometimes it can be triggered by stress, exercise or drinking alcohol.
2. Facial skin lesions- Purplish areas of spiderlike veins may appear on your nose and upper lip. Diarrhea.
Frequent, watery stools sometimes accompanied by abdominal cramps may occur in people who have
carcinoid syndrome.
3. Difficulty breathing- Asthma-like signs and symptoms, such as wheezing and shortness of breath, may occur at
the same time you experience skin flushing.
4. Rapid heartbeat- Periods of a fast heart rate could be a sign of carcinoid syndrome.

 Causes
Carcinoid syndrome is caused by a carcinoid tumor that secretes serotonin or other chemicals into your
bloodstream. Carcinoid tumors occur most often in the gastrointestinal tract, including your stomach, small
intestine, appendix, colon and rectum. Only a small percentage of carcinoid tumors secrete the chemicals that
cause carcinoid syndrome. When these tumors do secrete the chemicals, the liver normally neutralizes the
chemicals before they have a chance to travel through your body and cause symptoms. However, when an
advanced tumor spreads (metastasizes) to the liver itself, it may secrete chemicals that aren't neutralized before
reaching the bloodstream. Most people who experience carcinoid syndrome have an advanced cancer that has
spread to the liver. Some carcinoid tumors don't have to be advanced to cause carcinoid syndrome. For instance,
carcinoid lung tumors that secrete chemicals into the blood do so farther upstream from the liver, which then
cannot process and eliminate the chemicals.Carcinoid tumors in the intestine, on the other hand, secrete the
chemicals into blood that must first pass through the liver before reaching the rest of the body. The liver usually
neutralizes the chemicals before they can affect the rest of the body. What causes carcinoid tumors is unclear.
 Complications
Having carcinoid syndrome can cause the following complications:
1. Carcinoid heart disease- Some people with carcinoid syndrome develop carcinoid heart disease. Carcinoid syndrome
causes problems with the heart valves, making it difficult for them to function properly. As a result, the heart valves
may leak. Signs and symptoms of carcinoid heart disease include fatigue and shortness of breath. Carcinoid heart
disease can eventually lead to heart failure. Surgical repair of damaged heart valves may be an option.
2. Carcinoid crisis- Carcinoid crisis causes a severe episode of flushing, low blood pressure, confusion and breathing
difficulty. Carcinoid crisis can occur in people with carcinoid tumors when they are exposed to certain triggers,
including anesthetic used during surgery. Carcinoid crisis can be fatal. Your doctor may give you medications before
surgery to reduce the risk of carcinoid crisis.

 Diagnosis
Your doctor will assess your signs and symptoms to rule out other causes of skin flushing and diarrhea. If no other causes
are found, your doctor may suspect carcinoid syndrome. To confirm a diagnosis, your doctor may recommend further
tests, including:
1. Urine test. Your urine may contain a substance made when your body breaks down serotonin. An excess amount of
this substance could indicate that your body is processing extra serotonin, the chemical most commonly excreted by
carcinoid tumors.
2. Blood test. Your blood may contain high levels of certain substances that are released by some carcinoid tumors.
3. Imaging tests. Imaging tests may be used to locate the primary carcinoid tumor and determine whether it has spread.
Your doctor may start with a CT scan of your abdomen, because most carcinoid tumors are found in the
gastrointestinal tract. Other scans, such as MRI or nuclear medicine scans, may be helpful in certain situations. A
scope or camera to see inside your body. Your doctor may use a long, thin tube equipped with a lens or camera to
examine areas inside your body.An endoscopy, which involves passing a scope down your throat, may help your
doctor see inside your gastrointestinal tract. A bronchoscopy, which uses a scope passed down your throat and into
your lungs, can help find lung carcinoid tumors. Passing a scope through your rectum (colonoscopy) can help
diagnose rectal carcinoid tumors.
4. Removing tissue for laboratory testing. A sample of tissue from the tumor (biopsy) may be collected to confirm
your diagnosis. What type of biopsy you'll undergo depends on where your tumor is located.

 Treatment
Medication Summary
Currently, octreotide is considered the drug of choice worldwide for treating both carcinoids and related malignant
syndromes. Somatostatin is rarely administered because of its poor half-life. In patients with diffuse metastases,
antiproliferative drugs may be useful for symptom.

 Mechanism of Action
Octreotide binds to somatostatin receptors coupled to phospholipase C through G proteins and leads to smooth
muscle contraction in the blood vessels.

Treating carcinoid syndrome involves treating your cancer and may also involve using medications to control your
specific signs and symptoms.Treatments may include:
1. Surgery -Surgery to remove your cancer or most of your cancer may be an option.
2. Medications to block cancer cells from secreting chemicals. Injections of the medications octreotide
(Sandostatin) and lanreotide (Somatuline Depot) may reduce the signs and symptoms of carcinoid syndrome,
including skin flushing and diarrhea. A drug called telotristat (Xermelo) can be combined with these drugs to
control diarrhea caused by carcinoid syndrome.
3. Drugs that deliver radiation directly to the cancer cells. Peptide receptor radionuclide therapy (PRRT)
combines a drug that seeks out cancer cells with a radioactive substance that kills them. In PRRT for carcinoid
tumors, the drug is injected into your body, where it travels to the cancer cells, binds to the cells and delivers
the radiation directly to them. This therapy is used in people who have advanced cancer that hasn't responded
to other treatments.
4. Stopping blood supply to liver tumors. In a procedure called hepatic artery embolization, a doctor inserts a
catheter through a needle near your groin and threads it up to the main artery that carries blood to your liver
(hepatic artery). The doctor injects particles designed to clog the hepatic artery, cutting off the blood supply to
cancer cells that have spread to the liver. The healthy liver cells survive by relying on blood from other blood
vessels.
5. Killing cancer cells in the liver with heat or cold. Radiofrequency ablation delivers heat through a needle to
the cancer cells in the liver, causing the cells to die. Cryotherapy is similar, but it works by freezing the tumor.
6. Chemotherapy. Chemotherapy uses strong drugs to kill cancer cells. Chemotherapy drugs can be given
through a vein (intravenously) or in pill form, or both methods can be used.

 Nursing Interventions
1. Expect initial shock and disbelief following diagnosis of cancer and traumatizing procedures (disfiguring
surgery, colostomy, amputation).
2. Assess patient and SO for stage of grief currently being experienced. Explain process as appropriate.
3. Provide open, nonjudgmental environment. Use therapeutic communication skills of Active-Listening,
acknowledgment, and so on.
4. Encourage verbalization of thoughts or concerns and accept expressions of sadness, anger, rejection.
Acknowledge normality of these feelings.
5. Be aware of mood swings, hostility, and other acting-out behavior. Set limits on inappropriate behavior,
redirect negative thinking.
6. Be aware of debilitating depression. Ask patient direct questions about state of mind.
7. Visit frequently and provide physical contact as appropriate, or provide frequent phone support as
appropriate for setting. Arrange for care provider and support person to stay with patient as needed.
7. Reinforce teaching regarding disease process and treatments and provide information as
appropriate about dying. Be honest; do not give false hope while providing emotional support.
8. Review past life experiences, role changes, and coping skills. Talk about things that interest the
patient.
9. Note evidence of conflict; expressions of anger; and statements of despair, guilt, hopelessness,
“nothing to live for.“
10. Determine way that patient and SO understand and respond to death such as cultural expectations,
learned behaviors, experience with death (close family members, friends), beliefs about life after death,
faith in Higher Power (God).
11. Identify positive aspects of the situation.
12. Discuss ways patient and SO can plan together for the future. Encourage setting of realistic goals.
13. Refer to visiting nurse, home health agency as needed, or hospice program, if appropriate.
 ACROMEGALY
• Acromegaly is a rare disorder of excessive bone and soft tissue growth due to elevated levels of growth hormone. In
young children, prior the completed fusion and growth of bones, excessive growth hormone can cause a similar
condition called gigantism.
Causes:
• In most cases, acromegaly is caused by over-secretion of growth hormone (GH) produced by a benign tumor of the
pituitary gland. The pituitary gland is a small gland located at the base of the brain that produces many hormones. In a
small number of cases, malignant tumors of other organs (pancreas, adrenal, lung) may be the source of excess GH.
• Risk Factors:
• Some rare cases of acromegaly are hereditary.
• The average age of diagnosis is 40-45 years old.
Symptoms:
Adults with acromegaly do not grow tall, but may have the following symptoms:
• Enlarged or swollen body parts, such as the hands, feet or chest
• Changes in the face, including a prominent jaw, nose or forehead
• Excessive sweating or oily skin
• Numbness in the hands
• Joint pain
• Carpal tunnel syndrome or spinal cord problems
• Muscle weakness* Headaches
• Sleep apnea- a condition that causes the body to stop breathing for short bursts of time during sleep
• Changes in vision or voice
 PATHOPHYSIOLOGY
:Acromegaly develops when the pituitary gland releases too much GH(growth hormone) into the body over
a long period of time. When GH enters the blood, this signals the liver to produce another hormone, called
insulin-like growth factor I (IGF-I). IGF-I is the hormone that actually causes bones and body tissue to
grow.

DRUG OF CHOICE:
There are 3 medications used to treat acromegaly: -Somatostatin Analouges (SSAs)
- A somatostatin analogue is a man made (synthetic) version of somatostatin. It slows down the production
of hormones, especially the growth hormone and serotonin. This helps to control the symptoms of
carcinoid syndrome such as diarrhea and flushing of the skin.-Growth hormone receptor antagonists
(GHRAs)
- Growth hormone receptor (GHR) dimerization is a prerequisite to the generation of growth hormone
(GH) action.
- Dopamine Agonists- A dopamine antagonist, also known as an anti-dopaminergic and a dopamine
receptor antagonist, is a type of drug which blocks dopamine receptors by receptor antagonism.

MECHANISM OF ACTION:
SOMASTOTASTIN ANALOGUES
- Possible side effects: Some people taking SSAs develop certain side effects, but usually these aren't
severe, and they don't last long. The most common side effects are diarrhea, gas, and nausea.
DOMAPINE ANTAGONIST
- Possible side effects: People taking dopamine agonists may experience lightheadedness, nausea, vomiting,
stuffy nose, tiredness, dizziness, sleep problems and mood changes.
 GROWTH HORMONE ANTAGONIST
Possible side effects: As with any medication, there are possible side effects associated with GHRAs. The most common side
effects are headaches and fatigue. Some patients also experience liver function problems.

MEDICAL INTERVENTION:
There are several treatment options for acromegaly. The most common treatments for acromegaly are surgery, medication
and radiation therapy

Surgery:
-In many cases, surgery greatly improves acromegaly symptoms or corrects the condition entirely. The specifics of the
surgery will depend on the size and location of a tumor. The goal of surgery is to remove all of a tumor that is causing excess
growth hormone production. If doctors remove enough of the tumor, you may not need further treatment.

Medication:
-Injection medications such as somatostatin analogs (Sandostatin®) can help manage hormone levels. Medications work in
different ways to normalize the body’s growth hormone levels and improve your symptoms.
Radiation therapy:
-Radiation therapy can help lower growth hormone levels when medications aren’t effective. Radiation therapy uses
specialized equipment to target the tumor with radiation beams. This therapy works slowly. It may require several
treatment courses, with breaks in between, and may take several years for full effect.

NURSING INTERVENTION:
• Encourage clients to want to express their thoughts and feelings about body appearance changes.
• Help clients identify the strengths and positive aspects that can be developed by the client.
• Collaboration of drugs.
• Observation of the side effects of drug delivery.
 DIABETES INSIPIDUS
What is diabetes insipidus?
Diabetes insipidus is a rare disorder that causes the body to make too much urine. While most people make 1 to 3
quarts of urine a day, people with diabetes insipidus can make up to 20 quarts of urine a day. People with this
disorder need to urinate frequently, called polyuria. They may also feel thirsty all the time and drink lots of
liquids, a condition called polydipsia.

Diabetes insipidus has four types:

1. Central diabetes insipidus
2. Nephrogenic diabetes insipidus
3. Dipsogenic diabetes insipidus
4. Gestational diabetes insipidus

Pathophysiology
Diabetes insipidus is caused by abnormality in the functioning or levels of antidiuretic hormone (ADH), also
known of as vasopressin. Manufactured in the hypothalamus and stored in the pituitary gland, ADH helps to
regulate the amount of fluid in the body.

Are diabetes insipidus and diabetes mellitus the same?

Diabetes insipidus is not the same as diabetes mellitus. Although both conditions can increase thirst, intake of
liquids, and urination, they are not related.In diabetes mellitus, the level of glucose in your blood, also called
blood sugar, is too high. Your kidneys try to remove the extra glucose by passing it in your urine.In diabetes
insipidus, your blood glucose levels are normal, but your kidneys can’t properly concentrate urine.
How common is diabetes insipidus?
Diabetes insipidus is rare, affecting about 1 in 25,000 people worldwide.

Who is more likely to have diabetes insipidus?

People of all ages can develop diabetes insipidus. You are more likely to develop the condition if you
-have a family history of diabetes insipidus
-had brain surgery or a major head injury
-take medicines that can cause kidney problems, including some bipolar disorder medicines and diuretics
-have metabolic disorders (high blood calcium or low blood potassium levels)

What are the complications of diabetes insipidus?

The main complication of diabetes insipidus is dehydration, which happens when your body loses too much fluid and
electrolytes to work properly. If you have diabetes insipidus, you can usually make up for the large amount of fluids you pass in
your urine by drinking more liquids. But if you don’t, you could quickly become dehydrated.

Symptoms of dehydration may includethirst

-dry mouth-feeling dizzy or light
-headed when standing-feeling tired-difficulty performing simple mental tasks-nausea
-fainting

Seek care right away!

Severe dehydration can lead to seizures, permanent brain damage, and even death. Seek care right away if you feel
-confused
-dizzy
-sluggish
What are the symptoms of diabetes insipidus?
The main symptoms of diabetes insipidus are-needing to urinate often, both day and night-passing large
amounts of light-colored urine each time you urinate-feeling very thirsty and drinking liquids very often

What causes diabetes insipidus?

Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your
kidneys balance the amount of fluid in your body. Problems with a part of your brain that controls thirst
can also cause diabetes insipidus. Specific causes vary among the four types of diabetes insipidus: central,
nephrogenic, dipsogenic, and gestational.

Central diabetes insipidus

In central diabetes insipidus, your body doesn’t make enough vasopressin, also called “antidiuretic
hormone.” Vasopressin is produced in your hypothalamus, a small area of your brain near the pituitary
gland. When the amount of fluids in your body falls too low, the pituitary gland releases vasopressin into
your bloodstream. The hormone signals your kidneys to conserve fluids by pulling fluids from your urine
and returning fluid to your bloodstream. But if your body can’t make enough vasopressin, the fluid may
get flushed out in your urine instead.

Causes of central diabetes insipidus include

-damage to your hypothalamus or your pituitary gland from surgery, infection, inflammation, a tumor, or
a head injury
-an autoimmune disorder
-an inherited gene mutation
Nephrogenic diabetes insipidus
In nephrogenic diabetes insipidus, your body makes enough vasopressin but your kidneys don’t respond to
the hormone as they should. As a result, too much fluid gets flushed out in your urine. Causes include
-some medicines, especially those used to treat bipolar disorder
-low levels of potassium in your blood high levels of calcium in your blood
-a blocked urinary tract
-an inherited gene mutation-chronic kidney disease, though rarely

Dipsogenic diabetes insipidus

In this type of diabetes insipidus, a problem with your hypothalamus causes you to feel thirsty and drink
more liquids. As a result, you may need to urinate often.
Causes include
-damage to your hypothalamus from surgery, infection, inflammation, a tumor, or a head injury
-some medicines or mental health problems

Gestational diabetes insipidus

Gestational diabetes insipidus is a rare, temporary condition that can develop during pregnancy.

This type of diabetes insipidus occurs when the mother’s placenta makes too much of an enzyme that breaks
down her vasopressin. Women who are pregnant with more than one baby are more likely to develop the
condition because they have more placental tissue. Because the liver plays a role in curbing the enzyme that
breaks down vasopressin, diseases and conditions that affect liver function also increase risk. Examples
include preeclampsia and HELLP syndrome.
How do health care professionals treat diabetes insipidus?
The main way to treat diabetes insipidus is to drink enough liquids to prevent dehydration. But doing so
can disrupt your regular lifestyle, including your sleep. Your health care professional may refer you to a
specialist, such as a nephrologist or an endocrinologist for more specific treatments. Other treatments
vary by cause.

Central diabetes insipidus

Health care professionals most often treat central diabetes insipidus with a man-made hormone called
desmopressin, which replaces the vasopressin your body is not making.You can take this medicine as a
nasal spray, a pill, or a shot.

Nephrogenic diabetes insipidus

In some cases, nephrogenic diabetes insipidus may go away after treating its cause. For example,
switching medicines or taking steps to balance the amount of calcium or potassium in your body may be
enough to resolve the problem. Your health care professional may also prescribe a class of diuretic
medicines called thiazides to help reduce the amount of urine your kidneys make.Other treatments can
include nonsteroidal anti-inflammatory drugs or other types of diuretics.

Dipsogenic diabetes insipidus

Researchers haven’t found an effective way to treat dipsogenic diabetes insipidus. Sucking on ice chips or
sugar free candies to moisten your mouth and increase saliva flow may help reduce your thirst. If you
wake up many times at night to urinate, your health care professional may suggest you take a small dose
of desmopressin at bedtime. Your health care professional may also monitor your blood levels of sodium,
which can drop too low if you have this condition.
Gestational diabetes insipidus
Health care professionals treat gestational diabetes insipidus with desmopressin, which is safe for both
mother and baby. An expectant mother’s placenta does not destroy desmopressin as it does vasopressin.
Gestational diabetes insipidus usually goes away after the baby is born, but may return if the mother
becomes pregnant again.

Most people with diabetes insipidus can prevent serious problems and live a normal life if they follow their
health care professional’s recommendations and keep their symptoms under control.

How do eating, diet, and nutrition affect diabetes insipidus?

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing diabetes
insipidus. To reduce symptoms, your health care professional may suggest you eat a diet that is low in salt
and protein to help your kidneys make less urine. In some cases, these changes alone may be enough to
keep your symptoms under control, particularly if you have nephrogenic diabetes insipidus.
How do health care professionals diagnose diabetes insipidus?
Your health care professional will do a physical exam and ask questions about your health history,
including your family’s health. Other tests and procedures may include
Urinalysis. A urinalysis can show if your urine is too diluted, or watery. It can also show if the level of
glucose in your blood is too high, which is caused by diabetes mellitus, not diabetes insipidus.Blood tests. A
blood test can measure sodium levels and the amount of certain substances in your blood, which can help
diagnose diabetes insipidus and, in some cases, determine the type.Water deprivation test. This test can
help health care professionals diagnose diabetes insipidus and identify its cause. The test involves not
drinking any liquids for several hours. A health care professional will measure how much urine you pass,
check your weight, and monitor changes in your blood and urine. In some cases, the health care
professional may give you a man-made version of vasopressin or other medicines during the test.
Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to make pictures of your
brain tissues. Your health care professional may order this test to look for damage to your
hypothalamus or pituitary gland that could cause diabetes insipidus. Stimulation tests. During these
tests, you are given an intravenous solution that stimulates your body to produce vasopressin. A
health care professional then measures your blood level of copeptin, a substance that increases when
vasopressin does. Results can indicate if you have diabetes insipidus or a different condition called
primary polydipsia, which can cause you to drink lots of liquids.

Management and Treatment for Diabetes Insipidus Disease:

Various types of management and treatment for diabetese insipidus disease are mentioned below:
1. Drink enough fluid to replace urine losses.
2. If oral intake inadequate and hypernatremia present.-Infused dextrose or sterile water
intravenously that is hypo- osmolar concerning the patient serum.-Administer fluid at a rate of
500-750 ml/ hour to reduce the sodium level by approximately .5mmol/L per hour.
3. Desmopressin acetate (DDAVP) can be administered orally, intravenously, or as nasal spray.
4. Synthetic vasopressinor Aqueous vasopressin( pitressin) or Vasopressin tenant.
5. Hydrochlorothiazide+ low-sodium diet to induce mild sodium depletion.
6. Chlropropamide.
7. Carbamazepine.
8. Clofibrate.
9. The nonsteroidal anti-inflammatory drug when no better option exists.
10. Indomethacin may also be useful to reduce urine volume.
Nursing Intervention for Diabetes Insipidus Disease:
There are different types of nursing intervention for diabetes insipidus disease, which are mentioned in the following:
1. Maintain fluid and electrolytes imbalance by appropriate fluid replacement therapy strictly administer hypotonic
saline intravenously.
2. Monitor intake output chart hourly.
3. Monitor weight charts daily using the same scales at the same time and wearing the same clothing.
4. Monitor specific gravity of urine.
5. Monitor serum and urine osmolality.
6. Monitor serum electrolytes and blood urea levels.
7. Monitor for signs of hypovolemic shock (e.g., Tachycardia, Tachypnea, and Hypotension).
8. Monitor vital signs frequently.
9. Monitor skin turgor and neurologic status every 1-2 hours during the acute phase.
10. Ensure safety precautions if patients complain of dizziness or weakness.
11. Ensure easy access to bathroom, bedpan, or urinal when patient need.
12. Provide careful skin and mouth care to prevent trauma.
13. Give vasopressin with caution if the patient has coronary artery disease.
14. Encourage the patient to maintain adequate fluid intake to prevent severe dehydration.
15. Allow the patient to drink water at will.
16. Monitor for increased thirst (polydipsia).
17. Use skin barriers as needed to prevent redness or excoriation from urinary frequency.
18. Provide rest and assess the sleeping pattern of the patient.
19. Provide a calm and quiet environment and give psychological support.
20. Assess the anxiety level of the patient and explain the patient about the disease and treatment process.
 CENTRAL PRECOCIOUS PUBERTY
*is a condition that causes early sexual development in girls and boys.
*puberty normally starts between ages 8 and 13 in girls and between ages 9 and 14 in boys.
*Signs of puberty include development of pubic and underarm hair, a rapid increase in height (commonly referred to as a "growth
spurt"), acne and underarm odor.
*Girls also develop breasts and begin their menstrual periods.
*Boys have growth of the penis and testes and deepening of the voice.
*Developing ahead of their peers can be emotionally difficult for affected individuals and may lead to psychological and behavioral
problems.

Causes:
*The brain releases a hormone called gonadotropin-releasing hormone or GnRH. It tells the pituitary gland to release hormones
called gonadotropins. They tell the sex organs to make other hormones that start sexual development.*In central precocious puberty,
the brain releases GnRH at a younger-than-normal age and starts the process. Most of the time, it can't pinpoint an exact cause for
girls, have linked childhood obesity to early periods, and boys are more likely to have a specific trigger.

Symptoms:
The signs of CPP are the changes you'd expect to see in a maturing preteen or teen.
*Hair in underarms and on genitals, and, for boys, on the face
*Acne
*Adult body odor
*Sexual development like breast buds or testicle growth
*Emotional changes
*Mood swings
Sometimes, kids can have hair appear on their genitals and under the arm, but it doesn’t mean they are in true puberty.
Pathophysiology:
Hormones are chemicals produced by specialised endocrine glands. In normal puberty, hormones from an area
of the brain called the hypothalamus signal to the pituitary gland via a hormone called gonadotrophin-
releasing hormone to produce hormones known as gonadotrophins.

Drug of Choice:
*GnRH analogue therapy- usually includes a monthly injection of a medication, such as lerolide acetate
(Lupron Depot), or triptorelin (Trelstar, Triptodur Kit), which delays further development. Some newer
formulations can be given at longer intervals.*Leuprolide - is used to stop early puberty in children. It helps to
delay sexual development and the start of menstrual periods. It also helps slow down early bone growth to
increase the likelihood of reaching normal adult height.*Triptorelin -is an extended-release injectable
suspension approved to treat central precocious puberty in children aged 2 years and older*Gonadotropin-
releasing hormone agonist (GnRHa) - It works by making sure the pituitary gland ignores signals from the
hypothalamus and stops the release of sex hormones from the ovaries and testicles to delay the puberty process.

Mechanism of Action:
GnRH analogue therapy
*Leuprolide Acetate (Lupton Depot)- is safe and efficacious. Its effects are readily reversible after treatment is
discontinued, and menarche occurs at a normal bone age.
*Triptorelin - the possible side effects during treatment were headache, flushes and light vaginal bleeding for
girls.

Gonadotropin-releasing hormone agonists (GnRHa) -there are mild side-effects like headaches, mood changes,
weight gain, rashes and local irritation. Some girls may experience some vaginal bleeding early in the
treatment when it starts working.
Medical Intervention:
For central precocious puberty, medications called GnRH analogs are the standard treatment. They work by blocking the
hormones coming from the pituitary gland that trigger puberty. Most children who need treatment get these medicines as
injections or implants.
*Injections are given as monthly shots into muscles or daily shots given just under the skin.
*Implants are tiny tubes -- a little over an inch long -- that are placed under the skin, usually in the upper arm. They
gradually release medicine into the body.
*Nasal sprays are given daily.

Other treatments for central precocious puberty include:

*Progestin. Injections of progestin used to be the standard treatment for central precocious puberty. They are less
effective than GnRH analogs.
*Surgery and radiation might be necessary in cases where central precocious puberty has been triggered by a brain
tumor. Removing the tumor won't always resolve all the symptoms.

Nursing Intervention:
1. Talk to the child honestly about what is happening. He or she may be confused or embarrassed about being different
than other children. Explain that his or her body has started developing early but is growing normally. Keep the
informed about the treatment. Let him or her know what to expect along the way.
2. Help the child build healthy self-esteem and help him learn how to make and keep friends.
3. Teach the child how to start conversations and politely join in play.
4. Show the child how to have healthy friendships by being a good friend to others.
5. Encourage the child to talk about concerns and problems making friends.
6. Find the child's strengths, and work to build on them.
7. Assure the child that you accept him or her.