NURS 6501 ENDOCRINE DISORDERS MODULE 4 Scenario 1

NURS 6501 ENDOCRINE DISORDERS MODULE 4

Scenario 1

Syndrome of inappropriate antidiuretic hormone release (SIADH) is a disorder that is characterized by the unregulated release of antidiuretic hormone (ADH). ADH is a hormone that is involved in the regulation of water reabsorption in the kidney tubules. The pituitary gland produces it. The 77-year-old female has been diagnosed with SIADH. Several patient characteristics may have contributed to her developing the disorder. One of them is the use of medications. Medications such as those utilized in the treatment of depression and diabetes increase the risk of SIAD. The patient in the case study is diabetic and currently uses metformin to manage her blood sugar levels(Bal et al., 2022). She also has depression and uses escitalopram, which is among the risk factors associated with SIADH.

The other patient characteristic that may have contributed to the development of SIADH in the patient is neurological deficits. The patient currently suffers from peripheral neuropathy because of diabetes. Neurological disorders increase the risk of SIADH. The patient also has symptoms similar to those seen in patients suffering from stroke. Stroke is among the neurological disorders that increase the risk of patients developing SIADH. The signs and symptoms of stroke include unilateral paralysis, losing balance, and slurred or difficulty speaking. The patient in the case study demonstrates these symptoms. She may be suffering from early stages of stroke, which is a risk factor for SIADH. The patient may also have unknown hereditary SIADH. Hereditary SIADH also known as nephrogenic SIADH arises from vasopressin 2 mutations and may be transmitted from one family member to another (Harrois& Anstey, 2019). Therefore, history about the disease in the family should be obtained to rule out hereditary SIADH.

References

Bal, C., Gompelmann, D., Krebs, M., Antoniewicz, L., Guttmann-Ducke, C., Lehmann, A., Milacek, C. O., Gysan, M. R., Wolf, P., Jentus, M.-M., Steiner, I., &Idzko, M. (2022). Associations of hyponatremia and SIADH with increased mortality, young age and infection parameters in patients with tuberculosis. PLOS ONE, 17(10), e0275827. https://doi.org/10.1371/journal.pone.0275827

Harrois, A., & Anstey, J. R. (2019). Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone in Critically Ill Patients. Critical Care Clinics, 35(2), 187–200. https://doi.org/10.1016/j.ccc.2018.11.001

Scenario 2

Patients suffering from type 1 diabetes mellitus often experience symptoms that include polydipsia, polyphagia, and polyuria. Polydipsia refers to excessive thirst. Patients with type 1 diabetes mellitus develop excessive thirst due to several reasons. One of them is the excessive loss of fluids via the kidneys. Patients with this disorder have hyperglycemia. Under normal circumstances, the kidneys excrete negligible amounts of glucose. In diabetes mellitus type 1, the high level of glucose in the blood must be excreted in the urine, which causes fluid imbalances, hence, unsatiable thirst (Donath et al., 2019). Patients may also develop symptoms such as diarrhea and vomiting, which causes fluid and electrolyte imbalances, hence, polydipsia.

Polyuria refers to the passage of large amounts of dilute urine. As noted above, patients with type 1 diabetes mellitus have elevated blood glucose levels. The brain senses the elevated levels and stimulate glucose excretion through the kidneys with urine. As a result, patients report passing large amounts of urine frequently as part of the symptoms of type 1 diabetes mellitus. Polyphagia refers to increased appetite. Patients with type 1 diabetes mellitus lack insulin in their bodies. This means that the glucose in the blood cannot be moved into the cells for use for metabolism and undertaking cellular activities. The lack of glucose movement into the cells and tissues lowers energy production, with cells demanding more energy for optimum functioning, hence, the increased appetite. The brain stimulates the hunger centers to increase the need for food intake to meet the demands of the cells and tissues(Roep et al., 2019). Therefore, despite the high glucose levels in the blood, the cells do not get enough supplies for their functioning, leading to polyphagia.

References

Donath, M. Y., Dinarello, C. A., & Mandrup-Poulsen, T. (2019). Targeting innate immune mediators in type 1 and type 2 diabetes. Nature Reviews Immunology, 19(12), Article 12. https://doi.org/10.1038/s41577-019-0213-9

Roep, B. O., Wheeler, D. C. S., &Peakman, M. (2019). Antigen-based immune modulation therapy for type 1 diabetes: The era of precision medicine. The Lancet Diabetes & Endocrinology, 7(1), 65–74. https://doi.org/10.1016/S2213-8587(18)30109-8

Scenario 3

The patient in the case study has been diagnosed with type 1 diabetes mellitus. A correlation exists between genetics, environmental exposures, and type 1 diabetes mellitus. Genetic and environmental exposure interaction affect the development of the disease as well as response to treatment. The influence of genetics is evidence in individuals born to families with a history of diabetes mellitus. The susceptibility is estimated to be at least 80% in twin and family studies. Several genetic mutations have been shown to raise the risk of an individual developing type 1 diabetes mellitus. For example, the RAB38 gene mutation has been shown to increase the risk of type 1 diabetes and kidney disease in the affected populations. The major histocompatibility complex is also noted to contribute to about 4-50% of the familiar aggregation of type 1 diabetes mellitus (Blanter et al., 2019). Alles such as the human leukocyte antigen cause polymorphisms of class II human leukocyte antigen, a determinant of type 1 diabetes mellitus.

Environmental factors also contribute to the development of type 1 diabetes mellitus. For example, studies conducted in regions such as China shows that the risk of type 1 diabetes increases as one resides further aware from the equator. Environmental factors also cause changes in the autoantibody profiles of the populations, raising their susceptibility to type 1 diabetes mellitus. Additional aspects such as infant nutrition have also been identified as the risk factors for type 1 diabetes mellitus. The use of supplements for maternal breastmilk have been associated with the disease. Seasonal variations have also been shown to raise the risk of the disease among children (Cerna, 2020). Therefore, a strong correlation exists between type 1 diabetes mellitus, genetics, and environmental influences.

References

Blanter, M., Sork, H., Tuomela, S., & Flodström-Tullberg, M. (2019). Genetic and Environmental Interaction in Type 1 Diabetes: A Relationship Between Genetic Risk Alleles and Molecular Traits of Enterovirus Infection? Current Diabetes Reports, 19(9), 82. https://doi.org/10.1007/s11892-019-1192-8

Cerna, M. (2020). Epigenetic Regulation in Etiology of Type 1 Diabetes Mellitus. International Journal of Molecular Sciences, 21(1), Article 1. https://doi.org/10.3390/ijms21010036

Scenario 4

Type 2 diabetes mellitus is a type of diabetes that is characterized by the inadequate production of insulin by the pancreas. The insulin is essential for moving glucose into the cells for use in cell and tissue metabolism. The lack of adequate insulin results in the increase in the blood glucose level, leading to hyperglycemia. Patients with type 2 diabetes mellitus present the hospital with complaints such as polyuria, polydipsia, and polyphagia. Polyuria develops due to the brain stimulation of the kidneys to excrete excess glucose through urine. Patients also develop polydipsia. This refers to the increased thirst that patients report. The thirst arises from the excessive fluid loss from the body through the kidneys, as it tries to eliminate the excess glucose. Patients may also develop vomiting, which causes dehydration, fluid and electrolyte imbalances, and increased need for fluid intake. Polyphagia refers to the patients complaining of frequent hunger. The hunger arises from the decreased glucose supply to the cells(Galicia-Garcia et al., 2020). The inadequate production of insulin results in lowered movement of glucose to the cells, hence, low energy production. The body must meet its energy needs by stimulating increased food intake, which results in polyphagia.

Individuals develop type 2 diabetes mellitus because of several risk factors. One of them is genetics. Individuals that are born to families with individuals affected by type 2 diabetes mellitus are highly at a risk of developing the disease because of the inheritance of gene mutations. The other risk factor is sedentary lifestyle. Minimal engagement in active physical activity increases the risk of the disease due to obesity and overweight problems(Padhi et al., 2020). Unhealthy lifestyle such as poor diet also increases the risk.

References

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences, 21(17), Article 17. https://doi.org/10.3390/ijms21176275

Padhi, S., Nayak, A. K., & Behera, A. (2020). Type II diabetes mellitus: A review on recent drug based therapeutics. Biomedicine & Pharmacotherapy, 131, 110708. https://doi.org/10.1016/j.biopha.2020.110708

Scenario 5

Hypothyroidism is a thyroid disorder that is characterized by low levels of thyroid hormones. Thyroid hormones play essential roles such as regulating body’s metabolism rate. Several factors cause hypothyroidism. One of them is the excessive use of medications used to treat hyperthyroidism. Overdose of thyroid medications may cause severely low levels of thyroid hormones, leading to the disorder. The other cause is thyroid surgery. Total or partial removal of thyroid gland due to causes such as cancer may result in hypothyroidism(Gosi& Garla, 2022). The surgery may alter the normal functioning of the thyroid gland, leading to hypothyroidism.

The other cause of hypothyroidism is iodine deficiency. Iodine is a crucial ingredient needed for the development of thyroid hormones. Dietary sources such as salt are good sources of iodine. Inadequate dietary supplementation of iodine may result in hypothyroidism. Hypothyroidism may also develop from autoimmune disorders. Autoimmune diseases of the thyroid gland cause destruction of thyroid cells, causing reduced production of thyroid hormones. Treatments such as thyroid radioactive iodine therapy also cause hypothyroidism. Accordingly, it lowers the functioning ability of the thyroid gland, resulting in the reduced production of thyroid hormones.

The pituitary gland regulates the secretion of thyroid hormones. Any problems that affect the gland may also alter the production of the thyroid hormones, hence, hypothyroidism. Cancer treatments with medications such as anti-PD-L1/PD-1 therapy also cause hypothyroidism(Patil et al., 2022). They cause immunosuppression, which lowers the thyroid ability to produce thyroid hormones for use in body’s metabolism.

References

Gosi, S. K. Y., & Garla, V. V. (2022). Subclinical Hypothyroidism. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536970/

Patil, N., Rehman, A., & Jialal, I. (2022). Hypothyroidism. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519536/