Hypoparathyroidism is rare, and results from inadequate circulating PTH.
It is characterized by hypocalcemia resulting from a lack of PTH to maintain serum
The most common cause is iatrogenic, due to accidental removal of parathyroid glands or
damage to these glands during neck surgery.
Sudden decreases in serum calcium cause tetany, which is characterized by tingling of
lips, fingertips, and increased muscle tension with paresthesias and stiffness.
Painful tonic spasms of smooth and skeletal muscles (extremities and face), and
laryngospasms and a positive Chvostek sign and Trousseau sign are usually present.
Focus of patient care is to treat tetany, maintain normal serum calcium levels, and prevent
long-term complications. Emergency treatment of tetany requires IV calcium.
Instruction about lifelong treatment and follow-up care includes monitoring of calcium
Cushing syndrome is a spectrum of clinical abnormalities caused by excessive
corticosteroids, particularly glucocorticoids.
The most common cause is iatrogenic administration of exogenous corticosteroids (e.g.,
Most cases of endogenous Cushing syndrome are due to adrenocorticotrophic hormone
(ACTH) secreting pituitary tumor (Cushing’s disease).
Key signs include centripedal or generalized obesity, “moon facies” (fullness of face),
purplish red striae below the skin surface, hirsutism in women, hypertension, and
Treatment is dependent on the underlying cause, and includes surgery and drug therapy to
normalize hormone levels.
Discharge instructions are based on patient’s lack of endogenous corticosteroids and
resulting inability to react to stressors physiologically.
Lifetime replacement therapy is required by many patients.
In the patient with Addison’s disease, all three classes of adrenal corticosteroids
(glucocorticoids, mineralocorticoids, and androgens) are reduced. The etiology is mostly autoimmune where adrenal cortex is destroyed by autoantibodies.
Manifestations have a slow onset and include weakness, weight loss, and anorexia.
Skin hyperpigmentation is seen in sun-exposed areas of body, at pressure points, over
joints, and in palmar creases.
The treatment is replacement therapy. Hydrocortisone, the most commonly used form of
replacement therapy, has both glucocorticoid and mineralocorticoid properties. During
times of stress, glucocorticoid dosage is increased to prevent addisonian crisis.
Mineralocorticoid replacement with fludrocortisone acetate (Florinef) is given daily with
increased dietary salt. Patient teaching covers medications, techniques for stress
management, and that patient must always wear an identification bracelet (Medic Alert).
Patients with Addison’s disease are at ris