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Pathophysiology and Pharmacology 2 > Endocrine Overview > Flashcards

Endocrine Overview Flashcards

1
Q

Role of Endocrine Regulation

A 
Sodium & Water balance
control of BP/blood volume
regulation energy balance
coordination of responses to stress
reproduction, growth & development
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2
Q

Anterior Pituitary Hormones

A 
Thyroid-stimulating hormone (TSH)
adrenocorticotropic hormone (ACTH)
growth hormone (GH)
follicle-stimulating hormone (FSH)
Lutenizing hormone (LH)
Prolactin
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3
Q

Posterior Pituitary Hormones

A 
Antidiuretic hormone (ADH)
Oxytocin
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4
Q

Releasing Hormones

A

from hypothalamus to pituitary

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5
Q

Trophic Hormones

A

from pituitary to peripheral glands

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6
Q

Hypothalums Hormone patterns

A

TRH –> TSH –> Thyroid –> (t4/t3)
CRH –> ACTH –> Adrenal –> (glucocorticoids)
GnRH –> LH/FSH–> Ovary/Testis –> (estrogen/testosterone)
GHRH –> GH –> Liver –> (IGF-1)

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7
Q

Steroid Hormones

A

Cortisol
Estrogen
Testosterone

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8
Q

Peptide Hormones

A

Insulin
GH
Parathyroid hormone

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9
Q

Protein Hormones

A

ACTH
ADH
Glucagon

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10
Q

Amine Hormones

A

Epinephrine

Norepinephrine

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11
Q

Water Soluble Hormones

A

Receptor on cell membrane
fast action
dissolved in plasma
short half-life

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12
Q

Lipid Soluble Hormones

A

receptor inside cell
slow speed of action
attached to carrier proteins

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13
Q

Total Hormones

A

protein-bound hormones + free hormones

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14
Q

Hormone Disorders: Ranking

A

Primary: abnormality in gland
Secondary: ab in stimulation from pituitary
Tertiary: ab in stim from the hypothalamus

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15
Q

Hyperpituitarism (Acromegaly) cause

A

hyper secretion of GH by anterior pituitary in adults

usually by pituitary tumors

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16
Q

Hyperpituitarism (Acromegaly) assessment

A 
large hands/feet
thickening/protrusion of jaw
joint pain
visual disturbances
sweating
oily/rough skin
organomegaly
HTN
atherosclerosis
cardiomegaly
heart failure
dysphagia/sleep apnea
narrowing of airway
deepening of voice
hyperglycemia
colon polyps (increased risk for colon cancer)
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17
Q

Hyperpituitarism (Acromegaly) interventions

A

pharmacology to suppress GH or block GH
radiation to pituitary gland or removal
joint pain control/anti hypertensives

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18
Q

Acromegaly Medications

A 
Samastatin Analogs (octreotide, lanreotide)
Growth Hormone Receptor Antagonists [GHRAs] (pegvisomant)
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19
Q

Hypopituitarism cause

A

hyposecretion of pituitary hormones

tumors/trauma/encephalitis/autoimmunity/stroke

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20
Q

Hypopituitarism Hormones most affected:

A

GH/LH/FSH

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21
Q

Hypopituitarism Hormones Least Effected:

A

ACTH/ADH/TSH

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22
Q

Hypopituitarism assessment

A 
mild to moderatete obesity (GH/TSH) 
reduced cardiac output (GH ADH)
infertility/sexual dysfunction (FSH/LH/ACTH)
fatigue/low BP (TSH ADH ACTH GH)
headaches/visual defects
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23
Q

Hypopituitarism TX

A

hormone replacement for deficient hormones

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24
Q

Syndrome of Inappropriate Andtidiuretic Homrone (SIADH) causes

A 
hyperfunctioning of posterior pituitary gland causing ADH 
trauma
stroke
malignancies (lung/pancreas)
medications
stress
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25
Q

SIADH patho

A

excess ADH > excessive water absorption by kidneys > low serum osmolality/sodium > urine output decreased/concentrated

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26
Q

SIADH risks

A 
water intoxication
cerebral edema (seizure risk)
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27
Q

SIADH assessment

A 
pulmonary edema (pink, frothy sputum)
changes in LOC
weight gain
HTN
tachycardia
anorexia
nausea
vomiting
hyponatremia (dilutional)
low urinary output
high specific gravity of urine
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28
Q

SIADH TX

A 
monitor cardia/neuro status (telemetry)
monitor fluid balance (i/o > catheter)
monitor electrolytes/urine osmolality
restrict fluid intake
if IVF risk of fluid volume overload
hypertonic saline (3% saline) 
salt tablets
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29
Q

seizure precautions

A 
sodium <120
greatest threat to survival
fluid restriction
don't hold down if seize
pad beds
put hands on handrails
mouthguard maybe
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30
Q

SIADH Medications

A

loop diuretics
may need K+ replacement
aquaretics
vasopressin receptor antagonists (-vaptans) [conivaptan]
demeclocycline (tetracycline ABX decreases renal response to ADH)

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31
Q

Adrenal Medulla

A

Inner part of adrenal glands
secretes 75-80 epinephrine
15-20 norepinephrine
fight or flight

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32
Q

Adrenal Cortex Hormones

A

> 30% gluccocorticoids
Mineralocorticoids
Gonadocorticoids

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33
Q

Glucocorticoids

A 
cortisol
cortisone
corticosterone
impact metabolism in cells
prepare body for long-term stress
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34
Q

mineralocorticoids

A

aldosterone

promotes sodium reabsorption and potassium secretion by kidneys

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35
Q

Gonadocorticoids

A 
mostly androgens (male) 
small amounts of estrogen 
lower levels compared to testes/ovaries
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36
Q

zona glomerulosa

A

controlled by renin-angiotensin-aldosterone system

controlled by blanace in potassium/ACTH

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37
Q

primary adrenocortical insufficiency (Addison Disease) pathogenesis

A

dysfunction of adrenal cortex
hyposecretion of adrenocortical hormones
automimmune diesase
TB

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38
Q

Addison Disease s/s

A 
lowered plasma cortisol
increased plasma ACTH
fatigue
weakness
weight loss
anorexia
nausea
vomiting
abdominal pain
diarrhea
constipation
hypotension 
dehydration
hypoglycemia
hyponatremia
hyperkalemia
acidosis
pigmentation
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39
Q

Addison Disease TX

A

hydrocortisone
saline solution
glucose

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40
Q

Addison Disease Interventions

A

watch VS and I/O, blood glucose, potassium, sodium and lipids
lifelong glucocorticoid/mineralcorticoid therapy
may need insulin
avoid infections/strenuous exercise/stressful situations
wear med alert bracelet
high protein/carb diet
supplement calcium/vitamin D

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41
Q

prednisone

A

tx Addison’s

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42
Q

fludocortisone

A

synthetic adrenocoritcal steroid
tx addison’s
very potent mineralocorticoid

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43
Q

hydrocortisone sodium succinate or phosphate

A

drug of choice for adrenal crisis/daily maintenance Addison’s

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44
Q

daily dehydroepiandrosterone (DHEA)

A

androgen replacement

improve libido/well-being

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45
Q

hydrocortisone MOA and use

A 
synthetic corticosteroid (short-acting)
andrenocortical insufficiency (usually lifelong)
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46
Q

hydrocortisone SE

A 
sodium/fluid retention 
insomnia
anxiety
headache
vertigo
confusion
depression
high-doses increase dopamine (depression/mood swings/psychosis) + lower serotonin in brain 
impaired wound healing
adrenal atrophy
osteoporsis
muscle wasting
CHF
edema
cataracts
glaucoma
DON'T DISCONTINUE SUDDENLY = Addisonian crisis
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47
Q

Secondary Adrenocortical Insufficiency causes

A

hypothalamic-pituitary disease

ant pit malfunction leading to loss of ACTH production

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48
Q

Secondary Adrenocortical Insufficiency clincal manifestations

A

Primary w/out pigmentation changes
no hypokalemia
less prominent hypotension

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49
Q

Secondary Adrenocortical Insufficiency diagnosis

A 
basic metabolic panels
early morning cortisol levels
rapid ACTH stimulation test 
plasma ACTH levels
insulin-induced hypoglycemia
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50
Q

Secondary Adrenocortical Insufficiency TX

A

hormone replacement

adrenal crisis: replace glucocorticoids/water/sodium

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51
Q

cosyntropin use

A

diagnosing cause of adrenocortical insufficiency
injection then test for secretion of cortisol positive = adrenal gland issue negative = pituitary/hypothalamus issue
measure cortisol levels 30 - 60 min after admin

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52
Q

Cushing’s Syndrome causes

A 
chroniic exposure to excess glucocorticoids
change in protein/fat metabolism (central obesity/moonface/buffalo hump/thin skin/easy bruising/osteoporsis/diabetes)
change in sex hormones (excess hair growth/irregular menses/infertility/impotence)
changes in aldosterone (salt/water retention/^BP)
Cushings Disease (ACTH-dependent cushing syndrome)
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53
Q

Cushing Syndrome Manifestations

A 
obesity (thin arms/legs) 
osteoporosis
hyptention
cardiac hypertrophy
increased appetite
overactivity of steroid-producing cells
atrophy of skin
gains weight rapidly
irregular menses
increased protein breakdown
easy bruising
decreased immune/inflammatory response
labile mood
depression
anxiety
diabetes mellitus
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54
Q

Cushing Syndrome development

A

over a period of years

excessive ACTH > excessive stimulation of adrenal cortex = excessive production of glucocorticoids

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55
Q

Cushing’s Disease Diagnosis

A

establish presence of hypercorticolism

classifying as ACTH-dependent or independent

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56
Q

Cushing Syndrome Primary TX

A

resection of ACTH-secreting tumor
radiotherapy
lifetime replacement of glucocorticoids

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57
Q

Cushing Syndrome Iatrogenic syndrome:

A

gradual withdrawal of medications

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58
Q

ACTH-independent Cushing syndrome TX:

A

adrenalectomy

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59
Q

Cushing ACTH-secreting tumors TX:

A

resection when possible

60
Q

Cushing Metastaic disease TX:

A

medications

61
Q

Primary Hyperaldosteronism (Conn Syndrome) cause

A

renin-independent hyperaldosteronism
excess aldosterone production w/in adrenal cortex
commonly b/c of adenoma (benign tumors) or bilateral adrenocortical hyperplasia (^ # of cells)

62
Q

Conn Syndrome s/s

A 
electrolyte disturbances
ha
fatigue
muscle weakness
cardiac dysrhthmias
paresthesia
tetany (muscle spasms)
visual changes
glucose intolerance
elevated aldosterone
polydipsia
polyuria
unexplained hypokalemia
63
Q

Conn Syndrome Interventions

A 
VS (BP) i/o urine specific gravity
diuretics
ACE inhibitors
beta-blockers
adrenalectomy (followed by lifelong glucocorticoids)
64
Q

Adrenal Medullary Hyperfunction (Pheochromocytoma) cause

A

neruoendocrine tumors (typically benign)

65
Q

Pheochromocytoma risk factors

A

familial/genetic syndrome

men syndromes

66
Q

Pheochromocytoma manifestations

A 
severe headaches
excessive sweating
flushing
heat intolerance
sustained hypertension
palpitations
tachycardia
chest ppain
anxiety
panic attack
nausea/vomiting
weight loss
tremors
hyperglycemia
67
Q

Pheochromocytoma diagnosis

A

24 hr urine collection (measuring VMA)
CT w/ contrast
MRI
imaging w/ radioactive tracers

68
Q

Pheochromocytoma interventions

A

monitor VS
serum glucose
urine output (worry for hypertensive crisis)

69
Q

Pheochromocytoma TX

A

complete surgical removal of tumor
alpha-adrenergic blockers (10-15 days B4 surgery)
beta blockers/antihypertensives

70
Q

Pheochromocytoma Complications

A 
hypertensive crisis, hypertensive encephalopathy
retinopathy
nephropathy
cardiac enlargement
dysrhythmias
heart failure
MI
increased platlet aggregation
risk of stroke
shock 
renal failure
dissecting aortic aneurysm (death)
71
Q

Pheochromocytoma education

A 
promote rest/nonstressful education
avoid increased intra-abdominal pressure
avoid stimulants (nicotine/caffeine)/sudden position changes
72
Q

Pheochromocytoma first-line drugs therapy

A

Alpha-adrenergic blocking agents

prazosin/terazosin/doxazosin

73
Q

Pheochromocytoma secondary TX

A

beta blockers

propranolol nadolol

74
Q

Thyroid information

A

right and left lobe

thyroid follicle

75
Q

Thyroid hormones

A 
control basal metabolic rate
growth/development in infants&amp;children
mental development
sexual maturity
cardiovascular/respiratory/GI/neuromuscular function
triiodothyronine (T3)
Thyroxine (T4)
Calcitonin
76
Q

Graves Disease:

A

hyperthyroidism

77
Q

Hashimoto thyroiditis

A

hypothyroidism

78
Q

Thyroxine T4

A

storage form (converted into T3)

79
Q

Triiodothyronine (T3)

A

energy form

80
Q

Calcitonin

A

responsible for calcium homeostasis

81
Q

Iodine

A

essential for synthesis of T4/T3

82
Q

Thyroid Regulation

A

negative feedback loop

the more thyroxine = less TRH/TSH released

83
Q 
Thyroid Hormones: Actions
Metabolic
CV/Respiratory
GI
ETC
A

increases basal metabolic rate
increases CO/HR/ventilation/muscle contractilty/vasodilation
increases appetite/diarrhea
increases skeletal muscle activity
increase sympathetic activity
growth developments bone/sexual/cognitive

84
Q 
Hypothyroidism primmary causes
Goiter
Thyroiditis
Hashimoto's thyroiditis
Thyroidectomy
A

iodine deficiency
inflammation
autoimmune (most common)
surgical removal

85
Q

Hypothyroidism Secondary causes

A

deficient TSH secreted from anterior pituitary causes thyroid atrophy

86
Q

Secondary Hypothryoidism early vs severe symptoms

A 
generalized weakness
muscle cramps
dry skin 
vs
slurred speech
bradycardia
weight gain
decreased taste/smell
intolerence of cold
altered mental status (> coma)
87
Q

Goiters

A

abnormal growth of thryoid gland
nodular or diffuse
can cause normal/decreased or increased thyroid hormone production

88
Q

Nontoxic diffuse goiters

A

simple goiters

no overt hyper/hypo thyroidism

89
Q

nontoxic multinodular goiters

A

growth factors

normal TSH

90
Q

endemic goiter

A

iodine deficiency; increased TSH

91
Q

chronic autoimmune (Hashimoto) thyroiditis:

A

hypothyroidism

92
Q

toxic multinodular goiter (Graves)

A

hyperthyroidism

93
Q

Goiters causes

[worldwide - US - uncommon]

A

iodine deficiency

  • multinodular goiter/hashimoto/graves/increased TSH due to defect in hormone synthesis
  • tumors/thyroiditis/infiltrative disease
94
Q

Goiters s/s

A

associated w/ thryoidal dysfunction/growth rate of goiter

long standing goiters: obstruction/sudden increase in size

95
Q

Goiters diagnosis

A

physical exam thru palpation
clinical symptoms
TSH/T3/T4 autoantibodies

96
Q

Goiters TX

A

small/mod:
oral thyroid hormone
removal if malignancy is suspected

97
Q

Levothyroxine action/uses

A

endogenous thyroid hormone

replaces T4 in patients with low hyroid function

98
Q

Levothryoxine SE

A 
hyperthyroidism
palpitations
dysrhythmias
anxiety
insomnia
weight loss 
heat intolerance
menstrual irregularities
osteoporosis (in women)
99
Q

Levothyroxine Nursing interventions

A

VS/HR/rhythmn

monitor for overdose (tachycardia/chest pain/restlessness/nervousness/insomnia)

100
Q

Levothyroxine Teaching

A 
relief of symptoms 3-4 weeks
recheck hormone levels 4-6 weeks
full therapeutic 8 weeks
diet: 
low calorie/low cholesterol/low saturate fat/roughage/fluids help avoid constipation
daily exercise
101
Q

Levothyroxine AVOID

A

sedatives/opioid analgesics =sensitivity > myxedema coma

102
Q

Myxedma Coma causes

A 
persistently low thyroid production by
acute illness
rapid withdrawal of thyroid medications
anesthesia/surgery
hypothermia
use of sedatives/opioid analgesics
103
Q

Myxedma Coma Assessment:

A 
hypotension
bradycardia
hypothermia
hyponatremia
hypoglycemia
generalized edema
respiratory failure
coma
104
Q

Myxedma Coma interventions

A 
maintain patient airway
prevent aspiration (don't lie pts flat, have suction available)
assess body temp hourly BP frequently
monitor mental status 
monitor electrolytes /glucose levels
105
Q

Myxedema Coma TX

A

Iv fluids
levothyroxine sodium IV
IV dextrose (tx hypoglycemia/NPO)
corticosteroids

106
Q

Hyperthyroidism (Primary) causes

A 
Graves disease (most common)
multinodular goiters
toxic adenomas
iodine-induced hyperthyroidism
thyrotoxicosis factitial
107
Q

Hyperthyroidism (Primary) s/s

A 
tachycardia
atrial fibrillation
fine tremors
proximal muscle weakness
goiter
warm, moist skin
hyperreflexia
lid lag/retraction
stare
alopecia
exophthalmos (eye protrusion)
increased metabolism
anxiety
insomnia
palmar erythema
108
Q

Hyperthyroidism (Primary) Diagnosis

A

Suppressed serum TSH w/ elevated T4

thyroid peroxidase antibodies

109
Q

Hyperthyroidism (Primary) Interventions

A 
adequate rest/cool, quiet environment
daily weights
high calorie/low sodium diet
avoid stimulants
artificial tears/dark glasses
110
Q

Hyperthyroidism (Primary) TX

A

partial/total thyroidectomy
medications to decrease hormone production
radioactive iodine
propranlol (for tachycardia)

111
Q

Propylthiouracil (PTU) methimazole Action

A

inhibits incorporation of iodine into thyroid hormones

112
Q

PTU & methimazole Interventions/Labs

A

assess s/s of hypothyroidism, jaundice and bleeding

thyroid hormone levels, TSH, ECG, CBC, Liver enzymes

113
Q

PTU & methimazole SE

A

hepatoxic, agranulocytosis (decreased immune response)

114
Q

Radioactive Iodide Action

A

destroys cells in thyroid
more permanent/long-term solution
usually hypothyroid post-therapy (requiring levothyroxine)

115
Q

Radioactive Iodide teaching

A

avoid children/pregnant people one week post admin

limit contact with others for a few days post admin

116
Q

Thyroid Storm (Thyrotoxicosis) causes

A

acute/life-threatening
manipulation of gland in surgery
severe infection
stress

117
Q

Thyrotoxicosis s/s

A 
elevated body temperature
tachycardia
hypertension
n/v/d
tremors
anxiety
irritability
agitation
restlessness
confusion
seizures
delirium
coma
118
Q

Thyrotoxicosis TX

A 
maintain patient airway (don't lie on back)
monitor VS/CV
cooling blanket/ice packs
antithyroid meds (PTU)
radioactive iodide
propanolol
corticosteroids
iodine --> to prepare for throidectomy
DO NOT GIVE SALICYLATES (ASPIRIN)
119
Q

Thyroiditis etiology

A

inflammation of thyroid

120
Q

Subactue thyroiditis

A 
transient hypo/hyper thyroidism
upper respiratory infection 
tender
painful
minimally enlarged thyroid
121
Q

Painless thyroiditis

A

transient hyper/hypo thyroidism

122
Q

postpartum thyroiditis

A 
autoimmune disorder
transient hyper/hypothyroidism
follicular damage (release of stored t3/t4)
123
Q

infectious thyroiditis

A

infection of the thyroid gland

acute: sudden onset of neck pain, tenderness, fever, chills dysphagia, neck swelling

124
Q

Thyroiditis TX

A

normalize thyroid levels

125
Q

Thyroid Nodules Causes

A

abnormal growth of thyroid cells forming lumps
multinodular goiter
hashimoto thyroiditis
follicular adenomas

126
Q

Thyroid Nodules s/s

A

excessive T3/T4

obstructive symptoms

127
Q

Thyroid Nodules Diagnosis

A 
history/physical exam 
TSH
thyroid ultrasound
thyroid scintigraphy
fine-needle aspiration cytology biopsy
128
Q

Hyperthyroidism (Secondary) s/s

A

symptoms of hyperthyroidism

tumor mass s/s r/t obstruction

129
Q

Hyperthyroidism (Secondary) Diagnosis

A

hyperthyroidism w/ diffuse goiter w/o s/s of Graves

high/normal T4/3 w/ elevated TSH

130
Q

Thyroid Cancer types

A

Papillary (most common)
follicular (aggressive)
medullary (from parafollicular C cwlls)
anaplastic (undifferentiated follicular extremely aggressive)

131
Q

Thyroid Cancer s/s

A

rapid nodular growth; fixed
hoarseness/loss of voice
cervical lymphadenopathy

132
Q

Thyroid Cancer TX

A

papillary/follicular (total thyroidectomy, remnant ablation therapy, levothyroxine)
medullary (total thyroidectomy/levothyroxine)
anaplastic (surgical resection, radiation, chemotherapy)

133
Q

Parathyroid info

A

4 secreting glands
regulates calcium/phosphate
target organs (intestinal mucosa/kidney/bones)

134
Q

Hypoparathyroidism cause

A

surgery (most common)
autoimmune
familial
idiopathic

135
Q

Hypoparathyroidism s/s

A 
hypocalcemia
hyperphosphatemia
trosseau's and chvostek sign
increased neuromuscular excitability
tetany
bronchospasm 
laryngospasm
dysphagia
seizures
cardiac dysrhythmias
hypotension
anxiety
irritability
136
Q

Hypoparathyroidsim Diagnosis

A

calcium decreased

phosphate increased

137
Q

Hypoparathyroidism Interventions

A

monitor closely fo rhypocalcemia (spasms/cramps/tetany)

initiate seizure precautions

138
Q

Hypoparathyroidism thyroidectomy

A

prepare tracheostomy set/oxygen/suction equipment for return

139
Q

Hypoparathyroidism Diet

A

high calcium, low phosphorus
may need calcium supplements
vitamin D supplements
phosphate binders

140
Q

Hyperparathyroidism Primary

A

generalized disorder of calcium, phosphate and bone metabolism
resulted from increased PTH

141
Q

Hyperparathyroidism Secondary

A

diffuse hyperplasia of parathyroid glands due to external cause

142
Q

Hyperparathyroidism Tertiary

A

results from excessive sustained release of PTH

143
Q

Hyperparathyroidism s/s

A 
hypercalcemia/hypophosphatemia
fatigue
muscle weakness
bone deformities
fractures
skeletal pain
anorexia
N/v
epigastric pain
weight loss
constipation 
hypertension 
dysrhthmias
renal stones
144
Q

Hyperparathyroidism Diagnosis

A

calcium and PTH levels

radiologic studies

145
Q

Hyperparathyroidism TX

A

surgery
phosphates IV
IV/PO (sodium phosphate/potassium phosphate)
bisphophonates (alendronate sodium)

146
Q

Hyperparathyroidism Interventions

A

Monitor VS/BP/CV/IO/CA/PHOS
diet: high-fiber, moderate calcium
monitor for skeletal pain

Pathophysiology and Pharmacology 2 (27 decks)

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