Ch. 32 Disorders of Endocrine Control of Growth and Metabolism

Question 1

Functions of the endocrine systems

Answer 1

• controls growth/development
• regulates energy metabolism
• muscle/adipose tissue distribution
• sexual development
• fluid and electrolyte balance
• inflammation and immune response

Question 2

hormones

Answer 2

substances/chemical mediators that are released from endocrine tissues —> blood system—->target tissues to generate a response

Question 3

are the adrenal glands affected with renal failure?

Answer 3

no

Question 4

hypofunction

Answer 4

• absence or impaired development
• absence of enzymes
• gland destruction
• decline in function

Causes:

• blood clots/impeded blood flow
• septic/infection
• inflammation
• autoimmune
• neoplastic growth
• age
• atrophy(side effect of medication)

Question 5

hyperfunction

Answer 5

• excessive hormone production
• excessive stimulation
• hormone producing tumor (tumor forms originally on gland)

Question 6

primary defect

Answer 6

target organ defective

Question 7

secondary defect

Answer 7

organ that produces stimulating hormones defective

Question 8

tertiary defect

Answer 8

hypothalamic dysfunction(both primary and secondary)

Question 9

Hormones produced by the pituitary gland

Answer 9

ACTH (adrenal cortex tropic hormone)
TSH (thyroid stimulating hormone)
GH (growth hormone)
FSH (follicle stimulating hormone)
LH (luteinizing hormone)
PL (prolactin)

Question 10

How many lobes does the pituitary gland have?

Answer 10

2: anterior and posterior

Question 11

pituitary tumor

Answer 11

• could be primary or secondary
• functional or non functional
• small to large in size (large tumors will see increased intracranial pressure and experience vertigo, nausea, headache, vomiting)

Question 12

hypopituitarism

Answer 12

• decreased secretion
• congenital or acquired(tumor/medication)
• gradual/acute onset
• many physical manifestations (fatigue, loss of appetite, impaired sexual frustration, cold dysfunction, increased morbidity/mortality)

Question 13

what is the order that the pituitary hormones stop producing in?

Answer 13

1st- GH
LH
FSH
last- ACTH

Question 14

Where is growth hormone produced

Answer 14

in the anterior pituitary gland

Question 15

function of growth hormone

Answer 15

• necessary for linear bone growth
• abnormalities are not limited to just the skeleton… (englarged heart, metablolic disorders like fat and carbohydrate, impaired glucose tolerance)
• released during REM sleep, majority during childhood before puberty

Question 16

Causes of decreased GH in Children

Answer 16

1. idiopathic
   
   • short stature
   • no cause- etiology unknown
2. psychosocial
   
   • hypopituitarism
   • emotionally deprived (will manifest with potbelly and poor nutrition)

Question 17

excess GH in children

Answer 17

• Marfan’s syndrome (XXY) - arms are extremely long
• can be treated with hormones to close epiphyseal plate
• can result in gigantism

Question 18

gigantism

Answer 18

too much GH before puberty

Question 19

both gigantism and acromegaly can result in….

Answer 19

diabetes. because both are associated with increased glucose levels

Question 20

decreased GH in adults

Answer 20

GH naturally decreases with age, but is still released during REM sleep

can result in many systemic complications…

• cardiac
• increased lipids/hyperlipidemia
• decreased bone mineral density
• decrease in lean muscle body mass
• increase in fat mass
• reduced exercise capacity

Question 21

acromegaly

Answer 21

too much GH after puberty

-pronounced enlargement of face and nose (fingers too)

Question 22

excess GH in adults

Answer 22

-most commonly caused by benign adenomas - excessive GH made

Question 23

hypothyroidism

Answer 23

very common-5% of US population has

• Hair loss
• intolerance to cold
• receding hairline
• dark skin
• anorexia
• facial/eyelid edema
• thick tongue

treated with a synthetic hormone pill (synthroid)

Question 24

congenital hypothyroidism

Answer 24

-treatable if found at birth (at birth baby will appear normal b/c they still have thyroid hormones from the mother. But then urine output will decrease and they wont gain weight) by checking TSH and T4 levels

Question 25

acquired hypothyroidism

Answer 25

- slow, destruction/dysfunction - could be primary, secondary, tertiary - could be caused by iodine deficiency (result in goiter)

Question 26

Hashimoto Thyroiditis

Answer 26

- autoimmune thyroiditis-etiology unknown, thyroid just stops working - #1 most common type of hypothyroidism - more common in women S/S -tired, gain weight, eat less, cold intolerance, jaundice (affects liver), constipation

Question 27

if hypothyroidism isn't treated is could lead to...

Answer 27

myxedema - hard, non pitting edema - puffy eyes - tongue enlarged - coma/death - hypothermia - cardiovascular collapse - hypoventilation - hypernatremia - hypoglycemia - hypoxia

Question 28

hyperthyroidism (thyrotoxicosis)

Answer 28

high levels of circulating thyroid hormone Treatment: - radioactive iodine - surgical removal of all or part of thyroid S/S -irritable (don't sleep), tachycardic, weight loss, heat intolerance, restless, fine motor tremors, exopthalmos

Question 29

what do you worry about in patients hypothyroidism?

Answer 29

hyperthyroidism due to over medicating

Question 30

Graves Disease

Answer 30

- most common cause of hyperthyroidism - women ages 20-40 yrs old - women are five times more likely to have than men - autoimmune- etiology unknown - abnormal TSH stimulation- TSH levels elevated - often associated with other autoimmune diseases(myasthenia Gravis, pernicious anemia) - diarrhea is seen because the metabolism is increased which means the GI tract is moving too fast

Question 31

thyroid storm

Answer 31

crisis-life threatening - could be overdose of synthroid - precipitated by stress manifests by: - very high fever - tachycardia - CNS effects - mortality is high treated with a drug that blocks the hormones

Question 32

What medicine should not be used during a thyroid storm?

Answer 32

aspirin

Question 33

Addison's disease

Answer 33

Primary adrenal cortical insufficiency - lack of adrenal cortical hormones (steroids) - most common cause of Addison's disease today is autoimmune - most common cause of Addison's disease before the 1950s was TB - requires lifetime hormone replacement - adrenal cortex 90% destroyed before symptoms show

Question 34

Addison's patients...

Answer 34

require regular meals and exercise they respond poorly to stressors (cold, heat) acute adrenal crisis/Addisonian's crisis is treated with fluids and steroids

Question 35

Secondary Adrenal Cortical Insufficiency

Answer 35

- damaged pituitary gland or removal of pituitary gland - could also be due to patients not tapering off steroid medications. if so they will give patient a higher dose of steroids and taper them off in hopes of resetting the adrenal gland

Question 36

acute adrenal crisis

Answer 36

Addison's disease + stress or illness = nausea, vomiting, weakness, hypotension, dehydration, vascular collapse

Question 37

Glucocorticoid Excess

Answer 37

opposite of Addison's disease- think adrenal gland

Question 38

Cushing Syndrome

Answer 38

- glucocorticoid excess - Cushing disease if caused by pituitary tumor - adrenal form : benign/malignant adrenal tumor - ectopic : non-pituitary tumor that secretes ACTH - iatrogenic (physician induced) : cushing's syndrome caused by long term steroid use

Question 39

Cushing Syndrome manifestations

Answer 39

- thin arms and legs - large waist - diabetes - buffalo hump - Na+ and water retention - hypertension - cardiac hypertrophy - moon face - muscle wasting and fat accumulation