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advance patho > Chapter 22: Alterations in Endocrine system > Flashcards

Chapter 22: Alterations in Endocrine system Flashcards

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1
Q

SIADH

A

Increased ADH usually due to tumors

Can be caused by hypoglycemics, antidepressants, antipsychotics, narcotics, anesthesia, chemo, NSAIDs

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2
Q

S/S SIADH

A

Hypotonic hyponatremia, hypervolemia, weight gain, peripheral edema absent, lethargy, concentrated urine

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3
Q

Diabetes insipidus

A

Decreased ADH leading to polyuria and polydipsia

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4
Q

Neurogenic central DI

A

Insufficient secretion of ADH from hypothalamus

Usually due to pituitary surgery

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5
Q

Nephrogenic DI

A

Inadequate response of kidney to ADH

Genetic or damage due to drugs

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6
Q

Primary polydipsia

A

excessive fluid intake lowers plasma osmolarity to a point below threshold for ADH secretion

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7
Q

S.S DI

A

Polyuria, nocturia, continuous thirst, polydipsia

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8
Q

Causes of hypopituitarism

A

Inadequate supply of hypothalamic releasing hormones, damage to pituitary stalk, inability of gland to produce hormones

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9
Q

Panhypopituitarism

A

All hormones deficient

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10
Q

Pituitary gland vulnerable to

A

Ischemia and infarction due to being highly vascular

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11
Q

ACTH deficiency

A

Can be life threatening

N/V, anorexia, fatigue, weakness, hypoglycemia

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12
Q

TSH deficiency

A

Cold intolerance, skin dryness, mild myxedema, lethargy, decreased metabolic rate

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13
Q

Hyperpituitarism is usually due to

A

Primary adenoma: benign, slow growing tumor of anterior pituitary
Adenomatous tissue secretes the hormone of the cell type from which is arose

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14
Q

Hypersecretion of GH

A

Acromegaly
Due to GH secreting adenoma
Gigantism in children due to increased bone growth

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15
Q

S/S Acromegaly

A

Enlarged tongues, intersitital edema, overactive sweat glands, coarse skin and body hair, large joints, large face hands and feet, barrel chest

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16
Q

S/S prolactinoma

A

Amenorrhea, infertility, galactorrhea

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17
Q

Thyrotoxicosis

A

Any cause of increased TH levels

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18
Q

Hyperthyroidism

A

Excess amount of TH secreted by thyroud gland

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19
Q

S/S hyperthyroidism

A

Increased metabolic rate, heat intolerance, increased tissue sensitivity to stimulation by SNS

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20
Q

Graves disease

A

Autoimmune
Lymphocyte infiltration and stimulation of thyroid by autoantibodies directed against TSH receptor
Leads to goiter

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21
Q

2 major manifestations of Graves

A

Ophthalmopathy and dermopathy

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22
Q

Ophthalmopathy

A

Increased secretion of hyaluronic acid, adipogensis and inflammation and edema of orbital contents leads to exophthalmos

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23
Q

Pretibial myxedema

A

Subcutaneous swelling on anterior portion of legs characteristic of Graves

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24
Q

Thyrotoxic crisis

A

Thyroid storm
Death can occur within 48 hours
S/S: hyperthermia, increased HR, high output HF, agitation, delirium

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25
Most common causes of hypothyroidism
autoimmune thyroiditis, loss of thyroid tissue due to treatment of hyperthyroidism, head and neck radiation, iodine deficiency
26
S/S hypothyroidism
Decreased metabolic rate, cold intolerance, lethargy, tiredness
27
Characteristic sign of hypothyroidism
Myxedema: swelling of face, alopecia, loss of nails along with hardening of skin
28
Myxedema
non-pitting boggy edema caused by infiltration of mucopolysaccharides and proteins between connective tissue in the dermis
29
Myxedema coma
Diminished consciousness due to severe hypothyroidism
30
Most common cause of primary hypothyroidism
Iodine deficiency most common worldwide | Autoimmune thyroiditis most common in US
31
Subactue thyroiditis
Uncommon bacterial inflammation of thyroid preceded by viral infection Fever, tenderness, enlargement of thyroid
32
Primary hyperparathyroidism
Excess secretion of PTH due to adenomas | Increased Ca + PO4 hallmarks
33
Secondary hyperparathyroidism
Compensatory response to parathyroid glands to chronic hypocalcemia Usually due to CKD or vit D deficiency
34
Tertiary hyperparathyroidism
Due to chronic hypocalcemia | Usually due to renal transplant
35
Hyperparathyroidism can cause
Kidney stones and increased risk for fractures due to bone resorption
36
Hypoparathyroidism usually due to
Removal of PT gland with removal of thyroid gland
37
Hypomagnesia can cause
Decreased PTH
38
Glycosylated Hemoglobin
HbA1c | Permanent attachment of glucose to Hgb molecules and reflects average plasma glucose exposure over life of RBC
39
Labs for DM diagnosis
HbA1c >6.5% Fasting plasma glucose >126 2 hour plasma glucose >200 Random plasma glucose >200
40
Type 1 DM
Autoimmune | Environmental genetic factors trigger cell mediated destruction of pancreatic beta cells
41
Decreased insulin leads to
Marked increase in glucagon
42
What causes DKA
Increased hepatic metabolism of fat causing increased levels of circulating ketones
43
Risk factors for type 2 DM
Age, obesity, hypertension, physical inactivity, family history, metabolic syndrome
44
Metabolic syndrome
Central obesity, dyslipidemia, pre-hypertension, increased FPG
45
Obesity causes of insulin resistance
Increased leptin and decreased adiponectin Increase in free fatty acids and intracellular deposits of triglycerides and cholesterol Increased inflammatory cytokines
46
Maturity onset of diabetes of youth
Noninsulin requiring diabetes in lean individuals <25 with evidence of autosomal dominant inheritance
47
Somogyi effect
Too much intermediate acting insulin given at dinner followed by rebound hyperglycemia around 3am
48
Dawn phenomenon
Early morning rise in glucose due to nocturnal elevation of GH, which decreases metabolism of glucose
49
Diabetic ketoacidosis
Usually in type 1 DM | Due to decrease insulin and increase in levels of insulin counter-regulatory hormones
50
Most common precipitating factor for DKA
Intercurrent illness
51
S/S DKA
Kussmal respirations, postural dizziness, CNS depression, ketonuria, anorexia, N/V, abdominal pain, sweet breath, dehydration, thirst, polyuria
52
Most marked electrolyte imbalance in DKA
Decrease in total K+
53
Labs in DKA
Glucose >250, serum bicarb >18, ph <7.3, urine and serum ketones present
54
Hyperosmolar hyperglycemic nonketotic syndrome
High mortality complication of type 2 DM Similar to DKA but no ketones Extreme glucosuria and polyuria causing severe volume loss, increased serum osmolarity, intracellular dehydration, and loss of electrolyte
55
DX criteria for hyperosmolar hyperglycemic nonketotic syndrome
Glucose >600, normal bicarb and ph, osmolarity >320, no ketones
56
Microvascular disease due to DM
Capillary disease: leads to blindness, ESKF, neurppathies | Diabetic retinopathy, diabetic kidney disease
57
Diabetic retinopathy
Damage to retinal blood vessels and RBCs, platelet aggregation, relative hypoxemia, hypertension
58
Diabetic kidney disease
Glomeruli injured by protein denaturation, hyperglycemia with high renal blood flow, activation of RAAS, hypertension Microalbuminuria first manifestation
59
Diabetic neuropathies
Nerves are vulnerable to effects of chronic hyperglycemia | Axonal degeneration involving sensory nerve fibers and metabolic activity of schwann cells decreases
60
Charcot neuroarhtropathy
Progressive degeneration of joint, usually in foot or ankle
61
Macrovascular disease in DM
Increased risk for hypertension, accelerated atherosclerosis, CV disease, stroke and PVD
62
Risk for infection in DM
Increased due to decreased senses, hypoxia, pathogens liking glucose, decreased blood supply leading to decreased WBC, decreased immune response, delayed wound healing
63
Cushing syndrome
Chronic exposure to excess endogenous cortisol
64
Cushing disease
Excess endogenous secretion of ACTH
65
2 observations in cushing disease
Do not have diurnal or circadian secretion patterns of ACTH and cortisol Do not increase ACTH and cortisol in response to stressor
66
Most common feature of Cushing disease
Weight gain Central obesity, moon face, buffalo hump Due to lipolysis and altered fat distribution
67
S/S cushing disease
Glucose intolerance, protein wasting, increased bone resorption, hypercalciuria and kidney stones, vasoconstriction and hypertension, increased risk for CAD,
68
Congenital Adrenal hyperplasia
Autosomal, recessive | Deficiency in enzyme critical in cortisol synthesis
69
Conn syndrome
Primary hyperaldosteronism | Causes hypokalemia, induces insulin resistance, promotes inflammation, endothelial dysfunction and CV remodeling
70
Secondary hyperaldosteronism
Due to aldosterone secretion from angiotensin II through renin-dependent mechanism Compensatory due to low blood volume
71
S/S hyperaldosteronism
Hypertension, hypokalemia, hypervolemia, metabolic alkalosis
72
Virilization
Development of male sex characteristics due to over secretion of androgens
73
Addison disease
Primary hypocortisolism Inability of adrenals to produce and secrete adrenocortical hormones Decreased aldosterone and cortisol
74
Biggest concern with addison disease
hypotension--addisonian crisis
75
Prolonged addison disease usually due to
Prolonged administration of glucocorticoids
76
Hirsutism
Excessive growth of facial and body hair
77
Active anterior pituitary adenoma
Causes hypersecretion of hormones from the adenoma itself and hyposecretion of hormones from surrounding pituitary cells
78
Cretinism
Caused by untreated congenital hypothyroidism
79
Pheochromocytoma
Chromaffin cell tumors of adrenal medulla | Hypertension, tachycardia, palpitations, severe headache, diaphoresis, heat intolerance, weight loss, constipation
80
Gastroperesis
Complication of diabetes where patient feels full--microvascular problem of autonomic neuropathy

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