Endocrine Flashcards
(56 cards)
1
Q
5 mechanisms of endocrine disorders
A
- Failure of feedback
- Gland dysfunction
- Increased hormone degradation/inactivation
- Ectopic hormone release
- Target cell failure
2
Q
3 mechanisms of gland dysfunction
A
- Secretory cells unable to produce, obtain, or convert hormone precursor (Ex. iodine needed for TH)
- Gland synthesizes or released excessive amts of hormone
- Gland fails to produce enough hormone
3
Q
hormone released from organ that should not be releasing it
A
ectopic hormone release
4
Q
anterior pituitary hormones - 6
A
- Thyroid-stimulating hormone
- Follicle-stimulating hormone
- Luteinizing hormone
- Adrenocorticotropic hormone
- Growth hormone
- Prolactin
5
Q
stimulates release of glucocorticoids & androgens
A
ACTH
6
Q
stimulates lactation
A
prolactin
7
Q
posterior pituitary hormones - 2
A
- Antidiuretic hormone
- Oxytocin
8
Q
↑ reabsorption of water in kidneys
A
ADH
9
Q
stimulates uterine contractions & milk release
A
oxytocin
10
Q
↑ BMR
A
thyroid hormone
11
Q
2 thyroid hormones
A
thyroxine (T4) & triiodothyronine (T3)
12
Q
↑ blood calcium
stimulates bone resorption (ostoclasts)
↑ calcium absorption
A
PTH
13
Q
hormones of adrenal cortex - 3
A
- Mineralcorticoids (aldosterone)—zona glomerulosa
- Glucocorticoids (cortisol)—zona fasciculata
- Gonadocorticoids (androgens)—zona reticularis
14
Q
hormones of adrenal medulla - 2
A
Catecholamines (norepinephrine & epinephrine)—chromaffin cells
15
Q
↑ reabsorption of Na+ & water
↑ secretion of K+ in urine
A
aldosterone
16
Q
↑ breakdown of fat & protein
promotes stress resistance
inhibits immune response
A
cortisol
17
Q
mimic testosterone in females
A
androgens
18
Q
mimic SNS activation; “fight or flight”
A
epinephrine & norepinephrine
19
Q
pancreatic hormones - 2
A
- insulin
- glucagon
20
Q
↑ blood glucose
A
glucagon
21
Q
T1DM
explanation
etiology
r/f
s/s
tx
A
- Type 4 hypersensitivity - T-cells destroy pancreatic beta cells - pancreas produces little or no insulin
- Etiology - idiopathic
- r/f - genetics; infection; other autoimmune disorders
- s/s - “3 P’s” (polyuria - water follows glucose in tubules; polydipsia - dehydration from fluid pulling out of body; polyphagia - catabolic state); glucosuria; DKA; wt loss; fatigue; weakness; mood changes
- Tx - lifelong insulin replacement
22
Q
T1DM accounts for __% of diabetic population
A
10
23
Q
when does hyperglycemia occur in T1DM?
A
80-90% of beta cells are destroyed
24
Q
T2DM
explanation
r/f
s/s
A
-
Cellular resistance to insulin, then inability to produce adequate insulin
- Beta cells respond to resistance by producing more insulin
- Beta cells go through hyperplasia & hypertrophy - causes scarring in pancreas
- May need more and more medication/insulin as time goes on
- r/f - obesity; sedentary; genetics; HTN; family hx
- s/s - fatigue; pruritus; recurrent infections (glucose on urinary meatus); visual changes; neuropathy (hands and feet); high cholesterol (especially triglycerides - leads to atherosclerosis); HTN (damage to glomerulus)
25
3rd type of DM
gestational DM
26
dx tests for DM
* _Fasting blood glucose_ - fast must be at least 8hrs
* _Glucose tolerance test_ - screening for pregnant women around 28 weeks
* _Glycosylated hemoglobin (HA1C)_ - average of BG over 3 months’ time
27
complications of DM are most related to…
duration & extent of abnormal BG
28
complications of DM
* _microvascular changes_ (peripheral vascular disease; nephropathy; retinopathy; neuropathy)
* _CV disease_
* _DKA_ (type 1)
* _HHNS_ (type 2)
* _amputations_
* _hypoglycemia_
29
primary cause of mortality in adolescents with DM
DKA
30
DKA responsible for \_\_% of DM-related hospitalizations
carries a \_\_\_% mortality
15
1-3
31
**DIABETIC KETOACIDOSIS**
explanation
onset & duration
etiology
r/f
s/s
* _Lipolysis_ (to meet cellular energy needs) results in _acidic ketone body_ formation
* Sudden onset; \<2 days duration
* Etiology - usually _infection_; _stress_; dosing error; change in diet; alcohol intake; exercise; _noncompliance_ with insulin regimen
* r/f - T1DM; _\<40yo_
* s/s - _hyperglycemia_ (_\>200_); dry mucosa; dry skin; tachycardia; Na and K imbalance (↑ K+); hypotension; _glucosuria_; _3 Ps__;_ ketoacidosis; _acidemia_; _\<15 mEq/L bicarb;_ _Kussmaul_ respirations; _acetone breath_; lethargy; n/v; mental status changes; _coma_
32
DKA often mistaken for…
being drunk
33
**HYPEROSMOLAR HYPERGLYCEMIC NONKETOIC SYNDROME**
onset & duration
explanation/etiology
r/f
s/s
\_\_\_% mortality
tx
* _Insidious_ onset - may take days to manifest, and may be severe at that point; _\>5 days duration_
* Hyperglycemia caused by _↑ glucacon, catecholamines, cortisol, GH, and hepatic glucose production_ - _↑ osmolarity_ of extracellular space draws _fluid out of cells_ - kidneys filter glucose from blood - water loss through osmotic diuresis - results in _severe dehydration & hyperglycemia_
* r/f - T2DM; _\>60yo_; infection; medication _noncompliance_
* s/s - _severe hyperglycemia (\>800)_; _glucosuria_; few ketones; _polydipsia_; _polyuria_; dry mouth; fever; confusion; _hallucinations_; _hyperosmolarity_ (\>350 mOsm/L); hypotension; _profound dehydration_; _\>7.4 pH_; \>20 mEq/L bicarb; _↓ K+_
* 10-20% mortality
* Tx - _insulin & fluids_
34
extreme thirst, dehydration & polyuria
alkalosis
↓K+
HHNS
35
**HYPOGLYCEMIA**
criteria/levels
r/f
s/s
tx
* _\<60_ mg/dL BG
* r/f - _old and young_; skipping or missing meals; longer duration of DM; activity; _medications_ (insulin, PO DM meds)
* s/s - _dizziness_; fatigue; _pallor_; _shakiness_; palpitations; _sweating_; hunger; _irritability_; loss of consciousness; blurry vision; _change in mental status_; slurred speech; hypotension; _tachycardia_
* Tx - _sugar followed by protein_; milk, peanut butter; glucose tabs; glucose nasal spray
* Unconscious pts need sugar via _IV_, not PO
36
effects of GH
direct effect on tissues
stimulates liver to release IGF (insulin-like growth factor)
37
2 forms of growth hormone hypersecretion
* acromegaly - in adults
* gigantism - in children
38
**ACROMEGALY**
etiology
onset
s/s
screening tool
* Etiology - pituitary tumor; trauma
* _Insidious_ onset - not always obvious
* s/s - _soft tissue overgrowth_; joint pain; DM; _HTN_; _heart & resp failure_
* Ask adults if their shoes, gloves still fit the same
39
**GIGANTISM**
etiology
s/s
* Etiology - pituitary tumor; trauma
* s/s - _tallness_; _h/a_; vision problems; nausea; _excessive sweating_
40
↑GH
acromegaly
gigantism
41
↑ ADH
syndrome of inappropriate ADH secretion
42
**SIADH**
etiology
r/f
s/s
* Etiology - infection (_meningitis_); tumor; trauma; medications; advanced _pulmonary disease_
* r/f - kidney or _pulmonary_ disease
* s/s - _low urine output_; loss of thirst; _hyponatremia_; _fluid overload__;_ n/v; cramps; tremors; _seizure_; coma
43
**DIABETES INSIPIDUS**
etiology
r/f
s/s
* Etiology - _central_ (pituitary problem); _nephrogenic_ (kidney problem); _pregnancy_ (gestational)
* r/f - _male_; genetics
* s/s - _very_ _high urine output_; thirst; _hypernatremia_; _dehydration_; n/v; fever; wt loss; urinary frequency; _constipation_; delayed growth
44
↓ ADH
diabetes insipidus
45
↓ TSH
hyperthyroidism
46
↑ TSH
hypothyroidism
47
**HYPERTHYROIDISM**
explanation
etiology
r/f
s/s
complications
tx
* Metabolism increases
* Etiology - _thyrotoxicosis_ (idiopathic); _Graves’ disease_ (autoimmune)
* r/f - _female_; between _20-40yo or \>60yo_; autoimmune disorders; family hx; thyroid problems; nodules; goiter
* s/s - periorbital myedema; _exophthalamos_; nodular goiter; _wt loss_; _tachycardia_; tremor; _difficulty sleeping_; HF; _↑ body temp; heat intolerance_; sweating; _soft silky hair_; flushed warm skin; diarrhea; _hyperactivity_; low TSH (body trying to stop thyroid)
* Complications - _thyrotoxicosis crisis (thyroid storm)_ - increased body temp, HR - life threatening, needs immediate reversal
* Tx - radioactive _iodide_, drugs - cannot be used during pregnancy
48
**HYPOTHYROIDISM**
explanation
etiology
r/f
s/s
complications
tx
* Metabolism decreases
* Etiology - _iodine deficit; Hashimoto’s disease_ (autoimmune); tumor; thyroid removal
* r/f - _female_; _\>60yo;_ family hx; neck surgery or radiation; iodine deficit region
* s/s - hypometabolism; _cold intolerance_; constipation; _brittle hair;_ _wt gain;_ _lethargy__;_ _myxedema_ (nonpitting edema to tongue and face); dry skin; goiter; high TSH (body trying to stimulate thyroid)
* Complications - _myxedema coma_
* Tx - hormone replacement, _levothyroxine_
49
**HYPERPARATHYROIDISM**
etiology
r/f
s/s
* Etiology - tumor; renal failure; paraneoplastic syndrome
* r/f - _female_; ionizing radiation; genetics
* s/s - _hypercalcemia_; _forceful cardiac contractions_; osteopenia/_osteoporosis_; kidney _stones_; muscle _weakness_; _lethargy_; stupor; personality changes; anorexia; nausea; ↓ renal function; dysrhythmias
50
**HYPOPARATHYROIDISM**
etiology
s/s
* Etiology - tumor; congenital lack of parathyroid; _damage during surgery in neck_; autoimmune disease
* s/s - _hypocalcemia_; _Chvostek & Trousseau signs_; muscle _spasms_, twitching; hair loss; carpopedal spasm; _tetany_; _weak cardiac contractions;_ dysrhythmias; hypotension
51
Cushing's disease is r/t
pituitary adenoma
52
**CUSHING'S SYNDROME**
what does it cause in the body?
etiology
s/s
* Causes retention of _sodium and water_; _immune suppression_; _erythropoiesis_; _catabolism of bone_ & protein; delayed healing; _insulin resistance_; possible glucose intolerance
* Etiology - _adrenal adenoma_; _pituitary adenoma_ (↑ ACTH); ectopic carcinoma; iatrogenic conditions; substance abuse
* s/s - _rounded face__; truncal obesity;_ _buffalo hump_ (fat pad between scapulae); thin limbs; thin hair; _hirsuitism_; fragile skin; _purple striae_; euphoria; _mood swings_; loss of libido; _hyperglycemia; HTN_
53
2 types of r/f for Cushing's
* Exogenous - steroid use (asthma, COPD, RA pts)
* Endogenous - adenoma; cancer; between 30-60yo
54
**ADDISON'S DISEASE**
etiology
prevention
r/f
s/s
* Etiology - autoimmune; infection; medication
* Most often caused by _steroid use_ - hypothalamus tells adrenal glands to stop producing cortisol - _zona fasciculata shrinks_ _as a result of inactivity_ - _adrenal crisis_ _occurs when you go off the steroid medication_
* Important to _never d/c steroids suddenly_
* r/f - other autoimmune disorder; removal of adrenal gland; cancers; anticoag use
* s/s - unintentional _wt loss; hypoglycemia__;_ _bronzing_ (hyperpigmentation) inadequate stress response; fatigue; frequent infections; _hyponatremia; salt craving_; anorexia; hypovolemia; _hypotension_
55
d/c steroids suddenly leads to…
Addison's
56
**PHEOCHROMOCYTOMA**
explanation
r/f
s/s
* Adrenal tumor
* r/f - _neurofibramatosis_ type 1; Von Hippel-Lindau disease; Multiple endocrine neoplasia type 2
* s/s - increased _adrenalin_; _HTN_, flushed skin, _tachycardia_ (adrenalin rush that comes and goes)
