endocrine Flashcards

Question

Precocious Puberty

Answer 1

Early activation of hypothalamic pituitary gonadal axis Occurs before 6 in African American girls, 7 in Caucasian girls and 9 in boys of both races Development of secondary sex characteristics and fertility Tall stature in childhood and short stature in adulthood

Answer 2

Body’s largest single organ specialized in hormone production Thyroid hormone secretion regulated by the hypo-thalamic-pituitary-thyroid feedback Thyroid hormone increases metabolism and protein synthesis Thyroid Function Tests: T3, T4, TSH

Answer 3

General slowing down of the metabolic process Most often caused by Hashimoto Thyroiditis-autoimmune disorder than can destroy the thyroid gland Manifestations: gradual onset of generalized weakness, weight gain despite decrease appetite, cold intolerance, dry sterm-127kin, coarse, brittle hair, puffy face Diagnosis: elevated TSH, low T4 (primary)*Treatment: levothyroxine( synthroid)

Answer 4

non-pitting edema- especially face Myxedema coma: life-threatening , end stage hypothyroidism, coma, hypothermia, cardiovascular collapse, hypoventilation, hyponatremia, hypoglycemia and lactic acidosis Treatment: aggressive supportive therapy i.e. cardiovascular, electrolytes, warming blanket

Answer 5

High levels of thyroid hormone Due to hyperactive thyroid gland- graves disease, goiter Manifestations: nervousness, irritability, weight loss, tachycardia, palpitatins, SOB, excessive sweating, heat intolerance, exophthalmos Treatment- radioactive iodine to eradicate thyroid gland, surgery, antithyroid drugs- PTU, methimazole, and drugs to control symptoms- Beta-Blockers

Answer 6

Life-threatening thyrotoxicosis- rare now because of good diagnosis tools Caused when hyperthyroid is not adequately treated, precipitated by stress, infection, DKA, trauma or manipulation of the hyper active thyroid during thyroidectomy Manifested: Very high fever, tachycardia, CHF, angina. Agitation, restlessness, and delirium- high mortality rate Treatment- should be rapid- cooling w/o shiver response, fluids, glucose, steroids, PTU, methimazole, BB, NO ASA- increases levels of free thyroid hormones

Answer 7

Addison’s Disease- (rare) adrenal cortical hormones are deficient, ACTH levels are elevated because of lack of feedback Autoimmune destruction of the adrenal cortex, before 1950’s TB was the major cause, metastatic CA, CMV, hemochromatosis Manifestations: urinary loss of sodium, chloride and H2O, decrease loss of K+, decreased Cardiac output, hyperkalemia, orthostatic hypotension, dehydration, weakness and fatigue Treatment- fludrocortisone, hydrocortisone

Answer 8

Addison’s Disease- (rare) adrenal cortical hormones are deficient, ACTH levels are elevated because of lack of feedback Autoimmune destruction of the adrenal cortex, before 1950’s TB was the major cause, metastatic CA, CMV, hemochromatosis Manifestations: urinary loss of sodium, chloride and H2O, decrease loss of K+, decreased Cardiac output, hyperkalemia, orthostatic hypotension, dehydration, weakness and fatigue Treatment- fludrocortisone, hydrocortisone

Answer 9

Life-threatening, can be caused by illness in someone with Addison’s disease Manifestations- N/V, muscular weakness, hypotension, dehydration, and vascular collapse Treatment- fluids both NS and D5W, glucocorticoid replacement therapy

Answer 10

Hypercortisolism from any cause Manifesations- protruding abdomen, subclavicular fat pads, buffalo hump on back, moon face, weakness and thin extremities Treatment- remove or correct the cause of hypercortisolism

Answer 11

The body primarily metabolizes glucose and fatty acids for energy The brain does not produce or store glucose, but needs it exclusively for function Tissues obtain glucose from the blood Liver stores excess glucose as glycogen, and uses gluconeogenesis to convert amino acids, lactate and glycerol into glucose during fasting or when glucose intake does not keep up with demand Blood glucose levels reflect the difference liver released glucose and the amount of glucose removed from blood by body tissues Fats can be used for fuel during fasting or diabetes mellitus- the breakdown makes fatty acids that are converted to ketones in the liver (not converted to glucose) Energy metabolism is controlled by several hormones: insulin, glucagon, epinephrine, GH and glucocorticoids Insulin is the only hormone that controls blood glucose levels Insulin facilitates the transport of glucose into body cells, decreases livers production and release of glucose into the bloodstream Insulin decrease lipolysis and the use of the fats as fuel Glucagon and epinephrine promote glycogenolysis Glucagon and glucocorticoids increase gluconeogenesis

Answer 12

Type I- beta-cell destruction, absolute insulin deficiency Type 1A- immune mediated destruction of beta-cells (90%) Occurs more commonly in children and adolescents Genetic predisposition, environmental triggers, infection, and T-lymphocyte- mediated hypersensitivity Type 1B-idiopathic Strongly inherited African americans and Asian

Answer 13

Fasting glucose levels- plasma glucose levels after 8 hrs of fasting < 100 mg/dl nml 100-125 mg/dl impaired fasting glucose (pre-diabetes) >126 mg/dl provisional diabetes Oral Glucose Tolerance Test- measures bodies ability to remove glucose from the body within 2 hrs after consuming 75g on glucose 300ml of water <140mg/dl nml 140-199 mg/dl impaired (prediabetes) > 200 provisional diabetes HGA1C> 6.5 diabetes

Answer 14

Type II- insulin resistance, relative insulin deficiency Relative insulin deficiency 90% of Diabetes casesOlder and overweight, recently obese children Metabolic abnormalities- insulin resistance, increased glucose production by liver, impaired insulin secretion by pancreatic beta- cells Increased postprandial blood glucose levels Genetic, behavioral, environmental factor leads to diabetes Family history twofold-fourfold increased risk Obesity, inactivity Visceral obesity leads to increased postprandial glucose levels Metabolic syndrome (syndrome X, insulin resistance): hyperglycemia, hypertriglyceridemia, low HDL, high LDL, elevated CRP

Answer 15

Type 1 rapid onset Type 2 gradual usually detected through incidentsl blood tey 3 P’sPolyuria Polyphagia Polydipsia Weight-loss (type I) FBG<100 Casual or random blood glucose > 200mg/dl with 3P’s, and blurred vision OGTT after 2hr >200mg/dl HgA1c- >6.5

Answer 16

Exercise (especially type 2) Sulfonyurea’s (glipizide), meglitinides (repaglinide), biguinides (metformin), alpha-glucosidase inhibitors (acarbose), Incretin- based agents (exanatide), Insulin

Answer 17

hyperglycemia, metabolic acidosis, acute life-threatening complication of uncontrolled DM Usually affects Type 1, but can affect Type 2 (sepsis, severe trauma) Lethargy, vomiting, abdominal pain, coma, fruity breath Blood glucose levels > 250mg/dl Low bicarbonate mild (15-18mmol/L, ph 7.25-7.3); moderate (10-<15 mmol/l, ph 7.00-7.24), severe (<10mmol/L, ph <7.0) Leads to dehydration and electrolyte imbalance Goal of treatment- hydration, treat metabolic and electrolyte imbalances- insulins by infusion

Answer 18

Insulin reaction resulting from excess insulin, below normal blood glucose levels Occurs most often in patients taking insulin, sulfonylurea Over dose of insulin Failure to eat Exercise Decreased need for insulin (decreased stress, meds) Rapid onset-anxiety, tremors, tachycardia, cool clammy skin, incoherent, coma seizures- some people may have decreased reaction Treatment- juice, candy, glucagon

Answer 19

Somogyi Effect: hypoglycemia in pre-dawn hours 2-4am rapid decrease in blood glucose during nighttime hours stimulates release of hormones: cortisol, glucagon and epinephrine, to increase blood glucose by lipolysis, gluconeogenesis, and glycogenolysis Monitor glucose between 2-4 am, reduce insulin dose at bedtime

Answer 20

Dawn Phenomenon: Hyperglycemia on awakening Headache, sweats, nightmares increase bedtime dose of insulin Ketoacidosis: with inadequate amounts of insulin sugar can not be metabolized and fat catabolism occurs Extreme thirst, polyuria, fruity breath, kussmaul breathing, rapid thready pulse, dry mucous membranes, poor skin turgor, blood sugar level> 250mg/dl

Answer 21

paresthesia, numbness, tingling, impaired pain, decreased ankle and knee reflexes, ED

Answer 22

lesions that occur in the diabetic kidney, cause CKD- contributing factor- HTN, family history, smoking, HLD, poor glycemic control, increased urine albumin secretion >30mg/day

Answer 23

most frequent cause of new blindness, characterized by abnormal vascular permeability, mircro-aneurysm, hemorrhage, scarring, retinal detachment- poor glucose control, HTN. HLD- should have regular dilated eye exams

Answer 24

atherosclerosis, cerebral vascular disease, HTN, hyperglycemia, altered platelet formation, HLD- reduce risk factors

Answer 25

effect of neuropathy and PVD, should have full foot exam yearly

Answer 26

soft tissue, osteomyelitis, UTI, candida

Answer 27

activation of sympathetic nervous system, hypothalamic pituitary adrenal axis, immune system working to protect body from intense demands Alarm stage- activation of sympathetic nervous system Resistance stage- body selects most effective defense Exhaustion- physiologic resources are depleted, and signs of systemic damage appear

Answer 28

Individual has successfully created a balance between the stressor and the ability to deal with it Affected by experience and previous learning, how fast it needs to occur, gender, age, health status, nutrition, sleep-wake cycles and psychosocial factors

Answer 29

Stress response is designed to be self-limiting and protective Prolonged activation of stress response because of overwhelming or chronic stressor can be damaging to health Acute stress reaction and acute hyperglycemia are concerning in people with critical injuries or illness

Answer 30

Chronic activation of the stress response after experience that involved actual or threatened death or serious injury S&S: states of intrusion (flashbacks),avoidance (emotional numbing), hyperarousal (intense activation of neuroendocrine system)

endocrine Flashcards

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