Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MS > Endocrine > Flashcards

Endocrine Flashcards

1
Q

The endocrine system involves the release of chemical transmitter substances known as __ .

• These substances regulate and integrate body functions by acting on local or distant target sites.

• Hormones are generally produced by the endocrine glands but may also be produced by specialized tissues such as those found in the __, __, __

• Chemicals such as neurotransmitters (e.g., __) released by the nervous system can also function as hormones when needed.

A

hormones

gastrointestinal (GI) system, the kidney, and white blood cells.

epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Glands of the Endocrine System

• The endocrine system is composed of the (7)

• Most hormones secreted from endocrine glands are released directly into the __.

• However, __ glands, such as ,__ glands, secrete their products through ducts onto epithelial surfaces or into the GI tract.

A

pituitary gland, thyroid gland, parathyroid glands, adrenal glands, pancreatic islets, ovaries, and testes.

bloodstream

exocrine

sweat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Function and Regulation of Hormones

• Hormones help regulate organ function in concert with the __

• The __ action by the nervous system is balanced by hormonal action.

• The endocrine glands are composed of secretory cells arranged in minute clusters known as __.

• A ___ provides a vehicle for the hormones produced by the endocrine glands to enter the bloodstream rapidly.

• In the healthy physiologic state, hormone concentration in the bloodstream is maintained at a relatively __ level.

• To prevent accumulation, these hormones must be __ continuously by a __ so that when the hormone concentration increases, further production of that hormone is inhibited.

A

nervous system

rapid
slower

acini

rich blood supply

constant

inactivated
negative feedback system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hormones are classified into four categories according to their structure:

A
  1. amines and amino acids
  2. peptides, polypeptides, proteins, and glycoproteins
  3. steroids
  4. fatty acid derivatives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. amines and amino acids (e.g., __,__, __);
  2. peptides, polypeptides, proteins, and glycoproteins (e.g., __,__,__)
  3. steroids (e.g., __; which are hormones produced by the __ or their synthetic equivalents)
  4. fatty acid derivatives (e.g., __,__)
A

epinephrine, norepinephrine, and thyroid hormones

thyrotropin-releasing hormone [TRH],
follicle-stimulating hormone [FSH], and growth hormone [GH]);

corticosteroids,
adrenal cortex

eicosanoid, retinoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Some hormones act locally in the area where they are released; this is called ___
(e.g., the effect of __).

A

paracrine action
sex hormones on the ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Others may act on the actual cells from which they were released; this is called
(e.g., the effect of __).

A

autocrine action

insulin from pancreatic beta cells on those cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hormones can alter the function of the target tissue by interacting with __ located either on the cell membrane or in the interior of the cell (e.g. __ or __ for peptide and protein hormones).

___, because of their smaller size and higher lipid solubility, penetrate cell membranes and interact with intracellular receptors.

A

chemical receptors
cyclic AMP or the “second messenger”

  1. Steroid hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

• Releasing and inhibiting hormones
• Controls the release of pituitary hormones

A

HYPOTHALAMUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypothalamus hormones (4)

A

Corticotropin-releasing hormone (CRH)
Thyrotropin-releasing hormone (TRH)
Growth hormone–releasing hormone (GHRH)
Gonadotropin–releasing hormone (GnRH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anterior pituitary hormone

Give 5

A

Somatostatin

Adrenocorticotropic hormone (ACTH)

Follicle-stimulating hormone (FSH)

Luteinizing hormone (LH)

Prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

• Inhibits growth hormone and thyroid-stimulating hormone

A

Somatostatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

• Stimulates synthesis and secretion of adrenal cortical hormones

A

Adrenocorticotropic hormone (ACTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

• Female: stimulates growth of ovarian follicle, ovulation
• Male: stimulates sperm production

A

Follicle-stimulating hormone (FSH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

• Female: stimulates development of corpus luteum, release of oocyte, production of estrogen and progesterone
• Male: stimulates secretion of testosterone, development of
interstitial tissue of testes

A

Luteinizing hormone (LH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

• Prepares female breast for breast-feeding

A

Prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Posterior pituitary hormone

A

Adh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

• Increases water reabsorption by kidney

A

Antidiuretic hormone (ADH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ADRENAL CORTEX hormones 2

A

Mineralocorticosteroids, mainly aldosterone

Glucocorticoids, mainly cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

__
• Increase sodium absorption
• potassium loss by kidney

__
• Affect metabolism of all nutrients;
• regulates blood glucose levels,
• affects growth,
• has anti-inflammatory action, and
• decreases effects of stress.

A

Mineralocorticosteroids, mainly aldosterone

Glucocorticoids, mainly cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

THYROID (__)

Thyroid hormones: 2

A

FOLLICULAR CELLS

triiodothyronine (T3), and thyroxine (T4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

• Increase the metabolic rate;
• increase protein and bone turnover;
• increase responsiveness to catecholamines;
• necessary for fetal and infant growth and development

A

Thyroid hormones: triiodothyronine (T3), and thyroxine (T4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Lowers blood calcium and phosphate levels

A

Calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

THYROID C CELLS hormone

A

Calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

• Regulates serum calcium

A

Parathormone (PTH, parathyroid hormone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PANCREATIC ISLET CELLS

Give 3

A

Insulin

Glucagon

Somatostatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

• Lowers blood glucose by facilitating glucose transport across cell membranes of muscle, liver,
and adipose tissue

A

Insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

• Increases blood glucose concentration by stimulation of glycogenolysis and glyconeogenesis

A

Glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

• Delays intestinal absorption of glucose

A

Somatostatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

KIDNEY hormone

A

Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Activates renin–angiotensin–aldosterone system

A

Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

OVARIES hormones

TESTES hormones

A

Estrogen

Progesterone

Androgens, mainly testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

• Affects development of female sex organs and secondary sex characteristics

A

Estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

• Influences menstrual cycle; stimulates growth of uterine wall; maintains pregnancy

A

Progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

• Affect development of male sex organs and secondary sex characteristics; aid in sperm
production

A

Androgens, mainly testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Assessment
1. Health History

  • Patients should be asked if they have experienced changes in

Give 5

A

in energy level, tolerance to heat or
cold, weight, thirst, frequency of urination, fat and fluid distribution, secondary sexual
characteristics such as loss or growth of hair, menstrual cycle, memory, concentration, sleep
patterns, and mood, as well as vision changes, joint pain, and sexual dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q
  • It is important to document

Give 3

A

(1) the severity of these changes, (2) the length of time the patient
has experienced these changes, (3) the way in which these changes have affected the patient’s
ability to carry out activities of daily living, (4) the effect of the changes on the patient’s selfperception, and (5) family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q
  1. Physical Assessment

Give 2

A
  • should include vital signs; head-to-toe inspection; and palpation of skin, hair, and thyroid.
    Findings should be compared with previous findings, if available.
  • Physical, psychological, and behavioral changes should be noted.
  • The patient may also exhibit changes in mood and behavior such as nervousness, lethargy, and
    fatigue.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Diagnostic Evaluation

Give 2

A
  1. Blood Tests
  2. Urine Tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q
  • determine the levels of circulating hormones, the presence of autoantibodies, and the effect of a specific hormone on other substances.
  • The __ of a specific hormone may provide information to determine the presence of hypofunction or hyperfunction.
A
  1. Blood Tests
    serum levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q
  • used to measure the amount of hormones or the end products of hormones excreted by the kidneys.
  • __ or, in some disorders, ___ are collected to measure hormones or their metabolites.
A
  1. Urine Tests

One-time specimens
24-hour urine specimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Additional Diagnostic Studies

Give 4

A
  1. Stimulation tests
  2. Suppression tests
  3. Imaging studies
  4. Genetic screening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q
  • used to confirm hypofunction of an endocrine organ.
  • The tests determine how an endocrine gland responds to the administration of stimulating hormones that are normally produced or released by the hypothalamus or pituitary gland.
A
  1. Stimulation tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q
  • used to detect hyperfunction of an endocrine organ.
  • They determine if the organ is not responding to the negative feedback mechanisms.
A
  1. Suppression tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q
  • include radioactive scanning, MRI, CT, ultrasonography, PET and dual-energy x-ray absorptiometry (DEXA).
A
  1. Imaging studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q
  • DNA testing can be used for the identification of specific genes associated with endocrine
    disorders
A
  1. Genetic screening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

, is commonly referred to as the master gland because of the
influence it has on secretion of hormones by other endocrine glands.

A

The pituitary gland, or hypophysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

It is located on the __ of the brain and is divided into anterior and posterior lobes

It is controlled by the __, which is an adjacent area of the brain that is connected to the pituitary by the pituitary stalk.

A

inferior aspect

hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Anterior Pituitary

• The major hormones of the anterior pituitary gland are: 6

• The secretion of these major hormones is controlled by releasing factors secreted by the __.

• These releasing factors reach the anterior pituitary by way of the bloodstream in a special circulation called the __

• Other hormones include __ & __

• The hormones released by the anterior pituitary enter the general circulation and are transported to their target organs.

• The main function of __, __ ,__ ,__ is the release of hormones from other endocrine glands.

• __ acts on the breast to stimulate milk production.

• __ , the most abundant anterior pituitary hormone, regulates growth in children and energy and metabolism in adults.

• __ increases protein synthesis in many tissues, increases the breakdown of fatty acids in adipose tissue, and increases blood glucose levels.

• Secretion of GH is increased by (3)

A

FSH, luteinizing hormone (LH), prolactin (PRL), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), and GH (also referred to as somatotropin).

hypothalamus

pituitary portal blood system.

melanocyte-stimulating hormone and beta-lipotropin.

TSH, ACTH, FSH, and LH

PRL

GH

GH

deep sleep, stress, exercise, fasting, malnutrition, hypoglycemia, trauma, hypovolemic shock, and sepsis, and is decreased in the presence of obesity, depression, and hypothyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Posterior Pituitary
• The important hormones secreted by the posterior lobe of the pituitary gland are ___, also referred to as __, and ___.

A

Vasopressin
antidiuretic hormone (ADH)
Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

__ controls the excretion of water by the kidney; its secretion is stimulated by an increase in the osmolality of the blood or by a decrease in blood pressure.

A

Vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

__ secretion is stimulated during pregnancy and at childbirth. It facilitates milk ejection during lactation and increases the force of uterine contractions during labor and delivery.

A

Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Pathophysiology – pituitary gland

• Abnormalities of pituitary function are caused by __ or __ of any of the hormones produced or released by the gland.

• Abnormalities of the anterior and posterior portions of the gland may occur independently.

• Hypofunction of the pituitary gland (__) can result from disease of the pituitary gland itself or disease of the hypothalamus.

• it can result from __ to the head and neck area.

• The total destruction of the pituitary gland by trauma, tumor, or vascular lesion removes all stimuli that are normally received by the __,__,__

• The result is (3)

• Coma and death occur if the __

A

over-secretion or under-secretion

(hypopituitarism)

radiation therapy

thyroid, the gonads, and the adrenal glands.

extreme weight loss, emaciation, atrophy of all endocrine glands and organs, hair loss, impotence, amenorrhea, hypometabolism, and hypoglycemia.

missing hormones are not replaced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Pathophysiology - Anterior Pituitary

• Oversecretion (hypersecretion) of the anterior pituitary gland

• __ - group of symptoms produced by an oversecretion of ACTH.

• __ - a disorder caused by an excess of GH in __, results in enlargement of peripheral body parts and soft tissue, __ the fusion of the epiphyseal plates has occurred, without an increase in _.

• Oversecretion of GH in __, __ the fusion of epiphyseal growth plates result in ___ (7 or even 8 ft tall).

• Insufficient secretion of GH during childhood can result in generalized limited growth and ___.

• __ may result from destruction of the anterior lobe of the pituitary gland.

A

Cushing syndrome

Acromegaly
adults
after
height

children
Before
pituitary gigantism

pituitary dwarfism

Hypopituitarism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Pathophysiology - Posterior Pituitary

• The most common disorder related to posterior lobe dysfunction is __
(abnormally large volumes of dilute urine are excreted as a result of deficient production of __).

A

diabetes insipidus (DI)
vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

• Almost all pituitary tumors are __.

• The tumors may be __ or __ and __ or __

A

benign

primary or secondary

functional or nonfunctional.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

• Three principal types of pituitary tumors represent an overgrowth of

A

(1) Eosinophilic cells,
(2) Basophilic cells, or
(3) Chromophobic cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

• Functional tumors secrete __, whereas nonfunctional tumors secrete _

A

pituitary hormones

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

__ tumors that develop early in life result in __

• If the disorder begins during adult life __

• Many suffer from __ & __ because the tumors exert pressure on the optic nerves.

• Decalcification of the skeleton, muscular weakness, and endocrine disturbances, similar to those occurring in patients with ___.

A

Eosinophilic

gigantism

acromegaly

severe headaches and visual disturbances

hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Basophilic tumors give rise to __

A

Cushing syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

___ tumors represent 90% of pituitary tumors.

A

Chromophobic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

more than 7 ft tall and large in all proportions, yet so weak and lethargic

excessive skeletal growth in feet, hands, molar eminences, the nose, and the chin.

A

gigantism

acromegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

hyperadrenalism, masculinization and amenorrhea in females, truncal obesity, hypertension, osteoporosis, and polycythemia.

A

Cushing syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

___ tumors give rise to cushing syndrome

A

Basophilic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

• __ tumors usually produce no hormones but destroy the rest of the pituitary gland, causing __.

• Patients are often: give 4

A

Chromophobic

hypopituitarism

obese and somnolent and exhibit fine, scanty hair; dry, soft skin; a pasty complexion; and small bones.

• They also experience headaches, loss of libido, and visual defects progressing to blindness.

• Other signs and symptoms include polyuria, polyphagia, a lowering of the basal metabolic rate and a subnormal body temperature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Assessment and Diagnostic Findings

Diagnostic evaluation requires a careful history and physical examination, including assessment of visual acuity and visual fields.

• __ & __ are used to diagnose the presence and extent of pituitary tumors.

• Serum levels of pituitary hormones may be obtained along with measurements of hormones of target organs (e.g., __, __) to assist in diagnosis.

A

CT and MRI scans

thyroid, adrenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Medical Management

__ - surgical removal of the pituitary gland.

__ - external-beam radiation therapy precisely to the pituitary tumor with minimal effect on normal tissue.

• Replacement therapy with __ & __ is necessary.

A

Hypophysectomy

Stereotactic radiation therapy

corticosteroids and thyroid hormone

68
Q

• Other treatments include conventional radiation therapy, bromocriptine (__, a dopamine antagonist), and octreotide (__ , a synthetic analog of GH).

• Octreotide and lanreotide (__, a somatostatin analog) may also be used preoperatively to improve the patient’s clinical condition and to shrink the tumor.

A

Parlodel

Sandostatin

Somatuline Depot

69
Q

• a deficiency of ADH (vasopressin).

• It may occur secondary to head trauma, brain tumor, or surgical ablation or irradiation of the pituitary gland.

• It may also occur with infections of the central nervous system (give 2) or with ___.

• Another cause of DI is failure of the __ to respond to ADH.

A

Diabetes Insipidus

meningitis, encephalitis, tuberculosis
Tumors

renal tubules

70
Q

Clinical Manifestations of di

A

• An enormous daily output (greater than 250 mL per hour) of very dilute urine with a specific gravity of 1.001 to 1.005.
• The urine contains no abnormal substances such as glucose or albumin.
• Excessive thirst - 2 to 20 L of fluid daily and craves cold water.

71
Q

Assessment and Diagnostic Findings

  1. __ - carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost.

• The patient is ___ frequently during the test.

• ___ are performed at the beginning and end of the test.

• The inability to increase the specific __& __ of the urine is characteristic of DI

• The patient continues to excrete large volumes of urine with __ specific gravity and experiences weight loss.

• The test is terminated if __, __,__ develops

  1. Other diagnostic procedures include: 4
A

Fluid deprivation test

weighed

Plasma and urine osmolality studies

gravity and osmolality

low

tachycardia, excessive weight loss, or hypotension develops.

a. plasma levels of ADH
b. plasma and urine osmolality
c. trial of desmopressin (synthetic vasopressin) therapy
d. intravenous (IV) infusion of hypertonic saline solution.

72
Q

Medical Management

  1. Pharmacologic Therapy

a. __ - a synthetic vasopressin without the vascular effects of natural ADH.

  • given ___; the patient sprays the solution into the nose through a flexible calibrated plastic tube.
  • ___ administrations daily.
  • Vasopressin causes ___; thus, it must be used cautiously in patients with ___.

b. (Diabinese) and __ - used in __ forms of the disease because they potentiate the action of __.

  • is possible.

c. Thiazide diuretics, mild salt depletion, and prostaglandin inhibitors - used to treat the ___ of DI.

A

Desmopressin (DDAVP)

intranasally

One or two

vasoconstriction
coronary artery disease

Chlorpropamide and thiazide diuretics
mild
vasopressin

Hyperglycemia

nephrogenic form

73
Q

• excessive ADH secretion from the pituitary gland.

• Patients cannot excrete a dilute urine, retain fluids, and develop a sodium deficiency known as __

• SIADH is often of nonendocrine origin (__).

• Can be caused by disorders of the __, such as head injury, brain surgery or tumor, and infection.

A

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

dilutional hyponatremia

bronchogenic carcinoma

central nervous system

74
Q

Medical Management

• Interventions include eliminating the underlying cause, if possible, and ___

• Diuretic agents such as ___ may be used along with fluid restriction if severe ___ is present.

A

restricting fluid intake.

furosemide

hyponatremia

75
Q

The __ —the largest endocrine gland—is a butterfly-shaped organ located in the lower neck, anterior to the trachea.

• It consists of __ lateral lobes connected by an __.

• The gland is about 5 cm long and 3 cm wide and weighs about 30 g.

• The blood flow to the thyroid is very __, approximately five times the blood flow to the __.

• The thyroid gland produces three hormones:

A

thyroid gland

two
isthmus

high
liver

thyroxine (T4), triiodothyronine (T3), and calcitonin.

76
Q

• Thyroid hormone is comprised of __ & __. Both are amino acids that contain __ bound to the amino acid structure.

• These hormones are synthesized and stored bound to __ in the cells of the __.

A

T4 and T3

iodine molecules

proteins

thyroid gland

77
Q

Synthesis of Thyroid Hormone

• __ is essential to the thyroid gland for synthesis of its hormones.

• The major use of iodine in the body is by the __, and the major derangement in iodine deficiency is __.

• __ is ingested in the diet and absorbed into the blood in the GI tract.

• __ are converted to __, which react with __ (an amino acid) to form the ___

A

Iodine

thyroid

alteration of thyroid function

Iodide

Iodide ions
iodine molecules

tyrosine
thyroid hormones.

78
Q

Regulation of Thyroid Hormone

• The secretion of T3 and T4 is controlled by __ (also called ___) from the ___ pituitary gland.

• TSH controls the rate of thyroid hormone release through a

• The term __ refers to thyroid hormone production that is normal.

• __, secreted by the __, exerts a modulating influence on the release of TSH from
the pituitary

A

TSH
thyrotropin
anterior

negative feedback mechanism

euthyroid

TRH
hypothalamus

79
Q

Function of Thyroid Hormone

• The main function of thyroid hormone is to control __

• __, a relatively weak hormone, maintains body metabolism in a steady state.

• __ is about five times as potent and has a more rapid metabolic action.

These hormones accelerate __ by increasing the level of specific enzymes that contribute to __ consumption and altering the __ of tissues to other hormone

• The thyroid hormones influence __ and are important in __ development.

• Thyroid hormone is also necessary for __

A

cellular metabolic activity

T4

T3

metabolic processes
oxygen
responsiveness

cell replication
brain

normal growth.

80
Q

is secreted in response to high plasma levels of calcium, and it
reduces the plasma level of calcium by increasing its deposition in bone.

A

Calcitonin, or thyrocalcitonin,

81
Q

Inadequate secretion of thyroid hormone during fetal and neonatal development results in intellectual disability and stunted physical growth (___) because of general depression of metabolic activity.

• In adults, hypothyroidism manifests as (3)

• Oversecretion of thyroid hormones (__) is manifested by a greatly increased metabolic rate (usually associated with an enlarged thyroid gland known as a __).

A

congenital hypothyroidism

lethargy, slow mentation, weight gain, constipation, cold intolerance, and generalized slowing of body functions.

Hyperthyroidism

goiter

82
Q

Thyroid

Diagnostic Evaluation:

give 8

A
  1. Serum Thyroid-Stimulating Hormone -
  2. Serum Free T4 -
  3. Serum T3 and T4 -
  4. T3 Resin Uptake Test -
  5. Thyroid Antibodies -
  6. Radioactive Iodine Uptake -
  7. Fine-Needle Aspiration Biopsy -
  8. Thyroid Scan, Radioscan, or Scintiscan -
  9. Serum Thyroglobulin -
83
Q
  • Measurement of the serum TSH concentration is the
    primary screening test of thyroid function.
A
  1. Serum Thyroid-Stimulating Hormone
84
Q
  • a direct measurement of free (unbound) thyroxine, the only metabolically active fraction of T4. The range of free T4 in serum is normally 0.9 to 1.7 ng/dL (11.5 to 21.8 pmol/L).
A
  1. Serum Free T4
85
Q
  • includes protein-bound and free hormone levels that occur in response to TSH secretion. Normal range for T4 is 5.4 to 11.5 μg/dL (57 to 148 nmol/L). The normal range for serum T3 is 80 to 200 ng/dL (1.2 to 3.1 nmol/L)
A
  1. Serum T3 and T4
86
Q
  • an indirect measure of unsaturated TBG. Its purpose is to determine the amount of thyroid hormone bound to TBG and the number of available binding sites. The normal T3 uptake value is 25% to 35%.
A
  1. T3 Resin Uptake Test
87
Q
  • immunoassay techniques for antithyroid antibodies. Positive in chronic autoimmune thyroid disease (90%), Hashimoto thyroiditis (100%), Graves disease (80%).
A
  1. Thyroid Antibodies
88
Q
  • measures the rate of iodine uptake by the thyroid gland. The patient
    is given a tracer dose of iodine 123 (123I) or another radionuclide. Patients with hyperthyroidism exhibit a high uptake of the 123I and vice versa.
A
  1. Radioactive Iodine Uptake
89
Q
  • The use of a small-gauge needle to sample the thyroid tissue for
    biopsy is a safe and accurate method of detecting malignancy.
A
  1. Fine-Needle Aspiration Biopsy
90
Q
  • helpful in determining the location, size, shape, and anatomic function of the thyroid gland, particularly when thyroid tissue is substernal or large.
A
  1. Thyroid Scan, Radioscan, or Scintiscan
91
Q

Thyroglobulin (Tg) can be measured reliably in the serum by
radioimmunoassay. Clinically, it is used to detect persistence or recurrence of thyroid carcinoma

A

Serum Thyroglobulin

92
Q

Nursing Implications

• When __ are scheduled, it is necessary to determine if the patient is allergic to iodine (__) and whether the patient has taken medications or agents that contain iodine.

• Obvious sources of iodine-containing medications include __ and those used to treat thyroid disorders such as __.

• Less obvious sources of iodine are __; __ preparations; food supplements that may contain _ and _ (frequently found in health food stores); and __ (Cordarone), an antiarrhythmic agent.

• Other medications that may affect test results are , , amphetamines, chemotherapeutic agents, _, _, and diuretics.

A

thyroid tests
(shellfish)

contrast agents
radioactive iodine

topical antiseptics
multivitamin
Kelp and seaweed
amiodarone

estrogens
salicylates
antibiotics
corticosteroids

93
Q

•__ results from suboptimal levels of thyroid hormone.

• The most common cause in adults is autoimmune thyroiditis (__), in which the immune system attacks the thyroid gland

• Hypothyroidism also occurs in patients with previous hyperthyroidism that has been treated with __ or __ medications or __.

A

Hypothyroidism

Hashimoto disease

radioiodine,
antithyroid
thyroidectomy

94
Q

• Causes of Hypothyroidism:

Give 5

A
  1. Autoimmune disease (Hashimoto thyroiditis, post-Graves disease)
  2. Atrophy of thyroid gland with aging
  3. Therapy for hyperthyroidism
    a. Radioactive iodine (131I)
    b. Thyroidectomy
  4. Medications
    a. Lithium
    b. Iodine compounds
    c. Antithyroid medications
  5. Radiation to head and neck in treatment for head and neck cancers, lymphoma
  6. Infiltrative diseases of the thyroid (amyloidosis, scleroderma, lymphoma)
  7. Iodine deficiency and iodine excess
95
Q

Clinical Manifestations of hypothyroidism

give 5

A

Extreme fatigue
• Hair loss, brittle nails, and dry skin
• Numbness and tingling of the fingers
• The voice may become husky, presence of hoarseness.
• Menstrual disturbances such as menorrhagia or amenorrhea, loss of libido.
• Severe hypothyroidism results in a subnormal body temperature and pulse rate.
• Weight even without an increase in food intake.
• Face becomes expressionless and masklike.
• Cold intolerance
• Mental processes become dulled, and the patient appears apathetic.
• Speech is slow, the tongue enlarges, the hands and feet increase in size, and deafness may
occur.
• The patient frequently reports constipation.
• Advanced hypothyroidism may produce personality and cognitive changes characteristic of
dementia.
• Inadequate ventilation and sleep apnea can occur with severe hypothyroidism.
• Severe hypothyroidism is associated with an elevated serum cholesterol level, atherosclerosis, coronary artery disease, and poor left ventricular function.
• Myxedema - swelling of the face and swelling and thickening of skin anywhere on your body.
• Myxedema coma – a decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious.

96
Q

• ___ - swelling of the face and swelling and thickening of skin anywhere on your body.

A

Myxedema

97
Q

– a decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious.

A

• Myxedema coma

98
Q

Medical Management hypothyroidism

  1. Pharmacologic Therapy (4)
  2. Supportive Therapy (3)
A

a. Synthetic levothyroxine (Synthroid or Levothroid)
b. High-dose glucocorticoids (hydrocortisone)
c. Prevention of Cardiac Dysfunction
d. Prevention of Medication Interactions

  • Assisted ventilation to combat hypoventilation.
  • Oxygen saturation levels should be monitored using pulse oximetry.
  • Fluids are given cautiously because of the danger of water intoxication.
99
Q
  • commonly prescribed for treating hypothyroidism and suppressing nontoxic goiters.
  • every 8 to 12 hours for 24 hours followed by lowdose therapy is recommended until coexisting adrenal insufficiency is ruled out.
A

Synthetic levothyroxine (Synthroid or Levothroid)

High-dose glucocorticoids (hydrocortisone)

100
Q

Serum levels of __,__,__ should be obtained before and after administration of ACTH and before administration of glucocorticoid and thyroid hormone therapies.

c. Prevention of Cardiac Dysfunction – if angina or dysrhythmias occur, __ administration must be discontinued immediately.

A

T4, TSH, and cortisol

thyroid hormone

101
Q

There is a decrease in thyroid hormone absorption when patients are taking __ containing antacids.

  • Thyroid hormones may also decrease the pharmacologic effects of __
  • Doses of __ agents need to be decreased when beginning thyroid replacement because of the increased risk of bleeding.
  • __ & __ agents may induce profound somnolence, lasting far longer than anticipated and leading to __ (stupor like condition).
A

magnesium

digitalis glycosides.

anticoagulant

Hypnotic and sedative

narcosis

102
Q

• A form of thyrotoxicosis resulting from an excessive synthesis and secretion of endogenous or exogenous thyroid hormones by the thyroid.

• The most common causes are __, toxic multinodular __, and toxic __.

• Other causes include thyroiditis and excessive ingestion of thyroid hormone.

A

Hyperthyroidism

Graves disease
goiter
adenoma

103
Q

Hyperthyroidism

Clinical Manifestations

give 5

A

• The presenting symptom is often nervousness.
• These patients are often emotionally hyperexcitable, irritable, and apprehensive; they cannot sit
quietly; they suffer from palpitations; and their pulse is abnormally rapid at rest as well as on
exertion.
• They tolerate heat poorly and perspire unusually freely.
• The skin is flushed continuously, with a characteristic salmon color in Caucasians, and is likely to
be warm, soft, and moist.
• A fine tremor of the hands may be observed.
• Patients may exhibit as exophthalmos (abnormal protrusion of one or both eyeballs), which
produces a startled facial expression.
• Other manifestations include an increased appetite and dietary intake, weight loss, fatigability
and weakness, amenorrhea, and changes in bowel function.
• Cardiac effects may include sinus tachycardia or dysrhythmias, increased pulse pressure, and
palpitations.
• Myocardial hypertrophy and heart failure may occur if the hyperthyroidism is severe and
untreated.
• It is also likely to result in premature osteoporosis, particularly in women

104
Q

Assessment and Diagnostic Findings

• The thyroid gland is __

• It is soft and may __; a __ often can be palpated, and a __ is heard over the thyroid arteries.

• In advanced cases, the diagnosis is made on the basis of the symptoms, a decrease in __, increased __, and an increase in __.

A

enlarged

pulsate
thrill
bruit

serum TSH
free T4
radioactive iodine uptake

105
Q

Medical Management

Treatment of hyperthyroidism is directed toward reducing thyroid __ to relieve symptoms and preventing complications.

  1. Pharmacologic Therapy (2)

c. Surgical Management (1)

A

hyperactivity

Radioactive Iodine Therapy
Antithyroid medications

Thyroidectomy

106
Q
  • used to treat toxic adenomas, toxic multinodular goiter, and most varieties of thyrotoxicosis.
  • __ - given 4 to 6 weeks prior to administration of radioactive iodine.
  • contraindicated during pregnancy because it crosses the __.
  • thyroid cells exposed to the __ are destroyed, resulting in reduction of the hyperthyroid state and inevitably hypothyroidism.
  • ___ is started 4 to 18 weeks after the antithyroid medications have been stopped based on the results of thyroid function tests.
  • Once a normal thyroid state has been established, TSH should be measured every __
  • Patients should be informed that they can contaminate their household and other persons through saliva, urine, or radiation emitting from their body.
  • The patient is observed for signs of __
A

Radioactive Iodine Therapy
Methimazole

placenta
radioactive iodine

Thyroid hormone replacement

6 to 12 months for life.

thyroid storm.

107
Q

__ - inhibit one or more stages in thyroid hormone synthesis or hormone release.

  • take the medication in the __ on an empty stomach __ minutes before eating to avoid decrease in absorption.
  • it may take several ___ until symptom relief occurs.

Toxic complications of antithyroid medications are relatively __.

  • With any sign of infection, especially __ and __ or the occurrence of __, the patient is advised to __ the medication.
  • __ is recommended during the first trimester of pregnancy rather than __ due to the teratogenic effects
  • it should be discontinued __ trimester and the patient should be switched to MMI for the __ of the pregnancy and when __.
  • Discontinuation of antithyroid medications before therapy is complete usually results in relapse within ___.
A

Antithyroid Medications

morning
30 mins

weeks

uncommon

pharyngitis
fever
mouth ulcers
stop

PTU
MMI

after the first trimester

remainder
breast feeding

6 months

108
Q

Surgical Management of hyperthyroidism –

  • reserved for special circumstances (__ who are __ to antithyroid medications, in patients with _, or in patients who are unable to take antithyroid agents.
  • ___, an antithyroid medication is given until signs of hyperthyroidism have disappeared.
  • Medications that may prolong clotting (e.g., __) are stopped several __ before surgery.
  • Patients receiving iodine medication must be monitored for evidence of iodine toxicity (_), which requires immediate withdrawal of the medication.
  • Symptoms of iodinism include: (2)
A

Thyroidectomy (total, subtotal

pregnant women
allergic
Large goiter

Before surgery

aspirin
weeks

(iodinism)

swelling of the buccal mucosa, excessive salivation, cold symptoms, and skin eruptions.

109
Q

NURSING DIAGNOSES (2)

A

• Imbalanced nutrition: less than body requirements related to exaggerated metabolic rate, excessive appetite, and increased GI activity.

• Ineffective coping related to irritability, hyperexcitability, apprehension, and emotional instability

• Situational low self-esteem related to changes in appearance, excessive appetite, and weight loss

• Risk for imbalanced body temperature

110
Q

Nursing Interventions hyperthyroidism

• IMPROVING NUTRITIONAL STATUS

  • To reduce diarrhea, highly seasoned foods and stimulants such as __ are discouraged.
  • foods high in __ & __ are encouraged.

__ and dietary intake are recorded to monitor nutritional status.

• ENHANCING COPING MEASURES

  • Stressful experiences should be minimized and a quiet, uncluttered environment should be maintained.
  • It is important to balance periods of activity with __.

• IMPROVING SELF-ESTEEM

• MAINTAINING NORMAL BODY TEMPERATURE

  • the environment should be maintained at a cool, comfortable temperature, and the bedding and clothing should be changed as needed.
  • Cool baths and cool or cold fluids may also provide relief.

• MONITORING AND MANAGING POTENTIAL COMPLICATIONS (3)

A

coffee, tea, cola, and alcohol

High calorie, high protein

Weight

rest

  • Thyrotoxicosis or thyroid storm
  • Hypothyroidism
111
Q

Nursing Interventions for hyperthyroidism

A

• IMPROVING NUTRITIONAL STATUS

• ENHANCING COPING MEASURES

• IMPROVING SELF-ESTEEM
• MAINTAINING NORMAL BODY TEMPERATURE

• MONITORING AND MANAGING POTENTIAL COMPLICATIONS

112
Q

2 types of Thyroid Tumors

A

• Endemic (Iodine-Deficient) Goiter
• Nodular Goiter

113
Q

• __ is a compensatory hypertrophy of the thyroid gland, caused by stimulation by the pituitary gland.

• occurs when iodine intake is __

• __ has also been found to also have antithyroid actions.

• usually causes no symptoms, except for the swelling in the __, which may result in tracheal compression when excessive swelling is present.

• recedes after the __ is corrected.

• Supplementary iodine, such as ___, is prescribed to suppress the pituitary’s thyroid-stimulating activity.

• The introduction of __ has been the single most effective means of preventing goiter in at-risk populations.

A

Endemic (Iodine-Deficient) Goiter

deficient

Lithium

neck

iodine imbalance

SSKI

iodized salt

114
Q

__ Some thyroid glands are __ because of areas of hyperplasia (overgrowth).

No symptoms may arise as a result of this condition, but can cause __ pressure symptoms.

Some nodules become __, and some are associated with a __ state.

Therefore, the patient with many thyroid nodules may eventually require __.

A

Nodular Goiter
nodular

local

malignant
hyperthyroid

surgery

115
Q

THE PARATHYROID GLANDS

Anatomic and Physiologic Overview

• The parathyroid glands (normally __) are situated in the __ and embedded in the posterior aspect of the thyroid gland.

• Parathormone (parathyroid hormone) - regulates __ metabolism.

• Increased secretion of parathormone results in increased calcium absorption from the __,__,__

• Some actions of parathormone are increased by the presence of __.

• The serum level of ionized calcium regulates the output of parathormone.

• Increased serum calcium results in decreased __, creating a __

A

four
neck

calcium and phosphorus

kidney, intestine, and bones.

vitamin D

parathormone secretion
negative feedback system.

116
Q

• caused by overproduction of parathormone by the parathyroid glands.

• characterized by bone __ and the development of __ (kidney stones) containing __.

• Primary hyperparathyroidism occurs two to four times more often in __ than in __ and is most common in people between __ & __ years of age.

• __ occurs in patients who have chronic kidney failure and so-called __ as a result of phosphorus retention, increased stimulation of the parathyroid glands, and increased parathormone secretion.

A

Hyperparathyroidism (Increase Parathormone)

decalcification
renal calculi
calcium

women than in men
60 and 70

Secondary hyperparathyroidism
renal rickets

117
Q

CLINICAL MANIFESTATIONS hyperparathyroidism

Give 4

A

• The patient may have no symptoms or may experience signs and symptoms resulting from involvement of several body systems

• Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias may occur.

• Psychological effects may vary from irritability and neurosis to psychoses.

• Formation of stones in one or both kidneys (nephrolithiasis).

• The patient may develop skeletal pain and tenderness, especially of the back and joints; pain on weight bearing; pathologic fractures; deformities; and shortening of body stature.

• The incidence of peptic ulcer and pancreatitis is increased with hyperparathyroidism.

118
Q

• Formation of stones in one or both kidneys .

A

(nephrolithiasis)

119
Q

ASSESSMENT AND DIAGNOSTIC FINDINGS hyperparathyroidism

• diagnosed by persistent elevation of levels and an elevated concentration of __.

• __ for parathormone are sensitive and differentiate primary
hyperparathyroidism from other causes.

• Bone changes may be detected on __ in advanced disease.

• The __ is used to distinguish between primary hyperparathyroidism and malignancy as a cause of hypercalcemia.

• __,__,__,__ have been used to evaluate the function of the parathyroids and to localize parathyroid cysts, adenomas, or hyperplasia.

A

serum calcium
parathormone

Radioimmunoassays

x-ray or bone scans

double-antibody parathyroid hormone test

Ultrasound, MRI, thallium scan, and fine-needle biopsy

120
Q

Medical Management hyperparathyroidism

A
  1. Surgical Management

b. Hydration Therapy

c. Mobility

d. Diet and Medications

121
Q

Medical Management hyperparathyroidism

  1. Surgical Management – __
  • surgical removal of abnormal parathyroid tissue
  • recommended for asymptomatic patients who meet one or more of the following criteria:

a) younger than __ years
b) any patient unable or unlikely to participate in follow up care
c) serum calcium level more than _ mg/dL (0.25 mmol/L) above normal reference range
d) GFR __ < mL/min
e) urinary calcium level greater than 400 mg/day (10 mmol/day
f) bone density at hip, lumbar spine, or distal radius with T score < -2.5 or previous fracture
fragility at any site
g) nephrolethiasis or nephrocalcinosis

b. Hydration Therapy
- daily fluid intake of ___ ml or more is encouraged to help prevent calculus formation.

The patient is instructed to report other manifestations of renal calculi, such as abdominal pain and hematuria.

  • __ are avoided.
  • Because of the risk of hypercalcemic crisis, the patient is instructed to avoid __ and to seek immediate health care if conditions that commonly produce dehydration (e.g., vomiting, diarrhea) occur.

c. Mobility
- The patient with limited mobility is encouraged to __.
- __ increases calcium excretion and the risk of renal calculi.

d. Diet and Medications
- patient is advised to avoid a diet with restricted or excess __.
- If the patient has a coexisting peptic ulcer, prescribed __ and protein feedings are necessary.
- Because __ is common, efforts are made to improve the appetite.
- __, stool softeners, and physical activity, along with increased fluid intake, help offset constipation, which is common postoperatively.

A

parathyroidectomy

50
1
60

2,000 mL

Thiazide diuretics
dehydration

walk
Bed rest

calcium
antacids
anorexia
Prune juice

122
Q

What is the complication of hyperparathyroidism

A

Hypercalcemic crisis

123
Q

Complications: hyperparathyroidism

• __ can occur with extreme elevation of serum calcium levels.

• Serum calcium levels greater than __mg/dL (3.25 mmol/L) result in neurologic, cardiovascular, and kidney symptoms that can be life threatening.

• Rapid rehydration with large volumes of IV isotonic saline fluids to maintain urine output of _ to _ per hour is combined with administration of calcitonin.

• __ promotes renal excretion of excess calcium and reduces bone resorption.

• The saline infusion should be stopped and a loop diuretic may be needed if the patient develops
__.

• __ are added to promote a sustained decrease in serum calcium levels by promoting calcium deposition in bone and reducing the GI absorption of calcium.

• ,,_ may be used in emergency situations to decrease serum calcium levels quickly.

• A combination of & is given in emergencies to reduce the serum calcium level by increasing calcium deposition in bone.

A

Hypercalcemic Crisis

13 mg/dl

100
to 150 mL

Calcitonin

edema

Bisphosphonates

Cytotoxic agents, calcitonin, and dialysis

calcitonin and corticosteroids

124
Q

• __ inadequate secretion of parathormone

• caused by abnormal parathyroid development, destruction of the parathyroid glands (__ or __), and vitamin D deficiency.

• The most common cause is the near-total removal of the __.

• Deficiency of parathormone results in increased blood __ and decreased ___ levels.

• there is __ of dietary calcium and ___ of calcium from bone and through the renal tubules.

• Decreased renal excretion of phosphate causes __, and low serum calcium levels result in __.

A

Hypoparathyroidism

surgical removal or autoimmune response

thyroid gland

phosphate (hyperphosphatemia)
blood calcium (hypocalcemia)

decreased intestinal absorption
decreased resorption

hypophosphaturia
hypocalciuria

125
Q

Clinical Manifestations

• Hypocalcemia causes irritability of the neuromuscular system and contributes to the chief symptom of hypoparathyroidism— __.

• it is general muscle __, with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements.

• Symptoms of latent tetany are numbness, tingling, and cramps in the extremities, and the patient complains of stiffness in the hands and feet.

• In __, the signs include bronchospasm, laryngeal spasm, carpopedal spasm (flexion of the elbows and wrists and extension of the carpophalangeal joints and dorsiflexion of the feet), dysphagia, photophobia, cardiac dysrhythmias, and seizures.

• Other symptoms include anxiety, irritability, depression, and even delirium.

__ changes and __ also may occur.

A

tetany

hypertonia

overt tetany

ECG
hypotension

126
Q

Assessment and Diagnostic Finding in hypothyroidism (5)

A

• Chvostek sign
• Trousseau sign

• Tetany
• Serum phosphate levels are increased
x-rays of bone show increased density.
• Calcification is detected on x-rays
paraspinal basal ganglia of the brain

127
Q
  • positive when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye.
A

Chvostek sign

128
Q
  • positive when carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff
A

• Trousseau sign

129
Q

develops at very low serum calcium levels.

A

Tetany

130
Q

• The diagnosis of hypoparathyroidism often is difficult because of the vague symptoms, such as

• Serum __ levels are increased, and x-rays of bone show increased __.

• __ is detected on x-rays of the subcutaneous or paraspinal basal ganglia of the brain

A

aches and pains.

Serum phosphate levels
density

Calcification

131
Q

Medical Management hypoparathyroidism

• The goal of therapy is to increase the serum calcium level to __ to __ mg/dL (2.2 to 2.5 mmol/L) and to eliminate the symptoms of hypoparathyroidism and hypocalcemia.

• Treatment may include combinations of __,__,__,_, (ergocalciferol) or vitamin D3 (calcitriol).

• A __ may be given to help decrease urinary calcium excretion.

• ___ has been approved for the treatment of osteoporosis but not for hypoparathyroidism at this time.

• When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of ___. Sedative agents such as pentobarbital may be given.

• Because of neuromuscular irritability, the patient with hypocalcemia and tetany requires an environment that is free of noise, drafts, bright lights, or sudden movement.

• ___ may become necessary, along with bronchodilating medications, if the patient develops respiratory distress.

• A diet high in __ and low in __ is prescribed.

• Although milk, milk products, and egg yolk are high in calcium, they are ___ because they also contain high levels of phosphorus.

• Spinach also is avoided because it contains __, which would form insoluble calcium substances.

• Oral tablets of calcium salts, such as __, may be used to supplement the diet.

A

9 to 10

calcitriol, calcium, magnesium, and vitamin D2 or d3

thiazide diuretic

Recombinant parathyroid hormone

IV calcium gluconate

calcium
phosphorus

Tracheostomy or mechanical ventilation

restricted

oxalate

calcium gluconate

132
Q

Nursing Management hypoparathyroidism

• Care of postoperative patients who have undergone thyroidectomy, parathyroidectomy, or radical neck dissection is directed toward detecting early signs of __ and anticipating signs of tetany, seizures, and respiratory difficulties.

• __ should be available for emergency IV administration. If the patient requiring administration of calcium gluconate has a cardiac disorder, is subject to dysrhythmias, or is
receiving digitalis, the calcium gluconate is given slowly and cautiously.

• & increase systolic contraction and also potentiate each other; this can produce potentially __. Consequently, the cardiac patient requires continuous cardiac monitoring and careful assessment.

A

hypocalcemia

Calcium gluconate

Calcium and digitalis
fatal dysrhythmias

133
Q

Each person has __ adrenal glands, one attached to the upper portion of each __.

Each adrenal gland is two endocrine glands with separate, independent functions.

• The adrenal __ at the center of the gland secretes __, and the outer portion of the gland, the adrenal __, secretes __.

• The secretion of hormones from the adrenal cortex is regulated by the __

• Increased levels of the adrenal hormone inhibits the production or secretion of __ and __.

A

two
kidney

medulla
catecholamines

cortex
steroid hormones

hypothalamic–pituitary–
adrenal axis.

CRH and ACTH

134
Q

• __ functions as part of the autonomic nervous system.

• Stimulation of preganglionic sympathetic nerve fibers causes release of the __ hormones: &

• About 90% of the secretion of the human adrenal medulla is __ (also called __).

• regulate metabolic pathways to promote __ of stored fuels to meet caloric needs from endogenous sources.

• The major effects of epinephrine release are to prepare to meet a challenge (__).

• Secretion of __ causes decreased blood flow to tissues that are not needed in emergency situations and increased blood flow to tissues that are important for effective ___.

• Catecholamines also induce the release of __, increase the __, and elevate the .

A

Adrenal Medulla

catecholamine
epinephrine and norepinephrine.

epinephrine
adrenaline

Catecholamines
Catabolism

fight-or-flight response

epinephrine
fight or flight

free fatty acids
basal metabolic rate
blood glucose level

135
Q

______

• ____ make it possible for the body to adapt to stress of all kinds.

• The three types of steroid hormones produced by the adrenal cortex are ___; ___; ___

• Without the adrenal cortex, severe __ would cause peripheral circulatory failure, circulatory shock, and prostration.

• Survival in the absence of a functioning adrenal cortex is possible only with __, __, and __ replacement and appropriate replacement with exogenous adrenocortical hormones.

A

Adrenal Cortex

glucocorticoids: (cortisol)
mineralocorticoid (aldosterone)
sex hormones (androgens) (male sex hormones)

adrenocortical secretions

stress

nutritional
Electrolyte
fluid

136
Q

• Increased cortisol secretion results in elevated blood glucose levels.

A

Glucocorticoids

137
Q

secreted from the adrenal cortex in response to the release of __ from the anterior lobe of the pituitary gland.

• __ are the classification of drugs that include glucocorticoids.

• ___ are given to inhibit the inflammatory response to tissue injury and to suppress allergic manifestations.

• Corticosteroids side effects include the development of diabetes, osteoporosis, peptic ulcer, increased protein breakdown resulting in muscle wasting and poor wound healing, and redistribution of body fat.

• When large doses of exogenous glucocorticoids are given, the release of ACTH and endogenous glucocorticoids are inhibited. This can cause the adrenal cortex to __.

• If exogenous glucocorticoid administration is discontinued suddenly, ___ results because of the inability of the atrophied cortex to respond adequately.

A

ACTH

Corticosteroids

Corticosteroids

atrophy

adrenal insufficiency

138
Q

______

• exert their major effects on electrolyte metabolism.

• act principally on the renal tubular and GI epithelium to cause increased ___ ion absorption in exchange for excretion of ___ or hydrogen ions.

• primarily secreted in response to the presence of __ in the bloodstream.

• ___ is a substance that elevates the blood pressure by constricting arterioles.

• Its concentration is increased when renin is released from the kidney in response to decreased perfusion pressure.

• The release of aldosterone is also increased by ___.

• ___ is the main hormone for the long-term regulation of sodium balance.

A

Mineralocorticoids

sodium
potassium

angiotensin II

Angiotensin II

hyperkalemia

Aldosterone

139
Q

___

• exert effects similar to those of male sex hormones.

• may also secrete small amounts of some estrogens, or female sex hormones.

• __ controls the secretion of adrenal androgens.

• when secreted in excess, they produce masculinization in women, feminization in men, or premature sexual development in children (____).

A

Adrenal Sex Hormones (Androgens)

ACTH

adrenogenital syndrome

140
Q

______

• a tumor that is usually benign and originates from the chromaffin cells of the adrenal medulla.

• This tumor is the cause of __ in 0.1% of patients with hypertension and is usually fatal if undetected and untreated.

may occur at any age, but its peak incidence is between __ of age and affects men and women ___.

• family members of affected people, the patient’s family members should be alerted and screened for this tumor.

A

Pheochromocytoma

high blood pressure

40 and 50 years

equally

141
Q

Clinical Manifestations

• The typical triad of symptoms is __,__,__ in the patient with hypertension.

• ___ and other cardiovascular disturbances are common. The hypertension may be intermittent or persistent.

• Other symptoms may include tremor, headache, flushing, and anxiety.

• ___ - insulin may be required to maintain normal blood glucose levels.

• During attacks, the patient is extremely anxious, tremulous, and weak.

• The patient may experience headache, vertigo, blurring of vision, tinnitus, air hunger, and dyspnea.

• Other symptoms include polyuria, nausea, vomiting, diarrhea, abdominal pain, and a feeling of impending doom.

• ___ occurs in 70% of patients with untreated pheochromocytoma.

A

headache, diaphoresis, and palpitations

Hypertension

Hyperglycemia

Postural hypotension

142
Q

Assessment and Diagnostic Findings

• Pheochromocytoma is suspected if signs of sympathetic nervous system __ occur in association with marked __ of blood pressure.

• “five Hs”: ,,,,_

• Measurements of urine and plasma levels of ___ and ___, a catecholamine metabolite, are the most direct and conclusive tests.

• The total plasma catecholamine (epinephrine and norepinephrine) concentration is measured with the patient __

• Normal plasma values of epinephrine are __ pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L).

• Values of epinephrine greater than _ pg/mL (2,180 pmol/L) or norepinephrine values greater
than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma.
.
• A __ may be performed if the results of plasma and urine tests of catecholamines are inconclusive.

• __, such as CT, MRI, and ultrasonography, may also be carried out to localize the pheochromocytoma and to determine whether more than one tumor is present.

• __ is a centrally acting antiadrenergic medication that suppresses the release of neurogenically mediated catecholamines.

A

overactivity
elevation

hypertension, headache, hyperhidrosis (excessive sweating), hypermetabolism, and hyperglycemia.

catecholamines
metanephrine (MN)

supine and at rest for 30 minutes.

100
400

clonidine suppression test

Imaging studies

Clonidine

143
Q

Medical Management pheochromocytoma

During an episode or attack of hypertension, tachycardia, anxiety, and the other symptoms of pheochromocytoma, ___ is prescribed to promote an orthostatic decrease in blood pressure.

  1. Pharmacologic Therapy - goals are to control hypertension before and during surgery and volume expansion.
  • Preoperatively, the patient may begin treatment with a low dose of an __ 10 to 14 days or longer prior to surgery.
  • ___ are sometimes used as an alternative or supplement to preoperative alpha- and betablockers.
  • Additional preoperative medications include _
A

bed rest with the head of the bed elevated

alpha-adrenergic blocker

Calcium channel blockers

catecholamine synthesis inhibitors

144
Q
  1. Surgical Management
  • __ - removal of one or both adrenal glands.
  • Surgery may be performed using a __ approach or an __ operation.
  • __ may be necessary if tumors are present in both adrenal glands.
  • A __ can be given intraoperatively exclusively or in combination with the alpha- and beta-blockers to control blood pressure.
  • In response to hypertensive crisis, _ can be given.
  • __ is used to control cardiac arrhythmias
  • __ is required if bilateral adrenalectomy has been necessary.
  • __ and __ may occur in the postoperative period because of the sudden withdrawal of excessive amounts of catecholamines.
A

Adrenalectomy

laparoscopic
open

Bilateral adrenalectomy

sodium nitroprusside, phentolamine, or nicardipine

Lidocaine or esmolol

calcium channel blocker

Corticosteroid replacement

Hypotension and hypoglycemia

145
Q

Nursing Management pheochromocytoma

Give 2

A

monitored until stable with special attention given to ECG changes, arterial pressures, fluid and electrolyte balance, and blood glucose levels.

Iv access

146
Q

Decrease ACTH disease

A

Addison Disease

147
Q

occurs when the adrenal glands are damaged and cannot produce sufficient amounts of cortical hormones.

A

primary adrenal insufficiency (PAI),

148
Q

Primary adrenal insufficiency

• __ or __ of the adrenal glands is responsible for 80% to 90% of all cases.

• Other causes include __ of both adrenal glands and __ of the adrenal glands.

• __ & __ are the most common infections that destroy adrenal gland tissue.

• Inadequate secretion of __ from the pituitary gland is a secondary cause of adrenocortical insufficiency.

• Therapeutic use of __ is the most common cause of adrenocortical insufficiency.

• Symptoms of adrenocortical insufficiency may result from the sudden cessation of __, which suppresses the body’s normal response to stress and interferes with __ feedback mechanisms, adrenal insufficiency should be considered in any patient who has been treated with corticosteroids.

A

Autoimmune or idiopathic atrophy

surgical removal
infection

Tuberculosis and histoplasmosis

ACTH

corticosteroids

exogenous adrenocortical hormonal therapy

normal

149
Q

Addison’s disease

CLINICAL MANIFESTATIONS

Give 5

A

• muscle weakness; anorexia; GI symptoms; fatigue; emaciation; dark pigmentation of the
mucous membranes and the skin, especially of the knuckles, knees, and elbows; hypotension;
and low blood glucose, low serum sodium, and high serum potassium levels.
• Depression, emotional lability, apathy, and confusion are present in 20% to 40% of patients.
• In severe cases, the disturbance of sodium and potassium metabolism may be marked by
depletion of sodium and water and severe, chronic dehydration.
• With disease progression, addisonian crisis (i.e., hypotension, cyanosis, fever, nausea, vomiting, and signs of shock) develops.

150
Q

Addison’s disease

ASSESSMENT AND DIAGNOSTIC FINDINGS

Give 2

A

• The diagnosis is confirmed by laboratory test results.

• Combined measurements of early morning serum cortisol and plasma ACTH.

• Patients with primary insufficiency have a greatly increased plasma ACTH level and a serum cortisol concentration lower than the normal range.

• Other laboratory findings include hypoglycemia and hyponatremia, hyperkalemia, and leukocytosis.

151
Q

Addison’s disease

Medical Management

• Immediate treatment is directed toward combating circulatory shock: restoring ___, administering fluids and __, monitoring __, and placing the patient in a ___ position with the legs elevated.

• __ is administered by IV, followed by 5% dextrose in normal saline.

• __ may be required if hypotension persists.

• __ may be given if infection has precipitated adrenal crisis in a patient with chronic adrenal insufficiency.

• If the adrenal gland does not regain function, the patient needs __ replacement of & to prevent recurrence of adrenal insufficiency.

A

blood circulation
corticosteroids
vital signs
recumbent

Hydrocortisone

Vasopressors

Antibiotics

lifelong
corticosteroids and mineralocorticoids

152
Q

Addison’s disease

Nursing Management

(4)

A

• Assessing the Patient

• Monitoring and Managing Addisonian Crisis

• Restoring Fluid Balance

• Improving Activity Tolerance

153
Q

• results from excessive adrenocortical activity.

• Commonly caused by the use of __ medications.

• infrequently the result of excessive corticosteroid production secondary to __ of the adrenal cortex.

• may be caused by a __ of the pituitary gland.

• The signs and symptoms of Cushing syndrome are primarily a result of over secretion of &

A

Cushing syndrome

corticosteroid

hyperplasia

tumor

glucocorticoids and androgens.

154
Q

Cushing syndrome

CLINICAL MANIFESTATIONS

• arrest of growth, obesity, and musculoskeletal changes occur along with glucose intolerance.
• a fatty “__” in the neck and supraclavicular areas, a heavy trunk, and relatively thin extremities.
• The skin is thin, fragile, and easily traumatized; ecchymoses (bruises) and striae develop.
• The patient complains of weakness and lassitude.
• Sleep is disturbed because of altered diurnal secretion of cortisol.
• Excessive protein catabolism occurs, producing muscle wasting and osteoporosis.
• Kyphosis, backache, and compression fractures of the vertebrae may result.
• Retention of sodium and water occurs as a result of increased mineralocorticoid activity, producing hypertension and heart failure.
• The patient develops a “__” appearance and may experience increased oiliness of the skin and acne.
• Hyperglycemia or overt diabetes may develop.
• The patient may also report weight gain, slow healing of minor cuts, and bruises.
In females of all ages, virilization may occur as a result of excess androgens (hirsutism, breasts atrophy, menses cease, the clitoris enlarges, and the voice deepens.
• Libido is lost in men and women.
• Distress and depression are common.
• If Cushing syndrome is a consequence of pituitary tumor, __ may occur because of pressure of the growing tumor on the optic chiasm.

A

buffalo hump

moon-faced

visual disturbances

155
Q

Assessment and Diagnostic Findings

• The three tests used to diagnose Cushing syndrome are:

• __ of the three tests need to be unequivocally abnormal to diagnose Cushing syndrome.

  1. __ levels - usually __ in the early morning (6 to 8 am) and __ in the evening (4 to 6 pm). This variation is lost in patients with Cushing syndrome.
  2. test - requires a 24-hour urine collection.
    - If the results of the urinary cortisol test are three times the upper limit of the normal range, Cushing is suspected.
    • used to diagnose pituitary and adrenal causes of Cushing syndrome.
  • __ is given orally late in the evening or at bedtime, and a plasma cortisol level is obtained at 8 am the next morning.
  • Suppression of __ to less than 5 mg/dL indicates that the hypothalamic–pituitary–adrenal axis is functioning properly.
A

serum cortisol, urinary cortisol, and low-dose dexamethasone suppression test.

Two

Serum cortisol
higher
lower

Urinary cortisol

Dexamethasone

Overnight dexamethasone suppression test

cortisol

156
Q

Cushing syndrome

Medical Management

• If caused by pituitary tumors, treatment is directed at the __.

• Surgical removal of the tumor by ___ is the treatment of choice.

• ___ is the treatment of choice in patients with unilateral primary adrenal hypertrophy.

• Medical management is recommended for bilateral adrenal dysplasia.

• Temporary replacement therapy with __ may be necessary for several months.

• __ may be used to reduce hyperadrenalism if the syndrome is caused by ectopic ACTH secretion by a tumor that cannot be eradicated.

• If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to __ the medication to the __ dosage needed.

A

pituitary gland

transsphenoidal hypophysectomy

Adrenalectomy

hydrocortisone

Adrenal enzyme inhibitors

reduce or taper
minimum

157
Q

• Excessive production of aldosterone.
• occurs in some patients with __ of the adrenal gland.

A

Primary Aldosteronism (Increase Aldosterone)

functioning tumors

158
Q

Primary Aldosteronism (Increase Aldosterone)

Clinical Manifestations

• __ is the most prominent and almost universal sign.

• Patients with uncomplicated, complicated, and treatment resistant hypertension and hypertension with ___ should be considered at risk for this disorder.

• If hypokalemia is present, it may be responsible for the variable muscle ____

• Polyuria, polydipsia and arterial hypertension.

• ___ may decrease the ionized serum calcium level and predispose the patient to tetany and paresthesias (assess & signs).

• ___ may occur, because hypokalemia interferes with insulin secretion from the pancreas.

A

Hypertension

hypokalemia

weakness or paralysis, cramping, and fatigue.

Hypokalemic alkalosis
Chvostek and Trousseau

Glucose intolerance

159
Q

Aldosteronism

ASSESSMENT AND DIAGNOSTIC FINDINGS

• A blood test to measure the ratio of __ to ___ can be performed even while the patient is taking an antihypertensive.

• This should be followed by __ and subtype evaluation tests.

MEDICAL MANAGEMENT

• The recommended treatment of unilateral primary aldosteronism is total surgical removal of the adrenal tumor through ___.

• If the adrenalectomy is bilateral, __ will be lifelong.

• A normal serum glucose level is maintained with insulin, appropriate IV fluids, and dietary modifications.

• __ is recommended over open surgery to reduce complications and hospital length of stay.

• Hypokalemia should be treated with ___ preoperatively.

• Medical treatment rather than surgery is recommended for patients with ___ involvement due to poor blood pressure control and other risks.

A

PAC
PRA

aldosterone suppression confirmatory tests

laparoscopic adrenalectomy

Laparoscopic surgery

replacement of corticosteroids

bilateral adrenal

spironolactone

160
Q

Primary Aldosteronism

PHARMACOLOGIC THERAPY

• Pharmacologic management is required for patients with __ or __ who do not undergo surgery.

• __ is recommended as the first-line drug to control hypertension.

• __ a newer, more expensive drug is recommended as a second-line drug if the patient cannot tolerate side effects of spironolactone.

• Serum __ and __ should be monitored frequently during the first 4 to 6 weeks of taking spironolactone.

• The half-life of __ may be increased when taken with spironolactone, and its dosage may need to be adjusted.

A

bilateral adrenal hyperplasia or unilateral aldosterone hypersecretion

Spironolactone

Eplerenone

potassium

creatinine

digoxin

161
Q

Primary Aldosteronism

Nursing Management

Give 2

A

• Frequent assessment of vital signs to detect early signs and symptoms of adrenal insufficiency and crisis or hemorrhage.
• Explaining all treatments and procedures, providing comfort measures, and providing rest periods can reduce the patient’s stress and anxiety level.

162
Q

Corticosteroid Therapy

• Corticosteroids are used extensively for ___ and in suppressing inflammation and autoimmune reactions, controlling allergic reactions, and reducing the rejection process in __.

• Their anti-inflammatory and antiallergy actions make corticosteroids effective in treating rheumatic or connective tissue diseases, such as __

• They are also frequently used in the treatment of __, multiple sclerosis, and __ .

Side Effects

• The dose required for anti-inflammatory and antiallergy effects produces _, pituitary and adrenal gland __, and changes in the function of the central nervous system.

• Dosages of these medications are frequently altered to allow high concentrations when necessary and then tapered in an attempt to avoid undesirable effects.

• Suppression of the __ may persist up to __ after a course of corticosteroids.

A

adrenal insufficiency
transplantation

rheumatoid arthritis and SLE.

asthma
Other autoimmune disorders

metabolic effects
suppression

adrenal cortex
1 year

163
Q

Therapeutic Uses of Corticosteroids

Give 3

A

• Treatment of Acute Conditions - Examples include emergency treatment for bronchial obstruction in status asthmaticus and for septic shock from septicemia caused by gram-negative bacteria.

• Ophthalmologic Treatment - Outer eye infections can be treated by topical application of corticosteroid eye drops.

Dermatologic Disorders - Topical administration of corticosteroids in the form of creams, ointments, lotions, and aerosols is especially effective in many dermatologic disorders.

164
Q

Corticosteroids Dosage

• In keeping with the natural secretion of __, the best time of day for the total corticosteroid dose is in the ____

• If symptoms of the disorder being treated are suppressed, __ is helpful in reducing pituitary–adrenal suppression in patients requiring prolonged therapy.

• Corticosteroid dosages are __ to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency.

A

cortisol
early morning

alternate-day therapy

reduced gradually (tapered)

165
Q

Increase ACTH disease

A

Cushing Syndrome

MS (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions