Endocrine

Question 1

function: pituitary gland

Answer 1

many

Question 2

function: thyroid & parathyroid

Answer 2

metabolism, bones

Question 3

function: adrenals

Answer 3

stress response, sugar, electrolytes

Question 4

function: testes

Answer 4

male characteristics

Question 5

function: ovaries

Answer 5

female characteristics

Question 6

function: pancreas

Answer 6

glucose

Question 7

function: thymus

Answer 7

immune response

Question 8

function: pineal

Answer 8

body rhythms

Question 9

hypothalamus

Answer 9

master gland!- integration of neuroregulatory- critical link between CNS and endocrine- major controller of anterior, posterior pituitary

Question 10

HP & POA

Answer 10

hormones, pituitary & posterior: oxytocin ADH

Question 11

hypopituitarism: GH

Answer 11

children: small statureadults: osteoporosis

Question 12

somatomedin c

Answer 12

stimulated by GHbone and cartilage maintenance

Question 13

hypopituitarism: LH, FSH

Answer 13

men- decreased facial & body hair, libido, muscle mass- impotence- facial wrinkleswomen- amenorrhea, anovulation- breast atrophy- decreased libido, axillary and pubic hair- loss of bone density

Question 14

*hypopituitarism assessment

Answer 14

LOOK AT CLIENTsome hormones measured directlyindirectly: T3 & T4 for TSH- stimulation tests: insulin > increased GH, ACTH- changes in sella turcica: MRI, CT- hormone replacement necessary for the rest of their lives

Question 15

hyperpituitarism most common cause

Answer 15

pituitary adenoma (benign tumor)- tumor grows, neurological & endocrine issues emerge (HA, visual changes, intracranial pressure)

Question 16

hyperpituitarism: GH

Answer 16

gigantism before pubertyacromegaly: adult (high blood sugar = red flag)antagonist to insulin

Question 17

hyperpituitarism: GH manifestations

Answer 17

• organomegaly (larger larynx = deeper voice, larger tongue = dysphagia)- hypertension

Question 18

hyperpituitarism interventions

Answer 18

• drug therapy- radiation therapy- surgery

Question 19

*bromocriptine mesylate

Answer 19

Parlodel- *dopamine agonist given for hyperpituitarism- side effects: GI, orthostatic hypotension

Question 20

disorders of posterior pituitary

Answer 20

remember; HP & POA (oxytocin, ADH)- ADH deficiency: diabetes insipidus, polyuria -> dehydration, skin dry/turgor change– neuro: irritability, lethargy > coma– manage with vasopressin- ADH excess: SIADH, GI disturbances, hyponatremia due to free water retention– neuro: lethargy > coma– manage with diuretics, NaCl

Question 21

*Addison’s Disease

Answer 21

adrenal cortical hypofunction- *requires 90% destruction of gland- bronze skin, hirsutism

Question 22

Addison’s Disease causes

Answer 22

• idiopathic atrophy (autoimmune) - 60 to 70% of US cases- granulomatous disease (TB most common in 3rd world)- metastases (especially lung and melanoma)

Question 23

reduced cortisol results

Answer 23

HYPOGLYCEMIA (decreased gluconeogenesis)- seizures, confusion, combative- GFR, gastric acid production decreases -> increased BUN, anorexia, weight gain- muscle weakness, fatigue

Question 24

reduced aldosterone

Answer 24

HYPOKALEMIA (K excretion decreased)- K retention promotes reabsorption of H+ > acidosis- Na+, H20 excretion increased > hyponatremia, hypovolemia

Question 25

Addisonian Crisis

Answer 25

life-threatening event in which physiologic need for gluco and mineralocorticoid hormone is greater than supply- usually result of stressful event

Question 26

Addisonian Crisis s/s

Answer 26

- profound fatigue- dehydration- vascular collapse- renal shutdown- hyponatremia- hyperkalemia

Question 27

Florinef

Answer 27

fluocortisone- treatment for hypoaldosteronism, Addison's Disease- counterproductive effect with diuretics DO NOT GIVE WITH DIURETICS- always assess cardiovascular status, ESPECIALLY elderly

Question 28

adrenal insufficiency: diagnostic assessments

Answer 28

ACTH stimulation test = most definitive

Question 29

*Cushing's disease

Answer 29

adrenal gland hyperfunction

Question 30

*Cushing's syndrome

Answer 30

hypercortisol

Question 31

*hyperaldosteronism

Answer 31

excessive mineralocorticoid OR excessive androgen production

Question 32

*pheochromocytoma

Answer 32

tumor = hyperstimulation of adrenal medulla- excessive secretion of catecholamines (80% epi, 20% norepi): HR, BP- *HYPERTENSION hallmark of disease (doesn't resolve with dose of anti-hypertensive)- do NOT palpate abdomen

Question 33

Cushing's Syndrome causes

Answer 33

- pituitary adenoma (Cushing's disease)- adrenal cortical adenoma, carcinoma- ACTH-producing non-adrenal, non-pituitary tumor (lung, others)- iatrogenic (anti-inflammatory therapy)- self-administered (body builders, etc)

Question 34

Cushing's Syndrome s/s

Answer 34

- increased fat due to low turnover of plasma fatty acids: moonface, central adiposity + striae- increased breakdown of protein- decreased production of lymphocytes- htn, hyperpigmentation, hypokalemia, hyperglycemia

Question 35

pheochromocytoma treatment

Answer 35

adrenalectomycorticosteroids for rest of life

Question 36

assessing thyroid function

Answer 36

TSH - best screening test in outpatient setting

Question 37

Grave's Disease

Answer 37

hyperthyroidism- toxic, diffuse goiter- exopthalmia- heat intolerant- tachycardia, dysrhythmias- SOB w/ w/o exertion- weight loss, increased appetite, diarrheaincrease protein to prevent neg nitrogen!increase calories and carbs!

Question 38

thyroidectomy complications

Answer 38

- damage to laryngeal nerve- hypoparathyroidism - hypocalcemia

Question 39

hypoparathyroidism

Answer 39

hypocalcemia- increased neuromuscular activity > tetanyIV CALCIUM GLUCONATE!

Question 40

hypothyroidism

Answer 40

- main cause (US): thyroid surgery, radioactive iodine treatment for HYPER- most common in women 30-60- decreased metabolic rate!

Question 41

myxedema coma

Answer 41

usually in hypothyroid patients subject to stress- clinical features: CHF!, hypothermia, stupor/coma, hypoventilation/respiratory failure, hyponatremia, hypotension, seizures, hypoglycemia

Question 42

levothyroxine

Answer 42

(synthroid) treatment for hypothyroidism- synthetic T4- converts to T3- speeds up metabolism- be careful not to induce THYROTOXICOSIS

Question 43

PTH normal function

Answer 43

increased:- bone resorption- Ca resorption (urine)- calcitrol (Ca absorption from gut)stimultates:- new osteoid formation ready for calcification during increase of dietary calcium

Question 44

hyperparathyroid

Answer 44

HYPERCALCEMIA!- increased bone resorption- depressed serum P- hypercaluria- decreased neuromuscular irritability

Question 45

hypoparathyroid

Answer 45

- decreased bone resorption- depressed Ca serum- elevated serum P- increased neuromuscular activity = TETANY

Question 46

hyperparathyroid management

Answer 46

- diuretic + fluid therapy- drugs- surgical management

Question 47

hypoparathyroid management

Answer 47

- focus on correcting hypocalcemia, vitamin D deficiency- avoid P (milk, yogurt, processed cheese)