Endocrine Assessment Flashcards
(41 cards)
State some of the major endocrine glands
- hypothalamus
- pineal
- pituatary
- thyroid
- thymis
- adrenal
- islets of langahans
- ovaries
- testes
What specific things could be picked up in a history taking for endocrine assessments?
- Hormone replacement therapy
- Surgeries, chemotherapy or radiation
- Family history – diabetes, goitre, obesity, addison’s disease, infertility
- Sexual history – changes, characteristic, meinstruation and menopause
What are some specific things to ask during a history taking for an endocrine assessment?
- Energy level
- Fatigue
- Maintenance of ADLS
- Sensitivity to heat or cold
- Weight level
- Bowel movements
- Level of appetite
- Urination, thirst and salt craving
- Cardiovascular status changes
- Vision changing, tearing or eye edema
- Neurological – numbness, tingling lips or extremities (adrenal gland), mood, memory, sleep
- Integumentary – hair changes, skin changes, nails, bruising, wound healing times
During a physical assessment what red flags should you look for endocrine assessment?
- General appearance – vital signs, height or weight and changes
- Integumentary – skin colour, temp, texture, moisture - bruising, lesions, wound healing, hair and nail texture, hair growth
- Face – shape changes, symmetry, eyes and visual acuity and neck
- Respiratory = thorax for lung and heart sounds
- Extremiesies – sizes in hands feet truck, muscle strength and depp tendon reflexes, sensations to hot and cold and vibrations – extremity edema
What symptoms in older pateints can make endorcine assessment results unclear and diagnosis difficult?
- Relationship unclear
- Aging causing fibrosis of thyroid gland
- Reduces metabolic rate
- Contributes to weight gain
- Cortisol level unchanged in aging
Whats the action plan for a general endocrine assessment?
Diagnositic tests:
– Growth Hormone – fasting, well rested and not physical stressed
- Serum calcium or phosphatee – fasting may be required
- **Cortisol and aldosterone leave tests **
- **Epinephrine, norepinephrine and dopamine **– 24 hr urine collection to measure levels – can’t be stressed
How and where should you palpate to find the thyroid gland?
Just over the trachea.
Standing behind patient
run down the neck
noticing enlargement of trachea (check for lumps and if it is visible)
Explain the pathophysiology of how the thyroid gland should normally work
- Hypothalamic-pituitary-Thyroid axis
- Negative feedback loop was hormone T3/T4 increase the hypothalamus registers excess and stops the production of TRH
- TRH triggers TSH and T3/T4 used for liver function
- return to normal levels
What symptoms should you look for during assessment for hypothyroidism?
- Fatigue
- Constipation
- Apatchy more than 16 hours a day
- Weight gain
- Memory and mental impairment and decreased concentration
- Masklike face
- Menstrual irregularies and loss of liberia’s
- Course so or loss of hair and eyebrows
- Dry skin and cold intolerance
- Menstrual disturbances
- Numbness and tingling of fingers
- Tongue thicker,hand and feet enlarge
- Slurred speech and hoarseness
- Hyperlipidemai
- Reflex delay
- Bradycardia
- Hypothermia
- Cardiac and respiratory complication
- Diffused goitre (in primary hypothyroidism)
What is hypothyroidism Pathophysiology?
Low production of T3/T4 hormone effecting the liver.
Due to:
1. Reduced production of iodine in blood (iodine makes T3/T4)
2. Removal of thyroid gland (need hormonal therapy)
3. obstruction of gland
4. Inflammation of thyroid gland
What different categories of hypothyroidism?
- primary (thyroid),
- secondary (pituitary)
- tertiary (hypothalamus)
Whats the immediate action plan for treatment of hypothyrpidism?
- Life of hormonal therapy
- Labatrory assessment (low T3/T4, high cholestrol, high TRH)
- Other tests neck eco graphs, resonance, electrocardiography, gammagraphy
What would you look for to investigate primary (thyroid effecting) hypothyroidism?
- Low T4 (normal 60-150nmol/l)
- Low T3 (noraml 1-3mol/l
- High TSH (normal 0.5-3.5 pU/ml)
- High Cholestrol
- High TRH in stimulation test
What would you look for to investigate secondary (pituitary effecting) hypothyroidism?
- Low T3/T4 (noraml 60-150nmol/l and 1-3mol/l)
- Low TSH (noraml 0.5-3.5pU/ml)
- Prolonged or bad response to TRH
Whats the most common type of hyperthyroidism?
Graves disease
Autoimmune disease with genetic cause
What is Graves disease?
Type of hyperthyroidism
Excessive output of thyroid hormone
Due to too much T3/T4 hormone
Autoimmune disease with genetic link
What are some red flags that cause hyperthyroidism?
- May appear after emotional shock, stress or and infection
- Caused by thyroiditis and excessive ingestion of thyroid hormone
- Women 8x more likely than men (20-40 yo)
What symptoms should you look for in the assessment of hyperthyroidism?
- Increased T4 and T3
- Bulging eyes
- Dermatological problems (engrossed skin, distal part of legs and orange skin)
- Diffused goitre (unsymmetrical )
- Heat tolerance
- Palpation, tachycardia, elecvated systolic BP
- Increase appetite but weight loss
- Menstruation irregularies and decreased libido
- Perspiration, skin mood and flushed (elderly may be dry and pruritic)
- Insomnia
- Diarrhea
- Fatigue and muscle weakness
- Nervousness and irritability – can’t sit quietly
Whats the plan for treatment and assessment of hyperthyroidism?
- Clinical history
- Physical examination (goitre and eyes)
- Low levels of TSH and high levels of T4 and T3
- Normally surgical to remove parts (NBM)
What is the normal pathophysiology of adrenal glands?
Responsibel for retention of water due to sodium, potassium and hydrogen levels to effect pH.
-
Adrenal medulla - autonomic nervous system to release catecholamines like epinephrine and nor epinephrine
2. Adrenal cortex - glucocorticoids (cortisol) - mineralocorticoids and androgens
What is adrenal hyperfunction?
Excess of cortisol
from adrenal cortex
Causes cushing syndrome (primary, secondary, ectopic and latrogenic)
What is cushing syndrome?
- Adrenal hypertension causes
- Excessive adrenocortical activity or corticosteroid medication
- Excess cortisol
Whats a risk factor for cushing syndrome?
- Women between 20-40 (5x more likely than men)
