Endocrine Disorders Flashcards
(71 cards)
1
Q
Hormones
A
natural chemicals that exert their effects on specific tissues known as target tissues
2
Q
What is in place to prevent hormone accumulation?
A
negative feedback system
3
Q
Positive Feedback Mechanisms
A
- changes from the normal point & amplifies it
- Blood clot formation: vessel damages, platelets start to cling to injured site & release chemicals that attract more platelets until clot is formed
- Milk production: suckling baby
- uterine contractions: oxytocin release intensifies contractions
- Fever: body heats self to get rid of bacteria
4
Q
What does the Hypothalamus produce?
A
CRH, TRH, GHRH, GnRH, Somatostatin, Dopamine
5
Q
What does the anterior Pituitary produce?
A
TSH, ACTH, LH, FSH, PRL (prolactin), GH, MSH
6
Q
What does the posterior pituitary produce?
A
Vasopressin (ADH), oxytocin
7
Q
Deficient GH
A
growth retardation: short stature, decreased bone density, truncal obesity
8
Q
Deficient FSH & LH
A
Women: amenorrhea, breast atrophy, decreased axillary & pubic hair
Men: decreased facial & body hair, impotence, reduced muscle mass, & loss of bone density
9
Q
Deficient TSH
A
decreased TSH: weight gain, hirsutism, slowed cognition, lethargy, decreased metabolism
10
Q
Deficient ACTH
A
decreased cortisol levels: weakness, decrease resistance to infection, fasting hypoglycemia
11
Q
Hyperpituitarism
A
a hormone oversecretion that occurs with pituitary tumors or hyperplasia
- most common cause is a pituitary adenoma
- Results in gigantism or acromegaly
12
Q
Excess GH
A
Gigantism (before puberty)
Acromegaly (after puberty): Increase in lip & nose sizes, prominent brow ridge, increase in head, hand & foot size, protrusion of the lower jaw, enlarged organs
13
Q
Excess prolactin
A
Galactorrhea: discharge of a milk like substance thats not associated with breast feeding
14
Q
Excess ACTH
A
Cushings Disease
15
Q
Excess TSH
A
Elevated plasma TSH levels: weight loss, tachy, heat intolerance, fine tremors
16
Q
Hypophysectomy
A
removal of the pituitary gland & tumor by surgery, cryosurgery, or gamma knife
17
Q
Posterior Pituitary Hypofunction: Diabetes Insipidus
A
deficiency of production or secretion of ADH, decreased renal response to ADH
- results in fluid & electrolyte imbalances
- excretion of large volumes of dilute urine
- Increased plasma osmolality (hypernatremia)
18
Q
Symptoms of Posterior Pituitary hypofunction
A
Polyuria, Polydipsia, hypotension, tachycardia, poor turgor, drug mucous membranes, increased thirst, decreased cognition, weight loss, fatigue, weakness
19
Q
Posterior Pituitary Hyperfunction
A
- Syndrome of Inappropriate antidiuretic Hormone (SIADH)
- an excessive amount of serum ADH resulting in water intoxication & dilutional hyponatremia
- Results in fluid retention: increased plasma volume inhibits the release of renin & aldosterone
20
Q
Characteristics of Posterior Pituitary Hyperfunction
A
high intravascular volume, weight gain, pulmonary symptoms, lethargy, HA, changes in LOC, seizures, decreased DTR
21
Q
What does the thyroid produce
A
T3, T4, and calcitonin
22
Q
What is contained in the thyroid hormone?
A
iodine
23
Q
What controls release of pituitary hormones?
A
TRH from the hypothalamus
24
Q
What controls the release of thyroid hormone?
A
TSH from the anterior pituitary
25
What is the role of iodine?
taken from food and converts into T4 and T3 and thyroid cells are the only cells that can absorb iodine and they combine with amino acid and tyrosine to make T3 and T4
26
Hypothyroidism
a deficiency of thyroid hormone causing a general slowing of the metabolic rate
- causes: Hashimotos
- congenital: cretinism: deficient hormone during fetal/neonatal
27
What are symptoms of hypothyroid?
- fatigue, apathy
- amenorrhea
- Hair loss, brittle nails, dry & thick skin
- slow speech, subdued emotional responses, cold intolerance
- weight gain, constipation
- Dyspnea, deafness
- Advanced symptoms: demetia type changes, sleep apnea
- Myxedema coma: hypothermic, unconscious, stupor, fluid accumulates causing pericardial & pleural effusions
28
What do the labs look like for hypothyroid
TSH increased
T3 and T4 decreased
elevated cholesterol & triglycerides
29
Management of Hypothyroid
replace hormones
| levothyroxine (synthroid)
30
Symptoms of Hyperthyroid
- hyperexcitable, irritable, apprehensive
- cardiac symptoms
- weight loss, diarrhea, increased appetite
- fine tremors, insomnia, heat intolerance
- exophthalmos
- muscle fatigue, osteoporosis, fracture
- enlarged thyroid gland
31
What do the labs look like for hyperthyroid
decreased TSH
| increased T3 and T4
32
Acute Thyrotoxicosis (Thyroid Storm)
acute & severe when excess amounts of thyroid hormones released into circulation: high fever, tachy, delirium pyschosis
33
Management of hyperthyroid
antithyroid: Propylthiouracil, methimazole
| Iodine
34
Thyroid Medication: potassium Iodine
- salt of iodine (non-radioactive)
- protects thyroid gland against internal uptake of radioiodine released with a nuclear event
- Blocks absorption of radioactivity
35
Nursing Management for thyroid
- nutrition: high calorie diet (4000-5000 cal/day)
- General obsevations
- Eyes & skin
36
Thyroidectomy
- Subtotal thyroidectomy: remaining tissue supplies adequate hormone
- Hyperthyroidism
- goiter
- thyroid cancer
- Total thyroidectomy for some thyroid cancers
- requires life long thyroid replacement therapy
37
Thyroidectomy Preoperative
- may receive PTU or tapazole (antithyroid) 4-6 weeks priors to surgery
- monitor for hypothyroidsm
- Propranolol-blocks adrenergic effects
- Iodine for 10-14 days-reduces size & prevents excess bleeding
- Dietary information for metabolic needs & avoiding stimulants
- Medications to achieve euthyroid status
- Dietary information for metabolic needs & avoiding stimulants
- Routine pre-op instructions
38
Thyroidectomy Postoperative
- high fowlers position
- ask patient to talk to check for laryngeal nerve damage
- monitor for bleeding & hematoma; dressing
- avoid neck flexion or extension; neck support
- respiratory support
- monitor for hypocalcemia & tetany
39
Iodine deficiency
thyroid enlarges to obtain more iodine
40
Graves Disease
hypoerthyroidism-overstimulation causes the thyroid to swell
41
Hashimotos Disease
- Hypothyroidism-underactive thyroid
- sensing a low hormone level, the pituitary gland produces more TSH to stimulate the thyroid, which causes the gland the enlarge
42
Multinodular goiter
several solid or fluid filled lumps called nodules
43
Solitary thyroid nodule
a single nodule develops in one part of the thyroid-most are benign
44
Thyroid cancer
thyroid cancer can appear as an enlargement of one side of the gland
45
Inflammation
thyroiditis, an inflammation condition, that can cause pain and swelling in the thyroid
46
Parathyroid
- four glands on the posterior thyroid gland
| - parathyroid hormone regluates calcium & phosphorus balance
47
What does PTH regulates
serum calcium & phosphorus by stimulating bone resorption of calcium, renal tubular reabsorption of calcium, & activation of vitamin D
48
what does parathormone do
lowers phosphorus level
49
Hyperparathyroidism
-characterized by increased secretion of PTH
50
Primary hyperparathyroidism
benign adenoma tumor in the gland
51
secondary hyperparathyroidism
compensatory response to hypocalcemia
- chronic renal failure
- vitamin D deficiencies & malabsorption
52
Symptoms of hyperparathryroidism symptoms
- hypercalcemia (stones, bones, moans, groans, throne)
- CV: HTN, angina, arrhythmias
- GI: abdominal pain, constipation, PUD
- MS: skeletal pain, fractures, weakness
- Neuro: lethargy, psychosis, irritability
- Renal: stones, UTI, polyuria
53
Parathyroidectomy
- partial/complete per endoscopy
| - may have auto transplantation of normal parathyroid tissue
54
Nonsurgical Therapy
- asymptomatic or mild symptoms
- regular exams & PTH measurements
- Diuretics or Bisphosponates (Fosamax)
55
Hypoparathyroidism
- uncommon associated with iadequate circulating PTH
- Causes: most common from surgical removal, may be associated with hypothyroidism & hypogonadism
- Symptoms: Tetany, painful tonic muscle spasms -> laryngospasms, irritability, cardiac arrhythmias, labs
56
Management of hypoparathyroid
- replacement: IV calcium gluconate cautiously
- maintain airway
- PTH replacements not recommended
- oral calcium, Mg and vitamin D
- diet: high in calcium, low phosphorus, vitamin D
- lab monitoring follow up
- low calcium potentiates effects of Digoxin
57
Adrenal Medulla
- functions as part of the ANS
| - catecholamines, epinephrine & norepinephrine
58
Adrenal Cortex
- mineralcorticoids: aldosterone
- glucocorticoids: Cortisol
- sex hormones: androgens & estrogens
59
Cushings Syndrome
- excessive adrenocortical activity, particularly glucocorticoids
- Endogenous causes of increased cortisol
- ACTH secreting pituitary adenoma
- ACTH production by tumors usually of the lung or pancreas
- Adrenal adenoma
- Exogenous from therapeutic use of corticosteroid medications
60
Symptoms of Cushings syndrome
- weak, fatigue
- back & joint pain, fractures
- altered emotional state
- increased incidence of infection
- Fragile skin & blood vessels
- Changes in fat distribution (moon face, truncal obesity, buffalo hump)
- muscle wasting, hirsutism
61
Cushings management
- pituitary adenoma: transsphenoidal resection, radiation therapy
- Prolonged use of corticosteroids: gradually discontinuing, reduce dosage, alternate day dosing
- Adrenocortical adenoma, cancer, hyperplasia
- adrenalectomy
62
Addisons Disease
- Adrenocortical insufficiency
- Hypofunction of the adrenal cortex
- primary cause (Addisons disease)
- autoimmune or idopathic atrophy
- Glucocorticoids, mineralocorticoids, and androgens all reduced
- Secondary: inadequate secretion of ACTH from pituitary gland: resulting from decreased stimulation of the adrenal cortex
- Common cause: suppression of the hypothalamic-pituitary axis because of use of exogenous corticosteroids
63
Symptoms of Addisons disease
- Hyperpigmentation
- Hypotension & hypovolemia
- Muscle weakness & fatigue
- N/V
- Depression, apathy & emotional lability
64
Hyperpigmentation
low cortisol levels, increase secretion of ACTH with increased melanin synthesis
65
Addisonian crisis
insufficient adrenocortical hormones or sudden sharp decrease in these hormones
66
Complications
| addisonian crisis
abrupt discontinuation of a glucocorticoid medication or with a trauma, infection, stress-> circulatory shock
67
Complications
| Hypoglycemia
decrease glucocorticoids causes increase insulin sensitivity & decrease glycogen
68
Complication
| Hyponatremia/Hyperkalemia
increase excretion of sodium & decrease of potassium
69
Pheochromocytoma
-a catecholamine producing tumor of the adrenal medulla: rare & usually benign
-epinephrine & norepinephrine secreted
-produce SNS effects
Cause is unknown
-Riks factors: endocrine neoplasia, anesthesia, opiates, radiographic dye, foods high in tyramine
70
Symptoms of Pheochromocytoma
- hypertension
- HA
- hyperhidrosis
- ypermetabolism
- hyperglycemia
- chest pain
71
Corticosteroid Therapy
- corticosteroids are therapeutic for
- adrenal insufficiency
- suppress inflammation & autoimmune response
- control allergic reactions
- reduce trasplant rejection
- Common corticosteroids
- patient teaching
- timing of doses
- take as prescribed, tapering required, side effects
