Endocrine Exam #2 Flashcards
(94 cards)
1
Q
Hormones of the hypothalamus
A
- Corticotropin releasing hormone (CRH)
- Thyrotropin releasing hormone (TRH)
- Growth hormone releasing factor/somatotropin releasing hormone
- Gonadotropin releasing hormone (GnRH)
- Prolactin releasing hormone (PRH)
- Somatostatin (inhibits growth hormone release)
- Prolactin inhibiting hormone
- melanocyte hormone
2
Q
Pituitary Gland (hypophysis)
A
- master gland of endocrine system
- excretes hormones that have a regulatory effect over the endocrine glands
3
Q
All activities of the pituitary are controlled by….
A
Hypothalamus
4
Q
Anterior Pituitary
A
(Adenohypophysis) gland composed of cells that secrete protein hormones
-secretes 6 hormones
5
Q
Posterior pituitary
A
(Neurohypophysis) “storage shed” for hypothalamus
- directly connected to hypothalamus by nerve tract and composed of nerve tissue
- secretes ADH
6
Q
Rate of production
A
mediated positive and negative feedback circuits
7
Q
Rate of delivery
A
high blood flow to target organ/cells deliver more hormone than low blood flow
8
Q
Rate of degradation and elimination
A
hormones metabolized & excreted thru several routes dependent on biologic half life
9
Q
Growth Hormone
A
(liver, adipose tissue)
-promotes growth indirectly. Control of protein, lipid, and carb metabolism.
(growth and metabolism) (growth and tissue repair)
-increases glucose therefore giving people diabetes
10
Q
Thyroid stimulating hormone
A
(thyroid gland)
- stimulates secretion of thyroid hormones –thyroid to secrete t3 and t4
- secreted from cells thyrotrophs
- helps control body metabolism and influence physical and mental growth
11
Q
Adrenocorticotropic hormone (ACTH)
A
(adrenal gland, cortex)
-stimulates secretion of corticosteriods and glucocorticoid
-affects blood sugar, carb metab., influences sleep and protein breakdown.
controlled by CRH
12
Q
-Prolactin
A
(mammary gland) (lactogenic hormone)
-milk production, lactogenic hormone
13
Q
Gonadotropin hormones: FSH & LH
A
(ovary and testes)
-control reproduction function
14
Q
B-lipotropin
A
(target organs)
-stimulate target organs to release hormones growth and development target organs
15
Q
Growth Hormone (somatotropin)
A
- is a major participant in several physiologic processes including growth and metabolism
- pulsatile release pattern
16
Q
Growth hormone effects on growth
A
increases protein synthesis, breakdown of fatty acids, breakdown glycogen to glucose liver, increase blood sugar/insulin antagonist
17
Q
FSH: follicle stimulating hormone
A
- stimulates the epithelial cells of the testes to release testosterone
- —-male leydig cells are testicular cells that produce testosterone
18
Q
LH: luteinizing hormone
A
- women-ovarian follicle works with estrogen to cause release of ova from ovaries
- ovary: release progesterone, development mammary glands fro milk secretion
19
Q
Melanocyte-stimulating hormone
A
-stimulates production pigment cells in skin, eyes, and inside eyes
20
Q
what is the first sign of a pituitary tumor?
A
infertility
21
Q
Assessment of hypopituitarism
A
- hormone deficiencies involving anterior pituitary lead to end organ failure
- effects depend on specific hormone lacking
- deficient in ACTH & TSH cause tendency towards shock
22
Q
Diagnosing hypopituitarism
A
- H&P
- MRI/CT– for presence of tumor
- lab values –direct/indirect measurement of hormone levels
23
Q
Pituitary Dwarfism
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- hyposecretion of GH in childhood
- normal body proportions and IQ
- excessive body fat & poor muscle development
- immature facial features, high pitch voice, slow nail growth, thin hair
- sexual maturation may not occur or delayed puberty –normal sexual function
- stunted growth – < 3rd percentile
24
Q
1 Nursing goal for pituitary dwarfism
A
FIND & REFER
25
Nursing Management of pituitary dwarfism
- if tumor- remove (hypophysectomy)
- hormone replacement therapy - SQ GH injection
- teach lifelong replacement, psychologic support
26
Hyperpituitarism in children
Gigantism
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Hyperpituitarism in adults
Acromegaly
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Gigantism
- GH excess
- GH secreting adenoma --onset BEFORE closure of epiphyseal plate
- onset before closure of epiphyseal plate
- long bones still capable of longitudinal growth.
- caused by late ossification and hardening of bones
29
Signs and symptoms of Gigantism
- muscle weakness
- osteoporosis because of bones growing so fast and Calcium not being able to keep up
- arthritic changes and cardiac hypertrophy
30
Treatment of Gigantism
-GH WNL, surgery, radiation, meds
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Acromegaly
- excessive GH secretion by overgrowth of bone and soft tissues
- develops AFTER closure of epiphyseal plate so bones grow in thickness and width
- relatively rare
- usually begins gradually....3-4 decades of life
- typically 7-9 years btwn onset of symptoms and diagnosis
32
Signs and symptoms of acromegaly
- skin thick, leathery, oily
- enlarged hands, feet, nose, sinuses, forehead prominent, and visceral organs.
- hypertrophy of lips and tongue. (trouble swallowing and speaking
- atherosclerosis-->cardiomegaly-->diabetes
33
Complications of cardiomegaly
- alters glucose metabolism, hyperglycemia, symptoms of polydipsia and polyuria (hormone antagonizes action insulin)
- alters fat, cho, protein and metabolism raising lipid levels leading to HTN and athersclerosis
34
Diagnosis of Acromegaly
GH levels > 50
BEDREST PRETEST
-oral glucose challenge response test is a definitive test
-CT, MRI, bone density
-H&P, c/o changes in dentures, hat, glove, ring, and shoe size
35
Surgery for acromegaly: hypophysectomy
-remove only tumor causing GH secretion (if complete pituitary removed will need hormone replacement thru-out life (decreased sensation of smell, taste, edema, bruising of eyes, nose, upper face)
36
Post-op care of transphenoidal adenectomy
- I&O FREQUENTLY & HOB ^ 30 DEGREES
- check for cerebrospinal fluid (question about nasal drip is constant swallowing or halo on gauze)
- IV antibiotics for CSF leakage
- avoid sneeze, cough, strain
37
Medications for acromegaly
- somatostatin analogs = decrease GH WNL
- dopamine agonists = suppresses GH secretion
- GH receptor antagonists = blocks secretion
- --most common: Octreotide (sandostatin)
38
Nursing care for Acromegaly
- evaluate changes in physical size, appearance-- question changes in hat, glove and ring size
- good skin care
- high calcium diet
- pictures helpful bc changes occur slowly
- emotional support for appearance
39
Prolactinomas
- prolactin secreting adenoma accounts for 40-60% all hyperfunctioning tumors
- HAs, visual problems secondary to pressure optic chiasm
- galactorrhea, menstrual abnormalities, infertility, and hirsutism
- -drug therapy: first line Dopamine agonists,
- surgery depending on tumor size, radiation limited
40
Antidiuretic hormone (vasopressin) (ADH)
- **conservation of body water by reducing urine output
* *-channels transport solute-free water thru tubular cells back into blood leading to decreased plasma osmolarity & increased urine osmolarity
- ADH binds to receptors in distal or collecting tubules of kidneys and promotes resorption of water back into circulation
41
Plasma Osmolarity
- concentration solutes in blood
| - **ADH secretion also stimulated by decreased BP and increase in osmolarity
42
Syndrome of inappropriate ADH (SIADH)
- ADH released despite normal or low plasma osmolarity
| - results from abnormal production or sustained secretion ADH
43
Signs and Symptoms of SIADH
- fluid retention (you can't pee)
- serum hypo-osmolality
- concentrated urine with normal or increased intravascular volume and normal renal function
- increased ADH renal absorption of H20 into circulation, ECF volume, decreased NA in urine
- NO EDEMA
44
Main signs and symptoms of SIADH
- decreased Na leading to muscle cramps, twitching, and HA.
- increased urine specific gravity
- brain cells swell leading to neuro sings and symptoms--> lethargy, seizures, personality changes, coma and death
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SIADH diagnostics
- simultaneous measurement of urine and serum and osmolality
- **serum osmolality is less that urine osmolality because inappropriate excretion...concentrated urine and very diluted serum (DILUTE Na)
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Nursing care for SIADH
- restore fluid volume and osmolality
- diuretics, increase Na diet, Na and K supplements
- **sometimes develop heart failure so may need lasix
- HOB 10 degrees
47
Diabetes Insipidus
(may be transient or lifelong)
- deficiency of ADH: kidney tubules fail to reabsorb H20
- excrete large amounts of dilute urine without glucose
- polydipsia, polyuria--> DI increased even more
48
Causes of DI
problems with hypothalamus or pituitary--brain tumor, injury, meds, infection
--decreased response to ADH, inadequate ADH,
49
Assessment Diabetes insipidus
* * BP, SKIN TURGOR, I&O, DAILY WT
- urine is dilute, clear, colorless
- low specific gravity
- polydipsia-thirst mechanism stimulated and insatiable. Crave cold drinks
- combination of nocturia and polyuria
- wt loss, poor turgor, hypotension, tachycardia, shock
- hypernatremia
50
Diagnosis of diabetes insipidus
- **GOAL: maintain fluid and electrolyte balance
- water deprivation test: evaluates kidneys ability to produce urine with no PO water intake
- synthetic ADH hormone to determine is DI is caused by renal dysfunction
- low Na diet and thiazide diuretics
51
The adrenal gland
- small vascular glands located on upper portion of kidneys
| - two parts: adrenal cortex and adrenal medulla
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Adrenal Medulla
- extension of SNS
- secretes epi, norepi, and dopamine
- fight or flight response
- constriction of blood vessels and dilation of brinchioles
- increase HR, CO, pupil dilation
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Adrenal Cortex
-secretes glucocorticoids, mineralcorticoids, androgens
54
Glucocorticoids
- **cortisol most abundant and potent
- necessary for life
- regulates blood glucose concentration- breaks down sugar for energy
- promote metab of carbs
- inhibit inflammation
55
Mineralcorticoids
- primarily aldosterone
- maintains extracellular fluid volume
- promotes reabsoprtion of Na and excretion of K
56
Adrenal Androgens
-stimulate pubic, axillary hair and sex drive in women
-converted to estrogens in peripheral tissue
-major control - negative feedback
hypothalamus secretes CRH--CRH stimulates ant. pituitary to secrete ACTH --ACTH stimulates adrenal cortex to secrete cortisol
57
Cushing Syndrome
- caused by excess of corticosteroids particularly glucocorticoids
- caused by adrenal tumors and ectopic ACTH production by tumors
58
Signs and Symptoms of Cushing's Syndrome
- wt gain is most common
- buffalo hump
- sodium/water retention so monitor them.
- susceptibility to infection is a complication of long time hormone use
- hyperglycemia
- monitor skin
- purple striae on abdomen
- mineral corticoid excess may cause HTN secondary to fluid retention
59
Diagnosing Cushing's syndrome
- 24 hr urine for free cortisol
- **plasma cortisol levels may be elevated with loss of diurnal variation
- CT/MRI for tumor location
- **hyperglycemia and POLYCYTHEMIA
60
Nursing Care for Cushing's syndrome
- * surgery adrenalectomy or hypophysectomy (pituitary adenoma) or meds to suppress
- Mitotane: suppresses cortisol production, alters metabolism of cortisol and decreases plasma and urine
- acceptance of appearance --meticulous skin care, observe Na & H20 retention
61
Adrenalectomy
- HTN and hyperglycemia must be controlled
- hypokalemia is corrected with supplements
- **may be hypotensive post-op until regulated by steroids
- **high doses of cortisone pre/post op
62
Post-op Adrenalectomy
- ** if decreased urinary output due to Na retention
- ** may be hypotensive until steroid therapy regulation
- high doses of corticosteroids are administered IV during and several days after surgery to ensure adequate response to surgery
- monitor I&O
- wear medic alert bracelet at all times
- avoid exposure to extreme temps, stress, and infection
63
Hyperfunction of adrenal cortex
- excessive aldosterone secretion which causes Na retention K & hydrogen ion excretion
- ** hallmark of disease is hypertension & hyperkalemic alkalosis
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Signs and symptoms hyperfunctioning adrenal cortex
- Na retention leads to hypernatremia, htn, HA
- no edema
- potassium wasting leads to hypokalemia- cardiac arrhythmias, muscle weakness, may lead to tetany
65
Nursing care for hyperfunctioning adrenal cortex
- surgical removal if adrenal gland with adenoma
| - pre-op: low Na diet, k sparing diuretics, k supplements, CCBs to control BP
66
Addison's disease
- adrenocorticol insufficiency
- all 3 classes of adrenal corticosteroids are reduced -sugar, salt, sex
- autoimmune response destroying adrenal tissue
- insidious onset
- progressive weakness, fatigue, wt loss, anorexia are primary features
- Skin hyperpigmentation
67
Addison's disease tri-ad
hypotension, hyponatremia, hyperkalemia
| --hypotension, hyperpigmentation and weakness
68
Diagnosis and nursing care for Addison's disease
- **protect against stress!!
- ** diet high in protein, high calorie, extra salt/sodium
- ** maintain fluid and electrolyte balance
- large amounts of NS and D5 are administered to reverse hypotension and electrolyte imbalance
- wear medic alert bracelet
- take corticosteroids early am to avoid GI distress
* *-wt gain, moon face, edema, behavior changes, increased urination and thirst- S/S infection
69
Pheochromocytoma
- adrenal medulla tumor that produces excessive catecholamines (epi and norepi
- severe hypertension
70
Triad of Pheochromocytoma
-pounding HA, tachycardia, profuse sweating
71
what is necessary for the synthesis of thyroid hormones?
Iodine
| ---iodized salt, fish, bread
72
Thyroid gland
highly vascular organ regulated by TRH from hypothalamus and TSH from anterior pituitary
- major function is production, storage, and release of 3 hormones that regulate metabolic processes
- --t3, t4, and calcitonin
73
T3 and T4 affect...
metabolic rate, caloric requirement, O2 consumption, growth and development, and carb and lipid metabolism
74
calcitonin
produced by C cells in response to high circulating levels
| --inhibits bone resorption from bone, increases bone storage and renal excretion of Ca and phosphorus-lowers serum Ca
75
Radiologic studies for thyroid
- radiologic uptake thyroid scan- direct measurement activity, evaluation solitary nodules
- thyroid scan- evaluate nodules, benign= warm if malignant tumors= cold spots (bc doesn't take up radioactive iodine)
- thyroid ultrasound
76
Simple negative feedback
hypothalamus-->TRH-->Ant. pituitary --> TSH -->T3 &T4
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Hyperthyroidsim
- a sustained increase in synthesis and release of thyroid hormones by thyroid glands
- thyroiditis, nodular goiter, exogenous iodine excess, pituitary tumors, thyroid cancer
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Most common form of Hyperthyroidism
Grave's disease
79
Grave's disease
- autoimmune disease of unknown etiology
- thyroid enlargement and excessive thyroid hormone secretion
- precipitating factors: insufficient iodine supply, infections, stress, genetic factors
80
Hyperthyroidism Tri-ad
1) increased tissue sensitivity to stimulation of SNS
2) Goiter
3) exopthalmus
81
Exopthalmos
-impaired drainage from orbit, increased fat and edema in retro-orbital tissues
82
Grave's disease may have what effect on the CV system?
-give you palpitations!
| rapid HR and
83
Signs and symptoms of Grave's disease
^ HR, RR, appetite, thirst, wt loss
| --nervousness, wt loss, appetite
84
Thyrotoxic Crisis (thyroid storm)
- increased thyroid hormone in blood
- ** hyperthermia increase in temp to 105 degrees
- tachycardia, HF, restless, agitation, seizures, abd. pain, N/V/D, coma
85
Treatment and Therapy for Thyrotoxicosis
- therapy aimed at reducing fever, fluid replacement and management of stressors
- labs to see if FT4 is high and TSH low
- Beta blockers for symptomatic relief and decrease HR
86
why is iodine useful is treating thyrotoxic crisis
- large doses of iodine inhibit T3 and T4 and block their release into circulation
- available SSKI (sat sol potassium) & Lugol's solution
- decreases vascularity of thyroid making surgery safer and easier (bc thyroid very vascular)
- long term iodine therapy not effective
87
Anti-thyroid meds to treat thyrotoxic crisis
PTU and Tapazole inhibit the synthesis of thyroid hormones
88
Surgical therapy for hyperthyroidism
- subtotal thyroidectomy for those unresponsive to drug therapy with large goiters causing tracheal compression
- **Hemorrhage ASSESS by gently slipping hand behind neck to check for blood
- endoscopic thyroidectomy for small nodules
89
euthyroid
normal function
90
Nutrition for hyperthyroidism
- high caloric may be ordered for hunger and prevention of tissue break down
- avoid caffeine, highly seasoned foods, high fiber foods
- --major problem in inadequate diet
91
After thyroid surgery what is essential to keep at the bedside?
-suction equipment and tracheostomy tray
92
Tetany
numbness and tingling toes and fingers is possible post-op along with circumoral muscle twitch
93
Post-op of thyroid surgery
- stridor or numbness so may need IV calcium
- avoid goitrogens: rutabagas, turnips, and peanut skin
- avoid caloric intake
94
Thyroiditis
- inflammatory process in thyroid with several causes
| - viral, fungal, and autoimmune
