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Flashcards in Endocrine system Deck (52):
1

Endocrine system - Anatomy 

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Regulation of blood calcium 

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Hypothalamus & Pituitary Glands 

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Hormones secreted by anterior pituitary (adenohypophysis)

1. TSH (thyroid stimulating hormone) - thyroid

2. ACTH (adrenocorticotropic hormone) - adrenal cortex 

3. GH (growth hormone) - bones + tissues 

4. Gonodotropic hormones - LH + FSH

5. Prolactin - mammary glands 

5

Hormones secreted by adrenal cortex 

1. Glucocorticoids - Cortisol 

2. Mineralocorticoids - Aldosterone 

3. Androgens - Testosterone 

6

Acromegaly (adulthood) - cause, S/s

due to GH secreting tumor 

1. Enlargement of hands + feet 

2. Elongation of jaw bone 

3. Enlargement of visceral organs - hepatomegaly , cardiomegaly 

4. Hyperglycemia - GH blocks action og insulin 

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Prolactin secreting tumors - S/s 

1. Galactorrhea 

2. Hypogonadism 

3. Impotence 

4. Amenorrhea 

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Excess ACTH - S/s 

1. Cushing's syndrome 

2. Weight gain + HTN

3. Masculinization (facial hair, deep voice) , amenorrhea 

9

Hypophysectomy  - monitor !

 surgical removal of the hypophysis (pituitary gland) - transphenoidal approach 

! Electrolytes - DI ? SIADH ? ; I+O; Dont band head below waist for 2 weeks; oral hygiene - no toothbrush, warm saline rinses ; humidified O2 (mouth breathers) 

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Parlodel (bromocriptine mesylate) 

Dopamine receptor agonist 

TX: prolactin or GH secreting tumors; Parkinson disease 

NC: PO, take with food ( GI upset - nausea + constipation (Fiber 25g))

SE: Postural hypotension - get up slowly ;Orthostatic BP

- BP drops 20 - HR increase 20 

11

Sandostatin ( octreotide)

Somatostatin analogs 

TX: inhibits GH secretion; used pre-op to shrink the GH secreting tumor 

NC: must be given parenterally - subcut, IV or IM 

SE: Decreased GI and gallbladder motility  - gallbladder disease - bile duct stones + gallstones 

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Hormones secreted by Hypothalamus and stored + released by the Posterior pituitary gland 

1. Oxytocin - ejection of milk 

2. ADH - stimulates reabsorption of water by the kidneys ; vasoconstrictor 

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Diabetes Insipidus (DI) - S/s 

Decrease in ADH 

Polyuria - dehydration - increased serum osmolarity - polydipsia ; urine is dilute - low specific gravity 

Hypernatremia 

 

14

Hypernatremia - S/S 

135-145 

1. Thirst - craving cold water 

2. Sticky mucus membranes 

3. Increased T + HR 

4. Weak, irritable 

5. Mental confusion 

15

Fluid Deprivation Test 

DX of DI 

Pt. has no fluids - monitor Q1 - weight, urine output, Na level. 

Dehydration triggers kidneys to concentrate urine 

Stop :

1. Severe hypernatremia 

2. Loose more than 3-5 % of body weight 

3. Hypovolemia - shock 

16

DI - TX

1. Vasopressin - strong vasoconstrictive !!!! - CAD, PVD, Raynaud's 

2. DDAVP - Desmopressin acetate - synthetic without strong vasoconstr. properties - IV, nasal spray, PO

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SIADH - S/S 

Increase in ADH 

Water retention - decreased serum osmolarity - dilutional Hyponatremia - Oliguria - increased urine osmolarity and sp. gravity 

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SIADH - TX

1. Na = or > 125 - Fluid restriction - to balance Na and H2O - explain to pt. and family 

2. Na< 125 - S/s of hyponatremia develope - 

3% Hypertonic Saline - small amount, slowly ( 12 in 24 hrs increase) 

!!! Cerebral edema 

3. Demectocycline (Declomycin) - antibiotic - off label use - inhibits ADH secretion 

19

Cushing's disease - causes 

adrenal or pituitary tumors; steroids (Prednisone) 

Increase in glucocorticoids (Cortisol)

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Cushings - S/s 

1. Truncal obesity (alteration in fat metabolism) 

2. Moon face

3. Buffalo hump

4. Thin arms + legs (increase breakdown of protein ) 

5. Thin skin - increase fragility of capillaries - bleeding 

6. Generalized weakness + lethargy 

7. GI distress - increase acid 

8. Risk for infection - poor healing 

21

Cushings - labs 

1. Hyperglycemia - monitor sugar; tx: insulin

2. Hypokalemia - retaining Na + H2O - increase in aldosterone - HTN - I+O, weights 

3. Hypocalcemia - osteoporosis 

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Cushings - DX

1. H+P 

2. Dexamethasone (Decadron) suppression test - give lil dose PO (11pm) - to see if adrenal glnad shuts off; if doesnt - tumor - adrenal? pituitary? 

3. 24 hour urine (free cortisol levels)  - waste first; signs everywhere ; lab for instructions - ice? preservatives? 

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Cushings - TX

1. Pituitary ? - Hypophysectomy 

2. Adrenal ? - Adrenalectomy 

3. reduce/discontinue exogenous steroids 

4. Na restriction, low carbs diet

Increase Ca + vit D , protein and ambulation 

Fluid restrictions 

Emotional support 

24

Addisonian Crises 

Causes - both adrenal glands removed , abruptly stopped taking steroids (due to nausea?)

Life threatening event !!!

Decrease in Na and BP

Increase in K - tx: insulin drip (push K into the cell); Kayexalate (NG, PO, enema) and HR

TX: IV steroids replacement 

Fluid replacement 

Hypoglycemia  - D5W, D10W, Glucagon 

25

Addisons - S/s 

Decrease in mineral (aldosterone) and glucocorticoids (cortisol) 

1. Lethargic, weakness

2. Hypoglycemia - sweating, confusion, shakiness, tremors 

3. Postural hypotension

4. Weight loss - due to GI disturbances 

5. Bronze pigmentation of skin 

6. Mental instability - severe psychosis 

26

Addisons - TX

Lifelong hormone replacement therapy (Pt. and family teaching ) 

1. Cortisone , Hydrocortisone, Prednisone - in the am with breakfast - decrease GI upset - replace glucocorticoids 

2. Florinef (fludrocortisone) - replace mineralocorticoids 

Wear med. alert bracelet 

27

Primary Aldosteronism 

Increase in aldosterone 

1. Na + H2O retention 

2. Decrease in K + hydrogen ions - metabolic alkalosis 

DX: Abnormal electrolytes 

Renin (decrease) - aldosterone (increase) stimulation test 

TX: correct electrolytes imbalances ; Adrenalectomy (abdom. insicion)  if hyperplasia or tumor of adrenal gland 

28

Pheochromocytoma 

adrenal medulla disorder - tumor 

Increase in catecholamines - epinephrine + norepinephrine 

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Pheochromocytoma - S/s - 5 Hs

1. Headache - vasoconstriction 

2. Hypertension - severe - stroke ! - Hypertensive crisis 

3. Hyperhidrosis - excessive sweating 

4. Hyperglycemia - liver starts converting glycogen to glucose 

5. Hypermetabolism 

** Tachycardia 

30

Vanillylmandelic acid (VMA) - 24 hour urine test 

DX of Pheochromocytoma 

by-product of cathecholamine metabolism 

+ CT and MRI of adrenal gland 

31

Pheochromocytoma - NC

1. Avoid stimulants - coffee, chocolate

2. Do not palpate the abdomen - prevent tumor stimulation 

3. Pre-op - TX BP+ HR - Regitin 

32

Regitin 

alpha-adrenergic blocker; tx of HTN (phenochromocytoma); also tx of extravasation of vasoconstrictive meds (e: dopamine) to vasodilate the area 

33

Hypertensive crisis - TX

1. Nipride - vasodilator (smooth muscle relaxant) - IV drip - immediate reduction of BP - Monitor BP - A-line 

2. CCB 

34

Hormones secreted by thyroid gland 

1. T3 - triiodothyronine - 20% more potent 

2. T4 - thyroxine - 80 % 

3. Calcitonin - decrease blood calcium levels - buildup of bone 

35

Hyperthyroidism - S/s 

1. Nervous + irritable 

2. Palpitations, chest pain - increased metabolism - increased catecholamines 

3. Flushed skin

4. heat intolerance 

5. Weight loss 

6. Goiter 

7. Bulging eyes - Exophthalmos - fatty deposits behind eyes - Graves disease  (autoimmune)- artificial tears, patch eyes (at night) 

36

Hyperthyroidism - DX

1. Labs - Increase in TSH 

2. Thrill + bruit over thyroid gland -palpate 

3. Radioactive iodine 123 (short acting, no precautions) thyroid scan 

4. Ultrasonography + EKG 

37

Hyperthyroidism - TX - Radioactive iodine 131 

Long acting; Goal - destroy part of the thyroid gland - get pt. into euthyroid state (normal) 

SE: Hypothyroidism 

Radiation precautions 2 weeks - 1mo (avoid children, pregnant women) 

Avoid products with iodine - multivitamins, cough syrup, table salt 

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1. Propylthiouracil (PTU)

2. Tapazole (Methimazole)

Antithyroid medications - black box warning 

1. SE: liver failure 

2. SE: birth defects 

Takes time to work - 3-4 weeks for improvement 

39

Lugol's solution

SSKI

Iodine solutions - TX of hyperthyroidism 

Pt. drinks - mix with milk or water; use straw; - decreases amount of T3 + T4

Can be used pre-op to shrink thyroid gland - reduce vascularity ( decrease blood flow )

40

Thyroidectomy - subtotal or total (cancer)-  post op NC

1. Support neck 

2. Assess voice - laryngeal nerve damage ? - speak 

3. Airway !!! - edema ? bleeding ?

4. Stridor - emergency - blocked airway 

5. Vitals, trach tray at bedside 

6. Check dressing (look behind) ; JP 

41

Thyroid Storm or Crises - S/s 

due to uncontrolled hyperthyroidism (Grave's disease) - often triggered by stressor ( trauma, infection, post-op) 

1. Tachycardia 

2. Hypertension - tx: beta-blockers 

3. Fever - even 1 degree increase - report 

42

Thyroid storm - TX

1. Cooling blankets; ice packs; Tylenol ( No Aspirin !!!) 

2. O2

3. Fluid, glucose, antithyroid meds - Propylthiouracil + Tapazole

43

Hypocalcemia - S/s 

Ca 9-10.5 

due to hypoparathyroid; parathyroid gland can be removed during thyroidectomy 

1. Numbness + tingling - fingers, toes, around mouth 

2. Chvostek's (facial nerve twitching) + Troussea's signs (carpopedal spasm)

3. Laryngeal  spasm + hyperreflexia 

* Watch for tetany 

 

44

Hypocalcemia - TX 

1. Calcium gluconate IV - mix with D5W  not NS 

2. Phosphate binding meds - Phoslo ( calcium acetate); Dialume (aluminum hydroxide); Renagel

3. Diet high in Ca + Vit D; low in P - milk + dairy products high in both 

45

Hypoparathyroid - S/s 

1. Decrease in PTH 

2. Hypocalcemia 

46

Hyperparathyroid - S/s 

1. Increase in PTH 

2. Hypercalcemia - decrease in excitability of NS - hypoactive 

  • brittle bones
  • kidney stones (55%)
  • muscle weakness 
  • fatigue and mental confusion 
  • over time - stenosis 

 

47

Hyperparathyroid - DX

PTH levels 

Increase in Ca levels 

Decrease in P levels 

X-rays of bones 

48

Hyperparathyroid - Parathyroidectomy 

remove 2-3 out of 4 glands to get pt in normal state 

1. Hydration !!! 2L/day - helps flush kidneys, prevent formation of kidney stones

2. Loop diuretics - help toexcrete Ca 

3. Ambulation, exercise to strengten the bone 

4. Oral or IV Phosphate 

5. Diet low in Ca

6. Calcitonin - pushes Ca back into the bone - High allergic reaction !!!

49

Hypothyroidism - S/s 

Screening @ age 35 (every 5 years after) 

1. Extreme fatigue

2. Hair loss

3. Dry skin, brittle nails

4. Cold intolerence 

5. Facial + Eyelid edema - deposits of mucus 

6. Bradycardia 

7. Weight gain 

8. Flat affect, slow mental process 

50

Myxedema 

severe hypothyroidism - can lead to coma - thickening + swelling of the skin 

51

Synthroid 

Levothyroid 

synthetic thyroid replacement - life long ;

Takes time to work - 3-4 weeks

Admin. in am on an empty stomach ; same time each day; full glass of water 

Monitor labs - start on low dose - increased metab. - increase demand for O2 

52

Hypothyroidism - labs 

Increase in TSH 

Decrease in T3 + T4