Endocrine System Flashcards
(73 cards)
1
Q
What are the major hormone secreting organs?
A
- Hypothalamus
- Pineal
- Pituitary
- Thyroid
- Parathyroid
- Adrenals
- Islets of Langerhans (pancreas)
- Ovaries
- Testes
2
Q
What controls the Endocrine system?
A
Negative feedback mechanism
3
Q
Anterior Pituitary Gland
Hormones released
A
- Follicle Stimulating Hormone (FSH)
- Luteinizing Hormone (LH)
- Prolactin
- Adrenocorticotropic Hormone (ACTH)
- Thyroid Stimulating Hormone (TSH)
- Growth Hormone (GH)
4
Q
Posterior Pituitary Gland
Hormones Released
A
- Antidiuretic Hormone (ADH) (vasopressin)
- Oxytocin
5
Q
Hyper Anterior Pituitary Gland
Conditions
A
- Cushing’s syndrome: ACTH
- Gigantism: GH (growing very tall)
- Acromegaly: GH (enlarged bones, facial features, organs)
6
Q
Hypo Anterior Pituitary Gland
Conditions
A
- Addison’s Disease: ACTH
- Dwarfism: GH
- Panhypopituitarism
7
Q
Hyper Posterior Pituitary Gland
Conditions
A
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
8
Q
Hypo Posterior Pituitary Gland
Conditions
A
Diabetes Insipidus (DI)
9
Q
Diabetes Insipidus
Definition
A
ADH (vasopressin) deficiency due to injury to hypothalamus or pituitary gland
10
Q
Diabetes Insipidus
Causes
A
- Central (Brain) Tumor
- Nephrogenic: Kidney Injury
- Dipsogenic: defect in the hypothalamus
- Gestational: pregnancy induced
11
Q
Diabetes Insipidus
Clinical Manifestations
A
- Large amounts of diluted urine
- Extreme thirst
- Patient craves a LOT of cold water *(2L - 20L/day)
12
Q
Diabetes Insipidus
Diagnostics
A
- Daily weight
- Strict I&Os
- Specific gravity & osmolality
- Increased serum osmolality
- Elevated serum sodium levels
- Low plasma ADH levels
13
Q
Pituitary Tumors
A
- Almost all are benign and slow growing
- Diagnosed through visual acuity exam, CT, MRI, serum levels of pituitary hormones
- 90% are chromaphobic tumors: produce no hormones, destroy the pituitary gland
- Eosinophilic tumors cause giantism or acromegaly
- Basophilic tumors cause hyper-adrenalism (Cushing’s syndrome)
14
Q
Syndrome of Inappropriate Antidiuretic Hormone Secretion
Definition
A
Failure of negative feedback system that regulates secretion of ADH
15
Q
Syndrome of Inappropriate Antidiuretic Hormone Secretion
Clinical Manifestations
A
- Cannot excrete a dilute urine
- Fluid retention
- Hyponatremia (dumping sodium)
16
Q
Syndrome of Inappropriate Antidiuretic Hormone Secretion
Causes
A
- Can originate from lung disorders: bronchial cancers, pneumothorax, severe pneumonia
- Malignant tumors on other organs (cancer cells synthesize and release ADH)
- Can also result from central nervous system: head injury, brain surgery or tumor, infection stimulating pituitary gland
17
Q
Thyroid Gland
Hormones released
A
- T3: more potent and rapid acting than T4
- T4
- Calcitonin: secreted in response to high plasma calcium; increases calcium deposit in bone
18
Q
Thyroid Gland
Function
A
Controls cellular metabolic activity
19
Q
Thyroid Gland
Diagnostic Tests
A
- TSH
- Serum Free T4 (Thyroxine): 0.7 - 2.0 ng/dL
- Total serum T3 and T4
- T3 Resin Uptake Test
- Thyroid antibodies
- Radioactive iodine uptake
- Fine Needle Biopsy
- Tyroid scan, radioscan, or scintiscan
- Serum thyroglobulin
20
Q
Medications that can affect Thyroid Test Results
A
- Amiodarone
- Aspirin
- Cimetidine
- Diazepam
- Estrogens
- Furosemide
- Glucocorticoids
- Heparin
- Lithium
- Phenytoin and other antiseizures
- Propranolol
- Methimazole
21
Q
Hypothyroidism
Definition
A
- Suboptimal levels of thyroid hormone
- Affects all body functions
- Ranges from mild, subclinical forms to advanced life-threatening forms (ie. myxedema)
22
Q
Hypothyroidism
Causes
A
> 95% are from primary dysfunction of the thyroid gland
* Autoimmune disease
* Atrophy of the thyroid gland from aging
* Infiltrative diseases of the thyroid: amyloidosis, scleroderma, lymphoma)
* Iodine deficiency or excess
* Medications (e.g., Lithium)
* Radioactive iodine
* Therapy for hyperthyroidism
* Thyroidectomy
* Radiation to the head and neck
Central causes:
* Problems with the pituitary (decreased TRH)
* Problems with the hypothalamus (decreased TSH)
23
Q
Hypothyroidism
Clinical Manifestations
A
Could be very vague for some patients
* Brain fog, confusion, lethargy
* Coarse, dry, brittle hair
* Loss of lateral eyebrows
* Pallor
* Large Tongue
* Cold intolerance
* Slow pulse, enlarged heart
* Constipation
* Weight gain
* Peripheral edema
* Muscle weakness/aches
* Disturbed menstrual cycles
24
Q
Hypothyroidism
Gerontologic Considerations
A
- Increases with age
- Most often in women
- Can be mistaken for other symptoms
- Atypical manifestations - can be blurred between hypo- and hyper-
- Constipation is common and not noteworthy as a symptom
- Angina can occur with rapid replacement
- Tachyarrhythmias may worsen with treatment
25
**Hypothyroidism**
Medical Treatment
* Synthetic thyroxine *(Levothyroxine)* 75-150 mcg/day
* Slowly increase until TSH and FT4 levels normalize
* Monitor T3 and T4
* Prevent medication interactions *(warfarin, insulin, oral hypoglycemics, estrogen, vitamin supplements)*
* Prevent disease progression and complications
26
**Hypothyroidism**
Complications
* Cardiac dysfunction
* Increased serum cholesterol
* Atherosclerosis/CAD
* Angina
* Arrhythmias
* Myxedema coma
27
**Hypothyroidism**
Nursing Management
* Monitor vital signs: looking for low HR, arrhythmias, low BP, RR
* Monitor for Chest Pain/Angina
* Monitor for heat/cold intolerance: Provide blankets, discourage heating pads, protect from drafts
* Monitor for s/s of constipation: encourage fluids, fiber, and activity
* Monitor neurologic orientation
* Monitor for s/s of Myxedema: decreased LOC, decreased VS, difficulty to arouse
* Educate pt and family on prevention of Myxedema - DO NOT skip medications
* Promote self-care
* Educate on preventing infection *(can induce Myxedema coma)*
* Educate on medication regimen: Take Levothyroxine 1st thing in the morning, drug interactions, s/s of under or overdosing
28
**Hyperthyroidism**
Definition
* A form of thyrotoxicosis resulting from an excessive synthesis and secretion of thyroid hormones
* Affects women **eight** times more than men
29
**Hyperthyroidism**
Causes
* Most common: Graves disease *(autoimmune)*
* Toxic multinodular goiter
* Toxic adenoma
* Thyroiditis *(inflammation of thyroid)*
* Excessive ingestion of thyroid hormone
30
**Hyperthyroidism**
Clinical Manifestations
* Fine hair
* Nervousness, restlessness, anxiety, insomnia
* Bulging eyes *(Exopthalmos)*
* Goiter
* Sweating, heat intolerance
* Tachycardia, palpitations, elevated Systolic BP
* Muscle wasting
* Weight loss
* Increased appetite
* Fine tremors
* Oligomenorrhea *no menstrual cycles)*
* Red rash on legs
31
**Hyperthyroidism**
Medical Management
* Radioactive Iodine Therapy
* Medications
* Surgery
32
**Hyperthyroidism**
Medications
* **Methimazole** *(check for signs of agranulocytosis - LOW Neutrophil levels)*
* **Propylthiouracil**
* **Sodium or potassium iodine solutions**
* **Dexamethasone**
* **Beta Blockers** *(to lower HR, BP)*
33
**Hyperthyroidism**
Nursing Management
* Maintain adequate Cardiac Output: monitor VS, rhythms
* Improve nutritional status: encourage small frequent meals, nutrition consult
* Maintain normal body temp: provide cool environment
* Enhance coping: emotional support, reassurance, reduce anxiety
* Monitor for thyroid storm *(cardiac and respiratory symptoms)*
* Educate about medication regimen
34
**Thyroid Tumors**
Classifications
***Benign or malignant***
**Endemic (Iodine deficient) Goiter:**
* Caused by stimulation of the pituitary gland that excretes TSH
* Insufficient iodine availability to produce thyroid hormone
* Usually minimal symptoms except goiter
* reversed with iodine supplement
**Nodular Goiter:**
* Caused by hyperplasia *(overgrowth)*
* Can become malignant or cause hyperthyroid state
* Can require surgical removal
35
**Thyroid Cancer**
Risk Factors
* Smoking
* Decreased physical activity
* High stress
* Unhealthy eating habits *(processed foods, less vegetable intake)*
* Radiation of the head, neck, or chest in childhood
36
**Thyroid Cancer**
Diagnostics
* Biopsy
* U/S
* CT
* MRI
* Serum Thyroid hormone levels
37
**Thyroid Cancer**
Facts
* Less prevalent than other forms of cancer, but incidence has tripled over last 30 years
* Accounts for 90% of endocrine malignancies
* Women are 3x more likely than men to develop
* Median age is < 50
38
What is the treatment of choice for thyroid cancer?
**Thyroidectomy**
possible radioactive iodine after surgery to minimize metastasis
39
**Thyroidectomy**
Pre-Operative Goals
Reduction of stress and anxiety to avoid precipitation of a thyroid storm
40
**Thyroidectomy**
Post Operative Education
* Dietary guidance to meet patient's new metabolic needs
* Avoidance of caffeinated beverages and other stimulants
* Explanation of tests and procedures
* Head and neck support used after surgery
41
**Thyroidectomy**
Nursing Management
* Monitor airway/breathing due to edema of glottis, hematoma, or injury to laryngeal nerve
* Have tracheostomy tray at bedside for respiratory distress
* Assess anterior and posterior neck for hemorrhage/hematoma
* Monitor drains for output *(should be a lot initially, then slow down)*
* Give IVF as ordered
* Test swallowing
* Give ice chips initially, then soft or liquid diet
* If parathyroid was injured or removed, monitor serum calcium levels
42
What is the function of the parathyroid?
***Four glands on the posterior thyroid gland***
* Produces parathyroid hormone to regulate calcium and phosphorous balance
* Increased PTH elevates serum calcium by increasing calcium absorption from the kidney, intestine, and bone
* PTH lowers phosphorous levels
43
**Hyperparathyroidism**
Definition
* Overproduction of PTH = bone decalcification and development of renal calculi
* Occurs 2-4 times more often in women
* Median age 60-70
44
**Hyperparathyroidism**
Clinical Manifestations
* May have no symptoms
* Apathy
* fatigue
* muscle weakness
* nausea
* vomiting
* constipation
* hypertension
* cardiac disrhythmias
45
**Hyperparathyroidism**
Medical Management
* Surgical removal: Parathyroidectomy
* Hydration due to renal calculi risk *(> 2000mL)*
* Encourage activity due to increased serum calcium and bone density loss
* Avoid excess calcium in the diet *(dairy, seeds, leafy greens, almonds, calcium fortified foods)*
46
**Hyperparathyroidism**
Nursing Management
* Monitor for s/s of apathy, fatigue, muscle weakness, n/v, constipation, HTN, cardiac arrhythmias
* Monitor serum calcium/phosphorous balance
* Encourage fluid intake
* Monitor for s/s of kidney stones: flank pain, frequency, urgency, sediment in urine
* Monitor for Hypercalcemic crisis *(Ca++: > 13 mg/dL)*: neuro, CV, and kidney symptoms = rapid rehydration with high volume isotonic solutions (with UO of 100-150/hour); give mithramycin and calcitonin as ordered
* Educate patient on diet, risk for fractures, and treatment regimen
47
**Hypoparathyroidism**
Causes
* Abnormal parathyroid development
* Destruction of the parathyroid glands *(surgical removal or autoimmune response)*
* Vitamin D deficiency
48
**Hyperparathyroidism**
Diagnostics
* Persistent elevation of Serum Calcium levels
* Elevated PTH
* Radioimmunoassays
* Ultrasound
* MRI
* Thallium scan
* Fine Needle Biopsy
49
**Hypoparathyroidism**
Diagnostics
* Serum Calcium < 8mg/dL and high serum phosphate
* Positive Chvostek or Trousseau signs
* Increased bone density
50
**Hypoparathyroidism**
Clinical Manifestations
* Tetany
* numbness
* tingling in extremities
* stiffness of hands and feet
* bronchospasm
* laryngeal spasm
* carpopedal spasm *(Trousseau sign)*
* anxiety
* irritability
* depression
* delirium
* ECG changes
51
**Tetany**
General muscle hypotonia with tremor and spasmodic or uncoordinated contractions occuring with or without efforts to make voluntary movements
Can include hyperreflexia
52
**Chvostek Sign**
A sharp tapping on the facial nerve just in front of the parotid gland, anterior to the ear causes spasm or twitching of the mouth, nose, and eye
53
**Trousseau Sign**
Carpopedal spasm is induced by occluding the blood flow to the arm for three minutes with a blood pressure cuff
54
**Hypoparathyroidism**
Medical Management
* Increase serum Ca++ levels to 9-10 mg/dL
* Diet high in calcium, low in phosphorous
* Give Tums
* Give combo of calcium, magnesium, ergocalciferol, or calcitriol
* Thiazide diuretics to **decrease** urinary calcium excretion
**Severe hypocalcemia**
* IV Calcium Gluconate
* Sedatives: Pentobarbital
* Mechanical ventilation
55
**Hypoparathyroidism**
Nursing Management
* Administer calcium gluconate in severe hypocalcemia as ordered
* Monitor for fatal arrhythmias if giving calcium with patients on digoxin
* Monitor post-op thyroidectomy, parathyroidectomy, or radical neck dissection for: Tetany, Chvostek's or Trousseau's, seizures, respiratory difficulties
* Patient Education: treatment, diet high in Ca++, low in phosphorus, complications *(seizures, cardiac arrhythmias, cardiac arrest)*, seizure precautions, follow up appts, testing
56
Functions of the
**Adrenal Medulla**
Part of the autonomic nervous system
Releases **catecholamines**: **epinephrine** and **norepinephrine**
57
Functions of the
**Adrenal Cortex**
Releases:
* Glucocorticoids: Glucose metabolism = cortisol ⬆️, blood glucose ⬆️
* Mineralcorticoids: effect electrolyte metabolism; act on renal tubular and GI epithelium = sodium⬆️, potassium⬇️
* Androgens = sex hormones
58
**Adrenocortical Insufficiency**
Definition
* AKA: Addison's disease
* Adrenal suppression by exogenous steroid use
or
* Result of dysfunction of HPA (Hypothalamus-pituitary axis) feedback loop = insufficient production of steroids by the adrenal gland
59
**Addison's Disease**
Clinical Manifestations
* Muscle weakness
* Anorexia
* GI symptoms
* Fatigue
* Dark pigmentation of skin and mucosa
* Hypotension
* Low blood glucose
* Low serum sodium
* High serum potassium
* Apathy
* Emotional lability
* Confusion
60
**Addisonian Crisis**
* Shock
* hypotension
* rapid/weak pulse
* Rapid RR
* Pallor
* extreme weakness
61
**Addison's Disease**
Diagnostics
* Adrenocortical hormone levels
* ACTH levels
* ACTH stimulation test
62
**Addison's Disease**
***(Adrenocortical Insufficiency)***
Medical Management
* Combat circulatory shock
* Restore blood circulation
* IVF administration 3-4 L NS or 5% Dextrose
* Monitor VS
* Give hydrocortisone and/or vasopressors *(for severe hypotension)*
* Antibiotics for chronic immune suppression
63
**Addison's Disease**
***(Adrenocortical Insufficiency)***
Nursing Management
* Monitor for F&E imbalances
* VS
* Monitor for orthostatic hypotension
* Restore fluids as ordered
* Encourage fluid intake
* Monitor I&Os
* Give corticoid steroids as ordered
* Educate pt/family on life-long medication regimen *(do not stop suddenly)*, side effects, dosages
* Monitor for Addisonian crisis *(rapid, weak pulse, rapid RR, pallor, extreme weakness)*
* Explain rationale to minimize stress during acute crisis and gradually increase activity
64
**Cushing's Syndrome**
Definition
Excessive adrenocortical activity or corticosteroid medications
65
**Cushing's Syndrome**
Clinical Manifestations
* Hyperglycemia
* Central-type obesity with a "buffalo hump"
* heavy trunk and thin extremities
* Fragile, thin skin
* Ecchymosis
* Striae
* Weakness
* Lassitude
* Sleep disturbances
* Osteoporosis
* Muscle wasting
* Hypertension
* Moon face
* acne
* infection
* slow healing
* Virilization in women
* Loss of libido
* Mood changes
* Increased serum sodium
* Decreased serum potassium
66
**Cushing's Syndrome**
Diagnostics
Dexamethasone suppression test
67
**Cushing's Sundrome**
Medical Management
**Pituitary induced:**
* Surgical removal of the pituitary gland *(Hypophysectomy)*
* Radiation of pituitary gland\
**Adrenal Gland induced:**
* Adrenalectomy
* Adrenal enzyme inhibitors
**Exogenous corticosterioid use:**
* Reduce or taper dose
* Insulin therapy for hyperglycemia
68
**Cushing's Syndrome**
Nursing Management
* Monitor for Addisonian crisis after surgery or withdrawal of steroids
* Mantain adequate cardiac function
* Decrease risk for injury: fall prevention, avoid injury to bones/soft tissue
* Decrease risk of infection: avoid placing with other patients with infections; assess s/s of infection due to decreased inflammatory response
* Promote skin integrity: fragility of skin, assess bony prominences
* Improve body image due to weight gain/edema
* Improved coping: provide emotional support to pt and family due to mood swings, irritability, and depression
69
**Which of the following hormones is produced by the anterior pituitary gland?**
**a.** oxytocin
**b.** Luteinizing Hormone
**c.** Antidiuretic Hormone
**d.** Melatonin
**b. Luteinizing Hormone**
70
**What is the primary feedback mechanism that regulates pituitary hormone secretion?**
**a.** Positive feedback
**b.** Negative feedback
**c.** Direct stimulation
**d.** Neural feedback
**b. Negative feedback**
71
**Which hormone is primarily responsible for stimulating growth in children?**
**a.** Thyroid Releasing Hormone
**b.** Prolactin
**c.** Growth Hormone
**d.** Luteinizing Hormone
**c. Growth Hormone**
72
**Which of the following symptoms is indicative of a pituitary tumor?**
**a.** Sudden weight loss
**b.** Visual disturbances
**c.** Increased appetite
**d.** Hair loss
**b. Visual disturbances**
73
**Which hormone is primarily involved in the body's stress response?**
**a.** Thyroid Stimulating Hormone
**b.** Adrenocorticotropic Hormone (ACTH)
**c.** Growth Hormone
**d.** Luteinizing Hormone
**b. Adrenocorticotropic Hormone (ACTH)**
