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Pathophysiology > Final: Ch 32 Disorders of Endocrine Control of Growth & Metabolism > Flashcards

Final: Ch 32 Disorders of Endocrine Control of Growth & Metabolism Flashcards

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1
Q

anterior pituitary produces which hormones

A

GH

TSH, FSH

ACTH

LH

prolactin

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2
Q

posterior pituitary produces what hormones

A

ADH

Oxytocin

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3
Q

definition of hypo function

A

decreased gland function for any reason

congenital absence of gland or lack of enzyme

destruction by low blood flow, infection, inflammation, autoimmune rxn

aging decreases function, hormone receptors down-regulated

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4
Q

definition of hyper function

A

increased hormone production for any reason

overstimulation or tumor

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5
Q

primary disorders

A

in the gland itself

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6
Q

secondary disorders

A

result from altered stimulation of a normal gland

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7
Q

tertiary disorders

A

result from destruction of the hypothalamus

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8
Q

pituitary tumors are mostly ______

A

adenomas

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9
Q

symptoms of pituitary tumors depend on…

A

hormone secreted

can produce headache, n/v, visual disturbance

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10
Q

carcinoma of pituitary

A

uncommon

may need surgical removal

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11
Q

hypo pituitarism

A

decreased secretion of pituitary hormones

seen when 3/4 of anterior pituitary destroyed

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12
Q

symptoms of hypo pituitarism

A

weakness, fatigue

low appetite, sexual function

cold intolerance

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13
Q

sequence of loss for hypo pituitarism

A

look for the ademona (GH, LH, FSH, TSH, ACTH)

ACTH loss most serious –> adrenal insufficiency

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14
Q

Dx, Rx of hypo pituitarism

A

test for pituitary hormone levels

treat cause

replace hormones

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15
Q

assessment of hypothalmic-pituitary function

A

blood tests: ACTH, cortisol, PL, TSH, T3/4, FSH, LH, GH,

plasma/urine osmolarity

MRI of hypothalamus/ant pit

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16
Q

growth hormone (somatotropin) release is controlled by

A

GHRH and GHIH (somatostatin)

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17
Q

growth hormone is stimulated by

A

low BS

high aa

stress

exercise

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18
Q

what does growth hormone stimulate

A

growth via IGF-1 by upping protein synthesis

cartilage growth

bone growth

endocrine organ growth

muscle growth

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19
Q

growth hormone has anti-____ effects

A

insulin

ups lipolysis

lowers glucose use

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20
Q

definition of short stature in children

A

hight less than 3rd percentile or slow linear growth

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21
Q

treatment of short stature in children

A

rule out endocrine causes

test GH, IGF-1 levels

use bone x-ray to assess bone age

MRI or CT of hypothalamus/pituitary

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22
Q

idiopathic short stature

A

genetic/familial

correct patent’s height for sex and average

are the kids normally proportioned?

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23
Q

constitutional short stature

A

common in boys > girls

growth delay

late development/puberty/growth spurt

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24
Q

GH deficiency in children is from?

A

from lack of GHRH or from pituitary lack of GH (give GH)

inability to produce GH receptors (give IGF-1)

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25
GH deficiency in adults
can be present from childhood or develop in adulthood increases central obesity and atherosclerosis risk
26
GH production ____ with age
falls marketed as the fountain of youth
27
Dx Rx of GH deficiency in adults
Dx: stimulation test with insulin or L-dopa Rx: GH replacement, higher lean body bass, bone density, GF
28
tall stature in children
constitutional tall stature: tall vs. peers Marfan's XYY excessive sex hormones or GH
29
GH excess in children causes
gigantism high GH --> high IGF prior to closure of epiphyseal plates
30
causes of excessive GH in adults
GH secreting pituitary adenoma
31
symptoms of excessive GH in adults
acromegaly - soft tissue and flat bone growth deep voice, and malocclusion insulin resistance headaches visual disturbances
32
Rx of excessive GH in adults
correct metabolic abnormality remove tumor GH analogs stimulate neg feedback inhibition of GH
33
precocious puberty
early activation of hypothalmic-pituitary-gonad-axis early development of secondary sex characteristics idiopathic or from abnormality treatment depends on cause
34
anatomy of thyroid
gland located inferior and anterior to larynx contains colloid filled follicles colloid contains thyroglobulin
35
in the thyroid, iodine is captured by
Na+/I- co-transporter active process stimulated by TSH
36
in the thyroid, iodine is moved into the colloid by ______
pendrin active process
37
iodine is oxidized and added to ______
tyrosine --> T3, T4 uses thyroid peroxidase
38
T3/T4 added to __ and stored in _____
TG, colloid
39
what causes release of T3/T4
TSH T4 = 90% of released hormone travels in plasma bound to TBG/other proteins
40
control of thyroid hormone secretion
stress and cold trigger TRH release from hypothalamus TRH triggers TSH release from ant. pit. TSH triggers T3/T4 production and release from TG negative feedback inhibition of TRH/TSH
41
effect of thyroid hormone on metabolic rate
increases for all tissues (glucose, fat, protein use increases) normal levels of T3/T4 needed for protein synthesis
42
in hyperthyroidism, muscle breakdown _____
increases --> fatigue fat mobilization and use increases
43
in hypothyroidism what happens to serum cholesterol
increases
44
effect of thyroid hormone on the cardiovascular system
CO, HR, contractility, blood volume, O2 use all increase
45
effect of thyroid hormone on GI
motility and secretion increase diarrhea in hyperthyroidism
46
effect of thyroid hormone on neuromuscular system
increases muscle tone --> tremors in hyperthyroid needed for infant brain development more CNS activity --> nervousness in hyperthyroid
47
congenital hypothyroidism causes
lack of gland lack of ability to synthesize T3/T4 or TSH
48
symptoms of congenital hypothyroidism
slow brain development/overall development jaundice respiratory/feeding difficulties from large tongue sluggishness/lack of interest umbilical hernia
49
Dx, Rx of congenital hypothyroidism
Dx: screening for T4 and TSH Rx: hormone replacement begun by 6 wks of age = normal intelligence
50
acquired hypothyroidism (myxedema) in children or adults
usually primary - hashimoto's can be from surgery, iodine deficiency, or too much iodine
51
symptoms of acquired hypothyroidism
hypo-metabolic state weight gain fatigue cold intolerance fluid accumulation low HR
52
Dx of acquired hypothyroidism
T3/T4, TSH testing anti-thyroid Ab test (anti-TPO)
53
Rx of acquired hypothyroidism
synthetic T3/T4
54
myxedematous coma
potentially fatal complication of severe hypothyroidism coma, hypothermia, hypoventilation, cardiac collapse, electrolyte imbalance
55
precipitating factors of myxedematous coma
cold sedatives (low drug metabolism in hypothyroidism)
56
Rx of myxedematous coma
manage fluid and electrolyte imbalances treat hypercapnea/hypoxia don't re-warm b/c cardiovascular collapse
57
2 causes of hyperthyroidism
Grave's disease (autoimmune, most common) adenoma
58
symptoms of hyperthyroidism
hyper-metabolic state nervousness, irritability, tachycardia weight loss exopthalamus (eye bulge) heat intolerance
59
Rx of hyperthyroidism
remove gland w/ surgery or radioactive iodine anti-thyroid drugs block production of T3/T4 and T4 -> T3 beta-blockers reduce sympathetic symptoms
60
grave's disease (hyperthyroid state)
most common in 20-40 yoa autoimmune disease - Ab stimulate TSHr cytokines activate fibroblasts behind orbit --> exophthalmos
61
thyroid storm
life threatening crisis of thyrotoxicosis (hyperthyroidism) caused by disease stress (infection, ketoacidosis) large spike in thyroid hormone
62
symptoms of thyroid storm
high fever tachycardia angina HF
63
treatment of thyroid storm
cool down fluids beta-blockers anti-thyroid drugs steroids for stress
64
adrenal cortex secretes
steroids aldosterone cortisol testosterone
65
adrenal medulla secretes
catecholamines
66
biosynthesis of cortical steroids
made from cholesterol using enzymes
67
cortisol and testosterone are secreted to ____
ACTH
68
aldosterone regulated by which system
RAA
69
adrenal sex hormones (T) has little to no impact on _____
males body hair growth in females?
70
aldosterone does what
act on kidney to retain Na and excrete K
71
hypothalamus is stimulated by multiple ____ factors
stress dimural variation peak at 6-8 am
72
metabolic effects of cortisol
gluconeogenesis protein catabolism lipid mobilization higher blood sugar
73
psychological effects of cortisol (pharma dose)
psychosis behavioral change
74
anti-inflammatory effects of cortisol pharma dose
inhibit prostaglandin synthesis
75
immune effect of cortisol pharma dose
lower cell and humoral immunity
76
adrenal suppression
long-term cortisol therapy suppresses adrenal function recovery takes months
77
tests for adrenal function
cortisol aldosterone ACTH
78
congenital adrenal hyperplasia
recessive enzyme deficiency - low cortisol high ACTH and androgens 21alpha-hydroxylase most common, 11beta-hydroxylase rare decreased aldosterone
79
females congenital adrenal hyperplasia
virilization of genitalia
80
Rx of congenital adrenal hyperplasia
replace missing hormones surgical reconstruction of genitalia
81
primary adrenal cortical insufficiency (addison's disease)
autoimmune destruction of entire adrenal cortex can be from cancer or infection causes hyperpigmentation and requires lifelong hormone replacement
82
secondary adrenal cortical insufficiency
caused by pit defect or cortical suppression by exogenous steroids aldosterone normal no increased ACTH so no hyperpigmentation
83
acute adrenal crisis
happens when a person w/ cortical insufficiency is stressed (infection or surgery) replace salt, sugar, and steroids support any failing functions treat cause
84
glucocorticoid excess (cushing's syndrome) 4 causes
overproduction of ACTH by pit tumor adrenal tumor non-pit tumor secreting ACTH long-term cortisol therapy
85
symptoms of cushing's
fat pads (buffalo hump) muscle atrophy Na retention --> HTN K+ loss diabetes
86
Dx of cushing's
tert urine for 24 hr cortisol excretion test blood for ACTH to determine cause
87
Rx of cushing's
surgery irradiation medication
88
Addison's produces low levels of _______ but high levels of ____
Cortisol, ACTH
89
Does Hashimoto's (hypothyroidism) cause high trophic hormone levels?
Yes
90
Does grave's (hyperthyroidism) cause lowered trophic hormone levels?
Yes
91
Does secondary adrenal cortex insufficiency cause lowered cortisol and ACTH?
Yes
92
Does acromegaly mean high GH and IGF-1?
Yes
93
Do defects in the 21 and 11 hydroxylase genes cause less cortisol and aldosterone, but high testosterone?
Yes

Pathophysiology (24 decks)

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