master gland! - integration of neuroregulatory - critical link between CNS and endocrine - major controller of anterior, posterior pituitary

3 Endocrine Flashcards by Kara S

function: pituitary gland

many

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function: thyroid & parathyroid

metabolism, bones

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function: adrenals

stress response, sugar, electrolytes

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function: testes

male characteristics

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function: ovaries

female characteristics

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function: pancreas

glucose

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function: thymus

immune response

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function: pineal

body rhythms

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hypothalamus

master gland!

integration of neuroregulatory
critical link between CNS and endocrine
major controller of anterior, posterior pituitary

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HP & POA

hormones, pituitary & posterior: oxytocin ADH

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hypopituitarism: GH

children: small stature
adults: osteoporosis

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somatomedin c

stimulated by GH

bone and cartilage maintenance

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hypopituitarism: LH, FSH

men

decreased facial & body hair, libido, muscle mass
impotence
facial wrinkles

women

amenorrhea, anovulation
breast atrophy
decreased libido, axillary and pubic hair
loss of bone density

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*hypopituitarism assessment

LOOK AT CLIENT
some hormones measured directly
indirectly: T3 & T4 for TSH
- stimulation tests: insulin > increased GH, ACTH
- changes in sella turcica: MRI, CT
- hormone replacement necessary for the rest of their lives

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hyperpituitarism most common cause

pituitary adenoma (benign tumor)
- tumor grows, neurological & endocrine issues emerge (HA, visual changes, intracranial pressure)

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hyperpituitarism: GH

gigantism before puberty
acromegaly: adult (high blood sugar = red flag)

antagonist to insulin

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hyperpituitarism: GH manifestations

organomegaly (larger larynx = deeper voice, larger tongue = dysphagia)
hypertension

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hyperpituitarism interventions

drug therapy
radiation therapy
surgery

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*bromocriptine mesylate

Parlodel

*dopamine agonist given for hyperpituitarism
side effects: GI, orthostatic hypotension

disorders of posterior pituitary

remember; HP & POA (oxytocin, ADH)

ADH deficiency: diabetes insipidus, polyuria -> dehydration, skin dry/turgor change
- neuro: irritability, lethargy > coma
- manage with vasopressin
ADH excess: SIADH, GI disturbances, hyponatremia due to free water retention
- neuro: lethargy > coma
- manage with diuretics, NaCl

*Addison’s Disease

adrenal cortical hypofunction

*requires 90% destruction of gland
bronze skin, hirsutism

Addison’s Disease causes

idiopathic atrophy (autoimmune) - 60 to 70% of US cases
granulomatous disease (TB most common in 3rd world)
metastases (especially lung and melanoma)

reduced cortisol results

HYPOGLYCEMIA (decreased gluconeogenesis)

seizures, confusion, combative
GFR, gastric acid production decreases -> increased BUN, anorexia, weight gain
muscle weakness, fatigue

reduced aldosterone

HYPOKALEMIA (K excretion decreased)

K retention promotes reabsorption of H+ > acidosis
Na+, H20 excretion increased > hyponatremia, hypovolemia

Addisonian Crisis

life-threatening event in which physiologic need for gluco and mineralocorticoid hormone is greater than supply - usually result of stressful event

Addisonian Crisis s/s

- profound fatigue - dehydration - vascular collapse - renal shutdown - hyponatremia - hyperkalemia

Florinef

fluocortisone - treatment for hypoaldosteronism, Addison's Disease - counterproductive effect with diuretics DO NOT GIVE WITH DIURETICS - always assess cardiovascular status, ESPECIALLY elderly

adrenal insufficiency: diagnostic assessments

ACTH stimulation test = most definitive

*Cushing's disease

adrenal gland hyperfunction

*Cushing's syndrome

hypercortisol

*hyperaldosteronism

excessive mineralocorticoid OR excessive androgen production

*pheochromocytoma

tumor = hyperstimulation of adrenal medulla - excessive secretion of catecholamines (80% epi, 20% norepi): HR, BP - *HYPERTENSION hallmark of disease (doesn't resolve with dose of anti-hypertensive) - do NOT palpate abdomen

Cushing's Syndrome causes

- pituitary adenoma (Cushing's disease) - adrenal cortical adenoma, carcinoma - ACTH-producing non-adrenal, non-pituitary tumor (lung, others) - iatrogenic (anti-inflammatory therapy) - self-administered (body builders, etc)

Cushing's Syndrome s/s

- increased fat due to low turnover of plasma fatty acids: moonface, central adiposity + striae - increased breakdown of protein - decreased production of lymphocytes - htn, hyperpigmentation, hypokalemia, hyperglycemia

pheochromocytoma treatment

adrenalectomy | corticosteroids for rest of life

assessing thyroid function

TSH - best screening test in outpatient setting

Grave's Disease

hyperthyroidism - toxic, diffuse goiter - exopthalmia - heat intolerant - tachycardia, dysrhythmias - SOB w/ w/o exertion - weight loss, increased appetite, diarrhea increase protein to prevent neg nitrogen! increase calories and carbs!

thyroidectomy complications

- damage to laryngeal nerve | - hypoparathyroidism - hypocalcemia

hypoparathyroidism

hypocalcemia - increased neuromuscular activity > tetany IV CALCIUM GLUCONATE!

hypothyroidism

- main cause (US): thyroid surgery, radioactive iodine treatment for HYPER - most common in women 30-60 - decreased metabolic rate!

myxedema coma

usually in hypothyroid patients subject to stress - clinical features: CHF!, hypothermia, stupor/coma, hypoventilation/respiratory failure, hyponatremia, hypotension, seizures, hypoglycemia

levothyroxine

(synthroid) treatment for hypothyroidism - synthetic T4 - converts to T3 - speeds up metabolism - be careful not to induce THYROTOXICOSIS

PTH normal function

increased: - bone resorption - Ca resorption (urine) - calcitrol (Ca absorption from gut) stimultates: - new osteoid formation ready for calcification during increase of dietary calcium

hyperparathyroid

HYPERCALCEMIA! - increased bone resorption - depressed serum P - hypercaluria - decreased neuromuscular irritability

hypoparathyroid

- decreased bone resorption - depressed Ca serum - elevated serum P - increased neuromuscular activity = TETANY

hyperparathyroid management

- diuretic + fluid therapy - drugs - surgical management

hypoparathyroid management

- focus on correcting hypocalcemia, vitamin D deficiency | - avoid P (milk, yogurt, processed cheese)