Assessment of the Endocrine Sys Flashcards
Hypothalamus - neuroendocrine func - affect glands; act on pit which then acts on something; biggest regulatory gland within sys
Pit - ant and post
Thyroid and parathyroid - neck
Adrenal - top kidneys
Pancreas - diabetes; upper abd
Testes and ovaries
Various glands with the endocrine sys
Endocrine glands secretes certain hormones - huge regulatory; helps maintain homeostasis
Secreted hormones are transported via blood to the target tissues: other glands or other target tissues
Whole cycle releasing hormones which act on other things - another gland or tissue
Endocrine system works with the nervous system to control overall body function and regulation including: - affects everything
Endocrine sys and hormones work on - feedback loop; hormonal cycles in sys - feedback
Overview endocrine sys
Metabolism
Nutrition
Elimination
Temperature
Fluid and electrolyte balance
Growth
Reproduction
Endocrine system works with the nervous system to control overall body function and regulation including: - affects everything
initial stimulating and releases certain hormones that then stimulate ant pit; produces ADH (vasopressin) and oxytocin - catecholomines: stored in post pit;
Corticotropin-releasing hormone: CRH (cause ant pit release ACTH/corticotropin which then acts on adrenal gland), thyrotropin-releasing hormone: TRH (acts on TSH and acts on thyroid to release T3/4), gonadotropin-releasing hormone: GnRH, growthing hormone releasing hormone: GHRH, growth hormone inhibit hormone: somatostatin GHIH, prolactin-inhibity hormone: PIH, melanocyte-inhibiting hormone: MIH hormones act on ant pit to do something
Hypo
Adrenocorticotropic hormone: ACTH/corticotropin which then acts on adrenal gland, Thyroid-stimulating hormone: TSH and acts on thyroid to release T3/4, Luteinizing hormone: LH and Follicle-stimulating hormone: FSH work on gonads, prolactin - mammary glands to produce breast milk, growth hormone: GH - abnormalities with ant pit this is one of them and if increased going cause overgrowth bone and soft tissue; melanocyte-stimulating hormone: MSH - production melanin and increase pigment
Ant pit
stores from hypo vasopressin (antidiuretic hormone: ADH) and oxytocin
Post pit
triiodothyronine: T3, thyroxine: T4, Calcitonin
Thyroid
Parathyroid hormone (PTH) - regulates Ca
Parathyroid
steroids, glucocorticoids (cortisol), mineralocorticoids (aldosterone)
Adrenal cortex -
Catecholamines (epi and nor epi)
Adrenal medulla -
estrogen, progesterone
Ovary -
testosterone
Testes -
insulin, glucagon, somatostatin; endocrine gland and exocrine funcs - digestive enzymes secrete and empty into bowel; islets of Langerhans and 3 diff types cells: alpha - glucagon, beta - insulin (also helps store and metabolize proteins and fats), delta - somatostatin
Pancreas -
Target tissue: thryoid
Actions: stimulates synthesis and release of thyroid hormone
TSH -
Target tissue: adrenal cortex
Actions: stimulates synthesis and release of corticosteroids and adrenocortical growth
ACTH -
Target tissue: ovary, testis; gonads
Actions: stimulates ovulation, progesterone and testosterone secretion
LH; Leydig cell-stimulating hormone in males -
Target tissue: ovary, testis; gonads
Actions: stimulates estrogen secretion and follicle maturation; stimulates spermatogenesis
FSH; Sertoli cell-stimulating hormone in males -
Target tissue: mammary glands
Actions: breast milk production
PRL -
Target tissue: bone and soft tissue
Actions: promotes growth
GH -
Target tissue: melanocytes
Actions: promotes pigmentation
MSH -
Target tissue: kidney
Actions: promotes water reabsorption - body to hold onto water; retention of fluid/water reabsorption in kidneys
Vasopressin/ADH
Target tissue: uterus and mammary glands
Actions: stimulates uterine contractions and ejection of breast milk
Oxytocin
Decreased glucose tolerance
Decreased general metabolism
Decreased antidiuretic hormone (ADH) production
Decreased ovarian production of estrogen - older female pats
Endocrine changes with aging
Weight becomes greater than ideal - harder keep within norm range
Elevated fasting and random blood glucose levels
Slow wound healing due to higher BG
Frequent yeast infections due to higher BG
Polydipsia due to higher BG; very thirsty
Polyuria due to higher BG; peeing a lot
Decreased glucose tolerance
Less tolerant of cold
Increased weight gain
Decreased appetite
Decreased heart rate and blood pressure - VS slowing down
Decreased general metabolism
Body cannot reabsorb the fluid, more urine and more dilute; cannot concentrate when fluid intake is low - why older pops at great risk for dehydration - do need to hold onto water not able to because not have as much ADH to tell kidneys that low on fluid keep fluid in
Urine is more dilute and may not concentrate when fluid intake is low
Patient is at greater risk for dehydration
Decreased antidiuretic hormone (ADH) production
Bone density decreases - func estrogen: Ca in bones and bone density up; with less estrogen; likely for bones for leak Ca/get rid Ca
Skin is thinner, drier, and at greater risk for injury
Perineal and vaginal tissues become lot drier, and the risk for cystitis/bladder infections/UTI increases
Decreased ovarian production of estrogen - older female pats
Patient history
Physical assessment that could indicate endocrine alterations - notice; all indicate something diff; clues if abnormality
Psychosocial assessment
Lab assessment
Imaging assessment
Other diagnostic assessment
Assessment methods
Age and gender for baseline
Nutritional history
Family history and genetic risk - Imp assess
Current complaints - health problems
Patient history
Abnormalities in endocrine sys see nutritionally wise so if increase wanting drink and peeing lot indicates possibly diabetes; low adrenal func low Na level so Na craving; certain cravings
for N/V, abdominal pain, increase or decrease in food or fluid intake, changes in weight - abnormality in GH may have increased weight gain - high levels corticosteroids/steroids and adrenal gland hyperfunctioning causes retention fluid and increase fat deposit which increases weight, dietary deficiencies
All types things give clues if having issues
Nutritional history
include changes in energy level - thyroid issue, elimination, sexual and reproductive functions - look at if issue with gonadotropins, physical appearance - GH issue
Current complaints - health problems
Prominent forehead or jaw - abnormalities in GH
Round or puffy face - retention fluid - alterations/high levels adrenal
Dull or flat expression
Exophthalmos (protruding eyeballs and retracted upper eyelids) - thyroid
Vitiligo (patchy areas of pigment loss with increased pigmentation at the edges) - low adrenal func
Check the trunk for any abnormalities in chest size and symmetry - adrenal/GH
Striae (reddish purple “stretch marks”) - adrenal
Hirsutism (excessive growth of body hair) - GH
Palpate thyroid to enlargement - goiters/enlargement of thyroid gland imp assessment to
Physical assessment that could indicate endocrine alterations - notice; all indicate something diff; clues if abnormality
Abnormalities in hormone can affect stress and anxiety so need to assess that
Psychosocial assessment
Assays
Provocative/suppression tests
Urine tests
Tests for glucose
Lab assessment
Measures the level of a specific hormone in the blood or other body fluids
Often times due blood; also do urine and saliva
Assays
Specific to endocrine abnormalities; whole - feedback loop endocrine funcs base release one
Provocative tests: give a stimulus for a gland to see if the gland responds; give something that know stimulate gland to work and see if responds and if not something wrong with gland
Suppression tests: drugs or substances given that would normally suppress a hormone then lab work done; know have - feedback effect and see how gland responds
Have serial blood draws - do baseline level of hormone, give stimulate/suppress, serial blood draws for hormone levels
Look at with adrenal func: cortisol stimulating tests - see how adrenal gland reacts when given cortisol
Provocative/suppression tests
Typically done by 24 hour urine collection to give a better picture of endocrine function
Can test for hormone levels but vary in course day in what going on in body so typ do 24 hour urines because better pic of endocrine gland checking
Urine tests
Tests for the function of the islet cells of the pancreas (beta)
Ex. fasting glucose (short term glucose), glucose tolerance test (short term glucose), glycosylated hemoglobin (HgA1C - long term picture)
Tests for glucose
X-rays:
MRI:
CT:
Ultrasound:
Imaging assessment
evaluate bony pocket where pituitary gland rests; pit gland sitting in base skull and looking at that
X-rays:
best method to evaluate pituitary gland; typ for pit gland
MRI:
evaluate adrenal glands, ovaries and pancreas
CT:
evaluate thyroid (often), parathyroid (often), ovaries and testes
Ultrasound:
Needle biopsy for thyroid nodules - done quite often esp if concerned about cancers
Other diagnostic assessment
