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Pathophysiology > Ch. 32 > Flashcards

Ch. 32 Flashcards

1
Q

What has to be present for a cell to respond to a hormone?

A

the receptors for the hormone.

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2
Q

What is down/up regulation?

A

cell makes fewer/more hormone receptors

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3
Q

Do different cells respond differently to the same hormone?

A

YES

progesterone enlarges breast tissue, while it does something different in the uterus

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4
Q

What is endocrine function?

A

hormone has to travel in circulation

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5
Q

What is paracrine function?

A

hormones act on nearby cells

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6
Q

What is autcrine function?

A

hormone effects cell that made it

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7
Q

Where is T3 and T4 destroyed and passed out?

A

The liver and in bile

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8
Q

What is a primary hormone disorder?

A

an abnormality in the gland where the hormone is produced

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9
Q

What is a secondary hormone disorder?

A

This is where there is an abnormality in the stimulation from the pituitary.

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10
Q

What is a tertiary hormone disorder?

A

there is an abnormality in the stimulation from the hypothalamus

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11
Q

What happens with hormone regulation after the outside input has been processed by the hypothalamus?

A

The hypothalamus will decide to secrete more or less of a releasing hormone that will act on the pituitary gland

The pituitary gland will then release stimulating (trophic) hormones that will act on a peripheral gland

The peripheral gland will then release its hormone which will act on its target cells

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12
Q

What are the pituitary hormones that we need to know?

A

GH (growth hormone)

TSH (thyroid stimulating hormone)
What

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13
Q

What is the most common cause of hyperpituitary?

A

anterior pituitary adenoma

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14
Q

What are the S/S of hyperprolactinemia?

A

WOMEN:

amenorrhea - loss of period

galactorrhea - milk production without pregnancy

infertility

MEN:

impotence

loss of libido

galactorrhea

SOMETIMES BECAUSE OF CLOSE PROXIMITY TO OPTIC NERVE THERE WILL BE VISUAL ISSUES: LIKE LOSS OF PERIPHERAL FIELD

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15
Q

With hypopituitary, is it all the cells being affected, or a specific subset?

A

it can be either or

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16
Q

How much of the pituitary must be destroyed in order for hypopituitary to manifest?

A

70-90%

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17
Q

What are the causes of hypoptuitary?

A

congenital hypopituitary, space occupying lesions, or radiation therapy

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18
Q

Does hypopituitary progress rapidly?

A

No, its usually slow in prgression

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19
Q

What is the typical order you will loose hormones with hypopituitary?

A

1: GH, LH, FSH
2: TSH
3: ACTH
4: prolactin

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20
Q

What is another name for growth hormone?

A

somatotropin

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21
Q

What stimulates the release of GH??

A

hypoglycemia

fasting

starvation

stress

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22
Q

What inhibits GH secretions?

A

hyperglycemia, free fatty acid release, obesity, cortisol

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23
Q

`How do the growth promoting actions of GH work?

A

It tells the liver to secrete IGF-1 (insulin like growth factor)

this causes an increase in protein synthesis

This causes the bone and cartliage linear growth to increase, an increase in the size and function of body organs, and an increase in lean muscle mass

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24
Q

What are the anti-insulin actions of GH?

A

It increases lipolysis of adipose tissue, which increases our use a free fatty acids, as well as a decrease in adipose tissue

It also decreases the use of carbohydrates (glucose), which INCREASES BLOOD GLUCOSE

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25
Q

Can GH make cells resistant to insulin?

A

yes yes yes

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26
Q

What can be the causes of GH deficiency?

A

Idiopathic GH deficiency: lack of hypothalamic GHRH

pituitary tumors or agenesis of the pituitary: cant produce GH

Laron-type dwarfism: heredetary defect in IGF production

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27
Q

How do we name a GH excess that happens in different stages of life?

A

childhood: gigantism
adulthood: acromegaly (mainly effect cartilagenous tissue because growth plates have closed by this time) also can see heat intolerance, oily skin, muscle weakness, menstrual irregularity

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28
Q

What are some other manifestations of GH excess?

A

HTN

sleep apnea

paresthesias

headaches

ALL OF THIS IS FROM OVERGROWTH THAT TRAPS OR OBSTRUCTS OTHER TISSUES

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29
Q

What is a common cause of GH excess?

A

benign adenoma

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30
Q

What hormones does the thyroid release?

A

T3 and T4

CARRIED BY BINDING PROTEINS

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31
Q

What do we measure to test for thyroid function

A

T3

free T4

TSH

anti-TPO antibodies (autu-immune (like hashimotots)) destroys receptor sites on thyroid for TSH

radioiodine uptake (radiographic test)

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32
Q

What does T3 stimulate?

A

metabolism and protein synthesis in nearly all tissues of the body (including CNS)

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33
Q

Is T4 active?

A

No, not until it is converted into T3, happens in tissues

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34
Q

What controls the negative feedback look of thyroid hormones?

A

levels of T4 and T3

COMMUNICATE TO HYPOTHALAMUS

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35
Q

What tissues aren’t effected by the thyroid?

A

testes, spleen, retinas, lungs

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36
Q

What effect does the thyroid have on all cells?

A

increases metabolic rate, and muscle protein used for food

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37
Q

How does the thyroid affect our cholesterol?

A

hypo: high cholesterol
hyper: low cholersterol

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38
Q

What does hyperthyroidism do to our muscles and vitamin supply?

A

muscle fatigue

vitamin deficiency

39
Q

What do altered levels of thyroid hormone do to the heart?

A

Hyper: increased HR, contractility, CO (particularly dangerous increase in metabolism if some has atherosclerosis, danger of heart attack)

hypo: decreased HR, contractility, CO (very bad if someone has heart failure)

40
Q

What do altered levels of thyroid hormone do to the GI tract?

A

hyper: diarrhea (increased motility, and production of secretions)

Hypo: constipation (decreased motility and GI secretions)

41
Q

What do altered levels of thyroid hormone do to neuromuscular?

A

hyper: fine muscle tremor, nervous, anxiety
hypo: sluggish, mentally slow

42
Q

How do we treat hypothyroidism regardless of the cause?

A

hormone replacement, (sometimes treatment for hyperthyroidism causes hypothyroidism and need for supplementation)

43
Q

Can thyroid hormone cross the placenta? why is this important with congenital hypothyoidism?

A

YES

if the mom is providing the fetal thyroid hormone and the baby has a deficient thyroid, we wont know until the baby is born and shows symptoms)

44
Q

What are some symptoms of a baby with hypothyroidism?

A

jaundice

hoarse cry

sluggish

umbilical hernias

feeding issues

45
Q

What is the most preventable cause of mental retardation?

A

congenital hypothyroidism

46
Q

What is the most common type of hypothyroidism?

A

acquired (more specifically hashimotos thyroiditis)

47
Q

What are the types of acquired hypothyroidism?

A

hashimotos thyoiditis

thyroidectomy

48
Q

What is another name for hyperthyroidism?

A

thyrotoxicosis

49
Q

What is required for the synthesis of T3 and T4?

A

IODINE (if we dont have iodine we will have a decreased metabolism)

50
Q

Is there a negative feedback to the hypothalamus for TSH?

A

NO NO NO

51
Q

What happens if the thyroid cant make T3 or T4 and the hypothalamus continues to stimulate more and more production of T3 and T4 because of the low levels in the body?

A

The hypothalamus will continue to release TRH, which will tell the pituitary to make TSH, which will tell the thyroid to get to work.

This issue is that if the thyroid cant work to make these hormones (might not have the iodine building block to make it) then it will continue to get stimulated and will eventually hypertrophy causing a GOITER

52
Q

What do we eat that has been supplemented with iodine?

A

salt

53
Q

What are your T4 and TSH levels with hypothyroidism?

A

T4 low

TSH high

54
Q

Is hypothyroidism a primary, secondary, or tertiary disorder most commonly?

A

PRIMARY

55
Q

What can cause hypothyroidism?

A

thyroidectomy

radiation ablation

iodine deficiency or severe ingestion of iodine

hashimoto

56
Q

Go more in depth about hashimoto thyoiditis.

A

This is an autoimmune disorder

The body has anti-TPO antibody that attacks the receptors on the thyroid for TSH, which means they dont make more T4

TSH is high and T4 is low

sometimes will present with a goiter, but not always

treated with supplements

57
Q

What is myxedema?

A

a severe form of hypothyroidism where a levels get so low that we can go into a coma, become hypothermis (low metabolism), and cardiovascular collapse.

58
Q

What are the symptoms of hypothyroid?

A

cold intolerance,lethargy, impaired memory, peripheral edema and puffy face, deep coarse voice, bradycardia, constipation, gastric atrophy (can lead to B12 deficiency), gain weight, swelling, muscle weakness, pallor, coarse brittle hair, large tongue, loss of lateral eyebrows

59
Q

What is one of the most common causes of hyperthyroidism?

A

Graves disease

60
Q

describe graves disease and its defining manifestations.

A

an autoimmune disorder that causes abnormal stimulation of thyroid gland by it TSH receptor antibodies, happens mainly in women from 20 to 40

diffuse goiter

exopthalmus

61
Q

What are some other causes of hyperthyroidism?

A

multinodular goiter

adenoma

thyroiditis

iodine agent

62
Q

Describe a thyroid crisis (storm).

A

this is a severe thyrotoxic state with very high mortality rate if not diagnosed early and treated immediately

mortality rates are mainly associated with the cardiac complications it causes

63
Q

What is the function on ACTH? what secretes it?

A

It tells the adrenal cortex to produce hormones (cortisol, androgens, aldosterone)

the pituitary secretes it

64
Q

What type of hormones are produced by the adrenal cortex?

A

steroid hormones (30 different ones)

65
Q

What are these hormones synthesized from?

A

acetate and CHOLESTEROL

66
Q

`What metabolizes the hormones made by the adrenal cortex?

A

The liver (funny because the liver makes the cholesterol that makes the hormone and also breaks it down)

67
Q

What is the major glucocorticoid hormone?

A

cortisol

68
Q

What do androgens do?

A

chief sex hormone

effects pubic and axillary hair growth and fetal placental growth

69
Q

What is aldosterone?

A

major mineral corticoid steroid hormone

70
Q

What does aldosterone regulate?

A

sodium, potassium and water

71
Q

What regulates production of aldosterone as well?

A

renin and angiotensin levels

water, sodium, and potassium levels

72
Q

What regulates the production of cortisol?

A

negative feedback loop with hyperthalamus, pituitary, and adrenal cortex system

73
Q

What does cortisol do? (overview)

A

controls metabolic function of body and inflammatory response

74
Q

What do we have if we have too much cortisol?

A

cushings syndrome

75
Q

What effects does cortisol have on the body?

A

immune/inflammatory suppression

plasma proteins increased

CATABOLISM INCREASE:

muscle breakdown

sns response increase

blood glucose increase

free fatty acids increase

76
Q

How does cortisol specifically affect the immune/inflammatory response?

A

inhibition of prostaglandin synthesis

decreased capillary permeability

depression of phagocytosis

reduction of fever

inhibition of fibroblasts (exudate and healing)

decreased antibody formation

77
Q

`What are some things that can cause adrenal cortical disorders?

A

congenital adrenal hyperplasia

adrenal cortical insufficiency

excessive adrenal secretion

78
Q

Describe congenital adrenal hyperplasia.

A

autosomal recessive trait

lacking enzymes needed to synthesize corticol, therefore an increase level of ACTH overstimulates adrenal androgens and causes hyperplasia

79
Q

Describe adrenal cortical insufficiency, and the two types.

A

This is where the body cant make any of the 3 hormones

primary: addisons disease

secondary adrenal cortical isufficiency: issue with the pituitary gland OR withdrawal of glucocorticoids (mimics addisons disease)

80
Q

What is an acute adrenal crisisand its symptoms?

A

This is a life threatening condition

causes nausea and vomiting, muscle weakness, hypotension, dehydration, and vascular

81
Q

Other than cushings syndrome, what is another excess adrenal secretion condition?

A

hyperaldosteronism (a lot of time this is paired with cushings)

82
Q

Why is it important to slowly wean people off of glucocorticoids?

A

This is important so we dont have a secondary adrenal cortical insufficieny that mimics addisons

83
Q

What is another common time that people get a secondary adrenal cortical insufficiency?

A

when people are under a lot of stress.

84
Q

Describe addisons disease.

A

this is a primary adrenal cortical insufficiency

RARE autoimmune

affects all layers of the adrenal cortex

associated with TB infection

85
Q

What disorder mimics addisons disease?

A

secondary adrenal cortical insuficiency

86
Q

What are some other causes a adrenal insufficiency?

A

metastatic carcinoma

fungal (histoplasmosis)

cytomegalovirus

amyloid disease

hemochromotosis

87
Q

What are some manifestations of addisons?

A

hyperpigmentation of skin (bronze tone)

hypoglycemia

mucle weakness

loss of weight

vomiting diarrhea

cardiac insufficiency hypotension

adrenal atrophy destruction

urinary losses (sodium, water)

retention of potassium

88
Q

What is hypercorticolism of any cause called?

A

cushings syndrome

89
Q

What are the three important causes cushings syndrome?

A

tumor of pituitary gland (causes excessive ACTH production)

tumor of the adrenal gland

non-pituitary ACTH secreting tumnor

90
Q

What is an iatrogenic cause of cushings sydrome?

A

long term cortisone therapy (stopping or weaning treatment cures it in this case)

91
Q

What are some manifestations of cushings syndrome?`

A

buffalo hump and moon face (altered fat metabolism)

altered glucose metabolism (overt diabetes common)

skinny arms and legs, weakness, poor wound healing (protein breakdown and muscle wasting)

pupura

osteoporosis

bruising

amenorrhea

92
Q

With cushings syndrome, will we also see an increase in mineralcorticoids and androgen levels?

A

YES YES YES

93
Q

What is an incidental adrenal mass?

A

a tumor on the adrenal

most are benign

94
Q

At what size should an incidental adrenal mass be removed?

A

4cm

Pathophysiology (13 decks)

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