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advance patho > Chapter 22: Alterations in Endocrine system > Flashcards

Chapter 22: Alterations in Endocrine system Flashcards

1
Q

SIADH

A

Increased ADH usually due to tumors

Can be caused by hypoglycemics, antidepressants, antipsychotics, narcotics, anesthesia, chemo, NSAIDs

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2
Q

S/S SIADH

A

Hypotonic hyponatremia, hypervolemia, weight gain, peripheral edema absent, lethargy, concentrated urine

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3
Q

Diabetes insipidus

A

Decreased ADH leading to polyuria and polydipsia

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4
Q

Neurogenic central DI

A

Insufficient secretion of ADH from hypothalamus

Usually due to pituitary surgery

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5
Q

Nephrogenic DI

A

Inadequate response of kidney to ADH

Genetic or damage due to drugs

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6
Q

Primary polydipsia

A

excessive fluid intake lowers plasma osmolarity to a point below threshold for ADH secretion

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7
Q

S.S DI

A

Polyuria, nocturia, continuous thirst, polydipsia

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8
Q

Causes of hypopituitarism

A

Inadequate supply of hypothalamic releasing hormones, damage to pituitary stalk, inability of gland to produce hormones

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9
Q

Panhypopituitarism

A

All hormones deficient

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10
Q

Pituitary gland vulnerable to

A

Ischemia and infarction due to being highly vascular

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11
Q

ACTH deficiency

A

Can be life threatening

N/V, anorexia, fatigue, weakness, hypoglycemia

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12
Q

TSH deficiency

A

Cold intolerance, skin dryness, mild myxedema, lethargy, decreased metabolic rate

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13
Q

Hyperpituitarism is usually due to

A

Primary adenoma: benign, slow growing tumor of anterior pituitary
Adenomatous tissue secretes the hormone of the cell type from which is arose

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14
Q

Hypersecretion of GH

A

Acromegaly
Due to GH secreting adenoma
Gigantism in children due to increased bone growth

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15
Q

S/S Acromegaly

A

Enlarged tongues, intersitital edema, overactive sweat glands, coarse skin and body hair, large joints, large face hands and feet, barrel chest

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16
Q

S/S prolactinoma

A

Amenorrhea, infertility, galactorrhea

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17
Q

Thyrotoxicosis

A

Any cause of increased TH levels

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18
Q

Hyperthyroidism

A

Excess amount of TH secreted by thyroud gland

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19
Q

S/S hyperthyroidism

A

Increased metabolic rate, heat intolerance, increased tissue sensitivity to stimulation by SNS

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20
Q

Graves disease

A

Autoimmune
Lymphocyte infiltration and stimulation of thyroid by autoantibodies directed against TSH receptor
Leads to goiter

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21
Q

2 major manifestations of Graves

A

Ophthalmopathy and dermopathy

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22
Q

Ophthalmopathy

A

Increased secretion of hyaluronic acid, adipogensis and inflammation and edema of orbital contents leads to exophthalmos

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23
Q

Pretibial myxedema

A

Subcutaneous swelling on anterior portion of legs characteristic of Graves

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24
Q

Thyrotoxic crisis

A

Thyroid storm
Death can occur within 48 hours
S/S: hyperthermia, increased HR, high output HF, agitation, delirium

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25
Q

Most common causes of hypothyroidism

A

autoimmune thyroiditis, loss of thyroid tissue due to treatment of hyperthyroidism, head and neck radiation, iodine deficiency

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26
Q

S/S hypothyroidism

A

Decreased metabolic rate, cold intolerance, lethargy, tiredness

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27
Q

Characteristic sign of hypothyroidism

A

Myxedema: swelling of face, alopecia, loss of nails along with hardening of skin

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28
Q

Myxedema

A

non-pitting boggy edema caused by infiltration of mucopolysaccharides and proteins between connective tissue in the dermis

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29
Q

Myxedema coma

A

Diminished consciousness due to severe hypothyroidism

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30
Q

Most common cause of primary hypothyroidism

A

Iodine deficiency most common worldwide

Autoimmune thyroiditis most common in US

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31
Q

Subactue thyroiditis

A

Uncommon bacterial inflammation of thyroid preceded by viral infection
Fever, tenderness, enlargement of thyroid

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32
Q

Primary hyperparathyroidism

A

Excess secretion of PTH due to adenomas

Increased Ca + PO4 hallmarks

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33
Q

Secondary hyperparathyroidism

A

Compensatory response to parathyroid glands to chronic hypocalcemia
Usually due to CKD or vit D deficiency

34
Q

Tertiary hyperparathyroidism

A

Due to chronic hypocalcemia

Usually due to renal transplant

35
Q

Hyperparathyroidism can cause

A

Kidney stones and increased risk for fractures due to bone resorption

36
Q

Hypoparathyroidism usually due to

A

Removal of PT gland with removal of thyroid gland

37
Q

Hypomagnesia can cause

A

Decreased PTH

38
Q

Glycosylated Hemoglobin

A

HbA1c

Permanent attachment of glucose to Hgb molecules and reflects average plasma glucose exposure over life of RBC

39
Q

Labs for DM diagnosis

A

HbA1c >6.5%
Fasting plasma glucose >126
2 hour plasma glucose >200
Random plasma glucose >200

40
Q

Type 1 DM

A

Autoimmune

Environmental genetic factors trigger cell mediated destruction of pancreatic beta cells

41
Q

Decreased insulin leads to

A

Marked increase in glucagon

42
Q

What causes DKA

A

Increased hepatic metabolism of fat causing increased levels of circulating ketones

43
Q

Risk factors for type 2 DM

A

Age, obesity, hypertension, physical inactivity, family history, metabolic syndrome

44
Q

Metabolic syndrome

A

Central obesity, dyslipidemia, pre-hypertension, increased FPG

45
Q

Obesity causes of insulin resistance

A

Increased leptin and decreased adiponectin
Increase in free fatty acids and intracellular deposits of triglycerides and cholesterol
Increased inflammatory cytokines

46
Q

Maturity onset of diabetes of youth

A

Noninsulin requiring diabetes in lean individuals <25 with evidence of autosomal dominant inheritance

47
Q

Somogyi effect

A

Too much intermediate acting insulin given at dinner followed by rebound hyperglycemia around 3am

48
Q

Dawn phenomenon

A

Early morning rise in glucose due to nocturnal elevation of GH, which decreases metabolism of glucose

49
Q

Diabetic ketoacidosis

A

Usually in type 1 DM

Due to decrease insulin and increase in levels of insulin counter-regulatory hormones

50
Q

Most common precipitating factor for DKA

A

Intercurrent illness

51
Q

S/S DKA

A

Kussmal respirations, postural dizziness, CNS depression, ketonuria, anorexia, N/V, abdominal pain, sweet breath, dehydration, thirst, polyuria

52
Q

Most marked electrolyte imbalance in DKA

A

Decrease in total K+

53
Q

Labs in DKA

A

Glucose >250, serum bicarb >18, ph <7.3, urine and serum ketones present

54
Q

Hyperosmolar hyperglycemic nonketotic syndrome

A

High mortality complication of type 2 DM
Similar to DKA but no ketones
Extreme glucosuria and polyuria causing severe volume loss, increased serum osmolarity, intracellular dehydration, and loss of electrolyte

55
Q

DX criteria for hyperosmolar hyperglycemic nonketotic syndrome

A

Glucose >600, normal bicarb and ph, osmolarity >320, no ketones

56
Q

Microvascular disease due to DM

A

Capillary disease: leads to blindness, ESKF, neurppathies

Diabetic retinopathy, diabetic kidney disease

57
Q

Diabetic retinopathy

A

Damage to retinal blood vessels and RBCs, platelet aggregation, relative hypoxemia, hypertension

58
Q

Diabetic kidney disease

A

Glomeruli injured by protein denaturation, hyperglycemia with high renal blood flow, activation of RAAS, hypertension
Microalbuminuria first manifestation

59
Q

Diabetic neuropathies

A

Nerves are vulnerable to effects of chronic hyperglycemia

Axonal degeneration involving sensory nerve fibers and metabolic activity of schwann cells decreases

60
Q

Charcot neuroarhtropathy

A

Progressive degeneration of joint, usually in foot or ankle

61
Q

Macrovascular disease in DM

A

Increased risk for hypertension, accelerated atherosclerosis, CV disease, stroke and PVD

62
Q

Risk for infection in DM

A

Increased due to decreased senses, hypoxia, pathogens liking glucose, decreased blood supply leading to decreased WBC, decreased immune response, delayed wound healing

63
Q

Cushing syndrome

A

Chronic exposure to excess endogenous cortisol

64
Q

Cushing disease

A

Excess endogenous secretion of ACTH

65
Q

2 observations in cushing disease

A

Do not have diurnal or circadian secretion patterns of ACTH and cortisol
Do not increase ACTH and cortisol in response to stressor

66
Q

Most common feature of Cushing disease

A

Weight gain
Central obesity, moon face, buffalo hump
Due to lipolysis and altered fat distribution

67
Q

S/S cushing disease

A

Glucose intolerance, protein wasting, increased bone resorption, hypercalciuria and kidney stones, vasoconstriction and hypertension, increased risk for CAD,

68
Q

Congenital Adrenal hyperplasia

A

Autosomal, recessive

Deficiency in enzyme critical in cortisol synthesis

69
Q

Conn syndrome

A

Primary hyperaldosteronism

Causes hypokalemia, induces insulin resistance, promotes inflammation, endothelial dysfunction and CV remodeling

70
Q

Secondary hyperaldosteronism

A

Due to aldosterone secretion from angiotensin II through renin-dependent mechanism
Compensatory due to low blood volume

71
Q

S/S hyperaldosteronism

A

Hypertension, hypokalemia, hypervolemia, metabolic alkalosis

72
Q

Virilization

A

Development of male sex characteristics due to over secretion of androgens

73
Q

Addison disease

A

Primary hypocortisolism
Inability of adrenals to produce and secrete adrenocortical hormones
Decreased aldosterone and cortisol

74
Q

Biggest concern with addison disease

A

hypotension–addisonian crisis

75
Q

Prolonged addison disease usually due to

A

Prolonged administration of glucocorticoids

76
Q

Hirsutism

A

Excessive growth of facial and body hair

77
Q

Active anterior pituitary adenoma

A

Causes hypersecretion of hormones from the adenoma itself and hyposecretion of hormones from surrounding pituitary cells

78
Q

Cretinism

A

Caused by untreated congenital hypothyroidism

79
Q

Pheochromocytoma

A

Chromaffin cell tumors of adrenal medulla

Hypertension, tachycardia, palpitations, severe headache, diaphoresis, heat intolerance, weight loss, constipation

80
Q

Gastroperesis

A

Complication of diabetes where patient feels full–microvascular problem of autonomic neuropathy

advance patho (5 decks)

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