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Pathophysiology I > Chapter 32 disorderrs of endocrine control of growth and metabolism > Flashcards

Chapter 32 disorderrs of endocrine control of growth and metabolism Flashcards

1
Q

Describe the three general classes of endocrine disorders (based on cause)

A

PRIMARY: disorder of gland producing hormone

SECONDARY: disorder of pituitary (which stimulates gland)

TERTIARY: hypothalamic dysfunction

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2
Q

List the 7 hormones that are produced by the pituitary gland

A

Thyroid stimulating hormone (TSH)

ACTH

gonadotropin, LH, FSH

GH

Prolactin

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3
Q

Are hyperpituarism and pituitary adenomas metastic? what is the most common type?

A

No, usually benign

Adenoma most common type

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4
Q

Describe and list the 2 manifestations of hyperpituitarism and pituitary andenomas

A

Can be insidious

1) Enlargement of hands/feet tongue (leads to snoring, sleep apnea, arthritis, carpal tunnel)
2) Raises BG as counteracts action of insulin

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5
Q

List three causes of hypopituitarism

A

Congenital

Benign tumor compressing gland

Radiation

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6
Q

What is the result of hypopituitarism

A

Decreased production of all hormones

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7
Q

What hormone enhances release of GH? where is this hormone released from?

A

GHRH

from anterior pituitary

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8
Q

What hormone inhibits the release of GH?

A

somatostatin

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9
Q

Explain the 4 effects of GH

A

1) linear bone growth
2) inc protein synthesis by all cells
3) fatty acid mobilization and use
4) inc BG levels

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10
Q

Describe the three types of dwarfism (by cause) in childhood

A

IDIOPATHIC SHORT STATURE:

  • UKE with no other disease process
  • > 2 SD’s below normal height

PHSYCHOSOCIAL DWARFISM:
emotional deprivation

GH DEFICIENCY

  • lack of GHRH
  • dec birth length and growth
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11
Q

What is somatopause?

A

GH decline with age

Can result in defieciency

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12
Q

What are the two ways that adults can have GH deficiency

A

1) present from childhood

2) adult tumor

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13
Q

List the 5 manifestations of GH deficiency in adults

A

1) Decreased lean mass, increased fat mass; dec exercise tolerance and hyperlipidemia
2) decreased bone density
3) CVS: central adiposity, insulin resistance

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14
Q

What rare condition does GH excess in childhood lead to

A

Gigantism

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15
Q

What is the usual cause of gigantism?

A

adenoma

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16
Q

What age does excessive GH need to onset in order to cause Gigantism? Why?

A

Prior to puberty

- ephyses of long bone aren’t fused yet

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17
Q

What are the manifestations of gigantism?

A

massive skeletal growth

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18
Q

What is the name of the condition that is a result of excessive GH hormone in adults called?

A

ACROMEGALY

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19
Q

Describe what acromegaly is

A

It is a result of adenoma, usually benign after puberty

1) small bone growth
2) soft tissue/cartilage growth
3) organ hypertrophy

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20
Q

Describe the manifestations associated with small bone growth in acromegaly

A

Large/long fingers, hands, toes jaw, forehead

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21
Q

What vertebral change is associated with acromegaly?

A

kyphosis

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22
Q

What manifestations are associated with soft tissue/cartilage growth with acromegaly

A

Deep voice
Inc risk of bronchitis
Sleep apnea

Associated with changes in nose, larynx, resp tract

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23
Q

Explain the six manifestations of acromegaly associated with Gland/organ hypertrophy

A

Sebaceous glands: excessive sweating

Heart failure

Insulin resistance (may have symptoms of hyperglycemia

Muscle wkness
Fatigue
Menstrual irregularities

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24
Q

What symptoms can be a result of tumor growth in acromegaly?

A

h/a

Vision disturbances

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25
Q

Explain what Precocious puberty is

A

Early activation of hypothalamus, pituitary and gonadal hormones causing early emergence of secondary sex characteristics

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26
Q

What is the age of onset for precocious puberty for boys?

A

< 9

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27
Q

What is the age of onset for precocious puberty for girls?

A

< 6-7

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28
Q

What are the three causes of precocious puberty?

A

Idiopathic
CNS tumor
Gonadal, adrenal, or hypothalamic disorder

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29
Q

What hormone does TSH stimulate the release of and what does this hormone convert to?

A

Stimulates creation of T4 which converts to T3 in the tissues

T3 is the potent one that regulates body metabolic rate

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30
Q

What part of the pituitary secretes TSH?

A

anterior

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31
Q

Describe what hypothyroidism is

A

accumulation of mucopolysaccharide substance throughout the body’s CT

these are glycosaminoglycans

Commonly accumulate in middle ear, eyelids, face, tongue, wrist heart

32
Q

What is a good way to describe the condition of hypothyroidism to help remember the symptoms

A

TURNING OFF THE FURNACE

slowing of mind and body
COLD INTOLERANCE

33
Q

Describe the 5 CNS manifestations of Hypothyroidism

A 
Wt gain
Cold intolerance
Fatigue
Weakness
Mental dullness
34
Q

List the 2 CVS symptoms of hypothyroidism

A

Bradycardia

Myocardial dilation

35
Q

List the 5 GI symptoms of hypothyroidism

A 
Enlarged tongue
Voice changes
Constipation
Flatulence
Distension
36
Q

List the 2 musculoskeletal manifestations of hypothyroidism

A

myalgia

arthralgia

37
Q

List the 2 integument manifestations of hypothyroidism

A

Dry rough skin

Coarse, brittle hair

38
Q

When does cretinism (type of primary hypothyroidism) present?

A

after birth, but baby appears normal because of mom’s hormones

39
Q

What is the first sign of cretinism?

A

Prolongation of physiological jaundice

40
Q

What are the 6 symptoms of cretinism?

A

1) enlarged tongue: hoarse cry, difficulty feeding
2) enlarged abd
3) umbilical hernia
4) sluggishness
5) mental retardation
6) impaired growth

41
Q

What occurs to the symptoms of cretinism if it is treated?

A

if it is treated, their are minimal symptoms

42
Q

What is the most common form of hypothyroidism?

A

Hashimoto’s Thyroidosis

43
Q

Describe what Hashimoto’s Thyroidosis is.

A

An autoimmune disorder where lymphocytes infiltrate the thyroid gland

44
Q

What is the first sign of Hashimoto’s Thyroidosis?

A

GOITER (enlarged gland d/t infiltration

45
Q

What gender is more at risk of Hashimoto’s Thyroidosis?

A

Women more than men

46
Q

Are the manifestations the same for hypothyroidism and hashimoto’s thyroidism?

A

yes

47
Q

What are 4 non disease causes of primary hypothyroidism

A

1) hyperthyroid medication
2) Iodine deficiency
3) Surgical dmg/removal
4) Radiation therapy with Iodine

48
Q

Why can iodine deficiency lead to primary hypothyroidism?

A

because iodine is necessary for TH synthesis.

49
Q

Is iodine deficient primary hypothyroidism common? Why?

A

No, b/c of iodization of salt

50
Q

What is myxedema?

A

severe hypothyroidism

Non-pitting mucous type of edema d/t accumulation of mucopolysaccharide substance throughout CT

51
Q

What are the 5 manifestations of myxedema?

A 
Coma (life threatening)
CO2 retention
Hypoxemia
Fluid/electrolyte imbalance
Hypothermia
52
Q

What are 5 causes of secondary hypothyroidism

A 
Infection
Inflammation
Infiltration
Hemorrhage
Tumor
53
Q

What is the most common type of hyperthyroidism?

A

Grave’s disease

54
Q

Describe what Grave’s Disease is

A

An autoimmune disease where antibodies bind to TSH receptors in thyroid gland and stimulate production of T4 and T3

55
Q

What are the 3 CVS manifestations of Grave’s Disease?

A

Tachycardia
palpitations
Atrial fibrillation

56
Q

What are the 2 respiratory manifestations of Grave’s Disease?

A

SOB

Dyspnea

57
Q

List some of the 8 CNS symptoms of grave’s disease

A 
Nervousness
Irritability
WT LOSS
Heat intolerance (sweating)
fine muscle tremors
exophthalmos (BULGING EYE)
dec blinking
pretibial myxedema
58
Q

List the 2 integument symptoms of Grave’s disease

A

Thin, silky hair and skin

Vitiligo (pigment alteration of hands/arms)

59
Q

Explain what thyroid storm or thyrotoxicosis is.

A

it is a rare complication of Grave’s disease

60
Q

What are the 4 triggers for thyroid storm (thyrotoxicosis)

A

1) infection
2) DKA
3) trauma: physical/emotional
4) thyroid stim during surg

61
Q

List the 7 manifestations of thyroid storm (thyrotoxicosis)

A 
High fever
Tachycardia
Angina
Heart failure
agitation
restlessness
delirium
62
Q

What are the 4 ways that hyperthyroidism is treated?

A

B-blockers
Meds that dec circulating TH
Surgery
Radioactive Iodine

63
Q

What are the 3 hormones released by the adrenal cortex?

A

Aldosterone
Glucocorticoids
Androgens

64
Q

What are the 2 hormones secreted by the adrenal medulla?

A

Epinephrine

Norepinephrine

65
Q

Explain what Congenital Adrenal Hyperplasia is and what it results in.

A

Autosomal recessive trait resulting in deficiency of enzymes that synthesize cortisol

Results in inc ACTH which causes adrenal hyperplasia and over stim of adrenal androgen production

Boys: enlarged genitalia
Girls: ambiguous genitalia

66
Q

What is the most common type of primary adrenal cortical insufficiency?

A

Addison’s disease

67
Q

Explain what Addiso’s disease is and the 2 types of causes

A

It is when at least 90 percent of the gland is destroyed resulting in adrenal cortical insufficiency

1) autoimmune (most common)
2) TB, metastasis, fungal (rare)

68
Q

What is the treatment for Addison’s disease?

A

life long mineralcorticoid replacement

69
Q

Describe the implication of the loss of aldosterone in Addison’s disease

A

aldosterone increases absorption of ions and water in distal tubes of kidney

impact:
loss of Na, Cl, and water
retention of potassium
dehydration
hypotension
hypovolemic shock
wkness
fatigue
70
Q

Describe the implication of the loss of glucocorticoids in Addison’s Disease

A 
Hypoglycemia
dec immunity
fever
anorexia
lethargy
weakness
N and V
wt loss
hyperpigmentation (d/t elevated ACTH)
71
Q

What are 4 causes of secondary adrenal cortical insufficiency

A

hypopituitarism

removal of pituitary

hypothalamic defect

rapid withdrawal of glucocorticoids

72
Q

Describe the manifestations of acute adrenal crisis

A 
N and V
wkness
Hypotension
Dehydration
Vascular collapse

Hemorrhage related to septicemia, traum, anticoagulants, thrombosis, metastasis

73
Q

What is the cause of acute adrenal crisis?

A

Addison’s + Stress

74
Q

Explain what Cushing Syndrome is and the three possible causes

A

Glucocorticoid excess

Result of:
1) excess production of ACTH by pituitary tumor

2) Adrenal tumor

3) Non-pituitary ACTH 
secreting tumor (ex small cell carcinoma of lung)
75
Q

List the Manifesattions for Cushing’s Syndrome

A

Moon face
Personality changes
Infections
Large breasted males

Fat deposits on face and back of shoulders

Osteoporosis
Hyperglycemia
Irritability
Edema (na and fluid retention)
Inc acid

FEMALES: amenorrhea, hirsutism

thin skin
purple striae
bruises and petechiae

76
Q

What percentage of Cushing syndrome develop DM?

A

20 percent

Pathophysiology I (16 decks)

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