Chapter 32 disorderrs of endocrine control of growth and metabolism Flashcards by matthew tarzwell

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

PRIMARY: disorder of gland producing hormone

SECONDARY: disorder of pituitary (which stimulates gland)

TERTIARY: hypothalamic dysfunction

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List the 7 hormones that are produced by the pituitary gland

Thyroid stimulating hormone (TSH)

ACTH

gonadotropin, LH, FSH

Prolactin

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

No, usually benign

Adenoma most common type

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Describe and list the 2 manifestations of hyperpituitarism and pituitary andenomas

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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List three causes of hypopituitarism

Congenital

Benign tumor compressing gland

Radiation

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What is the result of hypopituitarism

Decreased production of all hormones

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

GHRH

from anterior pituitary

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What hormone inhibits the release of GH?

somatostatin

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Explain the 4 effects of GH

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

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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What is somatopause?

GH decline with age

Can result in defieciency

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What are the two ways that adults can have GH deficiency

1) present from childhood

2) adult tumor

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List the 5 manifestations of GH deficiency in adults

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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What rare condition does GH excess in childhood lead to

Gigantism

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What is the usual cause of gigantism?

adenoma

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

Prior to puberty

- ephyses of long bone aren’t fused yet

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What are the manifestations of gigantism?

massive skeletal growth

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

ACROMEGALY

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Describe what acromegaly is

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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Describe the manifestations associated with small bone growth in acromegaly

Large/long fingers, hands, toes jaw, forehead

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What vertebral change is associated with acromegaly?

kyphosis

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

Deep voice
Inc risk of bronchitis
Sleep apnea

Associated with changes in nose, larynx, resp tract

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

Sebaceous glands: excessive sweating

Heart failure

Insulin resistance (may have symptoms of hyperglycemia

Muscle wkness
Fatigue
Menstrual irregularities

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

h/a

Vision disturbances

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Explain what Precocious puberty is

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

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

< 9

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

< 6-7

What are the three causes of precocious puberty?

Idiopathic CNS tumor Gonadal, adrenal, or hypothalamic disorder

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

Stimulates creation of T4 which converts to T3 in the tissues T3 is the potent one that regulates body metabolic rate

What part of the pituitary secretes TSH?

Describe what hypothyroidism is

accumulation of mucopolysaccharide substance throughout the body's CT these are glycosaminoglycans Commonly accumulate in middle ear, eyelids, face, tongue, wrist heart

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

TURNING OFF THE FURNACE slowing of mind and body COLD INTOLERANCE

Describe the 5 CNS manifestations of Hypothyroidism

``` Wt gain Cold intolerance Fatigue Weakness Mental dullness ```

List the 2 CVS symptoms of hypothyroidism

Bradycardia | Myocardial dilation

List the 5 GI symptoms of hypothyroidism

``` Enlarged tongue Voice changes Constipation Flatulence Distension ```

List the 2 musculoskeletal manifestations of hypothyroidism

myalgia | arthralgia

List the 2 integument manifestations of hypothyroidism

Dry rough skin | Coarse, brittle hair

When does cretinism (type of primary hypothyroidism) present?

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

What is the first sign of cretinism?

Prolongation of physiological jaundice

What are the 6 symptoms of cretinism?

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

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

if it is treated, their are minimal symptoms

What is the most common form of hypothyroidism?

Hashimoto's Thyroidosis

Describe what Hashimoto's Thyroidosis is.

An autoimmune disorder where lymphocytes infiltrate the thyroid gland

What is the first sign of Hashimoto's Thyroidosis?

GOITER (enlarged gland d/t infiltration

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

Women more than men

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

yes

What are 4 non disease causes of primary hypothyroidism

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

Why can iodine deficiency lead to primary hypothyroidism?

because iodine is necessary for TH synthesis.

Is iodine deficient primary hypothyroidism common? Why?

No, b/c of iodization of salt

What is myxedema?

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

What are the 5 manifestations of myxedema?

``` Coma (life threatening) CO2 retention Hypoxemia Fluid/electrolyte imbalance Hypothermia ```

What are 5 causes of secondary hypothyroidism

``` Infection Inflammation Infiltration Hemorrhage Tumor ```

What is the most common type of hyperthyroidism?

Grave's disease

Describe what Grave's Disease is

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

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

Tachycardia palpitations Atrial fibrillation

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

SOB | Dyspnea

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

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

List the 2 integument symptoms of Grave's disease

Thin, silky hair and skin | Vitiligo (pigment alteration of hands/arms)

Explain what thyroid storm or thyrotoxicosis is.

it is a rare complication of Grave's disease

What are the 4 triggers for thyroid storm (thyrotoxicosis)

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

List the 7 manifestations of thyroid storm (thyrotoxicosis)

``` High fever Tachycardia Angina Heart failure agitation restlessness delirium ```

What are the 4 ways that hyperthyroidism is treated?

B-blockers Meds that dec circulating TH Surgery Radioactive Iodine

What are the 3 hormones released by the adrenal cortex?

Aldosterone Glucocorticoids Androgens

What are the 2 hormones secreted by the adrenal medulla?

Epinephrine | Norepinephrine

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

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

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

Addison's disease

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

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)

What is the treatment for Addison's disease?

life long mineralcorticoid replacement

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

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 ```

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

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

What are 4 causes of secondary adrenal cortical insufficiency

hypopituitarism removal of pituitary hypothalamic defect rapid withdrawal of glucocorticoids

Describe the manifestations of acute adrenal crisis

``` N and V wkness Hypotension Dehydration Vascular collapse ``` Hemorrhage related to septicemia, traum, anticoagulants, thrombosis, metastasis

What is the cause of acute adrenal crisis?

Addison's + Stress

Explain what Cushing Syndrome is and the three possible causes

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) ```

List the Manifesattions for Cushing's Syndrome

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

What percentage of Cushing syndrome develop DM?

20 percent