Chapter 32 disorderrs of endocrine control of growth and metabolism Flashcards
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
List the 7 hormones that are produced by the pituitary gland
Thyroid stimulating hormone (TSH)
ACTH
gonadotropin, LH, FSH
GH
Prolactin
Are hyperpituarism and pituitary adenomas metastic? what is the most common type?
No, usually benign
Adenoma most common type
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
List three causes of hypopituitarism
Congenital
Benign tumor compressing gland
Radiation
What is the result of hypopituitarism
Decreased production of all hormones
What hormone enhances release of GH? where is this hormone released from?
GHRH
from anterior pituitary
What hormone inhibits the release of GH?
somatostatin
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
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
What is somatopause?
GH decline with age
Can result in defieciency
What are the two ways that adults can have GH deficiency
1) present from childhood
2) adult tumor
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
What rare condition does GH excess in childhood lead to
Gigantism
What is the usual cause of gigantism?
adenoma
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
What are the manifestations of gigantism?
massive skeletal growth
What is the name of the condition that is a result of excessive GH hormone in adults called?
ACROMEGALY
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
Describe the manifestations associated with small bone growth in acromegaly
Large/long fingers, hands, toes jaw, forehead
What vertebral change is associated with acromegaly?
kyphosis
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
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
What symptoms can be a result of tumor growth in acromegaly?
h/a
Vision disturbances
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?
anterior
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
