Conditions of the Endocrine System Flashcards
What are some of common signs and symptoms of adrenocortical carcinoma?
Cushing’s Syndrome
Pain in abdomen or flank
Weight gain
Weakness
Insomnia
Virilization
What is a benign tumor of the Islets Langerhans called that secretes insulin?
Pancreatic Tumor, Insulinoma
80% have MEN I syndrome
What are some of common signs and symptoms of pancreatic cancer?
Fasting hypoglycemia causing mental status abnormalities such as headache, confusion, motor weakness, personality changes
Usually advanced stage before diagnosis
Abdominal (epigastric) pain
Jaundice
Weight Loss
Fatigue
What are the modern classifications of pituitary adenomas?
Secretory or non-secretory
Micro or Macro adenoma
What is the sequela of GH-secreting pituitary adenoma?
Giganitism in Children (excess GH secretion before epiphyseal fusion)
Acromegaly in Adults (excess GH in adults after epiphyseal fusion)
What are the signs and symptoms of prolactin secreting pituitary adenoma?
Headache
Vision changes- bilateral hemianopia
Acne, excess hair growth on face and body
Female: amenorrhea, galactorrhea, vaginal dryness
Male: Erectile dysfunction, infertility
What are the four types of thyroid cancer?
Papillary
Follicular
Anaplastic
Medullary (Parafollicular)
Which of the four types of thyroid cancer is the most common?
Papillary
Which of the four types of thyroid cancer is the most aggressive?
Anaplastic
What are some of the predisposing factors for the development of thyroid cancer?
Radiation Exposure
Low Dietary iodine intake: not causative
Family hx of thyroid cancer
What are the common signs and symptoms of thyroid cancer?
Painless, palpable solitary thyroid nodule
Cervical LAO
Diarrhea (calcitonin secreting)
Facial flushing (Calcitonin secreting)
What are some of the conditions of pituitary hypo-secretion? Name the hormone associated?
Addison’s Disease (ACTH)
Diabetes Insipidus ( ADH)
Impaired or failed lactation (Prolactin)
Secondary Hypothyroidism (TSH)
What are common causes of panhypopitutarism?
Congenital, trauma, space occupying lesions, radiation, stroke
All productions and secretions are reduced
What are the common signs and symptoms of growth hormone deficiency?
Children: Short stature
Adult: Decrease in lean body mass, bone density, increase in fat mass, fractures and cardiovascular disease
What is the difference between central and nephrogenic diabetes insipidus?
Central DI involves a deficient secretion of antidiuretic hormone where nephrogenic DI is related to a resistance to the action of ADH
What are the common signs and symptoms of diabetes insipidus?
Polyuria
Polydipsia
Nocturia
Hypernatremia
What are some of the conditions of pituitary excess? Name the hormone associated?
Cushing’s Syndrome (ACTH)
Gigantism and acromegaly (GH)
Hyper-prolactinemia (Prolactin)
Secondary Hyperthyroidism (TSH)
What is the difference between acromegaly and gigantism?
1) Acromegaly is after growth is done. Result in coarse features, oil skin, hyperhydrosis and protrusion of lower jaw
2) Gigantism is before the growth plates close. Result in elongated bones and macrocephaly
What are some of the signs and symptoms of Syndrome of Inappropriate anti-diuretic hormone (SIADH)?
Hyponatremia
Decreased reaction time
Confusion
Anorexia
Nausea
Malaise
Headache
Muscle Cramps
What is an autoimmune disorder that can cause hypothyroidism?
Hashimoto Thyroiditis
Non-toxic Goiter
What is an autoimmune disease that can cause hyperthyroidism?
Graves Disease
What are some of the signs and symptoms of hyperthyroidism?
Palpitations and/or tachycardia
Agitation or anxiety
Fatigue/weakness
Goiter
Insomnia
Tremor
Hyperreflexia
Weight Loss
What lab changes are noted with hyperthyroidism?
Low TSH
High FT3
What herbs are indicated for hyperthyroidism?
Lycopus virginicus
Lithospermum ruderale
Melissa officinalis
What heavy metal exposure is associated with Grave’s disease?
Mercury and cadmium
What are the signs and symptoms of Grave’s Disease?
1) Hyperthyroidism: Tachycardia, palpitations, weight loss, fatigue, diarrhea
2) Goiter
3) Exopthalmos: protrusion of eyeball
4) Pretibial Edema
What would you expect to see on a thyroid panel with Grave’s disease?
Low TSH
High T3 &T4
Postive Thyrotrophin receptor antibodies (TRab): Thyroid-stimulating immunoglobulin (TSI)
Postive Thyroid Peroxidase Anitbodies (TPO)
How does propanolol work for hyperthyroidism?
It does not actually affect the hormone; rather via its beta 1 and beta 2 blocking ability it suppresses tachycardia and other catecholamine-induced symptoms
What condition has single or multiple autonomously functioning hyperthyroid nodules?
Toxic Nondular Goiter/Toxic Adenoma/ Plummer’s Disease; one ore more nodule hypersecreting T3 and T4
What nutrient should be avoided with toxic nodular goiter?
Iodine
What diagnostic technique is often used for classifying thyroid nodules?
RAI scan and fine- needle biopsy
Thyroid Scan (Technetium-99)
Graves’ Disease: Diffuse Uptake
Toxic Multinodular Goiter: Multiple Discrete Area
Solid Toxic Adenoma: Single Intense Area of Uptake
What are the changes seen on a thyroid panel in someone with Hashimoto’s thyroiditis?
Normal to low T4
Increased TSH
(+) Anti-TPO or anti-thyroglobulin antibodies
What are some of the signs and symptoms of hypothyroidism?
Weight gain
Constipation
Dry Coarse hair and skin
Fatigue
Muscle Cramps
Cold Intolerance
Loss of hair on lateral 1/3 of eyebrows
What reflex is often delayed in hypothyroid cases?
Achilles Reflex
What lab changes are noted with hypothyroidism?
High TSH
Low T3 & T4
What happens to lipid levels in someone with hypothyroidism?
Increased LDL, triglyceride levels
Which drugs affect thyroid function ?
Amiodarone, Lithium, OCPs
Untreated congenital hypothyroidism can manifest as what condition in offspring?
Cretinism- characterized by physical deformity and learning disabilities
What are the features of myxedema?
Pretibial myxedema (thickening of dermis) due to excess glycosaminoglycans in the dermis
Seen in severe adult hypothyroidism
Non-pitting edema
Swelling around lips and nose
Decreased basal metabolic rate
Can progress to coma in untreated cases
A condition that affects the thyroid itself cause what type of hypothyroidism?
Primary Hypothyroidism (90%)
-Autoimmune: Hashimoto’s thyroiditis (90% of cases)
-Inadequate thyroid hormone production secondary to intrinsic thyroid defect
-Hypopituitarism, iodine deficiency
-Drugs: goitrogens (iodine), PTU, lithium, Amiodarone
What causes a tertiary hypothyroidism?
Insufficiency of hypothalamic TRH (rare)
Hypothalamic Problem
What happens to the TSH level in secondary (pituitary) and tertiary hypothyroidism?
Insufficiency of pituitary TSH/hypothyroidism
It is low
What proteins are used to carry thyroid in the body?
TBG (thyroid binding globulin) 80-85%
TBPA (Thyroid binding pre-albumin) 10-15%
Albumin 0-5%
What causes decrease in the thyroid binding globulin (TBG) or decrease in the protein that carries T3 and T4 in the blood?
Malnutrition (proteins)
Liver Cirrhosis
Nephrotic Syndrome
Protein Losing Enteropathy
Increase Androgens
Hyperthyroidism
Medication side effect
What are some of the medications used to treat hypothyroidism?
USP Thyroid: Porcine thyroid gland
Levothyroxine or Levoxyl (T4)
Liothyronine (T3)
What are the advantages of using USP Thyroid?
You get a full complement of secretions of thyroid gland: T4 and T3
What is an adverse effect of too much thyroid hormone supplementation?
Hyperthyroidism
What are some of the common signs and symptoms of hyperparathyroidism?
Hypercalcemia-elevated urinary calcium
Headache
Fatigue
Kidney stone Formation
Muscle Weakness
Bone, pain, osteoporosis
Thirst
Nausea, vomiting
Abdominal Pain
Anxiety, Depression, Psychosis
What is the mnemonic for hyperparathyroidism?
Painful bones, renal stones, abdominal groans, psychic moans
What are some of the predisposing causes of hypoparathyroidism?
Thyroidectomy
Radioactive Iodine Therapy
Congenital (DiGeorge Syndrome)
Hemochromatosis or Wilson’s Disease
Hypomagnesemia
What are some of the common signs and symptoms of hypoparathyroidism?
Hypocalcemia
Parasthesia
Fatigue
Chronic Tetany
Muscle Cramps
Emotional Instability: Anxiety, irritability
What are the 2 physical exam test that will be positive with hypoparathyroidism?
Chovstek’s sign
Trousseau’s sign
Explain Chvostek’s sign
When the facial nerve is tapped at the angle of the jaw the facial muscles on the same side of the face will contract momentarily (Typically a twitch of the nose or lips) because of hypocalcemia.
Explain Trousseau’s Sign
When a carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes.
Spasm in the hand or the foot when a tourniquet is applied at the wrist or ankle due to electrolyte imbalance
What is the autoimmune disease resulting from adrenal cortex destruction?
Addison’s Disease
What are the signs and symptoms of Addison’s Disease?
Weakness, fatigue
Weight loss, anorexia, salt cravings
N/V, diarrhea or abdominal pain
Depression
Orthostatic hypotension, dizziness
Hyperpigmentation
What are some of the tests used to help diagnose Addison’s disease?
Morning serum cortisol
ACTH stimulation test
Abdominal CT
What is the syndrome resulting from adrenocortical excess?
Cushing’s Disease
When is Cushing’s syndrome considered Cushing’s Disease?
When the excess cortisol comes from an ACTH-secreting pituitary adenoma it is considered Cushing’s Disease
What are some of the classic signs and symptoms of Cushing’s syndrome?
Moon facies
Hirsutism or virilization in women
Buffalo Hump
Slim Distal Extremities
Thinning skin, purple striae
Hypertension
Muscle Atrophy
Bone Loss: Osteoporosis, increased risk of fractures
What are some of the test used to help diagnose Cushing’s syndrome?
Urinary free cortisol (24- hour -elevated)
Dexamethasone Supression Test
-Normal inhibits ACTH, reduce cortisol
-Individuals w/ ACTH secreting tumors, low- dose does not inhibit cortisol; high- dose dexamethasone does
-With Adrenal Cortical Tumors; neither low or hight dose dexamethasone inhibits cortisol secretion
What will high levels of aldosterone secretion cause in the body?
Hypertension
Hypokalemia
Hypernatremia
What causes Type I Diabetes mellitus?
Autoimmune destruction of the beta cells of the pancreas
Which viruses may be associated with the development of Insulin Dependent or Type I DM in children?
Coxsackie B, rotavirus, mumps and cytomegalovirus
What is the classic triad of signs and symptoms for Insulin Dependent or Type 1 DM?
Polyuria
Polydipsia
Polyphagia accompanied by weight loss
Describe the signs and symptoms of Ketoacidosis
Acetone “fruity” smell on the breath
Drunken behavior
Disorientation
Sudden loss of consciousness
Low blood pressure
N/V, abdominal tenderness
Tachycardia
What is the definition of Non-Insulin Dependent or Type II Diabetes mellitus?
A syndrome of chronic insulin resistance and high blood glucose levels usually related to lifestyle factors
What are some of the sequelae of untreated diabetes mellitus?
Retinopathy, glaucoma, cataracts, blindness
Nephropathy
Neuropathy
Peripheral vascular disease
Extremity gangrene
Death
What level of fasting blood glucose establishes a diagnosis of DM?
> 126 mg/dl (US) or >/= 7.0 mmol/L (CA)
What level of random blood glucose establishes a diagnosis of DM?
> 200 mg/dl (US) or >/= 11.1 mmol/L (CA)
What finding on an oral glucose tolerance test (OGTT) is diagnostic for DM?
2 hour plasma glucose >200 mg/dl (US) or >/= 11.1 mmol/L (CA)
How does DM affect urine specific gravity?
Increased it. Usually above 1.025
What kind of urine crystals would most often see with DM?
Uric acid crystals
What are some of the nutrients used to manage DM?
EFAs
Fiber
Vitamin C
B3, B6
Zinc
Chromium
Magnesium
Potassium
Vanadium
Glutamine, Alanine
Bioflavanoids
Biotin
What herbs are indicated for DM?
Allium Cepa
Allium Sativum
Momardica Charantia
Panax ginseng
Syzgium Jambolnum
Gymmema sylvestre
Oral hypoglycemics are indicated for what type of DM?
Non-insulin dependent Type 2 DM
What is the diagnostic criteria for metabolic syndrome?
Abdominal obesity, waist circumference > 40 men; >35 women
Hyperglycemia
Dyslipidemia
Hypertension
