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Pathophysiology > Endocrine 1 > Flashcards

Endocrine 1 Flashcards

1
Q

What are the different types of endocrine pathologies?

A
  • Hyperfunction- too much hormone
  • hypofunction- not enough hormone
  • tumors/cancer
    • often causes hyperfunction
    • sometimes cause Bulk disturbance, where the size of the tumor affects the function of the cells that would normally release hormone (causing hypofunction)
  • Defective receptor or enzyme (genetic disease)
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2
Q

What kinds of dysfunctions can cause either an elevated or depression of hormone levels?

A
  • failure of feedback systems
  • dysfunction of an endocrine gland
  • secretory cells are unable to produce, obtain, or convert hormone precursors
  • the endocrine gland synthesizes or releases excessive amounts of hormone
  • increased hormone degredation or inactivation
  • ectopic hormone release
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3
Q

What are the different types of target cell failure?

A
  • Receptor-associated disorders
    • decrease in number of receptors
    • impaired receptor function (usually autoimmune)
    • presence of antibodies against specific receptors (usually autoimmune)
    • antibodies that mimic hormone action (ex. graves disease)
    • Unusual expression of receptor function
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4
Q

What are the different hyperthyroidisme diseases?

A

graves disease

hyperfunctioning adenoma (toxic goiter)

TSH cell adenoma

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5
Q

What are the different types of hypothyroidism diseases?

A

Hashimoto thyroiditis

iodine deficiency

ablation (usually accidental removal when trying to remove parathyroid)

idiopathic

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6
Q

What are the thyroid hormones?

How are they different?

How are they measured?

A
  • T4:T3 ratio is 10:1
  • T3 is 3-4x more active than T4
  • TSH is measured with the third generation of the TSH assay
    • it can distinguish even very slight abnormalities in levels of TSH secretion which is helpful in diagnosis
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7
Q

If TSH is elevated and T3/T4 are elevated, what might be the problem?

A
  • You have too much TSH being produced
    • Pituitary adenoma secreting TSH
    • Extopic TSH production (ex lung cancer)
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8
Q

If TSH is elevated and T3/T4 is decreased, what problems might you have?

A
  • Thyroid dysfunction:
    • Hashimotos thyroiditis- autoantibodies against thyroid proteins
  • Iodide deficiency
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9
Q

If you have decreased TSH and elevated T3/T4, what problems might you have?

A
  • Thyroxine production not under the control of TSH
    • graves disease
    • toxic goiter
    • Thyroxine secreting thyroid tumor
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10
Q

If you have decreased TSH and decreased T3/T4, what is probably causing your problems?

A
  • Pituitary dysfuntion
    • panhypopituitarism
    • null cell adenoma
    • sheehan’s syndrome
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11
Q

What are the symptoms of hyperthyroidism?

A
  • anxiety
  • irritability
  • difficulty sleeping
  • fatigue
  • rapid or irregular heartbeat
  • a fine tremor of hands or fingers
  • an increase in perspiration
  • sensitivity to heat
  • weight loss, despite normal food intake
  • brittle hair
  • goiter
  • light menstreal periods
  • frequent bowel movements
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12
Q

What are the treatments for a goiter?

A
  • BB for relief of S&S
  • anti-thyroid meds (PTU) which prevent conversion of T4 to T3
  • radioactive iodine
  • surgery
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13
Q

What are the causes of hypothyroidism?

A
  • Hypothyroidism- causes:
    • hashimoto disease
      • autoimmune destruction of gland
      • causes thyroid inflammation
    • lack of iodine
    • idiopathic causes like lack of appropriate enzymes required for thyroid hormone production
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14
Q

What are the symptoms of hypothyroidism?

A
  • increased sensitivity to cold
  • decreased:
    • CO
    • baroreceptor function
    • HR
    • slowed conduction
  • fatigue
  • constipation
  • pale, dry skin
  • a puffy face
  • hoarse voice
  • elevated blood cholesterol
  • unexplained weight gain
  • muscle aches, tenderness and stiffness
  • pain, stiffness or swelling in joints
  • muscle weakness
  • heavy menstrual periods
  • depression
  • mental retardation in infants or in utero
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15
Q

How is hypothyroidism treated?

A

Levothyroxine

iodine if issue is iodine deficiency

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16
Q

How does Hashimoto Thyroiditis work?

A
  • Helper T-cells induce the cytotoxic T cells and antibody secreting B cells to activate autoimmune response
    • cytotoxic T cells are mostly responsible for the parenchymal destruction
    • B cells secrete antibodies that inhibit the TSH receptor
  • Antighyroglobulin and antithyroid peroxidase antibodies do not really contribute to the disease, but are useful serologic markers of the disease
17
Q

What is Myxedema?

A
  • Almost total lack of thyroid hormone
  • increase in chondroitin and hyaluronic acid causing interstitial fluid to increase and cause edema
  • Why it happens is not clear
18
Q

What is cretinism?

A
  • Extreme hypothyroidism in fetal life, infancy or childhood
    • can be d/t lack of a thyroid gland
    • lack of thyroid hormone
    • lack of iodine
  • skeletal growth is more stunted than soft tissue
  • disproportionate stuntin of growth
    • obesity with large tongues
19
Q

What is pheochromocytoma?

A
  • neoplasm of chromaffin cells (on adrenal gland)
    • catecholamine secreting tumors
    • secretes mostly NE; 85:15 ratio to epi
    • rarely, in 15% of tumors epi excretion predominates
20
Q

What are the symptoms of pheochromocytoma?

A
  • tachycardia
  • palpitations
  • excessive sweating
  • chest pain
  • upper abdominal pain
  • severe HA
  • shaking of hands
  • anxiety
  • fright
  • HTN etc….
21
Q

How is pheochromocytoma treated?

A
  • Alpha blockers
  • beta blockers
  • surgery
22
Q

What are the different ways cushing syndrome can be caused? What is cushing syndrome?

A
  • Cushing syndrome is hypercorticalism
  • Pituitary cushing syndrom-Tumor in pituitary gland releasing too much ACTH which causes the adrenal to release lots of cortisol.
  • Adrenal cushing syndrome-Problem with the adrenal gland (either tumor or hyperplasia) causing excessive release of cortisol
  • Paraneoplastic cushing syndrome- lung or other non endocrine cancer that releases ACTH, causing the adrenal to release lots of cortisol
  • Iatrogenic cushing syndrome- pt taking exogenous steroids. The steroids cause the cushing syndrome while the adrenal gland atrophies
23
Q

What is the feedback loop for ACTH and glucocorticoid secretion?

A
  • Various stimuli cause the hypothalamus to release CRH which goes to the anterior pituitary
  • Anterior pituitary releases ACTH which goes to the adrenal.
  • Adrenal cortex releases glucocorticoid
  • Glucocorticoid provides negative feedback to anterior pituitary AND hypothalamus
24
Q

What are the effects of cushing’s syndrome?

A
  • increases blood glucose
  • increases protein catabolism causing muscle wasting and weakness
  • mobilization of fat from lower body to abdomen, face, trunk, and back
  • Other symptoms:
    • wt gain
    • fatigue
    • stretch marks
    • thin fragile skin
    • slow healing of cuts
    • depression
    • acne
    • irregular menstrual periods
    • high blood pressure
25
Q

What are the treatments for cushing’s syndrome?

A
  • reducing corticosteroid use
  • surgery
  • radiation therapy
  • medical therapy
26
Q

What is Conn’s disease?

A
  • Primary Aldosteronism (hyperaldosteronism)
  • Caused by tumors in the zona glomerulosa that releases aldosterone
  • sodium retention HTN
  • leads to hypokalemia
  • metabolic alkalosis
  • increases in ECF and blood volume
27
Q

What is Addison’s disease?

A
  • Adrenocortical insufficiency
  • Caused by primary atrophy or injury to adrenal cortices
  • Leads to decreased mineralocorticoid and glucocorticoid hormones
    • low aldosterone causes depletion of ECF with decrease in NA, BP, and CO; leading to hyperkalemia and mild acidosis
    • low glucocorticoid decreases the ability to maintain BP or ability to mobilize fat and proteins causes decreased metabolic function and decreased ability to respond to stressors
28
Q

What are the symptoms of Addison’s disease?

A
  • muscle weakness and fatigue
  • wt loss and decreased appetite
  • darkening of the skin
  • low BP, even fainting
  • salt craving
  • low BS
  • N/V/D
  • irritability
29
Q

What are the two types of hyperparathyroidism and what are the symproms?

Treatment?

A
  • Types:
    • Primary- usually caused by adenoma or hyperplasia
    • Secondary- usually caused by low Ca or high phosphate
  • Symptoms
    • hypercalcemia
    • hypercalciuria
    • kidney stones
    • heartburn, PUD
    • N/V appetite loss
    • osteoporosis
    • confusion
    • muscle weakness
  • Treatment
    • surgery, but cannot remove all four parathyroid glands permanently
30
Q

What happens with hypoparathyroidism?

Treatment?

A
  • Osteoclasts become almost totally inactive
    • decreases calcium levels
  • Tetany, especially in smaller muscles of the larynx
  • Treatment: parathyroid hormone and Vitamin D
31
Q

What hormones can a decreased hypothalamic function affect?

A

*Dopamine should say decreased PIF (prolactin realease inhibiting factor)

32
Q

What is diabetes insipidus?

A
  • A disease of the posterior pituitary
  • insufficiency of ADH
  • polyuria and polydipsia
  • partial or total inability to concentrate the urine
  • neurogenic
    • insufficient amounts of ADH
  • Nephrogenic
    • inadquate response to ADH
33
Q

What is SIADH?

A
  • hypersecretion of ADH
  • enhanced renal water retention
  • hyponatremia
  • hypoosmolarity
34
Q

What can cause hypopituitarism?

A
  • Pituitary infarction
    • sheehan syndrome- necrosis due to heavy blood loss in delivery of a baby
    • shock
  • Panhypopituitarism- usually due to cell destroying tumors
    • ACTH deficiency
    • TSH deficiency
    • FSH and LH deficiency
    • GH deficiency
  • Others- head trauma, infections, and tumors
35
Q

What usually causes hyperpituitarism?

How does it manifest?

A
  • commonly due to a benign, slow growing pituitary adenoma
  • Manifestations
    • HA and fatigue
    • visual changes
    • hyposecretion of neighboring anterior pituitary hormones
36
Q

What diseases can hypersecretion of growth hormone cause?

A
  • Acromegaly- if it happens in adulthood
    • big facial features
  • Gigantism- if it happens in children and adolescents
    • actual giant
37
Q

What causes dwarfism?

A
  • generalized deficiency in childhood
  • stunts growth
  • body develops appropriately propotional but growth rate is slowed
  • inability to go through puberty
    • in 1/3 only growth hormone is missing so can develop sexually and reproduce
38
Q
A

Pathophysiology (26 decks)

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