Endocrine 1 Flashcards
What is known as the “Master Gland”?
Pituitary gland (hypophysis)
What makes up the Pituitary gland?
Two Lobes:
- Anterior and Posterior
The 2 lobes that make up the pituitary gland suspend from what?
Hypothalamus via pituitary stalk
What is the size of the pituitary gland and where is it located?
- Garden pea size
- Located in sphenoid bone at base of brain
What are the 6 hormones that are produced, stored, and secreted by the anterior pituitary lobe?
- TSH
- ACTH
- FSH and LH
- GH
- PRL
- Endorphins
What are the 2 hormones stored and secreted by the posterior pituitary lobe?
- ADH
- Oxytocin
What 2 hormones are produces by the hypothalamus?
- ADH (vasopressin)
- Oxytocin (Pictocin)
GH is responsible for what?
Growth, physical, and muscle development
TSH is responsible for what?
Stimulation of thyroid gland (T3, T4, calcitonin)
Prolactin is responsible for what?
Mammary glands- milk production
ACTH-Adrenocorticotropic Hormone is responsible for what?
Stimulates adrenal glands to release Cortisol
- important for Addisons dx and Cushings
FSH is responsible for what?
Gonadotropin- stimulates testes –> sperm
LH is responsible for what?
Stimulates Ovaries –> eggs
ADH - Antidiuretic Hormone (vasopressin) is responsible for what?
Water regulation and retention
Oxytocin (Pictocin) is responsible for what?
- Uterine contraction before and after deliver
- Let down of milk in mammary glands
- given in ER for bleeding postpartum
What is Acromegaly?
- Disorder d/t excess GH that occurs after growth plate cartilage fused in adulthood
- Enlarged hands and feet, widening teeth and face
- Widening as opposed to lengthening
What is Sheehan Syndrome?
- Hypopituitarism caused by blood loss during childbirth
- Post-partum pituitary gland necrosis
What is postpartum pituitary gland necrosis?
Ischemic in nature, hypovolemic insult to mother during or immediately after child birth
What is orange peel skin? and what is it caused by?
- Cause: hyperthyroidism
- Cellular buildup around pores that enhances shadows making pore appear larger
- Dehydration adds cellophane like sheen to skin and rough texture.
What is gigantism? and when does it occur
- Abnormally high linear growth d/t excessive action of GH
- Occurs when epiphyseal growth plates are open during child birth
What is hypogonadism?
- The body’s sex gland produce little to no hormones
- Men: testes
- Women: Ovaries
What is the cause of dwarfism and how is it treated?
- GH deficiency
- Tx w/ GH
What is disproportionate in regards to dwarfism?
- Average size torso w/ shorter limbs
OR - Shortened trunk w/ longer limbs
What is proportionate in regards to dwarfism?
Body parts are in proportion but shortened
What are striae?
“Stretch marks”
- Form of scarring on the skin w/ an purplish color
- Caused by tearing of the dermis
- Often a result of rapid stretching or rapid weight changes.
Striae may be influenced by hormonal changes associated with what?
- Puberty
- Pregnancy
- Bodybuilding
- HRT
What is the overview of pituitary disease process?
- Gradual insidious progression over long period of time
- Generally a single hormone vs several involved.
In general what is the etiology of Hypopituitarism or Hyperpituitarism? and is usually a dysfunction of what?
- Tumors (adenomas)
- Trauma
- Malfunctions
- Inflammatory dz
- Dysfunction: hypothalamus or pituitary gland
Sxs in pituitary disease depends on what?
The hormones that are involved
What are the dx test for pituitary disease?
- Blood
- CT
- MRI
- XR
What are the tx options for pituitary disease?
- HRT
- Tx underlying cause: surgery, chemo or radiation
What is the basic thyroid process including the hormones?
Hypothalamus –> TRH –> Pituitary gland –> TSH –> Thyroid –> T3, T4, Calcitonin
What are sxs of hypothyroidism?
- Temp sensitivity
- Unexplained wt gain
- Increase cholesterol
- Hoarse voice
- Dry Skin
- Heavier menstrual flows
What are sxs of hyperthyroidism?
- Hyperactivity
- Anxiety
- Cardiac irritability (AF/VT)
- Wt loss w/ increased appetite
- N/V/D
What is the the MCC of primary hypothyrodisim? and what age group is affected?
Hashimotos Dz/Thyroditis
45-65 yo
What occurs if Hashimotos dz/thyroiditis is not treated?
Myxedema/Myxedema coma
- rare but can be life threatening d/t hypoTN and hypothermia
What is the MCC of hyperthyroidism?
Graves dz- autoimmune response
What are S/Sx of Graves dz?
- Goiter
- Exopthalmosis
- Orange peel skin
- Anxiety/Irritability
- Fine tremors in hands
- Wt. loss despite normal appetite
- Fatigue
- Heat sensitivity
What is the 2nd MCC of Hyperthyroidism?
Plummers Dz- multinodular adenomas
What is basic adrenal process including the hormones?
Hypothalamus –> Corticotropin releasing hormone –> Anterior Pituitary –> ACTH –> Adrenals Corticosteroids –> cortisol
What does Cortisol do?
- Maintain BP, CV fxn
- Regulates metabolism
- Weakens immune system and body’s response to stress
- Reduce histamine secretion
In Addisons disease are cortisol levels low or high? and what are the S/Sxs?
- Low cortisol levels
- Insidious onset
- Salt cravings
- Hyperpigmentation
- Mood/personality changes
- Joint and muscle pain
- Hypoglycemia
In Cushings syndrome are cortisol levels low or high? and what are the S/Sxs?
- High cortisol level
- Fatty deposite between shoulders (buffalo hump)
- Round face: moon face
- Striae
- Psych disturbances
What is the tx for addisons?
Oral hydrocortisone
What is endogenous cushings disease?
Abnormal secretion of cortisol (caused by factors within the body)
What is pituitary cushings?
A benign pituitary adenoma secreting large amounts of ACTH which elevates cortisol levels (MCC)
What is adrenal cushings?
Excess cortisol produced by adrenal gland tumors
What is the MCC exogenous cushings disease?
Iatrogenic- caused by factors outside the body, ie) meds for medical conditions:
- Glucocorticoids: dexamethasone, prednisone, hydrocortisone.
How do you diagnose Cushings disease?
- Dexamthasone suppression test OR - 24 hr urinary measurement of cortisol levels OR - 24hr Saliva cortisol levels - CT, MRI
What is the tx of cushings?
- Carefully taper off medication causing sxs
- Surgical removal of space occupying lesions w/ subsequent prednisone or hydrocortisone replacement therapy.
What is primary hypogonadism?
The ovaries or testes do not function properly
What is central hypogonadism?
The centers in the brain that control the gonads (hypothalamus or pituitary) do not function properly
What is the primary causes of hypogonadism?
- Autoimmune disorders
- Genetic/Development disorder
- Infxn
- Liver and kidney disease
- Radiation
- Surgery
What is the MC genetic disorder that cause primary hypogonadism?
- Turner syndrome (in women)
- Klinefelter syndrome (in men)
What are the causes for central hypogonadism?
- Bleeding
- Medication: steroids and opiates
- Genetics
- Infxn
- Nutritional deficiencies
- Iron excess hemochromatosis
- Radiation
- Rapid wt loss
- Surgery
- Trauma
- Tumors
If a brain tumor is present causing central hypogonadism there may be what?
- HA or vision loss
- Milky breast discharge (prolactinoma)
- Hypothyroidism
What are some clinical presentations that are seen in girls who have hypogonadism?
- Will not begin menstruating
- Will affect breast development and height in girls
What are the sxs of hypogonadism that occurs after puberty in women?
- Hot flashes
- Loss of body hair
- Low libido
- Menstruating stops
What are some clinical presentations that are seen in boys who have hypogonadism?
- Will have muscle and beard development issues
- Growth problems
What are the sxs of hypogonadism that occurs in adult men?
- Breast enlargement
- Decreased beard and body hair
- Muscle loss
- Sexual problems
What are the diagonstic test for hypogonadism?
- Estrogen level (women)
- FSH and LH level
- Testosterone level (men)
- many other lab test
- CT of head, MRI, and US of gonads
What is the tx for hypogonadism?
- Girls and women: estrogen an progesterone
- Boys and men: testosterone
- Surgery
- Radiation therapy
- consult and refer
What are the target organs for prolactin?
Mammory glands
- increases breast size during pregnancy
- increases milk production
What is the major prolactin inhibitor?
Dopamine
What is witches milk? and when does it resolve?
- Infants response to prolactin
- May grow breast and milk production
- Normal response
- Self resolves 1-2 wks
What are common complaints in a pt with prolatinemia?
- Amenorrhea
- Galactorrhea
- Erectile dysfunction
- Decreased libido
What is required in any pt you suspect has prolactinemia?
A pregnancy test
- unless pt is postmenopausal or has had a hysterectomy.
What is the tx for prolatinemia?
- Meds: dopamine
- Surgery
- Chemo/Radiation
- Never forget to consult early and often
What is the neuro effects of oxytocin?
Increased oxytocin promotes bonding and maternal behaviors at birth
What systems does ADH (vasopressin) regulate?
- Renal
- CV
- CNS
What does ADH do on the renal system?
Water regulation
- increases permeability to H2O in distal tubules
What does ADH do on the CV system?
Increase vascular resistance of peripheral vessels = increased arterial pressure
What does ADH do on the CNS system?
Implicated in memory formation of both short and long term
