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FPHCI- Metabolic Disorders > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Hypothalamus

A

Brain region controlling the pituitary gland

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2
Q

Pituitary gland

A

Secretes many different hormones, some of which affect other glands

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3
Q

Thyroid gland

A

Affects metabolism, among other things

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4
Q

Parathyroids

A

Help regulate level of calcium in the blood

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5
Q

Ovary

A

Secretes female sex hormones

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6
Q

Adrenal glands

A

Help trigger the fight or flight reponse

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7
Q

Pancrease

A

Regulates the level of sugar in the blood

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8
Q

Testis

A

Secretes male sex hormones

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9
Q

Common Findings of Endocrine Dysfunction

A 
Decreased energy level/fatigue
Intolerance to heat or cold
Changes in sexual function
Development of secondary sex characteristics 
Changes in mood, ability to concentrate
Changes in memory and sleep patterns
Exophthalmos
Hypotension or hypertension
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10
Q

Anterior Pituitary Hormones

A 
GH
ACTH
TSH
LH
FSH
Prolactin
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11
Q

Hormones in the Posterior Pituitary

A

Oxytocin
ADH
Produced in the hypothalamus, are stored for release

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12
Q

Pituitary Dysfunction

A

Under secretion or over secretion
Hypo: Hypopituitarism
Anterior pituitary hyper function- involves ACTH or GH
Posterior pituitary hypofunction- most commonly deficient secretion of ADH

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13
Q

Pituitary Imaging

A

MRI with gadolinium is the best procedure for most masses

90% sensitivity, specificity

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14
Q

Symptoms of Pituitary Tumor

A 
headache 
decreased libido (interest / desire in sex)
menstrual disorders 
cold intolerance
excessive perspiration (sweating)
decreased appetite
vision impairment, blurriness, 
blindness (particularly poor peripheral vision)
excessive thirst and frequent urination
growth failure
delayed or premature puberty
nausea
dry skin
constipation
fatigue
low or high blood pressure hypernatremia (high sodium in the blood)
frequent urination (diabetes insipidus)
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15
Q

Pituitary Tumors and the Diseases They Cause

A

Prolactinoma (nonfunctioning pituitary adenoma)
Acromegaly (Growth hormone secreting adenoma)
Cushing’s Disease (ACTH secreting adenoma)
Thyrotropin (TSH) secreting adenomas

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16
Q

Prolactinoma

A

Nonfunctioning pituitary adenoma

Infertility
amenorrhea (absence of menses or menstrual periods) oroligomenorrhea (irregular/sparse menstruation)
decreased libido (interest in sex)
galactorrhea (breast milk production/leakage/nipple discharge)
osteoporosis (brittle bones –actually calcium deficient)/bone fractures/breakage
impotence vaginal dryness (painful intercourse) visual loss

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17
Q

Acromegaly

A

Growth Hormone Secreting Adenoma

sleep apnea
hand, foot, face, or tongue growth or enlargement, swelling (soft tissue enlargement)
coarsening of facial featureschange in ring or shoe size
spreading teeth, bite difficulties (overbite/underbite)
Bell’s palsy (facial paralysis on one side)
carpal tunnel syndrome
joint and bone aches, pains and tenderness (including foot and tooth pain)
Gigantism
excessive perspiration (sweating)
oily skin
impotence

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18
Q

Cushing’s Disease Symptoms

A

ACTH Secreting Adenoma

fat build-up in the face (round or moon face)
back (characteristically the upper back causing a so-called hump), and chest, while the arms and legs to become relatively thin
hyperglycemia/diabetes (too much sugar in the blood)
weak and fragile muscles and bones
Backache
flushed (red) face
thin skin
increased bruising
skin ulcers
hypertension (high blood pressure)
weight gain
skin striae (lines/wrinkles/stretch marks)
decreased fertility in men
mood swings
excess hair growth
osteoporosis rib and vertebral compression fractures

Excessive adrenocortical activity
Most often due to corticosteroid use
Overnight dexamethasone suppression test
Indicators: ↑ Na+ ↑ glucose ↓ K+

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19
Q

Cushing’s Disease Causes

A

Excessive adrenocortical activity
Most often due to corticosteroid use
Overnight dexamethasone suppression test
Indicators: ↑ Na+ ↑ glucose ↓ K+

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20
Q

Cushing’s Syndrome Treatment

A 
Pituitary tumor
Surgical removal
radiation
Adrenalectomy
Adrenal enzyme inhibitors 
Metyrapone, glutethimide, ketoconazole
attempt to reduce or taper corticosteroid dose
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21
Q

Thyrotropin (TSH) Secreting Adenoma Symptoms

A

weight loss
increased appetite
heart palpitations or irregular heartbeat (supraventricular tachycardia, atrial fibrillation)
tachycardia (rapid heart rate)
heat intolerance and increased sweating
Tremor
frequent bowel movements
fatigue and muscle weakness
exertional intolerance and shortness of breath
oligomenorrhea (decreased menstrual flow)
nervousness and irritability and other mental disturbances
sleep disturbances (including insomnia)
changes in vision, photophobia, eye irritation, diplopia or exophthalmos
lower extremity edema (swelling)
sudden paralysis
impaired fertility

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22
Q

Hyperthyroidism

A

Most common between age 20 – 40, women > men
TSH < 0.35 mIU/L, FT4 > 12.5 mcg/dL
Causes include autoimmune disorders (Graves’ Disease), viral infections, multiple other causes
Treatment varies and is dependent on cause
May include hospitalization with IV treatments, & hydration if in thyroid storm, antithyroid drugs (PTU, Tapazole), radioactive iodine, or surgery
Thyroid function should be monitored at least twice per year
Goal of tx is euthyroid state

23
Q

Hypothyroidism

A

Almost 5% of US population, women > men
Hashimoto’s (autoimmune) is most common type (ages 30 – 60)
Need anti-TPO antibody to aid in diagnosis
Routine screening guidelines for asymptomatic patients vary and range from starting at age 35 to starting at age 50
TSH > 10 mIU/L & FT4 (normal to low)  need treatment
TSH 4.5 mIU/L > 10 mIU/L treatment guidelines vary
Treatment (Synthroid) – start 1.6 mcg/kg daily, adjust based on TSH levels every 4 – 6 weeks
If older or severe disease, start 12.5 mcg – 50 mcg daily
Levels should be monitored once – twice a year

24
Q

Thyroid Cancer

A

Papillary is the most common (60%), Follicular 2nd (20%)
Most are small and slow-growing
Most common in adults aged 20 to 54, women > men
Symptoms; lump or nodule in the neck, usually painless, tight or full feeling in neck, diff breathing or swallowing, hoarseness, hemoptysis
U/S if suspicion for multinodular or thyroid difficult to evaluate clinically
Radioactive iodine uptake determines functionality of nodule; positive uptake has more favorable prognosis
Diagnosis is made with fine-needle aspiration of a suspected nodule (generally those > 10 mm are biopsied)
Treatment – surgery and thyroid replacement, may/may not need radiation & chemo

25
Q

Syndrome of Inappropriate ADH Secretion (SIADH)

A

Excess secretion of ADH even with subnormal serum osmolality
Can not excrete a dilute urine
Retain fluids and develop dilutional hyponatremia
Usually non-endocrine cause
Typical interventions: treat underlying cause and restrict fluids
May use diuretics (furosemide) is severe ↓ Na

26
Q

Hyperparathyroidism Manifestations and Diagnostics

A

Manifestations:
Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, HTN, cardiac dysrhythmias

Dx: ↑ serum calcium and ↑ PTH concentrations

27
Q

Hyperparathyroidism Management

A

Management:
Surgical removal if symptoms
Monitor and wait if no symptoms
Avoid dehydration

28
Q

Hypoparathyroidism Manifestations and Diagnostics

A

Manifestations: Tetany
Latent: numbness, tingling, cramps in extremities, stiff hands and feet
Overt: bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, seizures, photophobia, cardiac dysrhythmias
Dx: Positive Chvostek’s and Trousseau’s sign

29
Q

Hypoparathyroidism Treatment

A

In acute hypoparathyroidism
IV parathormone
Chronic: diet high in calcium and low in phosphorus
Oral Ca gluconate, aluminum carbonate, vitamin D

30
Q

Trousseau’s Sign

A

Temporarily occlude arterial blood flow with a BP cuff to 20mmHg above the normal systolic pressure for 2-5 minutes. If hand and fingers contract positive.

31
Q

Chvostek’s Sign

A

Tap of the facial nerve just below the temple. The sign is positive if you see nose, eye, lip, or facial muscle twitching.

32
Q

Addison’s Disease

A

Acute Adrenal Insufficiency
Life-threatening
Cortisol and aldosterone needs are greater than the supply
Related to stress, trauma, severe infection

33
Q

Addion’s Disease Causes

A 
Autoimmune disease
Tuberculosis
Fungal lesions
AIDS
Hemorrhage (Adrenal)
Adrenalectomy
Radiation 
Secondary Causes: 
Pituitary hormones
Hypophysectomy
High dose pituitary radiation
Brain radiation
34
Q

Management of Adrenal Insufficency/Addison’s

A

Hormone replacement
Hyperkalemia management
Hypoglycemia management

35
Q

Addison’s Disease Diagnostics and Labs

A 
CMP
UA
CT
MRI
ACTH stimulation test (rapid and long)
36
Q

Long Term Management of Addison’s Disease

A

Hydrocortisone

  • Corrects glucocorticoid deficiency
  • Florinef maintains electrolyte balance
37
Q

Adrenal Insufficiency

A

Adrenal cortex function is inadequate to meet the needs for cortical hormones

Primary- Addison’s

Secondary- lack of ACTH, prednisone withdrawal

38
Q

Adrenal Gland Hyperfunction

A

Adrenal gland may over secrete one or more of the adrenal hormones

Cushings disease or hyperaldosteronism- excessive mineralcorticoid production

39
Q

Hypercortisolism

A

Patients with Cushing’s disease (hyper cortisolism) exhibit
Problems with nitrogen, carbohydrate and mineral metabolism.
Slow turnover is of plasma fatty acids
“Buffalo hump”
High levels of corticosteroids decrease immunity by destroying lymphocytes.
Increased androgen production causes hirsutism

40
Q

Causes of Increased Cortisol Levels

A 
Endogenous (Cushing disease)
Adrenal hyperplasia 
Adenoma
Carcinomas
Exogenous (Cushing Syndrome)
-asthma
-Autoimmune disorders
-Organ transplants
-Cancer chemo
-Allergic responses
-fibrosis
41
Q

Cushing’s Diagnostics

A

24-hour urinary free cortisol level

Midnight plasma cortisol and late-night salivary cortisol measurements

Low-dose dexamethasone suppression test (LDDST)

Dexamathasone-corticotropin-releasing hormone (CRH) test

CMP (Increased glucose, sodium. Decreased lymphocyte count, calcium and potassium).

U/A

CT, MRI

42
Q

Management of Cushing’s

A

Radiation therapy
-Treats pituitary adenomas
Surgery
-Removal of tumor or pituitary itself
Drug therapy
Lysodren - Mitotane is used to treat cancer of the adrenal glands. It works by slowing the growth of or killing adrenal gland cells and also decreases the amount of hormones made by the adrenal gland.
Elipten- An aromatase inhibitor that produces a state of “medical” adrenalectomy by blocking the production of adrenal steroids. It also blocks the conversion of androgens to estrogens. Elipten has been used in the treatment of advanced breast and prostate cancer. It was formerly used for its weak anticonvulsant properties.

43
Q

Hyperaldosteronism

A

Increased secretion of aldosterone which results in mineralocorticoid excess
Most often caused by adrenal adenoma (primary hyperaldosteronism)
Elevated levels of angiotensin II are seen in secondary hyperaldosteronism

44
Q

Clinical Manifestations of Hyperaldosteronism

A 
Hypokalemia and elevated BP
Headache
Fatigue
Nocturia
Polydipsia
Polyuria
paresthesia's
45
Q

Management of Hyperaldosteronism

A

Treatment goal in patients with primary aldosteronism is to prevent the adverse outcomes associated with excess aldosterone, including hypertension, hypokalemia, renal toxicity, and cardiovascular damage.
Surgery for early stage
Unilateral adrenalectomy
Drug therapy
Medication to increase K+
Spironolactone or Eplerenone
spironolactone starting dose is 12.5 to 25 mg daily with food
dose can be increased every two weeks until the target serum potassium of 4.5 mEq/L is reached. The typical maximum dose is between 100 to 400 mg daily.

46
Q

Pheochromocytoma

A

Catecholamine producing tumor that arises in chromaffin cells.
Occurs in a single lesion on adrenal gland
Releases epinephrine and norepinephrine
Cause is unknown occur more in women then men.
Could be inherited

47
Q

Clinical Manifestations of Pheochromocytoma

A 
Intermittent episodes hypertension (classic)
Headache
Sweating
Palpitations
Impeding doom
Drugs may induce hypertensive crisis
48
Q

Adrenal Gland Dysfunction: Pheochromocytoma

A

Tumor of the adrenal gland
Usually benign
Peak incidence between 40 and 50
Symptoms triad: headache, diaphoresis and palpitations
Hypertension and cardiac disturbances common
Acute, un-predictable onset with gradual resolution of symptoms
24-hour urine epinephrine

49
Q

Pheochromocytoma Diagnostics and Lab

A

24-hour UA to test for VMA (vanillylmandelic acid) a production of catecholamine metabolism)
CT
MRI

50
Q

Pheochromocytoma Management

A

Surgery- one or both adrenal glands are removed

Monitor BP and treat if hypertensive crisis

51
Q

Primary Aldosteronism

A

Profound ↓ K+ and H+ ions, ↑pH and HCO3
Near normal or ↑ Na
Universal sign: HTN
Dx:
Measurement of aldosterone excretion rate after salt loading
Renin-aldosterone stimulation test and bilateral adrenal venous samplin

52
Q

Primary Aldosteronism Symptoms

A 
Symptoms:
Muscle weakness
Cramping
Fatigue
Nonacid urine
Polyuria
↑ serum osmolality
Polydipsia
Arterial HTN
53
Q

Primary Aldosteronism Management

A

Surgical removal
Spironolactone for persistent HTN
Monitor for fluctuations in adrenal hormones
Corticosteroids, fluids, agents to maintain BP and prevent complications
Maintain normal serum glucose

FPHCI- Metabolic Disorders (3 decks)

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