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NS374—Pathophysiology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

5 mechanisms of endocrine disorders

A
  • Failure of feedback
  • Gland dysfunction
  • Increased hormone degradation/inactivation
  • Ectopic hormone release
  • Target cell failure
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2
Q

3 mechanisms of gland dysfunction

A
  • Secretory cells unable to produce, obtain, or convert hormone precursor (Ex. iodine needed for TH)
  • Gland synthesizes or released excessive amts of hormone
  • Gland fails to produce enough hormone
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3
Q

hormone released from organ that should not be releasing it

A

ectopic hormone release

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4
Q

anterior pituitary hormones - 6

A
  • Thyroid-stimulating hormone
  • Follicle-stimulating hormone
  • Luteinizing hormone
  • Adrenocorticotropic hormone
  • Growth hormone
  • Prolactin
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5
Q

stimulates release of glucocorticoids & androgens

A

ACTH

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6
Q

stimulates lactation

A

prolactin

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7
Q

posterior pituitary hormones - 2

A
  • Antidiuretic hormone
  • Oxytocin
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8
Q

↑ reabsorption of water in kidneys

A

ADH

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9
Q

stimulates uterine contractions & milk release

A

oxytocin

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10
Q

↑ BMR

A

thyroid hormone

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11
Q

2 thyroid hormones

A

thyroxine (T4) & triiodothyronine (T3)

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12
Q

↑ blood calcium

stimulates bone resorption (ostoclasts)

↑ calcium absorption

A

PTH

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13
Q

hormones of adrenal cortex - 3

A
  • Mineralcorticoids (aldosterone)—zona glomerulosa
  • Glucocorticoids (cortisol)—zona fasciculata
  • Gonadocorticoids (androgens)—zona reticularis
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14
Q

hormones of adrenal medulla - 2

A

Catecholamines (norepinephrine & epinephrine)—chromaffin cells

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15
Q

↑ reabsorption of Na+ & water

↑ secretion of K+ in urine

A

aldosterone

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16
Q

↑ breakdown of fat & protein

promotes stress resistance

inhibits immune response

A

cortisol

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17
Q

mimic testosterone in females

A

androgens

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18
Q

mimic SNS activation; “fight or flight”

A

epinephrine & norepinephrine

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19
Q

pancreatic hormones - 2

A
  • insulin
  • glucagon
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20
Q

↑ blood glucose

A

glucagon

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21
Q

T1DM

explanation

etiology

r/f

s/s

tx

A
  • Type 4 hypersensitivity - T-cells destroy pancreatic beta cells - pancreas produces little or no insulin
  • Etiology - idiopathic
  • r/f - genetics; infection; other autoimmune disorders
  • s/s - “3 P’s” (polyuria - water follows glucose in tubules; polydipsia - dehydration from fluid pulling out of body; polyphagia - catabolic state); glucosuria; DKA; wt loss; fatigue; weakness; mood changes
  • Tx - lifelong insulin replacement
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22
Q

T1DM accounts for __% of diabetic population

A

10

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23
Q

when does hyperglycemia occur in T1DM?

A

80-90% of beta cells are destroyed

24
Q

T2DM

explanation

r/f

s/s

A
  • Cellular resistance to insulin, then inability to produce adequate insulin
    • Beta cells respond to resistance by producing more insulin
    • Beta cells go through hyperplasia & hypertrophy - causes scarring in pancreas
    • May need more and more medication/insulin as time goes on
  • r/f - obesity; sedentary; genetics; HTN; family hx
  • s/s - fatigue; pruritus; recurrent infections (glucose on urinary meatus); visual changes; neuropathy (hands and feet); high cholesterol (especially triglycerides - leads to atherosclerosis); HTN (damage to glomerulus)
25
Q

3rd type of DM

A

gestational DM

26
Q

dx tests for DM

A
  • Fasting blood glucose - fast must be at least 8hrs
  • Glucose tolerance test - screening for pregnant women around 28 weeks
  • Glycosylated hemoglobin (HA1C) - average of BG over 3 months’ time
27
Q

complications of DM are most related to…

A

duration & extent of abnormal BG

28
Q

complications of DM

A
  • microvascular changes (peripheral vascular disease; nephropathy; retinopathy; neuropathy)
  • CV disease
  • DKA (type 1)
  • HHNS (type 2)
  • amputations
  • hypoglycemia
29
Q

primary cause of mortality in adolescents with DM

A

DKA

30
Q

DKA responsible for __% of DM-related hospitalizations

carries a ___% mortality

A

15

1-3

31
Q

DIABETIC KETOACIDOSIS

explanation

onset & duration

etiology

r/f

s/s

A
  • Lipolysis (to meet cellular energy needs) results in acidic ketone body formation
  • Sudden onset; <2 days duration
  • Etiology - usually infection; stress; dosing error; change in diet; alcohol intake; exercise; noncompliance with insulin regimen
  • r/f - T1DM; <40yo
  • s/s - hyperglycemia (>200); dry mucosa; dry skin; tachycardia; Na and K imbalance (↑ K+); hypotension; glucosuria; 3 Ps__; ketoacidosis; acidemia; <15 mEq/L bicarb; Kussmaul respirations; acetone breath; lethargy; n/v; mental status changes; coma
32
Q

DKA often mistaken for…

A

being drunk

33
Q

HYPEROSMOLAR HYPERGLYCEMIC NONKETOIC SYNDROME

onset & duration

explanation/etiology

r/f

s/s

___% mortality

tx

A
  • Insidious onset - may take days to manifest, and may be severe at that point; >5 days duration
  • Hyperglycemia caused by ↑ glucacon, catecholamines, cortisol, GH, and hepatic glucose production - ↑ osmolarity of extracellular space draws fluid out of cells - kidneys filter glucose from blood - water loss through osmotic diuresis - results in severe dehydration & hyperglycemia
  • r/f - T2DM; >60yo; infection; medication noncompliance
  • s/s - severe hyperglycemia (>800); glucosuria; few ketones; polydipsia; polyuria; dry mouth; fever; confusion; hallucinations; hyperosmolarity (>350 mOsm/L); hypotension; profound dehydration; >7.4 pH; >20 mEq/L bicarb; ↓ K+
  • 10-20% mortality
  • Tx - insulin & fluids
34
Q

extreme thirst, dehydration & polyuria

alkalosis

↓K+

A

HHNS

35
Q

HYPOGLYCEMIA

criteria/levels

r/f

s/s

tx

A
  • <60 mg/dL BG
  • r/f - old and young; skipping or missing meals; longer duration of DM; activity; medications (insulin, PO DM meds)
  • s/s - dizziness; fatigue; pallor; shakiness; palpitations; sweating; hunger; irritability; loss of consciousness; blurry vision; change in mental status; slurred speech; hypotension; tachycardia
  • Tx - sugar followed by protein; milk, peanut butter; glucose tabs; glucose nasal spray
    • Unconscious pts need sugar via IV, not PO
36
Q

effects of GH

A

direct effect on tissues

stimulates liver to release IGF (insulin-like growth factor)

37
Q

2 forms of growth hormone hypersecretion

A
  • acromegaly - in adults
  • gigantism - in children
38
Q

ACROMEGALY

etiology

onset

s/s

screening tool

A
  • Etiology - pituitary tumor; trauma
  • Insidious onset - not always obvious
  • s/s - soft tissue overgrowth; joint pain; DM; HTN; heart & resp failure
  • Ask adults if their shoes, gloves still fit the same
39
Q

GIGANTISM

etiology

s/s

A
  • Etiology - pituitary tumor; trauma
  • s/s - tallness; h/a; vision problems; nausea; excessive sweating
40
Q

↑GH

A

acromegaly

gigantism

41
Q

↑ ADH

A

syndrome of inappropriate ADH secretion

42
Q

SIADH

etiology

r/f

s/s

A
  • Etiology - infection (meningitis); tumor; trauma; medications; advanced pulmonary disease
  • r/f - kidney or pulmonary disease
  • s/s - low urine output; loss of thirst; hyponatremia; fluid overload__; n/v; cramps; tremors; seizure; coma
43
Q

DIABETES INSIPIDUS

etiology

r/f

s/s

A
  • Etiology - central (pituitary problem); nephrogenic (kidney problem); pregnancy (gestational)
  • r/f - male; genetics
  • s/s - very high urine output; thirst; hypernatremia; dehydration; n/v; fever; wt loss; urinary frequency; constipation; delayed growth
44
Q

↓ ADH

A

diabetes insipidus

45
Q

↓ TSH

A

hyperthyroidism

46
Q

↑ TSH

A

hypothyroidism

47
Q

HYPERTHYROIDISM

explanation

etiology

r/f

s/s

complications

tx

A
  • Metabolism increases
  • Etiology - thyrotoxicosis (idiopathic); Graves’ disease (autoimmune)
  • r/f - female; between 20-40yo or >60yo; autoimmune disorders; family hx; thyroid problems; nodules; goiter
  • s/s - periorbital myedema; exophthalamos; nodular goiter; wt loss; tachycardia; tremor; difficulty sleeping; HF; ↑ body temp; heat intolerance; sweating; soft silky hair; flushed warm skin; diarrhea; hyperactivity; low TSH (body trying to stop thyroid)
  • Complications - thyrotoxicosis crisis (thyroid storm) - increased body temp, HR - life threatening, needs immediate reversal
  • Tx - radioactive iodide, drugs - cannot be used during pregnancy
48
Q

HYPOTHYROIDISM

explanation

etiology

r/f

s/s

complications

tx

A
  • Metabolism decreases
  • Etiology - iodine deficit; Hashimoto’s disease (autoimmune); tumor; thyroid removal
  • r/f - female; >60yo; family hx; neck surgery or radiation; iodine deficit region
  • s/s - hypometabolism; cold intolerance; constipation; brittle hair; wt gain; lethargy__; myxedema (nonpitting edema to tongue and face); dry skin; goiter; high TSH (body trying to stimulate thyroid)
  • Complications - myxedema coma
  • Tx - hormone replacement, levothyroxine
49
Q

HYPERPARATHYROIDISM

etiology

r/f

s/s

A
  • Etiology - tumor; renal failure; paraneoplastic syndrome
  • r/f - female; ionizing radiation; genetics
  • s/s - hypercalcemia; forceful cardiac contractions; osteopenia/osteoporosis; kidney stones; muscle weakness; lethargy; stupor; personality changes; anorexia; nausea; ↓ renal function; dysrhythmias
50
Q

HYPOPARATHYROIDISM

etiology

s/s

A
  • Etiology - tumor; congenital lack of parathyroid; damage during surgery in neck; autoimmune disease
  • s/s - hypocalcemia; Chvostek & Trousseau signs; muscle spasms, twitching; hair loss; carpopedal spasm; tetany; weak cardiac contractions; dysrhythmias; hypotension
51
Q

Cushing’s disease is r/t

A

pituitary adenoma

52
Q

CUSHING’S SYNDROME

what does it cause in the body?

etiology

s/s

A
  • Causes retention of sodium and water; immune suppression; erythropoiesis; catabolism of bone & protein; delayed healing; insulin resistance; possible glucose intolerance
  • Etiology - adrenal adenoma; pituitary adenoma (↑ ACTH); ectopic carcinoma; iatrogenic conditions; substance abuse
  • s/s - rounded face__; truncal obesity; buffalo hump (fat pad between scapulae); thin limbs; thin hair; hirsuitism; fragile skin; purple striae; euphoria; mood swings; loss of libido; hyperglycemia; HTN
53
Q

2 types of r/f for Cushing’s

A
  • Exogenous - steroid use (asthma, COPD, RA pts)
  • Endogenous - adenoma; cancer; between 30-60yo
54
Q

ADDISON’S DISEASE

etiology

prevention

r/f

s/s

A
  • Etiology - autoimmune; infection; medication
  • Most often caused by steroid use - hypothalamus tells adrenal glands to stop producing cortisol - zona fasciculata shrinks as a result of inactivity - adrenal crisis occurs when you go off the steroid medication
  • Important to never d/c steroids suddenly
  • r/f - other autoimmune disorder; removal of adrenal gland; cancers; anticoag use
  • s/s - unintentional wt loss; hypoglycemia__; bronzing (hyperpigmentation) inadequate stress response; fatigue; frequent infections; hyponatremia; salt craving; anorexia; hypovolemia; hypotension
55
Q

d/c steroids suddenly leads to…

A

Addison’s

56
Q

PHEOCHROMOCYTOMA

explanation

r/f

s/s

A
  • Adrenal tumor
  • r/f - neurofibramatosis type 1; Von Hippel-Lindau disease; Multiple endocrine neoplasia type 2
  • s/s - increased adrenalin; HTN, flushed skin, tachycardia (adrenalin rush that comes and goes)

NS374—Pathophysiology (18 decks)

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