Endocrine Flashcards
5 mechanisms of endocrine disorders
- Failure of feedback
- Gland dysfunction
- Increased hormone degradation/inactivation
- Ectopic hormone release
- Target cell failure
3 mechanisms of gland dysfunction
- 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
hormone released from organ that should not be releasing it
ectopic hormone release
anterior pituitary hormones - 6
- Thyroid-stimulating hormone
- Follicle-stimulating hormone
- Luteinizing hormone
- Adrenocorticotropic hormone
- Growth hormone
- Prolactin
stimulates release of glucocorticoids & androgens
ACTH
stimulates lactation
prolactin
posterior pituitary hormones - 2
- Antidiuretic hormone
- Oxytocin
↑ reabsorption of water in kidneys
ADH
stimulates uterine contractions & milk release
oxytocin
↑ BMR
thyroid hormone
2 thyroid hormones
thyroxine (T4) & triiodothyronine (T3)
↑ blood calcium
stimulates bone resorption (ostoclasts)
↑ calcium absorption
PTH
hormones of adrenal cortex - 3
- Mineralcorticoids (aldosterone)—zona glomerulosa
- Glucocorticoids (cortisol)—zona fasciculata
- Gonadocorticoids (androgens)—zona reticularis
hormones of adrenal medulla - 2
Catecholamines (norepinephrine & epinephrine)—chromaffin cells
↑ reabsorption of Na+ & water
↑ secretion of K+ in urine
aldosterone
↑ breakdown of fat & protein
promotes stress resistance
inhibits immune response
cortisol
mimic testosterone in females
androgens
mimic SNS activation; “fight or flight”
epinephrine & norepinephrine
pancreatic hormones - 2
- insulin
- glucagon
↑ blood glucose
glucagon
T1DM
explanation
etiology
r/f
s/s
tx
- 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
T1DM accounts for __% of diabetic population
10
when does hyperglycemia occur in T1DM?
80-90% of beta cells are destroyed
T2DM
explanation
r/f
s/s
-
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)
3rd type of DM
gestational DM
dx tests for DM
- 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
complications of DM are most related to…
duration & extent of abnormal BG
complications of DM
- microvascular changes (peripheral vascular disease; nephropathy; retinopathy; neuropathy)
- CV disease
- DKA (type 1)
- HHNS (type 2)
- amputations
- hypoglycemia
primary cause of mortality in adolescents with DM
DKA
DKA responsible for __% of DM-related hospitalizations
carries a ___% mortality
15
1-3
DIABETIC KETOACIDOSIS
explanation
onset & duration
etiology
r/f
s/s
- 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
DKA often mistaken for…
being drunk
HYPEROSMOLAR HYPERGLYCEMIC NONKETOIC SYNDROME
onset & duration
explanation/etiology
r/f
s/s
___% mortality
tx
- 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
extreme thirst, dehydration & polyuria
alkalosis
↓K+
HHNS
HYPOGLYCEMIA
criteria/levels
r/f
s/s
tx
- <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
effects of GH
direct effect on tissues
stimulates liver to release IGF (insulin-like growth factor)
2 forms of growth hormone hypersecretion
- acromegaly - in adults
- gigantism - in children
ACROMEGALY
etiology
onset
s/s
screening tool
- 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
GIGANTISM
etiology
s/s
- Etiology - pituitary tumor; trauma
- s/s - tallness; h/a; vision problems; nausea; excessive sweating
↑GH
acromegaly
gigantism
↑ ADH
syndrome of inappropriate ADH secretion
SIADH
etiology
r/f
s/s
- 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
DIABETES INSIPIDUS
etiology
r/f
s/s
- 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
↓ ADH
diabetes insipidus
↓ TSH
hyperthyroidism
↑ TSH
hypothyroidism
HYPERTHYROIDISM
explanation
etiology
r/f
s/s
complications
tx
- 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
HYPOTHYROIDISM
explanation
etiology
r/f
s/s
complications
tx
- 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
HYPERPARATHYROIDISM
etiology
r/f
s/s
- 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
HYPOPARATHYROIDISM
etiology
s/s
- 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
Cushing’s disease is r/t
pituitary adenoma
CUSHING’S SYNDROME
what does it cause in the body?
etiology
s/s
- 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
2 types of r/f for Cushing’s
- Exogenous - steroid use (asthma, COPD, RA pts)
- Endogenous - adenoma; cancer; between 30-60yo
ADDISON’S DISEASE
etiology
prevention
r/f
s/s
- 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
d/c steroids suddenly leads to…
Addison’s
PHEOCHROMOCYTOMA
explanation
r/f
s/s
- 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)
