Endocrine Flashcards
What is the endocrine system involved in?
-growth, metabolism, and adaptation.
What can Hormones be categorized as?
- amines/Amino acids
- Peptides, polypeptides, glycoproteins and proteins
- Steroids
- Fatty acid derivatives
What are the main endocrine organs in the body?
- pineal
- Pituitary (A+P)
- Thyroid/parathyroids
- Adrenal (cortex/medulla)
- Stomach
- Pancreas
- Duodenum
- Ovary/testes
What is the HPA axis?
Hypothalamic-pituitary-Adrenal
The bodies hormone response to extrernalities such as stress, pain, infection, hypoglycaemia, trauma, hemorrhage, sleep resulting in cortisol reaching target organs.
Where is Glucagon secreted
The islets of Langerhans within the pancreas
Describe Adrenal Insufficiency
- decreased adrenal cortex function
- Decreased aldosterone and cortisol function
s/s of adrenal insufficiency
Weakness, dehydration, inability to respond to stress.
Describe Addisons disease
- primary adrenal insufficiency
- Adrenal cortical hormones, and elevated ACTH levels
S/S of Addisons Disease
- Bronze pigmentation
- Body hair distribution changes
- GI upset
- Weakness
- Hypoglycaemia
- hyperkalemia
- Hypotension
- Weight loss
What is primary Adrenal Insufficiency?
- mineralocorticoid deficiency
- Glucocorticoid deficiency
What is Secondary Adrenal Insufficiency?
More common
- Lack of ACTH secretion from the pituitary leading to a reduced production of cortisol
- Commonly found in patients who abruptly stop glucocorticoid therapy
Describe Cushings syndrome (Three forms hypersecretion)
Manifestation of hypercortisolism of any cause.
3 forms:
- pituitary form
- Adrenal Form
- Ectopic Cushings
May also result from long term glucocorticoids
Physical exam findings in the cushings patient
Moon face Buffalo hump Skin ulcers Osteoporosis Cardiac Hypertrophy Obesity
and more!
Other causes of Hypercortisolism
- pregnancy
- Malnutrition
- Alcoholism
Describe Congenital Hypothyroidism
- congenital malformation of thyroid gland
- Poor TH synthesis or TH synthesis
S/S of congenital hypothyroid
-large tongue
-weight gain
-Poor feeding
-Excessive sleep
-Constipation
Jaundice
-Poor muscle tone
-Umbilical hernia
Describe Hypothyroidism
- Hypo-metabolic state
- Myxedematous involvement of tissues
Describe a myxoedema coma
- Profound Hypothyroid
- Life threatening
- Most common in elderly women with Hx of hypothyroidism
Describe Hyperthyroidism
- Hyper-metabolic state
- Excessive delivery of T3 & T4 to peripheral tissues
- Most common in graves disease.
What is a thyroid storm
- Life-Threatening Thyrotoxicosis
- Precipitated by infection, DKA, trauma
What are three actions of insulin
- Promotes glucose uptake by target cells & provides for glucose storage as glycogen
- Prevents fat and glycogen breakdown and inhibits gluconeogenesis
- Increases protein synthesis
Describe T1DM
destruction of pancreatic beta cells
Describe T2DM
Results from increased insulin resistance
What are the three “polys” in diabetes
Polyuria
Polydipsia
Polyphagia
How is diabetes diagnosed?
Fasting BGL
-2 episodes over 7mmol/L
Random BGL
-1 episode over 11.1mmol/L with symptoms
What are the four principle types of exogenous insulin?
- Rapid acting
- Short acting
- Intermediate acting
- long acting
Describe DKA
When ketone production exceeds cellular use and renal excretion.
S/S of DKA
- Polyuria & Polydipsia over 2 days is common
- Kussmauls respirations
- Hypotension and tachycardia
Parts of definitive DKA diagnosis
- Hyperglycemia >14mmol/L
- Low bicarbonate <15mEq
- Low pH <7.35
- Excess ketone bodies
May aslo see
- HyperK
- Pseudohyponatremia
- Metabolic Acidosis
ACP Tx for DKA
- ABC’s
- fluid!
- If ECG changes suggesting hyper K present consider Calcium (1G), salbutamol (20mg)
When can Hyperglycemic hyperosmolar non-ketotic syndrome occur
- T2DM
- Acute Pancreatitis
- Severe Infection
How does HHNK present
- Dehydration
- Neuro compromise
a. seizures, hemiparesis, aphasia, nystagmus, hallucinations - Excessive thirst
- Generally progressive over days and may be mistaken for a stroke.
HHNK Diagnosis
- Hyperglycemia (>33mmol/L)
- Hyperosmolarity (<310)
- Dehydration
- Absence of ketoacidosis
- Depression of sensorium
HHNK management
Correct hypo perfusion
