Endocrine

Question 1

hypothalamic-pituitary endocrine system

Answer 1

pituitary gland located beneath hypothalamus at base of skull
pituitary has 2 lobes (anterior and posterior)
synthesis and secretion of pituitary hormones are controlled by hypothalamus

Question 2

anterior lobe of pituitary gland

Answer 2

secretes ACTH and thyroid stimulating hormone

Question 3

posterior lobe of pituitary gland

Answer 3

antidiuretic hormone (vasopressin) and oxytocin

Question 4

ADH (antidiuretic hormone)

Answer 4

released in response to high serum osmolality and/or hypotension
causes water retention via kidneys
This hormone stops the pee-pee

Question 5

adrenal glands

Answer 5

sit on top of kidneys (each consist of inner medulla and outer cortex)

Question 6

adrenal medulla secretes

Answer 6

epi and norepi

Question 7

in response to ACTH, the adrenal cortex secrete

Answer 7

glucocorticoids (cortisol) and mineralcorticoids (aldosterone), sex steroids (androgens)

Question 8

adrenal medulla hormones

Answer 8

secrete 2 catecholamines in response to SNS stimulation
epi and norepi prolong and enhance effects of SNS
think fight or flight

Question 9

adrenal cortex: steroid hormones

Answer 9

think sugar, salt, sex
3 steroid hormones secreted by adrenal cortex and essential for life
regulate body’s response to stress
made on demand not stored

Question 10

glucocorticoids

Answer 10

principal hormone is cortisol

hormones names for their primary effect on glucose metabolism

Question 11

functions of glucocorticoids include

Answer 11

raising blood sugar
protect against stress
suppress inflammatory and immune processes 
release muscle stores of protein
increase blood cholesterol

Question 12

mineralocorticoids

Answer 12

principal hormone is aldosterone
regulated by renin-angiotensin system in kidneys
function is to maintain salt and water balance
promotes secretion of potassium
triggered by angiotensin II, and aldosterone promotes sodium retention thus water retention

Question 13

parathyroid gland

Answer 13

promotes absorption of vitamin D

produce and secrete parathyroid hormone in response to hypocalcemia and break down calcium in blood

Question 14

what are the two adrenocortical hormone disorders?

Answer 14

Cushing’s syndrome

Addison disease

Question 15

Cushing syndrome

Answer 15

hypercortisolism

Question 16

what can cause hypercortisolism?

Answer 16

primary hyperfunction
secondary hyperfunction
exogenous steroids

Question 17

primary hyperfunction

Answer 17

disease of adrenal cortex

cushing syndrome

Question 18

secondary hyperfunction

Answer 18

disease of the anterior pituitary

cushing’s disease

Question 19

exogenous steroids

Answer 19

used in the management of various diseases

cushing’s syndrome

Question 20

what does cortisol do?

Answer 20

raises blood sugar (opposes insulin)
protects against the physiologic effects of stress
suppresses immune and inflammatory process
breaks down fat and protein
increases cholesterol
keeps BP up

Question 21

manifestations of cushings

Answer 21

glucose intolerance, hyperglycemia
HTN, ecchymoses
Muscle wasting, weakness, thinning of skin, osteoporosis, bone pain
redistribution of fat to abdomen, shoulders and face
impaired wound healing and immune response, risk for infection
mood swings, insomnia

Question 22

cushing patient presents with

Answer 22

moon face, thin extremities, fat deposits on back, gynecomastia in males, amenorrhea in females
purple striae, personality changes

Question 23

Addison disease

Answer 23

disease of adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones
sugar
salt
sex
most sever effects come from lack of cortisol

Question 24

causes of addison’s disease

Answer 24

idiopathic
autoimmune
other

Question 25

pathogenesis of addisons disease

Answer 25

adrenal gland destroyed get symptoms when 90% non-functional ACTH and TSH are secreted in large amounts

Question 26

early clinical manifestations of addison disease

Answer 26

anorexia, wt loss weakness, malaise, apathy electrolyte imbalances skin hyperpigmentation

Question 27

clinical manifestations for addison disease

Answer 27

hypoaldosteronism | hypocortisolism

Question 28

hypoaldosteronism

Answer 28

SODIUM AND WATER RETENTION hypotension ( decreased vascular tone, cardiac output, circulating volume) salt craving ( decreased serum sodium, INCREASED potassium levels and deyhdration)

Question 29

Hypocortisolism

Answer 29

``` lack of stress hormone, no energy hypoglycemia weakness and fatigue unsuppressed ACTH production hyperpigmentation ```

Question 30

Addisonian (adrenal) crisis

Answer 30

complication of Addison disease medical emergency r/t acute renal insufficiency, body has no cortisol to combat stress can be caused by stopping steroid abruptly

Question 31

what causes Addisonian crisis?

Answer 31

suddenly stopping steroids sudden loss of adrenal function sudden increase in stress

Question 32

what class of meds do you use to treat Addison's disease?

Answer 32

``` "sone's" hydrocortisone- drug of choice prednisone dexamethasone fludrocortisone ```

Question 33

what is the only medication that is considered a mineralocorticoid and what does it do?

Answer 33

fludrocortisone helps with water and salt balance dosed once daily

Question 34

what is important to remember when dosing meds for Addison's disease

Answer 34

``` dose mimics natural release of hormones timing is important doses are small NEVER stop abruptly INCREASE doses with stress situations ( surgery, trauma) ```

Question 35

what is the 3x3 rule?

Answer 35

take three times a normal dose for 3 days then taper off.

Question 36

what should you always do with your meds for Addison's disease, and what should you wear?

Answer 36

maintain an emergency supply (IM and PO), and wear a medical alert bracelet

Question 37

what is pheochromocytoma?

Answer 37

an adrenal medulla disorder rare tumor, benign produces excessive catecholamines, epi and norepi

Question 38

what is a risk factor for pheochromocytoma?

Answer 38

young to middle age

Question 39

pathogenesis of pheochromocytoma

Answer 39

SNS stimulation | tumor cells secrete catecholamines in response to SNS release

Question 40

what is the number 1 symptom of a pheochromocytoma?

Answer 40

HTN, followed by HA, diaphoresis and tachycardia

Question 41

what is the preferred tx of pheochromocytoma?

Answer 41

surgery

Question 42

when are alpha-adrenergic blockers used with pheochromochytoma

Answer 42

inoperable tumors pre-operatively to reduce risk of acute HTN meds given 10-14 days prior to surgery

Question 43

what is the principal cause of HTN with pheochromocytomas?

Answer 43

alpha 1 receptors on blood vessels