endocrine Flashcards
the endocrine system (what, includes (7)
works with the nervous system to control overall body function and regulation, including:
- metabolism
- nutrition
- elimination
- temperature
- fluid/electrolyte balance
- growth
- reproduction
tip:
- secretes hormones and substances into blood sugar from endocrine gland
- secrete substances to abductal system (epithelial surfaces) to salivary glands
disorders of the endocrine system are usually related to: (3)
- excess of a specific hormone (hyper)
- excess of a deficiency hormone (hypo)
- a receptor defect
tip:
- hypothalamus: corticotropin releasing hormone (CRH), thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone (GnHR), growth hormone releasing hormone (GHRH), growth hormone inhibiting hormone (somatostatin GHIH), prolactin-inhibiting hormone (PIH), melanocyte-inhibiting hormone (MIH)
- anterior pituitary: thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), growth hormone (GH), melanocyte stimulating hormone (MSH)
- posterior pituitary: vasopressin (ADH), oxytocin
- thyroid: T3, T4, calcitonin
- parathyroid: parathyroid hormone (PTH)
- adrenal cortex: glucocorticoids (cortisol), mineralcorticoids (aldosterone)
- ovary: estrogen, progesterone
- tests: testosterone
- pancreas: insulin, glucagon, somatostatin
the endocrine system uses the negative feedback loop concept: (4)
- hormone secretion usually depends on the body’s need for the final action of that hormone
- when a body condition starts to move away from the normal range, secretion of the hormone capable of starting the correcting action is stimulated until the need (demand) is met, and the body returns to normal
- as the correction occurs, hormone secretion decreases (may halt)
- control of hormone synthesis is “negative feedback” d/t the hormone causes opposite action of the initial condition change
tip:
- hormone increased concentration -> body will work to inhibit (decrease) levels
- hormone decreased concentration -> body will work to stimulate (increase) levels
- KEY: inverse relationship
functions of the thyroid hormones (8)
- control metabolic rate of all cells (increase O2)
- promote sufficient pituitary secretion of growth hormone and gonadotropins
- regulate protein, carbohydrate, and fat metabolism
- exert effects on heart rate and contractility
- increase RBC production
- affect respiratory rate and drive
- increase bone formation and decrease bone resorption of calcium (T3/T4/calcitonin)
- act as insulin antagonists
tip:
- PTH affects calcium
functions of the parathyroid hormone (4)
- regulates calcium and phosphorus metabolism by acting on bones, the kidneys, and the GI tract
- PTH INCREASES bone resorption (bone release of calcium -> blood from bone storage sites), this INCREASING serum CA
- PTH activates vitamin D, which then increases absorption of calcium and phosphorus from the intestines
- in the kidney tubules, PTH allows calcium to be reabsorbed and put back into the blood
functions of the adrenal gland (adrenal cortex (2), adrenal medulla (1))
1) adrenal cortex:
- mineralcorticoids: aldosterone maintains extracellular fluid volume by promoting sodium and water resorption and potassium excretion in the kidney tubules
- glucocorticoids: cortisol affects the body’s response to stress; carbohydrates, protein, and fat metabolism; emotional stability; immune function; H2O/Na balance
2) adrenal medulla:
- catecholamines: epinephrine/norepinephrine; where stress triggers increase secretion of these hormones, resulting in the fight-or-flight response
tip:
- adrenal cortex: androgens (male)
- adernal medulla: Autonomic nervous system, releases catecholamines
endocrine changes associated with aging (4)
- decreased ADH production: urine MORE DILUTE, may not concentrate when fluid intake is LOW
- decreased ovarian production of estrogen: bone density decreases, skin thinner/drier/greater risk for injury, perineal and vaginal tissues become drier and the risk for cystitis increases
- decreased glucose tolerance: weight increases, elevated BG lvls, slow wound healing, frequent yeast infections, polydipsia, polyuria
- decreased general metabolism: loss tolerant of cold, decreases appetite, decreased HR/BP
physical assessment endocrine system (3)
1) inspect:
- observe for prominent forehead/jaw
- round/puffy face
- dull/flat expressions
- hyperpigmentation
- buffalo hump (goiter)
- striae
- hirsutism (excess hair around mouth and chin)
2) palpate:
- palpate thyroid gland/tests
3) auscultate:
- auscultate chest for HR, rhythm
- assess BP
- assess for bruits
diagnostic labs (4)
- blood tests: determine the levels of circulating hormones, the presence of autoantibodies, and the effect of a specific hormone on other substances
- the serum levels of a specific hormone: may provide information to determine the presence of hypofunction/hyperfunction of the endocrine system and site of dysfunction
- radioimmunoassays: radioisotope-labeled antigen tests that are commonly indicated blood tests used to measure the levels of hormones or other substances
- urine tests: used to measure the amount of hormones or the end products of hormones excreted by the kidneys
the anterior pituitary gland (adenohypophysis) (what, which hormones (7), disorders (2))
1) controls growth, metabolic activity, and sexual development through the actions of these hormones:
- GH (growth hormone)
- TSH (thyroid stimulating hormone)
- ACTH (adenocorticotropic hormone)
- FSH (follicle-stimulating hormone)
- LH (luteinizing hormone)
- MSH (melanocyte stimulating hormone)
- PRL (prolactin)
2) disorders of the anterior pituitary gland include:
- hypopituitarism: dwarfism
- hyperpituitarism: gigantism (grow really tall, occurs post growth plate fusion), acromegaly
hypopituitarism (what, 3 subtypes, deficiencies/their reactions (3))
1) deficiency of one or more anterior pituitary hormones
- selective hypopituitarism: when only one hormone is affected
- panhypopituitarism: decreased production of ALL ANTERIOR PIT HORMONES
2) deficiencies and their reactions:
- ACTH/TSH: most life threatening, vital hormones for LIFE
- gonadotropins: changes sexual function in both men and women
- GH: changes tissue growth
tip:
- acth: adenocorticotropic hormone
- tsh: thyroid stimulating hormone
- gh: growth hormone
- one hormone decreases -> all other hormones decreased to a degree
hypopituitarism s/sx GH deficiences (4)
- decreased bone density
- pathologic fractures
- decreased muscle strength
- increased serum cholesterol levels
hypopituitarism s/sx gonadotropin (women (7), men (7))
1) women:
- amenorrhea
- anovulation
- low estrogen lvls
- breast atrophy
- loss of bone density
- decreased axillary/pubic hair
- decreased libido
2) men:
- decreased facial hair
- decreased ejaculation volume
- reduced muscle mass
- loss of bone density
- decreased body hair
- decreased libido
- impotence
hypopituitarism s/sx TSH deficiency (9)
- decreased thyroid hormone levels
- weight gain
- intolerance to cold
- scalp alopecia
- hirsutism
- menstrual abnormalities
- decreased libido
- slowed cognition
- lethargy
hypopituitarism s/sx ACTH deficiency (10)
- decreased serum cortisol levels
- pale
- sallow complexion
- malaise/lethargy
- anorexia
- postural hTN
- headache
- hypoglyemia
- hypoNA
- decreased axillary/pubic hair women
hypopituitarism s/sx ADH deficiency (8)
- DI
- greatly increased urine output
- low urine specific gravity
- hTN
- dehydration
- increased plasma osmolarity
- increased thirst
- output does not decrease when fluid intake decreases (polyuria)
hypopituitarism interventions (1, pharm (5))
- mgmt of the adult w/ hypopituitarism focuses on replacement of deficient hormones w/ lifelong treatment
pharm:
- testosterone parenteral or transdermal
- estrogen/progesterone
- human GH SQ injections
- thyroid replacement - will discuss w/hypothyroidism
- cortisol replacement - will discuss w/ addison’s (NOT ON EXAM)
hyperpituarism ((3))
hormone over secretion that occurs with pituitary tumors or tissue hyperplasia
- tumors occur most often in the anterior pituitary cells that produce GH, PRL, ACTH
- usually only ONE hormone is produced in EXCESS d/t cell types within pituitary gland are individually organized
hyperpituitarism s/sx PRL excess (9)
- HYPOgonadism (loss of secondary sexual characteristics)
- decreased gonadotropin levels
- galactorrhea
- increased body fat
- increased serum prolactin levels
- menstrual changes
- decreased libido
- painful intercouse
- difficulty becoming pregnant
hyperpituitarism s/sx GH excess (10)
acromegaly
- thickened lips
- coarse facial features
- increasing head size
- lower jaw protrusion
- enlarged hands and feed
- joint pain
- barrel shaped chest
- hyperglycemia
- sleep apnea
- enlarged heart, lungs, liver
hyperpituitarism s/sx TSH excess (6)
- elevated plasma TSH and thyroid hormone levels
- weight loss
- tachycardia, dysrhythmias
- heat intolerance
- increased GI motility
- fine tremors
hyperpituitarism s/sx ACTH excess (9)
cushing’s disease (pituitary)
- elevated plasma cortisol levels
- weight gain
- truncal obesity
- “moon face”
- extremity muscle wasting
- loss of bone density
- HTN
- hyperglycemia
- straie, acne
hyperpituitarism s/sx gonadoptropin excess (women (1), men (3))
1) women:
- normal LH, FSH levels
2) men:
- elevated LH, FSH levels
- hypogonadism
- hypergonadism
hyperpituitarism interventions (surgery (1), post op (5))
1) surgery:
- hypophysectomy: surgical removal of the pituitary gland/tumor
2) post op nursing interventions:
- monitor neuro status hourly x24H
- monitor fluid balance
- instruct patient to not cough, blow nose, sneeze, strain or bend at waist (no intense)
- use floss, oral mouth rinses until surgeon clears for use of toothbrush: goes through nose, NOT mouth
- monitor nasal drip pad for the type and amount of drainage
posterior pituitary gland (what, hormones (2), includes (2))
1) disorders of the posterior pituitary gland (neurohypophysis) occur with deficiency of excess of the hormones:
- vasopressin (ADH - antidiuretic hormone), oxytocin
2) disorders of the posterior pituitary gland include:
- diabetes insipidus (DI): PEE A LOT (decreased ADH)
- syndrome of inappropriate antidiuretic hormone (SIADH) -> NO PEE (increase ADH)
diabetes insipidus (DI) (what, leads to (3), w/o action (3))
1) water loss problem caused by insufficient ADH causing the excretion of large volumes of dilute urine because the distal kidney tubules and collecting ducts do NOT reabsorb water
2) leads to:
- polyuria
- dehydration
- disturbed fluid/electrolyte imbalance
3) w/o action of ADH:
- enormous daily output (>250 mL/hr) of very DILUTE urine
- specific gravity of 1.001-1.005 (normal 1.010)
- intense thirst (drinks 2-20 L fluid daily)
tip:
- empty bag often
- primary, secondary (tumors near hypothalamus), nephrogenic (renal/kidneys tubules can’t respond to ADH)
diabetes insipidus s/sx (cardio, GU, skin, neuro, acute hyper__)
- cardio: hTN, tachycardia, weak peripheral pulses, hemoconcentration
- GU: polyuria, dilute/low specific gravity
- skin: poor turgor, dry mucous membranes
- neuro: polydipsia, when rapid dehydration occurs: decreased cognition, ataxia, irritability
- acute hyperNA: lethargy, weakness, irritability, twitching, seizures, coma
diabetes insipidus diagnostic labs (4)/tests (3)
labs:
- 24 hour fluid I&O
- urine specific gravity 3-4L
- osmolarity (low)
- BMP
tests:
- trial of desmopressin
- CT
- MRI
diabetes insipidus interventions (non-pharm (4), pharm (3))
non-pharm:
- accurately measure I&O
- weight the patient daily
- monitor electrolytes and urine specific gravity
- urge the patient to drink fluids in an amount equal to urine output
pharm:
- vasopressin, desmopressin acetate (DDAVP) PO, intranasal
- ADH may be given IV or IM if severe dehydration occurs
- careful NS correction (NA >150 -> d5W fluid replacement)
syndrome of inappropriate antidiuretic hormone (SIADH) (what, s/sx (4), manifestations (4))
problem in which vasopressin (ADH) is excessively secreted
s/sx:
- loss of appetite, nausea, vomiting
- weight gain
- headaches, decreased LOC, disorientation, lethargy
- decreased DTR
manifestation (acute hypoNA):
- nausea
- malaise, lethargy, obtundation
- headache, seizures, coma
- respiratory arrest
tip:
- decreased Na levels
- dilution
- increased fluid volume -> bounding pulses
SIADH diagnostic labs (4)/tests (2)
labs:
- urine osmolarity
- urine sodium
- urine specific gravity
- serum sodium
tests:
- CT
- MRI
SIADH interventions (nonpharm (3), pharm (3))
nonpharm:
- restrict fluid intake, monitor I/O
- replace lost sodium and response to therapy
- provide safe environment
pharm:
- diuretics
- careful NS correction
- vasopressin antagonists: promote water excretion w/o causing sodium loss (tolvaptan (samsca), conivaptan (vaprisol))
hyperthyroid (what, function of thyroid hormone, produces what 3 hormone?))
excessive thyroid hormone secretion from the thyroid gland
- thyroid hormone: increased metabolism in all body organs, producing many different manifestations from hyper-metabolism and increased sympathetic nervous system activity
- thyroid gland produces 3 hormones: T3, T4, calcitonin
hyperthyroidism s/sx (skin, cardiopulm, GI, metabolic, neuro, psych, reproductive, other)
- skin: diaphoresis,, fine/soft/silky body hair, smooth/warm/moist skin, thinning scalp hair
- cardiopulm: palpitations, chest pain, increased SBP, tachycardia, dysrhythmias, rapid/shallow respirations, pretibial myxeema
- GI: weight loss, increased appetite, increased stools
- metabolic: increased basal metabolic rate, heat intolerance, low grade fever, fatigue
- neuro: blurred/double vision, eye fatigue, increased tears, injected (red) conjuntiva, photophobia, eyelid retraction, eye lid, glob lag, hyperactive DTR, treamors, insommnia
- psych: decreased attention span, restlessness/irritability, emotional lability, emotionally hyperexitable, manic behavior
- reproductive: amenorrhea, decreased fertility, increased libido
- other: goitier, exophathalmas, enlarged spleen, muscle weakness/weaking
hyperthyroid diagnostic labs (2)/tests(5)
labs:
- T3
- T4
tests:
- US
- radioactive iodine uptake test
- CT
- thyroid scan
- biopsy
hyperthyroidism interventions (3 + pharm (4))
- monitor cardiac function
- reduce stimulation and promote comfort
- surgery
pharm:
- thionamides -> block thyroid hormone production by preventing iodine binding in the thyroid gland (methimazole (tapazole), propythiouracil (PTU)
- radioactive iodine (RAI) therapy
- beta adrenergic blocking drugs for supportive therapy (propranolol
hyperthyroidism post op care after thyroid surgery (2)
- place patient, while awake, in a semi-fowler’s position
- monitor for complications: hemorrhage, resp. distress, parathyroid gland injury resulting in HYPOCA, damage to laryngeal nerves, thyroid storm
thyroid storm (aka, what, characterized by (3), causes (7)
AKA thyrotoxicosis
- life threatening event that occurs w/ uncontrolled hyperthyroidism and manifestations develop quickly and can lead to DEATH
- characterized by: high fever, severe HTN, tachycardia
- causes: trauma, infection, diabetic ketoacidosis, pregnancy, vigorous palpation for the goiter, exposure to iodine, radioactive iodine therapy (RAI)
thyroid storm s/sx (6)
- abdominal pain
- N/V/D
- anxiety, tremors, restlessness
- edema, chest pain, dyspnea, palpitations
- confused/psychotic, seizures
- coma leading to DEATH
thyroid storm emergency care of the patient (9)
- maintain patent airway and adequate ventilation
- give oral antithyroid drug as prescribed
- administer sodium iodine solution as prescribed
- give PROPRANOLOL as prescribed slowly over 3 minutes (cardiac monitor, CVP catheter should be in place)
- give glucocorticoids as prescribed
- monitor VS, cardiac dysrhythmias
- correct dehydration w/ NS infusions
- provide comfort measures (cooling blanket, ice packs, antipyretics, etc.)
- monitor for HYPOglycemia, treat w/ dextrose containing IVF
hypothyroidism (what, example)
thyroid gland can’t make enough thyroid hormone to keep the body running normally
- HASHIMOTO’s THYROIDITIS (HT)
hashimoto’s thyroiditis (what)
most COMMON hypothyroidism
- body’s immune system makes antibodies that attack and destroy a part of the thyroid hormone system, ultimately causing death of thyroid gland cells
hypothyroidism s/sx (skin, pul, cardio, metabolic, reproductive, psych, GI, neuromuscular, other)
- skin: cool/pale/yellowish/dry/coarse scaly skin, thick brittle nails, dry/coarse/brittle hair, decreased hair growth, loss of eyebrow hair, poor wound healing
- pul: hypoventilation, pleural effusions, dyspnea
- cardio: bradycardia, dysrhythmias, enlarged heart, decreased activity intolerance, hTN
- metabolic: decreased BMR, decreased body temp., cold intolerance
- reproductive: changes in menses (amenorrhea, prolonged menstrual periods), anovulation, decreased libido, impotence
- psych/emotion: apathy, depression
- GI: anorexia, wt. gain, constipation, abdominal distention
- neuromuscular: slowing of intellectual functions (slow/slurred speech, impaired memory, inattentiveness), lethargy/somnolence, confusion, hearing loss, paresthesias, decreased tendon reflexes, muscle aches/pain
- other: periorbital edema, facial puffiness, nonpitting edema of hands/feet, hoarseness, goiter, thick tongue, increased sensitivity to opioids and tranquilizers, weakness/fatigue, decreased U/O, easy bruising, iron deficiency anemia, vitamin deficiencies
hypothyroidism diagnostic labs (4)/tests(2)
labs:
- TSH
- T3
- T4
- thyrotropin receptor antibodies (TRAbs)
tests:
- thyroid scan
- US
hypothyroidism interventions (2, pharm (1))
- monitor VS frequently, assessing for respiratory or cardiovascular compromise
- monitor cognitive function. provide safety measures
pharm:
- levothyroxine sodium (synthyroid)
myxedema coma (what (3), s/sx (5))
rare, serious complication of untreated or poorly treated hypothyroidism
- mortality rate for myxedema coma is extremely HIGH
- LIFE THREATENING EMERGENCY
s/sx:
- respiratory failure
- hTN
- hypoNA, hypoglycemia
- hypothermia
- coma, shock, death
myxedema coma emergency care of the patient (10)
- maintain patent airway
- replace fluids w/ NS OR hypertonic NS IV as prescribed
- give levothyroxine IV as prescribed
- give glucose IV as prescribed
- give glucocorticoids as prescribed
- monitor VS hourly
- monitor for changes in mental status
- initiate aspiration precautions
- cover the patient w/ warm blanket
- turn the patient Q2H
hyperparathyroidism (what, s/sx (5))
an overproduction of parathyroid hormone, resulting in hyperCA, hypoPHOSphatemia
s/sx:
- arthritis, bone fractures or bone deformities in the extremities and back
- HTN, dysrhythmias
- kidney stones
- epigastric pain, nausea, vomiting, constipation, anorexia, weight loss
- fatigue, lethargy, psychosis that leads to coma and death
hyperparathyroidism diagnostic labs (2)/tests (3)
labs:
- serum PTH
- calcium
tests:
- XR
- US
- CT
hyperparathyroidism interventions (what, pharm (3), surgery (2))
- monitor cardiac function, electrolytes, and I/O
pharm:
- hydration therapy to help prevent renal calculi
- calcimemetics to bind to calcium sensitive receptors on parathyroid tissue to decreased calcium levels, stabilize other minerals and decreased progression of PTH-induced bone complications
- phosphates to inhibit bone resorption and interfere w/ calcium absorption
surgery:
- post surgery nursing care: place the patient, while he or she is awake, semi-fowler’s position
- monitor for complications: hemorrhage, resp. distress, hypoCA, damage to laryngeal nerves, thyroid storm
hypoparathyroidism (what, s/sx (6)
rare endocrine disorder in which parathyroid function is decreased causing hypoCA
s/sx:
- mild tingling/numbness, spasms of the hands and feet
- muscle tetany, severe muscle cramps
- seizures (no LOC, no incontinence), dysrhythmias
- anxiety, irritability, psychosis
- (+) chvostek’s sign
- (+) trousseau’s sign
hypoparathyroidism diagnostic labs (3)/tests(3)
labs:
- serum PTH
- calcium
- phosphorus
tests:
- XR
- EEG
- CT
hypoparathyroidism interventions (3 + pharm (4))
- monitor cardiac, respiratory, and neuro status
- provide calm environment
- educate on proper diet
pharm:
- calcium supplements: calcium PO, or calcium chloride/calcium gluconate IV
- vitamin D supplements: calcitriol PO, ergocalciferol
- magnesium supplements: mag sulfate
- thiazides diuretics
