Endocrine Flashcards
What are the five general functions of the endocrine system?
- A role in reproductive and CNS development
- Stimulating growth and development
- Sexual reproduction
- Maintaining homeostasis
- Responding to emergency demands
What is the difference between an endocrine and exocrine gland? Provide an example of each
Exocrine – secretes into ducts that empty into body cavity or onto a surface (Example – salivary glands)
Endocrine – secrete directly into the blood (Example – adrenal glands (epinephrine))
What is the difference between paracrine and autocrine action?
Paracrine action – act locally on nearby cells
Autocrine action – act on same cell that made it
What are the three common characteristics of hormones?
- Secreted in small amounts at variable but predictable rates
- Regulated by feedback systems
- Ability to bind to a specific target cell receptor
What is the difference between an endogenous and exogenous hormone?
Endogenous - produced within the body
Exogenous - from outside the body – need to supplement or assist the body
What is an example of a hormone that is both endogenous and exogenous?
Insulin
How do lipid soluble hormones act versus water soluble?
Lipid soluble – bound to plasma proteins as they travel, cross cell membranes by diffusion
Water soluble – circulate freely in the blood and act directly on target tissues
What is the difference between the circadian and diurnal rhythm?
Circadian – hormones fluctuate over 24-hour period
Diurnal – sleep wake cycle
What is the region that links the nervous and endocrine system?
The hypothalamus
What is the role of the pineal gland?
Controls the circadian rhythm and produces melatonin
What hormones does the thyroid release?
TSH, Thyroxine (T4) and triiodothyronine (T3), Calcitonin
What types of hormones does the thymus secrete?
Immune and lymphatic
Does the pancreas have endocrine, exocrine, or both actions?
Both
What do TSH, T3, and T4 blood studies indicate?
- TSH - Most sensitive method of evaluating thyroid disease
- T3 - Measures serum levels of the more active thyroid hormone
- T4 - Measures serum levels of the thyroid hormone that accounts for 90%
What does calcium, PTH, and phosphate blood studies indicate?
- Calcium - Measures serum levels of the electrolyte for skeletal mineralization
- PTH - Use to evaluate hyper/hypocalcemia
- Phosphate - Measures serum levels of the electrolyte necessary for bones and teeth
When assessing someone for hypo or hypercalcemia, what blood study would you order?
Parathyroid hormone (PTH)
What is the function of the parathyroid?
Creates PTH. This chemical regulates the amounts of calcium, phosphorus and magnesium in the bones and blood.
What does cortisol, aldosterone, and blood glucose blood studies indicate?
- Cortisol - Measures the most abundant and potent glucocorticoid
- Aldosterone - Measures a potent mineralocorticoid
- Blood glucose - Measures circulating levels of your body’s primary source of energy
What does HgBA1C, amylase, and lipase blood studies indicate?
- HgBA1C - Measures glucose control for the last three months
- Amylase - Measures amount of an enzyme used to digest proteins
- Lipase - Measures amount of an enzyme that helps the body absorb fat
What would the presentation of glucose, ketones, and WBCs show in a urinalysis (normal/abnormal)?
- Glucose - Normal result would be little or none
- Ketones - Present in urine when body needs to break down fats and fatty acids to use as fuel
- WBCs - May indicate infection or inflammation in the urinary tract
What time of day is peak metabolic function?
Morning to early/mid-afternoon is peak metabolism function
What do thyroid hormones T3/T4 stimulate?
They exert effects on almost every organ system and stimulate cell metabolism/activity
What seven general things do thyroid hormones effect?
- Metabolic rate
- caloric requirements
- oxygen consumption
- carbohydrate and lipid metabolism
- growth and development
- brain function
- nervous system activity
What is necessary in the diet for thyroid hormone synthesis?
Iodine
Define thyrotoxicosis and what condition it is synonymous for
Clinical state of high tissue levels of T3 and T4 and actions in the tissue
- Has potential to be life-threatening (ABCs may be compromised)
Synonymous with hyperthyroidism
Define Grave’s disease
Autoimmune disease, thyroid enlargement, and excessive hormone secretion
Does Grave’s disease have a known etiology?
No
How would we palpate for an enlargement of the thyroid?
sweeping motion along the neck to palpate for enlargement
What are the four precipitating factors for hyperthyroidism?
- Insufficient iodine supply
- Infections
- Stressful life events
- Interaction w/ genetics
What is a goiter?
An enlarged thyroid gland that is visibly noticeable
What are the 6 clinical manifestations of hyperthyroidism?
- Palpation or visualization of the thyroid gland
- bruit
- ophthalmopathy (abnormal eye appearance or function)
- exophthalmos (bilateral, unilateral, or asymmetrical protrusion of the eyeballs)
- weight loss
- nervousness
What is ophthalmopathy?
abnormal eye appearance or function due to hyperthyroidism
What is exophthalmos?
bilateral, unilateral, or asymmetrical protrusion of the eyeballs due to hyperthyroidism
What is thyrotoxic crisis (thyroid storm)?
A complication of hyperthyroidism that is rare, acute, and life-threatening
What is the cause of a thyrotoxic crisis? Does it happen in controlled or uncontrolled hyperthyroidism?
stressors in a patient with hyperthyroidism; may occur due to a stressful event (i.e., someone with hyperthyroidism is in a car accident)
May occur in anyone with hyperthyroidism, whether controlled or uncontrolled
What are the manifestations of thyrotoxic crisis?
severe tachycardia, heart failure, shock, hyperthermia (>39), restlessness, agitation, seizures, abdominal pain, nausea, vomiting, diarrhea, delirium, and coma
What type of diet should someone with hyperthyroidism be on?
high calorie, high protein, high carbohydrates, minerals, vitamins, substitutes for caffeine containing beverages
What is hypothyroidism?
High levels of TSH, low T4
Define the difference between primary and secondary hypothyroidism
primary - destruction of thyroid tissue/defective hormone synthesis
secondary - pituitary disease or hypothalamic dysfunction
What is the precipitating factor for hypothyroidism?
iodine deficiency
What are the clinical manifestations of hypothyroidism?
No symptoms to classic symptoms and physical changes, severity depends on deficiency
fatigue and lethargy
myxedema (characteristics facies – puffiness in the face)
What is myxoedema?
Puffiness in the face due to hypothyroidism
What is the most intense complication of hypothyroidism?
Myxedema coma – medical emergency, hypothermia, notable impairment of consciousness/coma, may not be LAO x3
What is euthyroid?
Homeostasis of the thyroid
What medication would be administered to someone with hypothyroidism?
Levothyroxine
What is levothyroxine? Contraindications? Side effects/cautions?
Thyroid replacement, treatment for hypothyroidism, acts in the same manner as endogenous thyroid hormones
Goal is to achieve euthyroid
Contraindications - allergy, recent MI, adrenal insufficiency, hyperthyroidism, gluten intolerance, lactose, certain foods (starch)
Caution - monitor thyroid function tests to titrate med
LONG-TERM/forever med
What time of day should levothyroxine be administered?
Morning, consistently, at the same time
Why should patients on levothyroxine report on high-stress life events?
thyroid function increases during this time and medication dose may need to be adjusted
How long will it take for an individual to adjust to levothyroxine?
6-8 weeks
How does PTH act on bone?
stimulates resorption and inhibits bone formation
Resorption – moving calcium from the bone to the blood
What is calcium resorption?
moving calcium from the bone to the blood
What is the relationship between calcium and phosphorus?
If we keep calcium, we lose phosphorus (inverse relationship)
How does PTH act on the kidneys?
Increases calcium resorption and phosphate excretion, renal conversion of Vitamin D
How does PTH act on the GI?
Either absorbs or excretes calcium
What are the symptoms of hypercalcemia?
Polydipsia (excessive thrist), polyuria, diminished deep tendon reflexes, hypertension
What are the symptoms of hypocalcemia?
Tetany (muscle contraction or tension), tingling in lips, fingertips, occasionally feet (paresthesia), increased muscle tension
What is tetany associated with?
hypocalcemia
Define primary hyperparathyroidism and what is it typically caused by?
Increased secretion of PTH
Benign neoplasm or single adenoma (cancer)
What is the age range for primary hyperparathyroidism and peak ages?
- 30-70 years of age
- Peaks in 50s and 60s
Define secondary hyperparathyroidism and its 4 causes
compensation to states that induce or cause hypocalcemia
- Vitamin D deficiencies
- Malabsorption
- Chronic renal failure (kidneys convert vitamin D normally, but may not do it appropriately if they are now failing)
- Hyperphosphatemia
Define tertiary hyperparathyroidism and what patient population is at risk for it
parathyroid glands are hyperplastic, negative feedback is lost
Kidney transplant clients
What are the 7 major manifestations of hypercalcemia? What condition is it associated to?
muscle weakness, loss of appetite, constipation, fatigue, emotional disorders, shortened attention spans
Hyperparathyroidism
What are the four major signs of hypercalcemia and what is it associated to?
loss of calcium from bones, fractures, kidney stones, muscle weakness
associated with hyperparathyroidism
What are the four serious complications of hyperparathyroidism?
renal failure, pancreatitis, cardiac changes, fractures of long bones
Define hypoparathyroidism
Rare condition, usually by accidental removal of glands or destruction of vascular supply
Which is more rare: hypo or hyperparathyroidism?
Hypoparathyoidism
What are the signs of hypocalcemia and what condition is it related to?
Tetany, tingling sensation in lips, fingertips, occasionally feet, increased muscle tension
Hypoparathyroidism
What are the two complications of hypoparathyroidism?
Dysphagia and laryngospasms (pt feels like they are choking at moments)
What is Alendronate? Cautions?
Antihypercalcemic agent, prevents bone loss and inhibits/reverses osteoclast resorption
Caution - Watch with patients with dysphagia, esophagitis, esophageal ulcer, or gastric ulcer
Take with 240mL of water first thing in the morning (0630) and do not lay down for 30 mins after - may cause esophageal erosion
How can we assess that alendronate is working effectively?
Complete a bone scan to ensure the medication is working, assess for previous fractures, ensure a safe environment to reduce risk of bone fractures
Define pancreatitis
Acute inflammation of the pancreas where pancreatic enzymes are spilling into surrounding pancreatic tissue causing auto digestion and severe pain
What age is pancreatitis most common in?
Middle aged men and women (~45)
What are the three most common causes of acute pancreatitis?
Most common cause gallstones and alcohol use disorder, and associated with hypertriglyceridemia (elevated triglycerides)
Describe how pain manifests in acute pancreatitis
Abdominal pain (distention of pancreas, peritoneal irritation, and obstruction of biliary tract)
Location - LUQ- midepigastrium- radiates to back
- Sudden onset, severe deep, piercing, continuous-steady
- Eating aggravates the pain, and so does lying flat
- No relief from vomiting
- Guarding
What are the 12 clinical manifestations of acute pancreatitis?
- Abdominal pain
- Decreased bowel sounds/absent (tympanic sounding – moving through a lot of air and hypoactive)
- Abdominal distention
- Flushing, cyanosis, dyspnea
- Issues with inhalation and exhalation
- Nausea, vomiting
- Low grade fever (38.3-38.5), leukocytosis (increased WBCs and brand-new WBCs)
- Hypotension, tachycardia
- Jaundice
- Crackles in lungs – risk for developing pneumonia
- Ecchymoses in the flanks, periumbilical area
- Shock can occur
What is Grey Turner’s and Cullen’s sign? What condition is it associated with?
- Grey turner’s sign: Bruising along the flank
- Cullen’s sign: Bruising along the umbilicus
Associated with acute pancreatitis
What is pseudocyst? Symptoms? What is it a complication of?
cyst that is developed not by the normal physiology of cysts
Accumulation of fluid, pancreatic enzymes, tissue debris, inflammatory exudates surrounded by a wall
- Abdominal pain, palpable epigastric mass, nausea, vomiting, anorexia
- Elevated amylase
- Cysts may resolve – body may absorb the contents over time
- May perforate (Peritonitis)
Complication of acute pancreatitis
What complication is elevated amylase associated with?
Pseudocysts from pancreatitis
Define an abscess, its symptoms, and what it is a complication of
A pocket of pus from a pseudocyst that becomes infected and necrosis occurs
This can rupture or perforate
- Severe upper abdominal pain, upper abdominal mass, high fever (39-39.5), leukocytosis
- As soon as it bursts, they state feeling better
Associated with acute pancreatitis
What are the 6 systemic complications of acute pancreatitis?
- Hypotension
- Tachycardia
- Pleural effusion
- Atelectasis
- Pneumonia
- Acute respiratory distress
What is the best diagnostic for acute pancreatitis?
CT
What are the 6 interprofessional goals for acute pancreatitis?
o Relief of pain
o Prevention/alleviation of shock
o Reduction of pancreatic secretions
o Control of fluid and electrolyte imbalance (NPO and parenteral nutrition)
o Prevent/treat infections
o Remove cause (if possible)
What will a patient’s nutritional therapy be for acute pancreatitis?
Initially NPO, enteral feedings to small frequent meals-high in carbohydrates, no alcohol
Low protein because it is hard to breakdown and the pancreas will excrete more enzymes
Define chronic pancreatitis
continuous, prolonged inflammation and fibrosing of the pancreas
Pancreas is progressively destroyed and replaced with fibrotic tissues, strictures, and calcifications may also occur
What is the most common cause of chronic pancreatitis?
Alcohol use disorder
What does it mean to say chronic pancreatitis is an idiopathic pancreatitis
No identifiable cause is found
What is the difference between obstructive and non-obstructive chronic pancreatitis?
Obstructive - associated with biliary disease
Nonobstructive - inflammation, sclerosis, ducts obstructed, calcify, fibrosis, glandular atrophy
What are the clinical manifestations of chronic pancreatitis?
- Abdominal pain
- May have episodes of acute pain but it is usually chronic (intervals of months/years)
- Attacks become more frequent until almost constant
- Pain is heavy, gnawing, burning, cramp-like
- Steatorrhea
What is steatorrhea? What is it associated with?
Floating, frothy, smelly BM
Chronic pancreatitis
What are the four symptoms of pancreatic insufficiency? What is it associated with?
- Malabsorption with weight loss
- Constipation
- Mild jaundice and dark urine
- Urine and stool may be frothy
Chronic pancreatitis
What will serum amylase and lipase come back as for someone with chronic pancreatitis?
May be slightly elevated or not at all due to chronic nature
What three things would be implemented for someone with pancreatic insufficiency?
- Diet
- Pancreatic enzyme replacement
- Control diabetes
What is pancrelipase?
supplemental pancreatic enzymes
Define type II diabetes mellitus
A multi-system disease where there is abnormal insulin production, impaired insulin utilization or both
What four ethnic groups have the highest rates of DM?
Hispanic, South Asian, African descent, Indigenous
How much % of diabetes is DM?
90
What % of individuals with DM are overweight?
80-90% (abdominal and visceral adiposity)
What age range does DM usually effect?
35-55
What four co-morbidities are associated with DM?
Vascular disease, GDM (gestational diabetes mellitus), hypertension, dyslipidemia
With DM, does the pancreas still produce endogenous insulin?
Pancreas usually continues to produce some endogenous insulin - This insulin is either insufficient for body needs, poorly utilized by tissues, or both
What four dysfunctions of the body is DM associated with?
- insulin resistance - glucose and lipid metabolism doesn’t respond to insulin
- Decrease in pancreas ability to produce insulin - Cells become fatigue by over production or loss
- Inappropriate glucose production - Liver is haphazard with production, not in response to body needs, increase in glucagon secretion
- Alteration in production of hormones and cytokines - These play a role in metabolism
What five conditions cause metabolic syndrome?
Abdominal obesity
Hypertension
Dyslipidemia
Insulin resistance
Dysglycemia
Is DM onset gradual or sudden?
Gradual onset
What are the 5 clinical manifestations of DM?
Nonspecific symptoms
1. Fatigue
2. Recurrent infections
3. Prolonged wound healing
4. Visual acuity changes
5. Painful peripheral neuropathy (noticed primarily in the feet)
What would a DM A1C, fasting glucose, random blood plasma glucose, and two-hour plasma glucose come back as?
o HGBA1C ≥ 6.5%
o Fasting blood glucose ≥ 7.0 mmol/L
o Random plasma glucose ≥ 11.1 mmol/L
o Two-hour plasma glucose ≥ 11.1 mmol/L
What is does a HGBA1C test?
Snapshot of 3 months of glucose control (100-120 days of a hemoglobin molecule)
What is the minimum time of fasting required for a fasted glucose?
8 hours
What is required to prep for a two-hour plasma glucose? What does it test?
- Requires ingestion of a specific glucose drink
- Tests how your body responds to an increase in glucose
What is the exercise prescription required for DM?
regular and consistent 150 minutes per week, moderate intensity aerobic, resistance training 3x per week
What is Gliclazide? Contraindications? What is its onset and when should it be administered? Cautions?
2nd generation sulfonylurea that stimulates pancreas to release insulin
Contraindications: allergy
Rapid onset, short duration, should be given 30 mins before meals
Cautions: Requires some pancreatic function, Hypoglycemia may occur after administration, ensure the patient has eaten prior and check glucose, Administer at the same time every day
What is AHS’ glycemic index?
5.0-11.0
What value is hypoglycaemic and how much sugar should be immediately administered?
Hypoglycemia is any value less than 4.0 mmol/L
Immediately administer 15g of apple juice
What is Metformin? Contraindications? What test must be done prior to administration?
Biguanide, inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin
Contraindications: allergy, liver/kidney disease, alcoholism, cardiopulmonary disease
LFTs must be completed because the liver metabolizes it, and kidney function tests because it will excrete the med
Cautions: observe for ketoacidosis (test blood glucose; it will be way above 18.0), risk for infection, dehydration, diarrhea, risk for hypoglycemia
Due to increased insulin sensitivity, they may require less insulin
What medication must be held prior to an iodized contrast diagnostics due to immediate chronic kidney failure occurring?
Metformin contraindicated in patients going for an iodized contrast diagnostic – medication must be held because we will put them into immediate chronic kidney failure – cannot be recovered from
