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326 Acute & Chronic Final Exam > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Describe the mechanisms of endocrine control?

A
  • Hormones: chemical messengers that control the flow of information between different tissues and organs
    • Integrate and regulate body functions
    • Released from endocrine glands
    • Some organs contain endocrine cells and tissue
      • Kidneys, heart, liver, stomach
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2
Q

What does the Hypothalamus do?

A
  • Hypothalamus controls release of anterior pituitary hormones
  • Hypothalamus communicates with posterior pituitary gland via nerve tracts
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3
Q

Examples of Hypothalamic hormones?

A
  • Somatostatin
  • Dopamine
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4
Q

What does the Posterior Pituitary gland do?

A
  • Posterior Pituitary gland (2 p’s)
  • Secretes 2 hormones:
    • Antidiuretic hormone (ADH/vasopressin)
    • Oxytocin
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5
Q

How does the Negative Feedback Loop work?

A
  • Hypothalamus produces releasing hormone that stimulates production of tropic hormone by anterior pituitary
  • Tropic hormone stimulates peripheral target gland to secrete hormone, which acts on target cells to produce physiologic response
  • ↑ in blood levels of target hormone travel back to hypothalamus and AP leading to a ↓ in tropic hormone
  • Maintains narrow range of target hormone in blood
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6
Q

Example of Negative Feedback Loop?

A
  • Thyroid hormone (T3, T4) levels lower than setpoint
  • Hypothalamus secretes TRH
  • TRH stimulates AP secretion of TSH
  • TSH signals thyroid to produce T3 and T4
  • ↑ in T3 and T4 turns off TRH and TSH signaling in hypothalamus and anterior pituitary gland
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7
Q

Example of Positive Feedback Loop?

A
  1. Baby moves deeper into mother’s birth canal
  2. Cervix of uterus is stretched
  3. Nerve impulses are sent to hypothalamus
  4. Hypothalamus sends impulses to posterior pituitary, where oxytocin is stored
  5. Posterior pituitary releases oxytocin to blood; oxytocin travels to uterine muscle
  6. Uterus responds to oxytocin by contracting more vigorously
  7. At birth, stretching of cervix lessens and positive feedback cycle is broken
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8
Q

Disorders of Anterior Pituitary are related to?

A
  • GH
  • TSH
  • ACTH
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9
Q

What causes Gigantism?

A

Hypersecretion of GH in children prior to closing of epiphyseal plates

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10
Q

What is Acromegaly?

A
  • Hypersecretion of GH during adulthood
  • GH-secreting pituitary adenoma
  • Enlarged body parts
  • ↑ risk of HTN, CAD, and stroke
  • GH affects glucose, lipid, and protein metabolism → hyperglycemia, insulin resistance, type 2 DM
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11
Q

Acromegaly manifestations?

A
  • Enlarged tongue
  • Broad nose
  • Protruding lower jaw
  • Slanting forehead
  • Enlarged hands and feet
  • Nerve entrapment
  • Kyphosis
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12
Q

Acromegaly treatment?

A
  • Correct metabolic abnormalities
  • Remove or reduce pituitary tumor mass
  • Relieve pressure to nerves
  • Pharmacotherapy
    • Somatostatin
      • Inhibits GH secretion
    • Dopamine agonists
      • ↓ release of GH and prolactin
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13
Q

What causes Diabetes Insipidus (DI)?

A

Central:

  • Pituitary gland is not releasing enough ADH (antidiuretic hormone)

-or-

Nephrogenic:

  • Kidneys are not responding to ADH
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14
Q

Diabetes Insipidus (DI) manifestations?

A
  • “Dry Inside”
  • ↑ sodium, ↑ urine output
  • ↓ BP (orthostatic hypotension)
  • Neuro status (restlessness, weakness, agitation, seizures, coma)
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15
Q

What causes SIADH?

A
  • Hypersecretion of ADH
  • Tumors
  • CNS (pain, stress)
  • Drugs
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16
Q

SIADH manifestations?

A
  • “Soaked Inside”
  • ↓ sodium, ↓ urine output
  • ↑ BP
  • Neuro status (seizures, coma, death)
  • GI effects (cramps, N/V)
  • Edema
17
Q

SIADH treatment?

A
  • Diuretics
    • Loop diuretics, mannitol
  • Hypertonic 3% saline
  • Drugs that inhibit action of ADH in the kidneys
    • conivaptan, tolvaptan
18
Q

What does the Thyroid Hormone do?

A
  • ↑ metabolic rate
  • ↑ cardiorespiratory demands
  • ↑ GI motility and appetite
  • ↑ skeletal muscle tone and reflexes
  • ↑ CNS and SNS effects
19
Q

What is Hashimoto Disease?

A
  • ↓ T3/T4 and ↑ TSH/TRH
  • Autoimmune thyroiditis
    • Inflammatory destruction of thyroid tissue by autoreactive T lymphocytes and thyroid autoantibodies
    • Goiter due to inflammation
20
Q

Hypothyroidism manifestations?

A

↓ TH → ↓ metabolism and heat production

  • Thickened skin
  • Hair loss
  • Constipation
  • Lethargy
  • Weight gain
  • Bradycardia
  • Sleepy all the time
  • Anorexia (no appetite)
21
Q

Hyperthyroidism manifestations?

A

↑ TH → ↑ metabolism and heat production

  • Diarrhea
  • Increased appetite
  • Weight loss
  • Muscle weakness
  • Altered menstrual flow
  • Flushing
  • Fatigue
  • Palpitations
  • Nervousness
  • Irritability

Heat intolerance
Excitement (insomnia)
Angina
Restless
Tachycardia/Tremor

22
Q

What is Myxedema Coma?

A
  • Life threatening condition: severe end-stage hypothyroidism
  • ↓ cellular metabolism
23
Q

Myxedema Coma manifestations?

A
  • Hypothermia
  • Hypoventilation
  • Hard, non-pitting edema
  • ↓ level of consciousness/coma
  • Hypotension, hypoglycemia, and lactic acidosis
  • ↑ risk in older adults with comorbid conditions
24
Q

What is Graves Disease?

A
  • ↑ T3/T4 and ↓ TSH/TRH
  • Goiter due to hyperplasia of thyroid gland
25
Q

Graves Disease manifestations?

A
  • ↑ metabolic rate, heat intolerance
  • ↑ cardiovascular function
  • ↑ appetite, weight loss
  • ↑ neuromuscular effects
  • Exopthalmos
    • Corneal dryness and conjuctivitis
26
Q

What is Thyroid Storm?

A
  • Rare but potentially life-threatening
    • Fatal within 48 hours if untreated
  • Hyperthyroid condition plus stressor → ↑↑↑ T3 and T4
    • Ex. Infection, trauma, seizure, surgery, dialysis, emotional distress, pulmonary or cardiovascular disorder, OB complications
27
Q

Thyroid storm manifestations?

A
  • Hyperthermia
  • ↑ HR, HF, ↓ BP → shock
  • Neuro (restlessness, agitation, seizures, coma)
  • GI (abdominal pain, N/V/D)
28
Q

Thyroid storm treatment?

A
  • Antithyroid meds
    • Propylthiouracil (PTU), Methimazole
    • Blocks conversion of T4 to T3
  • Iodine
    • Large doses inhibit production and release of T3 and T4
  • Radioactive iodine therapy
  • Surgery
29
Q

What is Cushing Disease?

A
  • ↑ secretion of ACTH due to pituitary tumor → ↑ cortisol
30
Q

Cushing Disease manifestations?

A
  • Chronically elevated cortisol levels
  • Altered fat metabolism → adipose accumulation – ‘buffalo hump’ and ‘moon face’
  • ↑ androgen levels, ↑ blood glucose levels, ↑ BP
  • Visceral obesity
  • Purple striae on chest and abdomen
  • Insomnia
31
Q

How to treat Cushing Disease?

A

Treat cause:

  • Pituitary tumor
    • Transsphenoidal endoscopic surgery
  • Adrenal tumor
    • Adrenalectomy
  • Other ACTH secreting tumors
    • Lung or pancreas

Lifetime hormone replacement therapy.

32
Q

Post-op care Pituitary Tumor Removal?

A

Post-op assessment:

  • Neuro
  • Dressing

Complications:

  • Diabetes insipidus
  • CSF drainage
    • Halo effect
    • Glucose

Education:

  • Hormone replacement therapy
    • GH, TSH, ACTH
33
Q

Post-op care for Cushing Disease?

A
  • Transsphenoidal endoscopic surgery
    • CSF leakage, prevent sneezing, and/or nose blowing
  • Adrenalectomy
    • Monitor for ↑ risk of hemorrhage
  • Monitor BP, fluid overload, or diuresis
  • Critical period for circulatory instability
    • 24 – 48 hours
34
Q

What is Addison Disease?

A
  • Deficient adrenal cortical hormones
  • Autoimmune destruction of adrenal cortical cells
  • Inadequate corticosteroid and mineralocorticoid synthesis (↓ cortisol and aldosterone)
35
Q

Addison Disease manifestations?

A
  • Fatigue, orthostatic hypotension, weight loss
  • Hypoglycemia, anorexia, N/V/D
  • hyponatremia, hyperkalemia
  • Vascular collapse and shock (Addisonian or adrenal crisis)
36
Q

Addison Disease treatment?

A
  • Lifetime hormone replacement therapy
  • Glucocorticoid and mineralocorticoid supplements
  • Hydrocortisone for cortisol deficiency
  • Alendronate (Fosamax) to prevent osteoporosis caused by corticosteriods
  • Regular schedule for meals and exercise
37
Q

Addisonian Crisis treatment?

A
  • Shock management
    • Treat hypotension and electrolyte imbalances
  • Corticosteroid therapy
    • High-dose hydrocortisone replacement
  • Protect against exposure to infection and triggers

326 Acute & Chronic Final Exam (5 decks)

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