Endocrine Flashcards
The endocrine system is composed of _______ such as ….
Glands
- Hypothalamus
- Pituitary gland
- Pineal gland
- Thyroid/Parathyroid gland
- Adrenal gland
- Pancreas
- Ovaries/Testicles
The hypothalamus secretes __________ which _________
Releasing Hormones that tell other glands what to secrete
The hypothalamus is the main gland that produces Releasing Hormone
The Anterior Pituitary produces _________ Which _______
Tropic hormones which are signaling molecules that stimulate endocrine glands to produce and release specific hormones
What hormones does the Anterior pituitary release?
- Growth hormone > Bone, Muscle, and organs
- Prolactin > Breasts
- LH/FSH > Ovaries and Testes (Estrogen & Progesterone/Testosterone)
- ACTH > Adrenal cortex (Cortical hormones)
- TSH > Thyroid gland (Thyroid Hormone)
What Hormones does the Posterior Pituitary Release
- ADH > Kidneys
- Oxytocin > Breasts and Uterus
What could cause hypopituitarism, and what does hypopituitarism result in?
Causes
- Pituitary tumor
- TBI
- Iatrogenic injury (Surgery)
- Inflammatory conditions (TB)
Results in
Decreased Hormone levels which lead to decreased organ function
Causes of Hyperpituitarism
Pituitary Tumor
- Prolactinomas (Most common)
- TSHoma (least common)
Where do you find the Adrenal gland?
On top of the kidney (Kidneys Hat)
Where is the Adrenal cortex and what does it secrete
The adrenal cortex is the outside of the adrenal gland
It secretes Mineralcorticoids (Aldosterone) and Glucocorticoids (Cortisol)
Function of Aldosterone and Cortisol
Aldosterone (Mineralocorticoid): Increases sodium absorption, causes potassium excretion
Cortisol (Glucocorticoid): Affects glucose, protein, and fat metabolism, body response to stress, and immune function
Where would you find the adrenal medulla and what does it secrete?
The adrenal medulla is inside the adrenal gland
It secretes Epinephrine and Norepinephrine
What causes Addisons Disease/ Renal Insufficiency
Caused by damage by damage or dysfunction of adrenal cortex
What does dysfuntion of the adrenal cortex lead to?
Diminished production of mineralocorticoids and glucocorticoids –> leading to decreased cortisol and aldosterone
Lab tests to determine Addisons disease
Decreased sodium
Increased potassium
Hypoglycemia
Diagnostic test for Addisons disease
ACTH stimulation test
- Administer ACTH and measure cortisol production
Primary Problem (Problem with adrenal gland > Cortisol levels do not rise
Secondary Problem (Problem with pituitary) > Cortisol levels rise
Addisons disease signs and symptoms
Low Blood pressure
Weight loss
GI Issues
- N/V
- Diarrhea
- Constipation
- Abdominal Pain
Skin
- Vitiligo
- Hyperpigmentation
Adrenal Crisis
Acute drop in adrenal corticoids due to sudden discontinuation of glucocorticoid medications or induced by trauma, stress, or infection
Adrenal Crisis Signs and Symptoms
Fever
Syncope
Convulsions
Hypoglycemia
Hyperkalemia
Hyponatremia
Severe Vomiting and Diarrhea
Treatment for Adrenal Crisis
IV Steroids
Treating Hyperkalemia
- Insulin + Dextrose
- Thiazide Diuretics
- Heart Monitoring
Acidosis
- Sodium Bicarbonate
Cushing syndrome causes
More common than Cushing Disease
Caused by exogenous use of glucocorticoids
Cushing Disease cause
Due to endogenous causes of increased cortisol
Dangers of overusing prednisone
- Body thinks it is receiving exogenous glucocorticoid > Adrenal gland stops producing cortisol
- If prolonged occurrence can lead to atrophy of the adrenal gland
What happens if the adrenal gland atrophies and the body needs to produce cortisol?
It cant produce necessary cortisol because the receptor sites have become downregulated and the gland is atrophied
- Leads to adrenal crisis
Main signs of Cushing syndrome
Buffalo Hump (Fat Pads)
Moon Face
- Thinning of hair
- Increased body and facial hair
- Purple striae
- Acne
- Thin extremities with increased weight gain in abdomen
Cushing diagnostic tests, what are we looking for?
Confirming elevated plasma cortisol levels
1.) Midnight or late-night salivary cortisol
2.) Low-dose dexamethasone suppression test
- Administer Dexamethasone -> Should suppress levels of ACTH and endogenous cortisol
3.) 24-h urine cortisol
Cushing syndrome Medication treatments
Medications
- Ketoconazole: Corticosteroid inhibitor
- Mitotane: Destruction of adrenocortical cells (Monitor for hepatotoxicity and hypotension)
Cushing syndrome Surgical treatments
- Chemotherapy or radiation of adrenal gland
- Primary surgery (Remove adrenal gland)
- Secondary surgery (Remove pituitary gland)
What should you monitor post procedure for when treating cushings syndrome?
Adrenal Crisis
Thyroid gland location
Sits on top of the trachea (Potential for airway issues)
What is secreted by the thyroid gland, and what do they regulate?
Secrete Thyroid hormone( T3 and T4) and Calcitonin
Which regulates
- Overall body metabolism
- Energy Production
- Tissue use of fats, proteins, and carbs
What is necessary to make thyroid hormones
Iodine
What does calcitonin do and what is it secreted by?
Secreted by the thyroid
- Inhibits the mobilization of calcium from bone
- Reduces blood calcium levels
What is the most common cause of Hypothyroidism, and explain it
Hashimotos
- Autoimmune disorder
- Autoantibodies attack the thyroid gland, which leaves the thyroid gland unable to secrete T3 and T4
Who is affected more by thyroid disorders and what is important about mild hypothyroidism
Women are often affected more
Mild hypothyroidism has vague symptoms > Many go undiagnosed
Hypothyroidism Signs and Symptoms
Will show signs of slowed metabolism
- Thinner hair, Puffy face, Dry coarse skin, Swelling limbs
Lab values
- Increased TSH
- Decreased T3 and T4
What is hypothyroidism called in children and what might you see?
Called Cretinism
P-CUMS
- Protuding tongue
- Coarse facial features
- Umbilical hernia
- Mental retardation
- Short stature
How do we treat hypothyroidism, and what education/monitoring is required?
Levothyroxine
- Take in the morning without food
- Monitor for S/S of hyperthyroidism
Myxedema Coma
Not enough thyroid hormone
( MEDICAL EMERGENCY )
What can cause Myxedema Coma
(DIET)
Drugs
Infection
Exposure to cold
Trauma
Consequences of Myxedema coma
Cardiovascular collapse
Hypoventilation
Hypoglycemia
How to treat myxedema coma
IV thyroid hormone (Levothyroxine)
Supportive care
Most common cause of Hyperthyroidism and what is it?
Graves disease
- Autoimmune antibodies > Hypersecrete thyroid hormone
What lab tests would you see in Graves’ disease (Hyperthyroidism)
Serum TSH: Decreased
T3 and T4: Increased
Thyroid-stimulating immunoglobulins: Elevated
Thyrotropin receptor antibodies
What diagnostic procedure would you use for Graves’ disease (Hyperthyroidism)? What does it do?
Radioactive Iodine Uptake
- Clarifies the size and function of the thyroid
- Elevated uptake is indicative of hyperthyroidism
- Assess for shellfish allergy or iodine allergy
Nursing considerations for Graves’ disease
Minimize clients’ energy expenditure
Provide eye protection
Monitor temperature
Treatments for Graves’ disease
Medication
- Methimazole and propylthiouracil
- Thionamides (Decrease hormone levels before surgery)
Surgery
- Thyroidectomy
Radioactive Iodine Therapy
What precautions do clients need to take when undergoing radioactive iodine therapy?
Waste is hazardous
- No sharing toilets
- Flush multiple times
- Wash clothing separately
- Do not share food or drinks
- Do not sleep in same room
- Stay away from kids and pregnant women
What is a Thyroid Storm
AKA: Acute Thyrotoxicosis
Sudden surge of large amounts of thyroid hormones > Great increase in body metabolism
( MEDICAL EMERGENCY )
Findings with Thyroid Storm
Hyperthermia
Hypertension
Delerium
Vommiting
Abdominal Pain
Chest Pain
Dysryhtmias
Treatment for thyroid storm
Treat hyperthermia
- Give Acetaminophen, NOT NSAIDs (Increases thyroid levels)
- Cool bath
Supportive care
Thionamides to decrease the synthesis of thyroid hormone
- Surgery
What are the types of Thyroidectomies
Subtotal : Removal of part of thyroid (Residual thyroid can produce enough hormone)
Total: Life long thyroid replacement is needed
Post-thyroidectomy considerations
- Support neck on pillows (Avoid extension)
- Monitor for hypocalcemia (If parathyroid has been damaged or removed)
- Monitor airway (LARYNGEAL STRIDOR)
- Risk for edema leading to an occluded airway
Thyroid cancer nodule manifestations
Firm, palpable, non-tender mass
May have difficulty swallowing
May not have alterations in hormone levels
Diagnostic procedures for diagnosis of thyroid cancers
Imaging
- CT, MRI, PET
Fine needle biopsy
Radioactive Scan
- Hot nodules= HYPERactive (Not usually cancerous)
- Cold nodules= HYPOactive nodules (More likely to be cancerous)
Where is the parathyroid found and what does it do?
Four pea sized glands found within thyroid tissue
Produces and secretes Parathyroid hormone (PTH) in response to HYPOcalcemia = Break down of bone
What will HYPOparathyroidism look like
Less Common
Similar to s/s of hypocalcemia
- Possible side effect of thyroidectomy
What does HYPERparathyroidism look like
More common
Similar to s/s of hypercalcemia
- Surgery is the treatment of choice
What is insulins role in the body?
Insulin is the key to the cell
- Lets glucose into cells > Treats hyperglycemia
- Lets Potassium into cells > Treats hyperkalemia
What is the pancreas responsible for in diabetes? What are the pancreatic cells and what do they secrete?
Responsible for regulating blood sugar
- Beta Cells: Secrete insulin to move sugar into cells
- Alpha cells: Secrete glucagon to convert glycogen into glucose
Define metabolic syndrome
A collection of manifestation that lead to diabetes and cardiovascular diseases, like
- Abdominal obesity
- Insulin resistance
- Sedentary lifestyle
- Hypertension
- High cholesterol
What are the 3 types of Diabetes
Type 1: Autoimmune
Type 2: Acquired
Gestational
Type 1 Diabetes is an ________ disorder that will require __________
An autoimmune disorder that will require exogenous insulin for life
Type 2 Diabetes
- Cells become insulin resistant
- Decreased production of insulin by beta cells
- Fat cells are particularly insulin resistant (Need more insulin to have the same effect)
- Increased insulin production (Pancreas becomes exhausted, a decrease in function)
- Linked to obesity, sedentary lifestyle, genetics
When do symptoms for type 1 diabetes begin and what does a client look like?
Symptoms begin in childhood
Clinical presentation
- Young and thin
- Quick onset
- New onset > DKA (Diabetic ketoacidosis)
- 3Ps (Polyuria, Polyphagia, Polydipsia)
- Ketones in urine
How do we treat type 1 diabetes
Insulin
When do we see more type 2 Diabetes and what are the risk factors?
Seen more in adulthood due to insulin resistance
Risk factors
- Lifestyle
- Obesity
- Sedentary
- Poor diet
- Stress
- Genetics
What do clients with type 2 diabetes look like clinically? How do we treat it?
Clinical presentation
- Overweight
- Not quick onset
- Rare to see ketones
Treatment
- Diet and exercise
- Oral medications
What does A1C measure?
Average blood glucose level
Signs of HYPERglycemia
3Ps (Polyphagia, Polyuria, Polydipsia)
Dry skin
Blurred Vision
Delayed wound healing
Signs of HYPOglycemia
P-TIRED
Pallor/Clammy
Tachycardia
Irritability
Restlessness
Excessive Hunger
Dizziness
Would we rather have a client be hyperglycemic or hypoglycemic? If blood sugar levels are unknown what should we treat for?
Hyperglycemic
If blood sugar is unknown treat for hypoglycemia
Rule of 15
If glucose is lower than 70
- 15g PO fast-acting sugars (4oz juice, crackers, soda)
- Check in 15 minutes
- If still below 70, repeat treatment
If after 2-3 glucose is still below 70, contact physician
Other methods to raise glucose levels than PO
Glucose tablets
1mg Glucagon IM injection
Give a protein snack after fast acting sugars to stabilize glucose
If glucose levels are below 40
May need IV dextrose
1 ampule of D50
At what glucose level does inpatient treatment for hyperglycemia start
150
s/s
- 3Ps
- Dry mucous membranes
- Rapid Weak pulse
- Weakness and Malaise
Treatment:
- Short acting insulin (Novolog, humolog)
- Adjust basal-bolus regimen
Diabetes Complications
- Arteriosclerosis
- Peripheral angiopathy (lack of circulation)
- Diabetic retinopathy
- Diabetic neuropathy
- Autonomic neuropathy
- Diabetic nephropathy
- Immunosuppression
- Poor wound healing
What needs to happen to the feet of diabetics
- Clients should assess daily
- Toenails cut straight and filed down (Provider)
- Providers document foot assessment each visit
Why do clients not notice wounds on feet?
Peripheral neuropathy
Poor wound healing
If infection reaches the bone (Osteomyelitis) > Amputation
How does DKA occur
Insufficient insulin r/t untreated T1DM
No insulin > Liver starts Gluconeogenesis (using fats and amino acid to make glucose) > Byproduct = Ketones
What happens when cells sense high blood sugar
Pull water out of cells into blood bloodstream> Severe cellular dehydration (Life-Threatening)
How should patients demonstrate an understanding of the provided education
Teachback method
