Endocrine Flashcards
1
Q
endocrine + nervous system=?
A
homeostasis
2
Q
interface happens where
A
hypothalamus
3
Q
5 general functions of endocrine system:
A
1] differentiate reproductive and CNS of fetus
2] growth during adolescent and childhood
3] coordinates reproductive systems
4] maintains best internal environment through life
5] fight or flight- initiate responses
4
Q
Neural connection in postr pituitary but control antr and postr pituitary
A
hypothalamic control
5
Q
whats the disruption for hypothalamic control
A
excess/deficiency of hormones
6
Q
whats a secondary disruption of hypothalamic control
A
compression of optic nerve with visual issues
7
Q
two hormones in posterior pituitary
A
antidiuretic hormone (ADH) oxytocin
8
Q
etiology of hypo/hyperfunction
A
Tumor in hypothalamus, pituitary or endocrine glands◦ Inflammation (acute, chronic)
9
Q
chronic issues lead to?
A
hormone replacement therapy
10
Q
first places to look for any changes
A
in tumor
11
Q
neuroendocrine response to stress is to?
A
increase sympathetic response by stimulating adrenal cortex
12
Q
stimulating adrenal cortex gives you what
A
catecholamines
13
Q
examples of catecholamines
A
epinephrine, norepinephrine, dopamine
14
Q
Increased HR Peripheral vasoconstriction Elevated BP Increased blood glucose levels Stimulates breakdown of fats Stressors: exercise, temperature changes, emotional stress
effects of what?
A
stimulating adrenal cortex –> catecholamines
15
Q
what hormones stimulate pituitary
A
ADH, prolactin, GH, ACTH
16
Q
cortisol is where?
A
adrenal cortex
17
Q
Regulates metabolism to elevate blood glucose level, plasma lipid level
◦
create ketones
◦ Inhibits fibroblast proliferation, results in poor wound healing and increased risk for infection◦ Helps with fight or flight
◦ Anti-inflammatory protective mechanism
A
cortisol
18
Q
can be adaptive or destructive
A
cortisol
19
Q
Modulate transmission of pain perceptions (sedation, euphoria)
A
endorphins
20
Q
Skeletal and visceral growth via metabolism◦ Stressors: exercise, surgery
A
growth hormone
21
Q
affects breast tissue and creates milk production
A
prolactin
22
Q
Male characteristics, libido
◦ Decreases after exercise, surgery
A
testosterone
23
Q
msk sx of endocrine disease
A
Proximal muscle weakness; painlessHand contractures/ROM deficits Carpal tunnel (fluid volume)
24
Q
Usually ?? symptoms where overuse injuries are ??
- for carpal tunnel
A
bilateral
unilateral
25
Rheumatic symptoms
diabetes mellitus
26
Muscle weakness (proximal), atrophy,myalgias, fatigue
Thyroid disorders
Parathyroid disorders
Diabetes Mellitus
27
Carpal tunnel syndrome(Bilateral)
| 3
Diabetes Mellitus
Pregnancy
Hypothyroidism
28
Periathritis
Calcific Tendonitis (shoulders)
Gout
thyroid disorders
29
Spondyloarthropathy
Osteoarthritis
(spine type)
diabetes mellitus
30
posterior pituitary makes what two hormones?
oxytocin
| ADH
31
Contraction of uterus, makes breast milk
oxytocin
32
controls body fluid level in kidneys
- Cardiac responses
- Target of morphine, tranquilizers, anesthetics
ADH
33
anterior pituitary makes what two hormones?
prolactin
| GH
34
milk production
prolactin
35
growth via protein synthesis and fat metabolism
| Sx: dwarfism, gigantism
GH
36
Master gland for regulating other endocrine glands
| ◦ Influenced by hypothalamus
pituitary gland
37
Hyperpituitarism
◦ Hypopituitarism
◦ Local compression of brain tissue
-disorders of what lobe?
anterior lobe
38
Diabetes Insipidus
◦ SIADH
- disorders of what lobe?
posterior lobe disorders
39
pituitary tumors can be
primary or secondary
40
functional pituitary tumors will......
secrete hormones
41
headaches for pituitary tumors will
increase ICP
| decrease drainage from 3rd ventricle
42
visual disturbances for pituitary tumors will
occur in optic chiasm
| cause bilateral temporal hemianopia
43
oversecretion of one or more hormones
hyperpituitarism
44
acromegaly in adults occurs due to
GH
45
Sx: Excessive growth
Overgrow long bones
Hypertrophy of soft tissuesWidened joint spaces
acromegaly
46
```
Due to adenoma or exposure to glucocorticoids5:1 women to men
Childbearing years
Obesity
Glucose intolerance
Muscle wasting
Osteopenia
Moon face
Easy bruising
Abdominal striae
Acne
```
hyperpituitarism
ACTH increases due to Cushings Disease
47
```
Diaphoresis
◦ Milk production from breasts◦ Sleep apnea
◦ Carpal tunnel
◦ Joint pain
◦ Weakness
```
Sx of hyperpituitarism
48
first 2 things we looks for when diagnosing hyperpit.
levels of GH
| MRI of brain
49
resection of tumor
◦ beam radiation
◦ drug therapy- use of drugs afterwards to regulate hormones
tx for?
hyperpit.
50
Detn by level of GH, IGF-I; can develop bone tumors
prognosis for?
hyperpit.
51
decreased or absent hormone secretion by anterior pituitary
hypopit.
52
partial or total failure of all 6 hormones
panhypopit.
53
More than ??% of pituitary must be destroyed to demonstrate sx
75%
54
```
Removal/destruction of pituitary gland◦ Non secreting pituitary tumors
◦ Postpartum hemorrhage
◦ Anorexia
◦ Anemia
◦ GI dysfunction
```
etiology of?
hypopit.
55
depends on hormone lacking
sx for?
hypopit.
56
Stimulates liver to create insulin-like growth factors◦ Decreased growth, delayed puberty
```
GH deficiency
(dwarfism)
```
57
Decreased LH/FSH= sexual/reproductive disorders
hypothyroidism
58
whats the 2ndary dx to hypopit.?
hyperthyroidism
59
Removal of tumor
◦ Hormone replacement therapy
tx for?
hypopit and hypothyroidism
60
```
Fatigue
• Muscle weakness
• Weight loss
• Decreased appetite
• Joint stiffness
• Low BP
• Headaches
• Erectile dysfunction
• Infertility
• Hot flashes, irregular or no periods, loss of pubic hair, and inability to produce milk for breast-feeding inwomen
• Short stature in children
```
-signs and symptoms for?
hypopit.
61
* Normal birth length
* Develop change in growth curve by age 2-3 yo•Normal intelligence level
* Obesity
* Delayed skeletal maturation
* Delayed puberty
* Short stature
congenital GH deficiency
62
* Tumor or treatment for tumor•?Increased cardiac disease
* Central adiposity
* Insulin resistance
* Poor lipid profile
acquired GH deficiency
63
* Amenorrhea
* Breast atrophy
* Testicular atrophy
* Diminished libido
* Minimal pubic and axillary hair•Hypothermia
* Hypotension
* Hypoglycemia
for which hypopit disease?
gonadotropin deficiency
64
* Bloodwork:
* Serum cortisol
* Serum prolactin
* Serum thyroxine, TSH
* Serum testosterone
* Serum estrogen
* LH/FSH
* GH
* MRI of brain
* Xray of hands in children
tests and measures for hypopit.
65
* Removal of tumor
* Hormone replacement therapy- lifetime• Adrenal hormones- steroids
* TSH- synthroid
* Sex hormones
* GH
tx for?
hypopit.
66
whats a posterior lobe disorder?
diabetes insipidus
67
RARE imbalance of water due to ADH deficiency
diabetes insipidus
68
injury to hypothalamus, posterior pituitary
etiology for diabetes insipidus
69
Vasopression (ADH), diuretics
-Resect tumor
tx for?
diabetes insipidus
70
what are the hormones like for endocrine system
slow onset
| long duration/effect
71
SIADH stands for?
syndrome of inappropriate antidiuretic hormone secretion
72
Excessive ADH release with water imbalance
SIADH
73
Trauma/infection of pituitary
◦ Ectopic ADH production by malignancy/tumor
◦ Stress of surgery, systemic disorders, chemotherapy drugs (vincristine)
-etiology for?
SIADH
74
hyponatremia --> lethargy, nausea, anorexia, weakness, coma
- sx for?
SIADH
75
Correct sodium imbalance
◦ Surgery, chemo, radiation of tumor◦ Restriction of fluid intake
◦ Diuretics
tx for?
SIADH
76
Correct sodium imbalance
◦ Surgery, chemo, radiation of tumor◦ Restriction of fluid intake
◦ Diuretics
tx for?
SIADH
77
the thyroid is stimulated by ?
pituitary
78
pituitary creates ?
TSH
79
Thyroxine- 4
| ◦ Triiodothyronine- T3◦ Calcitonin
thyroid hormones
80
actions of the thyroid
Regulate basal metabolism
◦ Promotes growth and development◦ Metabolizes fat
◦ Exchange of electrolytes, protein
81
thyroid disorders are more common in?
women and thos with family hx
82
```
Effects multiple systems:◦ Nails
◦ Hair
◦ Eyes
◦ GI tract
◦ Lungs
◦ Heart
◦ Nervous tissue
◦ Bones
◦ Muscles
```
thyroid disorders
83
Excessive secretion of thyroid production
hyperthyroidism
84
Autoimmune disease
◦ Increased T4 production
◦ Women 20-40 yo
◦ Can occur during pregnancy
Graves disease
85
hyperthyroidism is of what origin?
auto-immune
86
* Enlargement of thyroid (goiter)•Nervousness
* Heat intolerance
* Weight loss
* Increased appetite
* Diaphoresis
* Diarrhea
* Tremor
* Tachycardia
* Exophthalmos (eye protrusion)
signs and sx of?
hyperthyroidism
87
hyperthyroidism MSK signs and symptoms
periarthritis
calcification in joints
proximal muscle weakness
88
Decreased or normal TSH
◦ Elevated T3, T4
◦ Increased radioactive iodine uptake
dx for?
hyperthyroidism
89
Spontaneous remission◦ Medications
◦ Radioactive iodine
◦ Surgery
tx for?
hyperthyroidism
90
Decreased thyroid hormones◦ DECREASED METABOLISM
hypothyroidism
91
what are the 2 types of hypothyroidism?
type 1- hormone deficient
| type 2- hormone resistant
92
```
Autoimmune- Hashimoto’s Thyroiditis◦
Surgery
◦ Overmedicated hyperthyroidism
◦ Diet
◦ Congenital
```
etiology for?
hypothyroidism
93
Rare, 1 in 5000
congenital hypothyroidism
94
Mental retardation◦ Motor retardation
| ◦ Delayed puberty
cretinism
95
```
Slowed metabolism
◦ Decreased GI tract mobility
◦ Weight gain
Bradycardia
Slowed neurological function
◦ Slow speech
◦ Decreased short term memory
◦ Increased sleep
◦ HA
Cerebellar ataxia
◦ Mood chages
Increased cholesterol and triglyceridesAnemia
```
sx of?
hypothyroidism
96
```
MSK Symptoms:
•Proximal hip weakness
•Myalgia
•Stiffness in small joints (arthritis)
•Paresthesia without objective findings•Joint edema
•Increased bone density
•Carpal tunnel syndrome
```
hypthyroidism
97
```
General Symptoms:
•Fatigue
•Dry skin
•Hair loss
•Cold intolerance
•Hoarse voice
```
hypothyroidism
98
TSH elevated
◦ T3 normal
◦ T4 decreased
◦ CPK-MB elevated (cardiac muscle)
dx for?
hypothyroidism
99
```
Synthetic thyroids (synthroid, levoxyl)◦
Side effects: afib, osteoporosis
```
tx for?
hypothyroidism
100
Severe CAD- atherosclerosis
◦
Increased triglycerides, cholesterol
prognosis for?
hypothyroidism
101
* Rare
* Slow growing
* Women, 20-60 yo
thyroid cancer
102
risk factors for thyroid cancer
low iodine
| radiation exposure
103
•Symptoms: nodule, vocal cord paralysis, lymphadenopathy
thyroid cancer
104
most common types of thyroid cancer
papillary and follicular carcinoma
105
Develops in one lobe
Slow growing
Spread to lymph nodes
papillary carcinoma
106
spreads to lung, bones
follicular carcinoma
107
```
Surgery
◦ Adioactive iodine
◦ Chemo
◦ Radiation
◦ 5 year survival rate: 97%
```
tx for?
thyroid cancer
108
manages calcium levels in the body
parathyroid hormone
109
MSK symptoms:
◦ Periarthritis
◦ Tendonitis
◦ Calcification
parathyroid
110
Primary: too much PTHHYPERcalcemia◦ Usually caused by tumor
hyperparathyroidism
111
```
Thirst
Frequent urinationHTN
Heartburn
Mental confusion
Kidney stones
Joint pain
```
sx of?
hyperparathyroidism
112
Secondary: low calcium levels in the blood and increase production of PTH
parathyroidism
113
Etiology: low vitamin D, kidney disease (phosphate)
hyperthyroidism
114
```
Risk Factors: most lead to hypocalcemia◦ Onset after 60 yo
◦ Benign tumor
◦ Renal failure
◦ Paget’s disease
◦ Multiple myeloma
◦ CA with bone metastasis
◦ Laxative abuse
◦ Vit D deficiency
```
hyperparathyroidism
115
Diagnosis:
◦ PTH measurement- hypercalcemic◦ Electrolyte measurement
◦ Xray of bones (demineralization)
hyperparathyroidism
116
Treatment:
◦ Parathyroidectomy
◦ IV hydration to drop Ca levels
hyperthyroidism
117
```
Decreased secretion of PTH
◦ HYPOcalcemia
◦ Increased phosphate
◦ Tetany
◦ Decreased bone reabsorption
```
hypoparathyroidism
118
```
Etiology:
◦ Iatrogenic
◦
◦
◦
◦
◦
◦
Removed during thyroidectomyInfarction of parathyroid
Scar tissue
Tumor
Trauma
Low vitamin D
```
hypoparathyroidism
119
```
CNS effects
◦ Irritability
◦ Anxiety
◦ Agitation
MSK effects
◦ Increased osteoclasts
◦ Tetany
◦ Spasm of respiration musclesCardiac effects
◦ Dysrhythmia
```
hypoparathyroidism
120
Diagnosis:
◦ Electrolyte levels
◦ Decreased PTH
hypoparathyroidism
121
```
Treatment:
◦ Tetany- emergent
◦ IV calcium
◦ Vit D supplementation◦ Maintain open airway
◦ Medications
◦ NO SURGERY
```
hypoparathyroidism
122
adrenal cortex secretes what 3 things/
mineralocorticoids
glucocorticoids
sex steroids
123
what 2 secretions of adrenal cortex regulate blood pressure?
mineralocorticoids
| glucocorticoids
124
Aldosterone- reabsorb Na, excrete K
mineralocorticoid
125
Cortisol- food metabolism, response to stress, dec inflammation
glucocorticoid
126
Testosterone
Estrogen
Progesterone
sex steroids
127
adrenal medulla secretes
epinephrine
128
INC heart rate
INC heart contraction
INC BP through vasoconstrictionINC blood glucose
effects of what hormone?
epinephrine
129
Insufficient cortisol and aldosterone secretion
| Men and women, 40-60 yo
addisons disease
130
```
Primary form: rare
◦ Complication from TB◦ Autoimmune
◦ Neoplasm
◦ Infection
◦ Radiation
```
what disease?
addisons disease
131
Risk factors:
◦ Surgery
◦ Pregnancy◦ Trauma
◦ Infection
addisons disease
132
Dehydration
◦ Hypotension
◦ Increased workload on heart◦ Poor coordination
effects of ____ for ____ disease
decreased aldosterone
| addisons disease
133
```
Hypoglycemia
◦ Hypotension
◦ Weakness
◦ Nausea
◦ Emotional disturbance
◦ Paranoia
◦ Increase in skin color on extensor surfaces
```
effects of _____ for _____ disease
decreased cortisol
| addisons disease
134
Diagnosis:
| ◦ Decreased serum cortisol
addisons disease
135
Treatment:
| ◦ Corticosteroids
addisons disease
136
Prognosis
| ◦ Fatal if untreated
addisons disease
137
Etiology:
◦ Tumor in hypothalamus or pituitary◦ Rapid taper of corticosteroids
◦
Suppresses ACTH
secondary adrenal insufficiency
138
Symptoms:
| ◦ Cortisol deficiency only: arthralgia, myalgia
secondary adrenal insufficiency
139
Symptoms:
| ◦ Cortisol deficiency only: arthralgia, myalgia
secondary adrenal insufficiency
140
Treatment
◦ ACTH replacement therapy
◦ Manage fluid/electrolyte balance
secondary adrenal insufficiency
141
excessive cortisol levels
cushings
142
Etiology:
◦ Tumor of adrenal gland
◦ High dose of steroids (usual PT presentation)◦ Excess of ACTH
cushings syndrome
143
MSK symptoms:
Proximal muscle wasting
Osteoporosis, fractures
Weakened muscle, skin tissue (stretch marks)
cushings
144
```
General symptoms:
Hyperglycemia
Hypertension
Decreased wound healingCushionoid face
Increased weight
Buffalo hump
```
cushings
145
adipose tissue
| roles
Conserve energy
◦ Vasoconstriction (angiotensin)
◦ Inflammation (leptin)
◦ Angiogenesis (vascular endothelial growth factor)
146
how does obesity occur?
Leptin alters hunger in the hypothalamus, INCREASE in humans
147
Metabolic disease that is defective in secretion of insulin, action of insulin, or both
diabetes mellitus
148
Deficiency of insulin production and secretion◦ Autoimmune disease of pancreas
◦ Require insulin injections
type 1 diabetes
149
Cellular resistance to insulin and inadequate insulin secretion response◦
Controlled with diet, exercise, oral hypoglycemic agents
type 2 diabetes
150
Decreased insulin sensitivity OR Increased insulin resistance
prediabetes
151
Decreased glucose into cells for energy= what?
INC glucose levels in bloodstream
152
```
Risk Factors:
◦ Family hx
◦ African American
◦ BMI >25
◦ Age >45 yo
◦ Sedentary lifestyle
◦ PMH gestational DM or delivery of 9 lb baby◦ Insulin resistance
◦ Vascular disease
◦ HTN
◦ HDL 250
◦ Smoker
```
risk factors for?
type 2 diabetes
153
Symptoms of:
•Hyperglycemia
•Blood and urine glucose•Ketone abnormalities
diabetes
154
Testing: diabetes
1. Classic sx plus casual plasma glucose of > ???? mg/dL
2. Fasting plasma glucose >????mg/dL (after 8 hrs)
3. 2 hr postload glucose >???? mg/dL in oral glucose tolerance test4. A1c > ????
200
126
200
6.5
155
Autoimmune destruction of beta cellsinsulin deficiency◦ Excess glucose from kidneysurineexcretepolydipsia
type 1 DM
156
Risk factors:
◦
◦
Likely to have another autoimmune disorder (Graves, Addisons)HLA/chromosomal abnormality (Down syndrome)
type 1 DM
157
major metabolic problems of type 1 DM
decreased use of glucose
increased fat metabolism --> ketones
impaired protein utilization
158
```
Symptoms:
◦ Hyperglycemia
◦ Polyuria
◦ Polydipsia
◦ Weight loss with polyphagia◦ Blurred vision
◦ Fatigue
◦ Diabetic ketoacidosis
```
type 1 DM
159
```
Treatment:
◦ Exogenous insulin
Fingersticks to determine amount1-4 x/day injections ie. Humalog
Insulin pump- constant
◦ Dietary management
```
type 1 DM
160
Difficulty with effective insulin action at the cellular level◦ Need to prevent HYPERglycemia
type 2 DM
161
```
Risk factors:
◦ Obesity
◦ Sedentary lifestyle◦ Smoking
◦ Gestational DM
◦ HTN
◦ Dyslipidemia
```
type 2 DM
162
```
Symptoms:
◦ Polydipsia
◦ Polyuria
◦ Visual blurriness
◦ Neuropathic pain
◦ Infections
◦ Blood lipid abnormalities◦ Comborbidities:
◦
◦
◦
◦
CVD
Neuropathy
Retinopathy
Nephropathy
```
type 2 DM
163
common symptoms for type 1 and 2 DM
polydipsia
polyuria
visual bluriness
164
```
Treatment:
◦ PREVENTION
◦
◦
◦
Exercise
Diet
Decrease BP
◦ Screening at 45 yo
◦ Medications: metformin
```
type 2 DM
165
comorbidities for DM
```
atherosclerosis
retinopathy
nephropathy
infection
neuropathy
```
166
inc glucose, inc fat
metabolism
• CAD, CVA, peripheral vascular disease• Diabetic cardiomyopathy
• Hypertension
atherosclerosis
167
ischemia
retinopathy
168
end stage renal disease
nephropathy
169
skin, UTIs
infection
170
Peripheral neuropathic pain◦ Foot ulcers
neuropathy
171
```
MSK:
◦ Syndrome of limited joint mobility- hands
◦ Tenosynovitis
◦ Carpal tunnel
◦ Adhesive capsulitis
◦ Diffuse idiopathic skeletal hyperostosis (DISH)◦ RA with Type 1
◦ OA with Type 2
◦ Osteoporosis
```
comorbidities for diabetes
172
```
Long Term Complications happen where for each thing?
_______: dialysis, kidney transplant
_______: MI, CVA
◦ Baby aspirin
◦ Cholesterol lowering drugs (statins)
_______:
◦ Diabetic ulcers --> prevent amputation
```
kidney
cardiac
integument
173
Shaky, hungry, HA, dizzy◦ Diaphoretic
◦ Shallow respirations
◦ Tachycardia
RAPID ONSET
pt implications for what?
hypoglycemia
174
Lethargic
◦ Dull, confused
fruity, acetone smell to breath
GRADUAL ONSET
pt implications for what?
hyperglycemia
