Endocrine and Metabolic system disorders Flashcards
What are the functions of the endocrine system
- differentiation of the reproductive and central nervous system of the developing fetus
- stimulation of sequential growth and development during childhood and adolescence
- coordination of the male and female reproductive system
- maintenance of optimal internal environment throughout the life span
- initiation of corrective and adaptive responses when emergency demand occurs
What organ is considered the main integrative center for the endocrine and autonomic nervous system
hypothalamus
Pituitary gland disorder types
Anterior lobe:
- hypopituitarism
- hyperpituitarism
Posterior lobe
- diabetes insipidus
- Syndrome of inappropriate antidiuretic hormone secretion
What are clinical manifestations of hypopituitarism
- growth hormone deficiency
- adrenocortical insufficiency
- hypothyroidism
- gonadal failure
- neurological signs (produced by a tumor)
Growth hormone deficiency
- short stature
- delayed growth
- delayed puberty
adrenocortical insufficiency effects
- hypoglycemia
- anorexia
- nausea
- abdominal pain
- orthostatic hypotension
Hypothyroidism
- fatigue
- lethargy
- sensitive to cold
- menstrual disturbances
- decreased metabolism
Gonadal failure
- secondary amenorrhea
- impotence
- infertility
- decreased libido
- absent secondary sec characteristics
Neurological signs produced by a tumor that cause hypopituitarism
- headache
- bilateral temporal hemianopia
- loss of visual acuity
- blindness
hypopituitarism of posterior pituitary
- rare
- decrease in ADH = no water retention
- imbalance of water
- polydipsia
- polyuria
- glucose in blood triggers thirst
- problems regulating blood pressure
treatment for hypopituitarism of posterior pituitary
- treatment: vasopressin or pitressin
Acromegaly
- hyperpituitary function
- more common in adults (in children it is called giantism)
- bones grow thicker
- more commonly in jaw, hands and feet
Adrenal gland hormones
- mineralocorticoids
- glucocorticoids
- androgens
- catecholamines
- peptides:
Affects of catecholamines
- dilation of bronchioles
- increase HR
- liver converts glycogen to glucose
- high blood pressure
- decreased digestive system activity
Affects of cortisol
- increased blood sugar
- suppress immune system
- decrease serotonin
- heightened memory and attention
- increase in blood pressure
- decrease sensitivity to pain
Adrenal gland disorders: general types
- adrenal insufficiency
- adrenal cortical hyperfunction
Primary adrenal insufficiency
- addison’s disease
- adrenal gland is insufficient
Secondary adrenal insufficiency
- other causes of adrenal insufficiency
- ex: hypothalamic or pituitary tumors
- too rapid withdrawal of corticosteroid drugs
adrenal cortical hyperfunction disorders
- cushing syndrome: too much cortisol
- conn syndrome: hypersecretion of aldosterone
- adrenal hyperplasia: over growth
Addison’s disease causes
- insufficient cortisol release from adrenal glands
- used to be a complication of TB but not more commonly idiopathic or autoimmune
- other: adrenalectomy, adrenal hemorrhage, malignant adrenal neoplasm, infections, meds
Addison’s disease: symptoms
- bronze pigment
- changes in body hair distribution
- GI disturbances
- weakness
- hypoglycemic
- othrostatic hypotension
- weight loss
Addison’s disease: PT implications
- caution using aquatic therapy- trouble maintaining body temp
- monitor vitals
- signs of crisis
- need to wear a bracelet and carry dexamethasone or hydrocortisone
adrenal crisis symptomes
- profound fatigue
- dehydration
- vascular collapse (decrease BP)
- renal shut down
- increase serum NA and decrease serum K
Cushing’s disease
- over-secretion of ACTH from pituitary
Cushing’s syndrome
- adrenal gland over-secretion of cortisol
or - too high of dose of corticosteroid meds
Cushing’s disease/syndrome treatment
- irradiation of pituitary or tumor,
- drug therapy
- surgery
- depends on underlying cause
Cushing’s disease/syndrome symptomes
- personality changes
- hyperglycemic
- red face
- increase susceptibility to infection
- Males: gynecomastia
- fat deposition in abdomen and back of neck
- osteoporosis
- bruises
- thin skin
- females: amenorrhea, hirsutism
- purple striae on abdomen
- GI distress/increase acid
- thin extremities
- fluid retention
- fat round moon face
- CNS irritability
thyroid gland disorders
- hyperthyroidism: graves disease
- hypothyrodism: type 1 = hormone deficient or type 2 = hormone resistant
- goiter
- thyroiditis
- cancer
hypothyroidism symptoms
- intolerance to cold
- receding hairline
- facial and eyelid edema
- dull-blank expression
- extreme fatigue
- thick tongue/slow speech
- anorexia
- brittle nails and hair
- menstrual disturbances
- constipation
- muscle aches/weakness
- dry skin
- lethargy
- apathy
- hair loss
hyperthyroidism symptoms
- intolerance to heat
- fine straight hair
- bulging eyes
- facial flushing
- enlarged thyroid
- tachycardia
- increase systolic BP
- breast enlargement
- weight loss
- muscle wasting
- menstrual changes
- tremors/increase diarrhea
- finger clubbing
treatment for hypothyroidism
- correct hormone deficiency
- synthroid, levethyroid, levoxyl
treatment for hyperthyroidism
- antithyroid medication
- radioactive iodine
- surgery
Parathyroid function
PTH secretion: (increase Ca in blood)
- bones release calcium
- kidneys: reduce calcium clearance and vitamin D activation
- intestines: activated vitamin D helps absorb calcium in gut
Hyperparathyroidism
- increase bone resorption
- elevated serum Ca levels
- depressed serum phosphate levels
- hypercalciuria and hyperphosphaturia
- decreased neuromuscular irritability
Hypoparathyroidism
- decreased bone resorption
- depressed serum Ca levels
- elevated serum phosphate levels
- hypocalciuria and hypophosphaturia
- increased neuromuscular activity which may progress to tetany
Adipose tissue hormones
- adiponectin: improves insulin sensitivity and decrease inflammation
- leptin: increases inflammation
Implications of adipose tissue for PT
- females > 35 inch wasit increased risk for DM
- males >40 inches waist increase risk of DM
- waist:heigh wt<1/2 ht
- educate about the importance of exercise
- BMI
metabolic syndrome
- large waistline
- high blood pressure
- low HDL
- high triglycerides
- high blood sugar
- insulin resistance
- dyslipidemia
Glucose regulation: pancreas
islet of langerhans
- alpha cells - glucagon (glucose into blood)
- beta cells: insulin (glucose into cells)
- delta cells: somatostatin which regulates glucagon and insulin production
Glucose regulation: adrenal gland
increases blood glucose
- medulla: stress response, release epinephrine which stimulates glycogenolysis in liver and muscles
- cortex: glucoocorticoids promote flow of amino acids to live where glucose is synthesized
Glucose regulation: pituitary
increases blood glucose
- ACTH: increases blood glucose
- GH: insulin antagonist: blocks action of insulin
Glucose regulation: thyroid
- may raise of lower glucose
Insulin facilitated trasnport
- insulin binds to cells
- causes glucose transporters (GLUTs) to become part of cell membrane
- GLUTs allow glucose to enter
Prediabetes
- increased insulin resistance and decreases insulin sensitivity
- borderline diabetic
- glucose fasting blood test: 100-125 mg/dL
- A1c blood test 5-6.5%
- insulin resistance syndrome = metabolic syndrome
Type 1 diabetes mellitus
- deficient insulin production and secretion
- 1.5: genetic and developed later on than type 1
type 2: diabetes mellitus
- producing insulin but it is ineffective
- insulin resistent
Diabetic ketoacidosis
- glucose > 300 for extended time
- develop slowly
- early symptoms: thirsty and frequent urination
- more sever symptoms: fast/deep breathing, dry skin and mouth, flushed face, fruity breath, headache, muscle stiffness/aches, tired, nausea and vomiting, stomach pain
- more common in type 1
Diagnostic criteria for diabetes mellitus
- classic symptoms and test values
- classic symptoms: polyuria, polydipsia and weight loss
- Fasting plasma glucose >125
- 2 hour postload glucose >200
- glucose tolerance test return to normal within 2 hours
- A1c: >6.5
Goals of treatment for DM
- A1c <7%
- BP<130/80
- LDL <70 mg/dL
- triglycerides <150 mg/dL
Treatment for type 1 DM
- insulin
- fast-acting: breakfast, lunch, dinner through subcutaneous pump or injection
- long acting: 1x/day (lantus and levemir) usually night time
treatment for type 2 DM
- diet and exercise
- medication that is usually not insulin until they are on 3 oral agents simultaneously
Hyperglycemia
- > 300 mg/dL
- Diabetic ketoacidosis
- hyperosmolar hyperglycemia state
Diabetic Ketoacidosis
- most common
-Signs
- Treatment
- most common in type 1 from severe insulin deficiency from infection or stress Or not adhering to diet/treatment
- acetone breath, dehydration, weak, and rapid pulse, reparations
- treatment: fluid, fast acting insulin, and correct metabolic abnormalities
Hyperosmolar hyperglycemic state
- extreme hyperglycemia (800-2000) = crisis
- no ketosis
- Polyphagia, polydipsia, polyuria, glycosuria, dehydration, weakness, coma, hypotension, shock
- treatment: short acting insulin, electrolyte replacement, careful fluid replacement
kussmaul respirations
- rapid deep breathing
- acidosis = trying to get rid of CO2
Long term complications of hyperglycemia
- atherosclerosis
- cardiovascular complications (risk of CVD, PVD)
- retinopathy and nephropathy
- infection/impaired healing
- musculoskeletal problems
- sensory, moto, and autonomic neuropathy
- causes damage to endothelial tissue when glucose is high in circulation
Complications with insulin
- hypoglycemia
- lipogenic effect of insulin
- diabetic ketoacidosis
complications with metformin
- vitamin B12 deficiency
- report any neurological signs
Hypoglycemia
- sweating
- weakness
- shaking
- nausea
- headache
- difficulty concentrating
lipogenic effect of insulin
thickening of subcutaneous tissue
- rotate injection site and pump
diabetic ketoacidosis signs
- acetone breath
- dehydration
- weak and rapid pulse
- kussmaul breathing
DM key point: safe glucose levels
- 100-250
- > 120 should be closely monitored
- 250-300 = caution zone
- <100 carb snack and retest
How to plan exercise around food intake and insulin/oral hyperglycemic agents
- no exercise during peak insulin times
- avoid unusual night exercise
What should occur in DM patients before exercise
- 16 oz of fluid
- monitor glucose pre-exercise
- no exercise if blood glucose is near 250 with urinary ketones and caution >300 with no ketones
- exercise 30 minutes
- do not use muscles of injection site with 1 hour
- type 1 DM may need to reduce insulin Orr increase food intake
- do not use drugs that may cause hypoglycemia (beta blocker, alcohol, diuretics, estrogens, phenytoin)
- increase insulin during menses
DM during exercise
- regular and consistent time of day 5x/week
- 40-60 min is optimal but 20-30 min has shown benefits in glucose regulation
- prolonged activity plan for easily absorb carb snack every 30 minutes
- replace fluids
- monitored glucose every 30 minutes
- don’t exercise alone
DM after exercise
- monitor glucose 15 minutes after exercise
- increase caloric intake for 12-24 hours after activity
- reduce insulin, which peaks at night according to intensity and duration
insulin resistance syndrome
- euglycemia test to truly determine insulin resist but expensive so typically if pre-diabetic then considered IR
- high levels of both insulin and glucose circulating in blood stream
- metabolic syndrome: HTN, carbohydrate intolerance, abdominal obesity, dyslipidema, accelerated atherosclerosis all associated with type 2 DM
- IRS = FGL between 100-126
