Endocrine and Metabolic Systems Flashcards
The hypothalamus controls release of pituitary hormones including
- Corticotropin-releasing hormone (CRH)
- Thyrotropin-releasing hormone (TRH)
- Growth hormone-releasing hormone (GHRH)
- Somatostatin
The anterior pituitary gland controls the release of which hormones
- Growth hormone (GH)
- Adrenocorticotropic hormone (ACTH)
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Prolactin
The posterior pituitary gland stores and releases which hormones
- Antidiuretic hormone (ADH)
- Oxytocin
S/S of diabetes mellitus
- Acute: excessive weight thirst/urination, fatigue, weight loss, vision problems, HA/dizziness
- Chronic: neuropathy, retinopathy, nephropathy, atherosclerosis (small and large vessels)
S/S of hyperthyroidism
- Graves disease
- Females age 20-40
- Weight loss, fatigue, excessive sweating, diarrhea, palpitations, hyperreflexia, tremor, & exophthalmos
S/S of hypothyroidism
- Females age 30-60
- Weight gain, hair loss, fatigue, bradycardia, constipation, anemia, carpal tunnel syndrome, fibromyalgia, depression
S/S of hyperparathyroidism
- Females age >60
- Bone decalcification
- Weakness/fatigue
- Joint hyper mobility
- Peptic ulcers, pancreatitis
- Renal calculi, renal failure
- CNS: memory, depression, personality changes
S/S of hypoparathyroidism
- Muscle weakness, pain, and tetany
- Trousseau sign (carpal spasm)
- Chvostek sign (facial spasm)
- Seizures
S/S of hypercortisolism
- Cushing’s syndrome/disease: Moon shaped face, dorsacervical fat pad, truncal obesity, slender limbs, thinning of the skin-striae, hair loss, bruise easily
S/S of adrenal insufficiency
- Addison’s disease
- Cortisol Sxs: personality changes, bronze skin pigmentation, hypoglycemia with associated symptoms, susceptible to infections
- Aldosterone Sxs: increased Na excretion-dehydration, hypotension, diarrhea, abdominal pain
The adrenal cortex controls the release of
- Mineral corticosteroids (aldosterone)
- Glucocorticoids (cortisol)
- Adrenal androgens (dehydroepiandrosterone - DHEA)
- Androstenedione
The adrenal medulla controls the release of
- Epinephrine
- Norepinephrine
The thyroid controls the release of
- Triiodothyronine
- Thyroxine
- Thyroid C cells control release of calcitonin
The pancreatic islet cells control the release of
- Insulin
- Glucagons
- Somatostatin
What is the function of insulin
- Allows uptake of glucose from the bloodstream
- Suppresses hepatic glucose production, lowering plasma glucose levels
- Secreted by beta cells
What is the function of glucagon
- Stimulates hepatic glucose production to raise glucose levels
- Secreted by alpha cells
What is the function of amylin
- Modulates rate of nutrient delivery
- Suppresses release of glucagon
- Secreted by beta cells
What is the function of somatostatin
- Acts locally to depress secretion of both insulin and glycogen
- Decreases motility of stomach, duodenum, and gallbladder
- Decreases secretion and absorption of GI tract
- Secreted by delta cells
Diagnosis of metabolic syndrome (syndrome X) requires the presence of 3 or more of the following risk factors
- Abdominal obesity: men ≥40inch and women ≥35inch
- High triglyceride level: ≥150 mg/dl or using a cholesterol medicine
- Cholesterol: low HDL (men <40 and women < 50) or using cholesterol medicine
- High BP: systolic ≥135 and/or diastolic ≥85
- Blood sugar: fasting plasma glucose level ≥100 mg/dl
Characteristics of Type 1 diabetes
- Decrease in size and number of islet cells resulting in absolute deficiency in insulin secretion
- Initially occurs in children and young adults, often with abrupt onset of symptoms around the age of puberty
- Insulin dependent: requires insulin delivery
- Prone to ketoacidosis: presence of ketone bodies in the urine
Characteristics of Type 2 diabetes
- Results from inadequate utilization of insulin (insulin resistance) and progressive beta cell dysfunction
- Individual is not prone to ketoacidosis (may form ketones with stress)
- Progressive disease caused by insulin resistance in muscle and adipose tissue, progressive decline in pancreatic insulin production, excessive hepatic glucagon secretion, and inappropriate glucagon secretion
Diagnostic criteria for DM
- Sx of diabetes plus casual plasma glucose concentration ≥200 mg/dl (causal defined as non fasting)
- Fasting plasma glucose ≥126 mg/dl
- 2-hour post load glucose ≥200 mg/dl (during an oral glucose tolerance test)
- A1c test measures average blood glucose for the past 2-3mo: normal = <5.7%; pre diabetes = 5.7%-6.4%; diabetes = ≥6.5%
Outcomes of regular exercise on diabetes
- Improved glucose tolerance
- Increased insulin sensitivity
- Decreased glycosylated hemoglobin
- Decreased insulin requirements
- BP reduction
Cardiovascular guidelines for exercise testing in patients with diabetes
- 50-80% of max oxygen uptake (VO2max) or HRR corresponding to RPE of 12-16 on the 6-20 Borg scale
- 3-7 days/week
- 20-60 minutes
- Rhythmic, large muscle activity: biking, treadmill walking, overground walking
Resistance training guidelines of testing in patients with diabetes
- 2-3 days/week
- Resistance 60-80% of 1RM, 2-3 sets of 8-12 reps
- Multijoint exercises of major muscle groups
- Minimize sustained gripping, static work, and Valsalva’s maneuver (essential to decrease risk of hypertensive response)
Formula for BMI calculations
- Individual’s weight in kilograms divided by the square of their height in meters
WHO classification of overweight, obesity, and morbid obesity BMI
- Overweight: BMI 25-29.9
- Obesity: BMI ≥30
- Morbid obesity: BMI >40
Health risks associated with obesity
- HTN
- Hyperlipidemia
- Type 2 DM
- Cardiovascular disease
- Stroke
- Glucose intolerance
- Gallbladder disease
- Menstrual irregularities
- Infertility
- Cancer: endometrium, breast, prostate, and colon
S/S of hypoglycemia
- Glucose <70
- Pallor
- Shakiness/trembling
- Sweating
- Excessive hunger
- Tachycardia & palpitations
- Fainting or feeling faint
- Dizziness
- Fatigue & weakness
- Poor coordination & unsteady gait
- Blurred or double vision
- Slurred speech
- Loss of consciousness & coma
S/S of hyperglycemia
- Glucose >300
- Weakness
- Increased thirst
- Dry mouth
- Frequent, scant urination
- Decreased appetite, N/V, abdominal tenderness
- Dulled senses, confusion, diminished reflexes, paresthesias
- Flushed, signs of dehydration
- Deep, rapid respirations
- Rapid, weak pulse
- Fruity odor to the breath (acetone breath)
- Hyperglycemic coma
Medical causes of obesity
- Endocrine and metabolic disorders: hypothyroidism, Cushing’s syndrome, metabolic syndrome
How many grams of carbohydrates should be taken per hour of intense exercise to prevent a hypoglycemic episode
- 15g of carbohydrates for every hour of intense activity
Exercise precautions for individuals with DM
- Check glucose prior and following exercise and do not exercise if glucose <70 or >300
- Do not exercise without eating at least 2 hours before exercise
- Do not exercise without adequate hydration
- Do not inject short-acting insulin in exercising muscles or sites close to exercising muscles as insulin is absorbed more quickly, abdominal injections its is preferred
Exercise prescription for obese patients
- Start slow with adequate warm-up/cool-downs
- Initial intensity should be moderate 40-60% VO2R or HHR
- 5-7 days/week
- 30-60 minutes
- Aerobic physical activities and use of circuit training to incorporate resistance training with aerobic training
Symptoms of hypothyroidism
- Hashimoto’s disease
- Constipation
- Depression
- Dry hair and hair loss
- Dry skin
- Fatigue
- Slow HR
- Swelling of thyroid gland (goiter)
- Unexplained weight gain or difficulty losing weight
- Carpal tunnel syndrome
Symptoms of hyperthyroidism
- Graves’ disease
- Nervousness
- Hyperreflexia
- Tremor
- Hunger
- Weight loss
- Fatigue
- Heat intolerance
- Palpitations
- Tachycardia
- Goiter
- Diarrhea
Treatment options for hyper/hypothyroidism’s
- Hypo: lifelong thyroid replacement therapy
- Hyper: radioactive iodine, surgical ablation may be necessary
Partial or complete failure of adrenocortical function; results in decreased production of cortisol and aldosterone
- Addison’s disease (primary adrenal insufficiency)
Adrenal disorders
