Endocrine Ch 28 Flashcards
panhypopituitarism
involves all the hormones of the pituatary gland
hypoglycemia
less than 60
hunger
lightheaded
pallor, cool skin
diaphoretic
decreasing LOC
HA, blurred vision
tachycardia
irritability
hyperglycemia
above 250
thirst
early- polyuria
late- oliguria
warm dry skin
weak pulse
kussmaul respirations with fruity breath (rapid deep)
diabetes dx
fasting glucose of 8 hrs above 126
expected HbA1c= 4-6%
type 1 diabetes
autoimmune destruction of pancreatic beta cells
most common in juvenilles
pancreas cannot make insulin - insulin deficient
symptoms appear more quickly
treat: insulin
type 2 diabetes
acquired (poor lifestyle)
insulin resistant
symptoms appear slower
can become prediabetic first
treat: lifestyle changes (exercise and diet), medications
insulin pump
atraumatic
catheter changed every 3 days, rotate sites
continuous glucose monitor
$$$
can read glucose levels on app
hypopituitarism
growth hormone deficiency
dysfunction of hypothalamus resulting in decreased growth hormone releasing hormone and less GH for bone growth
CM: short (less than 10th%)
dx: GH stimulating test (blood draw), skeletal survey in younger than 3yrs
treat: daily GH SQ injections
acromegaly
excess GH after epiphyseal closure (postpuberty)
commonly caused by tumor
CM: really tall, overgrowth of facial features, separation and malocclusion of the teeth, increased facial hair, thickened creased skin
dx: excessive GH via blood sample
manage: emotional support, oncology if r/t tumor
precocious puberty
sexual development before 8 yrs in girls and 9 yrs in boys
(occurs more in girls)
cause: t
diseases of growth hormone
GH deficiency
Acromegaly
diseases of ADH
KIDNEYS
DI
SIADH
diseases of ACTH
ADRENAL GLANDS
Addison’s disease
Cushing’s disease
Pheochromocytoma
diseases of LH and FSH
OVARIES AND TESTIES
precocious puberty
diseases of TSH
THYROID
hyperthyroidism
hypothyroidism
precocious puberty
sexual development before 8yrs in girls, 9yrs in boys
r/t tumor, infection, idiopathic
CM: growth spurt and secondary sex characteristics early
treat: LH releasing hormone injection until normal appropriate time for puberty
diabetes insipidus (DI)
undersecretion of antidiuretic hormone (ADH) by posterior pituitary resulting in extreme diuresis
CM: polyuria and polydipsia! (peeing up to 15L per day)
dx: water deprivation test
manage: synthetic ADH (desmopressin), monitor for heart dysrthymias and confusion from abnormal labs r/t dehydration
SIADH
hypersecretion of ADH causing kidneys to reabsorb too much water
can be r/t complication of MS
DECREASES ELECTROLYTES
CM: excessive thirst, fluid retention, anorexia, N/V, irritability
manage: fluid restriction (1200-1800mL/day), ADH antagonists, sodium replacements, monitor for respiratory distress, neuro assess, seizure precautions, telemetry
normal thyroid function
pituatary releases TSH, releasing thyroid hormone (T3 and T4) and calcitonin
calcitonin
prevents Ca from getting too high
works to keep it between 8.5-10
thyroid hormone
T3 and T4
regulates basal metabolic rate
juvenile hypothyroidism
deficiency in thyroid function
congenital(hypoplastic thyroid), acquired(r/t radiation, thyroidectomy), iodine deficiency
dx: decreased T3 and T4 (TH) and elevated TSH
CM: dry skin, sparse hair, periorbital edema, constipation, mental decline
treat: synthroid
can lead to intellectual disability if not treated early enough
lymphocytic thyroiditis
Hashimotos disease
autoimmune, antibodies attack thyroid
most common cause of juvenile hypothyroidism
CM: goiter, hypothyroidism symptoms
treat: daily thyroid replacement, steroids (NO surgery, autoimmune)
Graves disease
hyperthyroidism, autoimmune, antibodies attack and overstimulate thyroid
CM: goiter, exophthalmos, hyperactivity, tremors, insomnia, weight loss r/t increased BMR, warm moist skin, heat intolerance
dx: increased T3 and T4 (TH), low TSH
treat: antithyroid drugs, radiation to thyroid, thyroidectomy
thyrotoxicosis
thyroid crisis/storm
sudden release of TH
medical emergency
CM: extreme HTN, hyperthermia (104+), tachycardia, delirium
treat: stabilize pts with propranolol, antithyroid drugs
normal parathyroid function
4 parathyroid glands on back of thyroid
raises Ca levels in blood to keep between 8.5 and 10
hypoparathyroidism
deficient PTH resulting in hypocalcemia
CM: muscle cramps, brittle hair, tetany, HA,
chovstek sign- tap facial nerve and face will spasm
trousseau sign- squeeze carpal tunnel nerve and hand will contract
dx: hypocalcemia, decreased PTH, increased phosphorus
treat: calcium and vit D supplements
calcium and phosphorus relationship
inverse!
hyperparathyroidism
excessive PTH, hypercalcemia
CM: kidney stones, excessive thirst, N/V, joint pain, abd pain, fatigue
dx: hypercalcemia, increased PTH, decreased phosphorus
treat: remove tumor, vit D supplement
normal adrenal gland function
ACTH from pituitary stimulates adrenal glands on top of kidneys
medulla= catecholamines (epi + norepi)
cortex= cortisol+ aldosterone
addison’s disease
adrenocortical insufficiency
decreased cortisol and aldosterone resulting in hypovolemia and hypotension
caused by autoimmune response, cancer, infection
CM: hypotension, hair loss, skin darkening, weight loss, anorexia, muscle pain, abd pain, depression irritability
treat: cortisol and aldosterone replacement
cushing’s syndrome
too much cortisol released by adrenal glands
usually r/t tumor or prolonged steroid therapy
CM: excessive hair growth, moon face, red cheeks, weight gain, red striae on abdomen, poor wound healing, bruising
treat: cannot be treated if r/t steroids, adrenalectomy if r/t tumor
pheochromocytoma
adrenal tumor increasing epi and norepi (catecholamines)
CM: tachycardia, sweating, flushing, HTN, HA
dx: 24 hr urine collect, high levels of metanephrines (byproduct of epi and norepi)
treat: resect tumor
