Endocrine Conditions Flashcards
Name the endocrine glands
-Hypothalamus
-Pituitary
-Thyroids
-Parathyroids
-Adrenals
-Pancreas
-Ovaries
-Testes
-Pineal
What is a paracrine action?
When hormones act locally on cells but never enter the bloodstream
How are hormones classified?
Whether they are water soluble or lipid soluble
What are hormones that are secreted by the anterior pituitary gland called?
Tropic hormones
What is a tropic hormone?
A hormone that targets other endocrine glands
Which hormones are made in the hypothalamus?
Oxytocin and antidiuretic hormone (ADH)
Which hormones are secreted by the posterior pituitary?
Oxytocin and ADH
What is the main function of the pineal gland?
Secrete melatonin
What are the 3 hormones created by the thyroid gland?
T3, T4, Calcitonin
What is needed to make T3 and T4?
Iodine
What does T3 and T4 do?
-Metabolism
-Growth/Development
-Brain function
-O2 Consumption
-Carb and fat metabolism
-Caloric requirements
What stimulates the thyroid gland to make calcitonin?
High serum calcium levels
How does calcitonin lower serum calcium levels?
1) Inhibits transfer of calcium from bone to blood
2) Increases calcium storage in bone
3) Increases excretion of calcium in kidneys
What does parathormone do?
Increases serum calcium levels
What gland secretes the epinephrine hormones?
Adrenal medulla
What hormones does the adrenal cortex secrete?
-Glucocorticoids
-Mineralocorticoids
-Androgens
What is the most abundant glucocorticoid?
Cortisol
What does the pancreas release in response to low blood glucose, protein ingestion, and exercise?
Glucagon
What can decreased skin pigment indicate?
-Hypopituitarism
-Hypothyroidism
-Hypoparathyroidism
What is a common finding of Addison disease?
hyperpigmentation “bronzing” of the skin
What is the Chvostek sign?
Hyperreflexia and facial muscle contraction upon percussion of the facial nerve due to hypoparathyroidism
What is the Trousseau sign?
Muscle spasms of the hand upon application of a BP cuff for 3 minutes due to hypoparathyroidism
What is exophthalmos?
Condition where one or both eyes bulge from their sockets due to hyperthyroidism
What hormone is released for low calcium levels?
Parathormone
What is goiter?
Enlarging of the thyroid gland
Is hyperthyroidism associated with weight loss or weight gain?
Weight loss due to increased metabolism
Is cushing syndrome and hypothyroidism associated with weight loss or weight gain?
Weight gain
Which hormone level requires a patient to lay supine for 2 hours before a sample is collected?
Aldosterone
What is pheochromocytoma?
Tumor in the adrenal glands that causes body to produce too much adrenaline
What hormone decreases glucagon secretion
Amylin
What hormones are produced by the anterior pituitary gland?
-Prolactin
-Thyrotropin
-Somatotropin
What causes cortisol levels to rise?
-Fever
-Stress
-Burns
-Infection
-Acute anxiety
-Hypoglycemia
What are manifestations of hyperglycemia?
-High glucose
-More urination
-More appetite after anorexia
-Weakness, fatigue
-Blurred vision
-Headache
-Glycosuria
-N&S
-Ab cramps
-Progression to DKA or HHS
-Mood swings
What are manifestations of hypoglycemia?
-Glucose <70
-Cold, clammy skin
-Numbness of fingers, toes, mouth
-Tachycardia
-Emotional changes
-Headache
-Nervousness, tremors
-Faintness, dizziness
-Unsteady gait, slurred speech
-Hunger
-Vision changes
-Seizures, coma
Do corticosteroids cause hyperglycemia or hypoglycemia?
Hyper
What are some causes of hyperglycemia?
-Illness, infection
-Corticosteroids
-Too much food
-Inactivity
-Emotional, physical stress
-Insulin resistance
What are some causes of hypoglycemia?
-Alcohol without food
-Too little food
-Too much exercise without food
-B-blockers masking hypoglycemia
What are ketones?
By-products of fat metabolism that can cause serious issues when there is too much
What causes an increase in ketones?
When there isn’t enough insulin, glucose can’t be used sufficiently so the body starts to break down fat instead.
What are signs and symptoms of DKA?
-Dehydration
-Lethargy and weakness
-Ab pain
-Anorexia, N&V
-Sweet, fruit odor on breath
-Kussmaul respirations
-Sunken eyes
What are lab findings in patients with DKA?
-Glucose >250
-Blood pH <7.30
-Serum bicarbonate level <16
In a patient with hyperglycemia, why does a serum potassium lab need to be drawn?
If patient is hypokalemic, giving insulin will drop their potassium even more; insulin drives potassium into cells
Why is it important to avoid rapid drops of glucose in a patient?
It can cause cerebral edema by creating an osmotic gradient which causes fluid to rapidly into brain cells
What is an acceptable glucose reduction rate?
36 - 54mg/dL/hour
What does HHS stand for?
Hyperosmolar Hyperglycemia Syndrome
What are some common causes of HHS?
- UTI
- Pneumonia
- Sepsis
- Newly diagnosed Type II Diabetic
What is the main difference between HHS and DKA?
Patients with HHS usually have enough insulin to prevent DKA
What are some neurological manifestations of HHS?
- Somnolence (drowsiness or strong desire to sleep)
- Coma
- Seizures
- Hemiparesis (weakness or inability to move one side of the body)
- Aphasia
If a nurse is treating a patient with severe hyperglycemia with insulin, what do they do when glucose levels starts to reach about 250?
Administer dextrose IV to prevent it from dropping too low
What does your body do to fight hypoglycemia?
Activates the autonomic nervous system; produces glucagon and epinephrine
Why is mental functioning affected with low glucose levels?
Brain needs constant supply of glucose
What is an easy way to remember manifestations of hypoglycemia?
Manifestations mimic being drunk
What is the Rule of 15 for treating hypoglycemia?
- Glucose <70, ingest 15-20g of simple (fast-acting) carb like 4-6oz of a fruit drink or a soda
- Recheck glucose 15 minutes later
-If value is still <70, repeat above
- If still doesn’t work after 2-3 repeats, contact HCP
When treating hypoglycemia, why should you avoid giving carbs that have fat? (Candy bars, cookies, whole milk, ice cream etc)
The fat will slow glucose absorption and delay response to treatment
Which IV and how much is given for hypoglycemia?
20 - 50mL of 50% Dextrose
If giving 20 - 50mL of 50% Dextrose isn’t an option and patient can’t swallow, what are you other options?
1mg glucagon injection in shoulder
What is a common reaction to a glucagon shot?
- Nausea (turn patient on their side to prevent aspiration
What kind of patients will not respond well to glucagon?
- Alcohol-related liver disease
- Starvation
- Adrenal insufficiency
Will a patient with DKA pee a lot or a little? Will they have high or low blood pressure?
They will pee a lot and as a result will have low blood pressure due to volume loss
What is angiopathy?
Damage to blood vessels
Why does chronic hyperglycemia cause angipoathy?
- Build up of by-products of glucose metabolism damage vessels and cause them to thicken
- Causes problems with RBC function that leads to decreased oxygenation
- Formation of abnormal glucose molecules in vessels can travel to the eyes and kidney
Why should diabetics inspect their feet for skin breakdown?
Chronic hyperglycemia can cause destruction of nerves so they often won’t feel issues with their feet
What is Nonproliferative Retinopathy?
- Blood vessels in the retina weaken
- Microaneurysms develop in capillary walls
- Fluid leaks out causing retinal edema or hemorrhages
- If center of retina (macula) is affected, vision loss can be severe
What is Proliferative Retinopathy?
- Retinal cappilaries become occluded causing body to form new blood vessels
- New vessels are fragile and bleed easily causing vitreous contraction
- If new blood vessels pull on the retina while vitreous contracts, retinal detachment will occur
- If macula is involved, vision is lost
- Patient sees black or red spots/lines
What is Diabetes-Related Nephropathy?
- Damage to small vessels that supply the glomeruli of kidney
What is Acanthosis Nigricans?
Velvety light brown to black skin thickening that appear on the folded skin parts of the body; a sign of insulin resistance
What are 3 reasons older people are likely to get Type II?
- Reduction in B-cell function
- Decreased insulin sensitivity
- Altered carbohydrate metabolism
Counterregulatory hormones works against insulin. What are 4 examples?
- Glucagon
- Cortisol
- Epinephrine
- Growth Hormone
What is the risk that a mother with Type I diabetes with pass it along to offspring vs a father?
Mother: 1%-4%
Father: 5%-6%
What are the requirements to diagnose someone with Impaired Glucose Tolerance?
2-hour oral glucose tolerance test values are 140 - 199
What are the requirements to diagnose someone with Impaired Fasting Glucose?
Fasting glucose levels are 100 -125
What complications are increased by gestational diabetes?
- C-section
- Perinatal death
- Birth injury
- Neonatal complications
What A1C level is considered diabetes?
6.5%+
What is A1C?
The amount of hemoglobin that has glucose attached to it. Since glucose will be attached to the RBC for its entire life, A1C is a good measure of average glucose levels over the past 2-3 months
What are the ABCs of managing diabetes?
- A1C
- Blood pressure
- Cholesterol
What are 3 examples of rapid-acting insulin?
- Lispro Humalog
- Glulisine Apidra
- Aspart Novolog
What are 2 examples of Short Acting Insulin?
Humulin Regular
Novolin Regular
What are 2 examples of Intermediate Acting Insulin?
- Humulin N
- Novolin N
What are 3 examples of Long-Acting Insulin?
- Glargine
- Detemir
- Degludec
What is the Somogyi Effect?
- High dose of insulin causes glucose to tank at night
- Counterregulatory hormones are released to increase glucose levels
- Rebound hyperglycemia
What is the treatment for Somogyi Effect?
A snack at bedtime or reducing the dose of insulin
How does Metformin work?
- Makes the liver produce less glucose
- Improves insulin sensitivity at the tissue level
If a patient has what condition should they avoid taking Pioglitazone?
Heart Failure
What medication is useful for a patient that is insulin resistant?
Pioglitazone; it is an insulin sensitizer
What does Glucagon do?
When glucose is low, makes liver produce glucose to bring blood sugar back up
How do you remember short-term acting insulin names?
Short actresses (short acting), named Lin (Humalin, Novolin), and are 4’12” (4-12hr peak)
Which non-insulin drug class suppresses liver output of glucose?
Biguanides
Which non-insulin drug class stimulates insulin secretion by pancreatic b-cells?
Sulfonylureas
Which non-insulin drug class stimulates pro-insulin by beta cells?
Meglitinides
Which non-insulin drug class reverses insulin resistance by improving glucose utilization in muscle and fat?
Thiazolidinediones
Which non-insulin drug class prevents complex carbs from converting into simple sugars in the gut (slows glucose absorption after meals)?
Alpha-glucosidase inhibitors
Which non-insulin drug class prevents release of glucagon (increases insulin secretion, decreases gastric emptying, lowers blood glucose)?
Gliptins/DPP-4 Inhibitors
Which non-insulin drug class causes kidneys to remove glucose through the urine?
Sodium-glucose cotransporter 2
Name the top Biguanide drug
Metformin
How does metformin work?
-Decreases glucose, triglycerides, and cholesterol production in the liver which decreases glucose absorption in the gut
-Improves insulin sensitivity in targeted cells
Name Sulfonylurea drugs
-Glyburide
-Glipizide
-Glimepiride
Name Meglitinide drugs
Repaglinide
Which insulin is administered IV?
Regular insulin (Humulin R)
Do diuretics increase or decrease glucose levels?
Increases
Which drug inhibits the metabolism of Metformin?
Cimetidine
What is U-500 insulin?
Concentrated regular insulin; should not be administered with other insulin
Since Insulin Glargine is long-acting, can you mix it with other insulins?
No
How long does it take regular insulin to peak?
2.5 hours
Name 2 alpha-glucosidase drugs
- Miglitol
- Acarbose
What affects do hyperglycemia and hypoglycemia have on breast milk production?
Decreases milk production
Acarbose is contraindicated in patients with what kind of disease?
Inflammatory Bowel Disease
What are clinical manifestations of lactic acidosis?
- Muscle pain
- Ab pain
- Cold, clammy skin
Which 6 hormones does the pituitary gland secrete?
- GH
- Prolactin
- ACTH
- TSH
- FSH
- LH
What is acromegaly?
Condition caused by the overproduction of GH due to an adenoma (noncancerous tumor)
What are the manifestations of acromegaly?
- Thickening and enlargement of the soft and bony tissues of face, feet, and head
- Carpal tunnel syndrome
- Peripheral neuropathy
- Proximal muscle weakness and joint pain
- Deeper voice
- Sleep apnea
- Thick, leathery skin with acne outbreaks
- Vision changes and headaches
What studies are used to diagnose Acromegaly?
-IGF-1 Test
Insulin-like Growth Factor mediates the peripheral actions of growth hormone
As GH levels rise, so do IGF-1 levels (IGF-1 levels tend to be more accurate)
-Oral Glucose Tolerance Test
Growth hormone levels falls because glucose inhibits the secretion of GH
GH levels either rise or stay the same
- MRI/CT Scan
Contrast dye can help detect pituitary adenomas
What is prolactinoma?
A noncancerous tumor that causes the pituitary gland to make too much prolactin
What are the clinical manifestations of prolactinoma in women?
- Galactorrhea
- Anovulation
- Infertility
- Decreased libido
- Hirsutism
What are the clinical manifestations of prolactinoma in men?
-Impotence
-Decreased sperm density
-Decreased libido
What are the manifestations of hypopituitarism?
-Headaches
-Vision changes
-Loss of smell
-Nausea and vomiting
-Seizures
What happens when there is a deficit of ACTH?
Cortisol deficiency
What are the side effects of growth hormone replacement injections?
-Headache
-Muscle and joint pain
-Fluid buildup in the hands and feet
For what conditions is hormone therapy contraindicated?
-Phlebitis
-Pulmonary embolism
-Breast cancer
-Prostate cancer
What are manifestations of Syndrome of Inappropriate Antidiuretic Hormone?
-Low urine output
-Increased body weight
-Thirst
-Dyspnea on exertion
-Fatigue
How do doctors tell the difference between Nephrogenic Diabetes Insipidus and Central Diabetes Inspidius?
Water Deprivation Test
-Before test, measure body weight, urine osmolality, volume, and specific gravity
-Patient doesn’t drink water for 8-12 hours
-Give Desmopressin
-If central DI, urine osmolality goes up and volume goes down
-If nephrogenic, osmolality can’t get above 300
Measure ADH After Giving ADH Analog
-Give ADH analog
-If central, kidneys will respond to hormone by concentrating urine
-If nephrogenic, kidneys will not respond
What does Parathyroid Hormone do?
-Bone resorption of calcium
-Renal tubular reabsorption of calcium
-Activation of vitamin D
What is the difference between primary, secondary, and tertiary hyperparathyroidism?
Primary:
-Increased PTH secretion
Secondary:
-Compensatory response due to hypocalcemia
Tertiary:
-Hyperplasia of parathyroid gland
What medication class and name is given to a patient with hyperaldosteronism?
Potassium-sparing diuretics (spironolactone)
What is the difference between a hot and cold thyroid tumor?
Hot will take up radioactive iodine and are almost always benign whereas cold don’t.
