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Adult Health > Endocrine Conditions > Flashcards

Endocrine Conditions Flashcards

1
Q

Name the endocrine glands

A

-Hypothalamus
-Pituitary
-Thyroids
-Parathyroids
-Adrenals
-Pancreas
-Ovaries
-Testes
-Pineal

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2
Q

What is a paracrine action?

A

When hormones act locally on cells but never enter the bloodstream

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3
Q

How are hormones classified?

A

Whether they are water soluble or lipid soluble

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4
Q

What are hormones that are secreted by the anterior pituitary gland called?

A

Tropic hormones

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5
Q

What is a tropic hormone?

A

A hormone that targets other endocrine glands

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6
Q

Which hormones are made in the hypothalamus?

A

Oxytocin and antidiuretic hormone (ADH)

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7
Q

Which hormones are secreted by the posterior pituitary?

A

Oxytocin and ADH

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8
Q

What is the main function of the pineal gland?

A

Secrete melatonin

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9
Q

What are the 3 hormones created by the thyroid gland?

A

T3, T4, Calcitonin

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10
Q

What is needed to make T3 and T4?

A

Iodine

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11
Q

What does T3 and T4 do?

A

-Metabolism
-Growth/Development
-Brain function
-O2 Consumption
-Carb and fat metabolism
-Caloric requirements

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12
Q

What stimulates the thyroid gland to make calcitonin?

A

High serum calcium levels

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13
Q

How does calcitonin lower serum calcium levels?

A

1) Inhibits transfer of calcium from bone to blood

2) Increases calcium storage in bone

3) Increases excretion of calcium in kidneys

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14
Q

What does parathormone do?

A

Increases serum calcium levels

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15
Q

What gland secretes the epinephrine hormones?

A

Adrenal medulla

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16
Q

What hormones does the adrenal cortex secrete?

A

-Glucocorticoids
-Mineralocorticoids
-Androgens

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17
Q

What is the most abundant glucocorticoid?

A

Cortisol

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18
Q

What does the pancreas release in response to low blood glucose, protein ingestion, and exercise?

A

Glucagon

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19
Q

What can decreased skin pigment indicate?

A

-Hypopituitarism
-Hypothyroidism
-Hypoparathyroidism

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20
Q

What is a common finding of Addison disease?

A

hyperpigmentation “bronzing” of the skin

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21
Q

What is the Chvostek sign?

A

Hyperreflexia and facial muscle contraction upon percussion of the facial nerve due to hypoparathyroidism

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22
Q

What is the Trousseau sign?

A

Muscle spasms of the hand upon application of a BP cuff for 3 minutes due to hypoparathyroidism

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23
Q

What is exophthalmos?

A

Condition where one or both eyes bulge from their sockets due to hyperthyroidism

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24
Q

What hormone is released for low calcium levels?

A

Parathormone

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25
Q

What is goiter?

A

Enlarging of the thyroid gland

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26
Q

Is hyperthyroidism associated with weight loss or weight gain?

A

Weight loss due to increased metabolism

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27
Q

Is cushing syndrome and hypothyroidism associated with weight loss or weight gain?

A

Weight gain

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28
Q

Which hormone level requires a patient to lay supine for 2 hours before a sample is collected?

A

Aldosterone

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29
Q

What is pheochromocytoma?

A

Tumor in the adrenal glands that causes body to produce too much adrenaline

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30
Q

What hormone decreases glucagon secretion

A

Amylin

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31
Q

What hormones are produced by the anterior pituitary gland?

A

-Prolactin
-Thyrotropin
-Somatotropin

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32
Q

What causes cortisol levels to rise?

A

-Fever
-Stress
-Burns
-Infection
-Acute anxiety
-Hypoglycemia

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33
Q

What are manifestations of hyperglycemia?

A

-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

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34
Q

What are manifestations of hypoglycemia?

A

-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

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35
Q

Do corticosteroids cause hyperglycemia or hypoglycemia?

A

Hyper

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36
Q

What are some causes of hyperglycemia?

A

-Illness, infection
-Corticosteroids
-Too much food
-Inactivity
-Emotional, physical stress
-Insulin resistance

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37
Q

What are some causes of hypoglycemia?

A

-Alcohol without food
-Too little food
-Too much exercise without food
-B-blockers masking hypoglycemia

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38
Q

What are ketones?

A

By-products of fat metabolism that can cause serious issues when there is too much

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39
Q

What causes an increase in ketones?

A

When there isn’t enough insulin, glucose can’t be used sufficiently so the body starts to break down fat instead.

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40
Q

What are signs and symptoms of DKA?

A

-Dehydration
-Lethargy and weakness
-Ab pain
-Anorexia, N&V
-Sweet, fruit odor on breath
-Kussmaul respirations
-Sunken eyes

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41
Q

What are lab findings in patients with DKA?

A

-Glucose >250
-Blood pH <7.30
-Serum bicarbonate level <16

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42
Q

In a patient with hyperglycemia, why does a serum potassium lab need to be drawn?

A

If patient is hypokalemic, giving insulin will drop their potassium even more; insulin drives potassium into cells

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43
Q

Why is it important to avoid rapid drops of glucose in a patient?

A

It can cause cerebral edema by creating an osmotic gradient which causes fluid to rapidly into brain cells

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44
Q

What is an acceptable glucose reduction rate?

A

36 - 54mg/dL/hour

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45
Q

What does HHS stand for?

A

Hyperosmolar Hyperglycemia Syndrome

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46
Q

What are some common causes of HHS?

A
  • UTI
  • Pneumonia
  • Sepsis
  • Newly diagnosed Type II Diabetic
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47
Q

What is the main difference between HHS and DKA?

A

Patients with HHS usually have enough insulin to prevent DKA

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48
Q

What are some neurological manifestations of HHS?

A
  • Somnolence (drowsiness or strong desire to sleep)
  • Coma
  • Seizures
  • Hemiparesis (weakness or inability to move one side of the body)
  • Aphasia
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49
Q

If a nurse is treating a patient with severe hyperglycemia with insulin, what do they do when glucose levels starts to reach about 250?

A

Administer dextrose IV to prevent it from dropping too low

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50
Q

What does your body do to fight hypoglycemia?

A

Activates the autonomic nervous system; produces glucagon and epinephrine

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51
Q

Why is mental functioning affected with low glucose levels?

A

Brain needs constant supply of glucose

52
Q

What is an easy way to remember manifestations of hypoglycemia?

A

Manifestations mimic being drunk

53
Q

What is the Rule of 15 for treating hypoglycemia?

A
  • 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
54
Q

When treating hypoglycemia, why should you avoid giving carbs that have fat? (Candy bars, cookies, whole milk, ice cream etc)

A

The fat will slow glucose absorption and delay response to treatment

55
Q

Which IV and how much is given for hypoglycemia?

A

20 - 50mL of 50% Dextrose

56
Q

If giving 20 - 50mL of 50% Dextrose isn’t an option and patient can’t swallow, what are you other options?

A

1mg glucagon injection in shoulder

57
Q

What is a common reaction to a glucagon shot?

A
  • Nausea (turn patient on their side to prevent aspiration
58
Q

What kind of patients will not respond well to glucagon?

A
  • Alcohol-related liver disease
  • Starvation
  • Adrenal insufficiency
59
Q

Will a patient with DKA pee a lot or a little? Will they have high or low blood pressure?

A

They will pee a lot and as a result will have low blood pressure due to volume loss

60
Q

What is angiopathy?

A

Damage to blood vessels

61
Q

Why does chronic hyperglycemia cause angipoathy?

A
  • 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
62
Q

Why should diabetics inspect their feet for skin breakdown?

A

Chronic hyperglycemia can cause destruction of nerves so they often won’t feel issues with their feet

63
Q

What is Nonproliferative Retinopathy?

A
  • 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
64
Q

What is Proliferative Retinopathy?

A
  • 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
65
Q

What is Diabetes-Related Nephropathy?

A
  • Damage to small vessels that supply the glomeruli of kidney
66
Q

What is Acanthosis Nigricans?

A

Velvety light brown to black skin thickening that appear on the folded skin parts of the body; a sign of insulin resistance

67
Q

What are 3 reasons older people are likely to get Type II?

A
  • Reduction in B-cell function
  • Decreased insulin sensitivity
  • Altered carbohydrate metabolism
68
Q

Counterregulatory hormones works against insulin. What are 4 examples?

A
  • Glucagon
  • Cortisol
  • Epinephrine
  • Growth Hormone
69
Q

What is the risk that a mother with Type I diabetes with pass it along to offspring vs a father?

A

Mother: 1%-4%
Father: 5%-6%

70
Q

What are the requirements to diagnose someone with Impaired Glucose Tolerance?

A

2-hour oral glucose tolerance test values are 140 - 199

71
Q

What are the requirements to diagnose someone with Impaired Fasting Glucose?

A

Fasting glucose levels are 100 -125

72
Q

What complications are increased by gestational diabetes?

A
  • C-section
  • Perinatal death
  • Birth injury
  • Neonatal complications
73
Q

What A1C level is considered diabetes?

A

6.5%+

74
Q

What is A1C?

A

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

75
Q

What are the ABCs of managing diabetes?

A
  • A1C
  • Blood pressure
  • Cholesterol
76
Q

What are 3 examples of rapid-acting insulin?

A
  • Lispro Humalog
  • Glulisine Apidra
  • Aspart Novolog
77
Q

What are 2 examples of Short Acting Insulin?

A

Humulin Regular
Novolin Regular

78
Q

What are 2 examples of Intermediate Acting Insulin?

A
  • Humulin N
  • Novolin N
79
Q

What are 3 examples of Long-Acting Insulin?

A
  • Glargine
  • Detemir
  • Degludec
80
Q

What is the Somogyi Effect?

A
  • High dose of insulin causes glucose to tank at night
  • Counterregulatory hormones are released to increase glucose levels
  • Rebound hyperglycemia
81
Q

What is the treatment for Somogyi Effect?

A

A snack at bedtime or reducing the dose of insulin

82
Q

How does Metformin work?

A
  • Makes the liver produce less glucose
  • Improves insulin sensitivity at the tissue level
83
Q

If a patient has what condition should they avoid taking Pioglitazone?

A

Heart Failure

84
Q

What medication is useful for a patient that is insulin resistant?

A

Pioglitazone; it is an insulin sensitizer

85
Q

What does Glucagon do?

A

When glucose is low, makes liver produce glucose to bring blood sugar back up

86
Q

How do you remember short-term acting insulin names?

A

Short actresses (short acting), named Lin (Humalin, Novolin), and are 4’12” (4-12hr peak)

87
Q

Which non-insulin drug class suppresses liver output of glucose?

A

Biguanides

88
Q

Which non-insulin drug class stimulates insulin secretion by pancreatic b-cells?

A

Sulfonylureas

89
Q

Which non-insulin drug class stimulates pro-insulin by beta cells?

A

Meglitinides

90
Q

Which non-insulin drug class reverses insulin resistance by improving glucose utilization in muscle and fat?

A

Thiazolidinediones

91
Q

Which non-insulin drug class prevents complex carbs from converting into simple sugars in the gut (slows glucose absorption after meals)?

A

Alpha-glucosidase inhibitors

92
Q

Which non-insulin drug class prevents release of glucagon (increases insulin secretion, decreases gastric emptying, lowers blood glucose)?

A

Gliptins/DPP-4 Inhibitors

93
Q

Which non-insulin drug class causes kidneys to remove glucose through the urine?

A

Sodium-glucose cotransporter 2

94
Q

Name the top Biguanide drug

A

Metformin

95
Q

How does metformin work?

A

-Decreases glucose, triglycerides, and cholesterol production in the liver which decreases glucose absorption in the gut
-Improves insulin sensitivity in targeted cells

96
Q

Name Sulfonylurea drugs

A

-Glyburide
-Glipizide
-Glimepiride

97
Q

Name Meglitinide drugs

A

Repaglinide

98
Q

Which insulin is administered IV?

A

Regular insulin (Humulin R)

99
Q

Do diuretics increase or decrease glucose levels?

A

Increases

100
Q

Which drug inhibits the metabolism of Metformin?

A

Cimetidine

101
Q

What is U-500 insulin?

A

Concentrated regular insulin; should not be administered with other insulin

102
Q

Since Insulin Glargine is long-acting, can you mix it with other insulins?

A

No

103
Q

How long does it take regular insulin to peak?

A

2.5 hours

104
Q

Name 2 alpha-glucosidase drugs

A
  • Miglitol
  • Acarbose
105
Q

What affects do hyperglycemia and hypoglycemia have on breast milk production?

A

Decreases milk production

106
Q

Acarbose is contraindicated in patients with what kind of disease?

A

Inflammatory Bowel Disease

107
Q

What are clinical manifestations of lactic acidosis?

A
  • Muscle pain
  • Ab pain
  • Cold, clammy skin
108
Q

Which 6 hormones does the pituitary gland secrete?

A
  • GH
  • Prolactin
  • ACTH
  • TSH
  • FSH
  • LH
109
Q

What is acromegaly?

A

Condition caused by the overproduction of GH due to an adenoma (noncancerous tumor)

110
Q

What are the manifestations of acromegaly?

A
  • 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
111
Q

What studies are used to diagnose Acromegaly?

A

-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
112
Q

What is prolactinoma?

A

A noncancerous tumor that causes the pituitary gland to make too much prolactin

113
Q

What are the clinical manifestations of prolactinoma in women?

A
  • Galactorrhea
  • Anovulation
  • Infertility
  • Decreased libido
  • Hirsutism
114
Q

What are the clinical manifestations of prolactinoma in men?

A

-Impotence
-Decreased sperm density
-Decreased libido

115
Q

What are the manifestations of hypopituitarism?

A

-Headaches
-Vision changes
-Loss of smell
-Nausea and vomiting
-Seizures

116
Q

What happens when there is a deficit of ACTH?

A

Cortisol deficiency

117
Q

What are the side effects of growth hormone replacement injections?

A

-Headache
-Muscle and joint pain
-Fluid buildup in the hands and feet

118
Q

For what conditions is hormone therapy contraindicated?

A

-Phlebitis
-Pulmonary embolism
-Breast cancer
-Prostate cancer

119
Q

What are manifestations of Syndrome of Inappropriate Antidiuretic Hormone?

A

-Low urine output
-Increased body weight
-Thirst
-Dyspnea on exertion
-Fatigue

120
Q

How do doctors tell the difference between Nephrogenic Diabetes Insipidus and Central Diabetes Inspidius?

A

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

121
Q

What does Parathyroid Hormone do?

A

-Bone resorption of calcium
-Renal tubular reabsorption of calcium
-Activation of vitamin D

122
Q

What is the difference between primary, secondary, and tertiary hyperparathyroidism?

A

Primary:
-Increased PTH secretion

Secondary:
-Compensatory response due to hypocalcemia

Tertiary:
-Hyperplasia of parathyroid gland

123
Q

What medication class and name is given to a patient with hyperaldosteronism?

A

Potassium-sparing diuretics (spironolactone)

124
Q

What is the difference between a hot and cold thyroid tumor?

A

Hot will take up radioactive iodine and are almost always benign whereas cold don’t.

125
Q
A

Adult Health (12 decks)

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