Endocrine disorder Flashcards
What is thyroid disease occur more in?
Diabetes
Describe the thyroid
Located at base of neck, on the anterior side
Butterfly shaped hormone that is really thin and really soft
What is the thyroid responsible for ?
-Maintaining homeostasis through regulation of metabolism
-Incharge of all metabolic process
What does the thyroid gland secrete?
Two hormones
T3 & T4
What kind of feedback is the thyroid regulated through.
Thyroid is regulated through a negative feed back loop through with the anterior pituitary hormone and release of thyroid stimulating hormone
What happens when T3 Thyroid levels go down?
Thyroid stimulating hormone goes up
What happens when T3 and T4 levels go up?
Thyroid stimulation hormone goes down (TSH)
How are secretions of the thyroid stimulating hormone from the anterior pituitary guided?
-Guided by the release of thyrotropin releasing hormones in the hypothalamus
-Thyrotropin sends signals to increase or decrease the release of thyroid stimulating hormone and that regulates T3 and T4 through a negative feedback loop
What needs to happen for T3 and T4 to work properly?
-Amount of Iodine can’t be too high or too low it needs to be at the sweet spot. Sufficient Iodine intake so you appropriately use T3 and T4
-Foods that contain Iodine are found in egg yolks,fish, shellfish, and chocolate!
What is hypothyroidism?
low t3 nd t4
high tsh
What causes hypothyroidism ?
-Usually caused by:
Inflammation(Thyroiditis) or Hashimoto’s thyroiditis (autoimmune disease)
-It can also be caused by Idonine deficiency
Others that may be good to know:
-post partum thyroiditis 5-9% after birth, temporary
-non-functioning thyroid
-congenital
What are consequences of hypothyroidism
-Decrease in metabolic rate
-Accumulation of hydrophilic mucopolysaccharide (sugary substance) in the connective tissue. This means that sugar draws in water and causes a condition of edema which would be called myxedema
- Serum cholesterol will elevate, as metabolism gets wonky and keep fat behind
-Untreated congenital hypothyroidism can cause: Mental retardation or impaired physical growth aka cretinism
What are late symptoms of hypothyroidism?
Which is when this will lead to myxedema
-Subnormal temp
-Bradycardia
-Weight gain
-Thickening of skin
-Cardiac complications
What are physical signs and symptoms of hypothyroidism?
Think of everything is slowed
-Mental and physical sluggishness
-Somnolence(sleepy)
-Decreased cardiac output, bradycardia
-Constipation and decrease appetite due to your GI system is slow
-Hypoventilation due to decreased respiratory rate and decreased inflation of lungs
-Cold intolerance due to thermoregulation being slowed
- Coarse dry skin and dry hair due to shift in fluids
-Weight gain due to slowed down metabolic rate
Emergency is myxedema!!!
What is hyperthyroidism?
high t4 nd t3 low tsh
What causes hyperthyroidism ?
-Primarily caused by adenoma(tumor) or a toxic goiter or inflammation
-Sometimes is caused by excess thyroid medication/ other drugs. If someone is taking thyroid replacement overdoes it on the medication that can cause hyperthyroidism
-Graves disease also cause hyperthyroidism
What are consequences of hyperthyroidism?
All related to increase of metabolism
-Increased metabolic rate, Increase oxygen consumption. Burning through oxygen and energy faster
-Constant activation of sympathetic nervous system
What are signs and symptoms of hyperthyroidism?
All related to going too fast
-restless, irritability, anxious because of sns activation
-Wakefulness(hyperalert)
-Increased cardiac output
-Tachycardia and can lead to palpations
-Diarrhea, increased appetite die to overstimulation of gi tract
-Dyspnea due to fast respiration?
-Exophthalmos
-Heat intolerance, increased sweating
-Thin and and silky hair and skin
-Weight-loss due to increase metabolic rate
Emergency would be thyroid storm
What is a thyroid emergency?
Emergency related to hypothyroidism or hyperthyroidism.
***Thyroid emergency
What is myxedema?
-Emergency related to very slow metabolic rate from hypothyroidism
-Monopolysacchrides substances deposit into the connective tissues. Wherever glucose is there will be water, if there is sugary substances in the connective issue water will naturally be attracted
-non pitting Edema affecting extremities and the face
What are signs and symptoms of myxedema?
-Fatigue, lack of energy,lethargy,sleepiness
-constipation
-Can not process information,not being able to concentrate,forget
-hair loss,dry skin
-blurred vision
-decreased hearing
-fullness in throat,hoarseness
What are cardiovascular and respiratory symptoms of myxedema?
Low temp and blood pressure
Triggering infection
Shallow or slow breathing
Absent or slowed reflex
What happens if myxedema is untreated?
You will go into myxedema coma aka critical hypothyroidism
Why is the mortality rate of myxedema coma/critical hypothyroidism have a mortality rate of 60%?
-Long standing or preexisting hypothyroidism that is under-treated or not treated at all
What are signs and symptoms of myxedema coma?
-Metabolic activity is profoundly low: hypothermia, hypotension, bradycardia, mental status depression( no longer alert, orientated, and may even be comatos)
-Hypoventilation and hypercapnic respiratory failure due to increase of carbon dioxide leading to potential respiratory failure
-Adrenal insufficiency
-Low sodium(hyponatremia) which will lead to mental status
-Low sugar(Hypoglycemia) will lead to low metabolic, not enough energy wont be
-More edema in soft tissue around eyes, on eye lids, and on tongue
What are you gonna see in lab results for myxedema ?
Elevated TSH& low T3 and T4
What is thyroid storm?
Extreme fast thyroid
-Aka malignant or critical thyrotoxicosis
-rare
-Consequence of hyperthyroidism
What cause thyroid storm?
Excess thyroid hormone due to
- Taken excess amount of thyroid
-Tumor in thyroid gland
- Gortor in thyroid gland that is overproducing the hormone
-80-90 mortality rate if untreated
What are signs and symptoms of thyroid storm?
Everything going fast,
-hyper metabolism
- Organ dysfunction/organ failure due to Super high demand for oxygen and nutrients the body fails and can’t keep up
-Thermoregulatory: very high fever, moist skin
-Neurologic: Agitation, restlessness, delirium, seizure, hyperreflexia, lid lag, psychosis, coma
CV: Tachycardia, angnia, hypertension, Cardiovascular heart failure
Respiratory: dyspnea, tachypnea
GI: diarrhea, abdominal pain, n/v
What does the adrenal cortex produce?
Produces steroids
Mineralocorticoids
-Function in dosium,potassium, and water balance
Glucocorticoids(cortisol)
-Aids in regulating the metabolic functions of the body and in controlling inflammatory repsone
-essential for survival for stress situations
- Stimulates gluconeogenisis
-Mobilization of free fatty acids
-Glucose sparing
-Anti-inflammatory agent
Cortisol
-Glucose metabolism
-protein metabolism
-Fat metabolism
-Anti-inflammatory action
Adrenal sex hormones (androgens)
-Serve mainly as source of androgens for women
Gonadocorticoids
-Testosterone, estrogen, progesterone
what does the adrenal medulla produce?
Secretes catecholamines
epinephrine
-Increases heart rate and bP
-Increases respirations
-Increases metabolic rate
-Increases glycogenolysis
-norepinephrine(vasoconstrictors)
-House keeping system
What is the adrenal gland apart of and what is it responsible
Hypothalamic pituitary adrenal axis which is responsible for the production of glucocorticoids, and adrenal androgen
-Mediates affects of stress by regulating metabolism, immune responses and autonomic nervous system
***Adrenal gland
What is the function of Glucocorticoids(cortisol)?
-cortisol maintain blood pressure and blood glucose
-aids in metabolic function regulation and controlling the inflammatory response
-Glucose, protein, fat metabolism
-inflammatory action
***Adrenal gland
What is the function of Mineralocorticoids (alsodsterone)?
contributes to regulation of BP through the RAAS system
also helps with sodium,potassium and water balancewith ic important for maintaing blood pressure
What is adrenal insufficenicny?
-Adrenal gland not working properly
-pituitary gland not working properly
-Interruption in replacement therapy for adrenal specifically
What are 3 categories of adrenal insuffiency?
Primary
secondary
acute adrenal crisis
What is primary adrenal insufficiency ?
Addisons disease which involved destruction of adrenal cortex
What is secondary adrenal insuffiency?
insufficient pituitary related to hypopituitarism or
surgical removal of pituitary gland
what is acute adrenal crisis
Life threatening
What is addison’s disease?
Type of adrenal insufficiency where the adrenal cortex does not make enough hormone including cortisol
Both mineralocorticoids and glucocorticoids are deficient
What can cause addison’s disease/
-Autoimmune disease
-Stopping steroid medication. Patients take steroids, to treat conditions like COPD or other inflammatory conditions and those steroid medications should be slowly withdrawal before getting discounted. If they are discounted inproperly it can cause adrenal insufficiency or addisons disease
What are happens in earlier symptoms for Addison disease?
Vague, so hard to actually notice
weakness, fatique, orthostatic, hypotensions
What are later symptoms of Addisons disease?
-hyperpigmentation, especially around the bony prominences
-skin fold, scars
-bronze skin color
black freckles, or bluish black discoloration around the nipples (areolae) and mucous membranes
-dehydration
-hypotension
-high potassium
-low sodium
What is adrenal crisis?
Life threatening condition where this is not enough cortisol
(Stress hormone)
what causes adrenal crisis?
-Damage to adrenal gland because of disease or surgery
-Pituitary is injured and can not release ACTH leading to hypopituitarism
Also
-adrenal insufficiency is not treated properly
-Long term use of steroid medication that is stopped abruptly
-Dehydration and infection like sepsis
What are signs and symptoms of adrenal crisis?
Lack of apetite(anorexia),
-n/v
-Abdominal pain
-weakness ,fatigue
-fever
-lethargy
-hyponatremia
-hypperkalemia
-hypotension
-confusion or coma
What is cushings syndom?
Disorder that happens when there is too much cortisol especially over a long period of time
What can cause Cushing syndrome?
Most commonly seen in Someone is taking too much cortisol in the form of glucocorticoid medication for a long amount of time
others include:
-Overexposure to steroid therapy
-Familial cushing’s syndrome
-Primary adrenal gland disease
-Ectopic ACTH-secreting tumor:lungs,pancrease, thyroud
-Pituitary gland tumor(primary adenoma) resulting in excess pituitary production of adrenocorticotropic hormone (ACTH)
What are signs and symptoms of cushing’s syndrome?
-Moon face
-Obesity in trunk with thin limb
-Buffalo hump
-Stretch marks and thin fragil skin
-Poor wound healing
-bone loss due to change in calcium
-High blood pressure
-Muscle weakness
-Thicker facial hair in women
-Absent or irregular menstrual cycles
-Decreased of libido for men
-Muscle weakness
-Fatigue
-Acne
-Loss of emotional control
-Headaches
-GI distress due to increased acidity to stomach
-sodium and fluid retention leading to edema to the moon shape of face
What does the pancreas secrete?
Insulin and glucagon
What is Somatostatin
Produced by the in the GI tract, pancreas, hypothalamus and CNS.
Main purpose is to decreases the secretion of insulin and glucagon
-It also decreases GI motility and slows absorption
Compliment to the pancreatic hormones in the GI system
What is insulin?
-Hormone produced by beta cell in pancreas
-Assist/promotes in glucose uptake by muscles and tissues. Binds to glucose so muscle and tissues can use it
-Keeps the body from break down fat for energy and breaking down glycogen
-increase protein synthesis
Describe glucose metabolism
- High blood sugar because of intake of carbs or other sugars containing food
- As we eat it will signal pancreas to release insulin
- When insulin is released it will coordinate with the glucose to be able to be transported into muscles, tissues, and cells so it can be used for energy
- When it is absorbed into cell to be used as energy, blood sugar lowers
-other thing insulin will do is signal liver to store glucose in the form of glycogen
Blood glucoses used for body tissue function. Must have insulin for transport. Liver stores ingested glucose as glycogen. Liver releases glycogen for use as glucose through glycogenolysis. Liver can slo synthesize glucose through gluconeogenesis.
What is glucagon?
Glucagon is produced by the alpha cells in pancreas
-Maintains blood glucose between meals by signaling the liver to begin glycogenesis
Describe fat metabolism
Triglyceride metabolism from fats result in glycerol molecule and 3 fatty acids. Both can be used for energy glycolic pathway. Fatty acids used for energy results in ketones
Describe protein metabolism
Amino acids can not be stored for long.
Excess is converted into fatty acids ,ketones, or glucose
Describe what will happen if you have low blood sugar in blood stream
- The pancreas will be signaled to release glucagon from alpha cells
- Glucagon will signal the liver to transform glycogen into glucose to raise blood sugar
What is the direct affect of insulin
-ketone metabolism
inhibits: ketogenesis: ketone body production as a resultof fatty acid breakdown
-deficit result in ketoacidosis
-Protein metabolism
-Stimulates amino acid uptake and protein synthesize
-Inhibits protein degradation
-Deficit results in muscle wasting
what is Effects of insulin deficit on insulin dependent tissue?
-Decreased strength in ALL MUSCLE,
-Weaker cardiac muscle contractions, decreases peripheral circulation
-poor bowel tone
-poor vascular tone
-Decrease leukocyte function which leads to impaired healing
Describe pre diabetes?
-55% of beta cells are lost and no longer functioning
-There is peripheral resistance to the uptake of insulin which means glucose can not be used as energy
-Due to beta and alpha cells not functioning properly the liver can get signals to not make excess glucose so disregulation of hepatic glucose production
-More resistance of insulin cause inflammatio
What happens to the body when it is challenge with an excess amount of glucose?
-Pancreas tries to keep up by secreting more and more insulin
-At some point pancreas becomes fatigued and beta cells can no longer keep up and begin to fail
-This leads to hyperglycemia because there is not enough insulin and the liver does not get the signal to stop making glucose so sugar keeps building up.
What happens in peripheral insulin resistance?
-The muscle, tissues, and cells are not able to use glucose properly because they are not able to admit glucose into their cells because of a deficit in insulin
-Happens with obesity and hallmark sign of type ll diabetes
-Related to lifestyle of excess glucose intake
What will you see with insulin resistance?
-Higher than normal fasting blood glucose
-Normal random blood glucose after meals
What happens with the process of insulin resistance?
- Body breaks down food that you eat into glucose
- Glucose enters blood streams and signal pancreas to release insulin
3.Insulin is suppose to help glucose go into all kinds of tissue. When glucose enters those cells the blood sugar should decrease. - If overtime you can not have the process of glucose entering cell by assistance of insulin then you develop insulin resistance
Insulin resistance can be due to type ll diabetes, non alcholic fatty liver disease
What is impaired hepatic glucose regulation?
If alpha cells are damaged then the signal that tell liver not to produce glucose is impaired and can lead to over secretion of glucose by liver and high secretions of glucose
-Increased glucose output
-Fasting hyperglycemia
-Glycogen accumulation in liver
What is type l diabetes
-Immune disorder because pancreas is unable to make insulin or very little insulin is produced
-starts in children but can be diagnosed in adult hood
-High random blood glucose after meals
-High fasting blood glucose
-KETONES IS THE HALLMARK SIgn
What are signs and symptoms of diabetes
-Starvation of muscle cells and tissues due to glucose not being able to get in for energy
-Weight loss
-tinging in feet, weight loss
-Thirst,hunger,fatugue
-Excessive uriniation
-Blurry vision
-slow healing of cuts and sores
What are hallmark sign of type ll diabetes
Insulin resistance
-Muscle tissues, organs fat cells have all been resistance to the affects of insulin because of high levels of glucose
-Glucose can not be used for energy so it remains in the blood streams leading to high blood glucose levels
Ketons are not apart of type lll diabetes
What are signs and symptoms of type ll diabetes?
Insuline resistance
THE 3 P’s
Polydipsia- excessive thirst
polyphagia- excessive hunger
polyuria-excessive urination
Fatigue, blurred vision, frequent infections, numbness and tingling and legs and feet
What is hyperglycemia?
Super high blood sugar
-when excessive glucose is present in urine or blood
Signs and symptoms include the 3 p’s
polyphagia, polydipsia, polyuria
-blurred vision due to osmotic forces causing lenses to be swollen,fatigue
What is metabolic syndrome?
-cluster of condition that increases risk for cardiovascular disease and diabetes
-in order for it for 3 or more signs out of these must be seen.
~Elevated waits circumference
~Elevated triglyercerides
~Lower than normal HDl
~High blood pressure
~High fasting blood glucose
What can cause metabolic syndrome?
life style factors such as
poor diet
not enough sleep
mood disorders
alcohol abuse
What are 3 conditions that are emergencies related to diabetes?
Diabetic ketoacidosis
Hyperosmolar hypoglycemic state
hypoglycemia
What is Diabetic ketoacidosis
-Results from excessive amount of blood glucose with no insulin. The amount of glucose circulating in blood stream is too much for amount of insulin available
no sugar in cell so body must burn fat for fuel
The body decides that glucose metabolism is not available, so it switches to ketone or pyruvate metabolism instead which results in;
excess of ketones, shift to acidity, excessive amount of glucose in blood stream, dehydration, electrolytes imbalances
seen more in type l
What is the pathophysiology of Diabetic ketoacidosis ?
-Body is unable to manage excessive amount of glucose and can’t be used for energy so instead it turns into fatty tissue as a source for energy and the liver is signaled to make more and more glucose
Can be cause by:
Extreme insulin defiiency, infection, trauma, alchol. MI or stroke
What is hyperglycemic hyperosmolar states?
Occur if there isn’t enough insulin to assist in the transport of glucose OR if the muscle, tissues and cells become resistant to action of insulin
-results in excessive amount of glucose in blood stream.
glucose pulls fluid out the cells to match it, you will have osmotic diuresis
-Hyperosmolatiy secondary to hyperglycemia and water loss?
-electrolyte imbalance
-altered mental status
What is hyperglycemic hyperosmolar state caused by?
infection,diahrreah,burns,dialysis,MI.
Seen more in elderly, higher moratality rate than DKA
What is the pathophysiology of hyperglycemic hyperosmolar state ?
Liver is over producing glucose and peripheral tissue not using glucose that causes extreme hyperglycemia
-not ketoacidicosis due to lack of insulin
-Diuresses meaning fluid shifts out of intracelluar into extracellular leading to dehydration
What is the pathophysiology of hypoglycemia?
-Excess amount of insulin where blood glucose goes below 70
-can lead to coma, convulsions, slowed speech
-not enough energy
-it can be do to someone not eating enough or overdosing on insulin
What is the somogyi effect
bound effect from late night hypoglycemia causes early morning hyperglycemia
-During sleep you are not eating so blood sugar naturally drops. The alpha cells release glucagon and tells the liver to produce glucose so your glucose isn’t low overnight
-If the mechanism is not working properly the liver is over activated and causes an excessive amount of early morning glucose
What is Dawn phenomenon?
body fails to release more insulin to match the early-morning rise in blood sugar
-When glucose levels naturally rise in the morning due to glucose made by liver, the pancreas should excrete enough insulin to match the amount of glucose
-if pancreatic beta cells do not secret enough insulin to match amount og glucose the you will have excessive amount of blood glucose
What happens during microvascular?
~Eyes: damage to eye blood vessels; retinopathy, cataracts and glaucoma due to high blood pressure and high blood glucose
~KIDNEY; HIGH BLOOD PRESSURE DAMAGES SMALL BLOOD VESSELS AND EXCESS BLOOD GLUCOSE OVERWORKS KIDNEYs resulting in nephropathy
~ Neuropathy: hyperglycemia damages nerves in the peripheral nervous systems, could result in pain or numbness, feet wounds may go undetected
What happens during macrovascular
~Brain; Increased risk of stroke and cerebrovscular disease
~heart; High blood pressure and insulin resistance increases risk of coronary artery disease
~extremities: peripheral vascular disease results from narrowing of blood vessels increasing the risk for rediced or lack of blood flow into legs
