endocrine disorders Flashcards
what are the functions of the endocrine system
growth and development
sex differentiation
metabolism
adaptation to changing environment
how does the endocrine system adapt to a changing environment
regulation of digestion
use and storage of nutrients
electrolyte and water metabolism
reproductive fitness
true or false: hormones interact with high-affinity receptors
true
what are the categories of hormones
amines and amino acids
peptides, polypeptides, proteins, and glycoproteins
steroid
fatty acid derivatives
which of the following is a characteristic of a hormone?
a. a single hormone can exert various effects in different tissues
b. a single function can be regulated by several hormones
c. both
c
which is more predominant, positive or negative feedback?
negative
what hormones are essential for normal body growth and maturation
growth hormone (GH)
insulin
thyroid hormone
androgens
what are the three different endocrine disorders
hormone excess
hormone deficiency
altered response to hormone
what do thyroid glands do
increases metabolism and protein synthesis
influence growth and development in children (mental development and attainment of sexual maturity)
what are the primary functions of the thyroid
metabolism
cardiovascular system (increased O2 consumption)
gi function (promotes gi motility and vasodilation -> CO)
neuromuscular function (muscle function and control)
what is hyperthyroidism
a sustained increase in synthesis and release of thyroid hormones by thyroid gland
true or false: hyperthyroidism occurs more often in men
false: women
true or false: the highest frequency of hyperthyroidism is between ages 20-40 years
true
what is the most common form of hyperthyroidism
graves’ disease (75%)
what are other causes of hyperthyroidism
toxic modular goiter
thyroiditis
excess iodine intake
pituitary tumors
thyroid cancer
what are the signs of subclinical hyperthyroidism
low serum TSH level <0.4mlU/L
normal T4 and T3 levels
what are the signs of overt hyperthyroidism
low or index table TSH
elevated T4 and T3 levels
symptoms may or may not be present
what are the symptoms of hyperthyroidism
thyroid storm
restlessness, irritability, anxiety
wakefulness
increased cardiac output
tachycardia and palpitations
diarrhea, increased appetite
dyspnea
heat intolerance, increased sweating
thin and silky skin and hair
weight loss
what are the manifestations of thyroid storm
very high fever
extreme cardiovascular effects (tachycardia, congestive failure, and angina)
severe CNS effects (agitation, restlessness, and delirium)
GI symptoms
high mortality rate
true or false: thyroid storm results in delayed puberty
false
what are diagnostic tests for thyroid disease
measures of T3, T4, and TSH
resin uptake test
assessment of thyroid autoantibodies
radioiodine uptake test
thyroid scan
ultrasonography
CT and MRI
fine-needle aspiration biopsy of a thyroid nodule
what is primary hypothyroidism caused by
destruction of thyroid tissue or defective hormone synthesis
what is secondary hypothyroidism caused by
pituitary or hypothalamic dysfunction (low TSH or TRH)
what are the clinical manifestations of hypothyroidism
fatigue
cold intolerance
loss of eyebrow hair
sleep problems
muscle aches
infertility
slow heart beat
weight gain
constipation
headaches
depression
dizziness
brain fog
arthritis
brittle nails
heavy menstrual periods
what are the signs of subclinical hypothyroidism
TSH is >4.5 mlU/L
T4 levels normal
affects up to 10% of women over
what are the signs of nonthyroidal illness syndrome (NTIS)
critically ill patients
low T3, T4, and TSH levels
what condition does a thyroid goiter appear
any thyroid state
true or false: pancreas is only endocrine and not exocrine gland
false: both endocrine and exocrine
what does the islet of langerhans consist of and what do they secrete
alpha cells: glucagon
beta cells: insulin and amylin
delta cells: somatostatin and gastrin
F cells: pancreatic polypeptide
what is insulin regulated by
chemical, hormonal, and neural mechanisms
what is insulin’s secretion promoted by
increased blood glucose levels
what does insulin facilitate
the rate of glucose uptake into the body’s cells
what is diabetes mellitus and what is it characterized by
dysfunction in the production or action of insulin
characterized by hyperglycemia, resulting from defects in insulin secretion, insulin action, or both
what does diabetes mellitus affect
metabolism of fat, protein, and carbohydrates
what are the categories of diabetes mellitus
type 1
type 2
other specific types
gestational diabetes
what race has the highest percentage of diabetes
american indian or alaska native
what are the glucose regulating hormones
insulin
glucagon
somatostatin, amylin, and gut-derived hormones
counter-regulatory hormones
true or false: type 1 diabetes typically affects older people
false: younger
what is the genetic susceptibility of type 1 diabetes
1st degree relative (parent or sibling) with type 1 diabetes
strongest association with major histocompatibility complex (MHC) in HLA testing
what ages does type 1 diabetes usually peak at
4-7
10-14
what are the environmental factors of type 1 diabetes
viral infection
exposure to cow’s milk proteins
relative lack of vitamin D
what are the symptoms of diabetes
polyuria
polydipsia
polyphagia
weight loss or gain
blurred vision
fatigue/weakness
skin infections
true or false: type 1 diabetes is more common than type 2
false: type 2 is 90-95%
true or false: type 2 diabetes has insulin but it doesn’t work properly
true
true or false: people with type 2 diabetes are usually underweight
false: overweight
what is polyuria
excessive urination
what is polydipsia
excessive thirst
what is polyphagia
hungry
what are the diagnostic tests for diabetes
fasting plasma glucose test (FPG) 70-100 is normal, >126 = diabetic
random glucose test
oral glucose tolerance test (OGTT)
capillary whole blood glucose monitoring
hemoglobin A1C
urine tests (ketobodies and glucose)
how to treat diabetes
insulin replacement
- type 1 = insulin pump
- type 2 = oral therapies (metformin , etc)
weight loss (type 2)
diet control (ADA diet)
hydration
exercise
what are the acute complication of diabetes mellitus
diabetic ketoacidosis
hyperosmolar hyperglymeic state
hypoglycemia
what is the somogyi effect
hypoglycemia with rebounding hyperglycemia
counter regulatory hormones cause gluconeogensis
most common persons with type 1 diabetes and in children
what is the dawn phenomenon
early morning glucose elevation without nocturnal hypoglycemia
related to nocturnal growth hormone elevation
how do you treat dawn phenomenon
alter timing and dose of insulin
what are the microvascular chronic complication of diabetes
diabetic retinopathy
diabetic neuropathy
diabetic neuropathies
what are the macrovascular chronic complication of diabetes
coronary artery disease
myocardial infarction
cerebral vascular disease
peripheral vascular disease
what hyperfunctions increase cortisol
cushing disease
cushing syndrome
what hyperfunction increases aldosterone
primary or secondary hyperaldosteronism
what is a hypofunction of the adrenal cortex
addison disease
what is cushing syndrome
chronic excessive cortisol level, regardless of cause
what is cushing disease
overproduction of pituitary ACTH by a pituitary adenoma
lose diurnal and circadian patterns of ACTH and cortisol secretion
what is cushing-like syndrome
exogenous administration of glucocorticoids
how to diagnose cushing’s disease
urine and blood test
saliva cortisol test
CT and MRI
petrosal sinus sampling
what is hypoadrenalism
deficient production of adrenal hormones
- aldosterone (stimulus angiotensin II)
- cortisol (stimulus ACTH)
- androgens (stimulus ACTH)
- epinephrine (stimulus SNS)
what is the etiology/pathophysiology of hypoadrenalism
primary
- addison’s disease (autoimmune)
- lack of glucocorticoids, mineralocorticoids, and androgens
secondary
- lack of pituitary ACTH
- lack of glucocorticoids and androgens
what are the symptoms of addison’s disease
insidious onset (comes on slowly and does not have obvious symptoms at first)
- anorexia/weight loss
- nausea
- progressive weakness
- fatigue
disease often advances before detected
what is an acute adrenal insufficiency
insufficient or sudden, sharp decrease in hormones
life threatening
various triggers
iatrogenic - abrupt discontinuation of exogenous steroids
how to diagnose addison’s disease
CBC, CMP
ACTH stim test
insulin-induced hypoglycemia test
abd CT scan
MRI
