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Kydd - Pathophysiology > Endocrine Disorders (Thyroid, Adrenal, Pituitary) > Flashcards

Endocrine Disorders (Thyroid, Adrenal, Pituitary) Flashcards

1
Q

What are the major endocrine glands? Where are they located?

A
  1. Pineal Gland 2. Pituitary Gland 3. Thyroid Gland 4. Thymus 5. Adrenal Gland 6. Pancreas 7. Ovary (females) 8. Testis (male).
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2
Q

What are the two basic problems of endocrine disorders?

A
  1. Hypersecretion (Increased Hormone production) 2. Hyposecretion (Decreased or No Hormone production). This can also include in appropriate target cell responses.
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3
Q

What is the etiology of Hyposecretion?

A

A decrease or no hormone production can result from a variety of reasons. 1. Dietary Deficiency (Eg. Iodine deficiency leading to non-functional T3 and T4). 2. Metabolic Defect (lack of regular enzymes, or inhibited from acting). 3. Immune Disorder (Antibody targeting glands and/or receptors). 4. Receptor Defects (Not enough binding). 5. No trophic stimulation leading to atrophy. 6. Treatment for Hypersecretion (Surgery which removes part of the organ therefore less hormone secretion).

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4
Q

What are several etiologies for Hypersecretion function?

A
  1. Increased/Excessive trophic stimulation. 2. Defect in negative feedback loop therefore no longer stops/shuts off, continuous production of hormones. 3. Secretory Tumor (A tumor in the gland making more cells and larger gland releasing excess secreation).
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5
Q

How does a secretory tumor cause hyperfunction, what is an example of a secretory tumor?

A

An Ectopic Tumor. An ectopic tumor is a tumor that occurs outside a gland, but secretes a compound or hormone that closely resembles that which is normally released. The body mistakes this compound and the result is hyperfunction.

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6
Q

What results from a non-secretory tumor?

A

A non-secretory tumor does not secret compounds, but instead takes up space. Due to the loss of space, the endocrine gland does not produce and leads to a hypofunction state.

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7
Q

What is the most common endocrine disorder? What gland does it involve?

A

The most common endocrine disorder is diabetes mellitus. It involves the pancreas.

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8
Q

What is a goiter? How many different types of goiters are there?

A

A goiter is an enlargement of the thyroid gland. There are two types: 1. Endemic Goiter. 2. Toxic Goiter.

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9
Q

What is an endemic goiter?

A

An endemic goiter is caused by an iodine deficiency.

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10
Q

How does iodine deficiency cause an endemic goiter?

A

Iodine is needed to form the T3 & T4 hormones, which due to lack of iodine are decreased. As a compensatory mechanism, there is an increase in TSH released from the pituitary to create more T3 & T4. This causes hyperplasia and hypertrophy of cells in the thyroid, therefore cells spread/grow and divide leading to goiter.

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11
Q

What is a toxic goiter? What is it due to?

A

A toxic goiter is due to hyperactivity of the thyroid gland. It is toxicity from increased levels of hormones.

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12
Q

What are the full names of T3 and T4 hormones?

A

T3: Triiodothyroine. T4: Thyroxine

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13
Q

Where is the thyroid gland located?

A

Below the larynx in the anterior middle portion of the neck.

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14
Q

What is the shape and structure of the thyroid gland?

A

Shield like structure, composed of left and right lobes that are made up of many tiny, saclike structures call follicles.

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15
Q

What is the function of the thyroid gland?

A

The only function of the thyroid gland is to make thyroid hormone. Thyroid hormone has an effect on almost all tissues of the body, increasing cellular activity. The primary function of the thyroid is to regulate the body’s metabolism.

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16
Q

What is an essential element in the proper functioning of thyroid synthesis?

A

Iodine.

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17
Q

What regulates the secreation of the thyroid hormones? (feedback).

A

Hypothalamic-pituitary thyroid feedback system: Hypothalamus produces Thyrotropin-releasing hormone (TRH), stimulates the anterior pituitary to release Thyroid-stimulating hormone (TSH), TSH acts on thyroid gland to produce T3 and T4.

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18
Q

What is the most common cause of hyperthyroidism?

A

Autoimmunity

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19
Q

What is Graves Disease?

A

Graves disease a hyperthyroid condition that occurs when the body’s tissues are exposed to high levels of circulating thyroid hormone.

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20
Q

Who is most commonly affected with Grave’s disease?

A

Young women

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21
Q

What percentage of hyperthyroid conditions are known as Grave’s disease?

A

80-90 percent.

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22
Q

Graves disease has 3 hallmark characteristics. What are they?

A

Goiter, Hyperthyroidism, Exopthalmus

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23
Q

What is exopthalmus?

A

Exopthalmus is known as protruding eyeballs. It is caused by fluid deposits in fat pads which push the eyes forward.

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24
Q

What is the pathophysiology of Graves disease?

A

Autoimmunity targets TSH receptors on thyroid cells. Thyroid stimulating antibodies (TSAb), mimic TSH and bind to all the thyroid receptors. This stimulates thyroid hormone secretions (T3/T4). However, TSAb do not degradate from normal enzyme so they are active for a longer period, resulting in lots of T3/T4. The body compensates through negative feed back by decreasing TSH.

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25
Q

What would diagnostic tests show in the case of having Graves disease?

A

Elevated levels of T3 and T4, Low levels of Thyroid Stimulating Hormone.

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26
Q

What is Thyrotoxicosis?

A

Thyrotoxicosis occurs when hyperthyroidism or graves disease is not treated. It results in increased T3/T4 hormones, creates an increase in the body’s metabolism, creates exceesive metabolic heat, triggering compository heat loss mechanisms like flushed skin and perspiration.

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27
Q

Thyrotoxicosis will cause an intolerance to an increase in?

A

Body temperature

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28
Q

What are four behavioural signs of thyrotoxicosis?

A

Irritable, Excitable, Anxiety, Insomnia

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29
Q

What is the effect of thyrotoxicosis on the body’s metabolism?

A

The body will have an increased demand for energy, O2. This will increase the heart rate and cardio output. The body will need to remove excess waste, causing hyperventilating to expel CO2.

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30
Q

Why is weight loss a symptom of graves disease?

A

The body’s metabolism is increased requiring more energy and drawing from fat and protein stores.

31
Q

That is the treatment for Graves disease?

A

It is dificult to remove the cause of hyperthyroidism. 1. Antithyroid drugs (Tapazole). 2. Radioiodine Therapy. 3. Surgery for large goiters.

32
Q

Hypothyroidism can occur in 3 different progressions. What are they?

A

Primary: Thyroid. Secondary: Pituitary. Tertiary: Hypothalamus

33
Q

95 percent of all hypothyroidism occurs in which progression?

A

Primary - It affect the thyroid.

34
Q

What happens to the body’s metabolic rate when suffering hyporthyroidism?

A

It decreases.

35
Q

What are some associated problems of hypothyroidism?

A

Decreased body temperature. Decreased CNS function. Decreased cadiac output. Weak muscle action (d/t decreased ATP). Weight gain.

36
Q

Why is weight gain seen in hypothyroidism?

A

Normal food intake occurs which is they ingested, absorbed. However, it is not metabolized properly an instead it is stored resulting in weight gain.

37
Q

What is the most common hypothyroid state?

A

Hashimotos Thyroiditis

38
Q

What is the most common demographic affected by Hashimotos Thyroiditis?

A

Middle aged women. About 90% of all Hashimotos cases affect this demographic.

39
Q

What is the pathophysiology of Hashimoto’s Thyroiditis?

A

Hashimoto’s is an autoimmune desease that causes destruction of the gland. There is a dense accumulation of lymphocytes which lead to gland destruction. Antithyroid Abs block TSH binding (not stimulate like in hyper).

40
Q

What is the treatment for Hypothyroidism?

A

If there is an endemic goiter we will treat with dietary iodine. T4 hormone.

41
Q

Why do we treat Hashimoto’s with T4 and not T3

A

All thyroid hormone starts out at T4. Only when T4 hormones interact with other cells do they let go of one of the iodine atoms and become T3.

42
Q

Where is the adrenal gland located?

A

Superior to the kidneys. (It is not actually attached to the kidney)

43
Q

What is the outter layer of the adrenal gland? What situmluates it? What hormones does it secrete?

A

The outter layer of the adrenal gland is called the Cortex. It is stimulated by pituitary Adrenocorticotropic hormone (ACTH). The Cortex secretes three groups of hormones: 1. mineral corticoids - aldosterone. 2. glucocorticosteroids - cortisol. 3. androgens - testosterone (DHT stimunlates testosterone).

44
Q

What is the middle layer of the adrenal gland? What stimulates it? What hormones does it secreat?

A

The middle layer of the adrenal gland is called the Medulla. It is stimulated by the Sympathetic Nervous System and secretes: 1. epinephrine. 2. nonepinephrine

45
Q

What are the two possible function issues when dealing with the adrenal gland?

A

Hyperfunction and Hypofunction

46
Q

What are three possible etiological reasons for a hyperfunctioning adrenal gland?

A
  1. Coritcal tumor or hyperplasia (increased cortisol and decreased ACTH). 2. Tumor or hyperplasia of Anterior pituitary (increased ACTH). 3. Ectopic ACTH secretory tumor (Eg. In lung, releasing hormone like substance).
47
Q

Is Cushing’s Syndrome a hyper or hypo secretiion problem?

A

Hypersecretion.

48
Q

What are the characteristic features of Cushing’s syndrome?

A

Rounded Moon Face. Facial, Neck, and Abdominal fat deposits. Weak muscles (due to protein catabolism). Susceptible to infections (cortisol is an anti-inflammatory agent, the body cannot react against infections). Sodium and water retention resulting in HTN and hypokalemia

49
Q

What is the Pathophysiology of Cushing’s Syndrome?

A

Cushing’s syndrom is due to a glucocoricoid hypersecretion causing increased hormone actions. Increased metabolism results in protein catabolism resulting in weak muscles. Lipids are also broken down and deposited in areas not mormally depoisted, presenting with round face. Gluconeogenesis resulting with prolonged hyperglycemia. The prolonged hyperglycemia creates a state of insulin resistance and impaired glucose tolerance. The body also experiences sodium and water retention (HTN and Hypokalemia because persistant high levels of cortisol on the kidneys imitates the functions of aldosterone.

50
Q

Why are those suffereing from Cushing’s syndrome more suseptible to infections?

A

Cortisol is an anti-inflammatory agent. Due to this, the body cannot react with a normal inflammatory response to infections.

51
Q

Why is androgen hypersection and male sex characteristics a possible manifestation of Cushings? Why is this manifestaton more prominent in women?

A

Androgen production occurs typically in the adrenal cortex only in females. Male adrogens and mostly produced in the testicles. Thus, the male like characteristic will be more prominent in females. This manifestation does not always occur.

52
Q

What are different treatment options for Cushing’s syndrome?

A

Excise tumor, if present. Irradicate pituitary. If there is an ectopic tumor, take drugs. Aldrenalectomy (removal of part of entire adrenal gland, causing a hypo state).

53
Q

What is Conn Syndrome?

A

Conn syndrome is an uncommon hypersecretory syndrome of the adrenal gland. It deals typically with the mineral corticoid: aldosterone.

54
Q

What is the etiology of Conn Syndrome?

A

Conn syndrome impacts the cells that produce aldosterone. This is usually caused by a cortical adenoma (non-malignant cotical tumor). It can also occur because of idiopathic hyperplasia. The third etiology is from a renal tumor and causes increased renin secretion therefor causing a hypersecretion of aldosterone.

55
Q

What are the two prominent manifestations of Conn Syndrome?

A

HTN (major problem): D/t the function of aldosterone the body retains fluid resulting in blood volume increase and hypertension. Hypokalemia and Alkalosis: A minor function of aldosterone is the excretion of H- ions. Both K and H ions are positive which results in a higher PH balance.

56
Q

What are three different treatment options for Conn Syndrome?

A

Aldrenalectomy for adenoma. Drugs for hyperplasia (aldosterone receptor antagonist). Na restriction.

57
Q

What is primary deficiency of the Adrenal cortex called?

A

Addison’s disease.

58
Q

What group of hormones are affected by Addison’s disease?

A

All three main groups: Glucocorticoids, Mineral Cortisoids, and Androgens.

59
Q

What is the etiology of Addison’s disease?

A
  1. Autoimmunity. 2. Infection. 3. Tumor (non-secreatary cells, need space, so damage normal surrounding tissue causing decreased hormones). 4. High dose glucocorticoid treatment that causes decreased ACTH
60
Q

What are several manifestations of Addisons disease?

A
  1. Mineral corticoid difficency - increases urinary losses of Na, Cl and water. Fluid loss means hypovolemia and decreased cadiac output. Resulting in hypotension presenting as weakness, fatigue and hyponatremia. 2. Glucocorticoid deficiency - decreased amounts of cortisol results in poor tolerance to stress and a decreased general adaptive syndrome. 3. Weight loss. 4. Addisonian crisis - an actue insufficiency of hormones due to stress, disease, emotion, or infection which is not being adequately managed. Can be fatal.
61
Q

What are the possible treatments for acute and chronic adrenal gland hypofunctions?

A

Acute: IV fluids for hypvolemic state, and hypotension. Chronic: Hormone replacment of glucocorticoids and mineral corticoids.

62
Q

What are the two main components of the Pituitary Gland?

A

The Anterior pituitary and the Posterior pituitary.

63
Q

The majority of endrocrine disorders occur in which part of the pituitary gland?

A

Anterior pituitary

64
Q

What is the major cause of endorcrine disorders in the pituitary gland?

A

Adenomas.

65
Q

What is an adenoma?

A

An adenoma is a benign tumor of epithelial tissue with glandular origin or characteristics.

66
Q

What are trophic hormones? What are several examples?

A

Trophic hormones are hormones that have a growth effect (hyperplasia or hypertrophy) on the tissue it stimulates. Two examples are: thyroid-stimulating hormone (TSH) which stimulates the thyroid gland, if excessive, it cause create a goiter. Adrenocorticotropic hormone (ACTH) which stiumlates the adrenal cortex increasing the size and number of cells.

67
Q

What are tropic hormones? What are several examples of tropic hormones?

A

Tropic hormones are hormones that have other endocrine glands as their target. Most tropic hormones are secreated by the anterior pituitary. Several examples are: Thyroid stimulating hormone (TSH) which stimulates the thyroid gland to make and release thyroid hormone (T4 - Thyroxine). Adrenocorticotropic hormone (ACTH) which stimulates the adrenal cortex to release glucocorticoids. Lueinizing hormone (LH) and Follicle-stimulating hormone (FSH) which stiumlates the release of steroid hormones in the gonads.

68
Q

What are non-tropic hormones? What are several examples?

A

Non-tropic hormones are hormones that directly stimulate target cells to induce effects. The act at the end of the chain reaction on cells that are not part of other endocrine glands. Several examples are: Glucocorticoids secreted from adrenal glands which alter blood glucose, involved in stress response. Vasopressin (ADH) secreted by posterior pituitary and acts on kidneys to maintain water balance.

69
Q

What occurs when there is an adenoma which causes a hyperactivity of the anterior pituitary gland? What are two examples?

A

The adenoma can result in a hypersecretion of trophic (growth effect) and non-trophic hormones which result in hyperactivity of target glands. An example of a trophic stimulation is TSH being released which acts on the thryoid gland secreting Thyroxine (T4). An example of non-trophic stimulation is prolactinin (PRL) which stimlates the breast to produce milk.

70
Q

What is one result of hyperactivity of the posterior pituitary?

A

Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

71
Q

Explain what is happening during syndrome of inappropriate antidiuretic hormone (SIADH).

A

During SIADH the posterior pituitary is releasing an excessive amount of Anti-diuretic hormone resulting in excessive water retention increasing blood pressure stopping the renin-angiotension loop and impairing Na reabsorption and diluting components of the blood.

72
Q

When the body increases fluid through water retention, sodium follows. However, we become hyponatremic. Why? What is this called?

A

This is called dilutional hyponatremia. This occurs because the quantity of water in the body increases, diluting the sodium present.

73
Q

What is the treatment for a mild case of syndrome of inappropriate antidiuretic hormone?

A

Restriction of fluids. Diuretics. ADH antagonists.

74
Q

What disease is due to a hypoactive posterior pituitary and resultant ADH deficiency?

A

Diabetes Insipidus.

Kydd - Pathophysiology (15 decks)

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