Endocrine & Metabolic Disorders Flashcards
Adrenal Gland: Addison’s Disease
adrenal dysfunction that presents with hypofunction of the adrenal cortex causing a decrease in cortisol (glucocorticoid) and aldosterone (mineralcorticoid)
- Etiology
- when adrenal cortex produces insufficient cortisol and aldosterone = addison’s
- Signs/Sx
- widespread metabolic dysfunction 2nd to cortisol deficiency
- fluid and electrolyte imbalance 2nd to aldosterone deficiency
- hypotension
- weakness
- anorexia
- weight loss
- altered pigmentation
- shock and possible death (if not treated)
- Treatment
- long term drug intervention w/ synthetic corticosteriods and mineralocorticoids
Adrenal Gland: Cushing’s Syndrome
hyperfunction or oversecretion of adrenal cortex or long term use of corticosteriods due to inflammatory disorders results in excessive cortisol production
- Etiology
- when the pituitary gland produces excessive adrenocorticotropic hormone w/ subsequent hypercortizolism
- Signs/Sx
- evolve over a year
- persistent hyperglycemia
- growth failure
- truncal obesity
- purple abdominal striae
- moon shaped face
- buffalo hump
- excessive facial hair
- weakness
- acne
- HTN
- male gynecomastia
- depression, poor concentration, memory loss
- Treatment
- drug intervention
- radiation
- chemotherapy
- surgery
Thyroid Gland: Hypothyroidism
condition resulting from decreased thyroid hormone causing general depression of the metabolism. Diagnosed if TSH level is elevated
- Etiology
- Hashimoto’s Thyroiditis or underdeveloped thyroid
- Symptoms
- cold intolerance
- excessive fatigue/lethargy
- HA
- weight gain
- dry skin
- increasing thinness/brittle hair/nails
- peripheral edema
- peripheral neuropathy
- proximal weakness
- Treatment
- drug therapy
Thyroid Gland: Hyperthyroidism
Results from excessive production of thyroid hormone (Grave’s Disease) resulting in general elevation of body metabolism (iodine insufficiency)
- Etiology
- grave’s disease
- Symptoms
- tachycardia
- increased sweating
- heat intolerance
- increased appetite
- dyspnea
- weight loss
- inability to gain weight
- anxiety
- goiter
- exophthalmia (bulging of eyes)
- Treatment
- drug intervention
- radioactive iodine
- surgery
Metabolic X syndrome
abdominal
cholesterol
blood pressure
blood sugar
- abdominal obesity
- men > 40 inches
- women >35 inches
- cholesterol
- triglycerides > 150 mg/dL
- HDL < 40 men
- HDL < 50 women
- blood pressure
- SBP > 135
- DBP > 85
- blood sugar
- fasting glucose > 100 mg/dL
Type I Diabetes
Insulin-Dependent DM
- decreased number and size of islet cells resulting in absolute deficiency in insulin secretion
- children and young adults, symptom onset @ puberty
- Etiology
- autoimmune abnormalities
- genetic or environmental
- Requires insulin delivery via injection, insulin pump or inhalation
- prone to ketoacidosis (ketonuria)
Type II Diabetes
results from the inadequate utilization of insulin (insulin resistance) and progressive beta cell dysfunction; non-insulin dependent, adult onset
- Characteristics
- gradual onset
- not insulin depdendent
- not prone to ketoacidosis
- Etiology
- insulin resistance in muscle and adipose tissue
- progressive decline in insulin production
- innapropriate glucagon secretion
Classic Signs of DM
- hyperglycemia
- glycosuria
- polyuria
- polydipsia, dry mouth
- polyphagia
- unexplained weight loss
- fatigue
- blurred vision/HA
Complications of DM
microvascular disease
macrovascular disease
integumentary
musculoskeletal
neuromuscular
kidney impairments
vision impairments
liver impairments
- microvascular disease
- retinopathy
- renal disease
- polyneuropathy
- macrovascular disease
- dyslipidemia
- CVA, MI, PAD
- integumentary
- degeneration of connective tissue
- slow healing sores/cuts
- anhidrosis
- ulcers/infections
- musculoskeletal
- joint stiffness and contractures
- increased risk of adhesive capsulitis, tenosynovitis and plantar fascitis
- increased risk osteoporosis
- neuromuscular
- diabetic polyneuropathy
- cardiovascular autonomic polyneuropathy
- cardiovascular, integ, GI metabolic
- mononeuropathy
- entrapment neuropathy
- kidney impairments
- vision impairments
- liver impairments
Signs of Hyperglycemia:
- blood glucose > 180
- skin is dry and flushed
- fruity breath odor
- frequent urination (polyuria)
- unusual thirst (polydipsia)
- extreme hunger
- unusual weight loss (10 lbs/month)
- extreme fatigue
- irritability
- blurred vision
- fungal infections
- dizziness
Signs of Hypoglycemia
- blood glucose < 50-60
- skin is pale, cool and diaphoretic
- disoriented or agitated
- headache
- blurred vision
- slurred speech
- tachycardia w/ palpitations
- weak/shaky
- loss of consciousness
Diabetes Diagnosis Criteria
Symptoms of DM
casual plasma glucose >/= 200 mg/dL
fasting glucose >/= 126 mg/dL
2 hour post load glucose >/= 200 mg/dL
Hypoparathyroidism
decreased or absent production of PTH most common to injury/removal of the parathyroid gland.
Diagnosed w/ low serum calcium, and high phosphorous and low PTH levels
- neck stiffness/muscle cramps
- seizures
- irritability
- depression
- skeletal muscle twitching
- cardiac arrhythmias
- parasthesias (tips of fingers and mouth)
- Chvostek’s sign (twitching of facial ms w/ tapping of facial nerve in front of ear)
Hyperparathyroidism
(parathyroid glands secrete PTH, which regulates calcium and phosphorous metabolism)
Excess PTH leads to an elevated calcium level and decreased serum phosphate level.
Causes demineralization of the bone and subsequent loss of bone strength /density.
*most often discovered as asymptomatic hypercalcemia upon diagnosis*
- proximal weakness
- fatigue
- drowsiness
- arthralgia/myalgia
- depression
- glove/stocking sensory loss
- osteopenia/fractures
- confusion/memory loss
- pancreatitis
- gout
- osteitis fibrosa cystica (bone lesions = brown tumors)
Exercise Strategies for DM
- exercise produces insulin effect on body
- do not exercise during peak insulin time
- do not exercise 2-4 hrs after insulin injection
- decrease insulin dose 30-35% prior to exercise
- up to 30% after exercise
- inject insulin into non exercising body part > 1hr
- best time to exercise is 1 hr after meal
- increase complex carb intake atleast 24 hrs before and after
- check glucose prior to exercise
- 70 = carb snack and retest after 15 min
- >250 pt should not exercise
- between 70-100 = food if symptoms devel.
