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Pathophysiology and Pharmacology 2 > Endocrine Overview > Flashcards

Endocrine Overview Flashcards

1
Q

Role of Endocrine Regulation

A 
Sodium & Water balance
control of BP/blood volume
regulation energy balance
coordination of responses to stress
reproduction, growth & development
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2
Q

Anterior Pituitary Hormones

A 
Thyroid-stimulating hormone (TSH)
adrenocorticotropic hormone (ACTH)
growth hormone (GH)
follicle-stimulating hormone (FSH)
Lutenizing hormone (LH)
Prolactin
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3
Q

Posterior Pituitary Hormones

A 
Antidiuretic hormone (ADH)
Oxytocin
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4
Q

Releasing Hormones

A

from hypothalamus to pituitary

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5
Q

Trophic Hormones

A

from pituitary to peripheral glands

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6
Q

Hypothalums Hormone patterns

A

TRH –> TSH –> Thyroid –> (t4/t3)
CRH –> ACTH –> Adrenal –> (glucocorticoids)
GnRH –> LH/FSH–> Ovary/Testis –> (estrogen/testosterone)
GHRH –> GH –> Liver –> (IGF-1)

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7
Q

Steroid Hormones

A

Cortisol
Estrogen
Testosterone

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8
Q

Peptide Hormones

A

Insulin
GH
Parathyroid hormone

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9
Q

Protein Hormones

A

ACTH
ADH
Glucagon

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10
Q

Amine Hormones

A

Epinephrine

Norepinephrine

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11
Q

Water Soluble Hormones

A

Receptor on cell membrane
fast action
dissolved in plasma
short half-life

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12
Q

Lipid Soluble Hormones

A

receptor inside cell
slow speed of action
attached to carrier proteins

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13
Q

Total Hormones

A

protein-bound hormones + free hormones

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14
Q

Hormone Disorders: Ranking

A

Primary: abnormality in gland
Secondary: ab in stimulation from pituitary
Tertiary: ab in stim from the hypothalamus

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15
Q

Hyperpituitarism (Acromegaly) cause

A

hyper secretion of GH by anterior pituitary in adults

usually by pituitary tumors

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16
Q

Hyperpituitarism (Acromegaly) assessment

A 
large hands/feet
thickening/protrusion of jaw
joint pain
visual disturbances
sweating
oily/rough skin
organomegaly
HTN
atherosclerosis
cardiomegaly
heart failure
dysphagia/sleep apnea
narrowing of airway
deepening of voice
hyperglycemia
colon polyps (increased risk for colon cancer)
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17
Q

Hyperpituitarism (Acromegaly) interventions

A

pharmacology to suppress GH or block GH
radiation to pituitary gland or removal
joint pain control/anti hypertensives

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18
Q

Acromegaly Medications

A 
Samastatin Analogs (octreotide, lanreotide)
Growth Hormone Receptor Antagonists [GHRAs] (pegvisomant)
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19
Q

Hypopituitarism cause

A

hyposecretion of pituitary hormones

tumors/trauma/encephalitis/autoimmunity/stroke

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20
Q

Hypopituitarism Hormones most affected:

A

GH/LH/FSH

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21
Q

Hypopituitarism Hormones Least Effected:

A

ACTH/ADH/TSH

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22
Q

Hypopituitarism assessment

A 
mild to moderatete obesity (GH/TSH) 
reduced cardiac output (GH ADH)
infertility/sexual dysfunction (FSH/LH/ACTH)
fatigue/low BP (TSH ADH ACTH GH)
headaches/visual defects
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23
Q

Hypopituitarism TX

A

hormone replacement for deficient hormones

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24
Q

Syndrome of Inappropriate Andtidiuretic Homrone (SIADH) causes

A 
hyperfunctioning of posterior pituitary gland causing ADH 
trauma
stroke
malignancies (lung/pancreas)
medications
stress
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25
SIADH patho
excess ADH > excessive water absorption by kidneys > low serum osmolality/sodium > urine output decreased/concentrated
26
SIADH risks
``` water intoxication cerebral edema (seizure risk) ```
27
SIADH assessment
``` pulmonary edema (pink, frothy sputum) changes in LOC weight gain HTN tachycardia anorexia nausea vomiting hyponatremia (dilutional) low urinary output high specific gravity of urine ```
28
SIADH TX
``` monitor cardia/neuro status (telemetry) monitor fluid balance (i/o > catheter) monitor electrolytes/urine osmolality restrict fluid intake if IVF risk of fluid volume overload hypertonic saline (3% saline) salt tablets ```
29
seizure precautions
``` sodium <120 greatest threat to survival fluid restriction don't hold down if seize pad beds put hands on handrails mouthguard maybe ```
30
SIADH Medications
loop diuretics may need K+ replacement aquaretics vasopressin receptor antagonists (-vaptans) [conivaptan] demeclocycline (tetracycline ABX decreases renal response to ADH)
31
Adrenal Medulla
Inner part of adrenal glands secretes 75-80 epinephrine 15-20 norepinephrine fight or flight
32
Adrenal Cortex Hormones
>30% gluccocorticoids Mineralocorticoids Gonadocorticoids
33
Glucocorticoids
``` cortisol cortisone corticosterone impact metabolism in cells prepare body for long-term stress ```
34
mineralocorticoids
aldosterone | promotes sodium reabsorption and potassium secretion by kidneys
35
Gonadocorticoids
``` mostly androgens (male) small amounts of estrogen lower levels compared to testes/ovaries ```
36
zona glomerulosa
controlled by renin-angiotensin-aldosterone system | controlled by blanace in potassium/ACTH
37
primary adrenocortical insufficiency (Addison Disease) pathogenesis
dysfunction of adrenal cortex hyposecretion of adrenocortical hormones automimmune diesase TB
38
Addison Disease s/s
``` lowered plasma cortisol increased plasma ACTH fatigue weakness weight loss anorexia nausea vomiting abdominal pain diarrhea constipation hypotension dehydration hypoglycemia hyponatremia hyperkalemia acidosis pigmentation ```
39
Addison Disease TX
hydrocortisone saline solution glucose
40
Addison Disease Interventions
watch VS and I/O, blood glucose, potassium, sodium and lipids lifelong glucocorticoid/mineralcorticoid therapy may need insulin avoid infections/strenuous exercise/stressful situations wear med alert bracelet high protein/carb diet supplement calcium/vitamin D
41
prednisone
tx Addison's
42
fludocortisone
synthetic adrenocoritcal steroid tx addison's very potent mineralocorticoid
43
hydrocortisone sodium succinate or phosphate
drug of choice for adrenal crisis/daily maintenance Addison's
44
daily dehydroepiandrosterone (DHEA)
androgen replacement | improve libido/well-being
45
hydrocortisone MOA and use
``` synthetic corticosteroid (short-acting) andrenocortical insufficiency (usually lifelong) ```
46
hydrocortisone SE
``` sodium/fluid retention insomnia anxiety headache vertigo confusion depression high-doses increase dopamine (depression/mood swings/psychosis) + lower serotonin in brain impaired wound healing adrenal atrophy osteoporsis muscle wasting CHF edema cataracts glaucoma DON'T DISCONTINUE SUDDENLY = Addisonian crisis ```
47
Secondary Adrenocortical Insufficiency causes
hypothalamic-pituitary disease | ant pit malfunction leading to loss of ACTH production
48
Secondary Adrenocortical Insufficiency clincal manifestations
Primary w/out pigmentation changes no hypokalemia less prominent hypotension
49
Secondary Adrenocortical Insufficiency diagnosis
``` basic metabolic panels early morning cortisol levels rapid ACTH stimulation test plasma ACTH levels insulin-induced hypoglycemia ```
50
Secondary Adrenocortical Insufficiency TX
hormone replacement | adrenal crisis: replace glucocorticoids/water/sodium
51
cosyntropin use
diagnosing cause of adrenocortical insufficiency injection then test for secretion of cortisol positive = adrenal gland issue negative = pituitary/hypothalamus issue measure cortisol levels 30 - 60 min after admin
52
Cushing's Syndrome causes
``` chroniic exposure to excess glucocorticoids change in protein/fat metabolism (central obesity/moonface/buffalo hump/thin skin/easy bruising/osteoporsis/diabetes) change in sex hormones (excess hair growth/irregular menses/infertility/impotence) changes in aldosterone (salt/water retention/^BP) Cushings Disease (ACTH-dependent cushing syndrome) ```
53
Cushing Syndrome Manifestations
``` obesity (thin arms/legs) osteoporosis hyptention cardiac hypertrophy increased appetite overactivity of steroid-producing cells atrophy of skin gains weight rapidly irregular menses increased protein breakdown easy bruising decreased immune/inflammatory response labile mood depression anxiety diabetes mellitus ```
54
Cushing Syndrome development
over a period of years | excessive ACTH > excessive stimulation of adrenal cortex = excessive production of glucocorticoids
55
Cushing's Disease Diagnosis
establish presence of hypercorticolism | classifying as ACTH-dependent or independent
56
Cushing Syndrome Primary TX
resection of ACTH-secreting tumor radiotherapy lifetime replacement of glucocorticoids
57
Cushing Syndrome Iatrogenic syndrome:
gradual withdrawal of medications
58
ACTH-independent Cushing syndrome TX:
adrenalectomy
59
Cushing ACTH-secreting tumors TX:
resection when possible
60
Cushing Metastaic disease TX:
medications
61
Primary Hyperaldosteronism (Conn Syndrome) cause
renin-independent hyperaldosteronism excess aldosterone production w/in adrenal cortex commonly b/c of adenoma (benign tumors) or bilateral adrenocortical hyperplasia (^ # of cells)
62
Conn Syndrome s/s
``` electrolyte disturbances ha fatigue muscle weakness cardiac dysrhthmias paresthesia tetany (muscle spasms) visual changes glucose intolerance elevated aldosterone polydipsia polyuria unexplained hypokalemia ```
63
Conn Syndrome Interventions
``` VS (BP) i/o urine specific gravity diuretics ACE inhibitors beta-blockers adrenalectomy (followed by lifelong glucocorticoids) ```
64
Adrenal Medullary Hyperfunction (Pheochromocytoma) cause
neruoendocrine tumors (typically benign)
65
Pheochromocytoma risk factors
familial/genetic syndrome | men syndromes
66
Pheochromocytoma manifestations
``` severe headaches excessive sweating flushing heat intolerance sustained hypertension palpitations tachycardia chest ppain anxiety panic attack nausea/vomiting weight loss tremors hyperglycemia ```
67
Pheochromocytoma diagnosis
24 hr urine collection (measuring VMA) CT w/ contrast MRI imaging w/ radioactive tracers
68
Pheochromocytoma interventions
monitor VS serum glucose urine output (worry for hypertensive crisis)
69
Pheochromocytoma TX
complete surgical removal of tumor alpha-adrenergic blockers (10-15 days B4 surgery) beta blockers/antihypertensives
70
Pheochromocytoma Complications
``` hypertensive crisis, hypertensive encephalopathy retinopathy nephropathy cardiac enlargement dysrhythmias heart failure MI increased platlet aggregation risk of stroke shock renal failure dissecting aortic aneurysm (death) ```
71
Pheochromocytoma education
``` promote rest/nonstressful education avoid increased intra-abdominal pressure avoid stimulants (nicotine/caffeine)/sudden position changes ```
72
Pheochromocytoma first-line drugs therapy
Alpha-adrenergic blocking agents | prazosin/terazosin/doxazosin
73
Pheochromocytoma secondary TX
beta blockers | propranolol nadolol
74
Thyroid information
right and left lobe | thyroid follicle
75
Thyroid hormones
``` control basal metabolic rate growth/development in infants&children mental development sexual maturity cardiovascular/respiratory/GI/neuromuscular function triiodothyronine (T3) Thyroxine (T4) Calcitonin ```
76
Graves Disease:
hyperthyroidism
77
Hashimoto thyroiditis
hypothyroidism
78
Thyroxine T4
storage form (converted into T3)
79
Triiodothyronine (T3)
energy form
80
Calcitonin
responsible for calcium homeostasis
81
Iodine
essential for synthesis of T4/T3
82
Thyroid Regulation
negative feedback loop | the more thyroxine = less TRH/TSH released
83
``` Thyroid Hormones: Actions Metabolic CV/Respiratory GI ETC ```
increases basal metabolic rate increases CO/HR/ventilation/muscle contractilty/vasodilation increases appetite/diarrhea increases skeletal muscle activity increase sympathetic activity growth developments bone/sexual/cognitive
84
``` Hypothyroidism primmary causes Goiter Thyroiditis Hashimoto's thyroiditis Thyroidectomy ```
iodine deficiency inflammation autoimmune (most common) surgical removal
85
Hypothyroidism Secondary causes
deficient TSH secreted from anterior pituitary causes thyroid atrophy
86
Secondary Hypothryoidism early vs severe symptoms
``` generalized weakness muscle cramps dry skin vs slurred speech bradycardia weight gain decreased taste/smell intolerence of cold altered mental status (> coma) ```
87
Goiters
abnormal growth of thryoid gland nodular or diffuse can cause normal/decreased or increased thyroid hormone production
88
Nontoxic diffuse goiters
simple goiters | no overt hyper/hypo thyroidism
89
nontoxic multinodular goiters
growth factors | normal TSH
90
endemic goiter
iodine deficiency; increased TSH
91
chronic autoimmune (Hashimoto) thyroiditis:
hypothyroidism
92
toxic multinodular goiter (Graves)
hyperthyroidism
93
Goiters causes | [worldwide - US - uncommon]
iodine deficiency - multinodular goiter/hashimoto/graves/increased TSH due to defect in hormone synthesis - tumors/thyroiditis/infiltrative disease
94
Goiters s/s
associated w/ thryoidal dysfunction/growth rate of goiter | long standing goiters: obstruction/sudden increase in size
95
Goiters diagnosis
physical exam thru palpation clinical symptoms TSH/T3/T4 autoantibodies
96
Goiters TX
small/mod: oral thyroid hormone removal if malignancy is suspected
97
Levothyroxine action/uses
endogenous thyroid hormone | replaces T4 in patients with low hyroid function
98
Levothryoxine SE
``` hyperthyroidism palpitations dysrhythmias anxiety insomnia weight loss heat intolerance menstrual irregularities osteoporosis (in women) ```
99
Levothyroxine Nursing interventions
VS/HR/rhythmn | monitor for overdose (tachycardia/chest pain/restlessness/nervousness/insomnia)
100
Levothyroxine Teaching
``` relief of symptoms 3-4 weeks recheck hormone levels 4-6 weeks full therapeutic 8 weeks diet: low calorie/low cholesterol/low saturate fat/roughage/fluids help avoid constipation daily exercise ```
101
Levothyroxine AVOID
sedatives/opioid analgesics =sensitivity > myxedema coma
102
Myxedma Coma causes
``` persistently low thyroid production by acute illness rapid withdrawal of thyroid medications anesthesia/surgery hypothermia use of sedatives/opioid analgesics ```
103
Myxedma Coma Assessment:
``` hypotension bradycardia hypothermia hyponatremia hypoglycemia generalized edema respiratory failure coma ```
104
Myxedma Coma interventions
``` maintain patient airway prevent aspiration (don't lie pts flat, have suction available) assess body temp hourly BP frequently monitor mental status monitor electrolytes /glucose levels ```
105
Myxedema Coma TX
Iv fluids levothyroxine sodium IV IV dextrose (tx hypoglycemia/NPO) corticosteroids
106
Hyperthyroidism (Primary) causes
``` Graves disease (most common) multinodular goiters toxic adenomas iodine-induced hyperthyroidism thyrotoxicosis factitial ```
107
Hyperthyroidism (Primary) s/s
``` tachycardia atrial fibrillation fine tremors proximal muscle weakness goiter warm, moist skin hyperreflexia lid lag/retraction stare alopecia exophthalmos (eye protrusion) increased metabolism anxiety insomnia palmar erythema ```
108
Hyperthyroidism (Primary) Diagnosis
Suppressed serum TSH w/ elevated T4 | thyroid peroxidase antibodies
109
Hyperthyroidism (Primary) Interventions
``` adequate rest/cool, quiet environment daily weights high calorie/low sodium diet avoid stimulants artificial tears/dark glasses ```
110
Hyperthyroidism (Primary) TX
partial/total thyroidectomy medications to decrease hormone production radioactive iodine propranlol (for tachycardia)
111
Propylthiouracil (PTU) methimazole Action
inhibits incorporation of iodine into thyroid hormones
112
PTU & methimazole Interventions/Labs
assess s/s of hypothyroidism, jaundice and bleeding | thyroid hormone levels, TSH, ECG, CBC, Liver enzymes
113
PTU & methimazole SE
hepatoxic, agranulocytosis (decreased immune response)
114
Radioactive Iodide Action
destroys cells in thyroid more permanent/long-term solution usually hypothyroid post-therapy (requiring levothyroxine)
115
Radioactive Iodide teaching
avoid children/pregnant people one week post admin | limit contact with others for a few days post admin
116
Thyroid Storm (Thyrotoxicosis) causes
acute/life-threatening manipulation of gland in surgery severe infection stress
117
Thyrotoxicosis s/s
``` elevated body temperature tachycardia hypertension n/v/d tremors anxiety irritability agitation restlessness confusion seizures delirium coma ```
118
Thyrotoxicosis TX
``` maintain patient airway (don't lie on back) monitor VS/CV cooling blanket/ice packs antithyroid meds (PTU) radioactive iodide propanolol corticosteroids iodine --> to prepare for throidectomy DO NOT GIVE SALICYLATES (ASPIRIN) ```
119
Thyroiditis etiology
inflammation of thyroid
120
Subactue thyroiditis
``` transient hypo/hyper thyroidism upper respiratory infection tender painful minimally enlarged thyroid ```
121
Painless thyroiditis
transient hyper/hypo thyroidism
122
postpartum thyroiditis
``` autoimmune disorder transient hyper/hypothyroidism follicular damage (release of stored t3/t4) ```
123
infectious thyroiditis
infection of the thyroid gland | acute: sudden onset of neck pain, tenderness, fever, chills dysphagia, neck swelling
124
Thyroiditis TX
normalize thyroid levels
125
Thyroid Nodules Causes
abnormal growth of thyroid cells forming lumps multinodular goiter hashimoto thyroiditis follicular adenomas
126
Thyroid Nodules s/s
excessive T3/T4 | obstructive symptoms
127
Thyroid Nodules Diagnosis
``` history/physical exam TSH thyroid ultrasound thyroid scintigraphy fine-needle aspiration cytology biopsy ```
128
Hyperthyroidism (Secondary) s/s
symptoms of hyperthyroidism | tumor mass s/s r/t obstruction
129
Hyperthyroidism (Secondary) Diagnosis
hyperthyroidism w/ diffuse goiter w/o s/s of Graves | high/normal T4/3 w/ elevated TSH
130
Thyroid Cancer types
Papillary (most common) follicular (aggressive) medullary (from parafollicular C cwlls) anaplastic (undifferentiated follicular extremely aggressive)
131
Thyroid Cancer s/s
rapid nodular growth; fixed hoarseness/loss of voice cervical lymphadenopathy
132
Thyroid Cancer TX
papillary/follicular (total thyroidectomy, remnant ablation therapy, levothyroxine) medullary (total thyroidectomy/levothyroxine) anaplastic (surgical resection, radiation, chemotherapy)
133
Parathyroid info
4 secreting glands regulates calcium/phosphate target organs (intestinal mucosa/kidney/bones)
134
Hypoparathyroidism cause
surgery (most common) autoimmune familial idiopathic
135
Hypoparathyroidism s/s
``` hypocalcemia hyperphosphatemia trosseau's and chvostek sign increased neuromuscular excitability tetany bronchospasm laryngospasm dysphagia seizures cardiac dysrhythmias hypotension anxiety irritability ```
136
Hypoparathyroidsim Diagnosis
calcium decreased | phosphate increased
137
Hypoparathyroidism Interventions
monitor closely fo rhypocalcemia (spasms/cramps/tetany) | initiate seizure precautions
138
Hypoparathyroidism thyroidectomy
prepare tracheostomy set/oxygen/suction equipment for return
139
Hypoparathyroidism Diet
high calcium, low phosphorus may need calcium supplements vitamin D supplements phosphate binders
140
Hyperparathyroidism Primary
generalized disorder of calcium, phosphate and bone metabolism resulted from increased PTH
141
Hyperparathyroidism Secondary
diffuse hyperplasia of parathyroid glands due to external cause
142
Hyperparathyroidism Tertiary
results from excessive sustained release of PTH
143
Hyperparathyroidism s/s
``` hypercalcemia/hypophosphatemia fatigue muscle weakness bone deformities fractures skeletal pain anorexia N/v epigastric pain weight loss constipation hypertension dysrhthmias renal stones ```
144
Hyperparathyroidism Diagnosis
calcium and PTH levels | radiologic studies
145
Hyperparathyroidism TX
surgery phosphates IV IV/PO (sodium phosphate/potassium phosphate) bisphophonates (alendronate sodium)
146
Hyperparathyroidism Interventions
Monitor VS/BP/CV/IO/CA/PHOS diet: high-fiber, moderate calcium monitor for skeletal pain

Pathophysiology and Pharmacology 2 (27 decks)

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