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NURS 322 > Endocrine System > Flashcards

Endocrine System Flashcards

1
Q

What are the 2 ways that hormones can achieve effect?

A
  1. single hormone can affect multiple tissues
    • estradiol – matures and maintains reproductive system, cause maturation and release of egg during menstruation, and thickens uterus lining
  2. single function regulated by multiple hormones
    • lipolysis controlled by many hormones
      • epinephrine
      • norepinephrine
      • thoralidor
      • growth hormone
      • cortisol
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2
Q

What are the 2 mechanisms of action for hormones?

A
  1. surface cell receptors – surface receptors receive hormone, effect achieved by second messenger
  2. nuclear receptor – hormone enters cell nucleus and alters cell function
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3
Q

What part of the brain is the coordinating center of the endocrine system?

A

hypothalamus

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4
Q

What is the purpose of the pituitary gland in the endocrine system?

A
  • AKA master gland
  • secretion of hormones that control functions of cells through negative feedback
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5
Q

What do the anterior and posterior pituitary control?

A

– anterior pituitary:

  • growth
  • metabolic activity
  • sexual development
  • secretes tropic hormones

– posterior pituitary:

  • secretes vasopressin (ADH)
  • secrete oxytocin (sexual reproduction, bonding hormone)
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6
Q

Where are the adrenal glands located?

A

on top of each kidney

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7
Q

What are the 2 hormones that the adrenal glands secrete?

A
  1. mineralocorticoids – controls body’s potassium and sodium content
    • ex: aldosterone
  2. glucocorticoids
    • metabolism of carbs, proteins, fat
    • stress response
    • emotional stability
    • immune function
    • ex: cortisol
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8
Q

What hormone does the adrenal medulla secrete?

A

catecholamines (stimulates fight/flight response)

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9
Q

How would you assess the endocrine system?

A
  • obtain a nutrition history
    • changes in food and fluid intake
    • dietary deficiencies
  • changes in energy level
    • may be due to thyroid or adrenal disorder
  • elimination patterns
  • sexual and reproductive function
    • greatly affected
  • physical appearance changes
    • hair texture/distribution
    • facial
    • voice quality
    • proportion
  • may be difficult to assess due to a variety of signs and symptoms
  • may be gender related
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10
Q

What kind of diagnostic tests could confirm endocrine disorders?

A
  • blood assays
    • test hormone levels
  • urine tests – usually 24 hour collection
  • stimulation and suppression tests
    • admin stimulating or suppressing agents and measure response
  • glucose tests
    • tests pancreas function
  • imaging – MRI or radioactive scanning
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11
Q

What are 2 disorders of the anterior pituitary gland?

A
  1. hypopituitarism
  2. hyperpituitarism
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12
Q

What is hypopituitarism?

A

deficiency of one or more hormones (like gonadotropins or growth hormone)

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13
Q

What results in a gonadotropin hormone deficiency?

A

changes in sexual function

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14
Q

What results in a growth hormone deficiency?

A
  • in children – short stature
  • in adults – increased rate of bone destruction
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15
Q

How does a gonadotropin deficiency present differently in males and females?

A
  • males – facial body hair loss, impotence
  • females – amenorrhea, dyspareunia (painful intercourse), decreased libido
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16
Q

What are some causes of hypopituitarism?

A
  • tumors (benign or malignant)
  • anorexia nervosa
  • shock
  • severe hypotension
  • head trauma
  • infection
  • pituitary adenoma
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17
Q

What are some assessment characteristics for hypopituitarism?

A
  • secondary sex characteristics
  • changes in visual acuity
    • vision
    • peripheral vision
    • diplopia
    • limited eye movement
    • headaches
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18
Q

What is the primary intervention for hypopituitarism?

A

replacement of deficient hormones

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19
Q

What is hyperpituitarism?

A

oversecretion of one or more hormones

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20
Q

What is acromegaly? Why is early detection and treatment important for acromegaly?

A

– acromegaly: an oversecretion of growth hormone after puberty

– early detection and treatment prevent irreversible damage

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21
Q

What is gigantism?

A

oversecretion of growth hormone before puberty

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22
Q

What is the most common cause of hyperpituitarism?

A

pituitary adenoma – abnormal growth of tissue surrounding pituitary gland (pituitary tumor that compresses the optic chiasm and arteries in the brain)

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23
Q

What are some assessment characteristics for hyperpituitarism?

A
  • impotence
  • amenorrhea
  • libido changes
  • fatigue
  • changes in visual acuity
    • headache
    • visual disturbance
  • weight changes – could indicate tumor
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24
Q

What are some treatment interventions for hyperpituitarism?

A
  • drug therapy
    • parlodel – reduces amount of GH produced
    • sandostatin – reduces amount of circulating GH
    • permax
    • dostinex
    • somavert
  • radiation
  • gamma knife procedure – emits radition to make pituitary gland/tumor smaller
  • hypophysectomy – removal of pituitary gland/tumor
  • operation
    • endoscopic transnasal
    • transsphenoidal approach
    • craniotomy
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25
Q

What are some important postoperative care interventions for hyperpituitarism?

A
  • monitor neuro response
  • assess for post-nasal drip or nasal drainage
    • could be CSF
  • elevate HOB
    • decreases chance of increased intracranial pressure
  • avoid coughing or straining (constipation)
  • avoid brushing teeth
  • assess for meningitis
  • avoid bending
  • educate on hormone replacement treatment
  • assess for numbness in incision area
  • assess for decreased sense of smell
  • administer vasopressin (ADH)
    • ADH production will be decreased with removal of pituitary
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26
Q

What are 2 disorders of the posterior pituitary?

A
  • diabetes insipidus
  • syndrome of inappropriate antidiuretic hormone (SIADH)
27
Q

What is diabetes insipidus?

A

a deficiency in ADH – the body does not naturally produce ADH

28
Q

What are some signs and symptoms of diabetes insipidus?

A
  • loss of large volumes of dilute urine
    • more than 4L in 24 hours
  • excessive thirst
  • hypotension
  • tachycardia
  • high hemoglobin and hematocrit
  • high BUN
  • dry, cracked mucus membranes
29
Q

How is diabetes insipidus diagnosed?

A
  • 24 hour intake and output measurement
  • MRI of head
  • urinalysis
30
Q

What are some interventions for diabetes insipidus?

A
  • encourage fluids
  • monitor I&Os
  • daily weights
  • medications
    • Diabinese (chlorpropamide) – diabetes medication that stimulates pancreas to produce insulin and decrease blood sugar
    • desmopressin – synthetic form of ADH
31
Q

What is syndrome of inappropriate antidiuretic hormone (SIADH)?

A

when ADH is secreted even when plasma osmolarity is low or normal

32
Q

What are some signs and symptoms of SIADH?

A
  • hyponatremia
  • fluid overload
  • lethargy
  • headaches
  • changes in LOC
  • tachycardia
  • hypothermia
33
Q

How is SIADH diagnosed?

A
  • labs
    • serum electrolytes
    • BUN
    • creatinine
    • urinalysis
34
Q

What are some interventions for SIADH?

A
  • fluid restriction
  • measure I&Os
  • daily weights
  • hypertonic saline – when serum saline is very low
  • medications
    • vasopressin antagonists – promote water excretion without sodium loss
      • Samsca (tolvaptan)
      • Vaprisol (conivaptan)
    • diuretics – when sodium is normal and HF is present
35
Q

What are 2 disorders of the adrenal gland?

A
  • adrenal gland hypofunction (acute adrenal insufficiency)
  • adrenal gland hyperfunction
36
Q

How does adrenal gland hypofunction (acute adrenal insufficiency) result?

A
  • destruction of adrenal glands (primary form AKA Addisons)
    • nonspecific autoimmune response
    • infection
    • trauma
37
Q

Discuss the pathophysiology of Addison’s disease.

A

– cortisol and aldosterone levels are low

– hypothalamus and anterior pituitary secrete:

  • CRH (corticotropin releasing hormone) – stimulates adrenal glands
  • ACTH (adrenocorticotrophic hormone) – stimulates secretion of cortisol (glucocorticoids) and aldosterone (mineralcorticoids)
38
Q

What are some signs and symptoms of Addison’s disease?

A
  • lethargy
  • fatigue
  • anemia
  • low BP
  • hyponatremia
  • hyperkalemia
  • hypercalcemia
  • bronze skin pigmentation – from increased secretion of ACTH which affects melanocyte stimulating hormone
  • thinning body hair
  • hypoglycemia
39
Q

How is Addison’s disease diagnosed?

A
  • ACTH stimulation study – most definitive
  • blood studies
    • decreased cortisol
    • decreased fasting blood glucose
    • decreased sodium
    • high potassium
    • high BUN
  • imaging – skull X-rays, CT
    • CT will determine pituitary or adrenal gland issue
40
Q

What are some interventions for Addison’s disease?

A
  • measure I&Os
  • daily weights
  • assess for hypoglycemia
  • assess vitals and heart rhythm
  • medications
    • cortisol replacement – prednisone
    • mineralocorticoid hormone – fludrocortisone (Florinef)
41
Q

What is adrenal gland hyperfunction?

A

oversecretion of one or many adrenal hormones

42
Q

What is an example of a disease that results from adrenal gland hyperfunction? What demographic more commonly gets this disease?

A

– Cushing’s disease – hypercortisolism

– more common in women

43
Q

What are some signs and symptoms of Cushing’s disease?

A
  • increased total body fat
    • trunk obesity
    • buffalo hump
    • moon face
  • hypertension
  • muscle atrophy
  • osteoporosis
  • striae
  • thinning skin
44
Q

What are some interventions for Cushing’s disease?

A
  • restore fluid balance
    • drug therapy – decrease cortisol production
    • nutrition
      • restrict fluids
      • restrict sodium
  • adrenalectomy
  • prevent skin injury
  • prevent infection
  • prevent acute adrenal insufficiency by regular administration of corticosteroids
45
Q

What is hyperthyroidism?

A

excessive secretion of thyroid hormone

46
Q

What is Graves’ disease? What are some signs and symptoms?

A

– Graves’ disease: autoimmune disorder where antibodies attach to TSH receptor sites, increasing thyroid gland size and increasing thyroid hormone production

  • most common manifestation of hyperthyroidism

– signs and symptoms:

  • goiter
  • exophthalmos (bulging eyeballs)
  • pretibial myxedema
47
Q

What are 2 other manifestations of hyperthyroidism?

A
  1. toxic multinodular goiter – hyperthyroidism caused by multiple thyroid nodules
  2. exogenous hyperthyroidism – excessive use of thyroid replacement hormones
48
Q

What are some signs and symptoms of hyperthyroidism?

A
  • heat intolerance – hallmark sign
  • weight loss
  • increased daily BMs
  • exophthalmos
  • photophobia (sensitivity to light)
  • goiter
  • mood swings
49
Q

How is hyperthyroidism diagnosed?

A
  • labs
    • serum T3
    • serum T4
    • free T4
    • TSH
    • TSH-RAb – high titers indicate Graves’ disease
  • thyroid scan – evaluates size and position of thyroid
    • increased uptake in iodine = hyperthyroidism
  • ultasonography – evaluate masses or nodules
  • EKG – assess tachycardia
50
Q

What are some interventions for hyperthyroidism?

A
  • monitor temperature
  • provide quiet environment
  • reduce room temp
  • encourage fluids
  • encourage cool showers
  • medication
    • antithyroid drugs (PTU) – decrease iodine uptake
    • iodine preparations
    • beta-adrenergic blocking drugs
  • radioactive iodine therapy (RAI)
    • thyroid picks up RAI
    • thyroid cells become destroyed by radiation
    • thyroid hormone replacements needed for life
  • thyroidectomy
51
Q

What are some etiologies of hypothyroidism?

A
  • thyroidectomy
  • RAI therapy
  • low iodine intake
52
Q

Describe the difference in incidence between hyperthyroidism and hypothyroidism.

A

– hyperthyroidism – more common in women 20 - 40 years old

– hypothyroidism – more common in women 30 - 60 years old

53
Q

What is hypothyroidism? What are 2 tell-tale signs of hypothyroidism?

A

– hypothyroidism: decreased metabolism from low levels of thyroid hormones

– 2 tell-tale signs:

  • myxedema: mucousy, nonpitting edema
  • myxedema coma: decreased metabolism of hypothyroidism causes reduced cardiac output and decreased perfusion to the brain and other organs
    • life-threatening
    • high mortality rate
    • rare
54
Q

What is Hashimoto’s disease?

A

an autoimmune disease of the thyroid, causing hypothyroidism

55
Q

What are some signs and symptoms of hypothyroidism?

A
  • increased time sleeping and lethargy
  • cold intolerance
  • facial edema
  • bradycardia
  • weight gain
  • goiter
  • depression
56
Q

How is hypothyroidism diagnosed?

A
  • labs
    • decreased T3
    • decreased T4
    • variable TSH
57
Q

What is thyroiditis? What are the 3 types?

A

– thyroiditis: inflammation of thyroid gland

– 3 types:

  1. acute – bacterial
  2. subacute – viral
  3. chronic – autoimmune (bacterial or viral)
    • Hashimoto’s disease – most common type
      • affects women more than men
58
Q

What are the 4 types of thyroid cancers? Which is most common? How do you treat each type?

A

– 4 types of thyroid cancers:

  1. papillary: slow growing; affects younger women
  2. follicular: invades blood vessels; adheres to trachea, neck, great vessels; affects older pts
  3. medullary: occurs as part of multiple endocrine neoplasia; affects pts 50+
  4. anaplastic: rapidly growing, aggressive tumor

– papillary is most common

– anaplastic is treated with radiation; papillary, follicular, and medullary are treated with surgery

59
Q

What is the function of the parathyroid glands?

A

maintain calcium and phosphate balance

60
Q

What is hyperparathyroidism? What is the result of hyperparathyroidism?

A

– hyperparathyroidism

  • causes increased production of parathyroid hormone (PTH)
  • this results in increased kidney absorption of calcium and increased excretion of phosphorus – hypercalcemia and hypophosphatemia

– result:

  • decreased bone density – PTH breaks down bone to increase serum calcium
  • increased calcium deposits in soft tissues
  • increased renal calculi
61
Q

What are some interventions for hyperparathyroidism?

A
  • monitor cardiac
  • monitor for tingling and numbness in muscles
  • prevent bone fractures and injury
  • medication
    • diuretics and hydration therapies – Lasix
    • oral phosphates
    • calcitonin
  • parathyroidectomy – ensure calcium levels are normal prior to removal
62
Q

What is an important assessment to make after hyperparathyroidectomy?

A

assess for hypocalcemia – Trousseau’s and Chvosteks sign

63
Q

What is hypoparathyroidism? What are the 3 types?

A

– hypoparathryoidism: decreased function of parathyroid gland resulting in a lack of PTH

  • rare

– 3 types:

  1. iatrogenic hypoparathyroidism: results from removal of parathyroid gland
    • most common form
  2. idiopathic hypoparathyroidism: unknown cause
  3. hypomagnesemia: caused by ETOH, malabsorption syndromes, and chronic renal failure
64
Q

What are some interventions for hypoparathyroidism?

A
  • correct hypocalcemia
  • correct vitamin D deficiency
  • correct hypomagnesemia

NURS 322 (19 decks)

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