Endocrine System Flashcards
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1
Q
hormones produced by thyroid regulate
A
HR, BP, body temp, hunger, thirst, weight, growth
2
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ADH antidiuretic hormone aka
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vasopressin
3
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goal of endocrine system
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homeostasis
4
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endocrine system consists of
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body’s glands and their hormones
5
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hormones travel via
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bloodstream
6
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endocrine and nervous relationship
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work together for homeostasis
7
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nervous sys response time and mechanism
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quick response via neurotransmitters in central or peripheral nervous sys
8
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endocrine sys response time and mechanism
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slower response via hormones in blood stream
9
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hypothalamus 2 types of hormones
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releasing and inhibiting (after negative feedback) hormones
10
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2 glands of endocrine sys that regulate hormones
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hypothalamus and pituitary glands
11
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small gland below the brain and behind the nose that regulates vital body functions
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pituitary gland
12
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pituitary gland 2 sides
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anterior and posterior pituitary
13
Q
hypothyroidism; what is it?
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low levels of thyroid hormone
14
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hypothyroidism causes
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pituitary failure to secrete TSH (thyroid secreting hormone), hypothalamus failure to secrete TRH (thyroid releasing hormone), post thyroidectomy, radiation, age
15
Q
hypothyroidism: 3 stages
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hypothyroidism>myxedema>myxedema coma
16
Q
myxedema population
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women over 60, people with Hashimoto
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myxedema cause
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untreated or undertreated hypothyroidism
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myxedema coma cause
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long term neglect of hypothyroidism
19
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myxedema coma clinical manifestations
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hypoventilation, respiratory failure, hypothermia, coma
20
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hyperthyroidism condition is
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elevated levels of thyroid hormone
21
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hyperthyroidism T3 and T4 levels? TSH level?
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T3 and T4 high; TSH low as body adjusts stimulation down in response to already high thyroid levels
22
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hyperthyroidism causes
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cancer, Grave’s Disease, overtreatment of hypothyroidism
23
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thyroid storm is a
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complication of hyperthyroidism. aka = thyrotoxicosis
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Grave’s Disease clinical manifestations
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elevated T3 and T4, goiter, exophthalmos
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Grave's Disease treatment
lower thyroid hormone secretion or Thyroidectomy
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hypothyroidism clinical manifestations
fatigue, sensitivity to cold b/c failure of thyroid hormones to regulate body temp, dry skin, high cholesterol
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Addison's Disease
adrenal gland insufficiency; adrenal cortex not secreting glucocorticoid/cortisol and mineralo corticoid/aldosterone
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adrenal cortex releases/secretes 3 hormones
aldosterone, cortisol, sex hormones (androgen and estrogen)
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adrenal cortex location and function
located on the outside of the adrenal gland, function is long term stress response
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Addison's Disease hormone levels
low cortisol, low aldosterone
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Addison's Disease secondary cause
chronic use of steroids medication (prednisone)
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Addison's Disease clinical manifestations
gradual onset, fatigue, weight loss, weakness, hypoglycemia
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adrenal medulla stimulated by
brain/nervous sys via spinal cord
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type of stimulation adrenal medulla receives from nervous sys
sympathetic nerves
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adrenal medulla releases 2 catecholamines
adrenaline/epinephrine and noradrenaline/norepinephrine
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sympathetic response "fight or flight" triggered by release of
epinephrine and norepinephrine
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adrenal medulla vs adrenal cortex response time difference
adrenal medulla nervous stimulation so immediate response
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adrenocorticotropin hormone (ACTH) released by
anterior pituitary gland. (posterior pituitary gland releases ADH
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ACTH enters bloodstream and targets cells in
adrenal cortex
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ACTH releases 3 hormones from adrenal cortex
mineralo corticoid/aldosterone, glucocorticoid/cortisol, sex hormones/androgen/estrogen
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too high cortisol level in serum triggers what action?
negative feedback mechanism, cortisol alerts hypothalamus to stop releasing ACTH b/c inc level cortisol in circulation
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kidneys/nephrons 3 primary functions
filter blood, reabsorbing and excrete via urine so role in BP
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kidneys/nephrons 3 primary functions
filter blood, reabsorbing water and sodium back into blood and excrete via urine so role in BP
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kidney reaction low BP
reabsorb water and sodium back into bloodstream; K+ will be reabsorbed into blood or urinated out depending on potassium level
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aldosterone and low BP
aldosterone stimulates water and sodium reabsorption back into blood stream at distal convolated tubule of kidney
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cortisol can cause hyperglycemia by
stimulating liver to begin glycogen synthesis, so glucose produced by gluconeogenesis process, induce insulin resistance, overreaction of glucose production and/or insulin resistance > hyperglycemia
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cortisol effect on immune system
suppress immune system so risk for infection
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why do cortisol and epinephrine stimulate glucose release into bloodstream?
the sympathetic response, "fight or flight" requires immediate glucose for large muscles and the brain
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cortisol and epinephrine primary actions during sympathetic response
cortisol narrows arteries to increase circulation and epinephrine increases heart rate
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hypofunction of adrenal cortex aka
Addison's Disease
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Addison's and adrenal cortex hormones
cortisol/glucocorticoids lower
aldosterone/mineralo corticoid lower: Na+ excreted in urine
androgen/estrogen lower
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Addison's and negative feedback
no negative feedback to hypothalamus b/c low cortisol level, no inhibition of ACTH
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Addison's and the skin
hyperpigmentation (JFK) tan appearance b/c excess melanin
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Addison's, ACTH negative feedback and adrenal gland insufficiency
Addison's condition low cortisol level so no negative feedback to hypothalamus to stop ACTH production, so ACTH excess which isn't accepted by adrenal cortex so uses alternate pathway to produce melanin.
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cortisol and inflammation
cortisol/steroids/hydrocortisone reduce inflammation by suppressing immune sys
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2 types of bacteria
self/good especially in GI Tract, and non-self/bad foreign
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autoimmune disease
body attacks itself aka good bacteria
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Addison's diagnostics: 3 tests
ACTH Stimulation Test, Serum Electrolytes levels, 24 hour cortisol urine test
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ACTH Stimulation Test
1. blood drawn from vein
2. ACTH/cortrosyn injected into vein
3. blood samples will show cortisol levels before and after ACTH stimulation
4. normal results high cortisol level after ACTH/cortrosyn injection
5. low levels indicate adrenal insufficiency/Addison's
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Addison's diagnostic Serum Electrolyte test
hyponatremia, hypoglycemia, increase potassium
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why serum electrolytes Na+ and glucose low in Addison's?
adrenal insufficiency, adrenal cortex not accepting ACTH so not releasing alsosterone (so low sodium) and not releasing cortisol (so low glucose in blood)
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24 hour cortisol urine test
test for cortisol levels in urine over 24 hours; use for Addison and Cushing
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Addison's expected 24 hour cortisol urine test results
low cortisol level in urine
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Addison's 4 nursing interventions
1. replace mineralo corticoids/aldosterone with Fludrocortisone
2. replace glucocorticoids/cortisol with hydrocortisone
3. monitor I/O, weigh daily, VS
4. teach b/c hormone replacement may need to vary
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Addisonian Crisis caused by
low cortisol levels already pushed to crisis stage
1. surgery
2. trauma
3. severe infection
4. sudden withdrawal of cortisol/hydrocortisone/prednisone or dexamethasone
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Addisonian Crisis: 2 routes
kidney insufficiency/inability to accept ACTH/low cortisol/low aldosterone so:
1. cortisol route: liver function decrease>no gluconeogenisis>no glucose to increase energy>hypoglycemia
2. aldostrone route: kidney not reabsorbing water and sodium>hypovolemia>low BP
extreme crisis of hypoglycemia and hypovolemia can lead to coma
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Addison's 4 nursing interventions
1. replace hormones cortisol/hydorcortisone and aldosterone/fludrocortisone
2. rehydrate with D5 NS
3. replace glucose with Dextrose 50%
4. if hyperkalemia, insulin with dextrose to shift K+ into cells/ICF from serum/circulatory sys/ECF
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Cushing Syndrome is
endocrine disorder that results from excess cortisol levels in the blood
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cortisol body levels circadian rhythms
cortisol peaks in morning "get up and go" and decline at night
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Cushing's symptoms
1. hyperglycemia
2. muscle, skin, bone breakdown
3. HTN
4. electrolyte imbalance: increased Na+ and water, low K+ (K+ diluted by excess fluids)
5. abnormal fat distribution
6. moon face b/c high levels of cortisol
7. buffalo hump
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Cushing's Syndrome: 2 primary causes
1. endogenous - high level cortisol made by body
| 2. exogenous - outside medications/steroids
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Cushing's diagnostics: 4 tests
1. hyperglycemia
2. electrolyte imbalance: sodium. water, potassium
3. 24 hour cortisol urine test (amt cortisol excreted in urine over 24 hours)
4. Dexamethasone Suppression Test - low dose steroid should lower cortisol level
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Cushing's surgery: 2 types
1. adrenalectomy - tumor or adrenal gland too large
| 2. transsphenoidal hypophysectomy - pituitary
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Adrenalectomy nursing interventions: 4
1. monitor for hemorrhage
2. deep breathing, coughing
3. hormone imbalances
4. IV steroids
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catecholamines: 2 hormones
epinephrine and norepinephrine secreted by adrenal medulla
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pheochromocytoma is
overstimulation of sympathetic nervous sys by tumor on adrenal medulla, excess epi and nor
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pheochromocytoma symptoms
high basal metabolic rate (BMR), HTN, high HR, headache
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24 hour tests for adrenal insufficiency:3 types
1. Addison's - 24 hour cortisol urine test (adrenal cortex)
2. Cushing's - 24 hour cortisol urine test (adrenal cortex)
3. Pheochromocytoma - 24 hour catecholamines urine test (adrenal medulla)
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hypothyroidism symptoms: 6
1. low BMI basal metabolic index
2. low GI motility, risk constipation, slow metabolic movement, less peristalsis
3. low HR
4. low energy, fatigue
5. impaired neurologic function
6. lipid metabolism abnormalities
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Hashimoto is
most common form of hypothyroidism
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hypothyroidism treatment
Levothyroxine sodium/Synthroid
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Levothyroxine nursing interventions: 4
1. teach b/c levo will bind to products with iron and calcium so don't take with food
2. take on empty stomach, 1 hour before eating or 3 hours after eating
3. check pulse daily
4. s/s hyper/hypo thyroidism
5. take in am b/c speeds up metabolism
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extreme, severe stage of hypothyroidism
myxedema coma
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myxedea coma symptoms: 4
1. significant drop core body temp
2. hypoxemia and hypercapnia decreased respirations, low cardiac output
3. hypoglycemia
4. hypotension
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pituitary gland lobes: 2
anterior and posterior
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posterior pituitary lobe produces
ADH
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anterior pituitary lobe produces
TSH - thyroid secreting hormone and ACTH which acts on adrenal medulla and cortex
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RAIU is
radioactive iodine uptake test
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thyroid gland and iodine relationship
thyroid gland needs iodine to secrete TSH/T3 and T4
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iodine sources: 2
seafood, table salt
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RAIU does what?
measures iodine uptake level in thyroid gland
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hyperthyroidism and RAIU
RAIU test results should be high in hyperthyroidism
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hypothalamus produces hormones: 2 types
ADH hormone and regulatory hormones
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hypothalamus regulatory hormones regulate?
pituitary gland hormones: ACTH and TSH (thyroid secreting hormone)
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hyperthyroidism symptoms: 5
1. nervous, irritated
2. hypercalcemia b/c thyroid hormones activate osteoclasts to release calcium from bone
3. warm/moist skin b/c higher BMR and glucose/energy production warm body
4. weight loss
5. insomnia
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parathyroid and calcium
releases calcium into bloodstream when hypocalcemia
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ADH aka vasopressin function
regulate fluid volume
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ADH = Antidiuretic Hormone regulates: 2
1. osmolality
| 2. volume of blood
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osmolality does what?
measures the concentration of dissolved particles (osmolality) in the blood.
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high osmolality (300+) and low blood volume, ADH reaction
ADH released, retain fluid to add water to offset high sodium
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low osmolality (less than 270) and high blood volume, ADH reaction
inhibit ADH, diuresis, fluid not retained
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ADH and the kidney/DCT/nephron
ADH increase water and reabsorption by the kidneys into the bloodstream/plasma, less urine output
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ADH and hemorrhage
release ADH to increase blood volume/water
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sodium level changes and mental status
sodium impacts brain and mental status so neuro assessment
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ADH disorders: 2
DI - Diabetes Insipidus
| SIADH - Syndrome of Inappropriate ADH
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DI (Diabetes Insipidus) ADH level:
deficiency of ADH
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deficiency of ADH and water level
water being excreted, not held
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DI symptoms: 6
1. low BP
2. polyuria
3. high HR, tachycardia
4. orthostatic hypotension
5. dry mucous membranes
6. polydipsia, thirst because lost fluid
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DI and sodium level: blood and urine
hypernatremia, b/c less water in blood; urine dilute so low urine osmolality
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DI and urine specific gravity
low urine specific gravity, dilute urine, mostly water b/c sodium, glucose water urinated out
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SIADH (Syndrome of Inappropriate ADH) ADH level:
excessive release of ADH
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excess of ADH and water level
high water level
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SIADH symptoms:
1. oliguria
2. high BP, but not fluid volume overload (FVE)
3. high HR, tachycardia
4. no edema or dehydration
5. weight gain b/c retain fluid
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SIADH and sodium
serum: hyponatremia b/c excess water offset salt
urine: high specific gravity
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hyponatremia brain risk
seizure
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SIADH and urine specific gravity
high b/c retaining water and urinate out particles with low percentage of water
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SIADH diet
fluid restriction
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DI urine specific gravity level
just above water, 1.01, water 1.00
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transsphenoidal approach to pituitary tumor
hypophysectomy
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transsphenoidal hypophysectomy path
removal of tumor on pituitary gland via nose/sphenoid cavity
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transsphenoidal hypophysectomy post op care
1. nasal packing
2. elevate HOB 15-30 degrees
3. prevent intracranial pressure
4. check for transferrin and glucose in drainage b/c likely CSF (cerebrospinal fluid)
5. hormone replacement
6. check eyesight
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anterior pituitary: 2 hormones
1. TSH thyroid stimulating hormone
| 2. ACTH adrenocorticotropic hormone
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thyroid gland hormones: 2
T3 and T4
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if T3 and T4 are high, then TSH
low, inhibited
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thyroid gland primary functions
increase metabolism (growth, body temp), and increase energy required for increased metabolism (glucose needed)
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hypothyroidism effect on GI system
lower metabolism>slower peristalsis>slower food movement via tract>constipation risk
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SIADH and urine, concentrated or dilute?
concentrated b/c retain water, urinate particles (Na+)
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bulging eyes due to fluid accumulation behind eyes
Grave's, hyperthyroidism, exophthalmos
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hyperthyroidism edema?
no edema, fluid retained by shifting between intracellular and extracelluar to maintain equilibrium
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hormone primarily responsible for metabolizing sodium
aldosterone
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ADH is affected by blood volume and blood osmolality?
true, ADH blood not urine
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thyroidectomy complication- 1
tetany, tingling aroung lips or muscular twitch b/c low calcium (procedure could have removed a parathyroid gland which raises calcium level if low.)
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parathyroid gland secretes
PTH, parathyroid hormone
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PTH, parathyroid hormone, function
regulates calcium and phosphorus by acting on bone
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PTY, parathyroid hormone, increases or decreases, bone resorption?
increases, resorption means returning to blood stream
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calcium normal range
8.5 to 10.5
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Grave's/hyperthyroidism autoimmune?
yes
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Grave's negative feedback?
yes, ample T3 and T4 in blood so TRH not produced but b/c autoimmune problem TSH keeps getting produced so more T3/T4>hyperthyroidism
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Grave's assessment: 5
1. goiter
2. weight loss. high metabolism
3. heat intolerance, unable to monitor body temp
4. tachycardia, high metabolism
5. anxious, irritable
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Grave's risk factors:
1. female
2. family history
3. stress
4. thyroiditis = infection
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Grave's and RAIU or Thyroid scan
high RAIU b/c high level of iodine so more T3 produced
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Grave's medications: 3
1. anti-thyroid drugs or PTU
2. SSKI saturated solution potassium iodine
3. Beta adrenergic blockers (lower sympathetic activity by adrenal gland receptors)
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Grave's/hyperthyroidism surgery
thyroidectomy
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hypocalcemia/thyroidectomy post op
hypocalcemia - Trousseau and Chvostek
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beta blocker pre administration
HR and BP
