Endocrine system screening and selected disorders Flashcards
What is the neuroendocrine system
- specifically refers to the endocrine system responses mediated through CNS, ANS, and visceral system
Where are neuroendocrine cells located?
- throughout the body
- especially in the GI tract, pancreas, gallbladder, thyroid
- lungs, airways, pituitary gland, parathyroid gland, adrenal medulla gland
- thyrmus, kidneys, liver, skin, reproductive glands
What are the main parts of the neuroendocrine system
- thyriod
- esophagus
- liver
- small intestine
- appendix
- bronchi
- lung
- stomach
- pancreas
- colon
- rectum
what are the horomones of the neuroendocrine system
- somatostatin
- gastrin
- insulin
- serotonin
- epinephrine
- growth hormone
Somatostatin: where is it released and what does it do
- hypothalamus: inhibits release of GH and TSH
- pancreas: inhibts release of insulin, glucagon
- GI tract: inhibits release of gastrin, reduces GI motility, reduces gastric secretion
where is gastrin released and what does it do?
- released in gut
- promotes release of gastric acid
- increases gastric motility
- promotes replenishment of gastric mucosa
- promotes action of pancrease and gallbladder
- influenced by vagus nerve and vagal system
vagus nerve = parasympathetic NS rest/digest
Serotonin: where is it produced
- produced in GI tract 90% and brain 10%
what is serotonin important for?
- affects mood, learning, memory
- modulates digestion and appetite
- used by platelets to promote arterial vasoconstriction/clotting
- sleep quality: used to melatonin
- sexual health
- bone health
Low serotonin and depression: medications
- MAOI: older not used as much due to requiring dietary restrictions
- SSRI, SNRI
Signs and symtpoms of neuroendocrine disorders
- abdominal pain, nausea, vomiting
- indigestion, stomach ulcers, diarrhea, constipation
- pneumonia, coughing, fatigue, dyspnea
- cushings
- hypoglycemia, hyperglycemia, blood clots jaundice
varies depending on hormones
Carcinoid syndrome
- neuroendocrine tumor of small intestine with metastsis to liver
- tumor causes increase release of serotonin
Carcinoid syndrome: signs and symptoms
- flushing of face and neck due to hard time managing CV system
- diarrhea
- wheezing, dyspnea
- tachycardia, arrhythmia
- hypotension
What are some common signs of endocrine dysfunction
- muscle atrophy
- changes in fat distribution
- chanages in hair
- excessive or delayed growth
- increased perspiration
- changes in HR, BP,
- changes in skin pigmentation
- changes in mentation
What are some common symptoms of endocrine dysfunction
- myalgia
- muscle weakness
- fatigue
- carpal tunnel*
- adhesive capsulitis*
- rheumatic symptoms
- osteoarthritis
- osteoporosis
- osteonecrosis
- increased perspiration
- arthralgia
- polydipsia
- polyuria
- hand stiffness
- pseudogout
- spondyloarthropahty
*insidous carpal tunnel or adhesive capsulitis = ask about blood sugar
Anterior pituitary gland hypofunction: causes
- tumor
- hypophysectomy: getting rid of pituitary
- post-partum hemorrhage
- anorexia, starvation
- GI disorders, anemia
hypopituitarism
what are common endorcine disorders
- diabetes
- hyper and hypothyroidism
- cushing’s syndrome
- addison’s disease
- giantism, acromegaly
- hyper- and hypoparathyroidism
anterior hypopituitarism symptoms
- delayed growth or puberty
- hypoglycemia
- orthostatis hypotension
- fatigue
- cold sensitivity
- infertiility
- headaches, somnolence
- blindness or bitemporal hemianopsia (tunnel vision)
treatment of anterior hypopituitarism
- removal of cause if possible
- hormone replacement: ACTH, cortisone, GH, TSH, reproductive hormones
Anterior pituitary gland hyperfunction
causes and example disorders
- tumor usually
- specific disorder based on hormones affected
- cushing’s disease (cortisol)
- acromegaly or gigantism (GH)
- hyperprolactinemia (prolactin)
- gynecomastia and impotence
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Growth hormone-secreting ademona
- gigantism: befoe epiphyseal plate closure
- abrupt growth up to 9 feet
- tumor may grow and affect anterior pituitary
- acromegaly: adults b/c epiphyseal are closed
What is acromegaly
- develops slowly
- cartilage and connective tissue overgrowth
- affects hands, face, ears, nose, tongue, jaw
- myopathy common
ademona treatment
- medication: drugs to increase somatostatin (inhibits GH), drugs for prolactin: drugs to inhibit prolactin
- surgery: may need follow up radiation
Adenoma PT implications
- post-surgical hypoglycemia
- weakness, esp. in acromegaly: due to stretching of joints/muscles
- joint pain and dysfunction
Posterior Pituitary Disorders
- diabetes insipidus: related ADH insufficiency
- Cancer: tumor, hypophysectomy, infection, aneurysm, autoimmune or hereditary, alcohol-induced, dilantin induced
Diabetes insipidus
- polyuria: dilate no glucose
- polydipsia
- dehydration
Diabetes insipidus treatment
- tumor removal
- fluid administration
- ADH replacemetn with diuretics: thyozides help keeps Na++
Posteiror pituitary disorders: hyperfunction
SIADH
syndrome of inappropriate ADH
- excessive release of ADH
- fluid retenion
- hyponatremia: lethary, anorexia, weakness, nausea, muscle cramps, thirst
- water intoxication possible
- CNS symptoms as hyponatremia increases
what are causes of SIADH
- oat cell carcinoma
- infection
- trauma
- stress of surgery
- drugs
- brain tumor, other neoplasms
- lupus
- guillian-barre
- CVA
- myxedema/severe hypothyroidism, psychosis, porphyria
Treatment SIADH
- correction of Na++ imbalance
- fluid restriction
- if tumor: surgery, radiation or chemotherapy
- diuretics
- drugs to block renal response to ADH: tetracycline, lithum, democlocycline
Parathryoid gland
- secrete parathyroid hromone
- regulates Ca++ and phosphorus metabolism
- promotes release of Ca++ and P from bone
- Kidney: promotes absorption of Ca++, excretion of P
- in GI tract: absoprtion of Ca++
- disorders affecting bone, joints, tendon
Hyperparathryiodism primary vs secondary vs tertiary causes
- primary: tumor, drugs (thiazides, lithium)
- secondary: due to another disorder that causes hypocalcemia, renal dysfunction, osteogenesis imperfecta, vitamin D deficiency, laxative abuse, cancer, pagets disease
- tertiary: related to dialysis
hyperparathyroid results
- hypercalcemia: Ca++ from bone to blood
- lethary, depression, decrease memory and mention
- increased DTRS, paresthesias, possibel sensory loss
- muscle weakness and atrophy, myalgia, arthralgia, bone pain, gout/pseudogout, joint hypermobility
Hyperparathyroid effects on GI and renal
- peptic ulcers
- kidney stones
- polyuria, polydipsia
- constipation, abdominal pain
- nausea, vomiting, anorexia
- renal infections, hypertension
- pancreatitis
hyperparathryoid treatment
- sugery
- medications: bisphosphonates, estrogen, calcitonin, calcimetics (promote bone density)
PT considerations with hyperparathyroid treatment
- fracture risk with falls
- consider muscular weakness and other pain
Hypoparathryiodism causes
- iatrogenic: accidental removal or infarct during thyroidectomy
- neoplasm, trauma, TB, sarcoidosis
- genetic, autoimmune
what are the effects of hypoparathyroidism
- low serum Ca++ high serum P
- muscular Tetany, cardiac arrhythmias, heart failure,
- seizures
- irritability, anxiety, depression
- nausea, vomiting, abdominal pain, constipation or diarrhea
- changes in hair, skin, nails
- cataracts
- CNS calcification
Whatt are hypoparathryoid treatmetns
- if tetany and or seizures: IV calcium and meds to control seizures
- long term: supplements: Ca++ and vitamin D
- diet with foods high in Ca low in P
