Endocrine2

Question 1

What does the endocrine system do what does it work through?

Answer 1

Affects most cell, organ, and body functions. Closely linked with neurologic and immune systems.
Negative feedback mechanism

Question 2

What are some things that make up the endocrine system?

Answer 2

Hypothalamus
Pituitary: anterior and posterior
Adrenal: cortex and medulla
Thyroid
Parathyroid

Question 3

This is the gatekeeper. Directed to the anterior pituitary gland.

Answer 3

Hypothalamus

Releasing hormones turn on, while inhibiting turn off.

Question 4

Blood and urine tests for endocrine function?

Answer 4

Blood: hypo and hyper function.
Urine: Amount of hormones. End products excreted, one time sample in 24 hours.
Stim: hypofunction, hypothalamus/pituitary or endocrine gland.
Supp: Hyperfunction of endocrine gland

Question 5

Explain the usually benign pituitary tumors in the anterior lobe.

Answer 5

Eosinophilic adenoma caused by growth hormone increase. Result in childhood gigantism, adulthood acromegaly.
Basophilic adenoma caused by ACTH increase. Cushing’s syndrome with a cortisol increase.

Question 6

Explain the pituitary tumors in the posterior lobe.

Answer 6

Anti-diuretic hormone decrease: diabetes insides.

Anti-diuretic hormone increase: SIADH (syndrome of inappropriate anti-diuretic hormone)

Question 7

Explain a mustache dressing

Answer 7

Headache due to increased cranial pressure. Excessive swallowing (CSF). Halo drainage. HOB 30 degrees. Frequent mouth care q4 hours. No coughing or blowing nose. No bending or straining.

Question 8

What are the three thyroid hormones?
This is contained in the thyroid hormone and is needed for its synthesis.
This is from the anterior pituitary and controls the release of thyroid hormone.

Answer 8

T3 (triiodothyronine), T4 (thyroxine), calcitonin
Iodine
TSH

Question 9

This controls cellular metabolic activity.

This is secreted in response to high plasma Ca level and increases Ca deposit in the bones.

Answer 9

Basal metabolism rate

Calcitonin

Question 10

Thyroid diagnostic tests?

Answer 10

Blood: TSH, T3, T4, thyroid antibodies

Fine-needle biopsy, thyroid scan, radioactive iodine uptake (check for allergy to iodine shellfish)

Question 11

Hashimoto’s disease. 95% autoimmune. Affects women 5x more frequently than men.

Answer 11

Hypothyroidism.
Early symptoms are nonspecific. Complications include myxedema stupor, coma, death, thyroidectomy. Radioactive iodine from hyperthyroidism.

Question 12

What are the clinical manifestations of hypothyroidism?

Answer 12

Extreme fatigue, low HR, sub-normal temp, thinning hair, coarsening skin, weight gain, coldness, processes to dullness of mental processes.

Question 13

Medical management of hypothyroidism?

Answer 13

Synthetic lveoyhtroxine (Synthroid) replacement therapy. Med must not be discontinued: lifelong. Effects of hypnotic and sedative agents

Question 14

Second most prevalent endocrine disorder. Affects women eight times more than men.

Answer 14

Hyperthyroidism. Nervousness, rapid pulse, heat intolerance, tremors. Warm, flushed, soft, moist skin. Exopthalmos, increased appetite,

Question 15

Most common cause of hyperthyroidism?

Answer 15

Graves’ disease. Autoimmune. Thyrotoxicosis. Excessive output of thyroid hormone, thyroid storm. Cause may or may not be the gland.

Question 16

S/s of graves disease?

Answer 16

Enlarged thyroid, hyper-exciteable, apprehensive, cardiac palpation (afib), poor heat tolerance, exopthalmos, cardiac dysrhythmia.

Question 17

Diagnostics for Graves’ disease?

Answer 17

Decreased TSH. Elevated T3, T4. Thyroid antibodies. Ultrasound. Thyroid scan. Increase in radioactive iodine.

Question 18

Medical management of hyperthyroidism?

Answer 18

Radioactive 131iodine therapy. Thionamides: propylthiouracil (PTU), methimazole (tapazole). Surgery, subtotal thyroidectomy. Na or K iodine solutions. Dexamethasone. Beta blockers.

Question 19

Treatment of choice for thyroid cancer, not hyperthyroid. Goals and education?

Answer 19

Thyroidectomy.
Preoperative goals: reduction of stress and anxiety to avoid precipitation of thyroid storm.
Education: dietary guidance to meet pt metabolic needs, avoidance of caffeine and other stimulants, explanations of tests and procedures, head and neck support used after surgery

Question 20

Manifestations of thyroid storm/thyrotoxic crisis?

Answer 20

Abrupt onset. Fatal if not treated. Severe hyper symoptoms: high fever, tachycardia, HTN, altered LOC. Precipitated by: surgery, trauma, severe infection.

Question 21

Management of a thyroid storm/thyrotoxic crisis?

Answer 21

Reduce temp (105 degrees). O2. Iv fluids with dextrose. Propylthiouracil (PTU) or methimazole, antithyroids. Steroids. Ioindine to decrease T4 output. Beta blockers/cardiac drugs.

Question 22

Postoperative care of thyroidectomy?

Answer 22

Monitor respirations, potential, airway impairment. Monitor for potential bleeding and hematoma formation, check posterior dressing. Assess pain and provide relief. Semi-fowler’s, support head and beck. Assess voice, discourage talking. Potential hypocalcemia related to injury or removal of parathyroid glands.

Question 23

Four glands on the posterior thyroid gland. Its hormone regulates calcium and phosphorus balance.

Answer 23

Parathyroid glands. Increased parathormone elevates blood Ca by increasing Ca absorption from the kidney, intestine, and bone. Parathormone lowers phosphorus level.

Question 24

Parathyroid deficiency caused by surgery: thyroidectomy, parathyroidectomy, or radical neck dissection. Results in hypocalcemia and hyperphosphatemia.

Answer 24

Hypoparathyroidism.
Tetany, numbness, tingling in extremities, bronchospasm, laryngeal spasm, carpopedal spasm, anxiety, irritability, depression, delirium, ECG changes.
Positive chvostek’s and trousseau’s sign.

Question 25

Management of hypoparathyroidism?

Answer 25

Increase serum Ca level to 9-10 mg/dL. Ca gluconate IV. Pentobarbital to decrease neuromuscular irritability. Parathormone administration, potential allergic reactions. Quiet environment, no drafts, bright lights, or sudden movement. Diet high in Ca and low in phosphorus. Vitamin D.

Question 26

Explain the center and outer portions of the adrenal glands?

Answer 26

Adrenal medulla (center): Functions as part of the autonomic nervous system. Catecholamines, epinephrin, norepinephrine.
Adrenal cortex (outer): Glucocorticoids, mineralocorticoids (aldosterone), androgens

Question 27

Benign tumor in the medulla. Manifestations and diagnosis? Treatment?

Answer 27

Pheocromocytoma. Extreme HTN, headache, diaphoresis, palpitations.
24 hr urine and plasma levels for catecholamine. MRI, CAT
Alpha adrenergic blockers (doxazosin cardura). Surgical removal of the tumor. Adrenalectomy laparoscopically.

Question 28

Addison’s disease. Can be caused by adrenal suppression by exogenous steroid use. Can cause addisonian crisis (shock: fluids, glucose, electrolytes, steroids)

Answer 28

Adrenocortical insufficiency.
Muscle weakness, anorexia, GI symptoma, fatigue, dark pigmentation of skin and mucosa, hypotension. Low blood glucose, low serum Na, high serum K.
Check andrenocortical hormone levels, ACTH levels, ACTH stimulation test.

Question 29

Excessive adrenocortical activity or corticosteroids. Hyperglycemia, increased serum Na, decreased serum K.

Answer 29

Cushing’s. Dexamethasone suppression test. Central-type obesity, acne, heavy trunk, thin extremities, muscle wasting. Fragile, thin skin. Ecchymosis, striae. Weakness, sleep disturbances, mood changes. Infection, slow healing.

Question 30

Suppresses inflammation and autoimmune response. Controls allergic reactions. Reduces transplant rejection.

Answer 30

Corticosteroid therapy.
Timing of doses, usually early in the morning. Need to take as prescribed, tapering required to discontinue or reduce therapy.