Endocrinology and Metabolic Disease- WK5 ( Ch11 )

Question 1

In middle-aged and older persons with diabetes, considerations for exercise should include:

Answer 1

Activity prescription, Comorbidities, Age-related musculoskeletal problems

Question 2

A patient with diabetes mellitus comes into your clinic for treatment. They state they have been feeling dehydrated and extremely hot and then cold. They also mention that they haven’t been able to control their glucose levels regularly. How would you begin the treatment?

Answer 2

You would not begin treatment as these are contraindications to exercise

Question 3

Which of the following should be done if you suspect a patient is hypoglycemic?

Answer 3

Give the patient 1/2 cup of fruit juice

Question 4

You are working out a patient at high intensity and they begin to experience weakness, profuse sweating, shaking, and a headache, what is the most likely cause of these symptoms?

Answer 4

Hypoglycemia

Question 5

The pathological outcomes of the endocrine system result from hypersecretion or hyposecretion.

hypersecretion is usually found with _________________________________.

hyposecretion is usually found with _________________________________.

Answer 5

neoplasm or autoimmune disorders

infarction, infection, autoimmune disorders

Question 6

Pituitary hypersecretion can cause Gigantism or Acromegaly. These two pathologies differ in when they occur.

Gigantism occurs _________ to epiphyseal closure, whereas Acromegaly occurs ___________ epiphyseal closure.

Answer 6

prior to, after

Question 7

Pathologies of the thyroid include:

Answer 7

goiter, hypothyroid, hyperthyroid, autoimmune disorders, neoplasms

Question 8

_________ is one of the most common, and treatable causes of goiter.

Answer 8

lack of iodine

Question 9

____________ is the most common disorder of the thyroid in the US and Canada

Answer 9

hypothyroidism

Question 10

What effect does cortisol have on blood glucose ?

Answer 10

blood glucose is increased

Question 11

Disorders of the adrenal gland include Cushing’s syndrome and Conn’s syndrome.

Cushing’s syndrome is caused by ____________.

Conn’s syndrome is caused by _______________.

Addison’s disease is caused by _______________.

Knowing the cause of each syndrome is helpful in understanding the signs and symptoms associated with each.

Answer 11

hypercortisolism, hyperaldosteronism, hypoadrenalism

Question 12

The three main functions of PTH are:

________ ( increase or decrease ) osteoclastic activity.

__________ ( build up/ or breakdown) bone.

____________ ( increase or decrease ) blood Calcium levels.

Answer 12

increase, breakdown, increase

Question 13

The cardinal signs and symptoms of diabetes include :

Answer 13

polyuria, polydipsia, polyphagia, hyperglycemia

Question 14

What is the pathogenesis and clinical symptoms of diabetes insipidus and what is the common treatment ?

Answer 14

posterior pituitary insufficiency reduces synthesis of ADH; leading to constant urination

polyuria, polydipsia

Treatment= adminstration of ADH

Question 15

What are the 7 hormones secreted by the anterior pituitary and the 2 secreted by the posterior pituitary ?

Answer 15

Ant.= growth hormone, follicle stimulating hormone, prolactin, thyroid stimulating hormone, adrenocorticotropic hormone, luteinizing hormone, melanocyte stimulating hormone

Post.= Vasopressin, Oxytocin

Question 16

What is the pathogenesis and clinical symptoms of diabetes insipidus and what is the common treatment ?

Answer 16

posterior pituitary insufficiency reduces synthesis of ADH; leading to constant urination

polyuria, polydipsia

Treatment= administration of ADH

Question 17

What are the consequences of anterior pituitary insufficiency ?

Answer 17

pallor ( decrease MSH ), hypthyroidism ( decrease TSH ), Failure to lactate ( decrase prolactin), Adrenal insufficiency ( decreases ACTH), Ovarian failure ( decrease FSH, LH )

Question 18

What are some consequences and manifestations of excess secretion of GH ?

Answer 18

thickened flat bones, classic facial change, goiter, barrel chest, cardiomegaly, glucose tolerance secondary to insulin resistance, sexual disorders, hands and feet excessively large, OA, thickened skin

Question 19

What are the main causes of hypothyroidism

Answer 19

Primary: congenital, loss of thyroid tissue, defective hormone synthesis

Secondary: pituitary neoplasm, pituitary insufficiency, postpartum necrosis ( Sheehan’s )

Question 20

What are some consequences and manifestations of hypothyroidism ?

Answer 20

CNS: slow mental function, fatigue, depression, mental retardation in children

MSK: proximal muscle weakness, myalgias paresthesias, muscular and joint edema, CAD

Hematologic: anemia, bruising

Respiratory: dyspnea, respiratory muscle weakness

Integ: myxedema ( non pitting edema), thickened cool skin, intolerance to cold, poor wound healing, coarse hair, brittle nails

GI: anorexia, constipation, weight gain disproportionate to caloric intake, decreased protein metabolism, delayed glucose uptake

Question 21

What are the main causes of hyperthyroidism ?

Answer 21

Graves disease ( 85%)- body creates antibody that is similar to TSH resulting in excess secretion of T4 leading to a thyroid storm of fever, tachycardia, delirium, dehydration, extreme aggression

Question 22

What are the signs and symptoms of hyperthyroidism ?

Answer 22

lower ext. myopathy, upper extremity tremor, myokymia ( persistent quivering muscles) , acute bulbar myopathy, dysphagia, hoarsness, nasal voice, weak cough, exopthalmos

Question 23

What are the 3 major divisions of the adrenal glands and what do they secrete ?

Answer 23

Zona glomerulosa: aldosterone

Zona fasciculata: cortisol

Zone reticularis: adrenal androgens, and progesterone and estrogen

Question 24

What is cushing’s syndrome ?

Answer 24

hypercortisolism of iatrogenic cause or due to neoplasm in the pituitary; affecting females over males of age 20-40

Question 25

What are the signs and symptoms of cushing’s ?

Answer 25

moon face, buffalo hump at the neck, abdomen protrusion with stretch marks, muscle wasting and weakness, decreased bone density, easy bruising, diabetes mellitus, slow wound healing, masculinizing effects on women

Question 26

What is Conn’s syndrome ?

Answer 26

hyperaldosteronism due to a benign neoplasm of the adrenal cortex; ooccuring in F > M age 30-50

leads to excess Na in blood, reduced K, fluid overload, HTN, and metabolic acidosis

Question 27

What is Addison’s Disease ?

Answer 27

idiopathic reduction in adrenal hormones; suppression by ACTH or steroid therapy

results in reduced aldosterone and cortisol

Question 28

What are the signs and symptoms of addison’s disease ?

Answer 28

• Adrenal Insufficiency resulting in decreased secretion of aldosterone and cortisol
• Effects of lack of cortisol: decreased gluceoneogenesis resulting in hypoglycemia; resulting in weakness, exhaustion, hypotension, anorexia, weight loss, nausea, vomiting

… acutely, severe abd. pain, diarhea, hypotension this is called addisonian crisis whcih can progress to hypovolemic shock from rapid fluid loss

• Pigmentation of skin increases due to hypersecretion of MSH and ACTH from the anterior pituitary gland since adrenal gland isn’t functioning properly
• Effects of lack of aldosterone: leads to loss of Na+ in urine, dehydration, hypotension, and decreased CO, this could affect heart size and lead to circulatory collapse, shock, and death

Question 29

What 3 substances does the adrenal medulla release ?

Answer 29

Epinephrine, Norepinephrine, and Enkephalins

Question 30

What is pheochromocytoma and effects ?

Answer 30

a neoplasm of the adrenal medulla that causes increased secretion of epi- and norepinephrine

increased, HR, total peripheral resistance, Cardiac output, blood pressure

Question 31

What is the normal function of the parathyroid gland ?

Answer 31

release PTH

Question 32

What are the systemic manifestations of hypoparathyroidism ?

Answer 32

personality changes, agitation, anxiety

hypocalcemia, spasm of intercostal muscles and diaphragm, positive chvostek’s sign

cardiac dysryhtmia’s, eventual heart failure, dry, scaly, coarse skin

Question 33

What are the systemic manifestations of hyperparathyroidism ?

Answer 33

lethargy, drowsiness, slow mentation, hyperactive deep tendon reflexes, mild to severe proximal muscle weakness to extremities, muscle atrophy, bone decalcification, gout, joint hypermobility

Question 34

What is the difference between a heat cramp, heat exhaustion and a heat stroke ?

Answer 34

Heat Cramps: spasm in exercised muscles due to electrolyte imbalance; normal body temp

Heat Exhaustion: due to activity on usually first hot and humid day; excessive sweating; presents as weak rapid pulse, low BP, headache, dizziness, general weakness; should move to cool environment to cool off

Heat Stroke: medical emergency; no thermoregulatory control, dry hot skin, headache, fatigue, confusion, vomiting, unconsciousness, body temp >104; must take aggressive steps to lower temp and replenish fluids; cold baths

Question 35

What are the differences between type I and type II diabetes ?

Answer 35

Type I: destruction of B cells in pancreas leads to insufficient insulin release

Type II: due to obesity and decreased insulin sensitivity

Question 36

What are the manifestations and treatments for a hypoglycemic insulin shock ?

Answer 36

rapid onset, pallor, perspiration, piloerection, increased HR, palpitation, weakness, hunger, shakiness, headache, slurred speech, fatigue, numbness of lips and tongue, confusion

Treatment: 1/2 cup of sugary desert, cola, or juice

Question 37

What are the signs symptoms and treatment for diabetic ketoacidosis ?

Answer 37

slow onset, headache, thirst, hyperventilation, fruity odor to breath due to ketone presence in blood, lethargy/confusion, coma, abdominal pain and distention, polyuria, flushed face, elevated temp

treatment: insulin, fluids

Question 38

What are the signs and symptoms of diabetic hyperglycemia ?

Answer 38

slow onset, thirst, polyuria, severe dehydration, lethargy, seizures, coma, abdominal pain

treatment: insulin and fluids