Endocrinology and Metabolic Disease- WK5 ( Ch11 ) Flashcards
In middle-aged and older persons with diabetes, considerations for exercise should include:
Activity prescription, Comorbidities, Age-related musculoskeletal problems
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?
You would not begin treatment as these are contraindications to exercise
Which of the following should be done if you suspect a patient is hypoglycemic?
Give the patient 1/2 cup of fruit juice
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?
Hypoglycemia
The pathological outcomes of the endocrine system result from hypersecretion or hyposecretion.
hypersecretion is usually found with _________________________________.
hyposecretion is usually found with _________________________________.
neoplasm or autoimmune disorders
infarction, infection, autoimmune disorders
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.
prior to, after
Pathologies of the thyroid include:
goiter, hypothyroid, hyperthyroid, autoimmune disorders, neoplasms
_________ is one of the most common, and treatable causes of goiter.
lack of iodine
____________ is the most common disorder of the thyroid in the US and Canada
hypothyroidism
What effect does cortisol have on blood glucose ?
blood glucose is increased
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.
hypercortisolism, hyperaldosteronism, hypoadrenalism
The three main functions of PTH are:
________ ( increase or decrease ) osteoclastic activity.
__________ ( build up/ or breakdown) bone.
____________ ( increase or decrease ) blood Calcium levels.
increase, breakdown, increase
The cardinal signs and symptoms of diabetes include :
polyuria, polydipsia, polyphagia, hyperglycemia
What is the pathogenesis and clinical symptoms of diabetes insipidus and what is the common treatment ?
posterior pituitary insufficiency reduces synthesis of ADH; leading to constant urination
polyuria, polydipsia
Treatment= adminstration of ADH
What are the 7 hormones secreted by the anterior pituitary and the 2 secreted by the posterior pituitary ?
Ant.= growth hormone, follicle stimulating hormone, prolactin, thyroid stimulating hormone, adrenocorticotropic hormone, luteinizing hormone, melanocyte stimulating hormone
Post.= Vasopressin, Oxytocin
What is the pathogenesis and clinical symptoms of diabetes insipidus and what is the common treatment ?
posterior pituitary insufficiency reduces synthesis of ADH; leading to constant urination
polyuria, polydipsia
Treatment= administration of ADH
What are the consequences of anterior pituitary insufficiency ?
pallor ( decrease MSH ), hypthyroidism ( decrease TSH ), Failure to lactate ( decrase prolactin), Adrenal insufficiency ( decreases ACTH), Ovarian failure ( decrease FSH, LH )
What are some consequences and manifestations of excess secretion of GH ?
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
What are the main causes of hypothyroidism
Primary: congenital, loss of thyroid tissue, defective hormone synthesis
Secondary: pituitary neoplasm, pituitary insufficiency, postpartum necrosis ( Sheehan’s )
What are some consequences and manifestations of hypothyroidism ?
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
What are the main causes of hyperthyroidism ?
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
What are the signs and symptoms of hyperthyroidism ?
lower ext. myopathy, upper extremity tremor, myokymia ( persistent quivering muscles) , acute bulbar myopathy, dysphagia, hoarsness, nasal voice, weak cough, exopthalmos
What are the 3 major divisions of the adrenal glands and what do they secrete ?
Zona glomerulosa: aldosterone
Zona fasciculata: cortisol
Zone reticularis: adrenal androgens, and progesterone and estrogen
What is cushing’s syndrome ?
hypercortisolism of iatrogenic cause or due to neoplasm in the pituitary; affecting females over males of age 20-40
What are the signs and symptoms of cushing’s ?
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
What is Conn’s syndrome ?
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
What is Addison’s Disease ?
idiopathic reduction in adrenal hormones; suppression by ACTH or steroid therapy
results in reduced aldosterone and cortisol
What are the signs and symptoms of addison’s disease ?
- 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
What 3 substances does the adrenal medulla release ?
Epinephrine, Norepinephrine, and Enkephalins
What is pheochromocytoma and effects ?
a neoplasm of the adrenal medulla that causes increased secretion of epi- and norepinephrine
increased, HR, total peripheral resistance, Cardiac output, blood pressure
What is the normal function of the parathyroid gland ?
release PTH
What are the systemic manifestations of hypoparathyroidism ?
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
What are the systemic manifestations of hyperparathyroidism ?
lethargy, drowsiness, slow mentation, hyperactive deep tendon reflexes, mild to severe proximal muscle weakness to extremities, muscle atrophy, bone decalcification, gout, joint hypermobility
What is the difference between a heat cramp, heat exhaustion and a heat stroke ?
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
What are the differences between type I and type II diabetes ?
Type I: destruction of B cells in pancreas leads to insufficient insulin release
Type II: due to obesity and decreased insulin sensitivity
What are the manifestations and treatments for a hypoglycemic insulin shock ?
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
What are the signs symptoms and treatment for diabetic ketoacidosis ?
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
What are the signs and symptoms of diabetic hyperglycemia ?
slow onset, thirst, polyuria, severe dehydration, lethargy, seizures, coma, abdominal pain
treatment: insulin and fluids
