exam 3 - endocrine - week 5 content Flashcards
______________ - A condition where the thyroid gland doesn’t produce enough thyroid hormone.
______________ - An autoimmune disorder where the body’s immune system attacks the thyroid gland, leading to hypothyroidism.
Hypothyroidism
Hashimoto’s thyroiditis
hypo vs hyperthyroidism s/s
___________
- high cholesterol
- weight gain
- decreased fertility
- delayed reflexes
- sluggish
- cold
- constipated
- lethargy
- fatigue
________
- anxiety
- tremor
- tachycardia
- warm
- weight loss
- exophthalmos
- A fib
hypo
hyper
_______ gland Location – neck, butterfly shape
thyroid
o Raise BS (opposing insulin)
o Protect against physiologic effects of stress
o Suppress inflammatory and immune processes
o Release muscle stores of proteins
o Increase cholesterol
which one?
o Glucocorticoids = cortisol = sugar
o Mineralocorticoids = aldosterone = salt
o Sex steroid = androgens = sex
o Glucocorticoids = cortisol = sugar
Manifestations DI or SIADH?
- Polyuria
- Polydipsia
- Dehydration
- Others based on severity
- Electrolyte imbalance
- Hypovolemic shock = death
DI
r/t too much fluid loss
Causes of Addison disease or Cushing disease?
- Idiopathic
- Autoimmune
- Other
Addison disease
Pituitary gland
- Anterior lobe secretes
1.
2.
- Posterior lobe secretes
1.
2.
Antidiuretic hormone – ADH – vasopressin
Thyroid stimulating hormone - TSH
Oxytocin
Adrenocorticotropic hormone – ACTH
Pituitary gland
- Anterior lobe secretes
o Thyroid stimulating hormone - TSH
o Adrenocorticotropic hormone – ACTH
- Posterior lobe secretes
o Antidiuretic hormone – ADH – vasopressin
o Oxytocin
Addison disease = disease of the adrenal cortex that causes
hyposecretion of all 3 adrenocortical hormones
OR
hypersecretion of all 3 adrenocortical hormones
hyposecretion of all 3 adrenocortical hormones
The 3 S’s
The most severe effects are from the lack of cortisol
primary cushing = issue in what location?
secondary cushing = issue in what location?
anterior pituitary
adrenal cortex
primary cushing = adrenal cortex issue
secondary cushing = anterior pituitary issue
Hyperparathyroidism results in ______calcemia
and that is what causes symptoms
- muscle weakness
- poor concentration
- neuropathies
- HTN
- Kidney stones
- Metabolic acidosis
- Osteopenia
- Pathologic fractures
- Constipation
- Depression, confusion, subtle cognitive deficits
hypercalcemia - sedative
hyperthyroidism = Everything is turned up or down?
up
thyroid
1. T3 active or inactive?
2. T4 active or inactive?
3. thyroxine = T3 or T4?
4. triiodothyronine = T3 or T4?
o T3 = triiodothyronine = active form
o T4 = thyroxine = inactive form
______________ – rare tumor of the adrenal medulla that produces excessive catecholamines
(TOO MUCH EPINEPHRINE AND NOREPINEPHRINE)
- 90% of time its benign
Pheochromocytoma
_______parathyroidism results in hypocalcemia
and that’s what causes symptoms
- Muscles cramps
- Irritability
- Tetany
- Convulsions
- trousseaus sign - Carpal spasm
- Chvostek’s sign - facial muscle twitch
Hypoparathyroidism
hypocalcemia - tetany
Cortisol functions ( and primary reason for s/s)
- Raises or lowers BS?
- Protect against physiologic effects of ______
- Suppresses or enhances inflammatory and immune processes?
- Releases or increases muscle stores of proteins?
- Increase or decrease cholesterol?
Cortisol functions (primary reason for s/s)
- Raise BS (opposing insulin)
- Protect against physiologic effects of stress
- Suppress inflammatory and immune processes
- Release muscle stores of proteins
- Increase cholesterol
Diagnosis of hyperthyroidism
- ____ TSH
- _____ T3 and T4
- Antithyroglobulin antibodies
- Antithyrtropin receptor antibodies
- Ultrasound with color doppler evaluation – blood flow over thyroid gland
- Radioactive iodine scanning and measurements of iodine uptake
Diagnosis
- Low TSH
- High T3 and T4
- Antithyroglobulin antibodies
- Antithyrtropin receptor antibodies
- Ultrasound with color doppler evaluation – blood flow over thyroid gland
- Radioactive iodine scanning and measurements of iodine uptake
SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)
TOO MUCH Anti-Diuretic Hormone
causes what with water
holding onto water abnormally
Manifestations Pheochromocytoma
- Hyper/hypotension?
- h/a
- tachy/bradycardia?
- diaphoresis
- Hypertension
- h/a
- tachycardia
- diaphoresis
The presence of these antibodies in the blood is a strong indicator of ______________
1. thyroid receptor antibodies
2. antithyroglobulin antibody
3. antithyroperoxidase antibody – hallmark of the disorder
Hashimoto’s thyroiditis.
_________ disease
- Autoimmune disorder
- Excess T3 and T4
- Thyroid stimulating antibodies
Grave’s
drug for hyperthyroidism
- Antithyroid hormone meds
- Blocks thyroid hormone synthesis
- suppresses conversion of T4 and T3
Propylthioracil (PTU)
thyroid Patho
1. Body senses we need __creased metabolism
2. Hypothalamus releases TRH
3. Anterior pituitary releases TSH - Thyroid stimulating hormone
4. Thyroid gland releases ___ (inactive form)
5. Increased T4 becomes activated = ___
6. Body senses we don’t need to ___crease metabolism anymore
Patho
1. Body senses we need increased metabolism
2. Hypothalamus releases TRH
3. Anterior pituitary releases TSH - Thyroid stimulating hormone
4. Thyroid gland releases T4 (inactive form)
5. Increased T4 becomes activated = T3
6. Body senses we don’t need to increase metabolism anymore
DI Patho
1. __creased ADH
2. __creased water absorption in renal tubules
3. __creased intravascular fluid volume
4. __creased serum osmolality
- Decreased ADH
- Decreased water absorption in renal tubules
- Decreased intravascular fluid volume
- Increased serum osmolality - high concentration of solutes (particles) in the blood (hypernatremia) and excessive urine output
hypothyroidism
types
1.
2.
which one is - not enough stimulus to tell thyroid we need more T3 and T4
which one is - increase in release of TSH from pituitary
primary - increase in release of TSH from pituitary
secondary - not enough stimulus to tell thyroid we need more T3 and T4
o Glucocorticoids = cortisol = sugar
o Mineralocorticoids = aldosterone = salt
o Sex steroid = androgens = sex
- essential for life?
- regulate body’s response to stress?
- made on demand or stored?
o essential for life – regulate body’s response to stress
o made on demand, not stored
nursing care for Pheochromocytoma
- _____ stimulation environment
- concern is increased ______ risk b/c high BP
low
stroke
Risk factors hyperthyroidism
- Family hx of _________ disease
- Age ____
- Women or men?
- White or balck?
- Meds – amiodorone
- Excessive iodine intake
- Pregnant
Risk factors
- Family hx of graves disease
- Age > 40
- Women
- White
- Meds – amiodorone
- Excessive iodine intake
- Pregnant
Addison disease pharm
- Life long ___________ replacement therapy
- Glucocorticoid – required by all pts
o Hydrocortisone – drug of choice, also contains mineralocorticoid
o Prednisone
o Dexamethasone - Mineralocorticoid – required by some pts
o Fludrocortisone
corticosteroid
Risk factors Pheochromocytoma
Young to middle aged
or
middle aged to OA
Young – middle aged
think DI
think
D – we want to ____ them up
I – actions for FV issues
L – _____ specific gravity
U – ________ a lot
T – ______ with desmopressin
E – r__________
D – dry
I – I&O, daily weight
L – low specific gravity
U – urinates a lot
T – treat = desmopressin
E – rEhydrate
Desmopressin “DDAVP”
for neurogenic DI or nephrogenic GI?
neurogenic DI
Pharm SIADH
_____ line = treat underlying cause (tumor, CNS problem, drug, other condition)
_____ line = drug for chronic SIADH = demeclocycline
first
second
hyperthyroidism/thyrotoxicosis
excessive secretion of T3 and T4
3 types - primary, secondary, tertiary
________ pituitary issue – brain problem
_______ thyroid issue
_________ hypothalamus – brain problem
- Primary – thyroid issue
- Secondary – pituitary issue – brain problem
- Tertiary – hypothalamus – brain problem
- drug treatment for hypothyroidism = _________
- Replacement hormone therapy
- T4 synthetic thyroid hormone - followed by Surgical intervention if necessary
levothyroxine
Pituitary gland
- _________ lobe secretes
o Thyroid stimulating hormone - TSH
o Adrenocorticotropic hormone – ACTH
- ________ lobe secretes
o Antidiuretic hormone – ADH – vasopressin
o Oxytocin
Anterior
Posterior
Hypothyroidism - A condition where the thyroid gland doesn’t produce enough thyroid hormone.
Risk factors
- female or male?
- age old or young?
- white or black?
- pregnant?
- hx of other autoimmune disorders
- family hx
- medications – amiodarone and lithium
- treatments for hyperthyroidism
Risk factors
- female
- age >50
- white
- pregnant
- hx of other autoimmune disorders
- family hx
- medications – amiodarone and lithium
- treatments for hyperthyroidism
which type of DI
________ DI Etiology
- ________ origin – central DI
- Cause – hypothalamus or pituitary gland
- Associate disorders - Stoke, TBI, Brain surgery, cerebral infections
- Onset – sudden
- Permanent
Neurogenic
neuro origin
Treatment for _____parathyroidism
- Reduce calcium levels
- Diuretics
- Calcitonin - decrease calcium levels
- Bisphosphonates – help decrease bone breakdown
- Vitamin D – helps absorb calcium
- Surgical interventions
hyperparathyroidism
Causes of Cushing syndrome/Hypercortisolism
1. Primary hyperfunction/“Cushing’s SYNDROME”
disease of the adrenal ________
2. Secondary hyperfunction/“Cushing’s DISEASE” = disease of the _________ pituitary gland
3. Exogenous steroids/“Cushing’s SYNDROME” = used in management of various diseases
- disease of the adrenal cortex (outer part of adrenal glands, makes 3 S’s) = “Cushing’s SYNDROME”
- disease of the anterior pituitary (makes ACTH) = “Cushing’s DISEASE”
- Exogenous steroids = used in management of various diseases = “Cushing’s SYNDROME”
Hashimoto’s/Hashimoto’s thyroiditis:
autoimmune disorder
most common cause of __________
hypothyroidism
treatment for Pheochromocytoma
- first line = surgery or drugs?
- drugs used = alpha _________ blockers
- # 1 surgery
- # 2 Alpha adrenergic blockers may be used ifo Inoperable tumors
o Pre-op to reduce risk of acute HTN
___________
Enlargement of the thyroid gland
- With or without symptoms of thyroid dysfunction?
- (non-toxic goiter) – with or without symptoms ?
- too much or too little TSH from pituitary?
- High or low iodine levels?
- ___________ are substances found in certain foods that can interfere with the thyroid gland’s ability to produce thyroid hormone. This can lead to goiter.
Goiter
- either
- without
- TOO MUCH TSH = enlargement
- low = iodine is necessary for synthesis of thyroid hormone T3 and T4, low iodine = low action = TOO MUCH TSH
- Goitrogens
o Aminoglutethimide - block synthesis of all adrenal steroid (3 S’s)
o Ketoconazole - antifungal that also inhibits glucocorticoid synthesis
treats what?
Cushing’s syndrome
hypothyroidism diagnosis
- ______ TSH levels - Primary hypothyroidism
- ______TSH levels – secondary hypothyroidism
- _____ T3 and T4 - both
- Antithyroglobulin (anti-Tg) - both
- Antithyroperoxidase antibodies (anti-TPO) - both
high
Low
Low
primary = increase in release of TSH from pituitary
Secondary = not enough stimulus (TSH) to tell thyroid we need more T3 and T4
Indications – neurogenic DI
MOA – synthetic ADH replacement, anti-diuretic effects (no pee)
Route – nasal spray, PO, IV, SQ
s/e
- Small doses = none
- Nasal spray = nasal irritation
- Large doses = hyponatremia, water intoxication
Desmopressin “DDAVP”
MOA – antifungal that also inhibits glucocorticoid synthesis
Indications – adjunct therapy to surgery or radiation for Cushing’s syndrome
Main s/e
- Severe liver damage
DO NOT take with alcohol or other drugs that harm the liver
DO NOT give during pregnancy – fetal thyroid damage
Ketoconazole
Addison disease = disease of the ______ _______ that causes hyposecretion of all 3 adrenocortical hormones
The 3 S’s
The most severe effects are from the lack of cortisol
adrenal cortex
Antidiuretic hormone (ADH)
1. Function = causes water retention (via kidneys action)
2. what 2 things cause the release of ADH?
High or low serum osmolality?
hypertension or hypotension?
- Function = causes water retention (via kidneys action)
- High serum osmolality and/or hypotension = release of ADH
Cushing’s Clinical manifestations
1. Glucose intolerance or tolerance?
2. hyperglycemia or hypoglycemia?
3. Hypertension or hypotension?
4. capillary friability (ecchymoses)
5. Muscle wasting?
6. weakness?
7. thinning skin or thickening skin?
8. osteoporosis?
9. bone pain?
10. Fat redistribution to abdomen, shoulders and face with thin extremities?
“moon face” ?
11. Impaired wound healing?
12. impaired immune response?
13. risk for infection?
14. Mood swings?
15. insomnia or oversleeping?
T/F
cortisol increases blood sugar
cortisol causes vasodilation
cortisol causes protein breakdown
cortisol causes fat breakdown
cortisol Suppress inflammatory and immune processes
cortisol causes CNS excitability
Cushing’s Clinical manifestations
1 -2 - Glucose intolerance and hyperglycemia = b/c cortisol increases blood sugar
3-4 - Hypertension, capillary friability (ecchymoses) = b/c cortisol causes vasoconstriction
5-9 - Muscle wasting and weakness, thinning skin, osteoporosis and bone pain = b/c cortisol causes protein breakdown
10 - Fat redistribution to abdomen, shoulders and face with thin extremities, and “moon face” = b/c cortisol causes fat breakdown
11 -13- Impaired wound healing, impaired immune response, risk for infection = b/c cortisol Suppress inflammatory and immune processes
14-15 - Mood swings and insomnia = b/c cortisol causes CNS excitability
cortisol increases blood sugar
X - cortisol causes vasoconstriction
cortisol causes protein breakdown
cortisol causes fat breakdown
cortisol Suppress inflammatory and immune processes
cortisol causes CNS excitability
manifestations
hyper or hypothyroidism
(early)
- cold intolerance
- weight gain
- lethargy
- fatigue
- memory deficits
- poor attention span
- increased cholesterol – hyperlipidemia
- muscle cramp
- raises carotene levels – yellow skin
- constipation
- decreased fertility
- puffy face
- hair loss
- brittle nails
(late)
- below normal temp
- bradycardia
- weight gain
- decreased LOC
- thickened skin
- cardiac complications – cardiomegaly
affects all body organs
- anemia
- decreases kidney filtration – risk of medication toxicity
- can cause hoarse voice
myxedema – dermatological change that occurs with hypothyroidism
- severe hypothyroidism (coma)
- undiagnosed/untreated long term
remember hypothyroidism = turns down metabolism
SIADH
Osmolality - a measure of the concentration of solutes (particles) in a solution
- Serum osmolality = high or low ?
- Urine osmolality and specific gravity = high or low?
- Serum sodium = high or low ?
- Urine output = high or low ?
- Weight = gain or loss?
- Serum osmolality = low
- Urine osmolality and specific gravity = high (this is high bc all the water is in the body, not in the urine, so the little bit of urine that does come out is concentrated)
- Serum sodium = low
- Urine output = low
- Weight = gain
thyroid
Iodine necessary for synthesis or metabolism of thyroid hormone T3 and T4?
Euthyroid – normally or abnormally functioning thyroid gland?
- Iodine – necessary for synthesis of thyroid hormone T3 and T4
- Euthyroid – normally functioning thyroid gland
what disorder?
too much Anti-Diuretic Hormone
SIADH
Syndrome of Inappropriate Anti-Diuretic Hormone
Hypoparathyroidism results in
- _______phosphatemia
- _______calcemia
- Hyperphosphatemia
- hypocalcemia
inverse relationship
Addison disease clinical manifestations
(think JFK)
Early
- Weight loss
- Anorexia
- Weakness
- Malaise
- Apathy
- Electrolyte imbalance
- Skin hyperpigmentation = the increased MSH makes them look tanned
Addison disease clinical manifestations
Early
- Weight loss
- Anorexia
- Weakness
- Malaise
- Apathy
- Electrolyte imbalance
- Skin hyperpigmentation = the increased MSH makes them look tanned
Patho SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)
1. ___creased ADH
2. ___creased water reabsorption in tubules
3. ___creased intravascular fluid volume
4. Dilutional hypo/hypernatremia and ___creased serum osmolality - concentration of solutes (particles) in the blood is abnormally low.
- Increased ADH
- Increased water reabsorption in tubules
- Increased intravascular fluid volume
- Dilutional hyponatremia and decreased serum osmolality - concentration of solutes (particles) in the blood is abnormally low.
o T3 = triiodothyronine = active form
o T4 = thyroxine = inactive form
is secreted by _________
thyroid
which type of DI
_________ DI Etiology
- _______ origin
- Cause – loss of kidney function, often drug related (ex: lithium)
- Associated disorders – CKD
- Onset – slow
- Progressive
Nephrogenic
Renal
Treatment for hypo/hyperthyroidism?
- PTU drug
- Radioactive iodine treatment – suppresses thyroid activity
- Surgery
hyperthyroidism
MOA – block synthesis or all adrenal steroid (3 S’s)
Indication – temporary therapy to decrease cortisol production
- Doesn’t treat the underlying disease
s/e
- Drowsy
- Nausea
- Anorexia
- Rash
Aminoglutethimide
for cushing syndrome
treats - hyperthyroidism
Antithyroid hormone meds
Blocks thyroid hormone synthesis
suppresses conversion of T4 and T3
nursing implications
- Hepatoxicity
- Can be used in 1st trimester with caution
Propylthioracil (PTU)
Pheochromocytoma
effects what gland?
medulla
Thyrotoxic crisis/thyroid storm
Overwhelming release of ________ hormones that exerts an intense stimulus on the metabolism
- Life threatening
- Follows ___________
Overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism
- Life threatening
- Follows surgery, trauma, infection - Reaction to major stressor
drug treatment for hypothyroidism
Replacement hormone therapy
T4 synthetic thyroid hormone
MOA
- Converted to T3 in the body – the activated form
Drug half-life – 7 days
Take for life
Take on empty stomach, morning
Warfarin + synthyroid = high bleed risk
s/e
- Hyperthyroidism
- Hypothyroidism
levothyroxine
Addison disease
Pharm considerations
- Dosing mimics natural release of hormones
- Adhering to time is important – bedtime, sometimes other times
- Doses are small or large?
- Never abruptly stop therapy – could cause ______
- Doses will need to be ___creased during stress – infection, surgery, trauma
- 3x3 rule – 3x normal dose for 3 days
- Always maintain an emergency supply
- Wear a medic alert bracelet
small
crisis
increased
drug that treats SIADH
Demeclocycline
parathyroid
Produces and secretes parathyroid hormone (PTH)
In response to
1. Hypocalcemia or hypercalcemia?
2. Bone breakdown or muscle breakdown?
- Goal = reestablish normal __________ in blood levels
- Promotes vitamin ___ production
- Hypocalcemia
- Bone breakdown
- calcium
- vitamin D
DI Osmolality
- Serum osmolality = high or low?
- Urine osmolality and specific gravity = high or low ?
- Serum sodium = high or low?
- Urine output = high or low?
- Weight = loss or gain?
Osmolality
- Serum osmolality = high
- Urine osmolality and specific gravity = low
- Serum sodium = high
- Urine output = high
- Weight = loss
Parathyroid
- Within thyroid, 4 pea size glands
- Controls_________levels in body
- Produce and secrete parathyroid hormone – PTH
- In response to ________calcemia and bone _________
- Goal = reestablish normal __________ in blood levels
- Promotes vitamin __ production by the kidneys
calcium
Hypocalcemia and bone breakdown
calcium
vitamin D
SNS stimulation (fight or flight) causes Medulla to secretes ___________ and ____________
ACTH coming from anterior pituitary gland causes cortex to secrete _______, _______, and ___________
epinephrine and norepinephrine
o Glucocorticoids = cortisol = sugar
o Mineralocorticoids = aldosterone = salt
o Sex steroid = androgens = sex
Adrenal glands
- Medulla = secretes ___________ and ________
- Cortex = secretes _________ , _______, and _________
- Medulla = secretes epinephrine and norepinephrine
- Cortex = secretes
o Glucocorticoids = cortisol = sugar
o Mineralocorticoids = aldosterone = salt
o Sex steroid = androgens = sex
________ Secretes
- T3 = triiodothyronine (active form)
- T4 = thyroxine (inactive form)
which one is the regulator of metabolism, influences almost everybody system?
thyroid
T4 = thyroxine (inactive form)
___________ dysfunctions
Hypothyroidism or Hyperthyroidism
- Enlargement/goiter can occur with _______
- Most likely in what gender _________
- Primary or secondary thyroid problems are most common?
Thyroid
both
women
primary
SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)
Characterized by
- Fluid retention
- Serum hypoosmolality - concentration of solutes (particles) in the blood is abnormally low
- Hyponatremia – dilution issue
- Concentrated urine
these are all r/t ________
holding onto water abnormally
Specific s/s of
Hypoaldosteronism - insufficient production of aldosterone (3 S’s) r/t Addison disease
- Hypotension or hypertension?
o Decreased vascular tone?
o Decreased CO?
o Decreased circulating blood volume ? - Salt craving ?
o ___creased Na levels
o ___creased K levels
o Dehydration?
- Hypotension = r/t not retaining water and sodium
o Decreased vascular tone
o Decreased CO
o Decreased circulating blood volume - Salt craving
o Decreased Na levels
o Increased K levels
o Dehydration
Patho of Addison disease
- _______ gland is destroyed (for whatever reason)
- s/s when ______ gland is 90% non-functional
- ___creased secretion of Adrenocorticotropic hormone ACTH and melanocyte-stimulating hormone MSH
- this acts like a compensatory mechanism to the body sensing there is too ____ of the 3 S’s
Adrenal
adrenal
increased
too little
- Lack of ADH
Or - Decreased renal response to ADH
Characterized by – excessive loss of water via the urine
Diabetes Insipidus
2 types of hypothyroidism -
1.Primary – increase in release of ____ from pituitary, low T3 and T4
- secondary - not enough stimulus, low T3 and T4, and low ____
primary = increase TSH, low T3 and T4
secondary = low TSH, T3 and T4
Class – tetracycline broad-spectrum abx
Indications
- Abx therapy
- Chronic SIADH
MOA – interferes with renal response to ADH
s/e
- Photosensitivity
- Teeth staining
- Nephrotoxic
Demeclocycline
Insufficient parathyroid hormone (PTH) secretions
Hypoparathyroidism
which disorder is
Too much of the 3 S’s
- Glucocorticoids = cortisol = sugar
- Mineralocorticoids = aldosterone = salt
- Sex steroid = androgens = sex
Too little of the 3 S’s
- Glucocorticoids = cortisol = sugar
- Mineralocorticoids = aldosterone = salt
- Sex steroid = androgens = sex
Cushing syndrome
Addison Disease
Specific s/s of
Hypocortisolism - insufficient production of cortisol (3 S’s) r/t Addison disease
- Hypo/hyperglycemia?
- Weakness and fatigue?
- ___creased ACTH levels
- Hyper/hypopigmentation – ___creased MSH levels
- Hypoglycemia
- Weakness and fatigue
- Increased ACTH levels
- Hyperpigmentation – increased MSH levels
_________ hypothyroidism – increase in release of TSH from pituitary
- This indicates a hypoactive thyroid
- most common
- Hashimoto’s thyroiditis – autoimmune disorder, most common cause of hypothyroidism
- labs = increase TSH and decrease in T3 and T4
_______ hypothyroidism – not enough stimulus to tell thyroid we need more T3 and T4
- labs = low TSH, T3 and T4
Primary
Secondary
manifestations
hypothyroidism = turns up or down metabolism?
down
Manifestations of hyper/hypothyroidism?
- Nervous
- Insomnia
- Sensitive to heat
- Weight loss
- Enlarged and palpable gland
- Audible bruit – high glandular blood flow
- A fib
- Myexedema – dermatologic manifestations
- Exophthalmos - Periorbital edema and bulging of the eyes
hyperthyroidism
s/s of SIADH or DI ?
s/s of hyponatremia
- Dyspnea
- Fatigue
- Neurologic
- Lethargy
- Confusion
- Dulled sensorium - decreased level of awareness or alertness.
- Muscle twitching
- Convuslions
- Impaired taste
- Anorexia
- Vomiting
- Cramps
Severe s/s (Na = 100-115)
- Irreversible neurological damage
Water intoxication
- Na in cells are higher than Na blood serum levels = cells SWELL (water follows salt)
s/s
- Neurologic issues
- Confusion
- Lethargy
- Coma
- Death
SIADH
r/t hyponatremia and FVE
Adrenal glands
1. _________ = secretes epinephrine and norepinephrine
- These are secreted in response to SNS stimulation (fight or flight)
2. ______ = secretes
- Glucocorticoids = cortisol = sugar
- Mineralocorticoids = aldosterone = salt
- Sex steroid = androgens = sex
- these are secreted in response to the ACTH coming from anterior pituitary gland
Medulla
Cortex
_____________
TOO LITTLE ADH
water =
___________
TOO MUCH ADH
water =
Diabetes Insipidus
too much water is lost
SIADH
too much water is retained
Adrenal crisis
- Sudden ___crease in cortisol = severe Cushing syndrome
- Sudden ___crease in cortisol = Addisonian crisis
Adrenal crisis
- Sudden increase in cortisol = severe Cushing syndrome
- Sudden decrease in cortisol = Addisonian crisis
Hypothyroidism
Insufficient levels of the thyroid hormones _____ and _______
T3 and T4
Hyperparathyroidism
Excessive secretion of PTH
Which results in
- bone __________
- ______calcemia
- bone breakdown
- hypercalcemia
Excessive secretion of PTH - parathyroid hormone
Hyperparathyroidism
Causes of ______thyroidism
- Graves disease – most common, autoimmune stimulation of the thyroid gland, primary
- Thyroid adenoma
- Subacute thyroiditis
- Toxic multinodular goiter
- Excessive iodine ingestion – jod basedow syndrome
- Excessive thyroid hormone replacement
hyperthyroidism
Etiology SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)
- Malignant tumors
o Ex: small cell carcinoma of the lung
- CNS disorders
o Head trauma, stoke, brain tumor
- Drug therapy
o Morphine, SSRI’s some chemo drugs
- Misc. conditions
o Hypothyroidism, infection
ADH comes from pituitary gland at base of skull
Class - alpha-adrenergic blocker.
Indication – pheochromocytoma
MOA – long lasting, irreversible, blockage of alpha-adrenergic receptors = smooth muscle relaxation and vessel widening = lower BP
(main cause of HTN is activation of the alpha 1 receptor on blood vessels)
s/e
- Orthostatic hypotension
- Reflex tachycardia
- Nasal congestion
- Sexual s/e in men
Phenoxybenzamine HCl
cushing syndrome
Treatment depends on cause
o Pituitary tumor or adrenal tumor = surgery or radiation
o Exogenous steroids causing Cushing’s = taper drugs slowly until_________
- Treatment depends on cause
o Pituitary tumor or adrenal tumor = surgery or radiation
o Exogenous steroids causing Cushing’s = taper drugs slowly until they don’t have the manifestations anymore
too little T3 and T4 =
too much T3 and T4 =
grave’s disease causes =
Hashimoto’s thyroiditis causes =
hypothyroidism
hyperthyroidism
hyperthyroidism, autoimmune
hypothyroidism, autoimmune
2 forms of diabetes Insipidus
- ______genic (central)
- ______genic
- Neurogenic (central)
- Nephrogenic
Patho ___________
SNS stimulation = excessive release of epinephrine and norepinephrine
Pheochromocytoma
Would desmopressin “DDAVP” work in
for
neurogenic DI? WHY
nephrogenic DI? WHY
What drug would be helpful for nephrogenic DI? WHY
Yes - with neurogenic, the hypothalamus or pituitary gland are having problems, which results in a lack of ADH. DDAVP is a ADH replacement, so that would be appropriate.
No – with nephrogenic, the issue is with the kidney, not with a lack of ADH, so adding more ADH wouldn’t be helpful since the kidneys cant function/respond to it.
Thiazide diuretics
b/c DI is characterized by – excessive loss of water via the urine
Paradoxical effect = decreases polyuria, increases urine osmolality
which steroid
- Regulated by Renin-angiotensin system in kidneys
- Function –
o maintain salt and water balance
o Promotes secretion of potassium - When triggered by angiotensin II =
o it promotes sodium retention and water retention
o Mineralocorticoids = aldosterone = salt
________________ - Periorbital edema and bulging of the eyes
“graves ophthalmopathy”
Women more affected with this compared to men
manifestation of hyperthyroidism
Exophthalmos
which disorder is
TOO LITTLE ADH
Diabetes Insipidus
DI
serum osmolality =
urine osmolality =
_____tension
DI = low ADH
no water = high blood concentration = high serum osmolality
excessive peeing = low urine concentration = low urine osmolality
HYPOtension
cushing syndrome most likely cause?
exogenous steroids
cortex issue
anterior pituitary issue
too much 3 S’s
most common - exogenous steroids
rare - cortex and anterior pituitary issue
primary disorder of adrenal gland
increases vs decreases?
corticoreleasing hormone =
adrenocorticotropic hormone =
cortisol =
corticoreleasing hormone = decreased
adrenocorticotropic hormone = decreased
cortisol = increased
cushing vs addison
___________
moon face
hyperglycemia
trunk obesity
__________
skin hyperpigmentation
hypotension
hyponatremia
cushing
addison
addison disease
______natremia
______kalemia
too little 3 S’s
hyponatremia
hyperkalemia
which is more active T3 or T4
T3 = active
T4 = inactive
