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
