Exam 6 Flashcards
Structures of the Endocrine System
Pineal gland Hypothalamus Pituitary gland Thyroid and parathyroid glands Thymus Adrenal glands Pancreas Ovaries/Testes
Pineal Gland
Hormones: Melatonin
Functions: Regulates our sleep cycles
Hypothalamus Hormones
Corticotropin releasing hormone Thyrotropin releasing hormone Growth hormone releasing hormone Gonadotropin releasing hormone Prolactin releasing factor Somatostatin Prolactin inhibiting factor
Functions of the Hypothalamus
Releases hormones that stimulate the release of other hormones from the pituitary
Anterior Pituitary Hormones
Growth hormone (dwarfism, gigantism) Thyroid stimulating hormone Adrenocorticotropic hormone Follicle stimulating hormone Lutenizing hormone Melanocyte stimulating hormone Prolactin
Posterior Pituitary Hormones
Antidiuretic hormone (increase is SIADH, decrease is diabetes insipidus) Oxytocin
Thyroid Gland
Hormones: T3 and T4, calcitonin
Functions: regulate metabolism, decreases serum calcium and phosphorus levels
Iodine is necessary for proper thyroid function
Parathyroid Gland
Hormones: parathyroid hormone
Functions: increases serum calcium and phosphorus
Thymus Gland
Hormones: thymosin
Functions: helps to train our immune system so it can recognize self from non-self
Can contribute to myasthenia gravis
Adrenal Medulla Hormones
Epinephrine
Norepinephrine
Pheochromocytoma is a tumor in the adrenal gland that stimulates excessive release of norepinephrine and epinephrine
Adrenal Cortex Hormones
Corticosteroids (cortisol), androgens, mineralcorticoids (aldosterone)
Cushing’s: too much cortisol
Addison’s/Adrenal Insufficiency: too little cortisol
Pancreas
Hormone: insulin
Functions: helps with uptake of sugar into the cells
Ovary
Hormones: estrogen and progesterone
Functions: aid in the development of women’s secondary sex characteristics, help prepare uterus for implantation of the egg, aid in fetal development
Polycystic ovarian syndrome
Testes
Hormones: testosterone
Functions: help to develop secondary sex characteristics in men
Disease Processes: erectile dysfunction, infertility
Diagnostic Tests for Endocrine Disorders
Labs: blood levels of hormones
Radiologic: x-rays, radiologic studies, CAT scans, MRIs
Urine: helps to assess cortisol levels
Clinical Manifestations of Hyperthyroidism
Weight loss, excess hunger, bounding pulse, goiter, brittle nails, sweating, elevated heart rate, excess fatigue, exophthalmos, hypertension, hair loss, menstrual irregularities, diarrhea
Diagnostic Tests for Hyperthyroidism
TSH levels
Free T3 and T4 levels
Radioactive iodine uptake study
Treatments for Hyperthyroidism
Radioactive iodine (will not know results for 2-3 months)
Medications (PTU, methimazole, potassium iodine, propanolol)
Surgery
Dietary Instructions for Hyperthyroidism
No caffeine Increase caloric intake to up to 4,000-5,000 calories/day 6 small meals per day Do not limit carbs/protein Watch fiber and spice intake
Equipment Needed for Post-Op Thyroidectomy
Oxygen
Suction
Tracheostomy kit
Calcium gluconate
Post-Op Interventions for Thyroidectomy
Elevate HOB 30 degrees Avoid flexion of the neck Monitor the airway/monitor for hemorrhage Monitor for hypocalcemia Monitor Chvostek's/Trousseau's signs
Discharge Teaching for Thyroidectomy
Watch for signs/symptoms of infection/hemorrhage Watch for signs of hypothyroidism Check hormone levels Adequate intake of iodine Smoking cessation
Clinical Manifestations of Hypothyroidism
Fatigue, constipation, feeling cold, difficulty concentrating, puffy face, angina, heart failure, decreased appetite, menstrual irregularities, increased sensitivity to sedation, increased number of infections
Diagnostic Tests for Hypothyriodism
Blood tests (TSH will be elevated or decreased)
T4 will be decreased
Treatment of Hypothyroidism
Levothyroxine taken entire life, reduce caloric intake until medication has taken full effect, may take 4-6 weeks to see improvement in symptoms
Increase fiber/fluids/activity
Cushing’s Syndrome
Overproduction of ACTH or corticosteroids
Commonly caused by exogenous administration of corticosteroids
Clinical Manifestations of Cushing’s Syndrome
Moon face, striae, truncal obesity, hypertension, thin extremities, buffalo hump, increased weight, hyperglycemia, hirsutism, acne, delayed wound healing, mood changes
Diagnostic Tests for Cushing’s Syndrome
Blood sugar, ACTH levels, cortisol levels, potassium levels (watch for hypokalemia)
Addison’s Disease
Primary adrenal insufficiency
Adrenal glands are not producing the hormones (mineralcorticoids, glucocorticoids, androgens) and ACTH is increased
Idiopathic
Clinical Manifestations of Addison’s Disease
Nausea, vomiting, diarrhea, hyponatremia, cardiac dysrhythmias due to hyperkalemia, hypotension, tachycardia, dehydration, hypoglycemia, weakness
Diagnostic Tests for Addison’s Disease
Serum electrolytes
ACTH and cortisol levels
CBC
Blood sugars
Treatment of Addison’s Disease
Hydrocortisone replaces glucocorticoids (2/3 in the morning, 1/3 in the late afternoon)
Fludrocortisone replaces mineralcorticoids (daily in the morning)
Patient Teaching about Medication for Addison’s Disease
Teach how/when to take medications
Increase dosage when under stress
Lifestyle Modifications for Addison’s Disease
High protein, high carb, increase salt
Acromegaly
Growth hormone excess in adults
Symptoms of Acromegaly
Excessive sweating, hyperglycemia, heart issues, increased body hair, joint pain, misaligned teeth, tongue enlargement
Diagnostic Tests for Acromegaly
Growth hormone levels
Transsphenoidal Hypophysectomy
Removal of the pituitary by going through the sphenoid sinuses
Post-Op Interventions for Transsphenoidal Hypophysectomy
HOB at least 30 degrees, monitor pupil reaction, do not strain/increase ICP, monitor for clear drainage and spinal headache, monitor LOC, watch urine output and make sure it isn’t greater than 200mL/hour for greater than 3 hours or specific gravity less than 1.005
Treatment for Diabetes Insipidus
Vasopressin to replace ADH
Fluid replacement
Clinical Manifestations of Polycystic Ovarian Syndrome
Weight gain, obesity, excessive hair growth, irregular menses, difficulty with conception, migraines, acne, insulin resistance, impaired glucose tolerance tests, elevated lipid levels, sleep apnea
Diagnostic Tests for Polycystic Ovarian Syndrome
Glucose tolerance test Blood sugar levels Ultrasound Insulin levels Pelvic exam Hormone levels Lipid levels
Treatment Options for Polycystic Ovarian Syndrome
Hysterectomy with bilateral salpingo-oophorectomy
Birth control (Clomid/Clomiphene)
Metformin (helps with insulin resistance, stimulates ovulation, helps with weight loss)
Spironolactone
Medication Education for Polycystic Ovarian Syndrome
Metformin takes 2-4 months to be effective
Need to monitor blood sugars
Don’t skip medications
Lifestyle Modifications for Polycystic Ovarian Syndrome
Exercise
Drink water
Well-balanced meals
Limit sugar intake
Clinical Manifestations of SIADH
Confusion, unsteadiness, headache, bounding pulse, weight gain, decreased serum sodium, decreased serum osmolality
Treatment for SIADH
ADH antagonist Restrict fluids to 800-1000 mL/24 hours Monitor serum sodium and serum potassium Diuretics Intake and output measurements Daily weight measurements Steroids to reduce ICP
Surgically Induced Thyrotoxicosis
Thyroid levels elevated after a thyroidectomy–expected reaction
Signs and Symptoms of Hypocalcemia
Numbness around the mouth
Tingling in the tips of the fingers
Restlessness
Common after thyroidectomy
Notify the physician, elevate HOB, monitor respiratory status, breathe into a paper bag
Clinical Manifestations of Pheochromocytoma
Atrial fibrillation, high blood pressure, vertigo, nausea, vomiting, diarrhea, anxiety, pallor, diaphoresis, headaches
Diagnostic Tests for Pheochromocytoma
Full work-up to rule out hyperthyroidism
Plasma metanephrin level
24 hour urine for catecholamines
MRI
Treatment for Pheochromocytoma
Surgical removal of the tumor
Adrenalectomy
