Exam 6 Flashcards by Kelsey Grunwaldt

Structures of the Endocrine System

Pineal gland
Hypothalamus
Pituitary gland
Thyroid and parathyroid glands
Thymus
Adrenal glands
Pancreas
Ovaries/Testes

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Pineal Gland

Hormones: Melatonin

Functions: Regulates our sleep cycles

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Hypothalamus Hormones

Corticotropin releasing hormone
Thyrotropin releasing hormone
Growth hormone releasing hormone
Gonadotropin releasing hormone
Prolactin releasing factor
Somatostatin
Prolactin inhibiting factor

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Functions of the Hypothalamus

Releases hormones that stimulate the release of other hormones from the pituitary

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Anterior Pituitary Hormones

Growth hormone (dwarfism, gigantism)
Thyroid stimulating hormone
Adrenocorticotropic hormone
Follicle stimulating hormone
Lutenizing hormone
Melanocyte stimulating hormone
Prolactin

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Posterior Pituitary Hormones

Antidiuretic hormone (increase is SIADH, decrease is diabetes insipidus)
Oxytocin

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Thyroid Gland

Hormones: T3 and T4, calcitonin

Functions: regulate metabolism, decreases serum calcium and phosphorus levels

Iodine is necessary for proper thyroid function

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Parathyroid Gland

Hormones: parathyroid hormone

Functions: increases serum calcium and phosphorus

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Thymus Gland

Hormones: thymosin

Functions: helps to train our immune system so it can recognize self from non-self

Can contribute to myasthenia gravis

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Adrenal Medulla Hormones

Epinephrine

Norepinephrine

Pheochromocytoma is a tumor in the adrenal gland that stimulates excessive release of norepinephrine and epinephrine

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Adrenal Cortex Hormones

Corticosteroids (cortisol), androgens, mineralcorticoids (aldosterone)

Cushing’s: too much cortisol

Addison’s/Adrenal Insufficiency: too little cortisol

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Pancreas

Hormone: insulin

Functions: helps with uptake of sugar into the cells

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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

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Testes

Hormones: testosterone

Functions: help to develop secondary sex characteristics in men

Disease Processes: erectile dysfunction, infertility

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Diagnostic Tests for Endocrine Disorders

Labs: blood levels of hormones

Radiologic: x-rays, radiologic studies, CAT scans, MRIs

Urine: helps to assess cortisol levels

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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

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Diagnostic Tests for Hyperthyroidism

TSH levels
Free T3 and T4 levels
Radioactive iodine uptake study

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Treatments for Hyperthyroidism

Radioactive iodine (will not know results for 2-3 months)
Medications (PTU, methimazole, potassium iodine, propanolol)
Surgery

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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

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Equipment Needed for Post-Op Thyroidectomy

Oxygen
Suction
Tracheostomy kit
Calcium gluconate

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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