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Pathophysiology > Final: Ch 32 Disorders of Endocrine Control of Growth & Metabolism > Flashcards

Final: Ch 32 Disorders of Endocrine Control of Growth & Metabolism Flashcards

1
Q

anterior pituitary produces which hormones

A

GH

TSH, FSH

ACTH

LH

prolactin

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2
Q

posterior pituitary produces what hormones

A

ADH

Oxytocin

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3
Q

definition of hypo function

A

decreased gland function for any reason

congenital absence of gland or lack of enzyme

destruction by low blood flow, infection, inflammation, autoimmune rxn

aging decreases function, hormone receptors down-regulated

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4
Q

definition of hyper function

A

increased hormone production for any reason

overstimulation or tumor

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5
Q

primary disorders

A

in the gland itself

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6
Q

secondary disorders

A

result from altered stimulation of a normal gland

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7
Q

tertiary disorders

A

result from destruction of the hypothalamus

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8
Q

pituitary tumors are mostly ______

A

adenomas

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9
Q

symptoms of pituitary tumors depend on…

A

hormone secreted

can produce headache, n/v, visual disturbance

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10
Q

carcinoma of pituitary

A

uncommon

may need surgical removal

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11
Q

hypo pituitarism

A

decreased secretion of pituitary hormones

seen when 3/4 of anterior pituitary destroyed

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12
Q

symptoms of hypo pituitarism

A

weakness, fatigue

low appetite, sexual function

cold intolerance

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13
Q

sequence of loss for hypo pituitarism

A

look for the ademona (GH, LH, FSH, TSH, ACTH)

ACTH loss most serious –> adrenal insufficiency

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14
Q

Dx, Rx of hypo pituitarism

A

test for pituitary hormone levels

treat cause

replace hormones

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15
Q

assessment of hypothalmic-pituitary function

A

blood tests: ACTH, cortisol, PL, TSH, T3/4, FSH, LH, GH,

plasma/urine osmolarity

MRI of hypothalamus/ant pit

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16
Q

growth hormone (somatotropin) release is controlled by

A

GHRH and GHIH (somatostatin)

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17
Q

growth hormone is stimulated by

A

low BS

high aa

stress

exercise

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18
Q

what does growth hormone stimulate

A

growth via IGF-1 by upping protein synthesis

cartilage growth

bone growth

endocrine organ growth

muscle growth

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19
Q

growth hormone has anti-____ effects

A

insulin

ups lipolysis

lowers glucose use

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20
Q

definition of short stature in children

A

hight less than 3rd percentile or slow linear growth

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21
Q

treatment of short stature in children

A

rule out endocrine causes

test GH, IGF-1 levels

use bone x-ray to assess bone age

MRI or CT of hypothalamus/pituitary

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22
Q

idiopathic short stature

A

genetic/familial

correct patent’s height for sex and average

are the kids normally proportioned?

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23
Q

constitutional short stature

A

common in boys > girls

growth delay

late development/puberty/growth spurt

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24
Q

GH deficiency in children is from?

A

from lack of GHRH or from pituitary lack of GH (give GH)

inability to produce GH receptors (give IGF-1)

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25
Q

GH deficiency in adults

A

can be present from childhood or develop in adulthood

increases central obesity and atherosclerosis risk

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26
Q

GH production ____ with age

A

falls

marketed as the fountain of youth

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27
Q

Dx Rx of GH deficiency in adults

A

Dx: stimulation test with insulin or L-dopa

Rx: GH replacement, higher lean body bass, bone density, GF

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28
Q

tall stature in children

A

constitutional tall stature: tall vs. peers

Marfan’s

XYY

excessive sex hormones or GH

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29
Q

GH excess in children causes

A

gigantism

high GH –> high IGF prior to closure of epiphyseal plates

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30
Q

causes of excessive GH in adults

A

GH secreting pituitary adenoma

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31
Q

symptoms of excessive GH in adults

A

acromegaly - soft tissue and flat bone growth

deep voice, and malocclusion

insulin resistance

headaches

visual disturbances

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32
Q

Rx of excessive GH in adults

A

correct metabolic abnormality

remove tumor

GH analogs stimulate neg feedback inhibition of GH

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33
Q

precocious puberty

A

early activation of hypothalmic-pituitary-gonad-axis

early development of secondary sex characteristics

idiopathic or from abnormality

treatment depends on cause

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34
Q

anatomy of thyroid

A

gland located inferior and anterior to larynx

contains colloid filled follicles

colloid contains thyroglobulin

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35
Q

in the thyroid, iodine is captured by

A

Na+/I- co-transporter

active process

stimulated by TSH

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36
Q

in the thyroid, iodine is moved into the colloid by ______

A

pendrin

active process

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37
Q

iodine is oxidized and added to ______

A

tyrosine –> T3, T4

uses thyroid peroxidase

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38
Q

T3/T4 added to __ and stored in _____

A

TG, colloid

39
Q

what causes release of T3/T4

A

TSH

T4 = 90% of released hormone

travels in plasma bound to TBG/other proteins

40
Q

control of thyroid hormone secretion

A

stress and cold trigger TRH release from hypothalamus

TRH triggers TSH release from ant. pit.

TSH triggers T3/T4 production and release from TG

negative feedback inhibition of TRH/TSH

41
Q

effect of thyroid hormone on metabolic rate

A

increases for all tissues (glucose, fat, protein use increases)

normal levels of T3/T4 needed for protein synthesis

42
Q

in hyperthyroidism, muscle breakdown _____

A

increases –> fatigue

fat mobilization and use increases

43
Q

in hypothyroidism what happens to serum cholesterol

44
Q

effect of thyroid hormone on the cardiovascular system

A

CO, HR, contractility, blood volume, O2 use all increase

45
Q

effect of thyroid hormone on GI

A

motility and secretion increase

diarrhea in hyperthyroidism

46
Q

effect of thyroid hormone on neuromuscular system

A

increases muscle tone –> tremors in hyperthyroid

needed for infant brain development

more CNS activity –> nervousness in hyperthyroid

47
Q

congenital hypothyroidism causes

A

lack of gland

lack of ability to synthesize T3/T4 or TSH

48
Q

symptoms of congenital hypothyroidism

A

slow brain development/overall development

jaundice

respiratory/feeding difficulties from large tongue

sluggishness/lack of interest

umbilical hernia

49
Q

Dx, Rx of congenital hypothyroidism

A

Dx: screening for T4 and TSH

Rx: hormone replacement begun by 6 wks of age = normal intelligence

50
Q

acquired hypothyroidism (myxedema) in children or adults

A

usually primary - hashimoto’s

can be from surgery, iodine deficiency, or too much iodine

51
Q

symptoms of acquired hypothyroidism

A

hypo-metabolic state

weight gain

fatigue

cold intolerance

fluid accumulation

low HR

52
Q

Dx of acquired hypothyroidism

A

T3/T4, TSH testing

anti-thyroid Ab test (anti-TPO)

53
Q

Rx of acquired hypothyroidism

A

synthetic T3/T4

54
Q

myxedematous coma

A

potentially fatal complication of severe hypothyroidism

coma, hypothermia, hypoventilation, cardiac collapse, electrolyte imbalance

55
Q

precipitating factors of myxedematous coma

A

cold

sedatives (low drug metabolism in hypothyroidism)

56
Q

Rx of myxedematous coma

A

manage fluid and electrolyte imbalances

treat hypercapnea/hypoxia

don’t re-warm b/c cardiovascular collapse

57
Q

2 causes of hyperthyroidism

A

Grave’s disease (autoimmune, most common)

adenoma

58
Q

symptoms of hyperthyroidism

A

hyper-metabolic state

nervousness, irritability, tachycardia

weight loss

exopthalamus (eye bulge)

heat intolerance

59
Q

Rx of hyperthyroidism

A

remove gland w/ surgery or radioactive iodine

anti-thyroid drugs block production of T3/T4 and T4 -> T3

beta-blockers reduce sympathetic symptoms

60
Q

grave’s disease (hyperthyroid state)

A

most common in 20-40 yoa

autoimmune disease - Ab stimulate TSHr

cytokines activate fibroblasts behind orbit –> exophthalmos

61
Q

thyroid storm

A

life threatening crisis of thyrotoxicosis (hyperthyroidism)

caused by disease stress (infection, ketoacidosis)

large spike in thyroid hormone

62
Q

symptoms of thyroid storm

A

high fever

tachycardia

angina

HF

63
Q

treatment of thyroid storm

A

cool down

fluids

beta-blockers

anti-thyroid drugs

steroids for stress

64
Q

adrenal cortex secretes

A

steroids

aldosterone

cortisol

testosterone

65
Q

adrenal medulla secretes

A

catecholamines

66
Q

biosynthesis of cortical steroids

A

made from cholesterol using enzymes

67
Q

cortisol and testosterone are secreted to ____

68
Q

aldosterone regulated by which system

69
Q

adrenal sex hormones (T) has little to no impact on _____

A

males

body hair growth in females?

70
Q

aldosterone does what

A

act on kidney to retain Na and excrete K

71
Q

hypothalamus is stimulated by multiple ____ factors

A

stress

dimural variation peak at 6-8 am

72
Q

metabolic effects of cortisol

A

gluconeogenesis

protein catabolism

lipid mobilization

higher blood sugar

73
Q

psychological effects of cortisol (pharma dose)

A

psychosis

behavioral change

74
Q

anti-inflammatory effects of cortisol pharma dose

A

inhibit prostaglandin synthesis

75
Q

immune effect of cortisol pharma dose

A

lower cell and humoral immunity

76
Q

adrenal suppression

A

long-term cortisol therapy suppresses adrenal function

recovery takes months

77
Q

tests for adrenal function

A

cortisol

aldosterone

ACTH

78
Q

congenital adrenal hyperplasia

A

recessive enzyme deficiency - low cortisol high ACTH and androgens

21alpha-hydroxylase most common, 11beta-hydroxylase rare

decreased aldosterone

79
Q

females congenital adrenal hyperplasia

A

virilization of genitalia

80
Q

Rx of congenital adrenal hyperplasia

A

replace missing hormones

surgical reconstruction of genitalia

81
Q

primary adrenal cortical insufficiency (addison’s disease)

A

autoimmune destruction of entire adrenal cortex

can be from cancer or infection

causes hyperpigmentation and requires lifelong hormone replacement

82
Q

secondary adrenal cortical insufficiency

A

caused by pit defect or cortical suppression by exogenous steroids

aldosterone normal

no increased ACTH so no hyperpigmentation

83
Q

acute adrenal crisis

A

happens when a person w/ cortical insufficiency is stressed (infection or surgery)

replace salt, sugar, and steroids

support any failing functions

treat cause

84
Q

glucocorticoid excess (cushing’s syndrome) 4 causes

A

overproduction of ACTH by pit tumor

adrenal tumor

non-pit tumor secreting ACTH

long-term cortisol therapy

85
Q

symptoms of cushing’s

A

fat pads (buffalo hump)

muscle atrophy

Na retention –> HTN

K+ loss

diabetes

86
Q

Dx of cushing’s

A

tert urine for 24 hr cortisol excretion

test blood for ACTH to determine cause

87
Q

Rx of cushing’s

A

surgery

irradiation

medication

88
Q

Addison’s produces low levels of _______ but high levels of ____

A

Cortisol, ACTH

89
Q

Does Hashimoto’s (hypothyroidism) cause high trophic hormone levels?

90
Q

Does grave’s (hyperthyroidism) cause lowered trophic hormone levels?

91
Q

Does secondary adrenal cortex insufficiency cause lowered cortisol and ACTH?

92
Q

Does acromegaly mean high GH and IGF-1?

93
Q

Do defects in the 21 and 11 hydroxylase genes cause less cortisol and aldosterone, but high testosterone?

Pathophysiology (24 decks)

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