Hormonal Regulation Flashcards
hypothalamus
- secretes a releasing factor that stimulates the pituitary gland
- sits right on top of the pituitary gland, connected by a stalk
pituitary gland
- master gland
- releases tropic hormones that target a specific endocrine organ
- the target organ secretes a hormone that acts on the body
- pea sized organ located in the center of the brain
what does too much of growth hormone result in (in children)
gigantism
too much growth hormone in adults results in
acromegaly
Growth hormone is secreted by
anterior pituitary
adrenocorticotropic hormone
- secreted by anterior pituitary
- goes to adrenal glands
thyroid stimulating hormone
- secreted by anterior pituitary
- to thyroid
posterior pituitary stores and releases
- oxytocin
- antidiuretic hormone (ADH): tells kidneys not to diurese
end organ
- bones
- adrenal cortex
- adrenal medulla
- thyroid
- parathyroid
- testes/ovaries
- mammary glands
- uterus
- kidneys
primary disorder
problem with the end organ
secondary disorder
problem with the pituitary gland
tertiary disorder
dysfunction caused by a hypothalamic origin
hypopituitarism
- secondary dysfunction
- most concerned about: adrenal glands, thyroid, diabetes insipidus
causes of hypopituitarism
- primary adenoma (benign tumor): MOST COMMON CAUSE
- pituitary tumor
- brain surgery
- radiation of brain tumor
- congenital tumor
- trauma, ischemia, and infarction can cause sudden loss of pituitary function
clinical presentation of hypopituitarism
- s/s depend on which hormones are NOT secreted
- age of onset
- acute = rapid deterioration of pt
how is hypopituitarism diagnosed
- blood tests to assess hormone levels
- MRI, CT
- corticotropin stimulation test (give ACT, cortisol levels should rise
tx for hypopituitarism
- giving hormones that pt needs
diabetes insipidus
- posterior pituitary malfunctioning
- lack of ADH or response to ADH
- kidneys are not told to diurese
- dilute, large volumes of urine
- plasma concentration increases
- central = pituitary not working
- nephrogenic = kidneys not working
clinical presentation of diabetes insipidus
- frequent urination
- thirst
- dehydration
- disorientation
- seizures
- hypovolemia
- hyponatremia
how is diabetes insipidus diagnosed
- differentiate from other causes of polyuria
- blood glucose testing
- urine analysis for glucose
- specific gravity
- osmolality
tx for diabetes insipidus
- administration of desmopressin or synthetic vasopressin
- surgical tx if caused by tumor
- ADH administration
most common cause of hyperpituitarism
pituitary adenoma (prolactinoma)
clinical presentation of hyperpituitarism
- acromegaly in adults
- gigantism in kids
- large tumors may cause headaches and visual disturbances bc of proximity to optic nerve
how is hyperpituitarism diagnosed
- high serum levels of tropic hormones, particularly GH and PRL
treatment for hyperpituitarism
depends on elevated hormones
syndrome of inappropriate antidiuretic hormone
- common in patients who sustain brain injury
- hyponatremia
- hypo-osmolality of blood causes excess water reabsorption into the bloodstream creating hypovolemia, dilutional natremia
clinical presentation of SIADH
- hypertension
- edema
- fluid retention
- concentrated urine
- dilute plasma
- hypervolemia
how is SIADH diagnosed
- elevated urine osmolality
- slow correction of hyponatremia
- ADH receptor antagonists may be used
- meds to diurese
tx for SIADH
- fluid restriction
- slow correction of hyponatremia
- ADH receptor antagonists may be used
- meds to diurese
what is goiter and what causes it
- enlargement of thyroid
- caused by excess TSH
- low iodine levels
- goitrogens
- foods or meds
causes of hypothyroidism aka Hashimoto’s thyroiditis
- drugs
- genetics
- cretinism
clinical presentation of hypothyroidism
- weight gain
- lethargy
- cold feeling
- hair loss
- hyperlipidemia
how is hypothyroidism diagnosed
- Primary: high TSH, low free T3, low free T4
- Secondary: low TSH, low free T3, low free T4
how is hypothyroidism treated
- replacement therapy with levothyroxine (synthetic T4)
- surgical intervention if necessary
hyperthyroidism- Grave’s disease causes
- autoimmune stimulation of the thyroid gland
clinical presentation of hyperthyroidism
- weight loss
- feeling warm
- tachycardia
- anxiety
- exophthalmos (eyes pushing forward)
how is hyperthyroidism diagnosed
- TSH level low
- high T3 and T4
- ultrasound radioactive iodine scanning
treatment for hyperthyroidism
- anti thyroid hormone (propylthiouracil PTU)
what is thyroid storm
- life threatening condition
- intense, overwhelming release of thyroid hormones
- MEDICAL EMERGENCY
- heart failure and pulmonary edema can develop rapidly and cause death
s/s of thyroid storm
- high fever
- tachycardia (170s and up
- agitation
- psychosis
hypoparathyroidism causes
- RARE
- inadvertent damage with thyroid surgery
- genetic disorders
hypoparathyroidism clinical presentation
- r/t decrease in serum calcium levels
- muscle cramps
- irritability
- tetany
- convulsions
- positive Trousseau’s sign
- positive Chvostek’s sign
how is hypoparathyroidism diagnosed
by seeing what PTH levels are in blood
hypoparathyroidism treatment
- replace TPH
- normalize serum calcium and Vitamin D levels
- educate that medications need to be taken consistently
hyperparathyroidism causes
- usually due to parathyroid adenoma
clinical presentation of hyperparathyroidism
- hypercalcemia
- neuropathies
- kidney stones
- osteopenia
- pathological fractures
treatment for hypothyroidism
- replacement therapy with levothyroxine (synthetic T4)
- surgical intervention if necessary
causes of hyperthyroidism
- Graves disease
- autoimmune stimulant of the thyroid gland
clinical presentation of hyperthyroidism
- weight loss
- anxiety
- exophthalmos
- feeling warm
- TACHYCARDIA (concerned about cardiac issues)
how is hyperthyroidism diagnosed
- TSH low, high T3 and T4
- ultrasound radioactive iodine scanning
- primary: low TSH, high T3 and T4
- secondary: high TSH, high T3 and T4
treatment for hyperthyroidism
- antithyroid hormone: propylthiouracil (PTU)
what is thyroid storm
- LIFE THREATENING CONDITION
- intense, overwhelming release of thyroid hormones
s/s thyroid storm
- high fever
- tachycardia (170s and up)
- agitation
- psychosis
- it is a MEDICAL EMERGENCY
- heart failure and pulmonary edema can develop rapidly and cause death
causes of hypoparathyroidism
- rare
- inadvertent damage with thyroid surgery
- genetic disorders
clinical presentation of hypoparathyroidism
- r/t decrease in serum calcium levels (hypocalcemia)
- muscle cramps
- irritability
- tetany
- convulsions
- positive Trousseau’s sign
- positive Chvostek’s sign
how is hypoparathyroidism diagnosed
- seeing what PTH levels are in blood
treatment for hypoparathyroidism
- replace TPH
- normalize serum calcium and Vitamin D levels
- educate that medications need to be taken consistently
causes of hyperparathyroidism
usually due to parathyroid adenoma
clinical presentation of hyperparathyroidism
- hypercalcemia
- neuropathies
- kidney stones
- osteopenia
- pathological fractures
how is hyperparathyroidism
- blood test
- primary: high PTH, high calcium
- secondary: high PTH, low calcium
treatment for hyperparathyroidism
- reduce elevated serum calcium levels with
- diuretics
- calcitonin
- bisphosphonates
- vitamin D
- Surgical Intervention if cause by tumor
- IV fluids to dilute calcium
- any disorder that causes hypocalcemia can induce secondary hyperparathyroidism
causes of Addison’s disease (hypoadrenalism)
- gradual autoimmune destruction of the adrenal gland leads to decreased cortisol response to stress and reduced cortisol reserves
- prolonged glucocorticosteroid use
clinical presentation hypoadrenalism
- hypotension
- hypoglycemia
- tanned appearance
- in women: amenorrhea, loss of pubic and axillary hair
how is hypoadrenalism diagnosed
- rapid ACTH
- abdominal CT
- BMP
treatment for hypoadrenalism
- daily replacement of glucocorticoid and mineralocorticoid
- parenteral steroid coverage in times of major stress, trauma, surgery
causes of hypoadrenalism (Cushing’s)
- excess corticosteroid use
- pituitary adenoma
- adrenal neoplasms
- ACTH secretion from cancerous tumors
clinical presentation hyperadrenalism
- weight gain
-weight redistribution to face, trunk and abdomen, moon faces, buffalo hump, striae - easy bruising
- poor wound healing
- amenorrhea
how is hyperadrenalism diagnosed
- MRI
- CT
- blood tests, salivary levels, and urine levels of cortisol
treatment for hyperadrenalism
- surgery to remove adenoma
- ketconazole
what is pheochromocytoma
caused by adrenal medulla tumor
- excessive sympathetic stimulation
- presents with HTN, tremors, tachycardia, arrhythmias
treatment for pheochromocytoma
surgery to remove tumor
cause of multiple endocrine neoplasia
- defective tumor suppressor gene
treatment for multiple endocrine neoplasia
surgery to remove tumor
cause of pineal gland dysfunction
- excess pressure in blood
- produces melatonin with the phases of the light and dark cycle
- presents with headache, nausea, vomiting, seizures, memory disturbances, visual changes
treatment for pineal gland dysfunction
ventriculoperitoneal shunt to drain CSF fluid
