Hormonal Regulation Flashcards
what is upregulation for receptor activty
increase receptors
not getting enough stimulation
what is downregulation
overstimulated
they stop responding
decreased number of receptors
what is neoplasia
tumor
what hormones does the anterior pituitary make
ACTH
GH
TSH
FSH
LH
PRL
what hormones are released by the pituitary but synthesized by the hypothalamus
oxytocin
ADH
what is the most common cause of hypopituitarism
primary adenoma
what are we concerned about with hypopituitarism
adrenal insufficiency
thyroid
diabetes insipidus
what lack of hormone/response is there with DI
ADH
what part of the pituitary causes DI
posterior
what is happening in DI
dilute urine
increase in plasma concentration (high electrolytes, hypernatremic, hypovolemic)
what is the most common cause of hyperpituitarism
pituitary adenoma (prolactinoma- self secretes prolactin)
what is PRL
sex hormone
s&s for hyperpituitarism
headaches and visual disturbances
symptoms of DI
frequent urination
thirst
dehydration
disorientation
seizures
diagnosis for DI
glucose testing (urine and blood)
specific gravity
osmolality
sodium
tx for DI
give ADH
diagnosis for hyperpituitarism
hormone levels (blood and urine)
dexamethasone suppression test
what hormone is excessive in SIADH
ADH
what are the causes of SIADH
brain injury
neurosurgery
neoplasms in brain
what is happening in SIADH
fluid volume overload (hypervolemia)
concentrated urine (polyuria)
dilute plasma
tx for SIADH
fluid restriction
slow correction of hyponatremia
ADH receptor agonists to block receptors in kidneys
what is required for synthesis of T3 and T4
iodine
what is an enlargement of the thyroid called
goiter
how do goiters develop
excess TSH
low iodine
goitrogens- foods/meds that interfere w/ thyroid
what is the most common cause of hypothyroidism
hashimoto’s thyroiditis
what is happening in hashimoto’s thyroiditis
increased # of lymphocytes
antibodies to TSH
T3 and T4 cannot be synthesized
what are other causes of hypothyroidism
drugs
genetics
cretinism (physical deformities and learning disabilities d/t poor thyroid fx)
s&s of hypothyroidism
wt gain
lethargy
coldness
hair loss
hyperlipidemia
what do levels look like for primary hypothyroidism
high TSH
low free T3 and T4
what do levels look like for secondary hypothyroidism
low TSH
low free T3 and T4
how do you diagnose hashimoto’s
anti-Tg and anti-TPO (antibodies)
what is the treatment for hypothyroidism
levothyroxine- synthesizes T4
what disease is the primary problem with hyperthyroidism
grave’s disease
what is grave’s diease
autoimmune stimulation of thyroid gland
excess secretion of T3 and T4
speeds up metabolism
s&s of hyperthyroidism
wt loss
anxiety
exophthalamos (eyes)
warmness
tachycardia
what do the levels look like for primary hyperthyroidism
low TSH
high free T3 and T4
what do the labs look like for secondary hyperthyroidism
high TSH
high free T3 and T4
how do we diagnose graves
anti-TPO and thyroid stimulating Ig (antibodies)
what is the treatment for hyperthyroidism
antithyroid hormone
what is thyrotoxic crisis (thyroid storm)
overwhelming release of thyroid hormones that stimulates metabolism
s&s for thyroid storm
high fever
tachycardia
agitation
psychosis
what is thyroid storm usually caused by
surgery/trauma
what can happen with thyroid storm
MEDICAL EMERGENCY
heart failure
flash pulmonary edema
death
what is the parathyroid
4 pea-sized glands w/in thyroid
produces PTH (promotes calcium reabsorption in renal tubules and release of calcium from bone)
promotes vit D production by kidney (needed for calcium absorption)
what causes hypoparathyroidism
damage done from thyroid surgery or genetic disorders
what is not being released in hypoparathyroidism
PTH
s&s of hypoparathyroidism
hypocalcemia:
positive trousseau’s and chvostek’s sign
muscle cramps, tetany
convulsion
tx for hypoparathyroidism
replacement PTH
normalize calcium and vit d levels
what is hyperparathyroidism caused by
parathyroid adenoma: produces excess PTH
what is primary hyperparathyroidism
elevated PTH and calcium
what is secondary hyperparathyroidism
not in parathyroid
elevated PTH
low/normal calcium
disorders that cause hypocalcemia can induce secondary
s&s of hyperparathyroidism
excess calcium:
neuropathies
kidney stones
osteopenia
pathological fractures
tx for hyperparathyroidism
iv fluids to decrease calcium
surgery
what does the adrenal medulla secrete
epi and norepi
what does the cortex of the adrenal gland secrete
glucocorticoids
sex hormones
ATCH
what is primary adrenal insufficiency and what is it also called
adrenal gland does not work
addison’s disease: autoimmune destruction of adrenal cortex
what does prolonged glucocorticoid use do
CRF-ACTH signals to adrenal cortex suppressed
adrenal gland down regulates receptors
s&s of adrenal insufficiency
hypotension
hypoglycemia
anorexia
tanned appearance d/t MSH
women: loss of pubic and axillary hair, amenorrhea (not producing sex hormones)
diagnosis of adrenal insufficiency
metabolic pannel
rapid ACTH test (determines if it is pituitary or adrenal)
tx of adrenal insufficiency
daily replacement of glucocorticoid and mineralocorticoid
parenteral steroid coverage in times of major stress, trauma, and surgery
what is hyperadrenalism also called
hypercortisolism
what are the causes of hyperadrenalism
cushing’s disease- pituitary (increase in ATCH)
cushing’s syndrome- adrenal (increase in cortisol)
pituitary adenoma
adrenal neoplasms
ACTH secretion from cancerous tumors
exogenous corticosteroids
what does excess corticosteroids do
weakens immune system
increases bg and fat levels
diagnosis of hyperadrenalism
cortisol levels (blood, saliva, urine)
dexamethasone suppression test (determine if its pituitary or adrenal)
MRI, CT
tx for hyperadrenalism
treat adrenal gland/pituitary tumor
surgery
ketoconazole: inhibits steroidogenesis
s&s of hyperadrenalism
redistribution of fat: face, trunk, abdomen
moon face
striae
buffalo hump
easy bruising
poor wound healing (excess sugar)
wt gain (metabolic syndrome)
what is pheochromocytoma
adrenal medulla tumor
secretes norepi and epi
excessive sympathetic stimulation
HTN, tremors, increased cardiac contractility, cardiac arrhythmias, tachycardia
24-hr urine for catecolamine metabolites
surgery to remove tumor
what is multiple endocrine neoplasia
MEN1 common
defector tumor suppressor gene
allows tumor growth throughout endocrine system
parathyroid, pituitary, and pancreas commonly affected
surgery to remove tumor
what is pineal gland dysfunciton
produces melatonin
tumor blocks pineal gland
blocks CSF flow
headache, nausea, vomiting, seizures, increased IC pressure, memory disturbances, visual changes
treatment: ventriculoperitoneal shunt- tube that drains CSF
