Hormonal Regulation Flashcards
Insulin, amylin, and glucagon are produced by
pancreas
i. Promotes utilization of glucose
ii. Lowers serum glucose by transporting glucose to the cell to be utilized or stored as glycogen
Insulin
i. Delays nutrient uptake and suppresses glucagon after meals
Amylin
i. Promotes glycogenolysis (the breakdown of glycogen, which is the storage form of glucose)»_space; raises serum glucose
Glucagon
is a state of insufficient blood glucose levels
< __
Hypoglycemia
70
is the maintenance of blood glucose in a normal range
a. 70 – ___ mg/dl at all times
b. Fasting blood glucose should be less than 100mg/dl
Euglycemia
70 - 140
_________ hemoglobin (HgbA1C) indicates glucose control over a longer period of time. The goal for normal glucose control would be ≤ 6%
Glycosylated
is a state of elevated blood glucose levels
a. > 100 mg/dl when fasting
b. > 140 mg/dl postprandial
Hyperglycemia
c. Hyperglycemia causes:
i. _____________
»_space; binding of glucose to collagen/proteins of blood vessels/tissues
» thickening basement membranes,
^^ cytokines,
^^ lipid oxidation,
^^ O2 free radicals
» tissue injury
ii. Excess glucose gets broken down into _______ and fructose that enters cells»_space; ^^H20
» cell injury
iii. ^^ PKC (Protein Kinase Inhibitor)
»^^ insulin resistance, cytokines & permeability
iv. Insulin _________
» ^^triglycerides & ^^ apoB lipoproteins & decreased HDL»_space; atherosclerosis
Glycosylation
sorbitol
resistance
(Hyperglycemia)
poly____ - ^ urination
poly_____ - ^ thirst
poly______ - ^ hunger
polyuria - ^ urination
polydipsia - ^ thirst
polyphagia - ^ hunger
(Hyperglycemia)
Risk Factors for Imbalanced Glucose
a. Infants (small or large for gestational age)
b. Older adults
c. _____ history of diabetes
d. _______
e. decreased HDL levels
f. ^^ _________ fat
g. ^^ trans fatty acids
h. decreased fiber intake
i. Lack of physical exercise/sedentary lifestyle
j. Infection
k. High ______
Family
Obesity
saturated
stress
Intra-abdominal obesity is the greatest risk factor in ____ _ diabetes. Excess nutrients
»^^ adipocytokines (IL-1, IL-6, TNFa)
» insulin resistance and beta cell death
» ______ serum glucose
Type 2
Excess
_________ Syndrome is a syndrome characterized by a combination of any 3 or more of the following
Abdominal obesity
≥ 40 in waist men; ≥ 35 in waist women
_____________ ≥150 mg/dl
_ _ _ ≤ 40 male; ≤ 50 female
Blood Pressure ≥ 130/ ≥ 85 mmHg or on meds
Fasting Glucose ≥___ mg/dl
Metabolic
Triglycerides ≥150 mg/dl
HDL ≤ 40 male; ≤ 50 female
Fasting Glucose ≥100 mg/dl
Diagnostic Numbers for Diabetes
Diabetes Mellitus
_______ ≥ 126mg/dl
2 hourpostprandial or random hyperglycemia ≥ 200mg/dl
Tests must be abnormal on 2 separate days unless extremely high
HgbA1C ≥ 6._%
___ Diabetes
Fasting Blood Sugar of 100-125mg/dl
2 hour postprandial of 140- 199mg/dl
Fasting
pre
________ ________ is characterized by hyperglycemia resulting from defects in insulin secretion and/or action.
Diabetes mellitus
Types of diabetes mellitus include:
a. Type 1: ________ insulin deficiency due to beta cell destruction; autoimmune cause
b. Type 2: insulin _________ with inadequate secretion due to decreased or abnormal beta cell function
c. Type 3: related to _______ defects
d. Type 4: ___________; glucose intolerance related to demands of *pregnancy
Type 1: absolute
Type 2: resistance
Type 3: genetic
Type 4: gestational
These are what type of complications for diabetes?
a. Infections (fungal, bacterial)
b. Hypoglycemia
c. Hyperglycemia
d. Diabetic Ketoacidosis
e. Somogyi Phenomenon
ii. Dawn Phenomenon
ACUTE
(Acute)
Diabetic ____________
i. More common in type _ as a result of profound insulin deficiency
ii. Specific to DKA:
1. Lipolysis»_space; formation of acetoacetic acids»_space; ______ in urine and
Kussmaul respirations
iii. Hyperosmolar Hyperglycemic NonKetotic Coma (HHNK)Only seen in type _ (there is still insulin to avoid lipolysis)
Diabetic Ketoacidosis (DKA)
1
ketones (chemicals that your liver makes)
2
_______ Phenomenon
i. There is SO much insulin given in the morning
» blood sugar drops (hypoglycemic) in the night
»_space; hyperglycemic rebound in the morning
» need ____ insulin
Somogyi Phenomenon
LESS
(Acute)
_______ Phenomenon
i. There is SO much insulin given in the morning
» blood sugar drops (hypoglycemic) in the night
»_space; hyperglycemic rebound in the morning
» need ____ insulin
Somogyi Phenomenon
LESS
(Acute) \_\_\_\_ Phenomenon Insulin given in morning >> only slight drop in glucose overnight (not hypoglycemic) + normal release of cortisol and growth hormone in the morning >> hyperglycemia in the morning >> need \_\_\_\_ insulin
Dawn Phenomenon
MORE
_______ complications of diabetes include:
Microvascular effects
- Neuropathy
- Ocular
- Nephropathy
- Dermopathy
Macrovascular
CHRONIC
MICROvascular effects:
____pathy
1. Nerve degeneration from poor perfusion and ischemia
______ Damage
- Retinal detachments
- Cataracts from sorbitol deposits in the lens»_space; opacity of lens
- Glaucoma from neovascularization that blocks outflow of aqueous humor
iii. _______pathy (kidney failure due to microalbuminuria and hypertension)
iv. _____pathy (non-healing skin and foot lesions)
Neuropathy
Ocular Damage
Nephropathy
Dermopathy
MACROvascular = increased _________, ________ wound healing, amputations
Due to:
- *Decreased sensory perception of pain»_space; risk for injury
- *Decreased visual perception»_space; risk for injury
- *Decreased vascular flow and increased HgbA1C»_space; hypoxia»_space; ineffective cell function (like WBCs)
- Hyperglycemia»_space; food for bacteria
infections
impaired
The _______ is responsible for production of:
a. Thyroid hormones (T_ & T_) that increase the rate of cellular metabolism
b. _________ that lowers serum calcium (osteoblastic)
thyroid
T3 & T4
Calcitonin
The parathyroid is responsible for the production of parathyroid hormone, which raises the serum _________ levels (osteoclastic)
calcium
is a thyroid dysfunction in which there is decreased production of T3 and T4. Consequently, when associated with primary loss (congenital loss, lack of iodine, treatment for hyperthyroidism), this leads to increased thyroid stimulating hormone (TSH).
Secondary loss (hypothalamic disease or a pituitary disease) results in normal or decreased TSH levels despite low T3 and T4 due to dysfunction or disease of the hypothalamus and/or pituitary gland that suppresses the negative feedback system.
Hypothyroidism
__________ disease is an autoimmune disease that leads to the destruction of thyroid tissue; it is the most common form of hypothyroidism.
Hashiomoto
Hashiomoto
Signs/Symptoms
i. __ TSH (Thyroid Stimulating hormone)
ii. Confusion
iii. ________ memory
iv. Lethargy/fatigue
v. Decreased DTRs (Deep Tendon Reflex)
vi. ^^ cholesterol
vii. Weight ____
viii. ____ intolerance
ix. Edema
x. Dry skin
xi. ______ (Kidney production of erythropoietin is slowed in hypothyroidism leading to a decrease in RBCs)
Increased
Decreased
Gain
Cold
Anemia
c. Hypothyroidism in its severest form presents as ________
i. May lead to ________ coma
1. Hypothermia without shivering
2. Hypoventilation
3. Hypotension
4. Hypoglycemia
5. Lactic acidosis
Myxedema
is a thyroid dysfunction in which there is increased production of T3 and T4, which leads to decreased thyroid stimulating hormone (TSH). This could be due to a primary thyrotoxicosis (Graves Disease, goiter, toxic adenoma, treatment of hypothyroidism) or a secondary thyrotoxicosis (pituitary adenoma).
Hyperthyroidism
______ disease is an autoimmune hyperplasia of the thyroid tissue that presents as a *goiter; it is the most common form of hyperthyroidism.
Graves
Hyperthyroidism
Signs/Symptoms
i. *Exophthalmos (protrusion of the eyes)
ii. *Goiter (enlargement of thyroid gland)
iii. __ TSH
iv. ____________
v. Insomnia
vi. Hyperreflexia - overactive reflexes
vii. Hypertension - High BP
viii. Heart failure
ix. Weight ____
x. ____ intolerance
xi. Increased blood sugar
xii. Diaphoresis (sweaty)
xiii. Increased appetite
Decrease
Restlessness
loss
heat
c. Extreme levels of thyroid hormone can lead to thyroid _____; may be triggered by excessive stress
i. Hyperthermia (103-105)
ii. Tachycardia
iii. Heart _______
iv. _______
v. Cardiac collapse and _____
thyroid storm
failure
delirium
death
The posterior pituitary is responsible for the production of
antidiuretic hormone (ADH)
i. ↑ ADH»_space; water retention → water intoxication, hyponatremia (b/c high water dilutes), ↑ specific gravity of urine (highly concentrated urine)
ii. May be due to posterior pituitary neoplasm, surgery, pulmonary disease, brain trauma/tumor
Signs/Symptoms
- Thirst
- Dulled consciousness (if sodium <130)
- Muscle twitching and convulsions (if sodium <115)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
i. ↓ ADH»_space; inability to concentrate urine due to low ADH, extreme polyuria
leading to ↓ specific gravity
ii. May be due to neurogenic causes or nephrogenic causes
Signs/Symptoms:
- Polyuria
- Nocturia
- Polydipsia
- hydronephrosis - excess fluid in kidney
Diabetes Insipidus (DI)
__________ Disease is a primary hypocortisolism; it occurs when there is decreased
production of cortisol and aldosterone.
a. Destruction of adrenal cortex»_space; decreased cortisol & decreased aldosterone with
^^ ACTH
b. Addison’s ______ occurs may occur during a time of increased stress
i. Severe hyponatremia (low sodium in blood)» dehydration & hypovolemia»_space; decreased CO»_space; decreased BP»_space; reflexic tachycardia»_space; _____
ii. Severe hypoglycemia
Addison’s
crisis
shock
____________ (such as in Addison’s and Secondary ____________) leads to:
a. Hypotension (decreased Na, more pronounced in Addison’s)
b. Dysrhythmia (^^ K, more pronounced in Addison’s)
c. Hypoglycemia (because cortisol normally antagonizes insulin)
d. Virilism (secondary male sex characteristics in the female)
e. Weakness
HYPOcortisolism
______________ can be classified as Cushing’s Syndrome or Cushing’s Disease.
a. Cushing’s Syndrome occurs when there is increased exposure to cortisol
b. Cushing’s Disease is hypercortisolism due to increased endogenous secretion of ACTH
(usually due to a pituitary tumor in adults or adrenal tumor in children)
Hypercortisolism
________
Signs/Symptoms:
a. Facial flush
b. ____ face
c. Purple striae
d. Pendulous abdomen
e. Easy bruising
f. Acne and increased body/facial hair (increased androgen levels)
g. Hyperpigmentation
h. Truncal obesity with thin extremities
i. Increased glucose levels (high sugar)
j. Impaired healing
Cushing’s
Moon
The adrenal medulla produces __________ and _____________ (catecholamines).
a. These catecholamines regulate blood pressure by effecting vascular smooth muscle and the heart
epinephrine & norepinephrine
