Med Surg Endocrine Flashcards
Endocrine system are all negative or positive feedback mechanisms?
Negative
Secretes directly into blood?
Hormones
Hormones and neuronal system regulate?
Organ function
Neuro=
Hormonal=
Fast
Slow regulation.
General S/S of malfunction
Changes in energy level Temperature tolerance Weight Sexual function Secondary sexual characteristics Mood, memory, ability to concentrate, and sleep.
Pituitary gland
Under control of hypothalmus
Although its knows as master gland, most hypo/hyper conditions are due to the target gland itself.
Anterior pituitary
GH, TSH, ACTH, FSH, LH, prolactin, and melanocyte stim hormone.
Posterior pituitary
Oxytocin and ADH (vasopressin)
Hypopituitarism
GH deficiency
Inhibit somatic growth (dwarf)
Can increase fat, decreased muscle, thin bones, reduced energy.
give GH when?
Before growth plate fuses.
Hyper-pituitary= excess what
GH
Vertical growth, weight is proportional.
Andre the giant.
Excess GH after epiphyseal closure is called?
Acromegaly.
Increased head lips tongue, jaw, mastoid sinuses
Precocious puberty
Early maturation and development of gonads and secondary sex characteristics.
More frequently in girls.
Diabetes insipidus DI
Principle disorder of the posterior pituitary.
Hyposecretion of ADH.
Uncontrolled diuretics.
Familial.
Secondary causes trauma, tumors, CNS infection, aneurysm.
Diabetes insipidus-
Decreased ADH— decreased h20 reabsorption— decreased intravascular fluid volume—increased osmolality(hyperNA)—excessive UO.
Can be neurological or kidney. Give thiazides and low NA diet. Do hourly weights. Make NPO to see in UO goes down. Give vasopressin.
DI
Cardinal signs
Polyuria, polydypsia, enuresis.
Infants- irritability relieved with feeding of water. Dehydration often occurs.
Daily vasopressin. For life.
Must wear ID band and keep med on them at all times.
Syndrome of inappropriate antidiuretic hormone SIADH
Give steroids
Oversecretion of posterior pituitary, increased ADH.
Fluid retention
Kidneys reabsorption water.
Anorexia, NV, irritability and personality changes.
SIADH s/s
Increased BP, HA, Decreased UO, increased specific gravity Hypoglycemia, decreased K and CA, NA Edema Fluid restriction Monitor LOC.
SIADH—
Increased ADH—increased water reabsorption in renal tubules—increased intravascular fluid volume—dilution always hypoNA and decreased osmolarity.
Adrenal glands secretes what from
Medulla?
Cortex?
M-catecholamines(epi, NE) increased BMR and glucose.
C-steroids. Hydrocortisone, cortisol, aldosterone.
Adrenal function
Cortex secretes three groups of steroids.
Glucocorticoids(cortisol, corticosterone) Mineralcorticoids(aldosterone) Sex steroids(androgens, estrogens, progestins)
Addisons
Acute adrenocortical insufficiency
Give NA and steroids. 911
Insufficient in all adrenal hormones. Weight loss, hypoglycemia, decreased NA. Increased K, CA Fatigue, muscle weakness. Check Ck, corticotropin. bronzing
Cushings
Too much steroids
Excessive circulating cortisol and ACTH
Don’t stop steroids abruptly.
Cushings s/s
Buffalo hump, heave trunk, thin extremities.
Glucose intolerance, osteoporosis, fragile skin. Moon face, mostly female 20-40. Amenorrhea. Sleep/mood changes, increased libido,facial hari, balding, fluid retention, HTN.
Pheochromocytoma
Tumor on adrenal.
Can lead to hypertensive crisis. HA, diaphoresis, increased CBG, SOB.
Elevate HOB, give muscle relaxants, klonadine.
Primary aldosteronism
Aldosterone controls blood volume, from adrenal cortex.
Excretes less NA, more K(causes hypoK) and hydrogen.
Decreased renin.
May cause HTN.
Thyroid
Synthesizes stores and releases hormones.
Increase BMR
Causes increased o2 demand and body temp.
Stimulate GI system.
Secretory function
Hypothalamus—>TRH(thyrotropin releasing hormone)—>pituitary gland—>TSH—>thyroid gland—> T3, T4–> body
Thyroid function
T3 T4
Amino acids with iodine attached.
Iodine essential for synthesis fo the thyroid hormones.
Parathyroid
Calcitonin. Secreated in response to high CA.
Reduces by depositing into bones.
TSH levels
0.4-6.15 is normal.
If elevated than hypothyroidism.
Hypothyroidism
Myxedema, hashimotos.
Hyperthyroidism
Graves (increased catecholamines)
Hypothyroidism
Cretinism(thyroid did not develop) stunted physical and mental development
Goiter-
Increased TSH
Mostly female.
Myxedema hypothyroidism.
Depressed metabolic activity.
Women.
Fatigue, feel cold,muscle weakness. CV issues. Can have polydypsia,
Activity intolerance, bad temp regulation, tough thought process.
No soy.
Hyperthyroidism
Graves Excessive hormone output. Women. Nervousness, emotional, irritable, palpitation, tachy, heat intolerant. Flushed, puritis, exophthalamos, increased appitite, amenorrhea, bad BM’s, HF, increased BMR, HTN, thyroid storm. Give PTU and beta blockers.
Thyroid storm
Severe hyperthyroidism,
Abrupt onset, fatal if untreated.
High fever over 101.3, tachy,altered Neuro, hyper GI and CV.
Cool them down, no ASA, give steroids, give NA.
Other thyroid conditions
Tumor- usually benign.
Endemic goiter-lack of iodine in diet.
Modular goiter- hyperplasia. Can be malignant.
Thyroidectomy
CA gluconate at bedside.
Post of bleeding, nerve injury, lymphatic drainage.
Parathyroid
Regulates CA and phos metabolism.
Increases CA and decreases phos.
Hyperparathyroidism
Bone decalcification and development of renal calculi.
primary Hyperparathyroidism
Decreased phos, tumor.
Women. May be asymptomatic.
Secondary hyper parathyroid
Renal insufficiency . Happens in renal failure. Phos retention.
Tertiary hyper parathyroid
Dialysis
Renal transplant.
Hyper parathyroid S/S
May have none.
Fatigue, HA, insomnia, stone formation, renal damage. HTN, NV, constipation, dysrhythmias, pathological fractures.
Get them mobile, hydrate, meds.
Watch for tetany.
Hypo parathyroid
Decreased hormone. Hyperphos, and hypoCA
Hypo parathyroid S/S
Irritability, tetany, tremor, anxiety, delirium,
Test CA, trousseau, and chvostek.
Hypo parathyroid tx
Give sedatives, CA gluconate. Increase vitamin D.
Metabolic syndrome
Not a disease but a cluster of disorders.
HTN, high CBG, excess of fat around waist. Abnormal cholesterol/triglycerides.
In combination these disorders increase the risk of diabetes and heart disease and stroke. Tendency to clot.
S/S metabolic syndrome.
Central obeisity, HTN, high triglycerides, low HDL, high LDL, insulin resistant.
Thirst, urination fatigue blurred vision.
Hyper parathyroid
Moans and groans- stones and bones
NV, constipations, HTN- renal calculi pathologically FX’s
