Metabolic and Endocrine Flashcards
Key Functions of the Metabolic System
- governs the chemical and physical changes that take place in the body.
- Metabolism includes breakdown of body’s complex organic compound – generates energy for body processes and synthesis of complex substances that form tissues and organs.
- Catabolism – organic compounds are broken down
- Anabolism – combines simple molecules for tissue growth
Key Functions of the Endocrine System
- Endocrine glands that secrete hormones that travel through the body to specific target cells.
- Hormones bind selectively to specific receptor sites on the surface of receptor cells.
- Endocrine and Nervous system work in conjunction to maintain homeostasis (can work together or alone)
- They regulate: metabolism, response to stress, sexual reproduction, blood pressure, and water and salt balance
What are the glands of the endocrine system
Hypothalamus
Pituitary Gland
Thyroid Gland
Parathyroid Glands
Adrenal Glands
Pancreas
Ovaries
Testes
Hypothalamus (as an endocrine gland)
*regulation of ANS
- Body temp, appetite, sweating, thirst, sexual behavior, rage, fear, BP, sleep)
- And other endocrine functions
*does this by its impact on the pituitary gland
Pituitary Gland
- Beneath the hypothalamus
- 2 parts: adenohypophysis (anterior) & neurohypophysis (posterior)
- Considered the most important part of the endocrine system. (the “master gland”)
- Secretes endorphins that act on the nervous system and reduce a person’s sensitivity to pain.
- Controls ovulation and works as a catalyst for testes and ovaries to create sex hormones
Thyroid Gland
- Produces thyroxine and triiodothyronine.
- Act to control rate at which cells burn the fuel from food
- Increase in thyroxine increases the rate of the chemical reactions within the body.
Parathyroid Glands
- Posterior surface of the thyroid’s lateral lobes
- Produces parathyroid hormone.
- Functions as an antagonist to calcitonin and important for maintenance of normal blood levels of calcium and phosphate.
- Parathyroid hormone increases the reabsorption of calcium and phosphate from bones to the blood.
- Stimulated by hypocalcemia
- Inhibited by hypercalcemia
- Normal clotting, neuromuscular excitability, and cell membrane permeability are depend on normal calcium.
Adrenal Glands
- Located on top of kidney
- Produces corticosteroids –
- Regulates water and sodium balance
- Body’s response to stress
- Immune system
- Sexual development and function
- Metabolism
- Adrenal medulla produces epinephrine that increases HR and BP when there is stress
Pancreas
- LUQ of abdomen
- Includes endocrine and exocrine glands
- Islets of Langerhans are the hormone-producing cells of the pancreas
- Alpha cell produce glucagon
- Beta cells produce insulin
Hormones Function, regulation, and secretion (Table on pg 524-525)
Aerobic metabolism:
The ATP producing metabolic processes that are dependent on oxygen transported via the circulatory system.
Aerobic metabolic functions typically provide energy for low intensity and/or longer duration activities.
Anabolism:
The metabolic process in which simple molecules (e.g., nucleic acids, polysaccharides, amino acids) are combined to create the complex molecules (e.g., proteins) needed for tissue and organ growth.
Anaerobic metabolism:
Metabolic functions that do not require the presence of oxygen and produce energy for high intensity, shorter duration activities.
Adenosine triphosphate (ATP):
The molecular unit within the body which transports the chemical compounds used for cellular metabolism.
Catabolism:
The metabolic process in which complex materials (e.g., proteins, lipids) are broken down in the body for the purpose of creating and releasing heat and energy.
DNA (deoxyribonucleic acid):
A double helix molecule that contains the genes that provide the blueprint for all of the structures and functions of a living being.
Metabolism:
The physical and chemical processes of cells burning fuel to produce and use energy. Examples include digestion, elimination of waste, breathing, thermoregulation, muscular contraction, brain function, and circulation.
Mitochondria:
The part of the cell that is responsible for energy production. The mitochondria are also responsible for converting nutrients into energy and other specialized tasks.
Osteopenia:
A condition presenting with low bone mass that is not severe enough to qualify as osteoporosis. Individuals with osteopenia may not have actual bone loss, but a naturally lower bone density than established norms.
Osteopetrosis:
A group of conditions characterized by impaired osteoclast function which causes bone to become thickened but fragile. Osteopetrosis is an inherited condition that can vary widely in symptoms and severity.
ph:
A measure of the hydrogen ion concentration in body fluid.
Addison’s Disease
- Adrenal dysfunction that presents with hypofunction of the adrenal cortex. (adrenal insufficiency)- Considered primary insufficiency
- Decreased production of both cortisol (glucocorticoid) and aldosterone (mineralocorticoid).
*Etiology
- When the adrenal cortex produces insufficient cortisol and aldosterone hormones
- autoimmune, infection, neoplasm, or hemorrhage
- Signs and symptoms
- Widespread metabolic dysfunction secondary to cortisol deficiency as well as fluid and electrolyte imbalances secondary to aldosterone dysfunction.
- Hyperpigmentation (typically 1st symptom to present) aka bronze skin
- Hypoglycemia
- susceptible to infections
- personality changes
- Hypotension
- Weakness, fatigue, myalgias
- Anorexia
- Weight loss
- dehydration
- Diarrhea
- If left untreated this condition will result in shock and possible death.
- Treatment - Treatment primarily consists of long-term pharmacological intervention using synthetic corticosteroids and mineralocorticoids.
- Pt implications:
- slow progression of exercise and monitor vital signs
- Fall risk 2* to hypoglycemia and OH
- most common in females 30-50 y/o
Adrenal Crisis
Significant N/V
Confusion
Cyanotic
Abdominal symptoms: abdominal distention, pain, and tenderness
Cushing’s Syndrome
- Adrenal dysfunction that presents with hyperfunction of the adrenal gland, allowing for excessive amounts of cortisol (glucocorticoid) production.
*Etiology
- Pituitary gland produces excessive adreno-corticotropic hormone (ACTH) with subsequent hypercortisolism.
- Most common etiology is pituitary or adrenal gland tumor
- Or could also be excess of corticosteroid medication
- Females’ 25-40 y/o most common
- Signs and symptoms
- Evolve over years and can include:
- Persistent hyperglycemia,
- HTN
- OP
- Growth failure,
- Truncal obesity,
- Purple abdominal striae,
- “moon shaped face,”
- “buffalo hump” posteriorly at the base of the neck aka dorsocervical fat pad
- weakness,
- slender limbs
- acne,
- thinning of skin-straie
- Hair loss
- Bruise easily
- male gynecomastia.
- Mental changes can include depression, poor concentration, and memory loss.
- Treatment - Treatment may include pharmacological intervention to block the production of the hormones, radiation therapy, chemotherapy or surgery.
- PT implications:
- Caution 2* to impaired wound healing/bruise easily
- Closely monitor resistance exercises for m pain or increased weakness
- Slow progressive WB and precautions with mobilization 2* to OP.
- FYI Cushing’s disease is due to a pituitary tumor that results in the same stuff as above.
DM (Type 1)
- Pancreas fails to produce enough or any insulin. * Normally diagnosed in childhood, but can occur at any age.
- AKA It is also known as insulin-dependent diabetes or juvenile diabetes.
- Requires subcutaneous insulin
*Etiology
- The exact cause is unknown, but genetic predisposition in combination with exposure to a viral or environmental trigger is believed to cause an immune reaction that damages the pancreas with subsequent failure in secretion of endogenous insulin.
- Signs and symptoms - rapid onset of symptoms:
- polyphagia,
- weight loss,
- ketoacidosis,
- polyuria,
- polydipsia,
- blurred vision,
- dehydration,
- fatigue.
Treatment -
- exogenous insulin injections that are required to maintain proper glucose blood levels and avoid complications.
- Proper nutritional management is also required for blood glucose control. Insulin pumps may be indicated for continuous administration of insulin.
- Presently, there is no cure for type 1 DM and as a result, the goal is to control the regulation of blood glucose levels (Fig. 7-5).
To diagnosis DM1 & DM2
- Asymptomatic pts: >126mg/dl of two different fasting plasma glucose (fasting = no caloric intake for 8 hrs)
- Symptomatic pt: a random (casual) glucose of 200 mg/dl
- 2 hours postload glucose > or = to 200 mg/dL during oral glucose tolerance test
- A1c test - diabetes = greater or equal to 6.5%
A1c
measure average blood glucose for past 2-3 months
- Normal <5.7%
- Prediabetes 5.7%-6.4%
- Diabetic > or equal to 6.5%
Complications of DM1
hypoglycemia/hyperglycemia
diabetic ketoacidosis
increased risk of infecitons
cardiovascular and peripheral vascular disease
retinopathy
nephropathy
impotence
acceleration of atherosclerosis
major cause of blindness in adults 20-74 y/o
Leading cause of non-traumatic LE amputation and end-stage renal disease
DM (Type 2)
- Over the age of 45 (however increase in children diagnosed due to childhood obesity)
- Typically retains the ability to produce some endogenous insulin. (but can eventually loose all ability)
- alteration in the metabolism of glucose.
- Excess body fat interferes with body’s ability to metabolize insulin correctly
- Etiology - Array of dysfunctions resulting from the combination of resistance to insulin action and inadequate insulin secretion. This disorder is characterized by hyperglycemia when the body cannot properly respond to insulin.
- Obesity is found to contribute to this condition by increasing insulin resistance.
- Signs and symptoms -
- Relatively the same as with type 1, however, ketoacidosis does not occur since insulin is still typically produced.
- polydipsia, polyuria, blurred vision, delayed healing and frequent infections
- Treatment - Treatment of type 2 diabetes includes blood glucose control through diet, exercise, oral medications or insulin injections when necessary.
Gout
- complex form of arthritis from abnormally high uric acid levels
- needle like crystals form and accumulate causing joint inflammation and swelling.
- Most common in males
- Joints affected: great toe, knee, and ankle
Acute
* single joint
* signs of inflammation (pain, redness, swelling, warmth)
* Pain (throbbing, crushing, or excruciating)
* Rapid progression that eases over time (night pain)
Chronic
* multiple joints
* less intense symptoms
* initially may be unrecognized due to the symptoms attributed from arthritis
* Firm, lumpy deposits of uric acide form under the skin
Increases risk:
* obesity, kidney disease, DM or diabetes insipidus, leukemia, and sickle cell anemia
Graves Disease
- Most specific cause of hyperthyroidism.
- Women over age 20 (occurs in men as well and can affect any age group).
- Etiology - Caused by an autoimmune disease in which certain antibodies produced by the immune system stimulate the thyroid gland causing it to become overactive.
- Signs and symptoms -
- Symptoms are consistent with hyperthyroid presentation.
- Classic signs of Graves’ disease:
- Mild enlargement of the thyroid gland (goiter),
- Heat intolerance
- Nervousness
- Weight loss,
- Tremor
- Palpitations
- Weakness
- Frequent bowel movement
- Cardio: DOE, palpitations, tachy, arrhythmias
- Cognitive: anxiety, mental fatigue, and difficulty concentration
- Treatment - Management includes pharmacological intervention and/or removal of the thyroid gland using radiation or surgical intervention.
Hyperparathyroidism
- Excessive levels of hormone production by the parathyroid gland that leads to hypercalcemia (in blood/urine) impacts multiple systems
- Leads to disruption of calcium, phosphate, and bone metabolism.
- Females age >60 y/o
- Symptoms:
- renal stones and kidney damage
- muscle wasting,
- bone deformity,
- myopathy.
- bone decalcification-pain/pathologic fx
- weakness/fatigue
- Joint hypermobility
- CNS: memory, depression, personality changes
- Acute treatment:
- pharmacological intervention that produces an immediate lowering of serum calcium using diuretics or antiresorptive medications.
- Surgical intervention is usually required to remove the diseased parathyroid gland.
- Pharmacological intervention may be used prior to surgery or for long-term management.
- Implication to PT: Bone pain (in spine), risk for fx, care with joint mobs, proper hydration and monitor for fatigue
Hypoparathyroidism
- hypo-secretion or low-level production of parathyroid hormone by the parathyroid gland causing hypocalcemia (in blood/urine).
- Symptoms:
- Muscle weakness, pain, and tetany
- Trousseau sign (carpal spasm)
- Chovostek sign (facial spasm)
- Cardiac arrhythmias
- hypocalcemia,
- Seizures
- cognitive defects
- short stature
- Shortened 4th and 5th metacarpals
- Treatment
- Acute hypoparathyroidism requires rapid elevation in serum calcium levels through intravenous calcium.
- Long-term treatment includes pharmacological management and dietary modifications
- Pt implications:
- Acute: Life threatening; immediate emergency care
- Chronic: Hyperventilation may worsen tetany; focus on breathing during exercise
- Cardiac complications may occur; careful monitoring of vital signs
Hyperpituitarism
- Excessive secretion of one or more hormones under the pituitary gland’s control (frequently growth hormone that produces acromegaly in adults).
- Disorders and symptoms are dependent on the hormone that are affected.
- Some disorders include gigantism or acromegaly, hirsutism, galactorrhea (abnormal lactation in males or females), amenorrhea, infertility, and impotence.
- Treatment is hormone and site dependent and can include tumor resection, surgery, radiation therapy, and hormone suppression or replacement (if gland becomes dysfunctional after treatment).
Hypopituitarism
- Decreased or absent hormonal secretion from the anterior pituitary gland.
- Rare disorder and symptoms are dependent on the age of the affected person and deficit hormones.
- Typical disorders may include short stature (dwarfism), delayed growth and puberty, sexual and reproductive disorders, and diabetes insipidus.
- Treatment is also based on the deficit hormones and usually includes pharmacological replacement therapy.
Hyperthyroidism
The thyroid is the metabolic regulator….This is increased so all metabolic functions are increased
- Excessive levels of thyroid hormones (T3 & T4) in the bloodstream.
- Females 20-40
- Typically Graves disease
- Symptoms:
- increase in nervousness,
- excessive sweating,
- fatigue
- palpitations
- hyperreflexia
- tremor
- weight loss,
- increase in blood pressure,
- exophthalmos,
- myopathy,
- chronic periarthritis,
- enlarged thyroid gland.
- atrial fibrillation, CHF, and MI
*Treatment may include pharmacological intervention, radioactive iodine, and surgery.
- PT implications: exercise intolerance and reduced exercise capacity.
-Thyrotoxicosis can aggravate a preexisting heart disease
Hypothyroidism
- Decreased levels of thyroid hormones (T3&T4) in the bloodstream, slowing metabolic processes within the body (so think everything slower).
- Symptoms
- fatigue,
- weakness,
- anorexia
- decreased heart rate,
- weight gain,
- constipation,
- delayed puberty,
- retarded growth and development.
- decreased absorption of food and glucose
- hair loss
- Anemia
- Carpal tunnel syndrome
- FMS
- Depression
- If chronic: forgetfulness, myxedema (excessive swelling of the body), coma/death
- Common causes of hypothyroidism are Hashimoto’s thyroiditis or an underdeveloped thyroid gland.
- Treatment includes oral thyroid hormone replacement therapy.
- PT implications: exercise intolerance with fatigue, weakness, myalgias, and risk of rhabdo if excessiv progression of exercise
- After long-term meds at risk for psudo-gout, osteoporosis, and A-fib
Hypogonadism (male)
- Primary hypogonadism is defined as a deficiency of testosterone secondary to failure of the testes to respond to FSH and LH (produced by the pituitary and hypothalamus).
- The most common cause of primary hypogonadism is Klinefelter’s syndrome.
- Secondary hypogonadism occurs when there is a failure of the hypothalamus or pituitary to produce the hormones that will subsequently stimulate the production of testosterone.
- If a male experiences this prior to puberty:
- sparse body hair,
- underdevelopment of skeletal muscles,
- long arms and legs secondary to a delay in the closure of the epiphyseal growth plates.
- Adult-onset testosterone deficiency
- decreased libido,
- erectile dysfunction,
- infertility,
- decreased cognitive skills,
- mood changes,
- sleep disturbances.
- Treatment includes hormone replacement pharmacological intervention.
Hypogonadism (Female)
- Primary hypogonadism results if the gonad does not produce the amount of sex steroid sufficient to suppress secretion of LH and FSH at normal levels.
- The most common cause of primary hypogonadism is Turner syndrome.
- Secondary hypogonadism occurs when there is a failure of the hypothalamus or pituitary to produce the hormones that subsequently stimulate the production of estrogen.
- If a female experiences this prior to puberty symptoms will include:
- gonadal dysgenesis,
- short stature,
- failure to progress through puberty or primary amenorrhea,
- premature gonadal failure.
- postpubescent females,
- secondary amenorrhea is the primary symptom.
- Treatment includes hormone replacement pharmacological intervention.
Metabolic Acidosis
- Accumulation of acids due to an acid gain or bicarbonate loss.
- pH drops below 7.35.
- Etiology - Metabolic acidosis commonly occurs with conditions such as renal failure, lactic acidosis, starvation, diabetic or alcoholic ketoacidosis, severe diarrhea or poisoning by certain toxins.
- Signs and symptoms - Symptoms include
- compensatory hyperventilation, (to induce respiratory alkalosis)
- vomiting,
- diarrhea,
- headache,
- weakness and malaise,
- hyperkalemia,
- cardiac arrhythmias.
- confusion
- lethargy
- tinnitus
- If left untreated the continued increase in acid can induce coma and eventual death.
- Treatment - Treatment includes managing the underlying cause, correcting any coexisting electrolyte imbalances, and administering sodium bicarbonate.
Metabolic Alkalosis
- Increase in bicarbonate accumulation or an abnormal loss of acids.
- pH rises above 7.45.
- Etiology - Commonly occurs when there has been continuous vomiting, ingestion of antacids or other alkaline substances or diuretic therapy. It may also be associated with hypokalemia or nasogastric suctioning.
- Signs and symptoms -
- nausea,
- diarrhea,
- prolonged vomiting,
- confusion,
- muscle fasciculations,
- muscle cramping,
- neuromuscular hyperexcitability,
- convulsions,
- paresthesias,
- hypoventilation.
- If left untreated the patient can become comatose, experience seizures, and respiratory paralysis.
- Treatment - The most important interventions include managing the underlying cause, correcting coexisting electrolyte imbalances, and administering potassium chloride to the patient.
Mitochondrial Disorder
- Over 100 different forms of mitochondrial disease and each produces a different spectrum of disability and clinical manifestations.
- Etiology - Mitochondrial disorders result from genetically inherited or spontaneous mutations in the DNA that lead to impaired function of proteins found within the mitochondria.
- Signs and symptoms - Symptoms vary depending on the type of mitochondrial disorder, however, can include:
- loss of muscle coordination,
- muscle weakness,
- visual and hearing problems,
- learning disabilities,
- heart,
- liver,
- kidney disease,
- respiratory, neurological, and gastrointestinal disorders, and dementia.
- Treatment - These diagnoses are relatively new and treatment is as varied as the symptomatology and presentation of the disease.
- Treatment is aimed at alleviating the current symptoms and slowing the progression of the disease process.
Osteomalacia
- Metabolic condition where bones become soft secondary to a calcium, phosphorus, or Vitamin D deficiency.
*Adequate bone matrix, however, there is insufficient calcification of the matrix due to the deficiency. - Etiology -
- Calcium is typically lost secondary to inadequate intestinal absorption
- Phosphorus is lost secondary to an increase in renal excretion.
- A deficiency in vitamin D will also cause osteomalacia.
- Signs and symptoms - vague presentation of
- aching,
- fatigue,
- weight loss.
- Myopathy and sensory polyneuropathy
- periarticular tenderness and pain,
- thoracic kyphosis deformity,
- bowing of the lower extremities.
- The patient may also struggle to perform transfers and assume a standing position.
- Treatment - Specific intervention will focus on the underlying etiology. Increased nutrition is recommended and pharmacological intervention may include vitamin D or phosphate supplements.
Osteoporosis
- Metabolic condition that presents with a decrease in bone mass that subsequently increases the risk of fracture.
- Primarily affects trabecular and cortical bone where the rate of bone resorption accelerates while the rate of bone formation declines.
- Declining osteoblast function coupled with the loss of calcium and phosphate salts will cause the bones to become brittle.
- Etiology -
- Primary osteoporosis can include idiopathic, post-menopausal or involutional (senile) osteoporosis.
- Secondary osteoporosis can occur as a result of another primary condition or with use of certain medications.
- Signs and symptoms -
- compression and other bone fractures,
- low thoracic or lumbar pain,
- loss of lumbar lordosis,
- deformities such as kyphosis,
- decrease in height,
- dowager’s hump
- postural changes.
- Treatment - Management of primary osteoporosis includes vitamin and pharmacological intervention, proper nutrition, assistive and adaptive device prescription, and patient education. Surgical intervention may be required for fracture stabilization.
- PT for WB activities. Aquatic therapy will assist with conditioning however shouldn’t replace WB activities
Paget’s Disease
- Metabolic condition characterized by heightened osteoclast activity.
- Excessive bone formation lacks true structural integrity.
- Bone appears enlarged, but lacks strength due to the high turnover of bone secondary to abnormal osteoclastic proliferation.
- Etiology - This disease has a genetic component as well as geographical incidence, and most commonly affects patients over 50 years of age.
- Signs and symptoms -
- MSK pain accompanied by bony deformities (kyphosis, coxa varus, bowing of the long bones, vertebral compression).
- Skull, clavicle, pelvis, femur, spine and tibia are common sites that will exhibit bony changes.
- Advanced progression of the disease include continued pain, headache, vertigo, hearing loss, mental deterioration, fatigue, increased cardiac output, and heart failure (secondary to an increased cardiac output).
- Treatment - Management relies heavily on pharmacological intervention using bisphosphonates in order to inhibit bone resorption and improve the quality of the involved bone.
- Exercise, weight control, and cardiac fitness are all key components in a program to maintain strength and motion.
Phenylketonuria (PKU)
- Autosomal recessive inherited trait characterized by intellectual disability and behavioral and cognitive issues
- Characterized by elevated of serum phenylalanine >6 mg/dl due to a deficiency of phenylalanine hydroxylase
- Symptoms include intellectual disability, gait disturbances, hyperactivity, psychoses, abnormal body odor, and light colored features than family members
- most common in Caucasian populations.
- If left untreated, severe intellectual disability will occur.
- Treatment - Phenylketonuria is treated through dietary restriction of phenylalanine throughout the person’s lifetime. Adequate prevention will avoid all manifestations of the disease.
Tay-Sachs Disease
(Lysosomal storage disorder)
* absence or deficiency of hexosaminidase
A.
* produces an accumulation of gangliosides (GM2) within the
- Etiology - This disease is an autosomal recessive inherited trait and carried primarily in the Eastern European (Ashkenazi) Jewish population.
- Signs and symptoms - At ~6 months of age, the child will start to miss developmental milestones and will continue to deteriorate in motor and cognitive skills. As symptoms progress, the patient develops significant intellectual disability and paralysis, and will usually die by the age of five.
- Treatment - There is currently no effective treatment for this condition. Genetic testing in high risk populations to identify the carriers prior to pregnancy is important in order to avoid this disorder.
Wilson’s Disease
- Rare inherited disorder that is most common in eastern Europeans, Sicilians, and southern Italians, but may occur in any group.
- Typically appears in people under 40 years old and symptoms can develop in children typically between 4-6 years of age.
- Etiology -
- Autosomal recessive inherited trait that produces a defect in the body’s ability to metabolize copper.
- The copper accumulates over time within the brain, liver, cornea, kidney, and other tissues.
- Signs and symptoms -
- Kayser-Fleischer rings surrounding the iris of the eye secondary to copper deposits,
- Degenerative changes in the brain (especially within the basal ganglia),
- Hepatitis,
- Cirrhosis of the liver,
- Athetoid movements,
- Ataxic gait patterns.
- There may also be emotional and behavioral changes as the copper continues to accumulate.
- Over time, and with severe disease, there will be deformities of the musculoskeletal system, pathologic fractures, osteomalacia, muscle atrophy, and contractures.
- Treatment - Treatment consists of continual pharmacological intervention using vitamin B6 and D-penicillamine as both promote the excretion of excess copper from the body. Treatment will also focus on prevention of hepatic disease since a patient will die from hepatic failure if the condition is left untreated.
Which metabolic/endocrine condition results in the demineralization of bone?
Hyperparathyroidism
What condition slows down the metabolic processes?
Hypothyroidism
What condition is often associated with decreased bone resorption?
Hypoparathyroidism
Avoiding food high in purine-containing nucleic acids is part of the treatment approach for what condition?
Gout
Gout is characterized by recurrent attacks of acute inflammatory arthritis and is caused by elevated levels of uric acid in the blood. Avoiding foods high in purines as well as avoiding alcohol (which promotes uric acid overproduction) and drinking plenty of water are important treatment priorities.
Examples of those high in purines: Organ meats, alcohol, seafood, sweetened beverages
Which condition would stimulate the secretion of parathyroid hormone?
hypocalcemia
The parathyroid glands produce parathyroid hormone, which functions as an antagonist to calcitonin and is important for the maintenance of normal blood levels of calcium and phosphate. Parathyroid hormone increases the reabsorption of calcium and phosphate from bones to the blood. Secretion of parathyroid hormone is stimulated by hypocalcemia and inhibited by hypercalcemia.
Which diagnosis would tend to result in low cortisol levels?
Addison’s
Addison’s disease is a form of adrenal dysfunction that presents with hypofunction of the adrenal cortex. Subsequently, there is decreased production of both cortisol and aldosterone. Symptoms may include hypotension, weakness, anorexia, and altered pigmentation. Weight loss often results from loss of appetite, chronic diarrhea, and vomiting.
Which form of diabetes is most prevalent, accounting for 90-95% of persons with diabetes mellitus?
Type 2
Type 2 diabetes, also known as non-insulin dependent, accounts for the vast majority of diabetes cases. Type 2 diabetes usually involves a defect in the insulin-releasing sites within the pancreas or a resistance to insulin due to the impairment of the receptor sites in the peripheral tissues.
Excess growth hormone secretion from the pituitary gland can cause:
acromegaly
Excess growth hormone is usually caused by an adenoma which places direct pressure of the pituitary gland. In acromegaly, bones become broader and heavier resulting in enlarged hands, thicker skull, and changes in facial features.
Gigantism could have been another answer
One of the most serious effects of hyperparathyroidism is:
muscle spasm
weak heart contraction
low serum calcium levels
osteoporosis
osteoporosis
Hyperparathyroidism occurs due to excessive levels of hormone production by the parathyroid gland. Increased parathyroid hormone causes calcium to leave the bone resulting in osteoporosis and other potential bone deformities.
Exophthalmos is most commonly observed in a patient with:
Addison’s disease
Graves’ disease
Paget’s disease
sarcoidosis
Graves’ disease
Exophthalmos refers to bulging or protruding eyeballs and is a common symptom associated with Graves’ disease. Graves’ disease is caused by an autoimmune disease in which certain antibodies produced by the immune system stimulate the thyroid gland causing it to become overactive
Metabolic acidosis is a decrease in a pH and what is the HCO3?
Also decreased
What often causes compensatory hyperventilation?
Metabolic acidosis
An individual with phenylketonuria should be most cautious to avoid which food?
honey
milk
spinach
apples
milk
Individuals with phenylketonuria should avoid foods that contain phenylalanine since they do not have the ability to break down the amino acid. Foods that are high in phenylalanine include meats, dairy, eggs, nuts, legumes, seeds, some breads, and foods that contain aspartame.
Which demographic has the greatest incidence of osteoporosis?
Caucasian males
African American males
Caucasian females
African American females
Caucasian females
Osteoporosis is a condition where bone deposition is less than bone resorption, resulting in decreased bone density. The condition occurs most often in the aged, particularly in postmenopausal women and is more common in Caucasians than African Americans.
A lack of or inability to use vitamin D is often associated with:
osteomalacia
Osteomalacia refers to a softening of the bones, often caused by a vitamin D deficiency or an inability to use vitamin D. Soft bones are more likely to bow and fracture than are harder, healthier bones. Osteomalacia results from a defect in the bone-building process, while osteoporosis develops due to a weakening of previously constructed bone.
What disease is characterized by extreme bowing of bones, especially affecting the legs of children?
Paget’s disease
osteoporosis
osteopenia
rickets
rickets
Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency. Adding vitamin D or calcium to the diet generally corrects any resulting bone problems in children.
Apparent enlargement (or thickening) of long bones, vertebrae, pelvis, or skull would be most characteristic of:
Paget’s disease
Paget’s disease (osteitis deformans) is a chronic bone disease of unknown etiology where there is thickened, spongy, and abnormal bone formation. Progression of the disease includes bowing of long bones, an increase in skull size, bone deformities, and fractures (especially of the vertebrae).
Which objective finding is not one of the diagnostic criteria for metabolic syndrome?
elevated blood glucose
body mass index >30
elevated blood pressure
decreased high density lipoproteins
BMI >30 ( because they do waist circumference and not BMI)
Metabolic syndrome is characterized by at least three of the following five objective findings: elevated blood glucose, elevated blood pressure, elevated triglycerides, decreased high density lipoproteins (HDL), abdominal obesity. Abdominal obesity is based on waist circumference, not body mass index (BMI).
Which of the following correctly states the expected blood gas measurements in a patient with uncompensated metabolic acidosis?
- decreased pH, decreased HCO3, and decreased PCO2
- elevated pH, elevated HCO3 and elevated PCO2
- elevated pH and elevated HCO3, normal PCO2
- decreased pH and decreased HCO3, normal PCO2
decreased pH and decreased HCO3, normal PCO2
Uncompensated metabolic acidosis presents with decreased pH and bicarbonate (HCO3). The condition occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body.
Which of the following is a common cause of metabolic alkalosis?
diarrhea
vomiting
hyperventilation
renal failure
Vomiting
Metabolic alkalosis occurs when excess bicarbonate accumulates in the body or acid is lost. The most common cause is loss of stomach acid from prolonged vomiting or excess gastric suction. Diarrhea and renal failure would be more likely to cause metabolic acidosis, while hyperventilation causes respiratory alkalosis.
Growth hormone- release hormone
Originates: Hypothalamus
Target: pitiuitary
Function: Increase the release of GH
Regulation of hormone: CNS feedback; circulating levels of hormones
Growth hormone-inhibiting hormone
Originates: Hypothalamus
Targets: Pituitary gland
Function: Decreases the release of GH
Regulation of hormone: CNS feedback; circulating levels of hormone
Gonadotropin-releasing hormone
Originates: Hypothalamus
Targets: pituitary
Function: increases the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
Regulation of hormone: CNS feedback; circulating levels of hormone
Thyrotropin-releasing hormone
Originates: Hypothalamus
Targets: Pituitary gland
Function: Increases the release of thyroid-stimulating hormone (TSH)
Regulation of hormone: CNS feedback; circulating levels of hormone
Corticotropin-releasing hormone
Originates: Hypothalamus
Targets: Pituitary
Function: Increases the release of adrenocorticotropic hormone
Regulation of hormone: CNS feedback; circulating levels of hormone
Prolactin-releasing hormone
Originates:
Targets: Pituitary gland
Function: stimulates release of prolactin
Regulation of hormone: CNS feedback; circulating levels of hormone
Prolactin-inhibitory factor; dopamine
Originates: Hypothalamus
Targets: Pituitary
Function: Decreases release of prolactin
Regulation of hormone: CNS feedback; circulating levels of hormone
Growth Hormone (GH)
Originates: Pituitary
Targets: Bone and muscle
Function: Promotes growth and development; increases rate of protein synthesis
Regulation of hormone: Hypothalamus
Follicle-stimulating hormone (FSH)
Originates: Pituitary
Targets: Ovaries and testes
Function: Promotes follicular development and the creation of estrogen in females; promotes spermatogenesis in males
Regulation of hormone: Hypothalamus
Luteinizing hormone
Originates: Pituitary
Targets: ovaries and testes
Function: promotes ovulation along with estrogen/progesterone synthesis from the corpus luteum in females; promotes testosterone synthesis in males
Regulation of hormone: Hypothalamus
Thyroid-stimulating hormone
Originates: Pituitary
Targets: Thyroid gland
Function: Increases the synthesis of thyroid horomones T3 and T4
Regulation of hormone: Hypothalamus
Adrenocorticotropic hormone
Originates: Pituitary
Targets: Adrenal cortex
Function: Increases cortisol synthesis (adrenal steroids)
Regulation of hormone: Hypothalamus
Prolactin
Originates: Pituitary
Targets: Mammary glands
Function: allows for process of lactation
Regulation of hormone: Hypothalamus
Oxytocin
Originates: Pituitary
Targets: Uterus and mammary glands
Function: Increase contraction of uterine muscles; promotes release of milk from mammary glands
Regulation of hormone: Nerve impulses from the hypothalamus; stretching of the cervix; nipple stimulation
Antidiuretic Hormone
Originates: Pituitary
Targets: Kidneys
Function: Increases water reabsorption; conserves water; increases BP through stimulating contracting of m in small arteries.
Regulation of hormone: Decreased water content
Androgen
Originates: Adrenal cortex
Targets: Ovaries and testes
Function: Increases masculinization; promotes growth of pubic hair in males and females
Regulation of hormone: Influenced by the hypothalamic production and release of GnRH and LH
Aldosterone (mineralocorticoid)
Originates: Adrenal cortex
Targets: Kidneys
Function: Increases reabsorption of Na+ ions by the kidneys to the blood; increases excretion of K+ ions by the kidneys into the urine
Regulation of hormone: Low blood Na+; high blood K+ levels
Cortisol (glucocorticoid)
Originates: Adrenal cortex
Targets: gastrointestinal system
Function: Influences metabolism of food molecules; anti-inflammatory effect in lg amounts
Regulation of hormone: Adrenocorticotropic hormone
Epinephrine
Originates: Adrenal medulla
Targets: Cardiovascular and metabolic systems
Function: Increases HR and force of contraction; increases energy production; vasodilation in skeletal m
Regulation of hormone: Sympathetic impulses form the hypothalamus in stress situations
Norepinephrine
Originates: Adrenal medulla
Targets: cardiovascular and metabolic systems
Function: Vasoconstriction in skin, viscera, and skeletal m.
Regulation of hormone: Sympathetic impulses form the hypothalamus in stress situations
Estrogen, progesterone
Originates: Ovaries
Targets: Uterus and mammary glands
Function: involved in regulation of the female reproductive system and female sexual characteristics
Regulation of hormone: Cyclical rise and fall fo hormone levels
Glucagon
Originates: Pancreas
Targets: Liver
Function: Increase blood glucose by stimulating the conversion of glycogen to glucose
Regulation of hormone: Hypoglycemia
Insulin
Originates: Pancreas
Targets: All body systems
Function: decreases blood glucose and increase the storage of fat, protein, and carbs
Regulation of hormone: Hyperglycemia
Parathormone
Originates: Parathyroid
Targets: bone, kidney, intestinal mucousa
Function: increases blood calcium
Regulation of hormone: Hypoclacemia
Testosterone
Originates: Testes
Targets: Pituitary gland
Function: involved in process of spermatogenesis and male sexual characteristics
Regulation of hormone: influenced by pituitary release of LH
Thyroxine (T4) and Triiodothyronine (T3)
Originates: Thyroid
Targets: all tissues
Function: involved with normal development; increases cellular level metabolism
Regulation of hormone: Thyroid stimulating hormone (TSH)
Calcitonin
Originates: Thyroid
Targets: plasma
Function: increases calcium storage in the bone; decreases blood calcium levels
Regulation of hormone: Hypercalcemia (too much calcium in blood)
How quick are the endocrine system’s regulatory effects and how long do they last?
Slow regulatory effects
Last for long periods
Where is the pancreas located?
LUQ
The adrenal cortex produces ___________ that will regulate water and sodium balance, the immune system, and metabolism
Corticosteroids
Location of the spleen?
LUQ
The spleen is an organ in the left upper portion of the abdomen, to the left of the stomach. The spleen is shaped like a fist and is usually about four inches in length.
Which endocrine gland helps to regulate the sleep-wake cycle?
pineal
The pineal gland secretes the hormone melatonin which targets melanocytes. The gland functions to cause drowsiness and to help regulate the sleep-wake cycle.
Which gland would have the greatest ability to influence the level of calcium in the blood?
parathyroid glands
The parathyroid glands produce parathyroid hormone, which functions as an antagonist to calcitonin and is important for the maintenance of normal blood levels of calcium and phosphate. Parathyroid hormone increases the reabsorption of calcium and phosphate from bones to the blood.
What gland produces the hormone calcitonin?
thyroid gland
Calcitonin acts to lower blood calcium levels and counteracts the parathyroid hormone. Calcitonin is produced primarily within the parafollicular cells of the thyroid.
Which endocrine structure is responsible for the uptake of blood glucose?
Pancreas
In response to elevated blood-glucose levels, the pancreas releases insulin, which stimulates the cellular uptake of glucose molecules. The pancreas also produces and releases glucagon, which stimulates the breakdown of liver and muscle glycogen into glucose to be released into the bloodstream.
The islets of Langerhans are found in which organ?
pancreas
The islets of Langerhans are found in the pancreas and perform three endocrine functions. These functions include producing glucagon to increase blood glucose, producing insulin to lower blood glucose, and producing somatostatin which regulates the release of glucagon and insulin.
Stimulation to the posterior pituitary gland results in the secretion of which two hormones?
- antidiuretic hormone and oxytocin
- thyroid-stimulating hormone and follicle-stimulating hormone
- luteinizing hormone and growth hormone
- prolactin and adrenocorticotropic hormone
antidiuretic hormone and oxytocin
Neural stimulation to the posterior pituitary gland results in the secretion of two effector hormones: antidiuretic hormone and oxytocin
Which term is most descriptive of a potassium deficit?
Hypokalemia
Hypokalemia refers to an abnormally low potassium concentration in the blood. The condition can be caused by vomiting, diarrhea, burns, uncontrolled diabetes mellitus, diuretic therapy, and steroid therapy.
What term describes the process of tissue growth and repair?
anabolism
Catabolism refers to the metabolic processes which provide heat and energy to the body by breaking down tissue and food into raw materials while anabolism refers to processes involved with tissue growth and repair using the raw materials created during the process of catabolism. The two processes work in opposite directions to create the body’s metabolism.
Which of the following is an example of catabolism?
dehydration synthesis
carbohydrate storage
hydrolysis
biosynthesis
hydrolysis
Catabolism is the set of metabolic processes that break down large molecules. The purpose of catabolic reactions is to provide the energy and components needed for anabolic reactions. Hydrolysis is an example of catabolism and refers to the process of breaking down water molecules.
“Moon face” and “buffalo hump” fat deposits are characteristic of:
chronic alcohol abuse
chronic cardiovascular problems
excess corticosteroids
hypothyroidism
excess corticosteroids
Excess corticosteroids over an extended period of time (such as due to Cushing’s syndrome) cause changes in fat deposition including “moon face” (rounded cheeks and face) and “buffalo hump” (fat deposits on the back of the neck and shoulders).
Rehab considerations of various patients (pt. 523-532)
Testing for DM (pg. 531)
What would be the lab results on thryoxine and TSH on someone with Graves disease?
- Increased thyroxine and decreased thyroid-stimulating hormone
A kidney injury would result in what S&S
Decreased urinary frequency
Generalized abdominal pain
Ipsilateral shoulder pain
Tenderness at the costovertebral angle
fever/chills
Increased urinary frequency
Blood in urine
Hyperesthesia of T9-10 dermatomes
Abdominal muscle spasm
nausea/vomiting.
Diabetes Insipidus
posterior pituitary dysfunction.
Imbalance with water due to ADH deficiency. So the kidneys dont resorb water and large amounts are excreted diluted.
Polydipsia, thirst, dehydration
Syndrome of Inappropriate secretion
What lab values will be different with acute renal failure
Hyperkalemia (too much potassium)
Increased creatinine levels
