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CNS Exam 2024 > MNT Endocrine > Flashcards

MNT Endocrine Flashcards

1
Q

hypothyroidism

A

> fatigue
weight gain
constipation
increased sensitivity to cold
dry skin
depression
muscle aches
reduced exercise tolerance, >irregular or heavy menses

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2
Q

Hashimotos

A

-there are no signs or symptoms that are unique to
Hashimoto’s thyroiditis” except elevated TPO (thyroid peroxidase) antibodies detected in blood tests.

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3
Q

Hyperthyroidism

A

> nervousness
-irritability
-increased sweating
-heart racing
-anxiety
-difficulty
-sleeping
-thinning of skin
-fine brittle hair
-weakness in muscles (upper arms and thighs)
-more frequent bowel movements (but diarrhea is uncommon)
-lose weight despite good appetite
-menstrual flow may lighten/periods may occur less
-Initially the patient has more energy but as the body breaks down, they become fatigued.
-Graves’ dermopathy (skin condition on shins

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4
Q

Graves disease

A

eye symptoms, such as Graves’ ophthalmopathy or orbitopathy
(1/3 of all individuals diagnosed) “bulging Eyes”

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5
Q

Nonmodifiable risk factors (Thyroid)

A

● There is a “genetic predisposition for the development of Hashimoto’s Thyroiditis in patients with positive family history of the disease (43.59% of patients with positive family history developed Hashimoto’s Thyroiditis themselves).
● Exposure to Epstein Barr Virus 7
● THEA Score: Verified, Predictive Score for the Occurence of Events in a Euthyroid Cohort of Women with First- or Second-Degree Relatives with Proven AITD

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6
Q

General nutrients of concern

A

Iodine
● Magnesium
● Selenium
● Vitamin D
● Iron
● Zinc
● Vitamin C
● Vitamin E
● Vitamin B12

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7
Q

General lifestyles of concern

A

● Overnight shifts
● Smoking
● Environmental, Toxin and Heavy Metal Exposure
● Stress; history of trauma
● Gut microbiota
● Other infections
● Prior use of medications

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8
Q

Role of nutrition professional (Thyroid)

A

-Inside scope of practice
○ Educate client on thyroid function
○ Support thyroid through food and supplementation
○ Support thyroid through lifestyle changes
○ Ensure client is taking prescription medication as directed
○ Communicate, if appropriate consent has been received, with endocrinologist or
PCP regarding client’s care plan
● Outside scope of practice
○ Recommend to a client change or stop prescription medicine
○ Diagnosis a client with a form of thyroiditis

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9
Q

Basics of Thyroid

A

Thyroid Stimulating Hormone (TSH) is the “test first” marker; this marker is inversely associated with thyroid function; TSH is a component of the metabolic pathway to ensure sufficient release of thyroid hormone
● Graves’ disease is the autoimmune disorder associated with hyperthyroidism (but not all hyperthyroidism is Graves’)
● Hashimoto’s disease is the autoimmune disorder
associated with hypothyroidism (but not all hypothyroidism is Hashimoto’s)

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10
Q

Thyroid hormones explained

A
  1. Low blood level of thyroid hormones or low metabolic rate stimulates release of TRH (Hypothalamus)
  2. TRH carried by hypophyseal portal veins to anterior pituitary stimulates release of TSH (anterior pituitary gland)
  3. TSH released into blood stimulates thyroid follicular cells
  4. Thyroid hormones released into blood by collicular cells
  5. Elevated level of thyroid hormones inhibits release of TRH and TSH
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11
Q
  1. Where is the Thyroid gland located? What shape is the thyroid gland?
A

Butterfly shaped structure that lies on the windpipe below the Adam’s apple. Wings wrap themselves around the windpipe. The Thyroid isthmus (body) lies over the second and third ring of the trachea and opposite the fifth, sixth and seventh cervical vertebrae. Right lobe larger than left. Sheath attaches thyroid to trachea and larynx. Pyramidal lobe is present in the center.

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12
Q
  1. Define and describe the roles of TSH, TGB, TRH, Including secreting gland for each.
A
  • Low blood level of thyroid hormones or low metabolic rate stimulates release of TRH (Hypothalamus)
    o Low T4 levels are the biggest stimulant of TRH
  • TRH stimulates the pituitary to produce a hormone called Thyroid stimulating Hormone (TSH) (Anterior pituitary)
  • TSH released into blood stimulates thyroid follicular cells
  • Thyroid hormone released into blood by follicular cells
  • Elevated level of thyroid hormones inhibits release of TRH and TSH
    o High T3 is the strongest inhibitor of TRH
  • TRH (Hypothalamic Releasing Hormone) in Hypothalamus
  • TSH (regulatory hormone) produced in the pituitary to control Thyroid function
  • Pituitary responds to T3, T4, and TSH
  • TBG Thyroid binding globulin:
    o The main binding protein (produce in the liver)
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13
Q
  1. What hormone(s) does the thyroid gland manufacture?
A

T4 (90%),T3 (10%), rT3 (1 %), T2 (very small amount)
Thyroid gland is the only gland to store its own hormone. 100 day supply.

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14
Q
  1. What are the roles of thyroid hormones?
A
  • Thyroxine (T4) is the primary hormone your thyroid makes and releases.
    o Produced in Thyroid in response to TSH
    o Converted into T3(triiodothyronine) or Reverse T3 (rT3) deiodination.
    o T4 is a stored in follicle or released into blood stream.
    *Triiodothyronine (T3): produces lesser amounts of T3 than T4 but much greater affect on metabolism than T4.
  • Reversed Triiodothyronine (RT3): very small amounts, reverses the effects of T3
    *Calcitonin: Helps regulate the amount of calcium in your blood

To make thyroid hormone, you must need iodine. Your thyroid gland traps iodine.

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15
Q

What function does the thyroid regulate

A
  1. metabolism: increase basal metabolic rate (BMR), amount our body uses during rest.
  2. Heart rate: increase the heart rate, stroke volume, and cardiac output.
  3. Body temperature
  4. Digestion: affect how quickly food moves through your digestive tract.
  5. Muscle strength: cause the development of fast twitch muscle fibers.
  6. Brain development: and maturation
  7. Bone maintenance and growth.
  8. Nervous system, increased alertness, attention, and quicker reflexes.
  9. Reproductive health:
  10. Menstrual cycle
    The Thyroid gland produces thyroid hormones.
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16
Q
  1. Where (in the body) does the conversion of T4-T3 take place?
A

peripheral tissue

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17
Q

Of the four iodinated molecules, which are biologically active?

A

T3 is considered the most metabolically active thyroid hormone.

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18
Q
  1. Why is tyrosine important?
A

Non essesntial amino acid that body produces from Phenylanine. It plays a role in many vital bodily functions: Neurotransmitters (dopamine, norepinephrine, epinephrine which affect mood, memory and alertness) Melanin : pigment that protects skin from sunburn
Hormones: helps adrenal, thyroid and pituitary glands produce and regulate hormones
Protein structure:
Cognitive function: improve especially under stress.

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19
Q

Why is 5’-doiodinase important?

A
  • Enzyme responsible for the conversion of T3 (selenium dependent enzyme)
  • Responsible for conversion of rT3 (not selenium dependent)
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20
Q

What is the function of the enzyme thyroid peroxidase (TPO

A

enzyme primarily found in the thryoid gland. Plays a crucial role in the production of thyroid hormones by facilitating the process of adding iodine to a protein call thyroglobulin.
-Assists in the chemical reaction that adds iodine to a ptoetin called thyroglobulin.

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21
Q

What is iodination?

A

*The substitution or addition of iodine atoms in organic compounds.

Iodination of thyroglobulin, synthesis of thyroid hormone, extracellular process that takes place inside the thyroid follicles.

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22
Q

What minerals are necessary for the conversion of thyroid hormones?

A

Iodine and selenium *Iodine ( key component of the thyroid hormone itself
* Selenium (crucial for the enzyme that converts the inactive T4 hormone to the active T3 form.

Other minerals that play a role:
Iron: deficiency can be linked to hypothyroidism (proper conversion of T4 and T3)

Zinc: important for conversion.

Copper: important for normal function.

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23
Q

What is the parathyroid?

A

Set of four pea sized glands that sit on the back of the thyroid gland in the neck.
-produce and release parathyroid hormone(PTH)
-PTH regulates calcium levels in the blood.
-When calcium levels are low, parathyroid releases PTH(works with Vitamin D) to increase calcium absorption from food.
-When calcium increase, the parathyroid glans stop releasing PTH.

Disorders: Hyperparathyroidism, Hypoparathyroidism,

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24
Q

Are most types of hormones fat soluble? Do they need a carrying protein?

A

No, most types of hormones are not fat soluble, only a subset of hormones, primarily steroid hormones like estrogen, testosterone and cortisol. These do need a carrying protein. These can pass through cell but can not dissolve in blood without carrier proteins that bind to hormone.

25
Q

Thyroid labs

A

● TSH or thyrotropin
● Total T3
● Total T4
● Free T3
● Free T4
● Reverse T3
● T3 Uptake
● FTI (Free Thyroxine Index)
● TBG (Thyroxine Binding Globulin)
● Thyroid Peroxidase (TPO) Ab
● Thyroglobulin Antibodies (TGA)
● Thyrotropin Receptor (TR) Ab

26
Q

Thyroid blood testing

A

Normal/optimal
TSH: .4-5.5 /1.3-2.0
Total T3 : 1.23-3.53 nmol/L /1.84-1.91
60-80 (US)/120-125 (US)
Total T4: 61.8-169.9/ 96.53-104.25
4.5-12.5 (US)/7.5-8.1 (US)
Free T3: 2.3-4.2 pmol/L/3.0-3.25
Free T4: 9.1-31.0/12.9-19.31 pmol
.7-2.5 (US)/1.0-1.5 (US)
Reverse T3 : 90-350 pg/ml/50-150 pg/ml

27
Q

Functional levels for thyroid

A

TSH: 1.8-3.0
T4: 6.0-12.0
T3: 100-180
Free T4: 1.0-1.5
Free T3: 3.0-4.0
T3 uptake: 28%-38%
FTI : 1.2-4.9
TBG: 18-27
Reverse T3: 9.2-24.1

28
Q

Functional assesment for Thyroid

A

Hypothyroidism:
Tsh: Elevated
T4: Normal Range or Low
Free T4: Normal Range or low
FTI: normal range or low
T3 uptake: Normal or low
Free T3: Normal or low
Reverse T3: Normal range

Hyperthyroidism:
TSH=low
T4= normal range or elevated
Free T4: Normal range or elevated
T3 uptake: Normal Range
Free T3: Normal range or elevated
Reverse T3: Normal range
Thyroid Abs= positive

29
Q

Functional Testing thyroid

A

ZRT Labs
○ Thyroglobulin; Total T4, Free T4, Free T3, TSH, TPO Ab
○ Nutrients (Iodine, Selenium) and Heavy metals (Arsenic, Cadmium, Mercury)
○ Bromine: ”An increase in plasma bromine could potentiate an increase in plasma TSH concentration,
probably as a consequence of a minor inhibitory effect on thyroid activity” 4
○ Lithium: “Hypothyroidism is a well-documented consequence of lithium treatment. Less well known is
a possible association between lithium therapy and hyperthyroidism.” 5
● Genova Labs
○ TSH, Free T4, Free T3, Reverse T3, Anti TG, Anti TPO

30
Q

Other thyroid information

A

Primary VS Secondary: A high TSH level indicates that the thyroid gland is failing because of a problem that is
directly affecting the thyroid (primary hypothyroidism). The opposite situation, in which the TSH level is low, usually
indicates that the person has an overactive thyroid that is producing too much thyroid hormone (hyperthyroidism).
Occasionally, a low TSH may result from an abnormality in the pituitary gland, which prevents it from making enough
TSH to stimulate the thyroid (secondary hypothyroidism).” 6
● Thyroid Storm: Read more in this 2012 PubMed article about this “life-threatening condition requiring emergency
treatment” 7
● Swinging levels are possible but rare. Read more here. 8
● Factitious thyrotoxicosis: Not so common. Read more here.

31
Q

Nodules, goiters, cancer

A

“Most nodules do not cause symptoms”
● “Thyroid nodules may produce excess amounts of thyroid hormone causing hyperthyroidism”
● “most thyroid nodules, including those that cancerous, are actually non-functioning, meaning
tests like TSH are normal”
● “The best way to find a thyroid nodule is to make sure your doctor checks your neck!”
● “By age 60, about one-half of all people have a thyroid nodule that can be found either
through examination or with imaging. Fortunately, over 90% of such nodules are benign.“
● “Hashimoto’s thyroiditis, which is the most common cause of hypothyroidism,is associated
with an increased risk of thyroid nodules. Iodine deficiency, which is very uncommon in the
United States, is also known to cause thyroid nodules.”

32
Q

Physical assessment

A

● Physical palpitation for goiter
● Achilles Return Reflex
● Iodine Patch Test
● Basal Body Temperature

33
Q

Thyroid management (Hypothyroid)

A

Levothyroxine monotherapy: standard
-food and medication is lekely to impair absorption. Taken either 60 minutes before breakfast or at bedtime (3 or more hours after eating).

34
Q

Hyperthyroid treatment

A

Patients with overt Graves should be treated as follows: RadioActive Iodine (RAI), AntiThyroid Drugs (ATDs), Thyroidectomy .

PReparation of patients for thyroidectomy: Calcium and 25 hydroxyl vitamin D should be assessed.

35
Q

T4 Synthetic medications

A

Levothyroxine sodium (generic), Common brand names:
● Synthroid: full prescribing info found here: https://www.rxabbvie.com/pdf/synthroid.pdf
● Estre
● Euthyrox
● Levo-T
● Levothroid
● Levoxyl
● Thyro-Tabs
● Tirosint
● Unithroid

36
Q

T3 only

A

T3-Only Synthetic Medications
Liothyronine sodium (Generic)
–Common brand names
● Cytomel
● Triostat

37
Q

Natural dessicated thyroid

A

Natural Dessicated Thyroid Medications
–Common brand names
● Armour Thyroid
● Nature Thyroid
● Nature-Throid
● NP Thyroid
● Westhroid
● WP Thyroid

38
Q

Anti thyroid medication

A

Anti-thyroid Medications
–Common brand names
● Northyx
● Tapazole

39
Q

medications that influence thyroid hormone

A

Inhibit pituitary TSH secretion: Dopamine, dobutamine, glucocorticoids, octreotide
Iodine load increases thyroid hormone synthesis: Contrast agents, amiodarone, topical preparations
Impair thyroid hormone release: Iodine excess, lithium, glucocorticoids, aminoglutethimide
Inhibit T4-T3 5’ deiodination: Amiodarone, glucocorticoids, beta blockers *Contrast agents, e.g. iopanoic acid, ipodate
Augment abnormal immune function: Interleukin 1, interferon α, interferon βMonoclonal antibody therapy
Modify binding of T4, T3 to plasma proteins
a. Increase concentration of T4 binding globulin: Estrogen, heroin, methadoneClofibrate, 5-fluorouracil, perphenazine, tamoxifen
b. Decrease concentration of T4 binding globulin: Glucocorticoids, androgens, l-asparaginase
c. Displace T4 and T3 from binding proteins: Furosemide, salicylates, phenytoin, carbamazepine; Non-steroidal antiinflammatory
agents
Displace T4 from tissue pool:Oral cholecystographic agents, some alkylating agents
Modify thyroid hormone action:Amiodarone, phenytoin
Increase clearance of T4, T3: Barbiturates, phenytoin, carbamazepine, rifampicin Sertraline?, fluoxetine?, dothiepin?
Impair absorption of ingested T4:Aluminium hydroxide, ferrous sulfate, cholestyramine, calcium carbonateColestipol, sucralfate,
soya preparations, kayexalate

40
Q

Thyroid comorbitities (AUTOIMMUNE)

A

Celiac Disease 1 (biopsy-verified) 1:62 of AITD individuals 2
● Psoriatic Arthritis 3
● Rheumatoid arthritis 3
● Sjogren’s syndrome 3
● T1DM 3 Autoimmune gastritis 4
● Major Depressive Disorder 5, 6
● Uticaria 7
● Polycystic Ovarian Syndrome (PCOS)

41
Q

Thyroid comorbities (hypothyroidism)

A

CVD in subclinical hypothyroidism
● Atrial fibrillation in subclinical hypothyroidism
● Insulin resistance, low density lipoprotein cholesterol, homocysteine
● Bone maintenance/fracture risk

42
Q

OTher thyroid comorbities

A

● Metabolic Syndrome - Thyroid nodules, Thyroid volume: Effects elderly the
most; gender neutral

43
Q
A

Foods
● Brassica/goitrogens: “Collards, brussels sprouts, and some Russian kale
(can)…potentially decrease iodine uptake…However, turnip tops, commercial
broccoli, broccoli rabe…can be considered minimal risk” 1 (hypo/Hashi)
● Remember, cooking reduces goitrogens
● If consuming soy, ensure sufficient iodine intake
Food sensitivities/intolerances/allergies
● Minimize gluten 4, 5 (hypo/Hashii, hyper/GD)
● Minimize dairy (if lactose intolerant)
Selenium
● “Selenium supplementation reduced serum TPOAb levels after 3, 6, and 12 months in an LT4-treated AIT population, and after
three months in an untreated AIT population” 10 (Hashi)
● Research study protocol built to assess supplementation for Hyper/GD 11 (Graves)
● There are two main growing regions for Brazil Nuts 12
○ 8 mcg per nut found in the Mato Grosso state
○ As much as 194 mcg per nut found in the Amazonas state
● “In regions of low selenium intake a supplement of 50-100mcg/day may be appropriate

Vitamin D● “Lower vitamin D status has been found in HT patients than in controls, and
inverse relationships of serum vitamin D with TPO/Tg antibodies have been
reported. However, other data and the lack of trial evidence suggest that low
vitamin D status is more likely the result of autoimmune disease processes
that include vitamin D receptor dysfunction” 13
● Measure and support levels

Iron:“Iron deficiency impairs thyroid metabolism. TPO, the enzyme responsible for
the production of thyroid hormones, is a heme (iron-containing) enzyme which
becomes active at the apical surface of thyrocytes only after binding heme.
HT patients are frequently iron deficient, since autoimmune gastritis, which
impairs iron absorption, is a common co-morbidity.” 1 (Hashi)
● Anemia is present in both hyper and hypo, but unclear which type
Iodine
● “Chronic exposure to excess iodine intake induces autoimmune thyroiditis,
partly because highly iodinated thyroglobulin (Tg) is more immunogenic.” 1
● Max of 150mcg for non pregnant adults with Hashimoto’s. (More for pregnant
women)

Iodine
● “Chronic exposure to excess iodine intake induces autoimmune thyroiditis,
partly because highly iodinated thyroglobulin (Tg) is more immunogenic.” 1
● Max of 150mcg for non pregnant adults with Hashimoto’s. (More for pregnant
women)

OTher for hyperthyroidism:● Zinc: Zinc plasma levels may appear normal, while urinary Zn excretion is higher compared to euthyroid patients
● Vitamin A (and monitor for toxic levels): believed to “block…excess thyroid hormone”
● Vitamin C: lower levels often found in hyperthyroid patients
● L-carnitine: 500mg 3xs/day for 5 weeks; no lasting effect to thyroid
● Choline: 500-1,000mg/day; manifestation of symptoms decreased
● Vitamin B12: assess and correct deficiency
● Vitamin B6: 100mg pyridoxine IM for 7 days to improve thyrotoxic myopathy
● Vitamin B1:1 - 1.5mg/day increased weight and appetite; decreased tachycardia
● CoQ10: 120mg/day improved cardiac performance (CVD often comorbidity)
● Essential Fatty Acids (and increased need for vitamin E): lower levels often found in hyperthyroid patients
● Magnesium: Tested IM (intramuscularly) and IV
● Potassium: Necessary to balance the Magnesium at such high doses

HYPERthyroid Key Support 19
● Selenium: 60mcg daily
● Vitamin C: 2 g twice daily
● Vitamin E: 800 IU daily (mixed tocopherols)
● Vitamins A: 50,000 IU daily
● L-Carnitine: 2-4 g daily
● CoQ10: 50-100mg daily

HYPOthyroid Key Support 1
● Zinc: 25mg daily 19, 17
● Copper: 5mg daily 19
● Selenium: 200mcg daily 19, 17
● Vitamin C: 1 - 3 g daily/divided doses 19
● Vitamin E: 400 IU daily (mixed tocopherols) 19, 17
● Vitamins A, B2, B3, B6: through food 19
● Vitamin B12: assess and correct 17
● Chromium 17
● Iron: assess and correct

Herbs: Herbs
● Insulin Plant (Costus pictus) (Hypo) 20
● Ashwaganda (Withania somnifera) (Hypo) 21
● Commiphora Mukul (Guggulu) (Hypo) 22
● Launaea procumbens methanol extract (LPME)

Phytochemicals: tumeric (+), resveratrol (-)
● Discussion as adjuvant therapy (tumeric) 24 (Hypo)
● Beware anti-thyroid and goitrogenic effect (resveratrol)

Add as needed: Liver support
● Digestive support
● Blood sugar support
● HPA Axis support
● Mood support
● Support for comorbidities

44
Q

Thyroid/Lifestyle and environment

A

Smoking
○ Agreed negative impact on Graves’ Disease
○ Many studies point to lower antibody counts related to Hashimoto’s, but some conflicting
reports
● Overnight shift work: “Night shift workers may have an increased risk of thyroid diseases”

Occupation: Exposure to…
○ Silica (mining, sandblasting, rock drilling, granite cutting, construction work, bricklaying,
cement work)
○ Mercury (gold mining)
○ Solvents
○ Pesticides
○ Cosmetics (hair dye, nail polish)

Environmental/Occupational Toxins
● PFCs (perfluorinated chemicals)
● PCBs (polycholorinated biphenyls)
● Overexposure to Manganese (found in contrast agents)
● Cadmium

stressors: Current emotional stress, as well as PTSD, and also physical stress can affect
hormone levels
● Basic Exercise to stimulate Vagus Nerve
● Exercise in appropriate amounts so as not to raise cortisol/stress
● Yoga to improve TSH 1

Other infections
● Parvovirus
● Epstein Barr virus
● HIV
● Hepatitis C virus

Other Medications
● INF-drugs (treatment for certain cancers, hepatitis infections,etc) 16
● Medications containing iodide (used for protection against radiation) 16
● Early evidence for linking estrogen-therapy with thyroid cancer

Thyroid dysfunction is often secondary to other disorders such as adrenal fatigue.

45
Q

Endocrine system explained

A

Your endocrine system is in charge of creating and releasing hormones to maintain countless bodily functions. Endocrine tissues include your pituitary gland, thyroid, pancreas and others. There are several conditions related to endocrine system issues — usually due to a hormone imbalance or problems directly affecting the tissue.

46
Q

What is the endocrine system?

A

Your endocrine system consists of the tissues (mainly glands) that create and release hormones.

Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it. Hormones are essential for life and your health.

47
Q

Function?

A

The main function of your endocrine system is to release hormones into your blood while continuously monitoring the levels. Hormones deliver their messages by locking into the cells they target so they can relay the message. You have more than 50 different hormones, and they affect nearly all aspects of your health — directly or indirectly. Some examples include:
Metabolism.
Homeostasis (constant internal balance), such as blood pressure and blood sugar regulation, fluid (water) and electrolyte balance and body temperature.
Growth and development.
Sexual function.
Reproduction.
Sleep-wake cycle.
Mood.

48
Q

What are the endocrine system glands?

A

Glands are special tissues in your body that create and release substances. Endocrine glands make and release hormones directly into your bloodstream. The endocrine glands in your body from head to toe include:

  1. Pineal gland: This is a tiny gland in your brain that’s beneath the back part of your corpus callosum. It makes and releases the hormone melatonin.
  2. Pituitary gland: This is a small, pea-sized gland at the base of your brain below your hypothalamus. It releases eight hormones, some of which trigger other endocrine glands to release hormones.
  3. Thyroid gland: This is a small, butterfly-shaped gland at the front of your neck under your skin. It releases hormones that help control your metabolism.

4.Parathyroid glands: These are four pea-sized glands that are typically behind your thyroid. Sometimes they exist along your esophagus or in your chest (ectopic parathyroid glands). They release parathyroid hormone (PTH), which controls the level of calcium in your blood.

  1. Adrenal glands: These are small, triangle-shaped glands on top of each of your two kidneys. They release several hormones that manage bodily processes, like metabolism, blood pressure and your stress response.
49
Q

What are the three tissues of the endocrine system?

A

Endocrine glands.
Organs.
Endocrine-related tissues.

50
Q

Endocrine system organs

A
  1. Hypothalamus: This is a structure deep within your brain (which is an organ). It’s the main link between your endocrine system and your nervous system. It makes two hormones that your pituitary gland stores and releases (oxytocin and vasopressin) and makes and releases two hormones (dopamine and somatostatin).
  2. Pancreas: This organ is in the back of your abdomen (belly). It’s both an organ and a gland and is also part of your digestive system. It releases two hormones that are essential to maintaining healthy blood sugar levels: insulin and glucagon.
  3. Adipose tissue (body fat): This is a connective tissue that extends throughout your body. It’s found under your skin (subcutaneous fat), between your internal organs (visceral fat) and in the inner cavities of bones (bone marrow adipose tissue). Adipose tissue releases many different hormones, including leptin, angiotensin and adiponectin.
  4. Ovaries: These are small, oval-shaped glands located on either side of your uterus. They produce and store your eggs (also called ova) and make sex hormones that control your menstrual cycle and pregnancy.
  5. Testicles (testes): These are small, round organs underneath your penis in your scrotum. They make sperm and sex hormones, particularly testosterone.
51
Q

OTher tissues that release hormones

A
  1. Digestive tract (stomach and small intestine): Your digestive tract is the largest endocrine-related organ system. It makes and releases several hormones that play a role in your metabolism. Examples include gastrin and ghrelin.
  2. Kidneys: Your kidneys are two bean-shaped organs that filter your blood. They’re part of your urinary system, but they also produce hormones, like erythropoietin and renin.
  3. Liver: Your liver is part of your digestive system, but it also produces hormones, including insulin-like growth factor 1 (IGF-1) and angiotensinogen.
  4. Heart: When your blood pressure rises, your heart releases two hormones called A-type natriuretic peptide and B-type natriuretic peptide.

Placenta: The placenta is a temporary endocrine organ that forms during pregnancy. It produces hormones that are important for maintaining a healthy pregnancy and preparing your body for labor and breastfeeding (chestfeeding).

52
Q

conditions and disorders

A

The below groupings cover some — but certainly not all — endocrine system-related conditions.

Diabetes and metabolic conditions:

Type 1 diabetes.
Type 2 diabetes.
Gestational diabetes
Metabolic syndrome.
Obesity.
Endocrine cancers and tumors:

Adrenal tumors.
Neuroendocrine tumors.
Pancreatic cancer.
Parathyroid cancer.
Parathyroid tumors.
Pituitary tumors.
Thyroid cancer.
Thyroid disease:

Hypothyroidism and hyperthyroidism.
Thyroiditis.
Thyroid nodule.
Sexual development, function and reproduction conditions:

Amenorrhea (absent periods).
Erectile dysfunction.
Growth hormone deficiency and excess (acromegaly or gigantism).
Hormonal acne.
Hormone-related infertility.
Hypogonadism.
Menopausal disorders.
Polycystic ovary syndrome (PCOS).
Premenstrual syndrome (PMS).
Calcium and bone conditions:

Hypercalcemia and hypocalcemia.
Osteopenia and osteoporosis.
Vitamin D deficiency.

53
Q

Diabetes Type 1

A

Diabetes is a condition that happens when your blood sugar (glucose) is too high. It develops when your pancreas doesn’t make enough insulin or any at all, or when your body isn’t responding to the effects of insulin properly.

Type 1 diabetes is a chronic (life-long) autoimmune disease that prevents your pancreas from making insulin.

People with Type 1 diabetes need synthetic insulin every day in order to live and be healthy.

Type 1 diabetes was previously known as juvenile diabetes and insulin-dependent diabetes.
Symptoms of Type 1 diabetes include:

Excessive thirst.
Frequent urination, including frequent full diapers in infants and bedwetting in children.
Excessive hunger.
Unexplained weight loss.
Fatigue.
Blurred vision.
Slow healing of cuts and sores.
Vaginal yeast infections.

How is type 1 diagnosed?
1. Blood glucose test: Your healthcare provider uses a blood glucose test to check the amount of sugar in your blood. They may ask you to do a random test (without fasting) and a fasting test (no food or drink for at least eight hours before the test). If the result shows that you have very high blood sugar, it typically means you have Type 1 diabetes.

  1. Glycosylated hemoglobin test (A1c): If blood glucose test results indicate that you have diabetes, your healthcare provider may do an A1c test. This measures your average blood sugar levels over three months.
  2. Antibody test: This blood test checks for autoantibodies to determine if you have Type 1 or Type 2 diabetes. Autoantibodies are proteins that attack your body’s tissue by mistake. The presence of certain autoantibodies means you have Type 1 diabetes. Autoantibodies usually aren’t present in people who have Type 2 diabetes.

Type 1 management :Insulin.
Blood glucose (sugar) monitoring.
Carbohydrate counting.

54
Q

Insulin

A

Insulin is an important hormone that regulates the amount of glucose (sugar) in your blood. Under normal circumstances, insulin functions in the following steps:

Your body breaks down the food you eat into glucose (sugar), which is your body’s main source of energy.
Glucose enters your bloodstream, which signals your pancreas to release insulin.
Insulin helps glucose in your blood enter your muscle, fat and liver cells so they can use it for energy or store it for later use.
When glucose enters your cells and the levels in your bloodstream decrease, it signals your pancreas to stop producing insulin.
If you don’t have enough insulin, too much sugar builds up in your blood, causing hyperglycemia (high blood sugar), and your body can’t use the food you eat for energy. This can lead to serious health problems or even death if it’s not treated

55
Q

The difference between type 1 and type 2

A

While Type 1 diabetes and Type 2 diabetes are both forms of diabetes mellitus (as opposed to diabetes insipidus) that lead to hyperglycemia (high blood sugar), they are distinct from each other.

In Type 2 diabetes (T2D), your pancreas doesn’t make enough insulin and/or your body doesn’t always use that insulin as it should — usually due to insulin resistance. Lifestyle factors, including obesity and a lack of exercise, can contribute to the development of Type 2diabetes as well as genetic factors.

In Type 1 diabetes, your pancreas doesn’t make any insulin. It’s caused by an autoimmune reaction.

Type 2 diabetes usually affects older adults, though it’s becoming more common in children. Type 1 diabetes usually develops in children or young adults, but people of any age can get it.

Type 2 diabetes is much more common than Type 1 diabetes.

56
Q

Diabetes related ketoacidosis

A

Diabetes-related ketoacidosis (DKA) happens when you have a lack of insulin in your body

Peeing more often than usual (frequent urination).
Extreme thirst (polydipsia).
Intense hunger (polyphagia).
Signs of dehydration, like dry mouth, headache and flushed (red) skin.
High amounts of ketones in your pee or blood (as shown by at-home tests).
High blood sugar levels (over 250 mg/dL).

More severe symptoms:
Nausea and vomiting.
Abdominal pain.
Rapid, deep breathing (Kussmaul breathing).
Fruity-smelling breath.
Feeling very tired or weak.
Feeling disoriented or confused.
Decreased alertness.
Loss of consciousness.

57
Q

Type 2 Diabetes

A

The main cause of Type 2 diabetes is insulin resistance.

Signs and symptoms: Increased thirst (polydipsia).
Peeing more frequently.
Feeling hungrier than usual.
Fatigue.
Slow healing of cuts or sores.
Tingling or numbness in your hands or feet.
Blurred vision.
Dry skin.
Unexplained weight loss.
People assigned female at birth (AFAB) may experience frequent vaginal yeast infections and/or urinary tract infections (UTIs).

If your body isn’t responding to insulin properly, your pancreas has to make more insulin to try to overcome your increasing blood glucose levels (hyperinsulinemia). If your cells become too resistant to insulin and your pancreas can’t make enough insulin to overcome it, it leads to Type 2 diabetes.

several factors that cause insulin resistance:
1.Genetics.
2. Excess body fat, especially in your belly and around your organs (visceral fat).
3. Physical inactivity.
4.Eating highly processed, high-carbohydrate foods and saturated fats frequently.
5.Certain medications, like long-term corticosteroid use.
6.Hormonal disorders, like hypothyroidism and Cushing syndrome.
7.Chronic stress and a lack of quality sleep.

Risk factors: Have a family history of Type 2 diabetes (biological parent or sibling).
Are older than 45.
Have overweight or obesity (a BMI greater than 25).
Are physically active less than three times a week.
Are Black, Hispanic, Native American, Asian American or Pacific Islander.
Had gestational diabetes while pregnant.
Have high blood pressure and/or high cholesterol.
Have prediabetes.
Have polycystic ovarian syndrome (PCOS).

Treatment:
Lifestyle changes, like more exercise and eating adjustments.
Blood sugar monitoring.
Medication.

Diet: Lean proteins, like chicken, eggs, fish and turkey.
Non-starchy vegetables, like broccoli, green beans, salad greens and cucumbers.
Healthy fats, like avocados, nuts, natural peanut butter and olive oil.
Complex carbohydrates, like beans, berries, sweet potatoes and whole-wheat bread.

58
Q

Metabolic syndrome

A

CNS Exam 2024 (50 decks)

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