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Pathophysiology > Module 7 endocrine dysfunction > Flashcards

Module 7 endocrine dysfunction Flashcards

1
Q

hyposecretion

A

endocrine gland released inadequate amount of hormone

secondary: when secretion of tropic hormone (TSH, ACTH) is inadeuqate to cause target gland to secrete adequetly.

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2
Q

primary hyposecretion

A

example thyroid

serum thyroid low but TSH high. thyroid not secreting adequately

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3
Q

secondary hyposecretion

A

example thyroid

Both TH and TSH low, anterior pituitary not secreting adequately

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4
Q

hypersecretion

A

primary: gland secretes abnormally high amount of hormone: tropic hormone low
secondary: related to elevated tropic hormone

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5
Q

hyporesponsive

A

hormone resistant

  • s/s same as hyposecretion
  • lack of or deficiency in receptors
  • loss common: secondary. messenger dysfunction
  • plasma level hormones normal or high r/t lack of negative feedback
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6
Q

tumors/cancer

A

pituitary tumors can cause

  • excessive hormone production
  • local effects of tumor
  • inadequate hormone production by the remaining pituitary gland
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7
Q

defective receptor or enzyme/genetic disease

A 
receptor associated disorders
-decreased number of receptors
- impaired function of receptor
antibodies against specific receptors
antibodies that mimic hormone action 
unusual expression of receptor function
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8
Q

hypopituitarism

A

decrease in production of hormones

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9
Q

panhypopituitarism

A

all hormones decreased or absent

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10
Q

aging and endocrine system

A

cellular processes slow with age: decline in GH and TH -> atrophy and dec. metabolism
regulatory and feedback mechanisms decline
binding affinities and receptor density decrease
tissues less responsive

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11
Q

hormones and aging endocrine system

A

decrease:
- aldosterone
- GH
- calcitonin
- renin
- T3 and T4
unchanged or slightly decrease:
- cortisol
- epinephrine
- insuline
increase
- FSH
- LH
- norepinephrine
- PTH

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12
Q

Diabetes insipidus s/s

A 
excessive thirst
large amounts of diluted urine 
nocturia
hypernatremia (r/t H2O deficit) 
- dry mucous membranes
- dec. sweat and saliva
- disoriented
- lethargy
- seizures
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13
Q

causes of diabetes insipidus

A

neurogenic: too little ADH
nephrogenic: normal ADH
psychogenic: normal ADH, too much water

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14
Q

neurogenic DI

A 
too little ADH: synthesis, transport, or release
pituitary tumors
brain tumors
infections
immunologic problems
thrombotic problems
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15
Q

nephrogenic DI

A 
normal ADH
acquired, permanent or reversible
renal tubule is insensitive to ADH
- levels of ADH normal but the tubules no longer respond 
causes
- pyelonephritis
- amyloidosis
- destructive uropathies
- polycystic kidney disease
- anesthetic drug use
- lithium carbonate
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16
Q

psychogenic DI

A

compulsive water drinking by individuals with psych disorders.
periodic polyuria, high urine volumes, and plasma osmolarity low

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17
Q

DI tx

A

replacement of ADH daily

DDAVP (vasopressin): synthetic analog of ADH

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18
Q

syndrome of inappropriate ADH (SIADH)

A

excessive release of ADH from the posterior pituitary gland or another source

  • hypervolemia
  • dilutional hyponatremia
  • increase in total body fluid
    causes:
  • tumors
  • non malignant lung disorders (TB)
  • primary lung malignancies
  • drug induced
    • carbamazapine, morphine, barbituates
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19
Q

SIADH s/s

A

due to hypotonicity of body fluids

  • hyponatremia
    • confusion, seizures, comea
  • fatigue
  • anorexia
  • increased urine specific gravity
  • weakness
  • muscle cramps
  • N/V
  • postural BP changes
  • lethargy
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20
Q

SIADH tx

A 
water restriction 
IV saline (Na) combined with diuretic
lithium: block ADH
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21
Q

GH function

A

increase cell size and mitosis
increase differentiation of cells
increased metabolism
bone and cartilage growth

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22
Q

GH deficiency categories

A

decreased GH secretion
defective GH action (abnormal GH or defective receptor)
defective IGF-1

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23
Q

dwarfism

A

insufficient GH resulting in stunted or halted growth

puberty may be delayed of not occur

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24
Q

dwarfism s/s

A

infants: normal birth wt and ht, hypoglycemia
children:
- below 3% in growth
- dental eruption delayed, permanent teeth irregular
- thin hair
- poor nail growth
- delayed bone formation
- delayed puberty

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25
Q

dwarfism tx

A

hormone replacement

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26
Q

GH excess

A

nearly always because of uncontrolled production of GH by a somatotropic tumor in pituitary gland

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27
Q

giantism

A

GH excess prior to epiphyseal plate closure, before puberty

28
Q

giantism s/s

A

95% growth percentile
up to 8 ft tall
cardiomegaly and heart failure

29
Q

acromegaly

A

excess GH after epiphyseal plate closure at puberty

30
Q

acromegaly s/s

A 
increased ring and shoe size
enlarged frontal sinuses: prominent brow
progressive underbite
coarsening of facial features, skin tags
internal organs increase in size
- goiter
- cardiomegaly
deep voice
large tongue: sleep apnea
31
Q

GH excess tx

A

surgical removal of tumor
counter effects of excess GH
octreotide: synthetic somatostatin
GH receptor antagonist

32
Q

hypothyroidism

A

congenital
- thyroid dysgenesis
- abnormal receptors
- defective synthesis
acquired
- lymphocitic thyroiditis (hashimoto, autoimmune)
– large thyroid caused by lymphocytic invasion

33
Q

hashimoto

A

thyroid specific CD4 helper T cells induce both the cellular (CD8 cytotoxic cells) and humoral (B cells) of the autoimmune response

  • T cells: parenchymal destruction
  • B cells: secrete inhibitory anti-TSH receptor and other antibodies
34
Q

hypothyroidism s/s infant untreated

A
  • dull appearance
  • thick, protuberant tongue
  • thick lips, feeding difficulty
  • prolonged jaundice
  • poor muscle tone
  • bradycardia
  • mottled extremity
  • umbilical hernia
  • hoarse cry
  • intellectual disability
35
Q

hypothyroidism s/s adult

A 
loss of hair
coarse brittle hair
periorbital edema
puffy face
normal or small thyroid
bradycardia
constipation 
cold intolerance
muscle weakness
edema of extremities
36
Q

hypothyroidism tx

A

TH replacement

37
Q

hyperthyroidism

A

follicular cell hyperfunction- increased synthesis and secretion of T3 and T4
excessive ingestion of Thyroid hormone
- graves disease
- hyperfunctioning adenoma (toxic goiter)
- TSH cell adenoma
- iatrogenic

38
Q

thyroid storm

A

life threatening thryotoxicosis - excessive TH acutely released

  • increased temp
  • tachycardia
  • dysrhythmia
  • CHF
  • extreme restlessness
  • agitation
  • psychosis
39
Q

hyperthyroidism s/s

A 
thin hair
exophthalmos
enlarged thyroid 
heart failure
wt loss 
diarrhea
warm skin, sweaty palms
hyperreflexia
pre-tibial edema
40
Q

hyperthyroidism tx

A

betablockers: acute symptoms
drugs to inhibit thyroid production
radioactive iodine to destroy part of thyroid gland
surgical removal of thyroid
- tumors
- could result in removal of parathyroid gland: hypocalcemia

41
Q

adrenocortical insufficiency

A 
hyposecretion of adrenocortical hormones results from 
- disease of adrenal cortex 
-- primary adrenocortical insufficiency
-- addisons disease 
inadequate secretion of ACTH
lack of CRH from hypothalamus 
congenital adrenal hyperplasia 
- adrenal insufficiency in peds
42
Q

addison’s (primary insufficiency)

A

destruction of adrenal cortex through idiopathic or autoimmune mechanisms, TB, trauma/hemorrhage, fungal disease, neoplasia
- due to high functional reserve, s/s may not be noticed till 90% of cortical tissue is destroyed

43
Q

addisonian crisis/ acute adrenal insufficiency

A 
true medical emergency
inadequate gluocorticoids/mineralcorticoids in circulation
dec. vascular tone
dec. cardiac output
inadequate blood volume -> vascular collapes
hypotension
tachycardia
shock s/s
44
Q

hypothalamic-pituitary dysfunction (secondary adrenal insufficiency)

A

iatrogenic: corticosteroid therapy for chronic illness
- prolonged exposure suppresses CRH and ACTH stimulation through negative feedback
- lack of ACTH results in atrophy of cortex

45
Q

adrenocortical insufficiency s/s

A 
weakness
hypotension
hypoglycemia
hyperpigmentation 
hyperkalemia
wt loss
46
Q

adrenocortical insufficiency tx

A

replacing hormones: 2/3 in am 1/3 in pm
adrenal crisis
- glucocorticoids IV until s/s resolve then titrated
volume replacement

47
Q

congenital adrenal hyperplasia (adrenogential syndrome)

A

enzyme needed for cortisol production lacking, due to gene defect
- autosomal recessive
decreased cortisol -> increased ACTH secretion -> adrenal hypertrophy and overproduction of steroid precursors -> shunted to androgens

48
Q

congential adrenal hyperplasia (adrenogential syndrome) s/s

A

infants: virilization of female genitalia
– enlarged clitoris
– fused labia
-males: enlarged penis and hyperpigmented scrotum
adulte female
- beard
- deep voice
- baldness
- masculine distribution of pubic hair
- growth of clitoris to resemble penis
- masculine characteristics

49
Q

congenital adrenal hyperplasia tx

A

glucocorticoids

50
Q

hypercortisolism

A

hyperfunction of adrenal cortex

  • primary: disease (adrenal adenoma)
  • secondary: hyperfunction of the anterior pituitary: increased ACTH (cushing disease)
  • tertiary: hypothalamic dysfunction or injury
51
Q

hypercortisolism/ cushing s/s

A 
truncal obesity
moon face
dorsocervical fat pad
hirsutism (women with hair growth like men)
muscle wasting
striae
petchiae
glucose intolerance
hypertension
hypokalemia
52
Q

hypercortisolism tx

A

result of exogenous glucocorticoid therapy
- reduce doses slowly
pituitary disease
- transspenoidal hypophysectomy or laser ablation of anterior pituitary
adrenal tumor
- unilateral adrenalectomy

53
Q

hyperaldosteronism

A

primary: conn syndrome
secondary: poor kidney perfusion

54
Q

conn syndrome

A

usually a result of aldosterone secreting tumors

  • aldosterone not under pituitary control
  • pt have decreased potassium and increased Na
55
Q

secondary hyperaldosteronism

A

conditions that stimulate the renin-angiotensin-aldosterone cascade

  • HF
  • decreased kidney perfusion
  • liver cirrhosis
56
Q

hyperaldosteronism tx

A

spironolactone: aldosterone antagonist
Na restriction
K replacement

57
Q

pheochromocytoma

A

tumor of chromaffin tissue that results in the excessive production and release of catechomamines
adrenal medula excretes 2 hormones
- epi and norepi
– bind to adrenergic receptors in heart, smooth muscle, glands
– sympathetic response

58
Q

pheochromocytoma s/s

A 
HTN
classic triad
- headache
- tachycardia
- diaphoresis
tremor
nervous
emotional
pallor
fatigue
GI complaints
orthro hypotension
59
Q

pheochromocytoma tx

A

surgical removal of tumore

sympathetic blocking medications

60
Q

hyperparathyroidism

A

primary: increased PTH
single parathyroid adenoma
hyperplasia
bone reabsorption and formation increases
Ca serum level does not rise uncontrollably

61
Q

hyperparathryroidism s/s

A

hypercalcemia

62
Q

hyperparathyrroidism tx

A

surgical removal of abnormal gland

63
Q

hypoparathyroidism

A

most frequently result of parathyroid or thyroid surgery or radiation
congenital: lack of parathyroid tissue and idopathic
autoimmune

64
Q

hypoparathyroidism s/s

A

hypocalcemia

65
Q

hypoparathyroidism tx

A

IV Ca
calcitriol: activated vitamin D
oral Ca supplement

Pathophysiology (80 decks)

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