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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
dwarfism tx
hormone replacement
26
GH excess
nearly always because of uncontrolled production of GH by a somatotropic tumor in pituitary gland
27
giantism
GH excess prior to epiphyseal plate closure, before puberty
28
giantism s/s
95% growth percentile up to 8 ft tall cardiomegaly and heart failure
29
acromegaly
excess GH after epiphyseal plate closure at puberty
30
acromegaly s/s
``` 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
GH excess tx
surgical removal of tumor counter effects of excess GH octreotide: synthetic somatostatin GH receptor antagonist
32
hypothyroidism
congenital - thyroid dysgenesis - abnormal receptors - defective synthesis acquired - lymphocitic thyroiditis (hashimoto, autoimmune) -- large thyroid caused by lymphocytic invasion
33
hashimoto
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
hypothyroidism s/s infant untreated
- dull appearance - thick, protuberant tongue - thick lips, feeding difficulty - prolonged jaundice - poor muscle tone - bradycardia - mottled extremity - umbilical hernia - hoarse cry - intellectual disability
35
hypothyroidism s/s adult
``` loss of hair coarse brittle hair periorbital edema puffy face normal or small thyroid bradycardia constipation cold intolerance muscle weakness edema of extremities ```
36
hypothyroidism tx
TH replacement
37
hyperthyroidism
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
thyroid storm
life threatening thryotoxicosis - excessive TH acutely released - increased temp - tachycardia - dysrhythmia - CHF - extreme restlessness - agitation - psychosis
39
hyperthyroidism s/s
``` thin hair exophthalmos enlarged thyroid heart failure wt loss diarrhea warm skin, sweaty palms hyperreflexia pre-tibial edema ```
40
hyperthyroidism tx
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
adrenocortical insufficiency
``` 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
addison's (primary insufficiency)
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
addisonian crisis/ acute adrenal insufficiency
``` 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
hypothalamic-pituitary dysfunction (secondary adrenal insufficiency)
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
adrenocortical insufficiency s/s
``` weakness hypotension hypoglycemia hyperpigmentation hyperkalemia wt loss ```
46
adrenocortical insufficiency tx
replacing hormones: 2/3 in am 1/3 in pm adrenal crisis - glucocorticoids IV until s/s resolve then titrated volume replacement
47
congenital adrenal hyperplasia (adrenogential syndrome)
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
congential adrenal hyperplasia (adrenogential syndrome) s/s
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
congenital adrenal hyperplasia tx
glucocorticoids
50
hypercortisolism
hyperfunction of adrenal cortex - primary: disease (adrenal adenoma) - secondary: hyperfunction of the anterior pituitary: increased ACTH (cushing disease) - tertiary: hypothalamic dysfunction or injury
51
hypercortisolism/ cushing s/s
``` truncal obesity moon face dorsocervical fat pad hirsutism (women with hair growth like men) muscle wasting striae petchiae glucose intolerance hypertension hypokalemia ```
52
hypercortisolism tx
result of exogenous glucocorticoid therapy - reduce doses slowly pituitary disease - transspenoidal hypophysectomy or laser ablation of anterior pituitary adrenal tumor - unilateral adrenalectomy
53
hyperaldosteronism
primary: conn syndrome secondary: poor kidney perfusion
54
conn syndrome
usually a result of aldosterone secreting tumors - aldosterone not under pituitary control - pt have decreased potassium and increased Na
55
secondary hyperaldosteronism
conditions that stimulate the renin-angiotensin-aldosterone cascade - HF - decreased kidney perfusion - liver cirrhosis
56
hyperaldosteronism tx
spironolactone: aldosterone antagonist Na restriction K replacement
57
pheochromocytoma
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
pheochromocytoma s/s
``` HTN classic triad - headache - tachycardia - diaphoresis tremor nervous emotional pallor fatigue GI complaints orthro hypotension ```
59
pheochromocytoma tx
surgical removal of tumore | sympathetic blocking medications
60
hyperparathyroidism
primary: increased PTH single parathyroid adenoma hyperplasia bone reabsorption and formation increases Ca serum level does not rise uncontrollably
61
hyperparathryroidism s/s
hypercalcemia
62
hyperparathyrroidism tx
surgical removal of abnormal gland
63
hypoparathyroidism
most frequently result of parathyroid or thyroid surgery or radiation congenital: lack of parathyroid tissue and idopathic autoimmune
64
hypoparathyroidism s/s
hypocalcemia
65
hypoparathyroidism tx
IV Ca calcitriol: activated vitamin D oral Ca supplement

Pathophysiology (80 decks)

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