Quiz 5a Flashcards
What are the 5 functions of the endocrine system?
Differentiation of reproductive and CNS of fetus
Stimulation of growth/development during childhood/adolescence
Coordination of reproductive systems
Maintaining optimal internal environment
Initiation of corrective and adaptive responses
Where does the endocrine system meet the nervous system?
Hypothalamic-Pituitary interface
What pathways do the hypothalamus control?
Neural and hormonal
What hormones stimulate the posterior pituitary?
ADH and Oxytocin
What hormones stimulate the anterior pituitary?
ACTH
TSH
LH
FSH
What inhibitory hormones act on the pituitary?
GH
Prolactin
What hormones act on the thyroid?
T4 and T3
Calcitonin
What hormone acts on the Parathyroid?
PTH
What hormones act on the Adrenal Cortex?
Aldosterone Cortisol Sex hormones (testosterone, estrogen, progesterone)
What hormones act on the Adrenal Medulla?
Epinephrine
Norepinephrine
What hormones act on the Pancreas?
insulin
Glucagon
What hormones act on the Gonads?
Estrogen
Progesterone
Testosterone
Adiponectin, Leptin, and Angiotensin
How does stress impact endocrine system?
Stress arouses the sympathetic nervous system, causing the medulla to release catecholamines (epinephrine, norepinephrine, and dopamine) into the blood
How do catecholamines impact the endocrine system?
They are released at the sympathetic nerve endings, causing the rate and force of contraction of the heart to increase, constriction of vessels, inc BP, inc blood glucose, inc blood lipids
What are the main functions of Cortisol?
Regulation of the metabolism of proteins, carbs, and lipids, causing an elevation of blood glucose
How does stress impact Endorphins?
They modulate the transmission of pain perceptions by raising the pain threshold
How does stress impact GH?
Levels increase in the blood after a variety of physically/physiologically stressful stimuli such as surgery, fever, physical exercise
How does stress impact Prolactin?
Levels in plasma increase by: gastroscopy, proctoscopy, pelvic exam, surgery
How does stress impact testosterone?
Decreases after: anesthesia, surgery, marathon, acute illness; decrease helps to preserve energy for protective responses
What signs/symptoms are associated with RA?
Myalgia
Arthralgia
Diabetes Mellitus
What signs/symptoms are associated with muscle weakness/atrophy?
Parathyroid or Thyroid disease Acromegaly Diabetes Cushing's Syndrome Osteomalacia
What signs/symptoms are associated with Carpal Tunnel?
Acromegaly, Hypothyroidism
Tenosynovitis (inflammed tendon sheaths)
Diabetes (neuropathy related to ischemia)
What signs/symptoms are associated with Periarthritis?
Inflammation of tendons, ligaments, joint capsule Calcific tendinitis (shoulders in endocrine disease) Chondrocalcinosis: deposition of calcium salts in joint cartilage Pseudogout: when accompanied with gout symptoms Hypothyroidism, hyperparathyroidism, acromegaly
What signs/symptoms are associated with Spondyloarthropathy?
OA
Hemochromatosis (iron metabolism)
Ochronosis: alkali deposits; discoloration
Acromegaly and DM
What signs/symptoms are associated with hand stiffness?
Pain, arthralgias of the small joints in the hand
Flexor tenosynovitis: common in hypothyroidism
What are the common neuromusculoskeletal signs/symptoms of endocrine dysfunction?
Rheumatic s/s, weakenss, myalgai, fatigue, CTS, DM, chondrocalcinosis, OA, Osteoporosis
What are the common systemic signs/symptoms of endocrine dysfunction?
excessive/delated growth, polyuria, mental changes, hair quality, skin pigmentation, body fat distribution, vital signs, heart palpitations, Kussmaul’s, dehydration
What are the main concepts of Hyperpituitarism?
Over secretion of one or more in anterior lobe (especially GH) leading to acromegaly (increased bone thickness and hypertrophy of soft tissues), gigantism (overgrowth of long bones), or Cushing’s (over secretion of ACTH, leads to excessive growth from GH, hyperprolactinemia, and overstimulation of target glands leads to excessive adrenocortical thryroid or sex hormones)
Usually caused by tumors, infarction, genetics, trauma
What are the main concepts of hypopituitaryism?
Decreased secretion leads to dwarfism or panhypopituitarism (partial/total failure of all pituitary hormones): hypophysectomy (removal of pituitary by surgery/radiation), nonsecreting tumors, reversible function disorders (anorexia, anemia, starvation)
What are the main concepts of Diabetes Insipidus?
Rare, physiologic imbalance of water from ADH
Caused by injury to hypothalamus/posterior pituitary
Large amounts of dilute urine without glucose, dehydration, muscle weakness, dizziness, fatigue
What are the main concepts of SIADH?
Excessive release of ADH; fluid/electroly imbalance; opposite of Diabetes Insipidus
Pituitary damage, surgery stress, systemic disorders
Fluid retention, swelling of brain tissues and sodium changes with the tissue, DNS dysfunction, hyponatremia, muscle cramps
What are the main concepts of Hyperthyroidism?
Elevation of body metabolism
Graves Disease (most common, increased T4, autoimmune): mild enlargement of thyroid, nervousness, heat intolerance, weight loss, increased appetite, sweating, diarrhea
Thyroid Storm: could be fatal in acute thyroid overactivity; fever, tach, delirium, dehydration
Exophthalmos: abnormal protrusion of eyes
Neuromusculoskeletal: pain, reduced ROM, calcification, frozen shoulder, weakness
Genetics, over function, over treatment of hypothyroidism, cancer
What are the main concepts of Hypothyroidism?
Slowed metabolism, most common thyroid disorder,
Type I: reduced thyroid tissue (slowed BMR, bradycardia, decreased GI)
Type II: inadequate stimulation because of pituitary and hypothalamic disease (failure of pituitary to release adequate TSH
Autoimmune, thyroid ablation (surgery)
Fatigue, cold, weight gain, forgetful, dry skin/hair, hoarseness, dec CO, sowed pulse, poor circulation, stiffness, RA, CTS, weakness
Thyroiditis causes
What are the main concepts of Thyroiditis?
Inflamed thyroid (autoimmune)
Destruction of thyroid (lymphocyte/antibody infiltration)
Increases TSH, Hypothyroidism develops
Painless, enlargement of gland, irregular surfaces, hypo/hyperthyroidism
What are the main concepts of thyroid cancer?
Rarely malignant tumors
Past Med History, radiation history
Hard, painless nodules on thyroid gland: vocal cord paralysis, cervical lymphadenopathy, malignant tumor (rarely metastasize)
Fine needle aspiration biopsy
What are the main concepts of Hyperparathyroidism?
At least one of the four, disrupts metabolism (calcium, phosphate, and bone)
Primary: PTH is interrupted, glands enlarged, increased PTH secretion
Secondary: hyperplastic, response to hypocalcemia (renal disease)
Tertiary: dialysis patients; hyperplasia, glands unresponsive to serum calcium levels
PTH maintains CA and Phosphate balance (ca is released into blood and bone damage/ hypercalcemia/ kidney damage
What are the main concepts of Hypoparathyroidism?
Hypocalcemia, children and women
Iatrogenic (radiation, drugs, surgery)
PTH low, bone reabsorption low, GI tract absorption low, low serum calcium, neuromusculoskeletal irritability
Acute is bad and there is a need to increase Ca levels quickly (IV, not surgery)
What are the main concepts of Adrenal Insufficiency?
Insufficient cortisol and aldosterone release -> metabolic disturbances
Autoimmune; originally thought from TB
Weak, exhausted, anorexia, weight loss, nausea, vomiting, emotional disturbances
Acute: abdominal pain, LBP, leg pain
Further: trauma or infection
ACTH secretion continues (tan appearance to skin)
Blood and urine tests
What are the main concepts of Adrenocortical Hyperfunction?
Excessive glucocortisols and androgens
Cushing’s (hypercortisolism): excessive cortisol/ATCH; hyperphysiologic doses/tumors of pituitary; protruding abdomen, purple striations, poor wound healing, thin skin, weakness, osteoporosis
Conn’s (adrenal lesion -> hypersecretion of aldosterone): benign aldosterone tumors; hypernatremia, alkalosis, HTN, renal disease, heart failure
What are the special implications for working with endocrine conditions?
Observe s/s Limit stress PT isn't likely with acute conditions Hypoparathyroidis: treat muscle weakness, LBP, and arthritis (listen for pulmonary adema, monitor vitals, early ambulation, encourage good fluid intake) Prevent loss of ROM Palpate for nodules Stretch
What are the two phases of metabolism?
Anabolic (building) and Catabolic (energy-production)
What increases metabolism?
Exercise, elevated temperature, hormonal activity, increased digestive action after eating
Why is adipose tissue considered an endocrine tissue?
Neurotransmitters and glucose directly act on adipocytes to induce the release of different proteins (adipokines) that act locally as autocrine hormones or through the blood as endocrine hormones
What impact do the adipokines have?
Assist to maintain energy balance, vasoconstriction, inflammation, or angiogenesis
What is the relationship between obesity and cancer?
High correlation
Men: colon and pancreatic
Women: weak -> increased BMI and all cancers; strong -> nonhodgkins lymphoma and uterine
Breast cancer rate increases with high BMI after 65 y/o
Obese pts vs lean pts have higher reoccurrence of cancer, malignancy, and worsened lifespan
What are the main concepts of Phenylkeonuria?
Autosomal recessive disease resulting from genetic defect in metabolism of amino acids phenylalanine
Accumulation of Phe in blood w/ excretion of phenylpyruvic acid in urine
Mental retardation, tremors, poor coordination, perspiration, mousy odors
No cure, nutrition key
What are the main concepts of Wilson’s Disease?
Progressive inherited autosomal recessive trait
Defect in metabolism of copper (accumulates in liver, brain, kidney, cornea)
Kayserfleischer rings around iris, cirrhosis of liver, degenerative brain changes
Liver disease (peds); neurologic (young adults)
Unsteady gait and uncontrollable rhythmic movements of writing and hands
Pill-rolling tremors, facial/muscle rigidity, dysarthria, emotional/behavioral changes
Pharmacological aimed at reducing copper in tissues
Aim to manage heptic disease
