Unit 5 Endocrine PP Flashcards
1
Q
What rates/rhythms govern secretion of hormones?
A
Diurnal (day/night)
Pulsatile
Circadian (ebbs and flows throughout the day)
2
Q
How are hormones excreted from the body and how are they classified?
A
- directly by the kidney OR
- metabolized to inactive state by liver so they become water soluble and can be excreted by kidney
Classified by their structure, gland or origin, effects, or chemical composition
3
Q
Pineal gland regulates
A
circadian rhythms and reproductive systems (inc
4
Q
Hormone release regulated by:
A
chemical factors (blood sugar, ca++ levels), endocrine factors (hormone from one gland controls another gland), and Neural control (
5
Q
Simple regulation of hormones involves…
A
chemical factors (like resetting a thermostat)– (blood sugar, Ca++ levels)
6
Q
Regulation by way of feedback systems is most important way hormone secretion is…
A
maintained within a physiologic range
Positive Feedback or Negative Feedback
7
Q
All HORMONES ARE REGULATED BY…
A
BLOOD FLOW
8
Q
What are 2 lipid soluble hormone and how do they pass through membrane?
A
Cortisol and adrenal androgens, pass freely bound to a protein transport molecule
9
Q
Peptide protein hormones include …and they pass through by… their half-life is…
A
insulin, pituitary, hypothalamic, parathyroid. They are water soluble & circulate freely. They have a short half life because they are catabolized by circulating enzymes
10
Q
Why MUST regular and short acting insulin be followed by food within 15 minutes (30 for regular)?
A
Because they are peptide protein hormones meaning that they have a short half-life!
11
Q
Fat soluble steroid, vitamin D, Retinoic acid, thyroid hormones bind with
A
cytosolic or nuclear receptors
12
Q
Water soluble hormones bind with…
A
receptors on cell membrane by interacting or binding
13
Q
First messenger—hormone
A
binds to cell
14
Q
Define signal transduction and ID what it results in
A
process where hormone is communicated into a cell. Involves series of steps that includes: production of a SECOND MESSENGER
Second messenger (inside cell) activates an intracellular enzyme that leads to the cellular response
15
Q
Normal fasting glucose is…
A
100mg/dL ~90mg/dL is good
16
Q
Name the 4 categories of DM and briefly describe first two
A
Type 1: ABSOLUTE INSULIN DEFICIENCY)
Type 2: (insulin resistance with an insulin secretory deficit)
Other specific types
Gestational diabetes
17
Q
What are the 2 types of Type 1 DM?
A
Type 1A, autoimmune
and
Type 1B, secondary to other disease
18
Q
_______ is a hormone that normally suppresses glucagon secretion
A
Insulin.
Lack of insulin leads to increased glucagon secretion
19
Q
Glucagon is a hormone produced by ______
A
the alpha cells of the islets of langerhans in the pancreas. Acts in liver to stimulate glycogenolysis and gluconeogenesis
20
Q
_____ is another beta cell hormone
A
Amylin, It suppresses glucagon release from alpha cells
21
Q
What condition is characterized by the following:
Insulin normally stimulates lipogenesis and inhibits lipolysis, preventing fat catabolism
When insulin is deficient, lipolysis is enhanced and there is an increase in the amount of non-esterified fatty acids delivered to the liver.
This causes increased glyconeogenesis, which leads to high blood glucose ad production of ketone bodies by the mitochondria of the liver at a rate that exceeds its use by the body
Accumulation of ketone bodies causes a drop in pH and triggers the buffering system associated with metabolic acidosis.
- caused by increased levels of circulating ketones in the absence of the antilipolytic effect of insulin
A
Diabteic Ketoacidosis (DKA)
22
Q
3P’s?
A
Polydypsia (increased thirst), Polyuria (increased urination), Polyphagia (increased hunger– but still lose weight)
23
Q
How is Type 1 DM evaluated?
A
HbA1C, random glucose, fasting glucose and symptoms.
24
Q
What does a HbA1C test provide us with?
A
3 month average of glucose level and is more reliable than one time tests.
25
What number do we want HbA1C to be at?
at or below 6.5 (green)
26
What is another essential test we should do in the eval of Type 1 DM?
capillary blood glucose (CBG)
27
In Type 1 DM, the body makes no ____. It is degraded in the stomach, so must be given __.
insulin. Must be given SQ.
28
Which DM is r/t genetic-environmental-lifestyle factors?
Type 2 DM
29
These risk factors: age, OBESITY, HTN (hypertension), physical inactivity, family history (Must have the gene), are associated with Type _ DM
Type 2
30
________ ________ is central obesity, dyslipidemia, prehypertension, elevated fasting CBG)=HIGH RISK for Type 2 DM.
metabolic syndrome
31
Type 2 DM risk factors:
Increased waist circumference (for men, women)
triglycerides
HDLs (for men, women)
BP
fasting plasma glucose
waist circumference
- men >40 inches
- women >35 inches
triglycerides > 150mg/dl
HDLs
<40mg/dl(men)
<50mg/dl (women)
BP
>130/85
fasting plasma glucose >100mg/dl
32
Pathophysiologic mechanisms: insulin resistance and decreased insulin secretion by beta cells are characteristic of Type _ DM
Type 2
33
Which is the most common DM?
Type 2
34
Elevated serum free fatty acids and intracellular deposits of triglycerides and cholesterol (also in obese people) are termed “metabolic overload” and cause changes that interfere with intracellular insulin signaling. This leads to
a decrease in tissue response to insulin
35
_____ is correlated with hyperinsulinemia and decreased insulin receptor density
Obesity
36
Many of the obesity related causes of insulin resistance also
promote programmed cell death in beta cells.
37
Diagnosis criteria for both types of DM are the same (HbA1C, fasting glucose, 2-hr plasma glucose)
HbA1c >6.5% OR
Fasting glucose >126mg/dl OR
2-hour plasma glucose >200mg/dl during OGTT OR
Random plasma glucose >200mg/dl in person with classic hyperglycemia symptoms
38
OGTT is and is used for... normal level is...
oral glucose tolerance test, measures your body's response to sugar (glucose). The glucose tolerance test can be used to screen for type 2 diabetes. Is equal to or less than 140 mg/dL (7.8 mmol/L) 1 hour after drinking the glucose solution.
39
Treatment for Type 2 DM
DIET AND EXERCISE!!!!!!
(remember, the insulin resistance can be reversed if they lose weight
1. If weight is lost, the body’s insulin resistance decreases, and glucose tolerance increases)
40
S/S of hyperglycemia (seen in both types of DM) include:
3Ps: polydipsia, polyuria, polyphagia (lots of thirst, hunger, pee)
41
Hypoglycemia is due to (2)
Due to too high an insulin dose
Due to not eating enough
42
Symptoms of ____________ result from either activation of the sympathetic nervous system (adrenergic) or from abrupt cessation of glucose delivery to the brain (neuroglycopenic), or both.
hypoglycemia
43
____________ (decreased substrate delivery to the brain) causes changes in neuronal kinase activity and firing rates, which produces symptoms like headache, dizziness, irritability, fatigue, poor judgment, confusion, visual changes, hunger, seizures, and coma
Neuroglycopenia
44
How is hypoglycemia treated? Provide two examples
immediate glucose replacement!
1. Apple juice q 15 min until > 60mg/dL, carbohydrate source (candy)
OR
2. IM glucagon
45
_________ _________: symptoms of autonomic warning (shaking, sweating, …) do not happen before the development of neuroglycopenia (happen at same time), So, symptoms and effects of hypoglycemia are SUDDEN!
Can happen over time
HYPOGLYCEMIC UNAWARENESS
46
Compare and Contrast: Hyperglycemia vs. Hypoglycemia
- high is dry: dry mouth, pee a lot, dry skin
- headache, sweating, shaking
- VISION PROBLEMS FOUND IN BOTH!
47
_____ is a LIFE-THREATENING emergency most often precipitated by infections, medications, co-existing diseases, and non=adherence to diabetes treatment
MORE COMMON IN TYPE 2 and can also occur in people with pancreatic destruction (chronic pancreatitis)
Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS/HHS)
48
_____ _____ Hypoglycemia followed by rebound hyperglycemia
Wakes up with hyperglycemia.
Hypoglycemia stimulates counterregulatory hormones (epi, GH, Corticosteroids)
Produce gluconeogenesis
Leads to hyperglycemia
Somogyi effect
49
______ _______
Early morning rise in blood glucose concentration with NO hypoglycemia during night
r/t nocturnal elevations of GH
Decreases glucose metabolism by muscle and fat
Changing time/dose of insulin corrects problem
Dawn Phenomenon
50
As the renal function gets worse, people with type 1 Diabetes may experience
hypoglycemia
51
If a client with Diabetes (especially type 1) tells the nurse that they have noticed a need for LESS INSULIN, this is
a HUGE RED FLAG!!!! =THINK NEPHROPATHY!!!!
52
A common complication of all types of DM, dyslipidemia, is...
the imbalance of lipids such as cholesterol, low-density lipoprotein cholesterol, (LDL-C), triglycerides, and high-density lipoprotein (HDL).
53
_______ _______ is caused by hypoxemia damage to retinal blood vessels, RBC aggregation, and hypertension
diabetic retinopathy
54
Name the 3 stages of diabetic retinopathy
Nonproliferative, pre-proliferative, and proliferative
55
Stage _ of diabetic retinopathy: increase in retinal capillary permeability, vein dilation, microaneurysm formation, and hemorrhages
1. Nonproliferative
56
Stage _ of diabetic retinopathy: retinal ischemia progresses and poor perfusion leads to infarcts
2. Pre-proliferative:
57
Stage _ of diabetic retinopathy: angiogenesis occurs with neovascularization and fibrous tissue forms within the retina or optic disc. Traction of the new vessels on the vitreous humor can cause retinal detachment or hemorrhage into the vitreous humor with severe blurring or loss of vision.
3. Proliferative:
58
______ _____ is the leading cause of blurred vision in people with DM
macular edema
59
________ is the most common cause of chronic kidney disease and end stage renal disease (ESRD)
diabetes
60
As renal function continues to deteriorate, people with TYPE __ DIABETES may actually experience hypoglycemia (due to a loss of renal insulin metabolism), which leads to the need for ____ _______.
Type 1. LESS INSULIN.
61
Need for decreased insulin is
a red flag!
62
In diabetic nephropathy (microvascular), as the glomerular filtration rate drops below _______ uremic signs like nausea, lethargy, acidosis, anemia, and uncontrolled hypertension will occur
10ml/min
63
Patho: chronic hyperglycemia causes both metabolic and vascular changes that lead to ischemia and demyelination which causes nerve changes and results in delayed conduction. What is it?
diabetic neuropathy
64
This DM complication results in loss of pain, temp, and vibration sensation, most commonly in hands and feet
diabetic neuropathy
65
In diabetic neuropathy, distal neuropathies plus vascular complications, infections or injury can lead to
AMPUTATION
66
__________ can occur during periods of good glucose control and is often the symptom that leads patients with type 2 diabetes to seek treatment
neuropathy
67
What are the 3 DM macrovascular complications?
1. CV disease
2. Stroke
3. PVD
68
In CV disease, the presence of CAD increases with the ________ not the ________ of the disease
DURATION
SEVERITY
69
CAD
coronary a. disease
70
What influences the main fxns of hormone receptors (5) ?
sensitivity, direct effects, permissive effects, permissive effects, and biphasic effects
71
_______ of the target cell to a particular hormone is related to the total number of receptors per cell. Cell can adjust its _______ to the concentration of the signaling hormone
1. _____ regulation: low concentrations of hormone causes an increase in the number of receptors per cell
2. _____-regulation: High concentrations decrease number of receptors
- sensitvity
1. up
2. down
72
_____ _____ are the obvious changes in cell function that specifically result from stimulation by a particular hormone:
direct fx
73
______ ______ Less obvious hormone-induced changes that facilitate the max response or function of a cell
Ex (both direct and permissive fx)?
permissive fx
ex: insulin has a direct effect on skeletal muscle cells that have insulin receptors and causes glucose transport inside these cells.
Insulin ALSO has a PERMISSIVE effect on mammary cells, and facilitates the response of these cells to the direct effects of prolactin (oxytocin)
74
______ ______ are dependent on the concentration of the hormone.
ex?
biphasic fx
Ex: low levels of ADH stimulate renal tubular reabsorption of sodium and water. However, at supraphysiologic levels (achieved by giving the hormone as a shot), ADH acts as a vasoconstrictor.
75
Think of the _______ as the MASTER SWITCH
hypothalamus
76
HPA (hypothalamic-pituitary axis) forms the structural and functional basis for central integration of
the neurologic and endocrine system aka: Neuroendocrine system
77
HPA produces hormones that affect many different body functions, these include:
Thyroid, adrenal, reproductive
78
Hypothalmic hormones are composed of...
neurosecretory cells
79
ADH secretion increases due to:
Volume loss of 7-25%, stress, trauma, pain, exercise, nausea, nicotine, heat, drugs (morphine)
80
ADH secretion decreases due to:
Decreased plasma osmolality, increased intravascular volume, hypertension, alcohol
81
amount of solute dissolved in solution...
osmolality
82
Major function of posterior pituitary is
control of plasma osmolality, which is regulated by ADH.
83
___ acts on the vasopressin 2 receptors of the renal tubule cells to increase their permeability, which leads to increased water reabsorption into the blood, and more concentrated urine.
ADH
84
ADH has no direct effect on electrolyte levels, but by increasing water reabsorption, serum concentrations can decrease. This is known as....
dilutional effect
85
Secretion of ADH regulated by _______ __ ________, which control thirst
osmoreceptors of hypothalamus
86
condition characterized by deficient ADH
Diabetes Insipidus
87
condition characterized by increased ADH
Syndrome of Inappropriate Antidiuretic Hormone
Think Syndrome of Increased Antidiuretic hormone (SIADH)
88
The following s/s and patho are characteristic of which condition?
DEFICIENT ADH (too little)
Inability to concentrate urine (partial to total)
Excrete LARGE volumes of dilute urine
Causes increased plasma osmolality
Urine specific gravity is LOW
Specific gravity, also called relative density, is the ratio of the density of a substance to the density of a reference substance; equivalently, it is the ratio of the mass of a substance to the mass of a reference substance for the same given volume
Dehydration develops QUICKLY without fluid replacement
S/S: fatigue, dehydration, thirst, orthostatic hypotension, tachycardia, weight loss
Hypernatremia and hyperosmolality occur if too much water lost.
Other electrolytes usually not affected.
DIabetes Insipidus
89
What are the 2 types of DI?
1. neurogenic/central
2. nephrogenic
90
________ DI: insufficient secretion of ADH
- Lesion/tumor, clot, aneurysm, infection, immune disorder in brain. (head trauma)
- Hypophysectomy (remove Pituitary)
neurogenic/central
91
_______ DI: Acquired
- Drugs: lithium, amphotericin B, loop diuretics, general anesthetics, demeclocycline
- Disorders: pyelonephritis, amyloidosis, destructive uropathies, polycystic kidney disease, sickle cell disease
nephrogenic
92
Treatment for DI, specifically for nephrogenic?
Treat the underlying cause (especially for Nephrogenic)
DISCONTINUE THE OFFENDING DRUG (LITHIUM), fluid replacement, Desmopressin (DDAVP = synthetic vasopressin analog), Thiazide diuretics to help improve salt and water retention in the kindey
93
These are all found in which condition?
Abnormal production or sustained secretion of ADH
Usually r/t tumors, pulmonary disorders or CNS disorders (encephalitis, meningitis, intracranial hemorrhage, head trauma, even surgery (especially pituitary)
Drugs: antihypoglycemic agents, narcotics, general anesthesia, chemo drugs, NSAIDs, synthetic ADH analogs, antidepressants.
ADH increases renal collecting duct permeability
Increases water reabsorption by kidneys
Causes expansion of extracellular fluid volume
Leads to DILUTIONAL HYPONATREMIA, hypoosmolarity, concentrated urine, pulmonary crackles.
Leads to extreme water retention and potential water intoxication
SIADH
94
_____ s/s: hyponatremia sodium level 130-140: thirsty, tired. When drops to 120-130: vomiting & abdominal cramps. When drops below 115: confusion, lethargy, muscle twitching & convulsions. Excessive fluid retention with weight gain, increased BP, pulmonary crackles, reduced urinary output.
SIADH
95
Tx for SIADH
correct underlying problem (treat the cause) PLUS: fluid restriction and diuretics (Mannitol & furosemide) to make the patient urinate the fluid out.
96
In SIADH, the body releases too much ___ and thus the body _____ water. Leads to hyponatremia
ADH, retains
97
Hormone produced/secreted by anterior pituitary (aka Somatropin, Somatatropin)
Growth hormone
98
Many of the anabolic functions of GH are mediated by ____. ____ is most biologically active form
insulin-like growth factor (IGF). IGF-1
99
___ and _____ have been linked to many forms of cancer because of their growth-stimulating effects
**(Remember Beckwith Weideman???)
IGF and IGFBPs
100
Mutation in the GH gene (Failure in GH secretion) causes...
Hypopituitary Dwarfism
101
Adults with complete or partial failure of the _______ ________
Symptoms are vague and include social withdrawal, fatigue, loss of motivation, and a diminished feeling of well-being
Osteoporosis and alterations in body composition are common
Associated with
reduced muscle mass, increased cardiovascular mortality, central adiposity, increased visceral fat,
insulin resistance & dyslipidemia
anterior pituitary.
102
Too much growth hormone caused by
Usually caused by a growth hormone secreting tumor in the ANTERIOR lobe of the pituitary. Leads to gigantism and acromegaly.
103
best indicator of thyroid function
TSH
104
thyroid hormone with most potent metabolic effect
T3
105
pro-hormone
indicator of available hormone
What the hypothalamus is looking for is this hormone
T4
106
thyroid produces this hormone active in bone development
Calcitonin (C cells)
107
Thyroid fxn test that:
Measures total bound thyroxine
Reflect overall thyroid activity
Used for screening & to monitor response to thyroid replacement therapy
Serum T4
108
Thyroid fxn test that:
Measures unbound thyroxine
Gives indication of active thyroxine
free T4
109
Thyroid fxn test that:
Measures total triiodothyronine
**** Used to diagnose hyperthyroidism because levels of hormone rise more rapidly and to greater extent than T4 alone *****
Can monitor response to thyroid replacement therapy
Serum T3
110
Thyroid fxn test that:
Measures response to negative feedback
*****Best test to dx hypothyroidism*****
Allows for differentiation of primary and secondary disease
Look at TSH compared to TRH and T3/T4
TSH
111
Thyrotoxicosis (2)
hyperthyroidism and Grave's disease
112
Thyrotoxicosis that results from:
excess circulating thyroid hormone
Gland enlarges when demand for TH increases
Pregnancy, puberty, iodine deficient states
hyperthyroidism
113
Thyrotoxicosis that results from:
(autoimmune, common)
Type II hypersensitivity
toxic nodular goiter
toxic adenoma
subacute or chronic thyroiditis
thyroid cancer (rare)
TSH-secreting pituitary tumor
Amiodarone therapy (each pill has 75mg iodide)
Grave's disease
114
Type II hypersensitivity reaction
increase synthesis of TH (especially T3)
Fat accumulation around eyes
Fat behind the eyes pushes them to protrude forward (exophthalmos)
Grave's disease
