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w5 Flashcards

1
Q

Addisonian disease:
disease of the _________ that causes hyp___secretion of _____________

The most severe effects come from the lack of _________

A

Addisonian disease
disease of the adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones
- Glucocorticoids = cortisol (sugar)
- Mineralocorticoids = aldosterone (salt)
- Sex steroids = androgens (sex)

The most severe effects come from the lack of cortisol

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2
Q
  • adrenal cortex’s steroid hormones:
  • Are essential for life
  • Regulate the body’s response to normal and abnormal levels of ______
  • Made on demand or stored in body?
A
  • adrenal cortex’s steroid hormones:
  • Are essential for life
  • Regulate the body’s response to normal and abnormal levels of stress
  • Made on demand, not stored in body
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3
Q

endocrine emeregencies

__________ – sudden insufficient levels of adrenal hormones

___________- Overwhelming release of T3 and T4

________ - Severe hypothyroidism

A

Addisonian crisis – sudden insufficient levels of adrenal hormones
Thyroid storm - Overwhelming release of thyroid hormones
Myxedema coma - Severe hypothyroidism

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4
Q

______ is resolved when =
- ketoacidosis has resolved (the anion gap has closed)
- pt is able to eat and can transition back to SQ insulin

______ is resolved when =
- patient is mentally alert and plasma osmolality has dropped
- pt is able to eat and can transition back to SQ insulin

A

DKA
HHS

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5
Q

DKA and HHS

  1. reduced effective action of circulating insulin
    - in ______ it’s caused by decreased insulin secretion
    - in _______ it’s caused by ineffective action of insulin
  2. elevated levels of glucagon, catecholamines, cortisol, and growth hormones (counter regulatory hormones) = __creased glucose production and impaired glucose utilization
    - dehydration and electrolyte abnormalities d/t osmotic diuresis caused by glycosuria
    - in _____ there is increased gluconeogenesis, lipolysis, ketogenesis, and decreased glycolysis
A

DKA
HHS

increased

DKA

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6
Q

DKA and HHS: potassium

total potassium levels =

serum/plasma potassium levels =

A

low

normal to high

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7
Q

Thyroid
- butterfly shaped gland
- found in neck
- secretes:
- ________ = inactive form
- _______ = active form

  • when T__ reaches organs and tissues to aid in metabolism it is converted to T__
  • __________ = necessary component in synthesis of thyroid hormone
  • _________ – normally functioning thyroid gland
A

Thyroid
- butterfly shaped gland
- found in neck
- secretes:
- T4 thyroxine = inactive form, either attached to protein when not needed or free T4 enters tissues when needed, more T4 in body
- T3 triiodothyronine = active form, converted from T4
- when T4 reaches organs and tissues to aid in metabolism it is converted to T3
- iodine = necessary component in synthesis of thyroid hormone
- euthyroid – normally functioning thyroid gland

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8
Q

DKA and HHS

with ______ there is enough insulin to prevent ketoacidosis, but not enough insulin to control hyperglycemia

with _____ there is profound deficiency of insulin which causes ketoacidosis and hyperglycemia

A

HHS

DKA

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9
Q
  • adrenal ________ secretes hormones called catecholamines:
  • Epinephrine
  • Norepinephrine

in response to ________ nervous system stimulation

A
  • adrenal medulla secretes hormones called catecholamines:
  • Epinephrine
  • Norepinephrine
  • adrenal medulla secretes catecholamines (Epinephrine and Norepinephrine) in response to sympathetic nervous system stimulation
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10
Q

s/s of which endocrine emergency?
- rapid onset (24 hours)
- polyuria, polydipsia (not polyphagia)
- GI effects – n/v, pain
- neurologic effects
- volume depletion
- Decreased skin turgor
- Dry oral mucosa
- Tachycardia
- Hypotension
- fruity breath odor
- Kussmaul respirations - rapid, deep breathing

A

DKA

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11
Q

______ treatment key points
- treat volume depletion rapidly with NS
- supplement potassium as needed
- IV infusion of insulin

_____ treatment key points
- treat volume depletion rapidly with NS
- correct electrolyte imbalances
- IV infusion of insulin

A

DKA treatment key points
- treat volume depletion rapidly with NS
- supplement potassium as needed
- IV infusion of insulin

HHS treatment key points
- treat volume depletion rapidly with NS
- correct electrolyte imbalances
- IV infusion of insulin

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12
Q

DKA, HHS, or both?

  • usually associated with T2DM
  • involves ketoacidosis and hyperglycemia
  • more common in age <65
  • involves severe hyperglycemia (not ketoacidosis)
  • usually associated with T1DM
  • more common in age >65
  • insulin deficiency and/or resistance is more severe, which causes significant lipolysis and ketone production
  • precipitated by stressors like infection in the setting of insulin deficiency or resistance.
  • hyperglycemia < 800
  • often pts present earlier with s/s of ketoacidosis, rather than hyperosmolality
  • tend to be younger and have higher GFR
  • hyperglycemia > 1000
  • higher mortality rate
A

H - usually associated with T2DM
D - involves ketoacidosis and hyperglycemia
D - more common in age <65
H - involves severe hyperglycemia (not ketoacidosis)
D - usually associated with T1DM (can occur in T2DM under extreme conditions like infections, trauma, CV events)
H - more common in age >65
D - insulin deficiency and/or resistance is more severe in DKA which causes significant lipolysis and ketone production
B - Both DKA and HHS are precipitated by stressors like infection in the setting of insulin deficiency or resistance.
D - hyperglycemia < 800
D - often DKA pts present earlier (vs HHS pts) with s/s of ketoacidosis, rather than hyperosmolality
D - tend to be younger and have higher GFR
H - hyperglycemia > 1000
H - higher mortality rate

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13
Q

DKA or HHS?

  • condition of:
  • ketones in the blood
  • metabolic acidosis leading to anion gap
  • (usually) hyperglycemia r/t insulin deficiency
  • characterized by:
  • Marked Hyperglycemia
  • Dehydration
  • Electrolyte imbalance
  • Hyperosmolality
A

DKA
HHS

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14
Q

Gluconeogenesis vs Glycogenolysis

__________ is the metabolic process where glycogen (the stored form of glucose in the liver and muscles) is broken down into glucose, and released into bloodstream for energy. (This process is stimulated by the hormone glucagon.)

__________ is a metabolic pathway that produces glucose from non-carbohydrate precursors like lactate, amino acids, and glycerol.

A

Glycogenolysis
Gluconeogenesis

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15
Q

DKA vs HHS?

  • common causes of _____:
  • Illnesses – PNA and UTI
  • Insulin deficiency
  • Inflammatory conditions
  • MI
  • Stoke
  • Severe dehydration
  • Some drugs
  • common causes of _____:
  • Lack of adherence to insulin doses
  • Physiological stressors – infection, MI
A

HHS
DKA

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16
Q
A
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17
Q
  • Severe hypothyroidism
  • medical emergency
  • high mortality rate
  • rare d/t earlier diagnosis capability
A

Myxedema coma

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18
Q
  • serious acute complication of DM or hyperglycemia
A

DKA and HHS

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19
Q
  • glucocorticoids principal hormone = ________
  • Primary effect is on the ________ metabolism, but they effect every tissue in the body

Functions:
- Raise or lower BS?
- Protect against physiologic effects of _______
- Suppress or enhance inflammatory and immune processes?
- Release muscle stores of ________
- ___crease blood cholesterol

A
  • glucocorticoids principal hormone = cortisol
  • Primary effect is on the glucose metabolism, but they effect every tissue in the body
  • Functions:
  • Raise BS (opposite of insulin hormone)
  • Protect against physiologic effects of stress
  • Suppress inflammatory and immune processes
  • Release muscle stores of proteins
  • Increase blood cholesterol
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20
Q

Thyroid storm
__________ of thyroid hormones that exert an intense stimulus on the _______
- rare
- life threatening

A

Thyroid storm
Overwhelming release of thyroid hormones that exert an intense stimulus on the metabolism
- rare
- life threatening

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21
Q

DKA vs HHS?

________s/s
- rapid onset (24 hours)
- polyuria, polydipsia (not polyphagia)
- GI effects – n/v, pain
- neurologic effects
- volume depletion
- Decreased skin turgor
- Dry oral mucosa
- Tachycardia
- Hypotension
- fruity breath odor
- Kussmaul respirations - rapid, deep breathing

________ s/s
- insidious (several days)
- polyuria, polydipsia (not polyphagia)
- weight loss
- lethargy, obtunded, coma
- volume depletion
- Decreased skin turgor
- Dry oral mucosa
- Tachycardia
- Hypotension

A

DKA
HHS

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22
Q

DKA and HHS: Plasma osmolality and sodium

  • In both (DKA) and (HHS), there is a ________ in plasma osmolality due to extreme hyperglycemia.
  • The high blood glucose levels = osmotic diuresis = significant fluid loss and dehydration = hyp___osmolar state with ___creased plasma osmolality
  • In _____, the accumulation of ketones also contributes to the elevated osmolality
  • hyperglycemia = p___ water ____ cells = expands ECF = ___creases plasma sodium (dilutional hyp__natremia)
  • glucosuria = osmotic diuresis = excretion of sodium, potassium, and water
A

Plasma osmolality and sodium
- In both (DKA) and (HHS), there is an elevation in plasma osmolality due to extreme hyperglycemia.

  • The high blood glucose levels = osmotic diuresis = significant fluid loss and dehydration = hyperosmolar state with increased plasma osmolality
  • In DKA, the accumulation of ketones also contributes to the elevated osmolality
  • hyperglycemia = pulls water out of cells = expands ECF = reduces plasma sodium (dilutional hyponatremia)
  • glucosuria = osmotic diuresis = excretion of sodium, potassium, and water
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23
Q

Parathyroid
- 4 pea sized glands
- located within the
__________ tissue of the neck
- parathyroid gland produces and secretes ____________
- PTH is secreted in response to hyp___calcemia and ______ breakdown
- PTH purpose is to re-establish normal _______ levels in blood
- PTH promotes vitamin ___ production

A

Parathyroid
- 4 pea sized glands
- located within the thyroid tissue of the neck
- parathyroid gland produces and secretes PTH (parathyroid hormone)
- PTH is secreted in response to hypocalcemia and bone breakdown
- PTH purpose is to re-establish normal calcium in blood
- PTH promotes vitamin D production

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24
Q

thyroid storm: Treatment

  • ____________
  • Controls s/s caused by increased adrenergic tone (r/t catecholamines: Epinephrine and Norepinephrine)
  • thionamide (propylthioracil/PTU)
  • ______ new hormone synthesis
  • Suppresses conversion of T__ to T__
  • iodine solution
  • Blocks the release of _______ hormone
  • _______corticoids
  • Reduces T4 to T3 conversion
  • Promotes vasomotor stability
  • Possibly treats an associated relative adrenal insufficiency
  • bile acid sequestrants
  • ___crease enterohepatic circulation and recycling of thyroid hormones
A

Treatment
- beta blocker
- Controls s/s caused by increased adrenergic tone (r/t catecholamines: Epinephrine and Norepinephrine)
- thionamide (propylthioracil/PTU)
- Blocks new hormone synthesis
- Suppresses conversion of T4 to T3
- iodine solution
- Blocks the release of thyroid hormone
- glucocorticoids
- Reduces T4 to T3 conversion
- Promotes vasomotor stability
- Possibly treats an associated relative adrenal insufficiency
- bile acid sequestrants
- Decrease enterohepatic circulation and recycling of thyroid hormones

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25
Q
  • _______ and _______ secreted by adrenal medulla, prolong and enhance the effects of the sympathetic nervous system (fight or flight)
A
  • Epinephrine and Norepinephrine
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26
Q

DKA and HHS

  • absolute deficiency in insulin = T1 or T2?
  • relative deficiency in insulin = T1 or T2?

Deficiency in insulin is caused by _______ counter regulatory hormones (glucagon, catecholamines, cortisol, and growth hormones)

Deficiency in insulin is more severe in DKA or HHS?

A

Deficiency in insulin:
- absolute deficiency = T1
- relative deficiency = T2

Is caused by excess counter regulatory hormones (glucagon, catecholamines, cortisol, and growth hormones)

And more severe in DKA

27
Q

DKA and HHS Risk factors

  • infection (PNA or UTI) without _______ adjustment
  • acute major illness or inflammatory process (MI, CVA, sepsis, pancreatitis)
  • new onset T__DM (commonly presents with DKA)
  • drugs that affect ________ metabolism (glucocorticoids, thiazide diuretics)
  • use of ______ inhibitors – treatment for T2DM and T1 DKA
  • cocaine or substance abuse
  • poor compliance with insulin regimen or faulty SQ insulin infusion device
A

Risk factors
- infection (PNA or UTI) without insulin adjustment
- acute major illness or inflammatory process (MI, CVA, sepsis, pancreatitis)
- new onset T1DM (commonly presents with DKA)
- drugs that affect carbohydrate metabolism (glucocorticoids, thiazide diuretics)
- use of SGLT2 inhibitors – treatment for T2DM and T1 DKA
- cocaine or substance abuse
- poor compliance with insulin regimen or faulty SQ insulin infusion device

28
Q

DKA s/s
- _______ onset
- polyuria, polydipsia (not polyphagia)
- GI effects – n/v, pain
- neurologic effects
- volume depletion
- Decreased skin turgor
- Dry oral mucosa
- ______cardia
- Hyp__tension
- fruity breath odor
- ________ respirations - rapid, deep breathing

A

DKA s/s
- rapid onset (24 hours)
- polyuria, polydipsia (not polyphagia)
- GI effects – n/v, pain
- neurologic effects
- volume depletion
- Decreased skin turgor
- Dry oral mucosa
- Tachycardia
- Hypotension
- fruity breath odor
- Kussmaul respirations - rapid, deep breathing

29
Q

Addisonian disease: Etiology
- idiopathic
-autoimmune
- other

Addisonian disease: Patho
1. ________ gland destroyed
2. s/s occur when ___% non-functional
3. 2 hormones are secreted in large amounts =

A

Patho
1. adrenal gland destroyed
2. s/s occur when 90% non-functional
3. 2 hormones are secreted in large amounts = adrenocorticotropin hormone (ACTH) and melanocyte-stimulating hormone (MSH)

30
Q

anterior pituitary vs posterior pituitary secretion?

  • TSH (thyroid stimulating hormone)
  • Antidiuretic hormone/vasopressin
  • Oxytocin
  • ACTH (adrenocorticotropic hormone)
A

TSH = anterior pit
ADH = posterior pit
oxytocin = posterior pit
ACTH = anterior pit

31
Q

Ketone production in DKA
- Insulin deficiency and resistance = glucose can’t get into cells = body uses ___ for energy (lipolysis)
- lipolysis is associated with ____
- lipolysis in peripheral fat storage release _______ and glycerol
- fatty acids are transported to _____ and become activated
- activated fatty acids are converted to acetylCoA and enter the ketogenic metabolic pathway forming _________
- accumulation of ketone bodies cause a _____ in pH = metabolic ________

A

Ketone production in DKA
- Insulin deficiency and resistance = glucose can’t get into cells = body uses fat for energy (lipolysis)
- lipolysis is associated with DKA
- lipolysis in peripheral fat storage release free fatty acids and glycerol
- fatty acids are transported to liver and become activated
- activated fatty acids are converted to acetylCoA and enter the ketogenic metabolic pathway forming ketone bodies
- accumulation of ketone bodies cause a drop in pH = metabolic acidosis

32
Q

Antidiuretic hormone
- released in response to _____ serum osmolality and/or hyp__tension
- causes water________ via action in the kidneys
- ADH = this hormone ______ pee

A

Antidiuretic hormone
- released in response to high serum osmolality and/or hypotension
- causes water retention (raises BP) via action in the kidneys
- ADH = this hormone STOPS pee

33
Q

s/s of which endocrine emergency?
- decreased mental status – coma
- hypothermia
- slowing of functions of other organs
- hypotension
- bradycardia
- hyponatremia
- hypoglycemia
- hypoventilation

A

Myxedema coma s/s

34
Q

Adrenal gland and Steroid hormones
- sits on ______
- adrenal gland 2 parts =

A

Adrenal gland and Steroid hormones
- sits on kidneys
- adrenal gland 2 parts = medulla (middle) and cortex (covers)

35
Q
  • mineralocorticoids principal hormone = __________
  • Regulated by the _______ system in the kidneys
  • When triggered by angiotensin II, aldosterone promotes ______ retention and thus _______ retention

Function:
- maintain ____ and _____ balance
- promote secretion or excretion of potassium?

A
  • mineralocorticoids principal hormone = aldosterone
  • Regulated by the renin-angiotensin system in the kidneys
  • When triggered by angiotensin II, aldosterone promotes sodium retention and thus water retention
  • Function:
  • maintain salt and water balance
  • promote secretion of potassium
36
Q

Myxedema coma =

Thyroid storm =

Addisonian crisis =

A

Severe hypothyroidism

Overwhelming release of thyroid hormones (hyperthyroidism)

insufficient levels of adrenal hormones

37
Q

addisonian disease: Pharm
- _________ corticoidsteroid replacement therapy
- all pts require ______corticoid
- Hydrocortisone – drug of choice
- Prednisone
- Dexamethasone
- some pts require _______corticoid
- Fludrocortisone

A

Pharm
- lifelong corticosteroid replacement therapy
- all pts require glucocorticoid
- Hydrocortisone – drug of choice
- Prednisone
- Dexamethasone
- some pts require mineralcorticoid
- Fludrocortisone

38
Q

Myxedema coma: Risk factors
- hyp___thyroidism – long standing and severe form
- precipitating acute event in poorly controlled hyp___thyroidism pt
- Infection, MI, cold exposure, surgery
- admin of _______ drug

A

Risk factors
- hypothyroidism – long standing and severe form
- precipitating acute event in poorly controlled hypothyroidism pt
- Infection, MI, cold exposure, surgery
- admin of sedative drug

39
Q

thyroid storm s/s
- fever
- ______cardia
- cardiac dysrhythmias (a fib/ a flutter)
- n/v
- agitation
- tremor
- psychosis
- stupor/coma
- hyp___tension

A

metabolism turned up

s/s
- fever
- Tachycardia
- cardiac dysrhythmias (a fib/ a flutter)
- n/v
- agitation
- tremor
- psychosis
- stupor/coma
- hypotension

40
Q

Review: normal response to hyperglycemia
1. extracellular concentration of glucose regulated by hormones: ______ and _______
2. when serum glucose rises = glucose enters _______ initiating insulin release
3. ________ restores normal glycemic levels by:
4. diminishing hepatic glucose production
5. __creasing glycogenolysis and gluconeogenesis
6. __creasing glucose uptake by skeletal muscle and adipose tissue

A

Review: normal response to hyperglycemia
1. extracellular concentration of glucose regulated by hormones: insulin and glucagon
2. when serum glucose rises = glucose enters pancreas initiating insulin release
3. insulin restores normal glycemic levels by:
4. diminishing hepatic glucose production
5. decreasing glycogenolysis and gluconeogenesis
6. increasing glucose uptake by skeletal muscle and adipose tissue

41
Q

Treatment of DKA and HHS
- fluid replacement
- Electrolyte correction
- insulin infusion
- sodium bicarbonate – with metabolic acidosis, pH < 7.2 (for DKA or HHS?)
- dextrose (for DKA or HHS?)

A

DKA
DKA

42
Q
  • adrenal cortex secretes steroid hormones (the 3 s’s):
  • Glucocorticoids = ______
  • Mineralocorticoids = ______
  • Sex steroids = androgens
A
  • adrenal cortex secretes steroid hormones (the 3 s’s):
  • Glucocorticoids = cortisol
  • Mineralocorticoids = aldosterone
  • Sex steroids = androgens
43
Q

Patho DKA
1. profound deficiency of_______.
2. increased breakdown of ___ (lipolysis) and _____ (catabolism).
3. liver produces excessive ______ from fats, causing metabolic _____.
4. Hyp___glycemia occurs due to ___creased gluconeogenesis and impaired glucose utilization.
5. And Dehydration and electrolyte imbalances develop from osmotic _______.

Patho HHS
1. triggered by extreme hyp__glycemia
2. severe dehydration and neurological changes occur due to the profound hyp__glycemia and hyp__osmolarity

A

Patho DKA
1. profound deficiency of insulin.
2. increased breakdown of fat (lipolysis) and proteins (catabolism).
3. liver produces excessive ketone bodies from fats, causing metabolic acidosis.
4. Hyperglycemia occurs due to increased gluconeogenesis and impaired glucose utilization.
5. And Dehydration and electrolyte imbalances develop from osmotic diuresis.

Patho HHS
1. triggered by extreme hyperglycemia (like DKA, but with less severe insulin deficiency which prevents significant lipolysis and ketone production)
2. severe dehydration and neurological changes occur due to the profound hyperglycemia and hyperosmolarity

44
Q

Hypothalamic-pituitary endocrine system

  • ___________ controls the pituitary hormones synthesis and secretions
  • _________ pituitary secretes hormones:
  • TSH (thyroid stimulating hormone)
  • ACTH (adrenocorticotropic hormone)
  • _______ pituitary secretes hormones:
  • Antidiuretic hormone/ vasopressin
  • Oxytocin
A

hypothalamus
anterior
posterior

45
Q

DKA and HHS: serum/plasma potassium level

  • In both (DKA) and (HHS), the serum/plasma potassium level (measures only the potassium concentration in the liquid portion of blood outside cells) is normal to _____

caused by:
- Hyp__osmolality
- Insulin deficiency
- __creased plasma osmolality causes water and potassium to move _____ cells
- insulin normally promotes potassium to move ______ cells
- lack of insulin contributes to __creased potassium levels

A
  • In both (DKA) and (HHS), the serum/plasma potassium level (measures only the potassium concentration in the liquid portion of blood outside cells) is normal to high
  • normal to high serum/plasma potassium levels are caused by:
  • Hyperosmolality
  • Insulin deficiency
  • increased plasma osmolality causes water and potassium to move out of cells
  • insulin normally promotes potassium to move back into cells
  • lack of insulin contributes to increased potassium levels
46
Q

Myxedema coma: Treatment

  • ________ hormone replacement – levothyroxine and liothyronine
  • IV slow bolus
  • Switch to daily doses
  • ________corticoids
  • IV
  • supportive measures
  • ICU
  • IV fluids
  • Electrolyte replacement
  • Mechanical ventilation
  • Glucose monitoring and replacement
  • Correction of hypothermia
  • Treat underlying infection (if cause)
A

Treatment
- thyroid hormones – levothyroxine and liothyronine
- IV slow bolus
- Switch to daily doses
- glucocorticoids
- IV
- supportive measures
- ICU
- IV fluids
- Electrolyte replacement
- Mechanical ventilation
- Glucose monitoring and replacement
- Correction of hypothermia
- Treat underlying infection (if cause)

47
Q

s/s of which endocrine emergency?
- fever
- Tachycardia
- cardiac dysrhythmias (a fib/ a flutter)
- n/v
- agitation
- tremor
- psychosis
- stupor/coma
- hypotension

A

thyroid storm

48
Q

HHS s/s
- _______ onset
- polyuria, polydipsia (not polyphagia)
- weight _____
- lethargy, obtunded, coma
- volume depletion
- __creased skin turgor
- ____ oral mucosa
- ______cardia
- Hyp___tension

A

HHS s/s
- insidious (several days)
- polyuria, polydipsia (not polyphagia)
- weight loss
- lethargy, obtunded, coma
- volume depletion
- Decreased skin turgor
- Dry oral mucosa
- Tachycardia
- Hypotension

49
Q

Addisonian crisis: etiology

  • caused by ________ levels of adrenal hormones (mainly serum ______steroids)
  • could be r/t:
  • Sudden loss of _______ gland
  • Sudden __crease in stress in chronic condition
  • Sudden _______ of long-term corticosteroid drug therapy
  • most common with ________ adrenal insufficiency/Addison’s disease (adrenal glands do not produce enough of the hormones cortisol and aldosterone)
A
  • caused by insufficient levels of adrenal hormones (mainly serum corticosteroids)
  • could be r/t:
  • Sudden loss of adrenal gland
  • Sudden increase in stress in chronic condition
  • Sudden cessation of long-term corticosteroid drug therapy
  • most common with Primary adrenal insufficiency/Addison’s disease (adrenal glands do not produce enough of the hormones cortisol and aldosterone)
50
Q

addisonian crisis: Treatment

  • IV _____cortisone (Bolus, than scheduled)
  • IV saline
  • IV dextrose
  • when pt is able, switch to PO meds and fluids = _____ dose until maintenance dose is achieved
  • lack of treatment = death
A

Treatment
- IV hydrocortisone
- Bolus, than scheduled
- IV saline
- IV dextrose
- when pt is able, switch to PO meds and fluids
- Taper dose until maintenance dose is achieved
- lack of treatment = death

51
Q
  • Complication of Addisonian disease
  • life-threatening, medical emergency
A

Addisonian crisis

52
Q

adrenal cortex secretes =

adrenal medulla secretes =

anterior pituitary secretes =

posterior pituitary secretes =

thyroid secretes =

parathyroid secretes =

A

steroid hormones (the 3 s’s):
- Glucocorticoids = cortisol
- Mineralocorticoids = aldosterone
- Sex steroids = androgens

  • Epinephrine
  • Norepinephrine
  • TSH (thyroid stimulating hormone)
  • ACTH (adrenocorticotropic hormone)
  • Antidiuretic hormone/vasopressin
  • Oxytocin

T3 and T4

PTH (parathyroid hormone)

53
Q

s/s of which endocrine emergency?
- sudden penetrating pain in lower back, abdomen, legs
- hyponatremia
- sever vomit and diarrhea
- dehydration
- low BP
- CNS changes – loss of consciousness, confusion, slurred speech
- hyperkalemia – EKG changes and hyponatremia

A

addisonian crisis

54
Q

DKA and HHS : total Potassium levels

  • In both (DKA) and (HHS), the total potassium level (refers to the total amount of potassium in the body, which includes both the potassium inside cells/intracellular and the potassium outside cells/extracellular) is ______

caused by:
- Increased urinary loss (with normal kidney function)
- GI losses

A

Potassium
- In both (DKA) and (HHS), the total potassium level (refers to the total amount of potassium in the body, which includes both the potassium inside cells/intracellular and the potassium outside cells/extracellular) is low
- low total potassium levels caused by:
- Increased urinary loss (with normal kidney function)
- GI losses

55
Q

endocrine emergency treatments:

____________
- IV hydrocortisone
- IV saline
- IV dextrose

__________
- beta blocker
- thionamide (propylthioracil/PTU)
- iodine solution
- glucocorticoids
- bile acid sequestrants

_____________
- thyroid hormones – levothyroxine and liothyronine
- glucocorticoids
- IV fluids

_____________
- fluid replacement
- Electrolyte correction
- insulin infusion
- sodium bicarbonate
- dextrose

A

Addisonian crisis
- IV hydrocortisone
- IV saline
- IV dextrose

Thyroid storm
- beta blocker
- thionamide (propylthioracil/PTU)
- iodine solution
- glucocorticoids
- bile acid sequestrants

Myxedema crisis
- thyroid hormones – levothyroxine and liothyronine
- glucocorticoids
- IV fluids

Treatment of DKA and HHS
- fluid replacement
- Electrolyte correction
- insulin infusion
- sodium bicarbonate – DKA with metabolic acidosis, pH < 7.2
- dextrose – DKA

56
Q

Hypothalamic-pituitary endocrine system

  • pituitary gland location – beneath __________ at base of skull
  • pituitary 2 lobes = ______
A

hypothalamus
anterior and posterior

57
Q

addisonian crisis s/s
- sudden penetrating pain in lower ____, abdomen, legs
- hyp__natremia
- sever vomit and diarrhea
- dehydration
- _____ BP
- CNS changes – loss of consciousness, confusion, slurred speech
- hyp__kalemia

A

s/s
- sudden penetrating pain in lower back, abdomen, legs
- hyponatremia
- sever vomit and diarrhea
- dehydration
- low BP
- CNS changes – loss of consciousness, confusion, slurred speech
- hyperkalemia – EKG changes and hyponatremia

58
Q

Addisonian disease: s/s
r/t hyp___aldosteronism
(______ and _____ retention problems)
- hyp___tension
- __creased vascular tone
- __creased CO
- __creased circulating blood volume
- ____ craving
- ____ serum Na levels
- ____ serum K levels
- Dehydration

Addisonian disease: s/s r/t hyp__cortisolism
- hyp__glycemia
- weakness and fatigue

Addisonian disease: s/s r/t unsuppressed ______ production
- hyperpigmentation

A

Addisonian disease: s/s
r/t hypoaldosteronism
(salt and water retention problems)
- hypotension
- Decreased vascular tone
- Decreased CO
- Decreased circulating blood volume
- salt craving
- Low serum Na levels
- High serum K levels (JFK = High K)
- Dehydration

Addisonian disease: s/s r/t hypocortisolism
(lack of stress hormones = no energy)
- hypoglycemia
- weakness and fatigue

Addisonian disease: s/s r/t unsuppressed ACTH production (secreted in large amounts)
- hyperpigmentation

59
Q
  • DKA usually presents with an _______ anion gap metabolic acidosis (caused by production and accumulation of _______)
  • severity of acidosis and increase of anion gap depends on:
  • Rate and duration of ketoacid production
  • Rate of metabolism and ketoacids
  • Rate of loss of ketoacid anions in urine
A
  • DKA usually presents with an elevated anion gap metabolic acidosis (caused by production and accumulation of ketones)
  • severity of acidosis and increase of anion gap depends on:
  • Rate and duration of ketoacid production
  • Rate of metabolism and ketoacids
  • Rate of loss of ketoacid anions in urine
60
Q

s/s of which endocrine emergency?
- insidious (several days)
- polyuria, polydipsia (not polyphagia)
- weight loss
- lethargy, obtunded, coma
- volume depletion
- Decreased skin turgor
- Dry oral mucosa
- Tachycardia
- Hypotension

A

HHS

61
Q

Cellular compensation DKA
1. acidosis = __crease in H+ concentration
2. H+ move _____ cell
3. there are now more + charged ions ___side the cell
4. K+ moves ____ the cell
5. electrical neutrality is restored inside the cell
6. a temporary correction of the ___ occurs
7. when pH returns to normal the H+ and K+ will return to normal
8. but if the kidneys are working, they would have already automatically excreted the excess ____
9. so when the pH returns to normal there is no more K+ to return to the cell and the body can have a K+ _______

A

Cellular compensation DKA
1. acidosis = increase in H+ concentration
2. H+ move into cell
3. there are now more + charged ions inside the cell
4. K+ moves out of the cell
5. electrical neutrality is restored inside the cell
6. a temporary correction of the pH occurs
7. when pH returns to normal the H+ and K+ will return to normal
8. but if the kidneys are working, they will automatically excrete the excess K+
9. so when the pH returns to normal there is no more K+ to return to the cell and the body can have a K+ depletion

62
Q

Addisonian disease: corticosteroid replacement therapy Teaching
- dosing _______ natural release of hormones:
- Timing _____ important
- Small or large doses?
- nerve ________ therapy
- ___crease doses during stress
- Infection, surgery, trauma,
- 3x3 rule
- keep an emergency supply of meds
- wear a medic alert bracelet

A

Teaching
- dosing mimics natural release of hormones:
- Timing is important
- Small doses
- nerve abruptly stop therapy
- increase doses during stress
- Infection, surgery, trauma,
- 3x3 rule
- keep an emergency supply of meds
- wear a medic alert bracelet

63
Q

Myxedema coma: s/s
- decreased mental status – coma
- hyp__thermia
- ______ of functions of other organs
- hyp__tension
- ______cardia
- hyp__natremia
- hyp__glycemia
- hyp__ventilation

A

Myxedema coma: s/s
- decreased mental status – coma
- hypothermia
- slowing of functions of other organs
- hypotension
- bradycardia
- hyponatremia
- hypoglycemia
- hypoventilation

64
Q

thyroid storm

Etiology
most commonly precipitated by:
- surgery
- trauma
- infection

Risk factors
- long standing untreated hyp___thyroidism (______ disease)
- occurrence of an acute event that triggers storm
- irregular use or d/c use of _______ drugs

A

Etiology
most commonly precipitated by:
- surgery
- trauma
- infection

Risk factors
- long standing untreated hyperthyroidism (graves disease)
- occurrence of an acute event that triggers storm
- irregular use or d/c use of antithyroid drugs

sav NUR 406 final exam (2 decks)

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