w7 quiz - endocrine Flashcards
Chemical structure: steroid
lipids that enter the cell nucleus to initiate transcription directly
chemical structure: nonsteroid
needs secondary messanger system to activate transcription in nucleus
What do the endocrine and nervous systems do?
regulate metabolic activites
positive feedback system
g
negative feedback system
g
what is an antogonist to calcitonin
parathyroid hormone
what is an antagonist for insulin
glucagon
Describe how hormone release is most often controlled by negative feedback mechanisms
Endocrine and nervous system work together to regulate metabolic activities
- complex system for some hormones
- secretion of hormones may be controlled by more than one mechanism
- rate and timing of secretion may vary (cyclic patterns)
endocrine disorders reflect what
impaired control or feedback
excess hormone levels are caused by what
a. tumor producing high levels
b. excretion by liver or kidney impaired
c. congenital condition produces excess hormones
Deficit of hormone or reduced effects are due to what
a. Tumor produced too little hormone caused by inadequate tissue receptors present
- antagonist hormone production is increased
- malnutrition
- atrophy, surgical removal of gland
- congential deficit
Endocrine system: diagnostic test
Blood tests (check hormone levels, radioimmunoassay, immunochemical methods)
urine tests
stimulation or suppression tests
scanning, ultrasound, MRI
Biopsy
Endocrine system treatments
Replacement therapy (hormone deficit)
medication, surgery, radiation (hormone excess)
diabetes mellitus results in
abnormal carb, protein and fat metabolism
some tissue can transport glucose in the absense of insulin such as
CNS, kidney, mycardium, gut, skeletal muscle
Type 1 diabetes
Autoimmune destruction of beta cells in pancreas
- insulin replacement requires
- not linked to obesity
- genetic factors
what type of diabetes has acute onset in children and adolescents
type 1
type 1 diabetes: metabolic changes
Catabolism of fats and proteins
- excess fatty acids and metabolites
- ketones in blood
What type of diabetes has decompensated metabolic acidosis
type 1
Type 2 diabetes
non-insulin dependent; caused by decrease production of insulin / decreased resistance by body cells to insulin
type 2 diabetes onset
slow and insideoous, unsually in those older than 50
- associated with obesity
what diabetes is associated with a component of metabolic syndrome?
2
Control of type 2 diabetes
diet, increase bodys use of glucose by exercise, reducing insulin resistance, stimulate beta cells of pancreas to produce more insulin
initial stage of diabetes
Insulin deficit
BG rise
excess glucose in urine (large urine vol.)
dehydration –> thirst
manifestations of diabetes
polyphagia, fatigue, hyperglycemia, glucosuria, dehydration, polyuria, polydipsia
diabetes diagnostics
fasting BG level glucose tolerance test glycosylated hemoglobin test -- clinical and subclinincal diabetes -- monitor glucose levels over several months
Diabetes treatment
Keep BG in normal range
diet and exercise (exercise lowers BG as skeletal muscle uses glucose)
oral medications (incurease insulin secretions, reduce BG levels)
insulin replacement
Complications of diabetes
Directly related to duration and extent of abnormal BG levels
Complications can be acute or chronic
What factors may lead to fluctuations in serum glucose levels
Variations in diet and alcohol use
Change in PA
Infection
Vomiting
Acute complication of diabetes: hypoglycemia (insulin shock)
more common with insulin replacement treatment; can occur because excess oral hypoglycemic drugs
What may cause an excess of insulin in ciruclation
Glucose deficit in blood strenuous exercise dosage error vomiting skipping meal after taking insulin
Hypoglycemic shock: s/s
disoriented / behavior change anxiety / decrease responsiveness decreased BP, increase HR may appear impaired decreased BG level Decrease level of consciousness
IMMIDIATE ADMIN. OF GLUCOSE IS REQUIRED TO PREVENT BRAIN DAMAGE
hypoglycemic shock: emergency treatment
If conscious, immidiately give sweet fruit juice, honey, candy, sugar
If unconscious, give nothing PO; IV glucose 50% required
Emergent treatment for diabetic ketoacidosis:
Insulin, fluid, and sodium bicarbonate.
Diabetic ketoacidosis (DKA)
Occurs in insulin dependent clients; more commonly in type 1
results of insufficient insulin in blood
high BG levels
What results in the production of ketoacids
Mobilization and use of lipids to meet cellular needs
what may DKA be initiated by?
infection or stress
what might DKA result from
dose error, infection, change in diet, alcohol, exercise
DKA s/s
Thirst Dry, rough oral mucosa Rapid pulse, but weak and thready BP low Oliguria Rapid, deep respirations Acetone breath (fruity) Lethargy and decreased responsiveness indicates depression of CNS, owing to acidosis and decreased blood flow
Metabolic acidosis
decrease serum bicarbonate levels and decreased serum pH
Metabolic acidosis s.s
dehydration progresses, renal compensation reduced, acidosis becomes decompensated
LOC
Hyperosmolar Hypoglycemic Nonketotic Coma (HHNK)
Type 2
Diagnosis often missed
Occurs in older pt. and assumed to be cognitive impairment
results in severe dehydration and electrolye imbalances
Manifestations of Hyperosmolar HypoglycemicNonketotic Coma (HHNK)
hyperglycemia
severe dehydration
- increased hemotocrit, loss of turgor, increase HR and resp.
Hyperosmolar HypoglycemicNonketotic Coma (HHNK) - electrolyte imbalances result in what
neurological deficits, muscle weakness, difficulties with speech, abnormal reflexes
Chronic complications of diabetes: vascular
atherosclerosis in small and large arteries
Chronic complications of diabetes: microangiopathy (changes in microcirculation)
Obstruction/rupture of small capillaries and arteries
- tissue necrosis and loss of function
- neuropathy and loss of sensation
- retinopathy (leading cause of blindness)
- chronic renal failure (degeneration of glomeruli in kidney)
Chronic complications of diabetes: macroangiopathy - affects large arteries
Result of abnormal lipid levels
- high incidence of MI, strokes, PVD
- may result in ulcers on legs and feet (slow healing)
- frequent infections and gangrenous ulcers
- amputation may be necessary
chronic complications of diabetes - peripheral neuropathy
Caused by ischemis and microcirculation to peripheral nerves
impair sensations, numbness, tingling, weakness, muscle wasting
Neuropathy leads to
impaired sensation, numbness, tingling, weakness, muscle weakness
chronic complications of diabetes: infections
infection in feet and legs caused by neurologic impairment
fungal infections common (candidica)
UTI
dental caries
gingivitis and periodontitis
chronic complications of diabetes: cataracts
Related to abnormal metabolism of glucose
chronic complications of diabetes - pregnancy
Both mother and fetus may experience complications
- spontaneous abortions
Infants born to diabetic mothers can experience what
increase size and weigh
hypoglycemia in first hours after birth
Hypoparathyroidism leads to
hypocalcemia
- weak cardiac muscle contractions
- increased excitability of nerves (spontaneous contraction of skeletal muscle)
causes of hypoparathyroidism
Congenital lack of parathyroid
Surgery or radiation in neck area
Autoimmune disease
hyperparathyroidism results in what
hypercalcemia
- forceful cardiac contractions
- osteoporosis
- predisposition to kidney stones
caused of hyperparathyroidism
tumor
secondary to renal failure
enlargement (hyperplasia) of glands
What are the most common cause of pituitary hormones
adenomas
Pituitary adenomas: effect of mass
May cause pressure in skull
– headaches, siezures, drowsiness, visual deficits
How to adenomas effect pituitary hormone secretion
Dependent on cells and location involved
May cause excessive or decreased release of hormones
Growth hormone (GH): Dwarfism
Deficit in growth hormone production and release
GH: gigantism
excess GH prior to puberty anf fusion of epiphysis
GH: Acromegaly
Excess GH secretion in adults
- associtated with adenoma
- bones: broader and heavy
- soft tissue grows (hands and feet, change in facial features)
How does diabetes insipidus is what
Deficit of ADH
What is Diabetes insipidus often associated with
adenoma
Diabetes insipidus may originate in the neurohypopysis, meaning what
Head injury or surgery
Possible genetic problem
Replacement treatment required
Inappropriate AHD syndrome
Excess ADH (temporary from stress, secreted from ectopic source such as tumor)
Innappropriate ADH syndrome Treatment
diuretics
Na supplements
Goiter: Endemic goiter
Hypothyroid condition in regions with low iodine levels in soil and food
Goiter: goitrogens
Foods that contain elements to block synthesis of T3 and T4
What are T3 and T4 (names)
triiodothyronine (t3) and thyroxine (t4)
goiter: toxic goiter
results from hyperactivity of thyroid glans
hyperthyroidism
Related to autoimmune factor
Hypermetabolism and increased stimulation of SNS
toxic goiter
Exophthalamos
Exophthalamos
Presense of protruding, staring eyes, decreased blind and eye movement
result of increased tissue mass in orbit
may result in visual impairment
Hypothyroidism
Iodine deficit
Hypothyroidism: hasmimoto thyroiditis
autoimmune disorder
hypothyroidism: tumor
surgical removal or treatment of gland
hypothyroidism: cretinism
Results in short statue and severe cognitive deficits
Untreated congenital hypothyroidism
May be related to iodine deficiency during pregnancy
Hypothyroidism manifestations
Goiter (if caused by iodine deficit)
intolerance to cold
increased BMI
lethargy and fatige
decrease appetite
Myxedema
myxedema
nonpitting edema in face, thickened tongue
myxedema coma
acute hypotension, hypoglycemia, and hypothermia result in loss of consciousness; life threatening if untreated
diseases of adrenal medulla
Pheochromocytoma
diseases of adrenal cortex
cushing syndrome
addisons disease
Pheochromocytoma
Benign tumor of adrenal medulla - secretes epinephrine, norepinephrine and possible other substances
occassionally many tumors
Pheochromocytoma s/s
HA, palpitation, sweating, intermittent or constant anxiety
Cushing syndrome
caused by excessive level of glucocorticoids
Cushing syndrome is a possible result of what
adrenal adenoma, pituitary adenoma, ectopic carcinoma, iatrogenic conditions, substance abuse
changes assiciated with Cushing syndrome (appearance)
round face with ruddy color, truncal obesity with fat between scalpulae, thin limbs, think hair, fragile skin, striae
What are systemic changes with Cushing disease
a. retention of Na and H2O
b. suppression of immune system
c. erythrocyte production
d. emotional lability and euphoria
e. increase catabolism of bone and protein
f. slowed healing
g. increase insulin resistance and possible glucose intolerance
Addison’s disease
Deficiency of adrenocorticoid secretions; autoimmune reason is a common cause
adrenal gland may be destroyed by hemorrhage or infection
Addisons disease s.s
decreased BG levels inadequate stress response fatigue weight loss infections lower serum Na concetration decrease BV hypotension high K+ levels
