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Advanced Clinical Practice Complex Patient > Week 4.1 Screening for Endocrine and Metabolic Diseases > Flashcards

Week 4.1 Screening for Endocrine and Metabolic Diseases Flashcards

1
Q

what are some general health endocrine symptoms

A

fatigue, unexplained weight change, weakness

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2
Q

what are some psychological and cognitive S+S of endo

A

personality changes, memory loss, confusion, irritability

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3
Q

what are some GI changes

A

nausea, vomiting, anorexia, dysphagia, diarrhea, constipation

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4
Q

what are some urogenital changes

A

incontinence, intermittent urine stream, dribbling, straining to void, impotence

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5
Q

what are some MSK changes

A

muscle weakness and cramps, arthralgia, myalgia, stiffness and bone pain

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6
Q

what are some sensory changes

A

paresthesias and numbness

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7
Q

dermatologic changes

A

foot ulcerations, edema, dry and coarse skin, impaired wound healing

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8
Q

MISC changes

A

temperature intolerance, visual changes, OH, increased bruising and increased thirst.

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9
Q

what is the main function of the endocrine system, and how does it do this

A

maintain body homeostasis, and it does this by hormones, and regulating and relaying information between the cells.

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10
Q

how many endocrine cells are there and what is the largest,

A

9, not including the largest which is adipose.

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11
Q

what does the endocrine system work to coordinate

A

metabolism, water balance, BP, stress response, sexual reproduction

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12
Q

the endocrine system and its organs are controlled by the…

A

CNS

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13
Q

what is the psychoneuroimmunology (PNI) system

A

this is interactive biological signaling that uses the hypothalamus and pituitary gland to regulate endocrine, behavioral and neural responses

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14
Q

the hypothalamus is the center for

A

homeostasis

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15
Q

what is the posterior pituitary controlled by

A

signals from the hypothalamus

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16
Q

what is the anterior pituitary controlled by

A

the hormones called hypothalamic releasing and hypothalamic inhibitory hormones

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17
Q

what is a primary endocrine pathophysiology

A

affects the glands

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18
Q

what is a secondary patho

A

affects the pituitary glans, by altering secretions. This can be caused by iatrogenic things, like surgery, chemo, removal of the glands, therapy fro non-endo things, and large dose corticosteroids

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19
Q

what do large doses of corticosteroids cause

A

Cushings

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20
Q

what is tertiary patho

A

affects the hypothalamus

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21
Q

what pathophysiology affect the pituitary gland

A
  • Diabetes insipidus
  • syndrome of inappropriate secretion of ADH (SIADH)
  • acromegaly
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22
Q

describe what diabetes insidious is

A

this is when you get a lack of secretion of vasopressin and ADH, which is usually involved in stimulating the distal tubules to absorb water. So when these two aren’t secreted, you do not get the re-absorption of water, and it is lost in the urine. this causes severe water loss and dehydration

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23
Q

what are the two types of DI

A

central (CDI) and nephrogenic (NDI)

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24
Q

what is the cause of primary/idiopathic CDI

A

autoimmune

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25
Q

what is secondary CDI

A
  • pituitary trauma (neurosurgery or head trauma)
  • infections (meningitis, encephalitis)
  • trauma (cranopharyngioma, pituitary adenoma, suprasellar meningioma, pineal gland)
  • anorexia
  • vascular lesions (aneurysms)
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26
Q

what causes NDI

A

defective hormone receptors thanks to

  • medications like lithium, demeclocycline, amphotericin, colchicine
  • alcohol imbalances (hyper and hypo kalmia)
  • renal diseases (sacoidosis, multiple myeloma, pyelonephritis, SLE)
27
Q

what are the signs and symptoms of DI

A 
polyuria 
nocturia 
polydipsia 
dehydration 
decreased urine specific gravity
increased serum sodium
28
Q

what is syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

A

this is when you have excessive vasopressin, so you have a lot of water retention. It is stored in the cells, and causes water intoxication. This can then cause swelling in the brain, and decreased urine output, headaches and hyponatremia because of the high concentrations of water.

29
Q

what are the 3 risk factors for SIADH

A
  • pituitary damage (due to infection or trauma or neoplasm)
  • secretion of vasopressin like substances
  • thoracic pressure changes from compression of pulmonary or cardiac pressure receptors or both
30
Q

what are the signs and symptoms of SIADH

A 
headache, confusion, lethargy 
decreased urine output 
weight gain without edema 
seizure 
muscle cramping 
vomiting and diarrhea 
increased urine specific gravity (>1.03)
decreased serum sodium (<135)
-swelling in the brain, and not enough sodium in the muscles.
31
Q

explain what acromegaly is

A

hyper secretion of GH from the pituitary, or increased insulin growth factor 1 (IGF-1) that causes an increase in the size of bones

32
Q

how does acromegaly affect the bones in an adult

A

it causes the face, jaw, hands and feet to grow, since the long bones are already developed by then

33
Q

what are the signs and symptoms of acromegaly

A

HTN, sweating, DM, amenorrhea

34
Q

how does acromegaly look in children

A

the GH stimulates the growth of long bones, and causes gigantism

35
Q

presentation of acromegaly

A
  • degenerative arthropathy
  • hand stiffness
  • CTS
  • proximal myopathy and fibromyalgia
  • back pain
  • poor exercise tolerance and muscle weakness
36
Q

what can exercise do for those with acromegaly

A

increase QOL, self esteem and body image

37
Q

how can acromegaly cause CTS

A

by compression of the median nerve in the wrist by either soft tissue hypertrophy or bony growth or even hypertrophy of the median nerve itself

38
Q

more signs and symptoms of acromegaly

A
  • body enlargement os fate face, jaw, hands and feet
  • amenorrhea
  • DM
  • CTS
  • sweating (diaphoresis)
  • HTN
  • hand pain and stiffness
  • back pain
  • proximal myopathy and poor exercise endurance
  • fibromyalgia
39
Q

what does the outer cortex of the adrenal glands do

A

secretion of mineral corticosteroids, that regulate water and minerals.
Glucocorticoids
Androgens (sex hormones)

40
Q

what does the inner medulla do

A

EPI and NE

41
Q

what do the adrenal glands play a large response in

A

stress

42
Q

what are some adrenal insufficiency diseases

A

Addison’s
Cushings
Grave’s

43
Q

what are some signs and symptoms of adrenal insufficiency

A 
dark pigmentation of skin (mouth and scars)
hypotension (OH)
fatigue progressive 
hyperkalemia 
GI problems 
anorexia and weight loss
nausea and vomiting 
arthralgia and myalgia 
tendon calcification 
hypoglycemia
44
Q

dark pigmentation of the skin occurs primarily with what

A

Addisons

45
Q

physical appearances associated with adrenal insufficiency

A
  • moonfaced, buffalo hump (neck- fatty deposits)
  • protuberant abdomen with accumulation of fatty tissue and stretch marks
  • decreased spine bone density
  • kyphosis
46
Q

what are some other S+S of adrenal insufficiency

A 
muscle wasting and weaknesses 
HTN 
back pain 
easy bruising 
psychiatric and emotional things 
impaired reproductive function (changes in menstrual cycle)
DM
slow wound healing 
emasculating effects (hair growth, breast atrophy, voice changes)
47
Q

what does the thyroid gland produce

A

thyroxine T4
Thyrothianine T3
calcitonin

48
Q

what does T3 and T4 do

A

they regulate the metabolic rate, and increase protein synthesis

49
Q

what does calcitonin do

A

weak effect on calcium and phosphorus balance in the body

50
Q

risk factors for thyroid disease

A

women over men
family history
over 50 years old

51
Q

what is a goiter

A

an enlarged thyroid due to the iodine insufficiency around the world. This iodine is needed for thyroid hormones. When it is lacking, there is an over secretion of TSH because there is no negative feedback loop

52
Q

S+S of a goiter

A

increased neck size

pressure on adjacent tissues like trachea and esophagus, leading to difficulty breathing, dysphagia and hoarseness.

53
Q

is goiter still a problem in this country

A

not really, but may still affect older people

54
Q

what is thyroiditis

A

an inflammation that is caused by infection or autoimmune things

55
Q

what is the most common thyroiditis and who does it affect

A

Hoshimotos affecting women over men aged 30-50

56
Q

how does early and later thyroiditis present

A

early: hyperthyroidism
late: hypothyroidism

57
Q

thyroiditis S+S

A
  • painless thyroid enlargement
  • dysphagia (tight sensation when swelling/ choking)
  • anterior neck, shoulder and rib pain that does not have biomechanical changes
  • gland easily palpable (warm, tender, swollen)
  • fatigue, weight gain, dry hair and skin, constipation
58
Q

what is an example of hyperthyroidism

A

Grave’s disease (enlarged gland, swollen neck and eyes due to retraction of eye lids)

59
Q

hyperthyroidism in the head and neck and chest

A

thin hair
exophthalmus (eyes bulging )
enlarged thyroid (warm and nodular)
heart failure (tachy)

60
Q

hypothyroidism in the head and neck and chest

A 
loss of hair, coarse and brittle, 
periorbital edema, 
puffy face, 
normal or small thyroid 
heart failure (Brady)
61
Q

hyperthyroidism in gut and skin

A

weight loss, diarrhea and warm skin and sweaty

62
Q

hypothyroidism in gut and skin

A

cold intolerance, and constipation

63
Q

hyperthyroidism in LE and muscles

A

hyperreflexia and pretibial edema

64
Q

hypothyroidism in LE and muscles

A

muscle weakness and edema in the extremities

Advanced Clinical Practice Complex Patient (16 decks)

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