Week 4.1 Screening for Endocrine and Metabolic Diseases Flashcards
what are some general health endocrine symptoms
fatigue, unexplained weight change, weakness
what are some psychological and cognitive S+S of endo
personality changes, memory loss, confusion, irritability
what are some GI changes
nausea, vomiting, anorexia, dysphagia, diarrhea, constipation
what are some urogenital changes
incontinence, intermittent urine stream, dribbling, straining to void, impotence
what are some MSK changes
muscle weakness and cramps, arthralgia, myalgia, stiffness and bone pain
what are some sensory changes
paresthesias and numbness
dermatologic changes
foot ulcerations, edema, dry and coarse skin, impaired wound healing
MISC changes
temperature intolerance, visual changes, OH, increased bruising and increased thirst.
what is the main function of the endocrine system, and how does it do this
maintain body homeostasis, and it does this by hormones, and regulating and relaying information between the cells.
how many endocrine cells are there and what is the largest,
9, not including the largest which is adipose.
what does the endocrine system work to coordinate
metabolism, water balance, BP, stress response, sexual reproduction
the endocrine system and its organs are controlled by the…
CNS
what is the psychoneuroimmunology (PNI) system
this is interactive biological signaling that uses the hypothalamus and pituitary gland to regulate endocrine, behavioral and neural responses
the hypothalamus is the center for
homeostasis
what is the posterior pituitary controlled by
signals from the hypothalamus
what is the anterior pituitary controlled by
the hormones called hypothalamic releasing and hypothalamic inhibitory hormones
what is a primary endocrine pathophysiology
affects the glands
what is a secondary patho
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
what do large doses of corticosteroids cause
Cushings
what is tertiary patho
affects the hypothalamus
what pathophysiology affect the pituitary gland
- Diabetes insipidus
- syndrome of inappropriate secretion of ADH (SIADH)
- acromegaly
describe what diabetes insidious is
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
what are the two types of DI
central (CDI) and nephrogenic (NDI)
what is the cause of primary/idiopathic CDI
autoimmune
what is secondary CDI
- pituitary trauma (neurosurgery or head trauma)
- infections (meningitis, encephalitis)
- trauma (cranopharyngioma, pituitary adenoma, suprasellar meningioma, pineal gland)
- anorexia
- vascular lesions (aneurysms)
what causes NDI
defective hormone receptors thanks to
- medications like lithium, demeclocycline, amphotericin, colchicine
- alcohol imbalances (hyper and hypo kalmia)
- renal diseases (sacoidosis, multiple myeloma, pyelonephritis, SLE)
what are the signs and symptoms of DI
polyuria nocturia polydipsia dehydration decreased urine specific gravity increased serum sodium
what is syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
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.
what are the 3 risk factors for SIADH
- 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
what are the signs and symptoms of SIADH
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.
explain what acromegaly is
hyper secretion of GH from the pituitary, or increased insulin growth factor 1 (IGF-1) that causes an increase in the size of bones
how does acromegaly affect the bones in an adult
it causes the face, jaw, hands and feet to grow, since the long bones are already developed by then
what are the signs and symptoms of acromegaly
HTN, sweating, DM, amenorrhea
how does acromegaly look in children
the GH stimulates the growth of long bones, and causes gigantism
presentation of acromegaly
- degenerative arthropathy
- hand stiffness
- CTS
- proximal myopathy and fibromyalgia
- back pain
- poor exercise tolerance and muscle weakness
what can exercise do for those with acromegaly
increase QOL, self esteem and body image
how can acromegaly cause CTS
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
more signs and symptoms of acromegaly
- 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
what does the outer cortex of the adrenal glands do
secretion of mineral corticosteroids, that regulate water and minerals.
Glucocorticoids
Androgens (sex hormones)
what does the inner medulla do
EPI and NE
what do the adrenal glands play a large response in
stress
what are some adrenal insufficiency diseases
Addison’s
Cushings
Grave’s
what are some signs and symptoms of adrenal insufficiency
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
dark pigmentation of the skin occurs primarily with what
Addisons
physical appearances associated with adrenal insufficiency
- moonfaced, buffalo hump (neck- fatty deposits)
- protuberant abdomen with accumulation of fatty tissue and stretch marks
- decreased spine bone density
- kyphosis
what are some other S+S of adrenal insufficiency
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)
what does the thyroid gland produce
thyroxine T4
Thyrothianine T3
calcitonin
what does T3 and T4 do
they regulate the metabolic rate, and increase protein synthesis
what does calcitonin do
weak effect on calcium and phosphorus balance in the body
risk factors for thyroid disease
women over men
family history
over 50 years old
what is a goiter
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
S+S of a goiter
increased neck size
pressure on adjacent tissues like trachea and esophagus, leading to difficulty breathing, dysphagia and hoarseness.
is goiter still a problem in this country
not really, but may still affect older people
what is thyroiditis
an inflammation that is caused by infection or autoimmune things
what is the most common thyroiditis and who does it affect
Hoshimotos affecting women over men aged 30-50
how does early and later thyroiditis present
early: hyperthyroidism
late: hypothyroidism
thyroiditis S+S
- 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
what is an example of hyperthyroidism
Grave’s disease (enlarged gland, swollen neck and eyes due to retraction of eye lids)
hyperthyroidism in the head and neck and chest
thin hair
exophthalmus (eyes bulging )
enlarged thyroid (warm and nodular)
heart failure (tachy)
hypothyroidism in the head and neck and chest
loss of hair, coarse and brittle, periorbital edema, puffy face, normal or small thyroid heart failure (Brady)
hyperthyroidism in gut and skin
weight loss, diarrhea and warm skin and sweaty
hypothyroidism in gut and skin
cold intolerance, and constipation
hyperthyroidism in LE and muscles
hyperreflexia and pretibial edema
hypothyroidism in LE and muscles
muscle weakness and edema in the extremities
