WK5: Adrenal/thyroid/GI/ADH Flashcards
Define Cushing Syndrome/disease and discuss the difference between primary hyperfunction, secondary hyperfunction, and exogenous steroid excess.
-Cushings is S/Sx associated with hypercortisolism
-SYNDROME: primary hyperfunction, Dz of adrenal cortex (use exogenous steroids to Trx)
-Dz: secondary hyperfunction, Dz of anterior pituitary
Define Cushing Syndrome/disease and discuss the difference between primary hyperfunction, secondary hyperfunction, and exogenous steroid excess.
-Cushings is S/Sx associated with hypercortisolism
-SYNDROME: primary hyperfunction, Dz of adrenal cortex (use exogenous steroids to Trx)
-Dz: secondary hyperfunction, Dz of anterior pituitary
what does cortisol do?
-increases BG
-protects against stress
-stops inflammatory/immune process
-breaks down proteins/fats (increases BP and cholesterol level)
when cortisol Increases glucose availability, what CM occurs?
Glucose intolerance, hyperglycemia
when cortisol Maintains the vascular system, what CM occurs?
Hypertension, capillary friability (ecchymoses)
when cortisol breaks down protein, what CM occurs?
Muscle wasting, muscle weakness, thinning of skin, osteoporosis and bone pain
when cortisol breaks down fat, what CM occurs?
Redistribution of fat to abdomen, shoulders, and face
when cortisol Suppresses the immune and inflammatory responses, what CM occur?
Impaired wound healing and immune response, risk for infection
when cortisol increases CNS excitability, what CM occur?
Mood swings, insomnia
What is Addisons Dz
Dz of the adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones:
cortisol, aldosterone and adrenaline.**
etiology of addison Dz
idiopathic, autoimmune or other
pathogenesis of addison Dz
- adrenal glad is destroyed
- Sx occur when 90% non-functional
- ACTH and MSH are secreted in large amounts
early CM of addisons Dz
anorexia, weight loss
weakness, malaise, apathy
electrolyte imbalance
hyperpigmentation
Late CM of addisons Dz
Hypoaldosteronism
-hypotension
-salt craving
Hypocortisolism
-hypoglycemia
-Wk, fatigue
Unsuppressed ACTH secretion
-hyperpigmentation
Addison adrenal crisis
-caused by?
-results in?
MEDICAL EMERGENCY
-caused by: sudden insufficiency of serum corticosteroids
-results in: sudden loss of adrenal gland, sudden increase in stress in chronic condition, sudden cessation of corticosteroid drug therapy
Adrenal insufficiency requires lifelong — replacement therapy
corticosteroid
important notes for steroid pharmacotherapy for addison Dz
-do not abruptly stop taking
-mimics natural release of hormones
(timing and dose important)
-increase doses during stress
-wear a medical alert bracelet
Pheochromocytoma
Rare tumor of the adrenal medulla that
produces excessive catecholamines (epi/norepi)
RF for Pheochromocytoma
young to middle age
CM of Pheochromocytoma
HTN
HA, diaphoresis, tachycardia
what is the preferred Trx for Pheochromocytoma?
surgery
why would a patient with Pheochromocytoma be taking an Alpha adrenergic blocker?
- inoperable tumor
- pre-op decreasing HTN
what are the two ADH conditions?
SIADH (high)
Diabetes inspidus (low)
what does SIADH stand for?
Definition?
syndrome of inappropriate antidiuretic hormone
-An abnormal production or sustained
secretion of ADH
general characteristics of SIADH
-Fluid retention
-Serum hypoosmolality and hyponatremia
-Concentrated urine
SIADH etiology
-malignant tumors
-CNS disorders
-drug therapy
-Misc. (hypothyroidism, infection)
SIADH osmolality
- Serum osmolality = LOW
- Urine osmolality & specific gravity = HIGH
- Serum sodium = LOW
- Urine output = LOW
- Weight = GAIN
**Pt is retaining pure water, no NA
Sx of SIADH are the same symptoms as what?
hyponatremia
what is diabetes insipidus ?
Deficiency of ADH or a decreased renal response to ADH
what are the two forms of DI?
- Neurogenic (Central)
- Nephrogenic
what is the cause of neurogenic DI?
Hypothalamus or pituitary gland damage
-sudden onset and usually permanent
cause of nephrogenic DI?
- Loss of kidney function
- Often drug-related (e.g., Lithium)
-slow onset and progressive
serum osmolality of DI
- Serum osmolality = HIGH
- Urine osmolality and specific gravity = LOW
- Serum sodium = HIGH
- Urine output = HIGH
- Weight = LOSS
CM of DI
- Polyuria
- Polydipsia
- Dehydration
-electrolyte imbalance and possible hypovolemic shock leading to death
Nephrogenic DI tx
thiazide diuretics d/t: Paradoxical effect: decreases polyuria, increases urine osmolality
Neurogenic DI Trx
synthetic ADH replacement
DI: DILUTE
Dry
I&O
Low specific gravity
Urinates a lot
Treat=vassopressin
rEhydration
what hormones does the thyroid gland secrete
triiodothyronine (T3)
thyroxine (T4)
what does Thyroxine do?
regulator of metabolism that influences almost every body system
____is a necessary component in the
synthesis of thyroid hormone.
iodine
The thyroid works off of a ____feedback loop
negative
goiter
A goiter is an enlargement of the thyroid gland with or w/o Sx of thyroid
dysfunction.
+TSH, - iodine levels
primary hypothyroidism
increases release in TSH from pituitary
what is the most common cause of hypothyroidism
Hashimoto’s (autoimmune)
what are the antibodies associated with Hashimoto’s?
-thyroid receptor antibodies
-anti-thyroglobulin antibody
-anti-thyroperoxidase antibody **
RF for hypothyroidism
female, >50y/o, caucasian, pregnancy, h/o other autoimmune disorders, Family Hx, medications, Trx for hyperthyroidism
early manifestations for hypothyroidism
cold intolerance, weight gain, lethargy, fatigue, memory deficits, poor attention span, memory deficits, poor attention span, increased cholesterol, muscle cramps, raises carotene levels, constipation, decreased fertility, puffy face, hair loss, brittle nails
late manifestations of hypothyroidism
below normal temp, bradycardia, weight gain, decreased LOC, thickened skin, cardiac complications (cardiomegaly)
how does hypothyroidism affect cholesterol?
raises it, hyperlipidemia
how does hypothyroidism affect H&H?
causes anemia
Myxedema
-dermatological changes with hypothyroidism
characteristics of hyperthyroidism
anxiety, tremor, tachycardia, feeling warm, loss of weight, exophthalmos, atrial fibrillation, decreased fertility
Diagnosis of hypothyroidism
High TSH level
Low free T3
low free T4
anti-thyroglobulin
anti-thyroperoxidase antibodies
treatment of hypothyroidism
replace hormone therapy= levothyroxine
types hyperthyroidism
-excessive secretion of T3 and T4
-primary: thyroid
-secondary: pituitary
-tertiary: hypothalamus
what is the most common cause of hypothyroidism? other causes?
-graves Dz
-thyroid adenoma, subacute thyroiditis, toxic multinodular goiter, excessive iodine ingestion, excessive thyroid hormone replacement
RF for hyperthyroidism
family Hx of graves, >40 y/o, women, caucasian, medications, excessive iodine intake, pregnancy
graves Dz
autoimmune disorder
excess levels of T3 and T4
thyroid stimulating antibodies
Graves Dz Sx
nervousness, insomnia, sensitivity to heat, weight loss, gland is enlarged/palpable, audible bruit d/t high glandular blood flow, Afib, Myxedema, Exophthalmos
what is exophthalmos
wide eyed stare
graves ophthamopathy
periorbital and bulging of the eyes
Dx of graves Dz
low TSH
high T3
high T4
anti-thyroglobulin
anti-thyrotropin receptor antibody
US w/ color-doppler evaluation
radioactive iodine scanning
Trx of hyperthyroidism
-antithyroid hormone medication (Propylthiouracil)
-radioactive iodine Trx
-surgery
thyrotoxic crisis (thyroid storm)
-overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism
-life-threatening condition most commonly caused by surgery, trauma, or infection
parathyroid gland
4 peas sized glands nestled within the thyroid tissues of the neck
-produces/secretes PTH
-controls calcium levels
-promotes vitamin D production
hypoparathyroidism Sx are result of ___
insufficient PTH secretion and resultant hypocalcemia
Sx:muscle cramps, irritable, tetany, convulsion
hypocalcemia causes: Trousseau’s sign, Chvostek’s
Hypoparathyroidism trx
replace PTH
normalize serum Ca and vitamin D levels
f parathyroid has been removed then replacement Trx is lifelong
hyperparathyroidism
muscle Wk, poor concentration, neuropathies, HTN, kidney stones, metabolic acidosis, osteopenia, pathological frx, constipation, depression, confusion, subtle cognitive deficits
Sx of hyperparathyroidism are caused by
excessive secretion of PTH with resulting hypercalcemia and bone breakdown
hyperparathyroidism TRx
reduce Ca levels
diuretics
calcitonin
bisphosphonates
vitamin D
surgical intervention
