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Paho Exam 9 Endocrinology
UCD Patho Endocrinology
181
Nursing
Undergraduate 3
05/05/2012

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Cards

Term
What are the organs considered to be part of the classical endocrine system?
Definition
-hypothalamus
-pituitary gland
-thyroid gland
-parathyroid glands
-thymus
-adrenal glands
-pancreas
-ovaries (female)
-testis (male)
Term
What are hormones?
Definition
-they are biochemical substances that exert a physiological effect
-they are messengers secreted into blood or body fluids to target organ/cell
Term
What are the four ways that hormones work?
Definition
-exocrine
-paracrine
-endocrine
-autocrine
Term
How do exocrine hormones work?
Definition
secreted externally or into a duct, affect distant targets
Term
How do paracrine hormones work?
Definition
secreted by one cell, acts on an adjacent cell in the same tissue. affects cells of a different type.
Term
How do endocrine glands work?
Definition
secreted internally
Term
What is the HPT Axis?
Definition
hypothalamic-pituitary-target organ
-to control protein synthesis is to control cell metabolism, intra/intercellular transport, F&E balance, growth & development, reproduction.
Term
For a hormone to have an action it must first interact with a what?
Definition
receptor
Term
What is receptor up-regulation?
Definition
when there is a low hormone concentration it causes the cell to increase the number & sensitivity of receptors
Term
How do autocrine hormones work?
Definition
factor acts on the same cell (itself), a cell of the same type.
Term
What is receptor down-regulation?
Definition
when there is a high hormone concentration is causes the cell to decrease the number & sensitivity of receptors
Term
What are the characteristics of water soluble hormones?
Definition
large, high molecular weight molecules that cannot readily pass through the cell membrane.
Term
How do water soluble hormones interact with the cell?
Definition
they activate the receptors on the plasma membrane (PM)
Term
What are the characteristics of lipid soluble hormones?
Definition
-bound to plasma proteins
-fat soluble
-freely dissolve through lipid bi-layer of the PM
-steroids
Term
How do most lipid‐soluble hormones regulate protein synthesis?
Definition
at the level of RNA transcription
Term
Describe negative feedback.
Definition
-most common method of hormonal control
-rising level of hormone will feed back to the source glad to shut down further production
Term
Describe positive feedback.
Definition
-a mechanism in which hormone stimulates the production of more hormone until a physiologic action occurs (ie. menstrual cycle & male ejaculation)
Term
Why do hormones go bad?
Definition
-failure of feedback mechanism
-hyporesponsiveness
-hyposecretion
-hypersecretion
-target cell may fail to respond
Term
What is primary gland failure?
Definition
gland fails
-inadequate hormone produced
-blood level of gland secreted hormone is too low
-tropic hormones are high
Term
What would tropic vs. peripheral hormone levels be with primary gland failure?
Definition
-tropic hormones are high
-peripheral hormones are low
Term
What is secondary gland failure?
Definition
-hypothalamus/pituitary fails to stimulate tropic hormone
Term
What would tropic vs. peripheral hormone levels be with secondary gland failure?
Definition
-tropic hormones are low
-peripheral hormones are low
Term
Growth hormone equals what?
Definition
somatotropin
Term
What does Growth Hormone do physiologically?
Definition
stimulates nutrient metabolism & tissue growth
Term
What is growth hormone target organ?
Definition
liver
Term
What does the thyroid gland secrete?
Definition
-T3 (3 atoms of iodine)
-T4 (4 atoms of iodine)
-structurally they are similarly but T3 is more potent
Term
What is the function of thyroid hormone
Definition
-stimulation of energy production
stimulation of heart and inotropic/chronotropic
promotion of growth and development of the brain and other nervous system componenets and the development of skeletal muscle
Term
How does the HP Axis apply to the thyroid?
Definition
-hypothalamus
-TRH (releasing hormone)
-anterior pituitary
-TSH
-thyroid gland
-T3, T4, thyroglobulin
Term
What is necessary for T3/T4 production?
Definition
iodine
Term
What hormone is secreted from zona glomerulosa?
Definition
aldosterone
Term
What hormone is secreted from zona fasicularis
Definition
glucocorticoid = cortisol
Term
What hormone is secreted from zona retucularis?
Definition
adrenal androgen
Term
What are the three zones / layers of the adrenal cortex?
Definition
-zona glomerulosa
-zona fascularis
-zona retucularis
Term
What is secreted from the adrenal medulla?
Definition
epinepherine
Term
What is important to remember about glucocorticoids and mineralocorticoids?
Definition
glucocorticoids can sometimes fill the receptor of a mineralcorticoid. They are a "good enough" fit for eachother
Term
What are the physiological effects of cortisol
Definition

Anti inflammatory: inhibits activity of phosphlipase A2, thus reducing LT, PG production

  • decreased capillary permeability of WBC
  • decrease immune system function

Metabollic effects

  • raise blood glucose for immediate use
  • glucogenesis from amino acids
  • increased appetitie
Term
What are the main functions of cortisol
Definition
  • increase blood sugar
  • suppress the immune system
  • aid in fat, protein and carbohydrate metabolism
Term
How do the adrenal glands fit into the HP axis
Definition
  • hypothalamus is stimulated (stress, pain, sleep, trauma)
  • hypothalamus releases corticotropin-releasing hormone (CRH)
  • CRH acts on the anterior pituitary
  • ACTH is released and acts on adrenal cortex
  • adrenal cortex releases cortisol
  • cortisol acts on target organ(s)
Term
Why is cortisol secretion critical for survival?
Definition
  • it is critical to balance stress in the body
  • without cortisol the body will not balance to homeostatsis during stressors
  • cortisol helps protect from damaging effects of stress by suppressing inflammation/immunity
Term
How many parathyroid glands are there?
Definition
4
Term
What do the parathyroid glands do
Definition
  • regulate Ca+
  • parathyroid hormone (PTH) acts on bone and renal tubules to cause increase calcium levels
Term
What is the function of PTH
Definition
  • increase osteoclast activity
  • increase release of calcium from bone matrix to ECF
  • increase renal calcium reabsorption
  • activates vitamin D
Term
What is the function of calcitonin?
Definition
It is the antagonist of PTH
Term
What is Diabetes insipidus (DI)
Definition
decreased production of ADH
Term
What is ADH/vasopressin?
Definition
  • acts as a potent vasoconstrictor in its own right
  • acts as anti0diuretic hormone (anti-pee)
Term
What happens when there is decreased AVP?ADH being procuced?
Definition
increased urine output
Term
What is the new name for ADH?
Definition
AVP (arginine vasopressin)
Term
What is the function of ADH/vasopressin?
Definition
  • decreased ADH: increase urine output
  • Increased ADH: decreased urine output
Term
What is the mechanism of ADH regulation?
Definition
When ADH/AVP is relesed it goes to renal tubule/collecting duct to reabsorb water from urine filtrate (anti-diuresis)
Term
What is primary DI?
Definition
idiopathic: caused by a defect in the pituitary gland, that causes decreased AVP/ADH
Term
What is secondary DI?
Definition
Caused by tumors int he pituitary region due to head traum and surgery (can also be drug induced)
Term
What is neurogenic DI?
Definition
lesion of the hypothalamus or infundibular system of the post pituitary that interferes with synthesis, transport, release of ADH
Term
What is nephrogenic DI?
Definition
insensitivity of the renal tubules to ADH, that inhibites cAMP as a second messenger, making kidneys non-responsive to ADH
Term
What is psychogenic DI?
Definition
pathological water intake, so much water intake that ADH is suppressed
Term
What are the clinical manifestations of DI?
Definition
  • large excretion of dilute urine (4-12L/d)
  • polyuria
  • polydipsia (increased thirst)
  • dehydration
  • increased plasma osmolarity (stimulates osmoreceptors)
  • UA has low SG
  • hypernaturemia (>145)
  • dry mucous membrames
Term
What happens to specific gravity of urine with DI?
Definition
  • SG is decreased (1.000-1.005)
  • water loss in plasma
Term
What happens to the sodium in plasma with DI?
Definition
  • sodium increases (>145)
  • water loss in plasma
Term
What is the concept behind water deprivation in DI?
Definition
  • no water or PO fluids for 4-18 hours
  • patient with DI continues to have high urine volume output
  • kidneys cannot concentrate urine
Term
What will the vasopressin test tell us with DI?
Definition
  • give synthetic ADH to determine if kidneys can concetrate urine
  • this test will tell us isf they have neurogenic DI or nephrogenic DI
Term
What is Syndrome of Inappropriate ADH (SIADH)?
Definition
increased production/secretion of ADH
Term
What is the most common cause of Syndrome of Inappropriate ADH (SIADH)?
Definition
  • independent secretion of ADH from a non-endocrine source
  • oat cell (small cell carcinoma of the lung), cancer in duodenum/pancrease and lymphomas
  • surgeries are notorious
  • drugs (chemo, thlenol, thiazide diuretics)
Term
What are the clincial manifestations of Syndrome of Inappropriate ADH (SIADH)?
Definition
  • hyponatremia (110-115)
  • increased risk of seizures
  • mental status change
  • decreased plasma osmolarity from volume expansion
  • increased levels of ADH
  • urine hyperosmolarity (concentrated)
Term
What happens to blood sodium levels with SIADH?
Definition
decrease on sodium (hpyponatremia) 110-115
Term
How does RAAS contribute to SIADH?
Definition
volume overload suppresses RAA, which decreases further reabsorption of sodium from renal tubules
Term
What is a symptom of sodium imbalance seen with SIADH?
Definition
seizures
Term
What is treatment for SIADH?
Definition
  • hypertonic NaCl for sodium replacement
  • PO fluid restriction to 600-800 mL/d
  • Lasix
  • Lithium to interfere with aDH at the kidney level
  • montior I&O, urine SG, CV changes, mental status
Term
What is giantism?
Definition
  • increased GH in childhood
  • overgrowth of long bones
  • increased activity of the bones at the epiphyseal plates

 

Term
What is acromegaly?
Definition
increased growth hormone in adults
Term
Which bones are affected in giantism?
Definition
long bones
Term
Which bones are affected in acromegaly?
Definition
short bones (facial, hands, feet)
Term
What is the significance of connective tissue changes in acromegaly?
Definition

enlargement of the visceral organs with connective tissue changes

  • left ventricular failure is prominent
  • nerves can become entrapped related to overgrowth of bone and skin: foot drop, muscular atrophy, weakness
Term
What are the metabolic effects in acromegaly?
Definition
  • increase metabolic rate and decrease carbohydrate tolerance (loss of insulin sensitivity from increased growth hormone, connective tissue in pancreas becomes fibrotic)
Term
What is often the cause of acromegaly?
Definition
somatotropic pituitary tumor
Term
What is hyperthyroidism?
Definition
excess thyroxine production
Term
Hyperthyroidism is also known as... (primary)
Definition
Graves' disease
Term
What is the probably mechanism behind most primary hyperthyroidism?
Definition

autoimmune process

  • increase levels of IgG, which bind to TSH receptors, mimicking TSH & increasing the production of T4
Term
What is a goiter?
Definition

condition when thyroid grows larger than normal

  • you will see exopthalmos (protrusion of eye) and associated lid lag
Term
What is the most common cause of goiter worldwide?
Definition
lack of iodine in the diet
Term
What are the clinical manifestations of hyperthyroidism?
Definition
  • increased metabolism/metabolic rate
  • nervousness
  • hadnd tremor
  • goiter
  • exophalmos
  • hair is fine, thinning
  • warm, moist baby-butt skin
Term
What will yo see in labs for primary disorder of hyperthyroidism?
Definition
  • TSH decreased
  • Free T4 should be increased
Term
What would you see in labs for secondary disorder of hyperthyroidism?
Definition
  • TSH increased
  • increased T4
Term
What is thyrotoxicosis?
Definition
Special case of hyperthyroidism but with the added complications of comorbidities such as infections, pregnancy, emotional stress, CV
Term
What is hypothyroidism?
Definition
decreased thyroxine production
Term
What is hypothyroidism also known as (primary)?
Definition
Hashimoto's thyroiditis
Term
What is the probable mechanism behind most primary hypothyroidism?
Definition
autoimmune destruction of the thyroid gland circulating anit-thyroid Anti-bodies
Term
What are th potential causes of primary hypothyroidism?
Definition

failure of the gland to produce thyroxine

  • Hasimoto's thyroiditis
  • patient treated with RA12 for Graves disease
  • iodine deficiency
  • medications: sulfonamides, lithium carbonate
  • post-surgical
  • congenital

 

Term
What are the potential causes of secondary hypothyroidism?
Definition

Failure of HPT axis

  • hypothalamic lesion
  • pituitary lesion
Term
What will you see in labs for primary disorder of hypothyroidism?
Definition
  • increaed TSH
  • decreased T4
Term
What will you see in labs for secondary disorder of hypothyroidism?
Definition
  • decreased TSH
  • decresed T4
Term
What are the clincial manifestations of hypothyroidism?
Definition
  • slow mental activity
  • depression
  • fatigue
  • weight gain
  • dry coarse skin
  • menorrhagia (heavy periods)
  • myxedema
Term

What is myxedema (fat face)

 

Definition
cutaneous and dermal edema secondary to icnreased deposition of connective tissue components (seen in Graves disease and hypothyroidism) also note it is non-pitting edema (especially noticed around eyes)
Term
Hypersecretion of the adrenal gland is also known as...
Definition

Cushing's disease

 

The patient is not able to respod to stressor because there are already high levels. Can be very damaging because we can't mobilize glucose like we normally would. Immune response will be down all the time. More likely to become sick.

Term
What is the mechanism behind hyper-secretion of cortisol?
Definition

Excess secretion of cortisol with or withoug pituitary involvement

  • usually from elevated levels of ACTH from anterior pituitary; sometimes from adrenal neoplasm
Term

Cushing's Disease

 

Role of exogenous glucocorticoid therapy?

Definition
Use of prednisone (which is manmade corticosteroid)
Term
Clinical manifestations of Cushing's Disease?
Definition
  • accumulation of adipose tissue
  • protein wasting
  • hyperpigmentation
  • HTN
  • mental status changes
  • poor wound healing
Term
Why would a patient with cushing's disease become hypertensive?
Definition

salt retention from cortisol and increased blood volume because of dual mineralcorticoid effect.

 

(cortisol is a good-enough fit for the aldosterone receptors)

 

Term
Hyposecretion of the adrenal cortex is also called...
Definition

Addison's disease

 

Term
Describe addison's disease
Definition

Hypercortisolism develops from inadequate stimulation by ACTH or decreased production of cortisol by the adrenal cortex

 

Term
What is the most concerning manifestation of Addison's disease?
Definition

 

Decreased cortisol and aldosterone

Term
What is primary adrenal insufficiency?
Definition
  • when cortisol, aldosterone and adrogens and all decreased
  • increased ACTH but inadequate synthesis and secretion of cortisol
  • possible autoimmune

 

Term
What is secondary adrenal insufficiency?
Definition
marked by decreased ACTH secretion from the naterior pituitary and decreased cortisol
Term
What would tropic (ACTH) vs peripheral hormones look like with primary adrenal insufficiency?
Definition

increased ACTh from anterior pituitary

decreased cortisol

Term
What would tropic (ACTH) vs peripheral hormones look like with seconday adrenal insufficiency?
Definition
decreased ACTH from anterior pituitary, decreased cortisol
Term
Clinical Manifestations of Addisons?
Definition
  • weakness
  • fatigue
  • mental confusion from hypoglycemia
  • hypotension
  • hypovolemia from decreased aldosterone
  • salt cravings
  • hyperpigmentation
  • vitiligo
Term
Why salt cravings with Addison's disease?
Definition

loss of sodium

increase in potassium

Term
What is an addisonian crisis?
Definition
severe hypotension leading to hypovolemic shock
Term
What is the factor that stimulates feedback for PTH (parathyroid hormone) secretion?
Definition
serum calcium
Term
define hyperparathyroid
Definition

excess PTH (parathyroid hormone)

 

Term
Primary hyperparathyroid
Definition
excess PTH due to adenoma/tumor in the gland itself
Term
Secondary hyperparathyroid
Definition
chronic low blood calcium causes overstimulation of the gland and excess PTH
Term
Cause of primary hyperparathyroidism
Definition
tumor
Term
Cause of secondary hyperparathyroidism
Definition

often related to renal failure → decreased Vit D activation → decreased GI absorption of calcium → decreased serum Ca++ → PTH stimulation

 

Term
Clinical manifestations of hyperparathyroid
Definition

"stones, bones, abdominal groans, psychic overtones"

 

renal stones, bone pain, fracture, nausea, vomiting, constipation, PUD, pancreatitis, depression, fatigure, anxiety

Term
Clinical manifestations of secondary hyperparathyroidism
Definition
Increased PTH with decreased serum calcium. chronic low serum calcium (from less absorption, renal failure, or external cause) stimulates PTH secretion from parathyroid
Term
Clinical manifestations of secondary hyperparathyroidism
Definition

Increased PTH with Decreased serum calcium. Chronic low serum Ca++ (from less absorption, renal failure, or external cause) stimulates PTH secretion from parathyroids

Term
What is hypoparathyroid?
Definition
decreased PTH
Term
Most common cause(s) of hypoparathyroid?
Definition
removal or damage to gland during surgery
Term
What happens to serum calcium with hypoparathyroid?
Definition
serum calcium is low and phosphate is increased
Term
Primary hypoparathyroidism:
Definition

Decreased PTH with decreased serum Ca++ (the parathyroid cannot respond to the low Ca++)

Term
Secondary hypoparathyroidism
Definition

Decreased PTH with increased serum Ca++ (if serum Ca++ is high for some reason, parathyroid does not respond. Would be corrected with correction of serum Ca++)

Term
Clincial manifestations of hypoparathytoidism
Definition

hypocalcemia

chvostek's sign

Trousseau's sign

parathesias

seizures

dysrhythmias

Term
Describe the role of insulin in energy metabolism
Definition
anabolic hormone
increases uptake of amino acids
decreases release of amino acids by skeletal muscles
suppresses lipolysis
Term
glucoregulatory
Definition
allows cells to store energy and utilize carbohydrate by changing membrane permeability to glucose
Term
anti-lipolytic
Definition
suppresses lipolysis
Term
lipolysis
Definition
breakdown of lipids to free fatty acids from starch
Term
Do neural tissues need insulin
Definition
no
Term
Do RBCs need inslin
Definition
no
Term
Does skeletal muscle need insulin?
Definition
yes
Term
Does adipose tissue need insulin?
Definition
yes
Term
What is glucagon?
Definition
hormone released from alpha cells in the pancreas, opposite action of insulin.

increases blood glucose from glcogenolysis
Term
3 things that can cause hyperglycemia
Definition
ingestion of food
gluconeogenesis - creation of new sugars
glycogenolysis
Term
What is the effect of the SNS and cortisol on blood glucose?
Definition
Will cause an increase
Term
What are ketones?
Definition
breakdown products of free fatty acid oxidation
Term
Where are ketones made
Definition
liver
Term
Why are ketones made
Definition
If adipose tissue can't use glucose from lack of insulin, ketones will break down free fatty acids rather than carbohydrates
Term
A normal FBG (fasting blood glucose) is below _____ mg/dl
Definition
100 mg/dl
Term
A normal post prandial glucose does not rise above ___mg/dl
Definition
140 mg/dl
Term
Type 1 diabetes
Definition
insulin deficiency
Term
Clinical manifestations of Type 1 diabetes
Definition
polyuria
plydipsia
polyphagia (hungry)
glycosuria
Term
What is osmotic dieresis
Definition
increased urine production caused by the osmotic pull of sugar into the collecting ducts
Term
DKA
Definition
Diabetic Keto-aciidosis: result of hyperglycemia from Type 1 DM leading to metabolic acidosis
Term
What is the effect of the SNS and cortisol on blood glucose?
Definition
Will cause an increase
Term
What are ketones?
Definition
breakdown products of free fatty acid oxidation
Term
Where are ketones made?
Definition
liver
Term
Why are ketones made?
Definition
If adipose tissue can't utilize glucose for energy from lack of insulin, it starts to oxidize free fatty acids instead of carbohydrates for energy
Term
A normal FBG is below ____ mg/dl
Definition
100 mg/dl
Term
A normal postprandial glucose does not rise above ____ mg/dl
Definition
140 mg/dl
Term
Type 1 diabetes
Definition
Insulin deficiency
Term
Clinical manifestations of Type 1 DM
Definition
polyuria
polydipsia
polyphagia
glycosuria
Term
What is osmotic dieresis
Definition
increased urine production caused by osmotic pull of sugar into the collecting ducts
Term
DKA
Definition
Diabetic Ketoacidosis
Term
Mechanism of DKA
Definition
Caused by physiological stressors (interruption of insulin administration), which will cause release of:
catecholamines, growth hormone and cortisol
Which results in increased glucose, muscle breakdown, releasing amino acids which convert to glucose. Furthering hyperglycemia
Leads to hyperosmolarity, dehydration, shock, death
Term
Type 2 diabetes
Definition
Insulin resistance
Term
What is insulin resistance
Definition
Ineffective use of insulin, glucose receptor on cells becomes insensitive
Term
Metabolic syndrome is also known as the _______ syndrome
Definition
Insulin resistance syndrome
Term
What is the significance of metabolic syndrome
Definition
Collection of conditions that often occur together and increase risk of T2 DM, stroke and heart disease
Term
Type 2 diabetes is increasing in parallel with
Definition
obesity
Term
Clinical manifestations of Type 2 DM
Definition
polydypsia
polyphasia
polyuria
weakness
proteineuria
hematuria
constipation
recurrent infections
impotence
blurred vision
tachycardia
dry mucous membranes
dypsnea
chest pains
Term
What is HHNC
Definition

hyperosmotic hyperglycemic nonketonic coma

 

Glucose > 800 mg/dl

Type 2

severe dehydration from osmotic diuresis and electrolyte shifting

Term
What is the mechanism of blood vessel damage in diabetes
Definition

AGE End products

 

atherosclerosis is accelerated poor circulation and sugary blood make more susceptible to infections, gangrene and amputation

Term
________ will kill your patient faster than hyperglycemia
Definition
hypoglycemia
Term
Clinical manifestations of hypoglycemia
Definition
mental status changes - subtle
-headache
-impaired mentation
-irritability
-poor concentration
-hand tremor
-palpitations
-sweaty, cool, clammy
Term
How do we treat hypoglycemia
Definition
sugar STAT (glucose paste, OJ)
if not conscious give glucagon
Term
Principle of hemoglobin A1C test
Definition
Shows average glucose level over past 3 months
Number of glycolated RBCs
Term
What are AGE's
Definition
Advanced Glycosylation Endproducts

accumulate and lay down meshwork that traps LDLs and exaserbates atherosclerosis

Affects all arteriols and capillaries
Term
Macrovascular complications of diabetes
Definition
accelerated atherosclerosis leading to HTN and coronary artery disease

Also cause impotence and leads to amputation of feet, toes and legs
Term
MIcrovascular complication of diabetes
Definition
caused by capillary membrane hypertrophy, leads to diabetic neuropathy, nephropathy and retinopathy
Term
Water deprivation test
Definition

Diabetes Insipidus

 

Limit water intake

If still pee a lot then it's true DI

Decreased urine is not DI

 

 

Term
Vasopressin Test
Definition

Give synthetic ADH

Draw blood to test ADH level

see if kidney can produce concentrated urine

If positive response: primary problem is decreased production (neurogenic)

If negative (no response): problem is nephrogenic - renal tubules are not sensitive to ADH

Term
Sodium, blood
Definition
SIADH
Clinical manifestations hyponatremia
Term
TSH
Definition
High TSH - not enough thryoid hormone
hypothyroid

Low TSH - too much thyroid hormone - hyperthyroid
Term
T4
Definition
Determines thyroid function

Thyroid storm - too much
Less than 2 mcg - myxodema coma
Term
Cortisol
Definition
blood or urine -
high levels: Cushings
Low levels: Addisons
Term
Exocrine
Definition
Hormones secrete through ducts to distant targets
Term
Paracrine
Definition
Hormone act on a neighbor cell in same tissue of a different type
Term
Endocrine
Definition
Hormones secrete internally.
Term
Chvostek's sign
Definition
Facial twitch
mild hypocalcemia
tap anterior to earlobe and cheek on same side will twitch
Term
Trousseau's sign
Definition
apply BP cuff and leave 3 minutes, twitch present hypocalcemia
Term
Glycogen
Definition
storage form of glucose made by muscle and liver
Term
Gluconeogenesis
Definition
production of glucose from amino acids in the liver
Term
Lipolysis
Definition
production of free fatty acids when adipose tissue is broken down
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