Endocrine

Question 1

5 mechanisms of endocrine disorders

Answer 1

• Failure of feedback
• Gland dysfunction
• Increased hormone degradation/inactivation
• Ectopic hormone release
• Target cell failure

Question 2

3 mechanisms of gland dysfunction

Answer 2

• Secretory cells unable to produce, obtain, or convert hormone precursor (Ex. iodine needed for TH)
• Gland synthesizes or released excessive amts of hormone
• Gland fails to produce enough hormone

Question 3

hormone released from organ that should not be releasing it

Answer 3

ectopic hormone release

Question 4

anterior pituitary hormones - 6

Answer 4

• Thyroid-stimulating hormone
• Follicle-stimulating hormone
• Luteinizing hormone
• Adrenocorticotropic hormone
• Growth hormone
• Prolactin

Question 5

stimulates release of glucocorticoids & androgens

Answer 5

ACTH

Question 6

stimulates lactation

Answer 6

prolactin

Question 7

posterior pituitary hormones - 2

Answer 7

• Antidiuretic hormone
• Oxytocin

Question 8

↑ reabsorption of water in kidneys

Answer 8

ADH

Question 9

stimulates uterine contractions & milk release

Answer 9

oxytocin

Question 10

↑ BMR

Answer 10

thyroid hormone

Question 11

2 thyroid hormones

Answer 11

thyroxine (T4) & triiodothyronine (T3)

Question 12

↑ blood calcium

stimulates bone resorption (ostoclasts)

↑ calcium absorption

Answer 12

PTH

Question 13

hormones of adrenal cortex - 3

Answer 13

• Mineralcorticoids (aldosterone)—zona glomerulosa
• Glucocorticoids (cortisol)—zona fasciculata
• Gonadocorticoids (androgens)—zona reticularis

Question 14

hormones of adrenal medulla - 2

Answer 14

Catecholamines (norepinephrine & epinephrine)—chromaffin cells

Question 15

↑ reabsorption of Na+ & water

↑ secretion of K+ in urine

Answer 15

aldosterone

Question 16

↑ breakdown of fat & protein

promotes stress resistance

inhibits immune response

Answer 16

cortisol

Question 17

mimic testosterone in females

Answer 17

androgens

Question 18

mimic SNS activation; “fight or flight”

Answer 18

epinephrine & norepinephrine

Question 19

pancreatic hormones - 2

Answer 19

• insulin
• glucagon

Question 20

↑ blood glucose

Answer 20

glucagon

Question 21

T1DM

explanation

etiology

r/f

s/s

tx

Answer 21

• Type 4 hypersensitivity - T-cells destroy pancreatic beta cells - pancreas produces little or no insulin
• Etiology - idiopathic
• r/f - genetics; infection; other autoimmune disorders
• s/s - “3 P’s” (polyuria - water follows glucose in tubules; polydipsia - dehydration from fluid pulling out of body; polyphagia - catabolic state); glucosuria; DKA; wt loss; fatigue; weakness; mood changes
• Tx - lifelong insulin replacement

Question 22

T1DM accounts for __% of diabetic population

Answer 22

10

Question 23

when does hyperglycemia occur in T1DM?

Answer 23

80-90% of beta cells are destroyed

Question 24

T2DM

explanation

r/f

s/s

Answer 24

• Cellular resistance to insulin, then inability to produce adequate insulin
  
  • Beta cells respond to resistance by producing more insulin
  • Beta cells go through hyperplasia & hypertrophy - causes scarring in pancreas
  • May need more and more medication/insulin as time goes on
• r/f - obesity; sedentary; genetics; HTN; family hx
• s/s - fatigue; pruritus; recurrent infections (glucose on urinary meatus); visual changes; neuropathy (hands and feet); high cholesterol (especially triglycerides - leads to atherosclerosis); HTN (damage to glomerulus)

Question 25

3rd type of DM

Answer 25

gestational DM

Question 26

dx tests for DM

Answer 26

* _Fasting blood glucose_ - fast must be at least 8hrs * _Glucose tolerance test_ - screening for pregnant women around 28 weeks * _Glycosylated hemoglobin (HA1C)_ - average of BG over 3 months’ time

Question 27

complications of DM are most related to…

Answer 27

duration & extent of abnormal BG

Question 28

complications of DM

Answer 28

* _microvascular changes_ (peripheral vascular disease; nephropathy; retinopathy; neuropathy) * _CV disease_ * _DKA_ (type 1) * _HHNS_ (type 2) * _amputations_ * _hypoglycemia_

Question 29

primary cause of mortality in adolescents with DM

Answer 29

DKA

Question 30

DKA responsible for \_\_% of DM-related hospitalizations carries a \_\_\_% mortality

Answer 30

15 1-3

Question 31

**DIABETIC KETOACIDOSIS** explanation onset & duration etiology r/f s/s

Answer 31

* _Lipolysis_ (to meet cellular energy needs) results in _acidic ketone body_ formation * Sudden onset; \<2 days duration * Etiology - usually _infection_; _stress_; dosing error; change in diet; alcohol intake; exercise; _noncompliance_ with insulin regimen * r/f - T1DM; _\<40yo_ * s/s - _hyperglycemia_ (_\>200_); dry mucosa; dry skin; tachycardia; Na and K imbalance (↑ K+); hypotension; _glucosuria_; _3 Ps__;_ ketoacidosis; _acidemia_; _\<15 mEq/L bicarb;_ _Kussmaul_ respirations; _acetone breath_; lethargy; n/v; mental status changes; _coma_

Question 32

DKA often mistaken for…

Answer 32

being drunk

Question 33

**HYPEROSMOLAR HYPERGLYCEMIC NONKETOIC SYNDROME** onset & duration explanation/etiology r/f s/s \_\_\_% mortality tx

Answer 33

* _Insidious_ onset - may take days to manifest, and may be severe at that point; _\>5 days duration_ * Hyperglycemia caused by _↑ glucacon, catecholamines, cortisol, GH, and hepatic glucose production_ - _↑ osmolarity_ of extracellular space draws _fluid out of cells_ - kidneys filter glucose from blood - water loss through osmotic diuresis - results in _severe dehydration & hyperglycemia_ * r/f - T2DM; _\>60yo_; infection; medication _noncompliance_ * s/s - _severe hyperglycemia (\>800)_; _glucosuria_; few ketones; _polydipsia_; _polyuria_; dry mouth; fever; confusion; _hallucinations_; _hyperosmolarity_ (\>350 mOsm/L); hypotension; _profound dehydration_; _\>7.4 pH_; \>20 mEq/L bicarb; _↓ K+_ * 10-20% mortality * Tx - _insulin & fluids_

Question 34

extreme thirst, dehydration & polyuria alkalosis ↓K+

Answer 34

HHNS

Question 35

**HYPOGLYCEMIA** criteria/levels r/f s/s tx

Answer 35

* _\<60_ mg/dL BG * r/f - _old and young_; skipping or missing meals; longer duration of DM; activity; _medications_ (insulin, PO DM meds) * s/s - _dizziness_; fatigue; _pallor_; _shakiness_; palpitations; _sweating_; hunger; _irritability_; loss of consciousness; blurry vision; _change in mental status_; slurred speech; hypotension; _tachycardia_ * Tx - _sugar followed by protein_; milk, peanut butter; glucose tabs; glucose nasal spray * Unconscious pts need sugar via _IV_, not PO

Question 36

effects of GH

Answer 36

direct effect on tissues stimulates liver to release IGF (insulin-like growth factor)

Question 37

2 forms of growth hormone hypersecretion

Answer 37

* acromegaly - in adults * gigantism - in children

Question 38

**ACROMEGALY** etiology onset s/s screening tool

Answer 38

* Etiology - pituitary tumor; trauma * _Insidious_ onset - not always obvious * s/s - _soft tissue overgrowth_; joint pain; DM; _HTN_; _heart & resp failure_ * Ask adults if their shoes, gloves still fit the same

Question 39

**GIGANTISM** etiology s/s

Answer 39

* Etiology - pituitary tumor; trauma * s/s - _tallness_; _h/a_; vision problems; nausea; _excessive sweating_

Question 40

↑GH

Answer 40

acromegaly gigantism

Question 41

↑ ADH

Answer 41

syndrome of inappropriate ADH secretion

Question 42

**SIADH** etiology r/f s/s

Answer 42

* Etiology - infection (_meningitis_); tumor; trauma; medications; advanced _pulmonary disease_ * r/f - kidney or _pulmonary_ disease * s/s - _low urine output_; loss of thirst; _hyponatremia_; _fluid overload__;_ n/v; cramps; tremors; _seizure_; coma

Question 43

**DIABETES INSIPIDUS** etiology r/f s/s

Answer 43

* Etiology - _central_ (pituitary problem); _nephrogenic_ (kidney problem); _pregnancy_ (gestational) * r/f - _male_; genetics * s/s - _very_ _high urine output_; thirst; _hypernatremia_; _dehydration_; n/v; fever; wt loss; urinary frequency; _constipation_; delayed growth

Question 44

↓ ADH

Answer 44

diabetes insipidus

Question 45

↓ TSH

Answer 45

hyperthyroidism

Question 46

↑ TSH

Answer 46

hypothyroidism

Question 47

**HYPERTHYROIDISM** explanation etiology r/f s/s complications tx

Answer 47

* Metabolism increases * Etiology - _thyrotoxicosis_ (idiopathic); _Graves’ disease_ (autoimmune) * r/f - _female_; between _20-40yo or \>60yo_; autoimmune disorders; family hx; thyroid problems; nodules; goiter * s/s - periorbital myedema; _exophthalamos_; nodular goiter; _wt loss_; _tachycardia_; tremor; _difficulty sleeping_; HF; _↑ body temp; heat intolerance_; sweating; _soft silky hair_; flushed warm skin; diarrhea; _hyperactivity_; low TSH (body trying to stop thyroid) * Complications - _thyrotoxicosis crisis (thyroid storm)_ - increased body temp, HR - life threatening, needs immediate reversal * Tx - radioactive _iodide_, drugs - cannot be used during pregnancy

Question 48

**HYPOTHYROIDISM** explanation etiology r/f s/s complications tx

Answer 48

* Metabolism decreases * Etiology - _iodine deficit; Hashimoto’s disease_ (autoimmune); tumor; thyroid removal * r/f - _female_; _\>60yo;_ family hx; neck surgery or radiation; iodine deficit region * s/s - hypometabolism; _cold intolerance_; constipation; _brittle hair;_ _wt gain;_ _lethargy__;_ _myxedema_ (nonpitting edema to tongue and face); dry skin; goiter; high TSH (body trying to stimulate thyroid) * Complications - _myxedema coma_ * Tx - hormone replacement, _levothyroxine_

Question 49

**HYPERPARATHYROIDISM** etiology r/f s/s

Answer 49

* Etiology - tumor; renal failure; paraneoplastic syndrome * r/f - _female_; ionizing radiation; genetics * s/s - _hypercalcemia_; _forceful cardiac contractions_; osteopenia/_osteoporosis_; kidney _stones_; muscle _weakness_; _lethargy_; stupor; personality changes; anorexia; nausea; ↓ renal function; dysrhythmias

Question 50

**HYPOPARATHYROIDISM** etiology s/s

Answer 50

* Etiology - tumor; congenital lack of parathyroid; _damage during surgery in neck_; autoimmune disease * s/s - _hypocalcemia_; _Chvostek & Trousseau signs_; muscle _spasms_, twitching; hair loss; carpopedal spasm; _tetany_; _weak cardiac contractions;_ dysrhythmias; hypotension

Question 51

Cushing's disease is r/t

Answer 51

pituitary adenoma

Question 52

**CUSHING'S SYNDROME** what does it cause in the body? etiology s/s

Answer 52

* Causes retention of _sodium and water_; _immune suppression_; _erythropoiesis_; _catabolism of bone_ & protein; delayed healing; _insulin resistance_; possible glucose intolerance * Etiology - _adrenal adenoma_; _pituitary adenoma_ (↑ ACTH); ectopic carcinoma; iatrogenic conditions; substance abuse * s/s - _rounded face__; truncal obesity;_ _buffalo hump_ (fat pad between scapulae); thin limbs; thin hair; _hirsuitism_; fragile skin; _purple striae_; euphoria; _mood swings_; loss of libido; _hyperglycemia; HTN_

Question 53

2 types of r/f for Cushing's

Answer 53

* Exogenous - steroid use (asthma, COPD, RA pts) * Endogenous - adenoma; cancer; between 30-60yo

Question 54

**ADDISON'S DISEASE** etiology prevention r/f s/s

Answer 54

* Etiology - autoimmune; infection; medication * Most often caused by _steroid use_ - hypothalamus tells adrenal glands to stop producing cortisol - _zona fasciculata shrinks_ _as a result of inactivity_ - _adrenal crisis_ _occurs when you go off the steroid medication_ * Important to _never d/c steroids suddenly_ * r/f - other autoimmune disorder; removal of adrenal gland; cancers; anticoag use * s/s - unintentional _wt loss; hypoglycemia__;_ _bronzing_ (hyperpigmentation) inadequate stress response; fatigue; frequent infections; _hyponatremia; salt craving_; anorexia; hypovolemia; _hypotension_

Question 55

d/c steroids suddenly leads to…

Answer 55

Addison's

Question 56

**PHEOCHROMOCYTOMA** explanation r/f s/s

Answer 56

* Adrenal tumor * r/f - _neurofibramatosis_ type 1; Von Hippel-Lindau disease; Multiple endocrine neoplasia type 2 * s/s - increased _adrenalin_; _HTN_, flushed skin, _tachycardia_ (adrenalin rush that comes and goes)