Endocrine

Question 1

What is the endocrine system involved in?

Answer 1

-growth, metabolism, and adaptation.

Question 2

What can Hormones be categorized as?

Answer 2

• amines/Amino acids
• Peptides, polypeptides, glycoproteins and proteins
• Steroids
• Fatty acid derivatives

Question 3

What are the main endocrine organs in the body?

Answer 3

• pineal
• Pituitary (A+P)
• Thyroid/parathyroids
• Adrenal (cortex/medulla)
• Stomach
• Pancreas
• Duodenum
• Ovary/testes

Question 4

What is the HPA axis?

Answer 4

Hypothalamic-pituitary-Adrenal

The bodies hormone response to extrernalities such as stress, pain, infection, hypoglycaemia, trauma, hemorrhage, sleep resulting in cortisol reaching target organs.

Question 5

Where is Glucagon secreted

Answer 5

The islets of Langerhans within the pancreas

Question 6

Describe Adrenal Insufficiency

Answer 6

• decreased adrenal cortex function

- Decreased aldosterone and cortisol function

Question 7

s/s of adrenal insufficiency

Answer 7

Weakness, dehydration, inability to respond to stress.

Question 8

Describe Addisons disease

Answer 8

• primary adrenal insufficiency

- Adrenal cortical hormones, and elevated ACTH levels

Question 9

S/S of Addisons Disease

Answer 9

• Bronze pigmentation
• Body hair distribution changes
• GI upset
• Weakness
• Hypoglycaemia
• hyperkalemia
• Hypotension
• Weight loss

Question 10

What is primary Adrenal Insufficiency?

Answer 10

• mineralocorticoid deficiency

- Glucocorticoid deficiency

Question 11

What is Secondary Adrenal Insufficiency?

Answer 11

More common

• Lack of ACTH secretion from the pituitary leading to a reduced production of cortisol
• Commonly found in patients who abruptly stop glucocorticoid therapy

Question 12

Describe Cushings syndrome (Three forms hypersecretion)

Answer 12

Manifestation of hypercortisolism of any cause.

3 forms:

• pituitary form
• Adrenal Form
• Ectopic Cushings

May also result from long term glucocorticoids

Question 13

Physical exam findings in the cushings patient

Answer 13

Moon face
Buffalo hump
Skin ulcers
Osteoporosis
Cardiac Hypertrophy
Obesity

and more!

Question 14

Other causes of Hypercortisolism

Answer 14

• pregnancy
• Malnutrition
• Alcoholism

Question 15

Describe Congenital Hypothyroidism

Answer 15

• congenital malformation of thyroid gland

- Poor TH synthesis or TH synthesis

Question 16

S/S of congenital hypothyroid

Answer 16

-large tongue
-weight gain
-Poor feeding
-Excessive sleep
-Constipation
Jaundice
-Poor muscle tone
-Umbilical hernia

Question 17

Describe Hypothyroidism

Answer 17

• Hypo-metabolic state

- Myxedematous involvement of tissues

Question 18

Describe a myxoedema coma

Answer 18

• Profound Hypothyroid
• Life threatening
• Most common in elderly women with Hx of hypothyroidism

Question 19

Describe Hyperthyroidism

Answer 19

• Hyper-metabolic state
• Excessive delivery of T3 & T4 to peripheral tissues
• Most common in graves disease.

Question 20

What is a thyroid storm

Answer 20

• Life-Threatening Thyrotoxicosis

- Precipitated by infection, DKA, trauma

Question 21

What are three actions of insulin

Answer 21

• Promotes glucose uptake by target cells & provides for glucose storage as glycogen
• Prevents fat and glycogen breakdown and inhibits gluconeogenesis
• Increases protein synthesis

Question 22

Describe T1DM

Answer 22

destruction of pancreatic beta cells

Question 23

Describe T2DM

Answer 23

Results from increased insulin resistance

Question 24

What are the three “polys” in diabetes

Answer 24

Polyuria
Polydipsia
Polyphagia

Question 25

How is diabetes diagnosed?

Answer 25

Fasting BGL -2 episodes over 7mmol/L Random BGL -1 episode over 11.1mmol/L with symptoms

Question 26

What are the four principle types of exogenous insulin?

Answer 26

- Rapid acting - Short acting - Intermediate acting - long acting

Question 27

Describe DKA

Answer 27

When ketone production exceeds cellular use and renal excretion.

Question 28

S/S of DKA

Answer 28

- Polyuria & Polydipsia over 2 days is common - Kussmauls respirations - Hypotension and tachycardia

Question 29

Parts of definitive DKA diagnosis

Answer 29

- Hyperglycemia >14mmol/L - Low bicarbonate <15mEq - Low pH <7.35 - Excess ketone bodies May aslo see - HyperK - Pseudohyponatremia - Metabolic Acidosis

Question 30

ACP Tx for DKA

Answer 30

- ABC's - fluid! - If ECG changes suggesting hyper K present consider Calcium (1G), salbutamol (20mg)

Question 31

When can Hyperglycemic hyperosmolar non-ketotic syndrome occur

Answer 31

- T2DM - Acute Pancreatitis - Severe Infection

Question 32

How does HHNK present

Answer 32

- Dehydration - Neuro compromise a. seizures, hemiparesis, aphasia, nystagmus, hallucinations - Excessive thirst - Generally progressive over days and may be mistaken for a stroke.

Question 33

HHNK Diagnosis

Answer 33

- Hyperglycemia (>33mmol/L) - Hyperosmolarity (<310) - Dehydration - Absence of ketoacidosis - Depression of sensorium

Question 34

HHNK management

Answer 34

Correct hypo perfusion