Endocrine Disorders Flashcards

Question

What does a glycosylated hemoglobin level measure?

Answer 1

* Reflects the average blood sugar level over 90-120 days * What percentage of Hgb has been exposed to sugar and how much sugar

Answer 2

* Identify prediabetes * Diagnose Type 1 and Type 2 DM (will perform two separate tests on different dates to confirm) * Monitor current diabetes treatment plan

Answer 3

► Normal A1C \<5.7% ►Prediabetes AIC _\>_5.7% and \<6.5% ►Diabetes AIC \>6.5% ![]()

Answer 4

* IGT is caused by diminished insulin secretion * IFG is caused by enhanced hepatic glucose output secondary to hepatic insulin resistance

Answer 5

* FPG: 100-125 mg/dl

Answer 6

* 140-199 mg/dl

Answer 7

* 5.7-6.4%

Answer 8

* Damage to the capillaries, including: * Retinopathy * Neuropathy * Nephropathy * Amputations

Answer 9

* Damage to the larger vessels, including: * CAD * Stroke * Peripheral vascular and cerebral vascular disease

Answer 10

* Chronic complications are caused by: * Insulin resistance/deficiency * Chronic hyperglycemia * Accumulation of advanced glycation end-products * Activation of metabolic pathways that cause tissue damage

Answer 11

* Tissues that are unable to downregulate the cellular uptake of glucose: * Kidneys * RBCs * Blood vessels * Eye lens * Nerves * Metabolic complications affect these tissues then and result in complications. These include: * Oxidative stress * Sunting of glucose to the polyol pathway * Activation of protein kinase C * Formation of AGEs * Accumulation of hexosamines

Answer 12

* The leading cause of blindness, end-stage kidney failure, and various neuropathies * Characteristics of diabetic microangiopathy include: * Occlusion of capillaries with thicking of the capillary basement membrane * Endothelial cell hyperplasia * Thrombosis * Pericyte degeneration * Hypoxia/ischemia

Answer 13

* Develops more rapidly in type 2 DM d/t longstanding hyperglycemia before diagnosis * Comorbid diseases include cataracts and glaucoma * **Results from:** * Damage to retinal blood vessels and red blood cells, p * Platelet aggregation * Relative hypoxemia & HTN

Answer 14

* **Stage 1: Nonproliferative** * Macular edema ⇒ The leading cause of visual impairment/blurring in DM * Vein abnormalities * Microaneurysm formation * Interretinal hemorrhage * Hard exudates * **Stage 2: Preproliferative** * Cotton-wool patches (d/t retinal ischemia) * Intraretinal microvascular shunts * **Stage 3: Proliferative** * Neovascularization * Glial proliferation * Vitreoretinal traction hemorrhage; retinal detachment

Answer 15

* Hyperglycemia activates the polyol pathway, hexosamine pathway, protein kinase C, production of advanced glycation end-products (AGEs), and inflammation ⇒ These all contribute to kidney tissue injury * Changes include: * Glomerular enlargement * Glomerular basement membrane thickening w/proliferation of mesangial cells * Proliferation of mesangial matrix

Answer 16

* Kimmelstiel-Wilson nodule (nodular glomerulosclerosis) * Podocyte loss * Decreased GFR * **_Microalbuminuria_** (30 to 300 mg/day) ► **First manifestation of kidney dysfunction** * **Seen often in Type 1 DM** * Later we may see... * Fluid overload * Hypoproteinemia * Decreased plasma oncotic pressure * Anasarca (generalized body edema) * HTN * **Macroalbuminuria (\>300 mg/day)**

Answer 17

* Since nerves do not require insulin for glucose transport, they are vulnerable to chronic hyperglycemia\* * More common in Type 2 DM * The underlying pathologic mechanism includes both: **Metabolic and vascular factors** r/t chronic hyperglycemia with... * Inflammation * Ischemia * xidative stress * Advanced glycation end-products * Increased polyol formation ⇒ **demyelination** * Nerve degeneration

Answer 18

* Nerve degeneration begins in the peripheral * Sensory deficits proceed motor involvement * Extremities involve first!! * "Stocking and glove" pattern

Answer 19

* **Most common neuropathy** and involves both small and large nerve fibers * **_Sensory, autonomic, and motor nerve involvement_** * Loss of small nerve fiber function ► Causes neuropathic pain and sensation loss, high risk of foot ulceration development, gangrene and amputation risk * Loss of large nerve fiber function ► Causes sensory loss of proprioception and vibration, ataxia, loss of coordination, the risk for falls/fractures * Motor weakness, muscle atrophy seen later in the disease of lower legs/feet

Answer 20

* Affect GI enteric nerves causing: * Nausea, bloating, diarrhea, gastroparesis, or constipation * Bladder/sexual dysfunction * Urinary retention, loss of bladder sensation, recurrent infection, erectile dysfunction * Cardiovascular autonomic neuropathy is a serious complication * HR variability, changes in baroreceptor reflexes, postural hypotension, dysrhythmias, painless MI, sudden death

Answer 21

* The progressive degeneration and structural disorganization of a joint, particularly in the foot or ankle in long-term DM * Is related to inflammation, loss of sensation, and neurally mediated vascular alteration with osteoclastic bone reabsorption

Answer 22

* Lesions in large and medium-sized arteries * **Increases risk for HTN, accelerated atherosclerosis, hyperlipidemia, CVD, stroke, and peripheral vascular disease** * Unrelated to the severity of DM unlike microangiopathy\*\* * Found in those with insulin resistance and impaired glucose tolerance

Answer 23

* Ultimate cause of death in DM * **Type 1 DM:** HTN is associated with the development of microalbuminuria * **Type 2 DM:** HTN is associated with metabolic syndrome * HTN increased risk for CAD and stroke * CAD prevalence increases with the duration but not the severity of DM * CAD and stroke in DM are the c**onsequence of accelerated atherosclerosis, HTN, and increased risk for thrombus formation**

Answer 24

* Is an atherosclerotic disease of the lower extremity and DM increases the incidence of PAD * Development is influenced by age, duration of diabetes, glycemic control, and smoking, hyperlipidemia, and HTN

Answer 25

* Pain from reduced blood flow (claudication) * Ulcers * Gangrene --\> Results in amputation * Results from **occlusion of small arteries and arterioles** * Occur in patchy areas to feet/toes * Begin as ulcers and progress to osteomyelitis or gangrene and require amputation

Answer 26

* Occurs when blood glucose levels are **less than 47 mg/dL in newborns** for the first 48 hrs of life _OR_ **less than 70 mg/dL in children and adults** * Occurs when blood glucose levels are low enough to cause epinephrine secretion resulting in the "flight or fight response" * Either there is excess insulin or decreased counter-regulatory hormones * Causes may be: * **Exogenous** ► Meds, EtOH, exercise * **Endogenous** ► Tumors of the pancreas or inherited DO's * **Functional** ► Hyperalimentation, spontaneous, or liver disease * Type 2 DM is less of a risk for hypoglycemia than Type 1 * Associated with insulin or oral medication use

Answer 27

* Insulin-treated patients * Selected PO hypoglycemic meds * Combo med/insulin therapy * Incorrect dose of meds * Decreased caloric intake * Skipping meals/snacks * Exercise or increased physical activity without adequate food intake

Answer 28

* Blood glucose levels decrease * In return, insulin levels appropriately decrease as well * Glucagon and other counter-regulatory hormones increase from the liver * Glucose level increases

Answer 29

* Blood glucose levels decrease * Insulin levels appropriately decrease * Glucagon and other hormones increase, but the response is not enough * **_Glucose levels do not sufficiently increase and patient remains hypoglycemia_**

Answer 30

* **Adrenergic reactions (Autonomic): Occur when decrease in glucose level is rapid** * Pallor * Sweating * Tachy/palpitations * Hunger * restlessness * Anxiety/tremors * **Neurogenic reactions (Neuroglycopenic):** * Fatigue * Irritability * Headache * Loss of concentration * Confusion * Transient sensory/motor defects * Convulsions * Coma/death

Answer 31

* When an individual with hypoglycemia **lacks appropriate autonomic warning signs** and recovery may be delayed because of impaired glycogenolysis and hampered delivery of gluconeogenic substrates the liver * Autonomic symptoms not felt due to **impaired glucagon response** * Glucagon doesn't rise and is sluggish in responding to hyperglycemia * Huge problem with Type 1 DM * Treatment: Lighten up on tight glucose control

Answer 32

* There is **increased lipolysis and triglyceride breakdown** * Body is digesting its fats * There’s also **decreased glucose uptake** * So the body is taking up less glucose and there’s **increasing breaking down of proteins** * In addition, there is **increased free fatty acids** which in turn leads to ketogenesis * increased formation of ketones which will, in turn, l**ead to acidosis** * Increased free fatty acids **also lead to hyperglycemia, as will decreased glucose uptake** * Hyperglycemia leads to i**ncreased glucose in the urine** which will, in turn, lead to more urine production ► **Osmotic diuresis** * Osmotic diuresis leads to **volume depletion and electrolyte loss as well** * May lead to impaired renal function which can worsen acidosis * Also have **increasing proteolysis** and increasing amounts of breaking down of the proteins * Lead to **increased amino acids, and then increased gluconeogenesis** * The **body responds by making more glucose which will, in turn, lead to worsening hyperglycemia** and increasing osmotic diuresis * Cellular dehydration leads to a loss of K from cells and a net loss of body K * OVERALL...DKA is r/t a deficiency of insulin and an increase in the levels of insulin counter-regulatory hormones (catecholamines, cortisol, glucagon, growth hormone)

Answer 33

* Weakness * Blurry vision * **Abdominal pain \*** * **Nausea/vomiting** * Altered mental status * **Kussmaul respirations** * **Hyperventilation d/t acidosis** * Hypotension * Tachycardia * Ketone smelling breath * Elevated blood sugar usually above 250 * **Serum ketones \> 15 (ketonuria)** * Anion gap **metabolic acidosis** * **Polyuria and dehydration due to osmotic dehydration** r/t hyperglycemia * ****Plasma glucose level is higher than the renal threshold, so significant amounts of glucose is lost in the urine * **Deficits in NA, phosphorous and Mg** * **Decreased total body K!! (level may appear normal/elevated)**

Answer 34

* Give insulin ⇒ Watch for K level drop!!! Give supplemental K as well

Answer 35

1. Dehydration 2. Fluid/electrolyte loss 3. Metabolic acidosis 4. Hyperglycemia

Answer 36

* Occurs in approx. 30 % of children with Type 1 DM * **More common in Type 1 d/t increased insulin deficiency** * **Obesity** * **Non-Hispanic black ethnicity** * **Intercurrent illness \*\* (infection, trauma, surgery, or MI)** * Poor med compliance and/or interruption of med treatment * **Poor glycemic control** * **Younger or older age** * Diagnostic error * Lack of health insurance in the US * Lower body mass index

Answer 37

1. Serum glucose \>250 mg/dL 2. Serum bicarb level \<18 3. Serum pH \<7.30 4. Presence of an anion gap 5. Presence of urine and serum ketones

Answer 38

* In the degree of insulin deficiency (more profound in DKA) and the elevation of glucose levels and degree of fluid deficiency (more profound in HHS) * HHS develops over time, where DKA has more of a rapid onset

Answer 39

* Insulin deficiency and increased levels of counter-regulatory/stress hormones (glucagon, catecholamines, cortisol, and growth hormone) * Insulin levels sufficient though to prevent excessive lipolysis but not to use glucose properly * Increased gluconeogenesis, and glycogenolysis * Inadequate use of peripheral tissues, primarily muscle * **Lack of ketosis**

Answer 40

* Type 2 DM * Elderly * Comorbid issues (infections, renal, or cardiac disease) * Massive fluid loss

Answer 41

* Glycosuria * Polyuria * Extreme serum glucose elevation * Severe volume depletion * Increased serum osmolality (up to 400) * Intracellular dehydration * Electrolyte loss (including K) * Neurologic changes (stupor)

Answer 42

1. **Very high serum glucose** (usually \> 600 mg/dL) 2. Near normal sodium bicarb and pH 3. A serum osmolarity usually \> 320 mOsm/L 4. **Absent or low ketones in the urine/serum**

Answer 43

* When excess amounts of TH are secreted from the thyroid gland * Primary causes include: * Grave's disease * Toxic multinodular goiter * Thyroid adenoma * Thyroiditis * Secondary causes include: * TSH-secreting pituitary adenomas

Answer 44

* Exact cause is unknown * Thought to be genetic factors interacting with environmental triggers * Is an autoimmune disease that results from stimulation of the thyroid by thyroid-stimulating immunoglobulins (TSI's) * TSI's override the normal negative feedback mechanisms and causes an increased synthesis of TH and hyperplasia of the gland (goiter) * TRH and TSH decrease

Answer 45

* More common in women * Familial predisposition of approx. 15% * Occurs at any age, but peak onset is 20-40 years

Answer 46

* Ophthalmopathy * Lag of the globe on upward gaze or lag of the upper lid on downward gaze * Dermopathy * Only with very high TSI levels * Subcutaneous swelling on the anterior portions of the legs and by indurated and erythematous skin * Exophthalmos (protrusion of the eyeballs) * Double vision * Periorbital edema * Decreased visual acuity

Answer 47

* Hyperthyroidism * Diffuse goiter (smooth and soft) * Ophthalmopathy (exophthalmos) * Dermopathy

Answer 48

* Endocrine * Enlarged thyroid gland (goiter) * Bruit heard over thyroid * Hypercalcemia * Decreased PTH secretion * Reproductive * Erectile dysfunction * Decreased libido * Menstrual abnormalities * GI * Weight loss * Nausea/vomiting * Anorexia * Abdominal pain * Integumentary * Warm skin with a velvety texture * Heat intolerance * Sweating * Hair that is fine and soft * Palmar erythema * Occasionally vitiligo * Hair loss * Eyes * Prominent stare * Lid lag * Failure of convergence * Failure to wrinkle brow on upward gaze * Cardiovascular * Tachycardia * Palpitations * Wide pulse pressure * Arrhythmias (i.e., elderly with atrial fibrillation) * Systolic murmors * Neurologic * Tremor * Hyperreflexia * Emotional lability

Answer 49

* Thyroid storm * Worsening of the hyperthyroid state * Death can occur within 48 hours without treatment * Typically occurs in individuals with undiagnosed or partially treated severe hyperthyroidism and who are subject to excessive stress * I.e., infection, cardiovascular disorders, trauma, burns, seizures, surgery * Symptoms are caused by the sudden release and increased action of thyroxine (T4) and triiodothyronine (T3) exceeding metabolic demands * Hyperthermia * Tachycardia (atrial dysrhythmia) * High-output HF * Agitation/delirium * Nausea/vomiting/diarrhea * Fluid volume depletion

Answer 50

* **Primary hyperthyroidism:** * Decreased TSH * Elevated T₃and T₃uptake * Decreased T₄ * Elevated serum TA * **Secondary hyperthyroidism:** * ****Normal to increased TSH * Elevated TH

Answer 51

* Congenital defects * Idiopathic * Past radioactive iodine surgery or irradiation * Biosynthetic defects * Drugs (i.e., Lithium!) * Iodine deficiency * Chronic thyroiditis (Hashimoto's thyroiditis) * Transient phase of subacute thyroiditis

Answer 52

* Radioactive uptake with thyroid suppression test in **increased** * **Grave's Disease** * A pattern of iodine uptake will show a diffuse and concentrated uptake occurring quickly * **Toxic Multinodular Goiter** * Iodine uptake will show in certain spots and there will be suppressed areas around * **Thyroid Adenoma** * Iodine uptake will show TH release concentrated to one area and suppression in the other surrounding areas

Answer 53

* Primary hypothyroidism * Leads to a decreased production of TH and an increased secretion of TSH and TRH * Most common cause ⇒ **Autoimmune thyroiditis (Hashimoto's)** * Head and neck radiation therapy * Endemic iodine deficiency * Central hypothyroidism * Caused by the pituitary's failure to synthesize adequate amounts of TSH or lack of TRH

Answer 54

* Most common cause of hypothyroidism and is an autoimmune disorder * Antimicrosomal antibodies present in 85% of cases * More common in women * Most sig. clinical feature is a goiter * Diagnosed by the presence of thyroperoxidase and thyroglobulin antibodies

Answer 55

* **Neurological** * Confusion * Lethargy * Slow/clumsy movements * Hearing loss * Night blindness * **Endocrine** * Increased TSH in primary hypothyroidism * **Reproductive** * Decreased androgen secretion in men * Increased estriol in women * **Hematologic** * Decreased RBC mass → Normochromatic anemia * Vitamine B₁₂deficiency and inadequate folate/iron absorption * **Cardiovascular** * Reduction in stroke volume and HR causing a decreased cardiac output * Cardiomegaly * Cool skin * Cold intolerance * **Renal** * Reduced renal blood flow and GFR leading to decreased renal water secretion * **GI** * Constipation * Weight gain * Fluid retention * Edema * Decreased glucose absorption and delayed glucose uptake * **Musculoskeletal** * The prolonged relaxation phase of deep tendon reflexes * General weakness * Lethargy * Arthralgias * **Integumentary** * Dry hair with the tendency for it to fall out * Cool, tough doughy skin * Myxedema * Slow wound healing * Flat face

Answer 56

* Myxedema coma ⇒ A diminished level of consciousness associated w/severe hypothyroidism * Usually not conscious * **Precipitating factors →** Infections, discontinued thyroid supplements, narcotic or sedative overuse consequence of acute illness * **Risk factors →** Older individuals w/comorbid conditions * **S/S's →** Hypothermia w/o shivering, hypoventilation, hypotension, hypoglycemia, lactic acidosis, and coma

Answer 57

* **Primary hypothyroidism:** * Increased TSH and TRH * Decreased TH * Decreased T₃ and T₄ * Hyponatremia * **Secondary hypothyroidism:** * **Pituitary malfunction:** * ****Low levels of TSH and TH * Increased TRH * **Hypothalamic malfunctions:** * ****Low levels of TRH, TSH, and TH

Endocrine Disorders Flashcards

(81 cards)