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Flashcards

Endocrine System

Marian Baxter English 85 cards

Cards in this deck (85)

  1. 1Most common cause for hyperpituitarismPituitary adenoma
  2. 2causes of hyperpituitarismpituitary adenoma, hyperplasia, carcinoma, extra pituitary tumors, certain hypothalamic lesions
  3. 3manifestations of hypopituitarismGH secretion impairment; hypogonadism; hypothyroidism (due to TSH deficiency); Adrenocorticotropic hormone deficiency (most serious)
  4. 4treatment of hypopituitarismtreat identified underlying cause; replacement therapy of hormone deficiency
  5. 5Insulin in relation to growth and deficienciesEssential role in growth, and carbohydrate and fat metabolism
    (e.g. children with DM and normal GH levels fail to grow normally)
  6. 6Thyroid hormone related growth and deficienciesDeficiency leads to bone growth and epiphyseal closure delay
  7. 7Androgens related to growth and deficienciesexert anabolic growth effects through their actions on protein synthesis
  8. 8glucocorticoids related to growth and deficienciesExcess leads to inhibition in growth
  9. 9Growth hormone disorders: what stimulates growth hormone?hypoglycemia, fasting, starvation, increased blood levels of amino acids, and stress conditions
  10. 10GH disorders: what inhibits GH?increased glucose levels, free fatty acid release, cortisol, and obesity
  11. 11Examples of GH disordersGH deficiency, short stature in children, tall stature, and GH excess in adults
  12. 12Causes of short stature (attained height below third percentile)Chromosomal abnormalities, malnutrition, chronic kidney disease, DM, malabsorption syndrome, and excessive glucocorticoid administration
    Emotional disturbances - functional endocrine disorders (causing psychosocial dwarfism)
  13. 13Diagnosis of short statureHeight measurements, tests to exclude non-endocrine and hormonal causes, imaging
  14. 14Constitutional delay in growth and pubertychildren of moderately short stature, thin build, delayed skeletal and sexual maturation, and absence of other causes of decreased growth
  15. 15Psychosocial dwarfismfunctional hypopituitarism seen in some emotionally deprived children
  16. 16Etiology of GH deficiency in childrenIdiopathic GH deficiency; pituitary tumors or genesis of pituitary; congenital GH deficiency; acquired GH deficiency
  17. 17effects of GH deficiency in childrennormal intelligence, short stature, obesity with immature facial features, delay in skeletal maturation, and puberty delayed
  18. 18treatment of GH deficiency in childrenGH replacement therapy and IGF-1 replacement therapy
  19. 19Treatment of tall statureSex hormones
  20. 20GigantismGH excess in children - GH excess occurring before puberty and before fusion of epiphyses of long bones
  21. 21AcromegalyGH excess in adults: occurs after the epiphyses of the long bones have fused
  22. 22signs of acromegalyexaggerated growth of the ends of extremities (fingers, hands and toes); metabolic effects
  23. 23treatment of GH excesspituitary tumor removal, radiation therapy and other pharmacological agents
  24. 24How does precocious puberty occur?qEarly activation of the hypothalamic-pituitary-gonadal axis; or idiopathic, gonadal, adrenal, or hypothalamic disorders, and tumors of the CNS
  25. 25Diagnosis of precocious pubertyBased on physical findings and radiologic findings of advance bone age
  26. 26Diagnosis of precocious puberty in girlsearly thelarche, adrenarche, and menarche,
  27. 27diagnosis of precocious puberty in boysearly genital enlargement
  28. 28bones in precocious pubertyRadiologic findings of advance bone age; tall as children but short as adults because of early closure of epiphyses
  29. 29Treatment of precocious pubertyMRI or CT, surgery, medication, or no treatment, and patient support
  30. 30Shape of the thyroidShield shaped structure - lateral lobes and a connecting isthmus
  31. 31Hormones of thyroidT3 (10%) and T4 (90%) go to circulation - T3 in active form?
  32. 32What are thyroid hormones bound to?Thyroid hormones bound to protein (thyroxine binding globulins - TBG) are not active
  33. 33What are free thyroid hormones?Responsible for pituitary feedback
  34. 34What alters protein binding of thyroid hormones?Medical conditions, medications, and genetic predisposition can alter protein binding of T3 and T4
  35. 35What regulates thyroid hormones?Regulated by HPT (hypothalamic-pituitary-thyroid) feedback system
  36. 36What stimulates the thyroid gland?TSH from anterior pituitary
  37. 37What causes feedback inhibition of HPT system?Increased thyroid hormones
  38. 38Actions of thyroid hormonesMetabolic rate - Increases - energy production increases
    Resp functions - increase O2 consumption, ventilation
    Cardiac functions - vasodilation - increase blood volume & cardiac output
    GI functions - diarrhea, increase appetite, weight loss
    Neuro- increase muscle contract, fine tremors, tachycardia, nervous, anxiety, insomnia
  39. 39Thyroid tests1) Immunoassay: free T4, TSH levels, Primary hypo: low T3, T4 and free T4 levels and high TSH
    2) Auto-antibodies
    3) Radioiodine uptake test
    4) Thyroid scans
    5) US, CT, MRI, Biopsy
  40. 40GoiterIncrease in size of thyroid gland; hypothyroid, euthyroid, hyperthyroid; toxic or nontoxic; produces signs of hyperthyroid; diffuse; entire thyroid gland; multi nodular goiters
  41. 41Congenital hypothyroidismlack thyroid gland or deficient TSH secretion; mental retardation and impaired physical growth
  42. 42Acquired hypothyroidismslows down metabolic process and causes myxedema; non-pitting edema
  43. 43Signs and symptoms of hypothyroidismgradual weakness, fatigue; weight gain despite lack of appetite; cold intolerance; dry and rough skin, thick-brittle hair; conductive deafness, constipation, bradycardia, lethargy, impaired memory
  44. 44Treatment of hypothyroidReplacement therapy (T3 or T4)
  45. 45Hashimoto thyroiditisAutoimmune disorder (thyroid destroyed); hyperthyroid state can occur midcourse; signs and symptoms of hypothyroidism
  46. 46Myxedematous comalife threatening end-stage of hypothyroidism; S/S: coma, hypothermia, CV collapse, hypoventilation, severe metabolic disorders (CO2 retention & hypoxemia, fluid-electrolyte imbalance, hypothermia)
  47. 47Treatment of myxedema Comamanage cardiopulmonary system -- thyroid replacement
  48. 48What is hyperthyroidism?high levels of circulating thyroid hormone; increased oxygen consumption and metabolism
  49. 49Signs and Symptoms of hyperthyroidismweigh loss despite large appetite; tachycardia, palpitations, SOB; excessive sweating, muscle cramps, heat intolerance; restlessness, muscle tremors; thin and silky hair; abnormal retraction of the eyelids and infrequent blinking
  50. 50Treatment of hyperthyroidismReduce levels of thyroid: radioactive iodine, surgical removal, anti-thyroid drugs
  51. 51Graves DiseaseAutoimmune disorder = abnormal stimulation of thyroid gland (thyroid stimulating antibodies)
  52. 52Clinical features of Graves DiseaseTriad of Symptoms:
    hyperthyroidism
    goiter
    opthalmopathy
    Cytokine activation of fibroblast in orbital tissue causes eye problem
  53. 53Treatment of Graves DiseaseGlucocorticoids with radio iodine
  54. 54What is Thyroid Storm?Life-threatening form of thyrotoxicosis - due to undiagnosed or ineffective treatment
  55. 55Cause of thyroid storm?stress (infection), DKA, physical or emotional trauma, manipulation of hyperthyroid (surgery)
  56. 56Manifestations of Thyroid StormVery high fever; CVS effects - tachycardia, angina, congestive heart failure; CNS effects - agitation, restlessness and delirium
  57. 57Treatment of Thyroid StormRapid diagnosis is crucial; peripheral cooling; replace fluids, glucose, electrolytes, beta-blockers, anti-thyroid medication
  58. 58Where are the adrenal glands?bilateral at apex of kidneys
  59. 59What are the parts of adrenal glandsMedulla (inner portion) produces the catecholamines epinephrine and norepinephrine
    Cortex:
    Mineralocorticoids - outer layer
    Glucocorticoids - middle layer
    Adrenal androgens and estrogens - inner layer
  60. 60MineralocorticoidsAdrenal hormone of the cortex
    Aldosterone: regulates ion transport; essential role in the regulation of potassium and sodium levels and water balance; controlled by the renin-angiotensis system and potassium levels; promotes the kidneys to hold on to sodium and excrete potassium
  61. 61glucocorticoidsAdrenal hormone of the cortex
    Cortisol: the main glucocorticoid produced by the adrenal cortex; controlled by the hypothalamic-pituitary- adrenal system; when body is stressed > hypothalamus releases corticotrophin releasing hormone > on anterior pituitary > ACTH > adrenal gland > cortisol; ACTH controls the release of cortisol; when cortisol levels rise ACTH levels fall (NEGATIVE FEEDBACK)
  62. 62Functions of GlucocorticoidsDirect effect on CHO metabolism; increases blood glucose concentration ; promotes gluconeogenesis by the liver; protein breakdown into amino acids; promotes mobilization of fatty acids from adipose tissue; promotes cell metabolism to use fatty acids for energy; suppresses the immune response; when cortisol (hydrocortisone) is administered it blocks inflammation; inhibits prostaglandin synthesis
  63. 63What do adrenal androgens do?Produces dehydroepiandrosterone (DHEA) which promotes pubertal growth of body hair in women; Production declines in women as they age and is referred to as adenopause; replacement of DHEA may help improve overall wellbeing and sexuality
  64. 64Adrenal SuppressionLong term therapy of glucocorticoids causes atrophy of the adrenal gland due to depression of the HPA system; Abrupt stopping of glucocorticoids can cause acute adrenal insufficiency; the recover phase to normal function can take up to 12 months or more
  65. 65Adrenal function testingBlood levels of cortisol, aldosterone and ACTH; 24 hour urine collection measuring for the end products of adrenal cortical hormones; 24 hour urinary free cortisol; late night serum or salivary cortisol levels; overnight 1 - mg dexamethasone suppression test; Test dose of ACTH; insulin-induced hypoglycemic test
  66. 66What is congenital adrenal hyperplasia?Autosomal recessive disorder: lack of synthesis of cortisol leading to abundance of ACTH and over production of androgen hormones
  67. 67Diagnosis of congenital adrenal hyperplasiaMale infants are usually not diagnosed; female infants have civilization syndrome
  68. 68Treatment of congenital adrenal hyperplasiaOral or parenteral glucocorticoid replacement; reconstructive surgery (consists of reducing the size of the clitoris; separating the labia; exteriorizing the vagina)
  69. 69Addison's diseaseCaused by a destruction of the adrenal gland, mainly related to autoimmune (TB can do this. not common in US)
  70. 70What is primary adrenal insufficiency (cortical)?Mainly related to autoimmune:
    1) Addison's disease (all adrenal glands are destroyed)
    2) TB
    3) Adrenal hemorrhage secondary to anticoagulant therapy, open heart surgery, child birth
    4) AIDS
    5) Drugs
  71. 71Secondary adrenal insufficiencyresults from disorders of the HPA system
  72. 72Signs and Symptoms of Addison's diseasesparse axillary and pubic hair in women; hyponatremia/hyperkalemia; decreased cardiac output; loss of extra cellular fluid; orthostatic hypotension; anorexia/weight loss; nausea/vomiting; hyper pigmentation of the skin
  73. 73Treatment of Addison's DiseaseOral replacement of glucocorticoid and mineralocorticoid agents (hydrocortisone, fludrocortisone, DHEAs in females); Educate about regular meals and exercise; need for medial attention during times of infection, trauma or unusual stress; may need to wear medical bracelet
  74. 74Secondary adrenal cortical insufficiency causes and treatmentHypopituitarism (remove pituitary gland); hypothalamic effect (tertiary); rapid withdrawal of glucocorticoids; treatment with glucocorticoids can cause adrenal atrophy and loss of cortisol production; long lasting effects; critical in stress or surgery
  75. 75Causes of Acute adrenal crisisLife threatening illness caused by:
    Uncontrolled Addison's disease; salt losing forms of CAH; massive bilateral adrenal hemorrhage; meningococcal septicemia; adrenal trauma; anticoagulant therapy; adrenal vein thrombosis; adrenal metastasis
  76. 76Signs and symptoms of adrenal crisisNausea/vomiting
    muscular weakness
    hypotension
    dehydration
    vascular collapse
  77. 77Treatment of adrenal crisisfluid replacement
    glucocorticosteroid replacement
    oral hydrocortisone
    fludrocortisone
    broad spectrum antibiotics
  78. 78What is Cushing syndrome?Secondary to Glucocorticoid excess
  79. 793 main forms of hypercortisolismPituitary form (increased ACTH)
    Adrenal form (caused by benign/malignant tumor)
    Ectopic Cushing syndrome (non-pituitary ACTH source, e.g. small cell lung carcinoma)
    Long term use of glucocorticoids (iatrogenic)
  80. 80Signs and Symptoms of Cushing SyndromeSecondary to exaggerated cortisol actions:
    Altered fat metabolism (moon face, buffalo hump)
    muscle weakness; skin changes; osteoporosis; DM/hypertension; immunocomporomise; GI bleeding; androgen effects (facial hair); emotional disturbances
  81. 81Diagnosis of Cushing syndrome24 hour excretion of cortisol in the urine; elevated cortisol levels between 11pm and midnight; overnight dexamethasone suppression test; elevated plasma ACTH level (pituitary tumor, ectopic ACTH); low plasma ACTH levels (adrenal tumor); MRI or CT scans to locate adrenal or pituitary tumors
  82. 82What happens if Cushing syndrome is not treatedserious morbidity and mortality
  83. 83Goal of treatment of Cushing Syndrometo remove or correct the source of hypercortisolism with least possible pituitary or adrenal damage
  84. 84Treatment of Cushing's syndromeTranssphenoidal, hemihypophysectomy - removal of pituitary; pituitary radiation; adrenalectomy; cortisol replacement therapy; removal of ectopic ACTH producing tumors; medications that block steroid synthesis for inoperable ectopic tumors or adrenal carcinomas; pneumonia prophylaxis
  85. 85—

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Flashcards on Endocrine System, created by Marian Baxter on 22/07/2017.
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Marian Baxter
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