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Patho-Exam 3

Ch. 17 Endocrine System

What is the Endocrine System Glands (produces hormones); regulate body growth, metabolism, sexual functions
What do hormones do? regulate and integrate body functions
A nurse recalls direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is an example of _____ control? Positive, Negative, or Neural? Neural
Endocrine System Functions (5)(DSCMI) All growth hormone; what doesn't it do?! (sarcasm) 1. Differentiation-repro/CNS in fetus 2. Stimulation- growth/dev. in child/adol 3. Coordination- M/F repro 4. Maintenance- Optimum int. env./life 5. Initiation- corrective/adapt- responses/emergency
Paracrine hormone communicates cell to cell Ex: sex steroids on ovary
Autocrine Hormones acts within cell Ex: cancer cells secrete hormones that direct their growth/survival
Hormones and body fluid levels Hyper/Hypo state at all times
Hormone interactions (3) -Some hormone receptors require transport/relay -interact w/high-affinity receptors -Some hormones modulate the synthesis of enzymes, transport proteins, or structural proteins.
Characteristics of hormones (5) 1. Specific rate/rhythm of secretion 2. +/- feedback systems 3. affect only target cells 4. Constantly exc-kidneys/deactivate -liver or cell mech 5. Classified by gland of origin (requires direction; fat/protein base)
Characteristics of hormones: hormone solubility Water soluble (protein based) lipid soluble (steroid based)
Lipid-soluble hormone receptors cross the plasma membrane by.... Diffusion
Hormones and lipids are made of.... Steroids
How many regions does the adrenal glands have? 2
What does the adrenal glands influence? -metabolism -blood chem -body characteristics -Nervous system (Fi/Fl)
Can the adrenal glands work individually? yes, bc can live with one (kidney/adrenal)
What does the hypothalamus do? activates/controls parts of nerv. syst. that controls involuntary body func. -reg. sleep (some part in sleep pattern) -stim. appetite
How does the hypothalamus system travel? travels to ant. pit. via hypophysial portal system
Oxytocin (hypothalamus) Secreted by pituitary via hypothalmus regulation
Pancreas insulin
Parathyroid glands Calcium
Pineal Melatonin production
Thymus immune system
Pituitary Gland Master gland; multi-hormonal release
Thyroid Metabolism, body heat prod, bone growth
What happens when ant/post pituitary is affected? symptoms and disorders vary by person and effect on pituitary (which hormone)
(AP) Growth Hormones (5) Liver adipose tissue Promotes growth (indirectly) control of protein lipid and carbohydrate metabolism
(AP) Adrenocorticotropic Hormone (ACTH) (adrenal gland-cortex) secretion of glucorticoids (ACTH)
(AP) Thyroid-stimulating hormone (thyroid gland) secretion of thyroid hormones (TSH)
(AP) Lutenizing hormone Ovary and testis- Control of reproductive function (ovulation)sac burst
(AP) Follicle-stimulating hormone Ovary and testis- Control of reproductive function (maturation/egg ready for sperm)
(PP) Antidiuretic hormone (ADH) (kidney) conservation of body water
(PP)Oxytocin (hypothalamus-regulates this) (ovary/testes)- stimulates milk ejection and uterine contraction
(PP) SIADH High levels of ADH w/o stimulation for release -continuous release of ADH (no stop) regardless of osmolarity (fluid conc.-in serum blood) -retain water/pee Na
(PP) SIADH caused by (4): Cancers (Leuk, hodge, sarc, etc...) CNS (brain trauma, stroke, hemm, dis. of pit Surgery (postop fluid- increase ADH) Psychiatric disorders/drugs
(PP) SIADH Patho: (3) WATER -Increase perm/reabsorb renal tubes -Incr. tot.body "Intoxication" too much ADH -Excess retent/water= hyponatremia in body
(PP) SIADH signs/symptoms (4) -serum hypoosmolarity/urine hyperosmolarity -Water rent/Wt. gain -Na secrete = Na intake -WATER INTOXICATION leads- HYPONATREMIA
(PP) SIADH Treatment (4) -Id cause resolve that -Fluid restriction "Fl In= U.O" -Hypertonic Saline (Na salty) + Lasix(careful) -Demeclocycline= med/blocks effects of ADH
(PP) SIADH symptoms resolve when? Na level is corrected
Diabetes Insipidus (DI) Insufficient ADH = Too little
Diabetes Insipidus (DI) Results in? -partial/total inabil to conc.urine -Increase in Plasma osmolarity -Polyuria "pee alot w/large quantity" -Thirst if mech working -"Dehydration dev.quickly"
Types of (DI) 1.Neurogenic/central cause 2.Nephrogenic 3.Psychogenic form (primary polydipsia)Thirst
(DI) Signs/Symptoms (12) -Polyuria -polydipsia = excess thirst -contin thirst leads h20 intoxication -low urine sp.grav -Low urine osmolarity -high Hct -high plasma osmolarity -DEhydration -Dry Skin -Serum Hypernatremia -Poor skin tugor -Large Bladder Capac/Developes
(DI) Main Treatment ***Hypotonic saline solution .45% Nacl-replacement therapy*** -Electrolyte replacement as indicated
(DI) Additional Treatments Depends on: -age -endocrine stat -cardiac stat -extent of ADH defic -water restriction -DDAVP(synthetic ADH) -Pitressin/aqueous vasopressin -increase oral intake
(AP) Anterior Pituitary Disorders (2) Hypopituitarism = 1 or more hormone Panhypopituitarism = " ALL "
(AP) Hypopituitarism -May include select hormones -Lack hormone = Loss funct.of it's gland/organ -2 people could have it and have diff/Labs
(AP) Hypopituitarism can be caused by? -"TUMORS" -tumors of pituitary gland or hypothalmus -Brain tumor -head trauma -Brain surgery -Stroke -Infections -Occasionally due to uncommon immune/metabolic diseases
(AP) Hypopituitarism Signs/Symptoms "Fatigue/Weakness" "Sensitivity to Cold" "Abdominal Pain" -decreased appetite/wt.loss -Low BP -Headache and visual disturbances -short stature (below 5 ft) -loss of armpit/pubic hair -
(AP) Hypopituitarism Key Signs/Symptoms Women -cessation of menstruation = no periods -Infertility = No babies -failure to Lactate = no milk
(AP) Hypopituitarism Key Signs/Symptoms Men -Decreased sexual interest (can, but doesn't want to) -Loss of body or facial hair
(AP) Hypopituitarism Treatment -surgically remove Tumor -radiation treatment of Tumor -Replace hormones even after surgery -Drugs to treat infertility men/women
(AP) Hypopituitarism Main Treatment "Hormone therapy is needed to replace hormones no longer made by organs under the control of the pituitary gland" Ex: -corticosteroids(cortisol) -thyroid hormone sex hormones -testosterone for men -estrogen for women -growth hormone
(AP) Panhypopituitarism "ALL" Hormones can: -Decrease or No ACTH – cortisol deficiency -Decrease or No TSH – thyroid deficiency -No ADH –Diabetes Insipidus -Decrease or No FSH/LH – gonadal failure -No Prolactin – no milk -Decrease GH – in children produces dwarfism
(AP) Panhypopituitarism Treatment "correct cause or hormone replacement"
Hyperpituitarism Pituitary Adenoma (HPPA) -Slow growing benign tumor, most microscopic -asymptomatic/idiopathic -Secretes hormone (origin) w/o feedback mechanism -Expansion creates pressure on cells (hyposecretion occurs in that area)
HPPA Signs/Symptoms (8) -hyper/hyposecretions/symptoms of specific hormone present-no Hmn release/body thinks it is -headache -neck pain/stiffness -fatigue -seizures -Visual changes-1 eye-can lead to other -if CN affected-neuromuscular func impaired -increased GH/prolactin
Growth Hormones (GH) Direct effects are the result of growth hormone binding its receptor on target cells. Ex: fat cells have GH receptors, and GH stims them to breakdown triglycerides & suppress their ability to take up and accumulate circulating lipids
GH Deficiency -Interferes w/linear bone growth -short stature (hypopit dwarfism) -abn short ht in childhood can occur if pit gland = not --enough hormones
GH Excess -(kids)Increased linear bone growth/gigantism -(Adults) Acromegaly +overgrowth of the cartilaginous parts of the skeleton +enlargement of the heart/other organs +metabolic disturbances
Acromegaly (GH excess) -Chronic metabolic disorder (too much GH) -Gradual enlargement of body tissues: face, jaw, hands, feet, skull
*Thyroid release process*?* TRH-TSH-Thyroid hormone-T3/T4
2 types of Thyroid hormone Thyroglobulin (T4)/Iodine(T3)
Thyroglobulin is a T...and what percent? Check T4 90%
Iodine is a T...and what percent Check T3 10%
What is T3/T4 used for? (3) -organ growth/development -metabolism -temp. control
What is thyroxine? Synthetic form of thyroid
What goes along with thyroxine production? *look up* T3
Hyperthyroidism: thyrotoxicosis (storm/crisis) Excess thyroid hormone secretion
Hyperthyroidism (storm) can be released...period(s) of time Short or long term
Hyperthyroidism presentation (4) -Graves' disease -Toxic multinodular goiter -Thyroid cancer -Thyrotoxic crisis (thyroid storm)
Thyrotoxic crisis: Thyroid storm, occurs rarely, but is serious spontaneously or in undiagnosed/untreated Graves disease
Thyroid storm is triggered by? (2) Stress or illness
Thyroid storm symptoms (8) -hyperthermia -tachycardia -high output -heart failure -agitation -delirium -N/V -diarrhea -volume depletion
Hypothyroidism Underactivity of the thyroid gland may cause various symptoms/affect all body functions.
(Hypothyroidism) The body's normal rate of function...causing... Slows,causing mental/physical sluggishness
How severe can hypothyroidism be and what is it called? mild-severe; myxedema (med emergency)
Hypothyroidism caused by (6) (SHILCC) -Surgical removal -Hashimoto’s disease (autoimmune) Most common -Iodide insufficiency -Longstanding hypothyroidism is myxedema; fluid -Congenital-causes cretinism -Central (secondary) hypothyroidism: pituitary fails to produce TSH or a lack of TRH
A patient is diagnosed with hypothyroidism, synthesis of what would decrease in this patient? Thyroid-xxxx-globulin
Myxedematous Coma Medical Emergency!
Myxedematous; lack of TH: end stage symptoms (5) -Hypothermia -low BP -low Resp R -dropping blood sugar -Lactic acidosis (decreased LOC)
Myxedematous (patho) (3) -carbon dioxide retention and hypoxia +Shallow breather -fluid and electrolyte imbalance -hypothermia (slow metabolism)
Thyroid's main functions (2) Temperature Regulation and Metabolism
Thyroid cancer Most common endocrine malignancy with 4% of all cancer cases in women in the U.S.
Thyroid cancer causes exposure to ionizing radiation in childhood most common cause
Thyroid cancer symptoms -small thyroid nodule that is palpable with normal T3 and T4, -may have metastasis to lungs, brain or bone. May have changes in voice or problems swallowing if tumor impinges on trachea or esophagus. -Diagnosis made by needle biopsy.
Parathyroid Disorder Decreased calcium leads to increased parathyroid hormone (PTH)/ works on bone resorption; works on kidney (phosphorus loss, save Calcium, activate Vit D)
Primary (PT disorder) usually in older adults and caused by chief cell adenoma
Secondary (PT disorder) results from chronic hypocalcemia
Hyperparathyroidism (response to hypocalcemia) Calcium lvls too low, body inc. production of PTH. -increase causes more Ca taken from bone and more reabsorbed by intestines/kidney
Hyperparathyroidism Signs/Symptoms (8) -May be asymptomatic -Hypercalcemia/hypophosphatemia -Alkaline urine -Bone resorption-causes osteoporosis -can lead to calci -mild insulin resistance -Hypercalcemia causes +muscular, nervous, and GI symptoms -Headache,depression,anorexia, N/V
Hypoparathyroidism lack of PTH (blood Ca lvl falls/phosphorus inc)
(Hypoparathyroidism)low Ca lvl can cause symptoms such as...and.. -tingling in lips, fingers, toes -muscle cramps or spasms
What is a common cause of hypoparathyroidism? Injury to the gland
Hypoparathyroidism Sign/Symptoms 1/2 (6) -Tingling lips, hands, and feet -Muscle cramps -Pain in the face, legs, and feet -Abdominal pain -Dry hair and brittle nails -Dry, scaly skin
Hypoparathyroidism Sign/Symptoms 2/2 (5) -Cataracts -Weakened tooth enamel in children -Muscle spasms called tetany (can lead to spasms of the larynx, causing breathing difficulties) -Positive Chvostek and Trousseau -Convulsions (seizures)
Adrenal Glands; each gland consists of a... Medulla (center of the gland)
Adrenal hormones (3 Ss) Sugar Salt Sex
Adrenal Glands; What is the medulla responsible for? Producing epinephrine/norepinephrine (adrenaline)
What are the 3 types of steroid hormones the adrenal cortex produces? -Mineralcorticoids (aldosterone/Na, K, H20 balance) -Glucorticoids (cortisol/sugars)aid in metabolism reg, inflammatory response -Adrenal sex hormones (androgens) main source of androgens -Females
If a tumor is removed in the adrenal gland, what would the nurse expect to find? *check w/Leffler* BP imbalance, bleeding, injury to other organs
Cushing Syndrome/Disease (Moon Face) Excessive ant. pit. secretion of ACTH (may come from ectopic site or pituitary)
(Cushing Syndrome)can occur regardless of the cause when there is an.........of cortisol Excessive level (adrenal hypersecretion or exogenous admin of glucorticoids) -also when in constant state of stress (Fi/Fl)
Cushing syndrome is the most common complication of... Cushing Disease
Cushing syndrome Sign/Symptoms 1/3 (6) -weight gain-most common sign -moon face (round, red, and full) -buffalo hump (a collection of adipose tissue between the shoulders) -central obesity with protruding abdomen and thin extremities -weakness -backache
Cushing syndrome Sign/Symptoms 2/3 (6) -headache -Acne or superficial skin infections -Thin skin with easy bruising -Thirst -Increased urination -Purple striations
Cushing syndrome Sign/Symptoms 3/3 (5) -Mental changes -Impotence or cessation of menses -Facial hair growth -Glucose intolerance and 20% develop diabetes -More prone to osteoporosis +Body is leaching calcium from bones
Adrenal Insufficiency (Addison's Disease) (Primary adrenal insufficiency) Hypocortisolism
Hypocortisolism is? And also produces.. -Adrenal cortical hormone deficiency caused by damage to the outer layer of the adrenal glands -The cortex produces 3 types of hormones and symptoms are related to each of the three hormones!
Hypocortisolism causes (2) -Autoimmune diseases -Chronic infection such as TB
Hypocortisolism Signs/Symptoms 1/2 (7) -Extreme weakness -Fatigue -Unintentional weight loss -Nausea and vomiting -Chronic diarrhea -Loss of appetite -Darkening of the skin - patchy skin color
Hypocortisolism Signs/Symptoms 2/2 (6) -Unnaturally dark color in some locations -Paleness may also occur -Mouth lesions on the inside of a cheek +(buccal mucosa) - pigmentation -Slow, sluggish, lethargic movement -Changes in the blood pressure or heart rate -Salt craving
Created by: kdbravo on 2013-09-25

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