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Unit 9 - Test 4

Endocrine system

These two systems coordinate and integrate the activity of the body cells. The __________ is fast to respond but short acting while the______ is slow to respond but long acting. Nervous system, endocrine system
What does tropic mean? Tropic refers to hormones that are produced and secreted by one endocrine gland to stimulate another endocrine gland.
These hormones are not bound to a protein. They decompose quickly and require frequent or continuous synthesis. Some example are insulin, pituitary hormones and parathyroid hormones. Water-soluble hormones
These hormones are bound to a protein for transport. They have a longer life span and are produced in more of a cycle pattern. They take longer to take effect in the body but last long. Steroid and Thyroid are examples Lipid Soluble Hormones
Lipid soluble hormones depend on what in order to reach their target tissue. Depend on having enough protein to bind to
These glands and ducts transport hormones/enzymes. Exocrine glands and ducts
What are some example of exocrine glands and ducts? Salivary glands, sweat glands, gastrointestinal tract glands and exocrine pancreas.
These glands are ductless and excrete their hormones into surrounding tissues or through the bloodstream. Endocrine glands
What are some examples of endocrine glands? thyroid, pituitary, adrenal, endocrine pancreas.
What organ is both endocrine and exocrine? Pancreas
The endocrine response is __________ because kidneys have to filter blood. prolonged
What is a direct test and give an example. measuring the level of a specific hormone in the blood serum. Example: Insulin directly measured with a blood test
This diagnostic method measures the substance regulated by a hormone. Give an example Indirect Test - Example Blood glucose levels - figure stick
Blood glucose levels can be checked as an indirect measurement to see if insulin is not working. Explain and why would you do an indirect test over a direct test for insulin? Glucose cannot enter cells of the body without insulin. If blood sugar is high, insulin is not working. This test is Cheaper & easier than measuring insulin directly.
This type of diagnostic test attempts to stimulate or suppress a hormone. The test is intended to provoke a certain response from a gland. Provocative testing
Glucose tolerance test is a provocative testing method. Explain what a glucose tolerance test does. provokes the pancreas to secrete insulin by having a patient drink a large dose of glucose-> measure BS levels at different times-> pancreas will secrete insulin to keep BS normal---> If BS rises & doesn't return to normal there is an insulin problem.
What are some of the effects of ageing on hormones? 1. decrease hormone secretion that increases the risk of hormone deficiencies 2. decreased clearance of hormones due to decline in renal function. Leads to increase levels of some hormones. 3. Decrease receptor binding causing erratic hormone levels
What hormones does the liver excrete? steroids, T3, T4, cholesterol and lipid soluble hormones in the bile.
The hypothalamus maintains ________. What are some examples homeostasis - body temp, blood osmolarity, blood nutrients, blood hormone levels, inflammatory mediators, emotions, pain and sleep cycles
The hypothalamic/pituitary axis (or “Hypophysis”) is the Endocrine System’s link to the_________. Nervous System
The Hypophysis connects the ___ to the ____ and allows the hormones required for a “fight or flight” response to be released without having to go through the general circulation. posterior pituitary to the hypothalamus
___________ hormones are released from the pituitary to tell specific peripheral glands to grow and produce their hormones. Trophic
This hormone controls thirst and the amount of urine produced by the kidneys ADH
This hormone triggers the thyroid gland to grow and release thyroid hormones (T4 & T3) Thyroid Stimulating Hormone (TSH)
This hormone causes adrenal gland to release several hormones. The major one is cortisol. Adrenocorticotropic Hormone (ACTH)
This is the main hormone for general body growth Growth hormone (GH)
This hormone stimulates uterine contractions in women Oxytocin
This hormone stimulates ovulation in women and the production of sperm in men. Follicle Stimulating Hormone (FSH)
This hormone stimulates ovulation in women and testosterone production in men Luteinizing Hormone (LH)
This Hormone is responsible for breast milk production in females. Prolactin
What are the two ADH imbalances? Syndrome of inappropriate ADH (SIADH) and Diabetes Insipidus (D.I)
SIADH or DI: caused by - Brain problem: injury/stroke/ cancer. Metastasized lung cancer, drugs or unknown. SIADH
SIADH or DI: inflammatory, autoimmune or vascular disease: Head injury/brain surgery, ect. DI
SIADH or DI: increase ADH leading to water retention and fluid overload. SIADH
SIADH or DI: Dilutional hyponatremia SIADH
SIADH or DI: increased volumes of dilute urine ->increased serum osmolarity DI
SIADH or DI: Dehydration DI
SIADH or DI: s/s - concentrated urine - hyponatremia (<135) SIADH
SIADH or DI: cerebral edema that can lead to change in LOC (dulled consciousness, seizures and/or coma) SIADH
SIADH or DI: Dilute urine (specific gravity <1.005) and polyuria (>200ml/hour) DI
SIADH or DI: hypernatremia and excess thirst DI
SIADH or DI: treatment - possibly use hypertonic solution to pull fluid out of the brain and correct they hyponatremia. SIADH
SIADH or DI: treatment - Medications and isotonic fluid replacement to reverse dehydration. DI
In SIADH the hyponatremia is a result of what? excess water (Dilution hyponatremia)
Grave's Disease is a __________ condition while Hashimoto's and Myxedema are __________ conditions. Hyperthyroidism, Hypothyroidism
T or F: Hyperthyroidism is less common than hypothyroidism. True
What are the two main signs of hyperthyroidism? hypermetabolism and exophthalmos (bug eyes)
a life-threatening condition that develops rapidly and causes a severe increase in the patient’s metabolic rate Thyroid storm or thyroid crisis
What is one of the main signs of thyroid storm that differentiates if from ordinary hyperthyroidism? elevation of body temp (could be as high as 105-106 F) and tachycardia/heart palpitations and dangerously high BP.
During this a patient might experience to chest pain, dyspnea and potential heart failure/cardiac arrest. Thyroid Storm
What is the treatment for a thyroid storm? medications to lower temp, heart rate and BP
________ usually occurs in the first 12 hours after a thyroidectomy Thyroid storm
What condition: anti-thyroid antibodies destroy the tissue; inherited immune dysfunction Autoimmune thyroiditis (Hashimoto disease)
an extreme complication of hypothyroidism in which patients exhibit multiple organ abnormalities and progressive mental deterioration. Myxedema
Myxedema is often used interchangeably with hypothyroidism and myxedema coma or crisis. Myxedema also refers to the _______________ that occurs in patients who have hypothyroidism. Swelling of the skin and soft tissues
________ occurs when the body's compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as infection. Myxedema
Hypothyroidism or hyperthyroidism: Basal metabolic rate and sympathetic response decreased Hypothyroidism
Hypothyroidism or hyperthyroidism: Basal metabolic rate and sympathetic response increased Hyperthyroidism
Hypothyroidism or hyperthyroidism: Weight Gain Hypothyroidism
Hypothyroidism or hyperthyroidism: Weight loss hyperthyroidism
Hypothyroidism or hyperthyroidism: cold intolerance, decrease sweating, Constipation. Decreased appetite Hypothyroidism
Hypothyroidism or hyperthyroidism: Heat intolerance. Increased sweating, Diarrhea and Increased appetite Hyperthyroidism
Hypothyroidism or hyperthyroidism: Decreased CO2, bradycardia, Hypoventilation Hypothyroidism
hyperthyroidism: decrease CO2, and....(3) tachycardia & palpitations, Dyspnea
Hypothyroidism or hyperthyroidism: Deep voice, impaired growth, brittle hair/nails. Impaired menstruation. Mental and physical sluggishness, somnolence, joint pain Hypothyroidism
Hypothyroidism or hyperthyroidism: Exophthalmos, lid lag, decreased blink, enlarged thyroid gland. Restless, irritability, anxiety wakefulness, Sore muscles Hyperthyroidism
Hyperparathyroidism leads to muscles being to_______ while hypoparathyroidism leads to muscles being to _______. Calm, excited
Hyperparathyroidism causes an elevated serum calcium level which leads to reduces calcium stores in the bone causing demineralization. This can lead to what? pathological fractures and a risk for injury
Hyperparathyroidism is most common in who and is characterized by what? most common in older women and characterized by bone pain, weakness and polyuria ( caused by hypercaliuria)
S/s of Hyperparathyroidism (Same as Hypercalcemia –“calms too much”) lethargy, drowsiness, N/V, decreased deep tendon reflexes (DTR) and increase chance for bone fractures.
Rx for Hyperparathyroidism Medications to decrease resorption of Ca++ from bone or surgical removal of glands.
Cause of hypoparathyroidism? atrophy, trauma, surgical removal along with thyroid
Decrease PTH leads to decrease __________ __ activation which leads to decrease Calcium absorption Vitamin D
S/S of hypoparathyroidism [same as hypocalcemia] tetany, paresthesia, irritability, and arrhythmias
Rx for hypoparathyroidism Vitamin D and Ca++ replacement
What are the two parts of the Adrenal Gland? What are they responsible for? Medulla (inner 10%) excretes catecholamines (epinephrine and norepinephrine). Cortex (outer 90%) excretes glucocorticoids (Cortisol), mineralocorticoids (Aldosterone), and Androgens (sex hormones).
T or F - Adrenal medullary and adrenal cortical function is essential for life. F - sympathetic nervous system also secretes the neurotransmitters epinephrine and norepinephrine so adrenal medullary function is not essential but adrenal cortical function is.
The Sympathetic Nervous system deals with _______________ and the Parasympathetic Nervous System deals with ____________. Fight or Flight, rest and digest
Another term for sympathetic NS. Adrenergic
What are the adrenergic receptors? A1, A2, B1, B2 and dopamine
Another term for parasympathetic NS? Cholinergic
what are the cholinergic receptors and chemical messenger? Muscarinic and Nicotinic
What Adrenergic receptor: Blood Vessels – arterial constriction, i.e. epinephrine used in a resuscitation to raise blood pressure Eyes - pupil dilation is more accurately “Iris constriction” A1 (constricts)
What Adrenergic receptor: Bladder - closes (“constricts”) sphincter to stop urine flow during fight or flight Colon - constricts rectal sphincter. Also results in constipation because peristalsis is slowed down for fight or flight A1 Constricts
What Adrenergic receptor: regulates/suppresses norepinephrine via biofeedback loop. Act like adrenergic blocker (antagonists) when they are stimulated. A2 (controls)
Example of A2 agonist is Clonidine which ________ blood pressure by “Activating” the A2 receptor. lowers
What Adrenergic receptor: Heart - ↑’d rate and contractility Kidney - ↑’d B/P due to renin release B1 (beats) (1 heart)
What Adrenergic receptor: Lungs - Bronchodilation Uterus - ↓’d uterine contractions (i.e. Terbutaline is a bronchodilator AND a tocolytic to stop labor) B2 (breathes) (2 lungs)
What Adrenergic receptor: Dilates kidney arteries Dopamine
This drug is given to patients in shock because it spares the kidney (epinephrine constricts renal arteries). Dopamine
Nicotinic [N1] = ______, Nicotinic [N2] =_______. Muscle, Nerves
What are some drugs that stimulate N1 and N2? what do they cause? narcotics, sedatives, or drugs used for general anesthesia. The cause relaxation of muscles and nerves.
Muscarinic: Increase ________ and ________ gland secretions. sweat and salivary
Muscarinic receptors are blocked by anti-cholinergic drugs like atropine which is given to stop the secretions that fill up the throat when a breathing tube is inserted for surgery. Why is this done? to prevent the patient from aspirating on their own secretions.
Adrenergic System “Fight or Flight” Response Receptors: A1 = “_________” (arteries) A2 = “_________” (keeps other receptors from working too hard) B1 = “_____” (‘one’ heart) B2 = “________” (‘two’ lungs) DOP = “_____” kidney arteries 1. CONSTRICTS 2. CONTROLS 3. BEATS 4. BREATHES 5. DILATES
These meds are anti-adrenergic drugs used to control high pressure. Alpha ("sin") and Beta-blocker ("olol")
Anti-Adrenergic drugs act like _______ system - because they BLOCK the _________system while Anti-Cholinergic drugs act like ________system - because they BLOCK the _________ system Cholinergic, Fight/Flight Adrenergic, Rest and digest
a tumor of the adrenal medulla that secretes excessive catecholamines (epinephrine/ norepinephrine/dopamine) resulting in what? Pheochromocytoma - HYPERtension, TACHYcardia, HYPERglycemia, HYPERmetabolism, and weight loss.
_________ is the major glucocorticoid, _________ is the principal mineralocorticoid, and _________ are the main sex hormones. cortisol (hydrocortisone), aldosterone, androgens
This hormone helps regulate the stress response and diverts metabolism from building tissues to supplying energy for dealing with stress. Cortisol
Cortisol Release leads to _____blood glucose, __________ heart rate, and __________ in nonessential energy-using activities increased, increased, decreased
Adrenal cortical HYPO secretion = ____________ Adrenal cortical HYPER secretion = _______________ ADDISON’S DISEASE CUSHING’S DISEASE
What are some of the main s/s of Addison's Disease? hypoglycemia, hyponatremia, hyperkalemia, Bronze like skin pigmentation
What are some of the main s/s of Cushing's Disease? hypernatremia, moon face and buffalo hump, hypokalemia, increase masculinity among females.
Cushing's Disease s/s are the same as the side effects of ___________. Prednisone (corticosteroid medication)
Pancreas alpha cells respond to what and secrete what? Respond to low Blood glucose and secrete glucagon
What does Glucagon do? - Stimulates immediate breakdown of glycogen to be used for energy. - Catabolic hormone also stimulates the breakdown of fats and proteins. - Raises blood glucose levels.
Pancreas beta cells respond to what and secrete what? Respond to high blood glucose and release insulin
What does insulin do? o Reacts with insulin receptor sites and stimulates movement of glucose into the cell. o Anabolic hormone: stimulates synthesis of glycogen, fats, and proteins o Lowers blood glucose levels.
Stressful situations will release ___________ (sympathetic response) and ___________. This will _______ insulin sensitivity and ________ glucose release which will lead to an increased need for______ (due to more glucose in the blood) epinephrine, and corticosteroids, decrease, increase, insulin
Loss of blood glucose control result from what 2 things? 1. Insufficient amounts of insulin released 2. decrease sensitivity of insulin receptors
Normal range for blood sugar as defined by the American Diabetes Association. 70 -130 mg/dL
What is the most common clinical sign of diabetes disorder of the pancreas? Hyperglycemia
What are the two test to measure blood sugar? Finger stick (blood glucose test) or A1c test
s/s of what: CNS changes due to brain using glucose as its only source of energy. Irritable, mental confusion, shaky/trembling, diaphoretic Hypoglycemia
Hyperglycemia is an increase blood sugar greater than ___ before a meal. 130
s/s of hyperglycemia: increased hunger because cells sense they are starving. What is this called polyphagia
s/s of hyperglycemia: increased thirst referred to as polydipsia
break down of fats for energy --->process stops at the ketone level due to no glucose---> results in increased ketones in blood. Ketoacidosis (ketosis)
What are 3 signs of impending danger associated with hyperglycemia? • Fruity breath: due to increased ketones in blood • Dehydration: due to increased loss of water and electrolytes (skin “Hot & Dry”) • Kussmaul respirations: Rapid, deep breathing to blow off CO2 (an acid) to compensate for acidosis
Type 1 Diabetes is insulin depended as a result of the autoimmune destruction of what? Beta cells on the pancreas
S/s of T1D polyuria, polydipsia, polyphagia, weight loss and frequent infections, wounds slow to heal (compromised immune system)
Why is there Weight loss with T1D because glucose is not being transported into cells – body “starves”
In the US what race is more likely to develop T1D? Caucasians
s/s of T2D? polyuria, polydipsia, polyphagia, weight gain, frequent infections, wounds slow to heal (compromised immune system)
What are some drugs that can induce T2D? Corticosteroids (prednisone); Cyclosporine (used to treat CA); antiretroviral drugs (used to treat HIV)
What races are at higher risk for T2D? Black, Hispanic, Native American
Why is obesity a risk factor for T2D? Adipose tissue activates the inflammatory process which then triggers insulin resistance and T2D
Type I or Type II diabetes: No islet cells --> no insulin --> hyperglycemia Type 1 diabetes
Type I or Type II diabetes: 80%-90% of total DM; usually after 40 yr; obesity increases risk Type II diabetes
Type I or Type II diabetes: FBS* > 126 mg/dl random glucose > 200; 3 “P’s” = polydipsia, polyphagia, polyuria Both
Type I or Type II diabetes: Diet, exercise, MUST have insulin Type I Diabetes
Type I or Type II diabetes:Diet, exercise, oral meds and may need insulin. Type II Diabetes
In Diabetes type 1 which is more common microvascular or marcovascular changes? What is more common in Type II? type 1 micro and type II is macro
Microvascular changes commonly happen in type TD1 by Altering carbohydrate metabolism (thickening of basement membrane, decreased normal capillary permeability). What vessels are most commonly involved and what are the effects? retinal (blindness, glaucoma, cataracts), renal (chronic renal failure), peripheral (impaired healing, increased gangrene)
T or F - In both Type 1 and type 2 glycosylated proteins alter vessel endothelium leading to increased platelet aggregation True
What are the vessels most commonly involved in the marcovascular changes the commonly occur with T2D? coronary (myocardial infarction), cerebral (stroke)
This occurs when nerves are damaged or destroyed and can't send messages from the brain and spinal cord to the muscles, skin and other parts of the body. What is this common in? Peripheral neuropathy and is common in T1D and T2D.
These are s/s of what decreased sensation, impaired sensation (numbness, tingling or intense pain) impaired GI motility, bladder dysfunction, impotence). Peripheral neuropathy
What are two of the most serious ACUTE complications of diabetes? Diabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)
What is characterized by ketoacidosis and hyperglycemia? What is characterized by more sever hyperglycemia but NO Ketoacidosis? DKA = Ketoacidosis and hyperglycemia while HHS =more sever hyperglycemia but no ketoacidosis
hyproglycemia, DKA, or HHS: Synonyms - Insulin shock, Insulin reaction High Risk -Taking insulin or oral antidiabetic meds; Brittle diabetic Predisposing factors -medication ⬇ food intake and ⬆exercise Laboratory Findings glucose < 70 mg/dL hypoglycemia
hyproglycemia, DKA, or HHS: Presenting symptoms - pale, sweating, tachycardia, hunger, anxiety, restlessness, tremors – Seizure/Coma Hypoglycemia
What is the treatment for hypoglycemia? Iv Glucose (D50)- hypertonic solutions
hyproglycemia, DKA, or HHS: High Risk: T1D or T2D or Undiagnosed DM Predisposing factors: Illness, sepsis, Stress, trauma, medications Laboratory Findings: Extreme Hyperglycemia &Ketones DKA
hyproglycemia, DKA, or HHS: Presenting symptoms: Polyuria, polydipsia, TISSUE dehydration, N/V, SZs, coma Acidosis: Kussmaul breathing, “fruity” acetone breath DKA
What is the treatment for DKA and HHS? 1. Rehydration – IV fluids (isotonic and hypOtonic fluids) 2. IV Insulin 3. Replace electrolytes as needed
hyproglycemia, DKA, or HHS: High Risk:Type II diabetics,Very old/very young, Renal compromise Predisposing factors -Sepsis/MI/Pancreatitis, Low perfusion Laboratory Findings - -Extreme Hyperglycemia HHS
hyproglycemia, DKA, or HHS: Presenting symptoms - Polyuria, polydipsia, TISSUE dehydration, N/V, SZs, coma , NO Acidosis HHS
caused by nighttime hypoglycemia--> rebound hyperglycemia in the early morning. Blood sugar drops (hypoglycemia) during nigh triggering the stress response (releasing epinephrine and cortisol). Cortisol stimulates gluconeogenesis to bring BS to normal . Somogyi phenomenon
the blood glucose level gradually rises through the night in response to cortisol release. This stimulates the liver to excrete glycogen throughout the night so there is no hypoglycemic episode Dawn phenomenon
What is Metabolic syndrome. What are the risk factors? group of risk factors not a disease. To have this a patient would have to have 3 or more risk factors - high triglycerides, hypertension, low hdl-cholesterol, visceral obesity, insulin resistance.
The risk factors for metablic syndrome double the risk of ____ & ____ which can lead to heart attacks and strokes. They increase the risk of ___ by five times. Blood vessel and heart disease, diabetes
T or F: metabolic syndrome can be controlled, largely with changes to lifestyle such as losing weight, exercising, and improving diet choices. True
The parathyroid gland controls what? High vs low Calcium - High - high calcium in the blood but reduces calcium in the bone. Low - decrease vitamin D leading to decrease calcium absorption.
Chemical messenger of the parasympathic NS. Acetylcholine
Muscarinic receptors are blocked by ______________ drugs like atropine? Anti-colinergic
Addison's (hyper) and Cushing (hypo) are related to what type of hormone problem? Cortisol
Three signs of impending danger for hyperglycemia. 1. Fruity breath 2. dehydration 3. kussmaul respirations
Created by: sbertelsen



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