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Endocrine Block 13

68WM6 Exam block 13- endocrine

QuestionAnswer
Describe the location of the adrenal glands. Small glands located on top of the kidneys
What hormones does the adrenal cortex release? 1. Mineralcorticoids 2. Glucocorticoids 3. Sex hormones
What does the adrenal medulla release? Epinephrine and norepinephrine during "Fight or Flight" response.
Causes of Cushing's Syndrome 1. Hyperplasia of adrenal tissue 2. Tumor of adrenal cortex 3. Overuse of corticosteroid drugs
What is Cushing's syndrome? Rare condition in which the plasma levels of adrenocortical hormones are increased, resulting in excess secretion of adrenal hormones.
Symptoms of Cushing's syndrome. 1. Irritability 2. Emotional instability 3. Depression 4. Backache 5. Decreased libido 6. Increased appetite
Signs of Cushing's syndrome. 1. Ecchymoses 2. Petechiae 3. Thin and fragile skin 4. Weight gain, edema 5. Hypertension 6. Muscle wasting 7. Moon face and buffalo hump 8. Prolonged wound healing 9. Hirsutism in women.
Medical management for Cushing's syndrome. 1. Adrenalectomy for adrenal tumor. 2. Irradiated or removed surgically for pituitary tumors. 3. Mitotane (Lysodern) cytotoxic agent that is toxic to adrenal glands for inoperable adrenocoritcal cancer.
Another term for Cushing's Syndrome. Adrenal HYPERfunction.
Another name for Addison's Disease Adrenal HYPOfunction.
Causes of Addison's Disease. 1. Adrenalectomy 2. Pituitary hypofunction 3. Longstanding steroid therapy 4. cancer of adrenal cortex 5. autoimmune disease 6. tuberculosis
What is Addison's disease? inadequate secretion of glucocorticoids (cortisol) and mineralcorticoids (aldosterone) by adrenal glands
Signs/symptoms of Addison's 1. Nausea, anorexia, salt craving 2. postural hypotension 3. vertigo, weakness, syncope 4. severe headache, abdominal pain 5. changes in color of mucous membranes 6. weight loss, vomiting, diarrhea 7. hypoglycemia, hyponatremia, hyperkalemia
Medical management of Addison's disease 1. restore fluid and electrolyte balance 2. replace deficient adrenal hormones
Diet of patient with Addison's disease High in sodium and low in potassium.
Definition of an Addisonian Crisis an acute, emergency, life-threatening state of profound adrenal cortical insufficiency that occurs when the adrenal glands suddenly fail.
Signs of an Addisonian crisis 1. Sudden, severe drop in BP 2. Anorexia, n/v 3. extremely high temp 4. diarrhea, abd. pain 5. profound weakness 6. headache, restlessness or fever
How is an Addisonian crisis treated? 1. Corticosteroids via IV solution of NS and glucose 2. Antibiotics due to low resistance to infection.
What is pheochromocytoma? Tumor, ususally found in adrenal medulla, causes excessive secretion of epinephrine and norepinephrine.
What is the principle manifestation of pheochromocytoma? Hypertension (hypertensive crisis with BP as high as 300/175 may occur)
What hormones does the anterior pituitary release? 1. Growth hormone (GH) 2. Thyroid stimulating hormone (TSH) 3. adrenocorticotrpoin hormone (ACTH) 4. Follicle stimulating hormone (FSH) 5. Luteinizing hormone (LH) 6. Melanocyte stimulating hormone (MSH) 7. prolactin
What hormones does the posterior pituitary release? 1. Anti-diuretic hormone (ADH) 2. oxytocin
Which condition develops before puberty: acromegaly or gigantism? Gigantism
What is acromegaly? Overproduction of growth hormone after puberty.
Manifestations of acromegaly. 1. Enlargement of cranium and lower jaw 2. Bulging forehead 3. Hands and feet become enlarged 4. Hepatomegaly, cardiomegaly, splenomegaly 5. Stiff joints 6. Impotence 7. Females- deepened voice, increased facial hair, amenorrhea
Drug of choice of acromegaly Bromocriptine mesylate (Parlodel)- antiparkinson drug that inhibits release of GH
What is dwarfism? deficiency in the growth hormone
Diagnosis of dwarfism is based on... 1. Radigraphic evaluation 2. Decreased plasma levels of growth hormone
Medical management for dwarfism 1. GH injections 2. Surgery for tumor removal
Most common complications associated with dwarfism musculoskeletal and cardiovascular
What are dopamine agonists such as bromocrpitine, cabergoline, and octreotide used for? to treat acromegaly
Side effects of dopamine agonists 1. dizziness 2. drowsiness 3. visual disturbances 4. hypotension 5. nausea 6. abdominal pain 7. constipation 8. digital vasospasm (acromegaly only)
Patient teaching for dopamine agonists. 1. Avoid use of alcohol 2. Do not double dose, take missed does w/in 4 hours. 3. May cause drowsiness and dizziness.
What is diabetes insipidus? deficienty of ADH
Causes of diabetes insipidus 1. Primary- malfunction of posterior pituitary 2. Secondary- head injury, intracranial tumor, intracranial aneurysm, infarct. 3. Infections
Common clinical manifestations of diabetes insipidus polyuria, instense polydipsia, dilute urine.
Treatment of diabetes insipidus 1. ADH administration (IM, SQ, nasal spray) 2. Eliminate caffeine 3. Monitor fluid and electrolyte balance
What is vasopressin (Pitressin) and what effect does it have? ADH- decreases urine output and increases urine osmolality in diabetes insipidus
Side effects of vasopressin 1. "pounding" sensation in head 2. belching, flatulence 3. paleness 4. perioral blanching 5. trembling
What are the s/s of toxicity and overdose of vasopressin? s/s of water intoxication
What is desmopressin (DDAVP) and what is it used for? ADH- to prevent nocturnal enuresis
What is Syndrome for Inappropriate Secretion of Anti-Diuretic Hormone (SIADH)? Occurs when pituitary releases too much ADH, and kidneys absorb more water, results in: hyponatremia, hemodilution, and fluid overload
Risk factors for SIADH 1. medications 2. duodenal, pancreatic cancer 3. tuberculosis or pneumonia 4. head trauma 5. meningitis 6. cerebral atrophy 7. hypothyroidism 8. lupus
S/S of SIADH 1. hyponatremia 2. water retention 3. vague complaints (weakness, nausea, headache) 4. Changes in LOC 5. Intake exceeds output
T4 thyroxine
T3 triiodothyronine
Another name for hyperthyroidism Graves disease, exophthalmic goiter, thyrotoxicosis
Major manifestations of hyperthyroidism 1. anterior neck enlargement 2. exophthalmos
Laryngospasms, Trousseau's sign, and Chvostek's sign are signs of... HYPOparathyroidism
What hormone do the parathyroid glands produce at what is it used for? 1. Parathromone 2. Increases calcium concentration and regulates the amount of phosphorus in the blood.
What is the function of calcium in the body? 1. makes muscles contract and gives bone rigidity 2. provides for normal conduction of electrical currents along nerves 3. essential element of the clotting process
What is the function of phosphorous in the body? 1. energy storage and transfer 2. component of teeth and bones 3. decreased levels will lead to poor growth
What is the most common cause of hypoparathyroidism? Accidental removal or destruction of the parathyroid glands during a thyroidectomy.
What are the s/s of hypoparathyroidism? 1. hypocalcemia 2. hyperphosphatemia 3. hypocalcemic tetany 4. muscle spasms 5. kidney stones 6. dysrhythmias 7. muscle cramping 8. dysphagia
How will severe hypocalcemia manifest? 1. laryngeal spasm 2. stridor 3. cyanosis with increased risk for asphyxia 4. calcification of basal ganglia in the brain
Management of hypoparathyroidism 1. IV calcium gluconate/chloride 2. Vitamin D 3. Bronchodilators
Diet for hypoparathyroidism High in calcium, low in phosphorous
What is hyperparathyroidism? Overproduction of parathormone, resulting in increased urinary excretion of phosphorus, bones become demineralized because it enters the bloodstream from the bones.
Complications of hyperparathyroidism 1. bones become weak 2. fractures 3. kidney stones 4. renal disease
Signs of tetany 1. numbness or tingling 2. carpopedal spasm 3. tachycardia 4. tachypnea 5. hypertension 6. laryngeal spasm 7. Chvostek's and Trousseau's sign
What is a thyroid storm? Over-release of thyroid hormone in bloodstream, resulting from manipulation of the thyroid
How do you treat a thyroid storm? 1. IV fluids 2. Sodium iodide and corticosteroids 3. Antipyretics and oxygen as needed.
A severe form of hypothyroidism in adults is called... Myxedema
CLinical manifestations of hypothyroidism 1. hypothermia/cold intolerance 2. weight gain 3. impaired memory, slow thought 4. anorexia and constipation 5. menstrual irregularities 6. enlarged facial features 7. weakness, clumsiness
What is the medical management for hypothyroidism? Thyroid hormone replacement therapy
Important dietary restrictions for hypothyroidism? High-fiber, low-calorie
What is a goiter? enlargement of the thyroid gland
Medical management for a goiter consists of what? 1. oral potassium iodine 2. diet rich in iodine
Who is most commonly affected by thyroid cancer? females and Caucasians
Types of thyroid cancer papillary, follicular, anaplastic
What is the most dangerous and most rare type of thyroid cancer? anaplastic
What is the most common, least severe type of thyroid cancer? papillary
How is thyroid cancer diagnosed? 1. Thyroid scan 2. Thyroid function tests 3. needle biopsy
What is the risk involved in needle biopsy? Risk of "seeding" the cancer cells into surrounding tissue, causing metastasis
Who is the coolest guy ever? RPB
Classic clinical manifestations of Diabetes Mellitus Polyuria, Polydipsia, polyphagia
Classic laboratory findings used to diagnose diabetes mellitus? 1. random blood glucose over 200 mg/dl 2. glycosuria 3. ketonuria
Causes of diabetes mellitus. 1. unknown 2. genetic predisposition 3. viruses (coxsackievirus, rubella, mumps) 4. aging 5. diet and lifestyle
What causes glycosuria? Body attempts to rid excess glucose that is in the body due to lack of insulin or misuse of insulin.
Why does diabetes mellitus cause polyphagia? Glucose can not be used without insulin, so the cells starve, and the body tries to compensate by overeating.
Why are there excess ketones in the blood in a diabetic patient? body's fat and protein sources are broken down for energy.
Accumulation of ketones in the blood causes... ketoacidosis
Type 1 Diabetes Mellitus Insulin Dependent Diabetes Mellitus (IDDM)- little or no insulin produced
Type II Diabetes Mellitus Non-insulin dependent diabetes mellitus (NIDDM)
Differences in Type 1 and Type 2 DM Type 1- 1. rapid onset 2. Thin clients due to muscle wasting 3. Manifestations- nocturia, blurred vision, halo around lights Type 2- 1. slow wound healing 2. legs and feet cold to touch 3. decrease sensation in extremities
Normal fasting blood glucose 60-120 mg/dl, greater than 126 is abnormal
Difference in oral glucose tolerance test (OGTT) results for a non-diabetic and diabetic client Non-diabetic: blood glucose returns to normal levels in 2-3 hours, urine negative for glucose Diabetic: blood glucose levels return slowly, urine is positive for glucose
What is done in a postprandial blood sugar? Fasting client is given a measured amount of carbohydrate solution orally, blood drawn after 2 hours. BG > 160 indicates DM
What is HgbA1c? glycosylated hemoglobin
Classic laboratory findings used to diagnose diabetes mellitus? 1. random blood glucose over 200 mg/dl 2. glycosuria 3. ketonuria
Causes of diabetes mellitus. 1. unknown 2. genetic predisposition 3. viruses (coxsackievirus, rubella, mumps) 4. aging 5. diet and lifestyle
What causes glycosuria? Body attempts to rid excess glucose that is in the body due to lack of insulin or misuse of insulin.
Why does diabetes mellitus cause polyphagia? Glucose can not be used without insulin, so the cells starve, and the body tries to compensate by overeating.
Why are there excess ketones in the blood in a diabetic patient? body's fat and protein sources are broken down for energy.
Accumulation of ketones in the blood causes... ketoacidosis
Type 1 Diabetes Mellitus Insulin Dependent Diabetes Mellitus (IDDM)- little or no insulin produced
Type II Diabetes Mellitus Non-insulin dependent diabetes mellitus (NIDDM)
Differences in Type 1 and Type 2 DM Type 1- 1. rapid onset 2. Thin clients due to muscle wasting 3. Manifestations- nocturia, blurred vision, halo around lights Type 2- 1. slow wound healing 2. legs and feet cold to touch 3. decrease sensation in extremities
Normal fasting blood glucose 60-120 mg/dl, greater than 126 is abnormal
Difference in oral glucose tolerance test (OGTT) results for a non-diabetic and diabetic client Non-diabetic: blood glucose returns to normal levels in 2-3 hours, urine negative for glucose Diabetic: blood glucose levels return slowly, urine is positive for glucose
What is done in a postprandial blood sugar? Fasting client is given a measured amount of carbohydrate solution orally, blood drawn after 2 hours. BG > 160 indicates DM
What is HgbA1c? glycosylated hemoglobin-measures the amount of glucose bound to hemoglobin
Management of DM Diet, exercise, educationA
Quantitative Emphasis on total amount of complex carbohydrates consumed rather than type 45-50% kcals from COOH 10-20% kcals from protein no more than 30% kcals from fat
Qualitative unmeasured and more unstructured, stresses moderation, reduce intake of simple carbs, saturated fats, and alcohol, food intake evenly throughout day
Humulin R short/rapid acting insulin onset: 30-60 min peak: 3-6 hours duration: 6-8 hours
NPH, Novolin N, Humulin N intermediate acting insulin onset: 60-90 minutes peak: 8-12 hours duration: 24 hours
Ultralente, Humulin U long-acting insulin onset: 4-8 hours peak: 16-19 hours duration:36 hours
Humalog insulin lispro, onset: 15 minutes, used in insulin pumps
Lantus insulin glargine, long-acting synthetic insulin, administered once per day
How long is each cannula on an insulin pump good for? 72 hours
Who is a good candidate for a pancreas transplant? Type 1 diabetic with renal failure
What occurs in an islet cell transplantation? islet cells are harvested from human donors and pigs, injected into the clients peritoneum to produce insulin.
What is neuropathy? abnromal condition characterized by inflammation and degeneration of the peripheral nerves
What visual changes do diabetics need to watch out for? diabetic retinopathy- microvascular changes affect retinal capillaries
Manifestations of diabetic ketoacidosis 1. weakness, drowsiness 2. vomiting 3. thirst 4. abdominal pain 5. hot, dry skin, dry mouth, flushed cheeks LATE 1. Kussmaul's breathing 2. sweetish odor to breath (acetone) 3. hypotension 4. rapid, weak pulse
Blood glucose levels in diabetic ketoacidosis 300-800 mg/dl
serum pH in diabetic ketoacidosis 6.8-7.3.
Sulfonylureas (glipizide), meglitinides (repaglinide), biguanides (metformin) types of oral hypoglycemics that lower blood glucose by stimulating insulin secretion by beta cells of the pancreas and increase insulin sensitivity at receptor sites *requires pancreatic function*
alphaglucosidase inhibitors (acarbase) delays digestion of carbohydrates, lowering blood glucose. may combine with sulfonylureas
thiazolidinesdiones ((pioglitazone) increase insulin sensitivity
Contraindications for oral hypoglycemics 1. type 1 DM 2. hypoglycemia 3. any severe endocrine dysfunction 4. pregnancy and lactation
Ingestion of alcohol with oral hypoglycemics may cause disulfiram-like reaction
levothyroxine (Synthroid, Levothroid) T4 preparation for thyroid replacement therapy
liothyronine (Cytomel, Triostat) T3 preparation for thyroid replacement therapy
liotrix (Thyrolar) combination T3/T4 preparation
desiccated thyroid preparations Armour Thyroid, Thyrar
Interactions of thyroid preparations 1. may alter effectiveness of warfarin 2. may increase requirement for insulin or oral hypoglycemics in diabetic patients 3. increased cardiovascular effects 4. decrease response to beta blockers
For patients who have difficulty swallowing levothyroxine tablets: 1. may be crushed and placed in 5-10 ml of water 2. must be administered immediately 3. do not store suspension
Only insulin that can be administered IV short-acting (regular) insulin
methimazole and propylthiouracil are examples of.. anti-thyroid agents
indications for use of anti-thyroid agents 1. palliative treatment of hyperhtyroidism 2. adjuct to control hyperthyroidism in prep for thyroidectomy
Iodine-containing agents are used for 1.adjunct therapy for preparation of thyroidectomy 2. treatment of thyrotoxic crisis
What is the effect of iodine-containing agents? 1. rapidly inhibit release and synthesis of thyroid hormones 2. decrease vascularity of thyroid gland
hormones (like Ocreotide) are used for 1. treatment of severe diarrhea and flushing episodes in patients with GI/ endocrine tumors 2. relief of symptoms in pituitary tumors
Oral and IV electrolyte replacement is used to treat and prevent hypocalcemia
phentolamine (Regitine) pheochromocytoma agent
Use of pheochromocytoma agents IV: control of BP during surgical removal of a pheochromocytoma
Created by: hegaub