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Endocrine asses/dia

endocrine assess/diagnostic eval

1. What is the function of the endocrine system? * closely linked w/ nervous & immune system; * exerts control by releasing (chemical substances) hormones into the blood
2. What do hormones do? affect other endocrine glands or body systems
3. What is the difference between exocrine and endocrine glands exocrine – (outside) into organs and sweet glands ** endocrine (Inside ) the blood (in circulation to affect other body tissues and systems)
4. Growth and development
5. Metabolism of energy thyroid
6. Adipose tissue distribution
7. Sexual development progesterone/ testosterone / LH / prolactin
8. Fluid and electrolyte balance
9. Inflammation and immune responses
10. What glands make up the endocrine system? pituitary ; thyroid; parathyroid; adrenal; pancreatic islets; ovaries;; testes
11. 4 categories of hormones 1- amines and amino acid 2- peptides (protein) act on cell surface 3- steroids – act inside cell 4- fatty acid derivatives
12. Hypothalamus – releasing hormones (CRH) corticotropin releasing hormone (TRH) thyrotrophic RH ( GHRH) Growth Hormone RH- (GnRH) Gonadotropin RH ((controls the release of pituitary hormone))
13. Hypothalamus inhibiting hormone somatostatin – ((inhibits growth hormone and thyroid- stimulating hormone))
14. Anterior pituitary – releases what hormones GH- growth hormone; ACTH- adrenocorticotropic hormone; TSH- thyroid stimulating hormone ; FSH follicle stimulating hormone ; LH luteinizing hormone ; prolactin
15. GH – growth hormone (Anterior Pituitary) stimulates growth of muscle/bone; promotes protein synthesis and fat metabolism. Decreases carbohydrate metabolism
16. ACTH- Adrenocorticotropic hormone (Anterior Pituitary)stimulates synthesis /secretion adrenal cortical hormones
17. TSH- thyroid stimulating hormone (Anterior Pituitary)stimulates synthesis /secretion of thyroid hormone
18. FSH- follicle stimulating hormone (Anterior Pituitary)female: ovarian follicle ; ovulation Male: sperm production
19. LH- luteinizing hormone- (Anterior Pituitary) Female: corpus luteum, release oocyte; estrogen/ progesterone
20. Prolactin (Anterior Pituitary) preps female breast for feeding
21. Posterior pituitary release what hormones? ADH – antidiuretic hormone ; Oxytocin
22. ADH- Antidiuretic hormone (Posterior Pituitary ) increase water reabsorption by kidney
23. Oxytocin- (posterior Pituitary ) uterine contractions; milk ejection after birth
24. Hormones released by adrenal cortex? Mineral corticosteroids (aldosterone); glucocorticosteriods (cortisol) ; adrenal androgens (dehydrpepiandrosterone) DHEA) and andresetedeione
25. Function of Mineral corticosteroids (aldosterone); increase sodium absorption, potassium loss by kidney
26. Function of glucocorticosteriods (cortisol); affect metabolism of all nutrients; regulates blood glucose levels. Affects growth, anti-inflammatory action; decrease effects of stress
27. Function of adrenal androgens (dehydrpepiandrosterone) DHEA) and andresetedeione minimal intrinsic androgenic activity; they are converted to testosterone and dihydrotestosterone in the periphery
28. Hormones released by the adrenal medulla epinephrine; norepinephrine
29. Function of epinephrine and norepinephrine neurotransmitters for the sympathetic nervous system (SNS)
30. Hormones released by thyroid (follicular cells) thyroid hormones (T3- triidothyronine) (T4- thyroxin)
31. Function of thyroid hormones (T3- triidothyronine) (T4- thyroxin) increase metabolic rate; increase protein and bone turnover; increase responsiveness to catecholamine’s; necessary for fetal growth and development
32. Hormones released by thyroid C cells Calcitonin
33. Function of calcitonin (thyroid C cells) lowers blood calcium and phosphate levels
34. Parathyroid glands parathormone (PTH, parathyroid hormone) regulates serum level
35. Pancreatic Islet cells Insulin; glucagon ; somatostatin
36. Function of insulin lowers blood glucose by facilitating blood glucose transport across cell membranes of muscle, liver, and adipose tissue
37. Function of glucagon increase blood glucose concentration by stimulation of glycogenolysis and glyconeogenesis
38. Function of somatostatin delays intestinal absorption of glucose
39. Hormones released by kidneys 1,25 dihydroxyvitamin D; renin; erythropoietin;
40. Function of 1,25 dihydroxyvitamin D stimulate calcium absorption from intestine
41. Function of renin activates renin-angiotensin- aldosterone system
42. Function of erythropoietin increase red blood cell production
43. Hormones released by ovaries estrogen; progesterone
44. Function of estrogen development of fetal sex organs; secondary sex characteristic
45. Function of progesterone menstrual cycle; stimulates growth of uterine wall; maintains pregnancy
46. Hormones released by testes androgens; (main testosterone)
47. Function of androgens (testosterone) development of male sex organs – secondary sex characteristics; aid in sperm production
48. Hormones are produced by what type of glands endocrine glands which have no ducts; they do have a rich blood supply
49. Hormones are responsible for what maintenance of optimal internal environment; corrective/adaptive responses in crisis
50. Where are most endocrine hormones released? most are released into the bloodstream, some require a protein carrier
51. neurons release some hormones into the blood stream- Epinephrine – is one such hormone released by neurons
52. where does the hypothalamus release its hormones? directly to cells in the posterior pituitary by nerve cell extension
53. health history – family hx any family members first generation mother, father, siblings, children
54. health hx- energy level – fatigued; easily tire; when did symptoms first appear; duration of symptoms
55. health hx- tolerance to heat cold- temp changes and tolerance to changes can reflect certain disorders
56. health hx change in thirst appetite, urination polyphagia (eating too much) , polydipsia (excessive thirst) , polyuria(excessive urination) , oliguria (no urination)
57. health hx- weight changes increase or decrease in fluid retention
58. health hx- secondary sexual characteristics
59. health hx- sexual dysfunction decreased libido
60. health hx- memory concentration
61. health hx- sleep pattern
62. health hx- Physical assessment
63. physical assessment – vital signs
64. physical assessment –visual head – to –toe
65. physical assessment –tactile exam
66. physical assessment –changes in physical characteristics Cushing’s (moon face, buffalo hump, facial hair on females) Addison’s (bronze skin) Hyperthyroid ( bulging eyes - xeothalmus )
67. physical assessment –alterations in skin texture
68. physical assessment –blood pressure
69. physical assessment –behavioral changes extreme changes in behavior can be indicative of a hormonal imbalance
70. what is the natural response of the negative feedback system try’s to suppress the production of the hormone
71. diagnostic tests- blood test general test and / or specific to suspected diagnoses- usually a CBC w/ diff
72. diagnostic tests- urine tests- including 24 hour urine- checks for electrolytes ; hormones can be excreted through the urine
73. diagnostic tests- stimulation and suppression tests
74. Diagnostic tests- radioimmunoassay: RIA special type of invitro procedure –combines the use of radio chemicals and antibodies to measure the levels of hormones, vitamins, drugs in pts. /. Blood
75. diagnostic tests- CT scans;
76. diagnostic tests- MRI
77. diagnostic tests- PET
78. diagnostic tests- DEXA bone density scan- for bone structure
79. Thyroid Diagnostic test: TSH
80. Thyroid Diagnostic test: serum free T4
81. Thyroid Diagnostic test: T3 and T4
82. Thyroid Diagnostic test: T4 resin uptake
83. Thyroid Diagnostic test: Thyroid antibodies
84. Thyroid Diagnostic test :Radioactive iodine uptake
85. Thyroid Diagnostic test: fine needle biopsy
86. Thyroid Diagnostic test: Thyroid scan ; radio scan; scintscan
87. Thyroid Diagnostic test: serum thyroglobulin
88. Hypothalamus master gland extension of the pituitary, controls the release of pituitary hormones ; CHR (corticotropin), THR Thyrotrophic, GHRH (growth hormone) GnRH ( gonadotropin )
89. Pituitary 1 cm in diameter (size of pea); In sella turcica (depression in sphenoid bone) connected to hypothalamus by slender stalk
90. Location of pituitary in relation to optic chiasm Blurred vision
91. Posterior pituitary (neurohypophysis)- extension of hypothalamus; stores /releases 2 hormones Produced in hypothalamus (ADH/ Oxytocin) ; controlled by nerve stimulation;
92. Posterior pituitary (neurohypophysis)- ADH ADH – anti diuretic hormone (vasopressin) – inhibits urine production by kidney; reabsorbs water& returns to the bloodstream (controls “pee” )
93. Posterior pituitary (neurohypophysis)- oxytocin (Pitocin) stimulates urine contraction in pregnancy;, milk ejection from breast after childbirth
94. Anterior pituitary (adenohypophysis) controlled by releasing hormones of hypothalamus GH; ACTH; TSH; FSH; LH; MSH; PRL
95. Anterior pituitary (adenohypophysis) GH growth hormone (somatotropin)
96. Anterior pituitary (adenohypophysis) ACTH adrenocorticotropic
97. Anterior pituitary (adenohypophysis) LH luteinizing hormone
98. Anterior pituitary (adenohypophysis) MSH melanocyte stimulating hormone (melanin in skin, appetite, sleep cycles, sexual function
99. Anterior pituitary (adenohypophysis) PRL prolactin (lactogenic hormone)
100. What causes hyper function of the anterior pituitary usually caused by benign tumor (adenoma) or hyperplasia (too cells or cells that have grown too big)
101. What is the effect of excessive adrenocorticotropic hormone? Cushing’s syndrome
102. What is the effect of excessive growth hormone (after the epiphyseal plate “growth plate” closes) and who does it affect Acromegaly – occurs only in adult hood
103. What is the effect of excessive growth hormone (before the epiphyseal plate “growth plate” closes) and who does it affect Gigantism – occurs only in childhood
104. What can result is Cushing’s syndrome *- long term steroid therapy *Cancer malignancy (ectopic production) – tumors of the pituitary /adrenal cortex *- over production of ATCH
105. Cushing’s disease (manifestations/classic signs) * fatty “buffalo hump” in neck; * Moon faced appearance; * thin fragile kin; * weakness, sleep disturbance; * kyphosis, backache*
106. Cushing’s has a higher prevalence for which category women 20-40 yrs. of age\
107. What is Hirsutism- presentation of masculine traits in women (facial hair)
108. Cushing’s disease diagnostic test is very time precise
109. Cushing’s disease diagnostic test overnight dexamethasone suppression test given orally –specific time with blood draw at specific time
110. Cushing’s disease diagnostic test overnight dexamethasone suppression test results increase in serum sodium and blood gas; decrease in serum potassium, reduction in eosinophil’s; disappearance of lymphoid tissue; 24 hour urinary free cortisol level; CT; MRI,US
111. Cushing’s syndrome treatment depends on the cause
112. Cushing’s syndrome treatment pituitary tumor transphenoidal hypphysectomy ; radiation
113. Cushing’s syndrome treatment adrenal cortex adrenalectomy ; replacement therapy to tx symptoms of adrenal insufficiency
114. Cushing’s syndrome treatment corticosteroid medications reduce or taper to the minimum dosage( DO NOT STOP STEROIDS ABRUPTLY )
115. Cushing syndrome nursing interventions: decrease risk of injury; decrease risk of infection; prep for surgery ( insulin “decreased Blood glucose” Tx peptic ulcers “) encourage rest, activity; promote skin integrity (thin /fragile) education
48. Hormones are produced by what type of glands endocrine glands which have no ducts; they do have a rich blood supply
• Acromegaly bone and connective tissues continue to grow; in adults only ; caused by the release of too much GFH; congenital dysfunction
• Physical characteristics of acromegaly enlarged forehead. Lengthened maxilla, enlarged tongue, deep voice, large hands and feet
• Physiological characteristics of acromegaly peripheral nerve damage, headache, HTN, CHF, seizures, visual disturbances, diabetes
• Hyperpituitarisim occurs when only in adults- extremities
• Anterior pituitary under secretion ACTH adrenocortical insufficiency (can be caused by tumors)
• Growth hormone before epiphyseal plate closes is known as Dwarfism- (normal body parts- just small)
• Anterior Pituitary Under secretion caused by: congenital dysfunction, tumors, surgical removal of pituitary glands, radiation, pituitary infarction, infection or trauma
• Hypopituitarism Not enough (or none) hormone, can be anterior/posterior or both (panhypopituitarism)
• Simmonds’s disease RARE- total absence of all pituitary secretions- very rare- non-secreting pituitary tumor
• Sheehan’s syndrome postpartum pituitary necrosis: severe blood loss & hypotension; DIC (disseminated intravascular coagulation)
• Hypopituitarism can result from disease of gland itself; disease of hypothalamus; radiation to head and neck; trauma, tumor or vascular lesion ((brain tumors- health tissue being destroyed)
• Pituitary tumors are generally benign
• What is the biggest complication for tx of pituitary tumors location is the problem (located in the sela turcia of the sphenoid bone- entry is generally through the nasal cavity)
• Problems in relation to location of the pituitary gland can manifest other complications such as @ visual disturbances, visual fields color, diplopia
• Diagnostic test for pituitary includes CT. MRI, pituitary hormone levels
• How are pituitary removed thru trans-spheroidal approach (nasal) and stereotactic radiation therapy
• Medication for pituitary tumors used to improve clinical condition
• Medication for pituitary tumors- bromocriptine meslylate (parlodel)- amenorrhea, infertility , hypogonadism, Parkinson’s & acromegaly
• Medication for pituitary tumors – octreotide (sandostatin) inhibits growth hormone; second line drug when no response to surgery of parlodel
• Medication for pituitary tumors cabergoline (dostinex) hyperprolactinemia
• Medication for pituitary tumors pegvisomant (somavert) analog of human growth hormone block of endogenous GH from cell receptors
• Pituitary tumors several approaches to surgical removal of pituitary glands (no menstruation / replacement therapy needed)
• How does surgical removal of pituitary gland affect acromegaly? they are unaffected by surgical removal of the tumor
Created by: Kyn269