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