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Endocrine
Endocrine (3rd test, 2nd Semester)
| Question | Answer |
|---|---|
| Hyperthyroidism intolerance to temperature? | Hyperthyroidism is intolerant to HEAT. Metabolic rate is up, so you are already hot. |
| Hypothyroidism intolerance to temperature? | Hypothyroidism is intolerant to COLD. Metabolic rate is down, so you already cold. |
| Grave's Disease is what? | Grave's Disease is hyperthyroidism. HYPER "Too High, and You Die" . . . and go to your "Grave". |
| Hashimoto's Disease is what? | Hashimoto's Disease is hypothyroidism. HYPO |
| Hypothalamus Gland regulates what? | Hypothalamus Gland regulates: Temperature; Respiration Rate; Blood Pressure; Emotional state: fear, anxiety, anger, rage, pleasure, pain; HSH hypothalamic-stimulating hormone regulates pituitary gland |
| Which gland is the "Master Gland" ? | The Pituitary Gland is the "Master Gland". |
| The Pituitary Gland has anterior and posterior lobes. What are their other names? | Posterior Pituitary Lobe is also called the Neurohypophysis. Anterior Pituitary Lobe is also called the Adenohypophysis. |
| What does the Posterior Pituitary Lobe / Neurohypophysis release? | The posterior pituitary lobe / neurohypophysis releases vasopressin / antidiuretic hormone ADH . . . and oxytocin. |
| What does the Anterior Pituitary Lobe / Adenohypophysis release? | The anterior pituitary lobe / adenohypophysis releases: growth hormone GH; follicle-stimulating hormone FSH; corticotropin (then adrenals release corticosterone); luteinizing hormone LH; prolactin; thyroid-stimulating hormone TSH |
| What hormones does the Thyroid Gland secrete? | The thyroid gland secretes: thyroxine T4; triiodothyronine T3; thryocalcitonin (also called calcitonin, lower serum calcium by promoting bone formation) |
| The basal metabolic rate is stimulated by what hormones? | The basal metabolic rate is stimulated by: thyroxine T4 triiodothyronine T3 |
| What hormone decreases the level of serum calcium? | Thyrocalcitonin (also known as calcitonin) decreases serum calcium levels. The thyroid gland secretes thyrocalcitonin. |
| What hormone increases the level of serum calcium? | parathyroid hormone (PTH) increases the level of serum calcium. The parathyroid gland secretes parathyroid hormone PTH. |
| Iodine is essential for what gland, and what hormones? | Iodine is essential to the thyroid gland, because it is needed to synthesize thyroxine T4 and triiodothyronine T3, which regulates basal metabolic rate. |
| What hormones does the Adrenal Glands secrete? | The adrenal cortex (outside) secretes glucocorticoids (cortisol) which regulates glucose; mineralocorticoids (aldosterone) which makes nephrons retain sodium; sex hormones; --adrenal medulla (inside) secretes epinephrine and norepinephrine |
| What two glands and their hormones increase blood pressure? | Posterior Pituitary Gland (neurohypophysis) : ADH antidiuretic hormones Adrenal Cortex : aldosterone (a mineralocorticoid) Both cause the nephrons to retain water, thus volume and BP goes up. |
| What hormones that regulate digestion, does the Pancreas secrete? | The pancreas secretes these digestive hormones: amylase (enzyme that converts starches into simple sugars); lipase (enzyme : hydrolysis lipids); trypsin (trypsy=crushes : proteins) |
| What serum glucose regulating hormones does the Pancreas secrete? | The pancreas secretes: insulin (which causes serum glucose levels to go down); glucagon (glucagon turns liver glycogen into glucose (glycogenolysis) thus serum glucose goes up. |
| Key signs and symptoms of endocrine disorders? | Key signs and symptoms of endocrine disorders are: Changes in weight; hair quality and distribution; muscle mass; body fat. Changes in mood or behavior. Changes in menses and libido. Intolerance to Heat (hyperthyroidism), or Cold (hypothyroidism) |
| Key physical examination findings in endocrine disorders? | Key physical examination findings in endocrine disorders are: skin changes (color, temperature, texture); changes in level of consciousness LOC or mental status; changes in urine production (polyuria) and thirst (polydipsia) |
| Addison's Disease is what? | Addison't Disease is when your adrenal glands do not secrete enough of their hormones. Lifelong treatment involves replacing the absent hormones (oral hydrocortisone aka cortisol to raise blood glucose . . . fludrocortisone to replace the aldosterone ) |
| What are the signs of Addison's Disease? | With Addison's your adrenals stop making cortisol, thus hypoglycemic, so profoundly weak. Pituitary ups ATCH which leads to too much MSH so hyperpigmentation. Hypotension (no mineralocorticoids). Pain in lower back and abdomen. Anorexia, weight loss. |
| What is Addison's Crisis? | Addison's Crisis is also know as Acute Adrenal Insufficiency. The Adrenal glands are not secreting enough cortisol (glucocorticoid), so you go into a hypoglycemic coma and die if untreated. |
| What is the treatment for Addison's Crisis aka acute adrenal insufficiency? | Addison't crisis treatment: immediate injection of hydrocortisone through a vein (intravenous) or muscle (intramuscular). |
| If you have tachycardia, which endocrine disorders might you have? | If you have tachycardia, you might have: hyperthyroidism (Grave's disease is one hyperthyroidism, thyroid secretes too much T3 T4, metabolism goes up); pheochromocytoma (adrenal gland tumor, secreting too much epinephrine); hypoglycemia; DKA |
| How is diabetes, hyperglucose, and DKA diabetic ketoacidosis related? | If you are diabetic, blood glucose is high (hyperglucose) because there is no insulin to move the glucose into the cells, or the cells are resistant to glucose. They convert fat into energy, producing ketones, which causes metabolic acidosis. |
| Why is it important to keep the tracheostomy tray next to patient after they have had any throat surgery? (e.g. thyroidectomy) | Because the trauma of the throat surgery can lead to swelling, bleeding, and laryngeal spasms, all of which may block their trachea (airway). So you must be ready for a tracheostomy. |
| What does renal calculi and hyperparathyroidism have to do with each other? | When the parathyroids make too much PTH (hyperparathyroidism), serum calcium levels rise, and the kidneys can't keep up, so you end up with kidney stones which are called renal calculi. |
| How does hyperthyroidism lead to polyuria and polydipsia? | When the parathyroids make too much PTH (hyperparathyroidism), serum calcium levels rise, and the kidneys try to flush the excess calcium out which causes polyuria, and then your thirsty (polydipsia). |
| What is the difference between diabetes insipidus, and mellitus 1 &2? | Diabetes gets its name from the Greek word for polyuria. Diabetes Mellitus 1 & 2 produce too much urine because of hyperglycemia. But Diabetes Insipidus is a problem with ADH. So either not enough ADH is being secreted, or the kidneys are resistant to ADH |
| What is the difference between diabetes mellitus 1, and diabetes mellitus 2? | Diabetes mellitus 1 is caused when your pancreas stops making insulin (or enough of it), and until insulin injections it was fatal. Type 2 is when you are fat and eat too much sugar all the time, your body become resistant to insulin. |
| Why does your urine specific gravity go way up with diabetes mellitus, but go way down with diabetes insipidus? | Diabetes mellitus is an insulin problem, causing hyperglycemia, thus excessive solute concentration from all that serum glucose they kidneys are excreting. But diabetes insipidus is a problem with ADH, so polyuria, but no extra solute concentration. |
| What is the urine specific gravity for diabetes mellitus (untreated)? What is the urine specific gravity for diabetes insipidus (untreated)? | Mellitus' urine specific gravity is greater than 1.026 . Insipidus' urine specific gravity is less than 1.005 (even though norm is 1.000 - 1.030 ) |
| Why does hyperpituitarism lead to skeletal abnormalities with a protruding jaw? | When there is a tumor pressing the pituitary gland, it over secretes growth hormone GH, which leads to giantism called acromegaly. |
| What is the difference between Cushing's syndrome, and Cushing's disease? | Cushing's syndrome is any source of excessive cortisol (glucocorticoid); whereas Cushing's disease is when that excessive cortisol is caused by a pituitary tumor, causing it to secrete too much ACTH adrenocorticotropic hormone, aka corticotropin |
| What happens to you when you are exposed to excessive levels of cortisol (glucocorticoids)? | You get Cushing's syndrome, and rapidly gain weight in trunk and face (moon face) (buffalo hump). Hypertension (due to cortisol's enhancement of epinephrine's vasoconstrictive effect). Hirsutism; reduced libido; excess ACTH may hyperpigmentation |
| Addison's disease VS. Cushing's syndrome . What is the difference? | Addison's disease is adrenal insufficiency (not making enough cortisol). Cushing's syndrome is overproduction of cortisol (the adrenal glands are over secreting cortisol, because the pituitary tumor is secreting too much ACTH adrenocorticotropic hormone.) |
| What does cortisol come from? What does hydrocortisone do? | Cortisol (aka hydrocotisone) is a glucocorticoid secreted only by the adrenal glands, and its Its primary functions are to increase blood sugar through gluconeogenesis; it also suppresses the immune system, and decreases bone formation. |
| What chemistry lab value would we be looking for if you were "ruling-out" Addison's disease? | Cortisol level would be lower than normal. |
| How long do you withhold food and fluids before a "Fasting" serum glucose test? | 12 hours, no food, no fluids, before "Fasting" serum glucose test. |
| What are you measuring with "fasting" and "2-hour postprandial" serum glucose tests? | You are measuring the body's use of, and disposal of glucose. If glucose levels are higher than normal, it means you body is not making enough insulin, or is insulin resistant, and can't get the glucose into your cells and out of the blood serum. |
| What machine would you use to help you visualize the pituitary (for signs of a tumor)? | CT computed tomography would let you see the sella turcica area where the pituitary gland is. |
| What machine would you use to help you visualize the thyroid gland? | Ultrasonography helps you visualize the thyroid gland. |
| How long do you withhold all thyroid and cough medication before dong the RAIU radioactive iodine uptake test? | 7 to 10 days, withhold all thyroid and cough medications. Also, for 24 hours, withhold any iodine rich foods, such as iodized salt or shellfish, before the test. |
| What is the difference between the RAIU radioactive iodine uptake test, . and the radioactive iodine therapy? | RAIU uses radioactive iodine to scan the thyroids and see how much of it it has absorbed (lower than normal means thyroiditis; higher means Grave's disease; uneven means nodules) . . . therapy uses high doses to kill the thyroid |
| How is Grave's disease, and radioactive iodine therapy related? | Grave's disease is an autoimmune disorder that leads to overactivity of the thyroid gland (hyperthyroidism). Since the thyroid absorbs almost all iodine, if you give doses or radioactive iodine, you kill the over active thyroid. |
| What is a thyroid storm? | A thyroid storm is a life-threatening condition of hyperthyroidism (Grave's disease), when thyrotoxicosis crosses the line into the crisis zone. (T3 and T4 levels very high, while TSH is too low to detect.) One major sign is dangerously high fever. |
| Grave's disease VS. Hashimotos's disease? | Grave's disease is hyperthyroidism (T3 and T4 levels way up, TSH way down.); whereas Hashimoto's disease is hypothyroidism (T3 and T4 are way down, but TSH is way up.) The pituitary is releasing TSH to try and get T3 and T4 levels up, but can't. |
| Grave's disease VS. other kinds of hyperthyroidism? | Grave's disease is an auto immune disease that that causes excessive secretions of T3 and T4, so TSH is very low since the pituitary is trying to slow down the thyroid. But excessive THS can cause non-Grave's forms of hyperthyroidism. (Tumor in pituitary) |
| Hashimoto's disease VS. other kinds of hypothyroidism? | Hashimoto's disease is an auto immune disease that causes the decrease secretions of T3 and T4 while TSH levels are very high, because the pituitary is trying to get the thyroid working. But other forms of hypothyroidism come from too low TSH secretion. |
| What does SIADH stand for? | SIADH stands for: syndrome of inappropriate antidiuretic hormone secretion |
| SIADH leads to what? Fluid overload OR Fluid deficiency? | The result is hyponatremia and sometimes fluid overload. |
| Is retinopathy micro or macro vascular problem? | Mircrovascular |
| Is CVA micro or macro vascular problem? | Stroke |
| Diabetes can lead to macrovascular complications? | Macrovascular complications include heart disease, stroke and peripheral vascular disease (which can lead to ulcers, gangrene and amputation). |
| Diabete can lead to microvascular complications? | Microvascular complications include neuropathy (nerve damage), nephropathy (kidney disease) and vision disorders (eg retinopathy, glaucoma, cataract and corneal disease). |
| SIADH and DI, what is their relationship to ADH? (syndrome of inappropriate antidiuretic hormone secretion; and diabetes insipidus) | SIADH and DI are opposite reactions to problems with ADH. They are both conditions of the brain, because it is the posterior pituitary gland that secretes ADH. Too much ADH = water overload = SIADH. Too little ADH = losing fluid = diabetes insipidus. |
| Vassopressin is another name for what? | ADH (antidiuretic hormone) |
| Aldosterone and ADH (aka Vassopressin) do what? | Aldosterone and ADH (aks Vassopressin) both cause the nephron to reabsorb water, thus volume goes up, thus BP blood pressure goes up. |
| Ascites, what is it? | ascites : an accumulation of fluid in the peritoneal cavity (often caused by cirrhosis . . . alcohol abuse, hepatitis C or B, are the two most common causes of cirrhosis) Causes abdominal swelling and difficulty breathing because of pressing on diaphragm |
| What gland secretes ADH? | The posterior pituitary gland secretes ADH . . . antidiuretic hormone. |
| As nurses, what are we looking for to detect SIADH and Diabetes Insipidus? | We are looking for urine and serum sodium. Because, a normally dehydrated client will have high serum sodium AND high urine sodium concentrations. SIADH will have high urine sodium, BUT low serum sodium. With DI, sodium is: serum=high, urine=low. |
| To help you understand osmolarity, just substitute ________ (this word) for osmolarity. | Concentration (osmolarity is measuring the solute concentration). (For example: high serum sodium osmol is the same as high serum sodium concentration.) |
| How does SIADH and dehydration differ? | A client who is dehydrated will have too little fluid to flush out sodium, so both serum and urine concentration levels will be higher than normal. But with SIADH, they have too much ADH, thus water overload, so serum sodium is low, urine sodium is high. |
| How does DI diabetes insipidus and over hydration differ? | With a normal client, if they are over hydrated, both their serum and urine sodium concentrations will be lower than normal. But with DI, they have too little ADH, so urine sodium is very low, but the serum sodium is high. Dangerously dehydrating with DI. |
| The lab value for serum sodium is 125mEq/L. Why is that consistent with SIADH? | It is consistent with SIADH because since SIADH is caused by too much ADH, the client is retaining too much water (overload), diluting their serum sodium levels, and 125 is lower than normal. (Norm: 135-145mEq/L) Remember: s/he would still have dark urine |
| What is the priority treatment for someone with diabetes insipidus? | Normal saline IV, because this patient is inappropriately dumping off fluids, so we need to get fluids back into them. Insulin will help them later, but right now they need fluids. |
| What is furosemide, and why would you NOT give it to a diabetes insipidus patient, but you WOULD give it to a SIADH patient? | Furosemide is a loop diuretic, and helps rid the body of fluids, which is good for someone with fluid overload caused by SIADH, but bad for someone already unloading fluids too fast because of diabetes insipidus. |
| How are hyponatremia and SIADH related? How are they different? | When a client has hyponatremia (too little sodium in their blood serum) it is usually because of fluid overload |
| Explain: The different types of Hyponatremia: Hypervolemic from Cirrhosis, CHF, massive edema, SIADH, Hypothyroidism, Glucocorticoid deficiency.; Hypovolemic from Addison's disease, prolonged vomiting, poor intake, severe diarrhea, | Hypervolemic Hyponatremia is by far the most common kind, and it is caused by fluid overload diluting the normal sodium to sub norm; Euvolemic Hyponatremia |
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