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Patho - Endocrine
Pathophysiology - Endocrine Disorders
| Question | Answer |
|---|---|
| What does type II diabetes involve? | decreased pancreatic beta cells production of insulin, increased production resistance by body cell to insulin, increased production of glucose by the liver or a combination of these factors. |
| What methodologies can be used to adjust the need for insulin, thereby controlling Type II diabetes. | regulating dietary intake, increase use of glucose such as with exercise, reducing insulin resistance, stimulating the beta cells of the pancreas to produce more insulin |
| There has been an increased incidence of type II diabetes in adults who are identified with what? | metabolic syndrome |
| What is metabolic syndrome? | complex of several pathophysiologic conditions marked by obesity, cardiovascular changes, and significant insulin resistance due to increased adipose tissue. |
| What is gestational diabetes? | diabetes that may develop during pregnancy and disappear after the delivery of a child. |
| Why does excess glucose spill over in urine? | Excessive level of glucose in filtrate exceeds the capacity of the renal tubular transport limits to reabsorb it. |
| What are the initial stages of an insulin deficit? | decreased transportation and use of glucose in many cells of the body, excess glucose spills into urine, large loss of fluid and electrolytes from the body tissues,dehydration, stimulation of appetite |
| Why is a large volume of urine excreted from the body? | Glucose in the urine exerts osmotic pressure in the filtrate |
| What causes the lost of electrolytes and fluid from the body tissues? | excess urine lost from the body as glucose in the urine exerts osmotic pressure in filtrate |
| What causes dehydration? | fluid loss through the urine and high blood glucose levels draw water from cells |
| What stimulates appetite? | lack of nutrients entering the cells |
| What are the progressive effects of an insulin deficit? | catabolism of fats and proteins, excessive amounts of ketones in blood, which cause ketoacidosis, decrease in PH of body fluids, ketoacids are excreted in urine, decompensated metabolic acidosis |
| What leads to an excessive amount of fatty acids and their metabolites, known as ketones or ketoacids in blood | Lack of glucose in cells, which results in catabolism of fats and proteins |
| What causes an excessive amount ketones in blood, which lead to ketoacidosis? | Because the liver is limited on the amount of lipids, fatty acids, or ketones that they can process completely within a given amount of time. |
| What leads to an decrease of Ph of body fluids? | ketoacids bind withbicarbonate buffer in the blood, leading to decreased serum bicarbonate |
| What leads to decompensated metabolic acidosis? | filtration rate in the kidney is decreased, and excretion of acids becomes more limited |
| What heralds the onset of diabetes? | polyuria, polydipsia,polyphagia |
| What controls the severity of insulin deficit oertime | diet and exercise, oral medication, insulin replacement |
| What do oral medications for diabetes do? | increase insulin secretion or reduce insulin resistance |
| What kind of diet therapy is recommended in order to control diabetes? | Complex carbohydrates with a low glycemic index, adequate protein, as well as maintianing low cholesterol and low lipid levels, increased fiber with meals, food intake must match available insulin and metabolic needs including activity level |
| What does regular exercise do? | increases uptake of glucose by muscles w/o increase in insulin use, assists in weight control, reduces stress, and improves cardiovascular fitness |
| What increases the risk of hypoglycemia (insulin shock) | Strenuous or prolonged exercise, increased absorption of insulin from the injection site |
| What can decrease the risk for hypoglycemia? | Increasing carbohydrate intake by eating a snack to compensate for exercise can decrease the risk. |
| What is effective in treating mild forms of diabetes? | combination of diet, exercise, and oral hypoglycemic drugs |
| What can lead to fluctuations in serum blood glucose levels and cell metabolism throughout the body | variations in diet or physical activity,the presence of infections or alcohol use. |
| What are long-term complication of diabetes? | VASCULAR DISEASE |
| What does vascular disease result from? | degenerative changes in the tissues. |
| What is hypoglycemia precipitated by? | excess insulin |
| What does excess insulin in the blood cause? | deficit of glucose in the blood |
| Hypoglycemia, which usually occurs in patients with type I diabetes and quite suddenly as a result of what? | strenuous exercise, an error in dosage, vomiting, or skipping a meal after taking insulin |
| What is the manifestations of hypoglycemia directly related to? | Low blood glucose levels, not to the high insulin levels |
| Signs of hypoglycemia? | impaired neurological function and stimulation of sympathetic nervous system |
| What are the signs related to impaired neurological function? | poor concentration, staggering gait |
| What are the signs related to stimulation of the sympathetic nervous system? | increased pulse, pale, moist skin, anxiety, and tremors |
| What happens if hypoglycemia remains untreated? | loss of consciousness, seizures, and death |
| What can happen if hypoglycemia is not treated promptly | brain damage |
| Ketoacidosis is most common in what type of diabetic patient? | Type 1 patients |
| What can ketoacidosis be precipitated by? | infection or stress, error in dosage, or overindulgence in food or alcohol |
| What are the sign and symptoms of diabetic ketoacidosis? | dehydration, metabolic acidosis, and electrolyte imblance |
| What are the major endocrine glands that are scattered throughout the body and include the pituitary gland? | two adrenal glands, thyroid gland, four parathyroid glands, the endocrine portion of the pancreas, the gonads, the pineal gland,thymus |
| Where do endocrine glands secrete hormone directly into? | Blood |
| What type of exocrine glands secrete directly into a duct. | Mucous glands, pancreatic digestive enzyme |
| Hormones are chemical messengers that can be classified by what? | Action, Source, Chemical Structure |
| What hormones affect blood glucose levels? | Insulin, Glucagon, Epinephrine, Cortisol, and Growth Hormone |
| Where are peptides or proteins synthesized and then stored in vesicles? | Insulin, ADH, GH, Releasing Hormones (Corticotrophin releasing hormones) |
| The release of hormones from glands is most frequently controlled by what? | negative feedback mechanisms |
| What is an example of a negative feedback mechanism? | as levels of glucose increase, the secretion of insulin increase as glucose levels decrease, insulin secretion deceases. |
| What hormones are controlled by the nervous system through the hypothalamus? | Epinephrine and Norepinephrine |
| The hypothalamus in conjunction with the pituitary gland comprises a more complex system for some hormones by doing what? | By initially secreting, releasing, or inhibiting hormones |
| What type of releasing and inhibiting hormones do the hypothalamus release? | Thyrotropin-release factor(TRF) acts on the pituitary gland to secrete the thyroid-stimulating hormone (TSH) |
| What is necessary to check with regards to hormonal deficits or excesses? | Pituitary hormone levels as well as target glands |
| A deficit in the hormone thyroxine could result from what pituitary as well as target glands? | Pituitary problem(decreased secretion of TSH)or a problem in the thyroid gland |
| If there is a problem in the thyroid gland what would be the cause? | TSH levels would be high and thyroxine levels would be low. |
| What is an example of a hormone that is controlled by more than one mechanism? | Aldosterone is regulated by rennin secretion and serum levels of NA+ and K+. |
| What may be required to maintain a well-controlled blood level of a substance such as calcium? | A balance of the parathyroid hormone and calcitonin. |
| What are antagonistic hormones? | Hormones that have opposing actions on serum calcium |
| What are variables that affect hormone levels? | The level of glucose in the blood and fluid balance rate of timing of secretion |
| The rate of timing of estrogen in a women follows what type of manner? | cyclic |
| Adrenocorticotropic hormones and cortisol are secreted in what type of manner? | secreted in a diurnal pattern (pattern that occurs daily) |
| What things can change hormonal secretions to be greatly deficient? | individual sleep pattern, acute stress stimulates the sympathetic nervous system resulting in a great overflow of ACTH and cortisol |
| what are the two categories of endocrine problems? | Excessive amount of hormones and a deficit of hormones |
| What is the most common cause of endocrine disorders? | development of a benign tumor or adenoma |
| What is the cause of adenomas | They may be secretory, causing excess hormone, or they may have a destructive effect on the gland causing and hormonal deficit. |
| What will a pituitary gland located on the bony sella turcia on the inferior surface of the brain cause? | Increased intracranial pressure and neurologic effects |
| What is the result of target cells being resistant or insensitive to the hormone, thus creating the effect of a hormone deficit? | Genetic defect and autoimmune response, or excessive demand on the target cells, low blood glucose levels |
| What is an example of receptor insensitivity to an hormone? | Receptor insensitivity to the hormone insulin may be seen in type 2 diabetes mellitus. This decreases insulin in your body |
| What are the causes of hormonal imbalance? | Congenital defects in the glands, hyperplasia or infection in the glands, abnormal immune reactions, vascular problems. |
| What are tropic hormones? | Hormones that have other endocrine glands as their target. Most tropic hormones are produced and secreted by the anterior pituitary gland. |
| What other places can an excessive amount of hormones arise from? | Ectopic(outside)sources such as bronchogenic cancer, rather than from a gland |
| In what cases are levels of tropic hormones low? | When they arise from sources such as bronchogenic cancer, rather than from a gland |
| What is the cause of diabetes mellitus? | Decreased secretion of the insulin hormone and insulin resistance |
| What is symptoms or problems that arise in the initial stages of diabetes mellitus | Abnormal carbohydrate, protein, fat metabolism |
| Why does deficient insulin result in abnormal carbohydrate, protein, and fat metabolism> | Because the transport of glucose and amino acids into cells is impaired as well as the synthesis of protein and glycogen. |
| What does metabolic abnormalities affect? | Lipid metabolism |
| what cells are not affected directly by the deficit of insulin? | those cells that are not required for transport of glucose in brain cells in the digestive tract, insulin not required for glucose absorption, exercising muscles can utilize glucose without proportionate amounts of insulin. |
| What is the severe form of diabetes? | Type I or juvenile diabetes |
| What does insulin deficiency result from? | Destruction of pancreatic beta cells in an autoimmune reaction |
| Type I diabetes acute complications are what? | hypoglycemia, ketoacidosis |
| Type I diabetes predisposes to what diseases | Stroke, heart attacks, peripheral vascular disease, amputation, kidney failure, and blindness. |
| What are the signs and symptoms of diabetic ketoacidosis | dehydration, metabolic acidosis, and electrolyte imbalance |
| Signs of dehydration relative to ketoacidosis include | Thirst, dry, rough oral mucosa, and warm, dry skin, weak and thready rapid pulse, low blood pressure as vascular volume decreases, decreased urine output(oliguria) |
| What happens in ketoacidosis when dehydration advances or progresses? | renal compensation is reduced, acidosis becomes decompensated, serum pH falls, resulting in loss of consciousness |
| What causes metabolic acidosis with regard to ketoacidosis? | The binding of ketoacids with bicarbonate ions in the buffer. |
| What does electrolyte imbalance include with regard to ketoacidosis? | imbalances of sodium, potassium, and chloride |
| Signs of electrolyte imbalance with regard to ketoacidosis include? | abdominal cramps, nausea, and vomiting, as well as lethargy and weakness. |
| What happens if electrolyte imbalance is not controlled? (Ketoacidosis) | centeral nervous system depression develops owing to the acidosis and dehydration leading to coma. |
| Hyperosmolar hyperglycemic nonketotic coma is frequent in patients with what form of diabetes? | Type 2 Diabetes |
| What does severe cellular dehydration result in? | neurologic deficits, muscle weakness, difficulties with speech, and abnormal reflexes. |
| Which form of diabetes is weight gain or increased abdominal girth present? | Type 2 diabetes |
| What are chronic complications that arise as a result of diabetes? | degenerative changes in tissue, alterations in metabolic pathways, vascular problems. |
| What is microangiopathy | It is occurs when the capillary basement membrane becomes thick and hard. |
| What does microangiopathy lead to? | obstruction or rupture of capillaries and small arteries. |
| What does the obstruction or rupture of the capillaries and small arteries caused by microangiopathy lead to? | tissue necrosis and loss of function |
| What is retionopathy? | leading cause of blindness |
| What is diabetic nephropathy? | vascular degeneration in the kidney glomeruli, which eventually leads to chronic renal failure. |
| what is Macroangiopathy? | disease that affects the large arteries |
| What is caused by macroangiopathy? | high incidences of heart attaches, stroke, and peripheral vascular disease in diabetics |
| What is caused by peripheral neuropathy | leads to impaired sensation, numbness, tingling, weakness, and muscle wasting |
| Autonomic nerve degeneration caused by diabetes leads to what? | bladder incontinence, impotence, and diarrhea |
| What is the cause of infections in diabetic patients? | Delays in healing due to an insulin deficit and the increased glucose levels in the body fluids support infection |
| What are the type of infections seen in patients with diabetes? | fungal infections such as candida and periodontal disease, and dental caries |
| What is problem of the eyes that can occur in patients with diabetes? | cataracts. |
| What are the complications that a newborn can incur if their mother developed maternal diabetes | The newborn infant is usually larger than average in size and predisposed to complications |
| What may be the cause of Hypoparathyroidism? | congenital lack of the four parathyroid glands,following surgery or radiation in the neck region, or as a result of autoimmune disease. |
| What does Hypoparathyroidism Lead to | hypcalcemia or low serum calcium levels. |
| What does low serum calcium levels result in? | Week cardiac muscle contractions and also an increase in the excitability of nerves, which leads to spontaneous contraction of skeleteal muscle |
| Tetany caused by low serum calcium levels or spontaneous contraction of skeletal muscle is initially observed in what location. | Usually observed first in the face and hands. |
| Why does hypocalcemia affect the cardiac muscle cells | Cardiac muscle cells do not have large stores of calcium, but rely instead on calcium for the blood for contraction |
| What causes hypercalcemia or high serum calcium levels | Hyperparathyroidism |
| Hyperparathyroidism may be caused by what factors? | adenoma, hyperplasia, or secondary to renal failure. |
| What can be caused by hyperparathyroidism? | Osteoporosis, predisposition to kidney stones |
| Where does the most serious effects of Hyperparathyroidism occur? | occurs in bone tissue |
| what other factors besides hormone disorders can be the cause an imbalance in calcium? | serum levels of PTH and calcium |
| When does hypocalcemia(hypoparathyroidism) lead to high levels of PTH? | When there is a retention of phosphate ion and hyperphosphatemia in the blood during renal failure (low serum ca++ and high serum PTH) |
| When does hypocalcemia(hypoparathyroidism) lead to low levels of PTH | when hypercalcemia may be present along with low levels of PTH in cases of immobile patients or patients with bone cancer (high blood ca++ and low serum PTH) |
| Hypocalcemia(hypoparathyroidism) does what to the heart? | causes weak cardiac muscle contractions, arrhythmia, hyptension |
| What does hypocalcemia(Hypoparathyrodism) do to the gastrointestinal area | increased peristalsis, diarrhea, nausea, cramps |
| What are the most common cause of pituitary hormones? | benign adnomas |
| What two type of manifestations does benign adenomas lead to (cause of pituitary disorder) | Increased intracrainial pressure, excessive, deficient hormone secretions, hemorrhage or infarction.. |
| What is called when an adenoma causes destruction of part of a pituitary gland called? | pituitary apoplexy |
| What is it called when an untreated adenoma leads to destruction of all types of cells | panhypopituitarism |
| What do hypothalamic disorders include | tumors or infection |
| What causes dwarfism or short stature | deficit of growth hormone |
| What are the signs of pituitary dwarfism. | normal intelligence, normal body proportions, some delay in skeletal maturation, and puberty |
| What causes gigantism | Excess Growth Hormone before puberty and fusion of the epiphyses |
| What is acromegaly | effects of excess GH secretion in the adult, usually by an adenoma |
| What are the signs of acromegaly | bones become broader and heavier, soft tissue grows, resulting in enlarged hands and feet, a thicker skull and changes in facial features. |
| What causes diabetes insipidus | a deficit of anti-diuretic hormone (ADH) |
| What are the clinical manisfestations of diabetes insipidus | polyuria with large volume of dilute urine and thirst, that eventually leads to dehydration |
| What is not present in the urine with diabetes insipidus | glucose |
| What causes inappropriate ADH syndrome also called syndrom of inappropriate ADH | excess ADH |
| What causes Inappropriate ADH syndrom | stress, or may be secreted by ectopic sources (brochogenic carcinoma) |
| What is the sign of inappropriate ADH syndrome | severe hyponatremia |
| What are the two thyroid hormones? | thyroxine and triiodothyronin |
| What is the cause of thyroid disorders | pituitary or thyroid gland dysfunction |
| What happens when cabbage, turnips, and other related vegetables, lithium and flouride are injested in large quantities | blocks synthesis of T3 adn T4 increasing TSH secretions |
| What does increased TSH secretions cause | hyperplasia of the gland and goiter formation |
| What is goiter | Enlargment of the thyroid gland |
| What does goiter cause | compression of the esophagus intefering with swallowing or it can cause pressure on the trachea. |
| What is a form of hyyperthyroidism with increased T3 and T4 secretion | Grave's disease |
| Grave disease is manifested by what signs | hypermetabolism, toxic goiter, and exophthalmos, increased stimulation of the sympathetic nervous system magnifies the metabolic effects. |
| Exophthamos is evident by what? | presence of protruding, staring eyes, and decreased blink and eye movement. |
| Thyrotoxic crisis or thyroid storm results from what? | uncontrolled hyperthyroidism |
| Why is throtoxic crisis or thyroid storm life threatening | because of hyperthermia, tachycardia, and heart failure delirium |
| What are the several form that Hypothyroidism occur in? | hashimoto's thyroidits, myxedema, cretinism |
| What is hashimoto's thyroiditis? | destructive autoimmune disorder |
| What is Myxedema | severe hypothyroidism in adults |
| myxedema coma(acute hypothyroidism) results in what? | hypotension, hypoglycemia, hypothermia, and loss of consciousness |
| What is cretinism? | untreated congenital hypothroidism, related to iodine deficiency during pregnancy or may be a developmental defect. |
| What is the cause of cretinism | iodine deficiency during pregnancy or a developmental defect |
| what can accompany the early hypothyroidism disease of cretinism | mental retardation |
| What does lack of treatment of cretinism lead to? | severe impairment of all aspects of growth/physical development |
| Why does cretinism lead to severe impairment of growth | because the thyroid hormone affect the metabolism of all cells |
| What is pheochromocytoma? | benign tumor of the adrenal medulla that secretes epinephrine, norepinephrine, and other substances |
| What does pheochromocytoma cause | hypertension (but it is a treatable cause of hypertension) |
| If pheochromocytoma is diagnosed with regards to hypertension what are the signs | headache, heart palpitations, weating, and intermittent or constant anxiety |
| What is Cushing's syndrome | disease caused by excessive amounts of glucocorticoids |
| What does excess glucocorticoids result from? | adrenal adenoma, pituitary adenoma, ectopic carcinmoma, iatrogenic conditions |
| What is associated with Cushing's Syndrome | moon face, heavy trunk with fat at the back of the next, wasting of muscle in the limbs, fragile skin, catabolic effects such as osteoporosis, delays in healing, increased gluconeogenesis and insulin resistance, which may result in diabetes mellitus, |
| What is associated with cushing's syndrome | retention of sodium and water leading to hypertension, edema, and hyperkalmeia, suppressed immune response, atrophy of lymphoid tissue, erythrocyte production stimulated, emotional liability and euphoria |
| Two concerns of Cushing's syndrome | risk of local or systemic infection, a decreased stress response |
| What causes a decreased stress response in a patient iwth iatrogenic cushing's syndrome | atrophy of the adrenal cortex |
| What is addison's Disease | deficiency of adrenocortical secretions, the gloccorticoids, mminteralocoricoids and androgens |
| What is the major effects of hormonal deficits in addison's disease | decreased blood glucose levels, poor stress response, fatigue, weight loss, and frequent infection |
| What is the result in a deficit in mineralocoricoids when it comes to addison's disease | low serum sodium concentrain, decreased blood volume, and hypotension, accompanied by high potassium levls, cardiac arrhythmias and failure, decreased body hair |
| What causes decreased body hair in person with addisons disease | lack of androgens and hyper pigmentation in the extremities |
| what happens due to increased ACTH resulting from low cortisol secretion | lack of androgen and hyperpigmentain in the extemities, skin creases, buccal mucosa, and tongue. |
| Goiter refers to enlargement of the thyroid gland that can develop with what two conditions | hypothyroid and hyperthroid |
| Cushing's Syndrome is caused by excess glucocorticoids resulting from what? | pituitary or adrenal cortical tumor, ectopic tumor, or ingestion of glucoccorticoids |
| What are the major affects of cushing's syndrome | catabolic action on the bone, muscle, skin and depressed inflammatory and immune response. |
| The deficit of glucocorticoids, mineralcorticoids, and androgens, in addison's disease results in what? | affects blood glucose levels, fluid and electrolyte balance and the stress response. |
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Mickensg
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