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80 Cards in this Set
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- Back
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Endocrine System |
"complex arrangement of glands that impact and regulate multiple body systems through the synthesis and secretion of hormones." - organs release hormones into the circulation
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Endocrine Glands |
hypothalamus pituitary thyroid parathyroid adrenals pancreas (islets) gonads |
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Hormones |
blood-borne chemicals which regulate/coordinate biological functions
structurally are amines, peptides or steroids - water or lipid soluble |
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Hormone Secretion Regulation |
Feedback mechanisms - positive or negative feedback (negative is more common)
Direct signaling - neurally mediated: nerve is stimulated which stimulates the tissue to produce whatever it makes
Circadian rhythm - natural time clock of your body
Cycling - varying release based on a temporal parameter greater than 24hrs (monthly or yearly) - EX: menstrual cycle - exact mechanism is uncertain |
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Hormonal Interaction w/ Nervous and Immune Systems |
Nervous and endocrine systems show significant interdependence - autonomic nerves control endocrine gland blood flow - hormone can regulate nervous tissue
Immune and endocrine systems both use the nervous system and hormones as a means of communication allowing reciprocal regulation - immune disorders can cause endocrine disorders |
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Endocrine Gland Dysfunction |
Disease is most often a case of hypofunction and hyperfunction
Can also be due to tumors - tumors can cause the hypo or hyperfunction, but can do other things as well |
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Common Facts of Endocrine Diseases |
- function is tightly regulated - prolonged hyper stimulation by trophic hormones or metabolic signals leads to organ hyperfunction and enlargement of the target tissues (hypertrophy) * enlargement may be hyperplastic or neoplastic - hypofunction is usually due to incomplete development, atrophy or destruction of the organ's secretory cells - neoplastic (&hyperplastic) enlargement can cause lesions which compress adjacent structures causing a mass effect |
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Mass Effect |
If something is too big in a confined space it will push on things and cause symptoms (often gives the first symptoms that something is wrong)
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Endocrine Diseases: Tumors |
It is difficult for physicians to differentiate benign from malignant tumors in endocrine tissues
Some tumors may be paraneoplastic
Some tumors are associated w/ neoplasms of other glands |
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Hypothalamus |
- part of diencephalon, connected to pituitary gland - communication w/ anterior lobe is via hormones - communication w/ posterior lobe is via neurotransmitters |
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Hypothalamus Functions |
- body temperature - appetite - thirst - GI secretion and motility (peristalsis = gentle smooth contractions that move food through GI) - BP - sleep - circadian rhythms - fight/flight responses |
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Target Tissue of Hypothalamus |
Pituitary Gland |
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Hypothalamus Hormones |
- oxytocin - ADH (vasopressin) - corticotropin releasing hormone (CRH) - thyrotropin releasing hormone (TRH) - growth hormone releasing hormone (somatotropin) - growth hormone inhibiting hormone (somatostatin) - gonadotropin releasing hormone - prolactin releasing factor - prolactin release inhibiting factor |
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Pituitary Gland |
Sits in the sella turcica (base of brain, above the sphenoid bone)
Has an anterior and posterior lobe
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Functions of Pituitary Gland |
- control of most other endocrine glands * anterior lobe functions to control metabolism, reproductive and body growth, secretion of steroid hormones * posterior lobe functions to regulate reproduction (milk secretion, uterine contraction) and fluid balance (electrolytes) |
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Target Tissue of Pituitary Gland |
Gonads, thyroid, adrenals kidneys |
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Pituitary Gland Hormones |
- growth hormone - thyroid stimulating hormone (TSH) - adrenocorticotropic hormone (ACTH) - prolactin - follicle stimulating hormone - leutinizing hormone - vasopressin - oxytocin |
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Dysfuntion/Disease of Hypothalamus & Pituitary Glands |
Disease states due to tumors, elevated ICP, inflammatory diseases, infections, surgical excision of the gland and autoimmune disease or ischemia
Hyperfunction most often due to pituitary adenoma (can be common even in kids)
Hypofunction most often due to congenital/developmental defects, trauma or tumors |
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Non-functing Pituitary Tumors |
Non-secretory cell hyperplasia called "hormonally silent pituitary adenomas" - have some other glial cell tumor
Causes "mass effect" on nearby structures - compression of optic chiasm can cause partial blindness (bitemporal hemianopsia) - may also raise ICP (if they become big enough) * causes initial symptoms that seem unrelated |
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Signs and Symptoms of Growth Hormone Dysfunction |
Overproduction - gigantism (children) - acromegaly (adults) - bony/soft tissue overgrowth - enlarged hands, feet and head - goiter - amenorrhea in females (abnormal fertility cycle
Underproduction - slow growth - dwarfism in kids - few symptoms in adults |
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Signs & Symptoms of Prolactin Dysfunction |
Overproduction - amenorrhea in females - hypogonadism - breast enlargement - decreased female fertility
Underproduction - fatigue - loss of axially/pubic hair - inability to produce breast milk |
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Signs & Symptoms of Luteinizing Hormone Dysfunction |
Overproduction - no significant effect
Underproduction - hypogonadism - amenorrhea in females
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Signs & Symptoms of FSH Dysfunction |
Overproduction - no biological effect
Underproduction - hypogonadism - amenorrhea in females
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Signs & Symptoms of ADH (Vasopressin) Dysfunction |
Anti-duretic hormone for BP and blood volume regulation
Overproduction - increased body water retention
Underproduction - diabetes insipidus (excessive urination, dilute urine, polydipsia = excessive thirst) |
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Signs & Symptoms of Oxytocin Dysfunction |
Overproduction - no effect
Underproduction - decreased milk secretion - decreased uterine contraction during birth |
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Thyroid Gland |
Bi-lobed organ of the anterior neck, resting just below the larynx
Innervated by the adrenergic nervous system via the cervical ganglia and the cholinergic nervous system via the vagus nerve - sympathetic and parasympathetic control
Can hold a 30 day supply of hormones - makes it harder to treat |
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Thyroid Gland Functions |
- secretes thyroid hormones (requires IODINE) which control functions which influence protein production and O2 consumption |
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Target Tissue of Thyroid Gland |
many bodily tissues (anything that requires protein and O2) |
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Thyroid Gland Hormones |
T3 & T4 - control energy metabolism, growth/development, metabolic speed, body temp (more metabolism = more heat as a by-product) - a T3/T4 serum increase will increase basal metabolic rate
Calcitonin - regulates Ca++ and PO4 levels by stimulating demineralization of bone
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Thyroid Function is Altered by... |
- pregnancy - age - glucocorticoids (prednizone; steroid) - environmental temperatures - nutritional states - non-thyroid illness (thyroid lags after the illness is gone which causes symptoms) |
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Hyperthyroidism |
- associated w/ Graves Disease - toxic nodular goiter - secondary hyperthyroidism * thyroid storm - goes off the deep end resulting in tachycardia, hypertension, high BP (medical emergency)
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Hypothyroidism |
3 types of thyroiditis - Hashimoto's thyroiditis (autoimmune) - Subacute granulomatous thyroiditis (post viral illness) - Silent lymphocytic thyroiditis (occurs in new mothers after birth)
Also, due to thyroid cancers or insufficient intake of dietary iodine
Myxedema Coma |
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Myxedema Coma |
Thyroid goes on vacation and stops working
Severe untreated hypothyroidism w/ life-threatening bodily decompensation
- low body temp - low BP - slow HR - also a medical emergency |
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Signs & Symptoms of Thyroid Dysfunction: Cardiovascular System |
Hyperthyroidism (elevated BMR) - increased HR - palpitations at rest - increased cardiac output - hypertension - cardiac hypertrophy - angina - dyspnea on exertion (short of breath) - elevated respiratory rate
Hypothyroidism (lower BMR) - decreased HR - decreased cardiac output - narrow pulse pressure (difference between diastolic and systolic) - tendency toward CHF & MI - dyspnea |
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Signs & Symptoms of Thyroid Dysfunction: Neurological |
Hyperthyroidism (elevated BMR) - tremors - anxiety - mood lability (fast mood changes) - restlessness - confusion - rapid speech - agitation
Hypothyroidism (lowered BMR) - slow/slurred speech - impaired hearing - bilateral carpal tunnel syndrome (due to fluid retention) - depression - confusion - dementia - hoarse voice |
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Signs & Symptoms of Thyroid Dysfunction: Gastrointestinal |
Hyperthyroidism (elevated BMR) - diarrhea/frequent bowel movements - weight loss w/ increased appetite - splenomegaly
Hypothyroidism (lowered BMR) - constipation - distended abdomen - weight gain w/ decreased appetite |
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Signs & Symptoms of Thyroid Dysfunction: Musculoskeletal |
Hyperthyroidism (high BMR) - weakness w/ proximal muscle wasting (muscle is attacked and broken down)
Hypothyroidism (low BMR) - muscle aches and pains |
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Signs & Symptoms of Thyroid Dysfunction: Reproductive |
Hyperthyroidism (high BMR) - menstrual irregularities - decreased libido - impotence
Hypothyroidism (low BMR) - infertility - decreased libido - menstrual irregularities |
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Signs & Symptoms of Thyroid Dysfunction: General Appearance |
Hyperthyroidism (high BMR) - swollen, bulging eyes - hair loss - brittle nails - premature graying of hair - palmar erythema - goiter - appear skinny
Hypothyroidism (low BMR) - drooping eyelids - loss of eyebrows - dry skin - decreased sweating - "puffy face" - appear heavier |
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Signs & Symptoms of Thyroid Dysfunction: Other |
Hyperthyroidism (high BMR) - intolerance to heat - increased basal temp - increased sensitivity to stimulant medications - fatigue - insomnia - photophobia
Hypothyroidism (low BMR) - intolerance to cold - increased susceptibility to infections - anemia - enlarged tongue |
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Medical Treatment of Thyroid Dysfunction |
People can go between hyper and hypothyroidism, but the change does not happen rapidly - difficult to regulate w/ medications
Medications +/- surgical intervention (if necessary) |
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Parathyroid Gland |
4 small glands located behind the thyroid gland
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Functions of the Parathyroid Gland |
Calcium and phosphate homeostasis
Production of PTH |
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Target Tissue of the Parathyroid Gland |
- bone - kidney - intestinal mucosa |
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Hormones Made by the Parathyroid Gland |
PTH - stimulates the body to reserve its serum Ca++ by inhibiting bone formation and increasing Ca++ absorption in the intestinal mucosa |
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Diseases of Parathyroid Glands |
Hyperparathyroidism Hypoparathyroidism |
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Hyperparathyroidism |
Usually due to hereditary diseases or tumors
Secondary causes include renal disease or nutritional deficiencies (Ca++ and Vitamin D)
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Hypoparathyroidism |
Most often due to removal during surgery for disease of parathyroid, thyroid or other nearby tissues - most common thing is a thyroidectomy which can cause other damage to nerves or vessels (transient hypoparathyroidism) |
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Signs & Symptoms of Parathyroid Disease: Hyperparathyroidism |
GI - constipation - indigestion - nausea - vomiting - pancreatitis - anorexia (loss of appetite) Renal - kidney stones - polyuria - polydipsia - uremia Skeletal - osteitis fibrosa - osteoporisis - osteomalacia - arthritis Mental - lethargy - fatigue - depression - memory loss - psychotic paranoia - confusion Other - proximal muscle weakness - itching
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Signs & Symptoms of Parathyroid Disease: Hypoparathyroidism |
Neurological - seizures - paresthesias - organic brain syndrome - basal ganglia calcification Cardiac - QT interval prolongation - CHF Skeletal - shortened digits (especially 4th & 5th digits) Reproductive - infertility in males - oliomenorrhea in females Skin - dry, flaky skin and brittle nails |
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Adrenal Glands |
Located superior/medial to the kidneys
Composed of adrenal cortex and adrenal medulla
Influenced by the hypothalamic-pituitary axis and the autonomic nervous system
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Function of Adrenal Glands |
- regulate metabolism - cardiovascular function - renal function |
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Target Tissue of Adrenal Glands |
- kidneys - GI tract - cardiovascular structures - reproductive organs |
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Hormones of the Adrenal Glands |
Aldosterone (promotes renal sodium conservation and potassium excretion) * glucocorticoids - anti-inflammatory steroids
Cortisol (catabolic effect on cellular proteins, regulates foodstuff metabolism, anti-inflammatory, promotes normal excitability of the myocardium)
Androgens (increases masculinization, targeted body hair growth)
Epinephrine & Norepinephrine - stress response (fight or flight response) - increases HR & contractility - promotes vasoconstriction - dilates bronchioles - blocks insulin secretion - promotes glucagon release
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Adrenal Gland Diseases: Androgens |
Overproduction - hirsuitism - vertex alopecia - acne - testicular atrophy - uterine atrophy
Underproduction - insignificant
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Adrenal Gland Diseases: Aldosterone |
Overproduction - weakness - parestheias - muscle spasms - paralysis - polydipsia - increased urination
Underproduction - hypotension - cardiac failure - hypoglycemia - fatigue - decreased stress tolerance |
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Adrenal Gland Diseases: Cortisol |
Glucocorticoid - can happen when ppl take too much prednisone
Overproduction - "Cushing's Syndrome" - obesity - increased abdominal/torso fat - thinned skin - poor wound healing - hypertension - osteoporosis - impaired infection resistance - diabetes mellitus - kidney stones
Underproduction - "Addison's Disease" - fatigue - postural hypotension - skin darkening - weight loss - dehydration - myalgias (general muscle pain) - GI upset - hypoglycemia |
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Adrenal Gland Diseases: EPI & NOR |
Overproduction - hypertension - increased HR w/ increased force of contraction - excessive sweating - tachypnea - angina - GI upset
Underproduction - insignificant |
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Pancreas |
Intra-abdominal organ located behind the stomach, anterior to L1/L2
Performs endocrine and exocrine functions
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Functions of Pancreas |
Glucose homeostasis - endocrine function |
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Target Tissue of Pancreas |
all major body systems |
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Hormones of the Pancreas |
Insulin - promotes cellular uptake of ingested foodstuffs - reduces serum glucose levels
Glucagon - enhances adipose tissue lipolysis - increases serum glucose levels - stimulates hepatic glycogenolysis and gluconeogenesis
Somatostatin - inhibits insulin & glucagon |
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Metabolic Syndrome |
AKA "pre-diabetes"
Presence of 3 out of 5 diagnoses: - abdominal (central) obesity - hypertension - elevated fasting plasma glucose (above 110mg/dL) - hypertrigylceridemia - decreased high-density cholesterol (HDL) levels
Rare to see the pancreas go into overdrive and make too much insulin |
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Risk Factors of Metabolic Syndrome |
First world problem Warning system for diabetes development
Risk factors: - genetics - psychological stress - rheumatic disease - schizophrenia - sedentary lifestyle (poor diet choices, increased caloric intake, etc.) - aging (present in over 40% of the pop'n over 50 years old)
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Diabetes Mellitus Type I |
AKA juvenile onset
Auto-immune destruction of beta cells, causing minimal to no insulin production
Juvenile onset common, almost always by age 30
5% of all patients w/ diabetes |
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Diabetes Mellitus Type II |
Failure of beta cells to meet increased insulin demand due to peripheral tissue resistance to insulin
Onset after age 30, w/ obesity being a major risk factor
Appears to have a genetic link, w/ families having higher incidence (but not always) |
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Diabetes Mellitus Signs & Symptoms |
Polydipsia: constantly thirsty Polyuria: constantly peeing Polyphagia: increased appetite and eat more - but w/ weight loss often in Type I and weight gain in Type II
Elevated serum glucose levels - fasting glucose above 140 mg/dL - AVOID exercise in untreated person w/ DM if glucose is above 350 mg/dL
HgbA1C: measure of glycated hemoglobin (glucose pieces bound onto Hgb without the help of enzymes - "accidental bonding") - normal is 4%-6.5% - corresponds to trends in glucose levels over time - how much is deposited onto Hgb depends on how much glucose is in your system - way to check patient compliance or if the meds are working properly (measure over time) |
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Diabetic Ketoacidosis (DKA) |
Life-threatening state which occurs in patients w/ type I DM
Without proper amounts of insulin, cells burn protein and fat for energy - by-product of this metabolism is ketone bodies (ketones) due to anaerobic metabolism - this excess of ketones spill into the blood stream and urine - this low energy, acidotic state pushes the patient far out of metabolic homeostasis and can be deadly (dehydration, extremely high blood sugar levels) - treated in the intensive care unit w/ insulin, IV hydration, electrolyte replacement and other means of supportive care
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Diabetes Mellitus Chronic Complications |
Diabetic Neuropathy - chronically elevated serum glucose causes thickening of the vessel walls of arterioles (and arteries) of the extremities in a distal to proximal pattern (stocking and glove distribution) * lack of nourishment to peripheral nerve ends - local ischemia causes peripheral nerve dysfunction, causing: * paraesthesias/numbness, neuralgias * motor loss * muscle atrophy (ape hand) * autonomic dysfunction (postural hypotension, abnormal cardiac regulation) - if arterioles are not as responsive to HR changes when standing up they will develop postural hypotension |
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Diabetic Neuropathy: What it causes and treatment |
Impaired sensation places patients at high risk for un-noticed injuries (particularly the feet) - if you cannot feel your feet you will have a lack of balance and will not be able to compensate for that lack of balance due to muscle atrophy - if you cannot feel your feet, you can have an injury and not know it which can be complicated by poor bloody supply
No treatment to reverse condition
Treatment - daily skin inspection - serial sensory and motor testing - help them to learn to deal w/ their symptoms |
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Diabetes Mellitus Chronic Complications: Coronary, Cerebrovascular and Peripheral Vascular Disease |
Leading cause of death in persons w/ Type I DM
Atherosclerosis occurs earlier and more extensively in patients w/ DM - glycation (extra sugar in lining of vessels) - will also cause increased incidence of systemic hypertension
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Diabetes Mellitus Chronic Complications: Nephropathy |
Kidney Disease
DM is most common cause for end-stage kidney disease
Causes glomerular destruction of proteinuria due to ischemia |
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Diabetes Mellitus Chronic Complications: Retinopathy |
DM is leading cause of blindness in adults 20-74 years old
Retinopathy related to vascular abnormalities causing microaneuysms, neovascularization, hemorrhage and ischemia of the retina
DM is also associated w/ glaucoma, cataract formation and macular degeneration |
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Diabetes Mellitus Wound Healing |
Atherosclerotic changes due to DM pose a large risk successful wound healing - includes problems in microcirculation: basement membrane thickening, amyloid deposition, increased platelet aggregation and impaired fibrinolysis
Poor circulation to wound beds leads to slow healing
Additionally, hyperglycemia increases risk of wound infection and severity of infection - leukocyte dysfunction - germs like sugar!
Post-surgery doctors will put patients on insulin IV to tightly regulate blood glucose levels b/c low blood glucose levels decreases the risk of systemic and local infections |
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Neuropathic Joint Disease/ "Charcot Foot" |
Progressive destruction of weight bearing joints (usually of the foot and ankle)
Insidious onset - happens over time and you don't notice it
Process is a cascade of bone destruction, bone resorption and joint deformity - as it progresses, leads to skin/soft tissue ulceration, infection, and loss of function - may require amputation |
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2 Symptoms of Neuropathic Joint Disease |
Neurotrauma & Neurovascular |
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Neurotrauma of Neuropathic Joint Disease |
Loss of peripheral sensation of proprioception leads to repetitive "microtrauma" to the joint in question - this damage goes unnoticed by the neuropathic patient - the resultant inflammatory resorption of traumatized bone renders that region weak and susceptible to further trauma - vicious cycle - in addition, poor fine motor control generates unnatural pressure on certain joints leading to additional microtrauma |
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Neurovascular Symptom of Neuropathic Joint Disease |
Neuropathic patients have dysregulated autonomic nervous system reflexes - de-sensitized joints receive significantly greater blood flow - the resulting hyperemia leads to increased osteoclastic resorption of bone, and this, in concert w/ mechanical stress, leads to bony destruction |
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Charcot Foot |
Medial longitudinal arch flattens and reverses - can happen unilaterally or bilaterally
Can develop wounds from local ischemia |
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Treatment of Charcot Foot |
- make sure you check their feet for wounds - sensory and motor exam of their feet - prevent progression - local wound care - neuromuscular re-education - offload the joint (orthotics) - energy conservation (walking techniques) - aerobic and anaerobic conditioning |
