9.2A Pathophysiology - Endocrine Function And Metabolism

Front 1

______ gland regulates Ca levels

Back 1

Parathyroid gland (PTH)

- Disorders result in alt. of serum Ca levels

(less common than throid disorders)

Front 2

- Increase in the secretion of PTH
- Affects kidneys and bones
- Occurs rarely

Back 2

Hyperparathyroidism

Front 3

Patho of ______

- increased resorption of Ca and excretion of phosphorus by kidneys
- increased HCO3 excretion and decreased H+ ion excretion
- increased release of Ca and Phophorus by bones
- Deposits of Ca in soft tissues / renal calculi

Back 3

Hyperparathyroidism

Front 4

S&S of ______

- Asymptomatic
- Bone pain/ pathological fractures
- Renal calculi
- Abdominal pain
- Muscle weakness
- Acid-base disorder
- Electrolyte disorder

Back 4

Hyperparathyroidism

Front 5

DX for Hyperparathyroidism

Back 5

- Serum Ca levels
- Serum PTH levels
- Phosphorus
- Electrolytes
- Bone Scans

Front 6

Low levels of PTH hormone, decreased serum Ca levels, occurs rarely

Back 6

Hypoparathyroidism

Front 7

S&S of ______

- Parathesia
- Tetany
- Numbness
- Muscle spasms
- Hyperactive reflexes
- Malabsorption
- Seizures

Back 7

Hypoparathyroidism

Front 8

DX for Hypoparathyroidism

Back 8

- Serum Ca level
- Serum Phosphorus level
- Positive Chvostek & Trousseaus's signs

Front 9

Constructive phase; Requires energy, synthesis of protoplasm for growth and repair.

Back 9

Anabolism

Front 10

The destructive phase; Complex substances converted to ATP.

Back 10

Catabolism

Front 11

T/F - Brain & Nervous depend exclusively on glucose metabolism for energy.

Back 11

True

Front 12

T/F - Brain & NS can store and synthesize glucose.

Back 12

False, must extract it from the blood.

Front 13

How much glucose does the body need daily?

Back 13

100-115 grams / day

Front 14

Liver's role in glucose metabolism?

Back 14

Liver regulates entry of glucose into the blood.

Front 15

1. breakdown of glycogen to produce glucose for energy
2. Occurs while in the liver or after stored

Back 15

Glycogenolysis

Front 16

Hormone control of _______ ?

- Glucagon - in liver
- Epinephrine - in skeletal muscle

Back 16

Glycogenolysis

Front 17

1. Synthesis of glucose from sources other than glycogen
2. Amino acids, lactate, & glycerol converted
3. Occurs mostly in liver
4. Glucose stored as glycogen or released into blood

Back 17

Gluconeogenesis

Front 18

Hormonal control of ______ ?

- Glucagon (in blood)
- Glucocorticoid (adrenal hormone)
- Thyroid hormone

Back 18

Gluconeogenesis

Front 19

Enzymes & lipases breakdown triglycerides.

Back 19

Fat metabolism

Front 20

Most amino acids contained in body proteins excess are converted to fatty acids, ketones, & glucose

Back 20

Protein metabolism

Front 21

Hormonal control of Metabolism

Pancreas secretes insulin (b cells) which:

Back 21

1. Provides for glucose storage
2. Prevents fat breakdown into ketones (acids)
3. Increases protein synthesis

Front 22

Hormonal control of Metabolism

Pancreas secretes Glucagon (a cells) which:

Back 22

- Breakdown of glycogen via glycogenolysis
- Synthesis of glucose via gluconeogenesis
- increase Fat & protein breakdown

Front 23

The ratio of glucagon to insulin actually determines _____ ?

Back 23

blood glucose levels

Front 24

_______ _________ levels are the amount of sugar which is released into blood by liver and removed by body tissues

Back 24

Blood glucose

Front 25

Hormones helping maintain or increase Blood Glucose Levels (besides insulin or glucagon)

Back 25

1. Epinephrine
2. Growth Hormone
3. Glucocorticoid

Front 26

Identify the following:
1. ACTH
2. FSH
3. TSH
4. GH
5. ADH

Back 26

1. adrenocorticotropic hormone
2. follicle-stimulating hormone
3. thyroid stimulating hormone
4. somatotropin
5. antidiuretic hormone

Front 27

Alpha cells produce ________ which _______ blood glucose.

Beta cells produce _______ which ______ blood glucose.

Back 27

glucagon, elevates

insulin, lowers

Front 28

Which hormones promote glycogenesis and gluconeogenesis?

Back 28

- glucagon
- epinephrine
- GH
- glucocorticoid

Front 29

Feedback Mechanisms
increase hormone levels = _______
decrease hormone levels

Back 29

decreased hormone synthesis and release

increased hormone synthesis and release

Front 30

- Secreted by pituitary
- Children = req. for growth
- Adults = maintain organ size/ protein synthesis

Back 30

GH (somatotropin)

Front 31

Causes Deficiency of ______ ?

- Idiopathic (lack of _____ releasing factor)
- Pituitary tumors (cause decrease in _____)
- Dwarfism (levels are present but body unable to utilize them)

Back 31

GH

Front 32

Causes Excess _______ ?

- Usually pituitary tumor
- Gigantism - excess _____ before puberty
- Acromegaly - over-stimulation of Beta cells in pancreas; excess _____ after puberty

Back 32

GH

Front 33

Clinical Manifestations of ______ ?

- Usually adults, thickened bones and soft tissue
- enlargement of hands and feet

Back 33

Excess GH

Front 34

_________ which primarily secrete thyroglobulin regulate pressence of Iodine. Takes up & concentrates large amts. of Iodine (in the form of Iodine) for T4 (thyroxine) and T3 (triodothyronine)

Back 34

Follicular cells

Front 35

What hormones are these?

- Thyroglobulin
- T4 (Thyroxine)
- T3 (Triodothyronine)

Back 35

Thyroid Hormones

Front 36

Function of _______ ?

- increase metabolism of all cells
- Helps regulate metabolism of carbohydrates, lipids, protein
- increase protein synthesis
- Catabolizes protein
- promotes G & D in children
- Synergistic effect with catecholamines

Back 36

Thyroid

Front 37

Congenital hypothyroidism

Back 37

cretinism

Front 38

Aquired (Etiological factors) of _______ ?

- Hashimoto's Thyroiditis
- Aging
- Thyroidectomy
- Radiation to neck/head
- Scleroderma
- Iodine Deficiency
- Antithyroid medications
- Defective hormone synthesis

Back 38

Hypothyroidism

Front 39

Clinical manifestions of _______ ?
- from decreased BMR, mild initially
- fatigue
- weight gain
- cool dry skin
- hoarseness
- goiter
- cold intolerance
- decreased sweating

Back 39

Hypothyroidism

Front 40

Complications from _______ ?

- Arteriosclerosis and coronary heart disease
- Anemia
- Increased risk of infections
- Respiratory distress
- Myxedema (acute hypothyroidism)

Back 40

Hypothyroidism

Front 41

Develops in undiagnosed or undertreated hypothyroidism

Back 41

Myxedema

Front 42

Precipitating factors of _______ ?

- physical stress
- trauma
- exposure to extreme cold
- drugs (anesthesia, sedatives, narcotics)
- excess antithyroid medication

Back 42

Myxedema

Front 43

S&S of _______ ?

- slowed movement
- cool dry skin
- fatigue
- hoarseness
- cold intolerance
- facial & body puffiness
- weight gain
- goiter
- decreased sweating

Back 43

Myxedema

Front 44

Grave's Disease; autoimmune disorder

Back 44

Hyperthyroidism

Front 45

Causes of ________ ?

- Thyroid carcinoma
- Toxic nodular goiter
- too much thyroid replacement medication
- most common cause is Grave's Disease

Back 45

Hyperthyroidism

Front 46

- Primarily affects women 30-40 years old
- thought to be autoimmune diseases -> antibody production -> TSH receptors -> excessive TH secretions
- primary characteristics: Hyperthyroidism, goiter

Back 46

Grave's Disease

Front 47

Clinical Manifestations of ________ ?

- nervousness
- irritability
- fatigue
- weight loss with large appetite
- increased HR
- SOB
- excess sweating
- heat intolerance
- fine motor tremor
- exophthalmos
- goiter

Back 47

Hyperthyroidism

Front 48

Lab finding with _______ ?

- decreased TSH
- increased T3 and T4

Back 48

Hyperthyroidism

Front 49

Complications of ________ ?

- Exophthalmus - can lead to corneal ulceration (bulging eyes)
- Heart disease - Atrial fibrillation, tachycardia CHF
- Thyroid Storm

Back 49

Hyperthyroidism

Front 50

Also called vasopressin. Synthesized in hypothalamus; stored in pituitary gland. Secretion stimulated by increase in osmalality of the blood and decrease in blood pressure.

Back 50

Anti-diuretic hormone

Front 51

Function of ADH

Back 51

controls the excretion of water by the kidneys. has "antidiuretic" effect

Front 52

Decreased ADH

Back 52

Diabetes Insipidus

Front 53

Causes of _______ ?

- Head trauma
- Brain tumor
- Removal of pituitary
- CNS infection
- Unresponsive renal tubules

Back 53

Diabetes Insipidus

Front 54

Lab findings of _______ ?

- Low urine osmolality
- Serum osmolality
- Hypernatremia
- Hypokalemia

Back 54

Diabetes Insipidus

Front 55

Complication of _______ ?

- Hypovolemic shock

Back 55

Diabetes Insipidus

Front 56

Increased ADH

Back 56

Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)

Front 57

Causes of _______ ?

- Small cell carcinoma
- Brain trauma
- Infections
- Some chemotherapy agents
- Excessive treatment with DDAVP

Back 57

SIADH

Front 58

Lab finding of _______ ?

- Hyponatremia
- Increased urine sodium
- BUN increased
- Decreased serum osmolality
- Increased urine osmolality

Back 58

SIADH

Front 59

Complications of _______ ?

- seizures
- brain damage

Back 59

SIADH

Front 60

Adrenal gland hormone of the Inner Medulla

Back 60

Epinephrine/Norepinephrine

Front 61

Adrenal gland hormone of the Outer cortex

Back 61

Corticosteroids

Front 62

Adrenal gland hormone of the Mineralcorticoids

Back 62

Aldosterone

Front 63

Control mechanisms of _______ ?

- high serum potassium
- low serum sodium
- ACTH - adrenocorticotropin

Back 63

Mineralcorticoids

Front 64

Functions of _______ ?

- Increases sodium absorption
- Increases potassium excretion

Back 64

Mineralcorticoids

Front 65

Adrenal gland hormone of the Glucocorticoids

Back 65

Cortisol

Front 66

Functions of _______ ?

- regulated through a neg. feedback system
- increases blood glucose levels
- Stimulates appetite
- Increases blood concentrations of amino acids
- Increases use of fatty acids as energy
- Decreases capillary permeability
- Inhibits prostaglandin synthesis

Back 66

Glucocorticoids

Front 67

Steroid hormone, such as testosterone or androsterone that controls the development and maintanance of masculine characteristics

Back 67

Androgens

Front 68

Excess production of glucocorticoids, mineralcorticoids, and androgens

Back 68

Hyperfunctioning Adrenal Gland

Front 69

Cushing's Syndrome

Back 69

Hypercortisolism

Front 70

Causes of ________ ?

- High-dose glucocorticoid use (Most common iatrogenic cause)
- Adrenal tumors
- Pituitary tumors

Back 70

Hypercortisolism

Front 71

Manifestations of _______ ?

- Fat deposition
- protruding abdomen "buffalo hump" "moon face"
- muscle wasting and weakness
- thin extremities

Back 71

Hypercortisolism

Front 72

Excess production of mineralcorticoid hormone (aldosterone) by adrenal cortex.

Back 72

Primary aldosteronism

Front 73

Causes of _______ ?

(primary) - defect or tumor of adrenal
(secondary) - CHF
- Cirrhosis of liver
- Nephrotic syndrome

Back 73

Primary aldosteronism

Front 74

Clinical manifestations of _______ ?

- Hypertension
- decrease K+
- hypernatremia

Back 74

Primary aldosteronism

Front 75

Autoimmune disorder; 90% of gland destroyed before symptomatic.

Back 75

Addison's Disease

Front 76

Addison's Disease

Back 76

Hypofunctioning of Adrenal Gland

Front 77

Risk factors for ________ ?

- history of other endocrine disorders
- sudden cessation of glucocorticoids if taken > 3 weeks
- Tuberculosis
- Adrenalectomy
- Primary vs. Secondary -> life long tx

Back 77

Addison's Disease

Front 78

Clinical Manifestations of ________ ?

- Anorexia
- weight loss
- N/V
- Myalgia
- arthralgia
- orthostatic hypotension
- hyponatremia
- hyperkalemia

Back 78

Addison's Disease

Front 79

A severe phase or attack of a chronic adrenocortical disorder, characterized by insufficient amounts of the adrenocortical hormones and resulting in nausea, vomiting, low blood pressure, and life-threatening imbalances in electrolytes.

Back 79

Adrenal Crisis (Addisonian Crisis)

Front 80

Inadequate or lack of insulin resulting in hyperglycemia

Back 80

Diabetes

Front 81

Types of Diabetes (8)

Back 81

1. Type I
2. Type II
3. Maturity Onset Diabetes of the Young (MODY)
4. Idiopathic Type I Diabetes (Type 1b)
5. Latent Autoimmune Diabetes in Adults (LADA)
6. Youth Onset Atypical Diabetes (YOAD)
7. Impaired Glucose Tolerance
8. Gestational Diabetes

Front 82

Insulin Dependent Diabetes

Back 82

Type I Diabetes (IDDM)

Front 83

- characterized by destruction of pancreatic beta cells
- absolute insulin deficiency
- was named "Juvenile Diabetes"
- more common occurence in younger people but can occur at any age
- immune mediated more common
- Idiopathic

Back 83

IDDM

Front 84

Non-insulin Dependent Diabetes

Back 84

Type II Diabetes (NIDDM)

Front 85

- presence of hyperglycemia in association w/ relative insulin deficiency
- can have high, low or normal insulin levels
- Dysfunction of both insulin levels and insulin function

Back 85

NIDDM

Front 86

Clinical manifestations of _______ ?

- polyuria
- polydipsia
- polyphagia
- dry flushed skin
- confusion
- Kussmaul resp.
- N/V
- fruity breath
- lethargy - coma

Back 86

NIDDM

Front 87

Routine Monitoring Lab Test

Back 87

- fasting blood glucose
- Hgb A1C - measures glucose control over time
- urine glucose & ketones
- urine protein

Front 88

S&S of _______ ?

- pallor
- diaphoresis
- hunger
- nausea
- anxiety
- irritability
- difficulty concentrating
- decreased LOC - coma

Back 88

Hypoglycemia

Front 89

Acute complications of Diabetes (3)

Back 89

- Hypoglycemia
- Diabetic Ketoacidosis
- Hyperosmolar Coma (HHNK)

Front 90

- accumulation in blood & tissues large quantities of ketone bodies --> metabolic acidosis; ketone production by the liver exceeds cellular utilization & renal excretion; lack of insulin --> breakdown of fats

Back 90

Diabetic Ketoacidosis

Front 91

Diabetic Ketoacidosis occurs with which diabetes?

Back 91

Type I

Front 92

Clinical manifestations of _______ ?

- slow onset
- polyuria
- polydypsia
- N/V
- fatigue progressing to coma

Back 92

Diabetic Ketoacidosis

Front 93

Extreme hyperglycemia and serum osmolality.

Back 93

Hyperosmolar Coma (HHNK)

Front 94

Hyperosmolar Coma (HHNK) occurs with which diabetes?

Back 94

Type II

Front 95

Occurs with
- acute pancreatitis
- severe infections / MI
- hyperthyroidism
- hyperalimentation
- Type II diabetes

Back 95

Hyperosmolar Coma (HHNK)

Front 96

Clinical manifestations of ________ ?

- dehydration
- neurological symptoms (seizures)
- excessive thirst

Back 96

Hyperosmolar Coma (HHNK)

Front 97

Complications of Diabetes

Back 97

- Metabolic syndrome
- Microvascular
- Macrovascular

Front 98

- increased triglycerids
- decreased HDL
- HTN
- CHD (coronary artery disease)
- increased waist ratio

Back 98

Metabolic syndrome

Front 99

- Capillary basement membrane thickening
- Diffuse glomerular sclerosis
- Nodular glomerulosclerosis
- Leading cause of ESRD
- First manifestation of microalbuminemia

Back 99

Nephropathy

Front 100

- Leading cause of blindness
- Abnormal retinal permeability
- Microaneurysms
- Neovascularization
- Hemorrhage
- scarring
- retinal detachment
- on exam hemorrhages & exudates

Back 100

Retinopathy

Front 101

What are the two Microvascular Diabetes complications?

Back 101

1. Nephropathy
2. Retinopathy

Front 102

What are the two Macrovascular Diabetes complications?

Back 102

1. Cardiovascular
2. Neuropathy

Front 103

Diabetes appears to act as an amplifier of CV risk, multiplying the impact of underlying risk factors.

Back 103

Cardiovascular diabetes complications

Front 104

- Hyperlipidemia
- HTN (very important risk factor) - Particularly true for microvascular complications
- CVA, CAD, PVD
- Hyperlipidemia

Back 104

Cardiovascular diabetes complications

Front 105

- decreased sensation
- peripheral pulses
- "stocking ang glove"
- can affect cranial nerves
- diabetic foot leading cause of non traumatic amputation
- More at risk for infection

Back 105

Peripheral Neuropathic diabetes complications

Front 106

- Impotence
- gastroparesis

Back 106

Autonomic Neuropathic diabetes complications

Front 107

Age related changes (diabetes)

- Other chronic illnesses cause problems.

Back 107

Elderly

Front 108

Age related changes (diabetes)

- usually type I
- diet challenges
- puberty

Back 108

Child

Front 109

What hormone corresponding to adrenergic receptors (SNS) causes vasodilation in kidneys, heart, and viscera

Back 109

Dopamine

Front 110

What adrenergic receptor (SNS) causes
- vasoconstriction of blood vessels
- decreased renin
- glycogenolysis/gluconeogenesis
- GU contraction
- Uterine contraction
- Myadriasis

Back 110

Alpha 1 Receptors

Front 111

What controls involuntary responses in smooth muscle and secretory glands & visceral organs
- Functions to maintain homeostasis
- Responds to stress and repair tissues.

Back 111

Autonomic Nervous System (ANS)

Front 112

What causes:
- "fight or flight" / stress state (adrenergic response)
- sympathetic neurotransmitters
- catecholamines (epinephrine, norepinephrine, dopamine)

Back 112

Sympathetic Nervous System (SNS)

Front 113

What does mnemonic SLUDGE stand for?

Back 113

S alivation
L acrimation
U rinary incontinence
D iarrhea
G I cramps
E mesis

Front 114

What action is the mnemonic SLUDGE describing?

Back 114

PNS Acetylcholine action

Front 115

What is responsible for:
- Rest and Digestion / Calming (cholinergic response)

Back 115

Parasympathetic Nervous System (PNS)

Front 116

What is the primary cholinergic neurotransmitter and where is it active?

Back 116

Acetylcholine (ACh), active with the PNS. (75% nerve fibers in vagus nerve.)

Front 117

What adrenergic receptor (SNS) causes:
- increased HR
- increased myocardial contraction
- increased automaticity
- increased rate of conduction
- increased renin

Back 117

Beta 1 Receptors

Front 118

What adrenergic receptor (SNS) causes:
- bronchodilation
- vasodilation
- decreased GI motility
- gluconeogenesis/glucogenolysis
- GU relaxation
- uterine relaxation

Back 118

Beta 2 Receptors

Front 119

What adrenergic receptor (SNS):
- inhibits release of norepinephrine
- inhibits receptory

Back 119

Alpha 2 Receptors

Front 120

What system regulates the body levels of thyroid hormone?

Back 120

hypothalamic-pituitary-thyroid feedback system

Front 121

What hormone causes these actions?

- constricts bronchioles
- decreases HR
- vasodilation
- increased GI motility
- constricts pupils
- contracts bladder

Back 121

Actions of Acetylcholine (ACh)

Front 122

What are the two main pancreas secretions?

Back 122

- insulin (b cells)
- glucagon (a cells)

Front 123

which adrenergic receptors (SNS) inhibit release of norepinephrine; (inhibitory receptor)

Back 123

Alpha 2 receptors

Front 124

The actions below are from what hormone?

- provides for glucose storage
- prevents fat breakdown into ketones (acids)
- increases protein synthesis

Back 124

Insulin (b cells)

Front 125

The actions below are from what hormone?

- breakdown of glycogen via glycogenolysis
- synthesis of glucose via gluconeogenesis
- increased fat & protein breakdown

Back 125

Glucagon (a cells)