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125 Cards in this Set

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______ gland regulates Ca levels
Parathyroid gland (PTH)

- Disorders result in alt. of serum Ca levels

(less common than throid disorders)
- Increase in the secretion of PTH
- Affects kidneys and bones
- Occurs rarely
Hyperparathyroidism
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
Hyperparathyroidism
S&S of ______

- Asymptomatic
- Bone pain/ pathological fractures
- Renal calculi
- Abdominal pain
- Muscle weakness
- Acid-base disorder
- Electrolyte disorder
Hyperparathyroidism
DX for Hyperparathyroidism
- Serum Ca levels
- Serum PTH levels
- Phosphorus
- Electrolytes
- Bone Scans
Low levels of PTH hormone, decreased serum Ca levels, occurs rarely
Hypoparathyroidism
S&S of ______

- Parathesia
- Tetany
- Numbness
- Muscle spasms
- Hyperactive reflexes
- Malabsorption
- Seizures
Hypoparathyroidism
DX for Hypoparathyroidism
- Serum Ca level
- Serum Phosphorus level
- Positive Chvostek & Trousseaus's signs
Constructive phase; Requires energy, synthesis of protoplasm for growth and repair.
Anabolism
The destructive phase; Complex substances converted to ATP.
Catabolism
T/F - Brain & Nervous depend exclusively on glucose metabolism for energy.
True
T/F - Brain & NS can store and synthesize glucose.
False, must extract it from the blood.
How much glucose does the body need daily?
100-115 grams / day
Liver's role in glucose metabolism?
Liver regulates entry of glucose into the blood.
1. breakdown of glycogen to produce glucose for energy
2. Occurs while in the liver or after stored
Glycogenolysis
Hormone control of _______ ?

- Glucagon - in liver
- Epinephrine - in skeletal muscle
Glycogenolysis
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
Gluconeogenesis
Hormonal control of ______ ?

- Glucagon (in blood)
- Glucocorticoid (adrenal hormone)
- Thyroid hormone
Gluconeogenesis
Enzymes & lipases breakdown triglycerides.
Fat metabolism
Most amino acids contained in body proteins excess are converted to fatty acids, ketones, & glucose
Protein metabolism
Hormonal control of Metabolism

Pancreas secretes insulin (b cells) which:
1. Provides for glucose storage
2. Prevents fat breakdown into ketones (acids)
3. Increases protein synthesis
Hormonal control of Metabolism

Pancreas secretes Glucagon (a cells) which:
- Breakdown of glycogen via glycogenolysis
- Synthesis of glucose via gluconeogenesis
- increase Fat & protein breakdown
The ratio of glucagon to insulin actually determines _____ ?
blood glucose levels
_______ _________ levels are the amount of sugar which is released into blood by liver and removed by body tissues
Blood glucose
Hormones helping maintain or increase Blood Glucose Levels (besides insulin or glucagon)
1. Epinephrine
2. Growth Hormone
3. Glucocorticoid
Identify the following:
1. ACTH
2. FSH
3. TSH
4. GH
5. ADH
1. adrenocorticotropic hormone
2. follicle-stimulating hormone
3. thyroid stimulating hormone
4. somatotropin
5. antidiuretic hormone
Alpha cells produce ________ which _______ blood glucose.

Beta cells produce _______ which ______ blood glucose.
glucagon, elevates

insulin, lowers
Which hormones promote glycogenesis and gluconeogenesis?
- glucagon
- epinephrine
- GH
- glucocorticoid
Feedback Mechanisms
increase hormone levels = _______
decrease hormone levels
decreased hormone synthesis and release

increased hormone synthesis and release
- Secreted by pituitary
- Children = req. for growth
- Adults = maintain organ size/ protein synthesis
GH (somatotropin)
Causes Deficiency of ______ ?

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

- Usually pituitary tumor
- Gigantism - excess _____ before puberty
- Acromegaly - over-stimulation of Beta cells in pancreas; excess _____ after puberty
GH
Clinical Manifestations of ______ ?

- Usually adults, thickened bones and soft tissue
- enlargement of hands and feet
Excess GH
_________ 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)
Follicular cells
What hormones are these?

- Thyroglobulin
- T4 (Thyroxine)
- T3 (Triodothyronine)
Thyroid Hormones
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
Thyroid
Congenital hypothyroidism
cretinism
Aquired (Etiological factors) of _______ ?

- Hashimoto's Thyroiditis
- Aging
- Thyroidectomy
- Radiation to neck/head
- Scleroderma
- Iodine Deficiency
- Antithyroid medications
- Defective hormone synthesis
Hypothyroidism
Clinical manifestions of _______ ?
- from decreased BMR, mild initially
- fatigue
- weight gain
- cool dry skin
- hoarseness
- goiter
- cold intolerance
- decreased sweating
Hypothyroidism
Complications from _______ ?

- Arteriosclerosis and coronary heart disease
- Anemia
- Increased risk of infections
- Respiratory distress
- Myxedema (acute hypothyroidism)
Hypothyroidism
Develops in undiagnosed or undertreated hypothyroidism
Myxedema
Precipitating factors of _______ ?

- physical stress
- trauma
- exposure to extreme cold
- drugs (anesthesia, sedatives, narcotics)
- excess antithyroid medication
Myxedema
S&S of _______ ?

- slowed movement
- cool dry skin
- fatigue
- hoarseness
- cold intolerance
- facial & body puffiness
- weight gain
- goiter
- decreased sweating
Myxedema
Grave's Disease; autoimmune disorder
Hyperthyroidism
Causes of ________ ?

- Thyroid carcinoma
- Toxic nodular goiter
- too much thyroid replacement medication
- most common cause is Grave's Disease
Hyperthyroidism
- Primarily affects women 30-40 years old
- thought to be autoimmune diseases -> antibody production -> TSH receptors -> excessive TH secretions
- primary characteristics: Hyperthyroidism, goiter
Grave's Disease
Clinical Manifestations of ________ ?

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

- decreased TSH
- increased T3 and T4
Hyperthyroidism
Complications of ________ ?

- Exophthalmus - can lead to corneal ulceration (bulging eyes)
- Heart disease - Atrial fibrillation, tachycardia CHF
- Thyroid Storm
Hyperthyroidism
Also called vasopressin. Synthesized in hypothalamus; stored in pituitary gland. Secretion stimulated by increase in osmalality of the blood and decrease in blood pressure.
Anti-diuretic hormone
Function of ADH
controls the excretion of water by the kidneys. has "antidiuretic" effect
Decreased ADH
Diabetes Insipidus
Causes of _______ ?

- Head trauma
- Brain tumor
- Removal of pituitary
- CNS infection
- Unresponsive renal tubules
Diabetes Insipidus
Lab findings of _______ ?

- Low urine osmolality
- Serum osmolality
- Hypernatremia
- Hypokalemia
Diabetes Insipidus
Complication of _______ ?

- Hypovolemic shock
Diabetes Insipidus
Increased ADH
Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)
Causes of _______ ?

- Small cell carcinoma
- Brain trauma
- Infections
- Some chemotherapy agents
- Excessive treatment with DDAVP
SIADH
Lab finding of _______ ?

- Hyponatremia
- Increased urine sodium
- BUN increased
- Decreased serum osmolality
- Increased urine osmolality
SIADH
Complications of _______ ?

- seizures
- brain damage
SIADH
Adrenal gland hormone of the Inner Medulla
Epinephrine/Norepinephrine
Adrenal gland hormone of the Outer cortex
Corticosteroids
Adrenal gland hormone of the Mineralcorticoids
Aldosterone
Control mechanisms of _______ ?

- high serum potassium
- low serum sodium
- ACTH - adrenocorticotropin
Mineralcorticoids
Functions of _______ ?

- Increases sodium absorption
- Increases potassium excretion
Mineralcorticoids
Adrenal gland hormone of the Glucocorticoids
Cortisol
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
Glucocorticoids
Steroid hormone, such as testosterone or androsterone that controls the development and maintanance of masculine characteristics
Androgens
Excess production of glucocorticoids, mineralcorticoids, and androgens
Hyperfunctioning Adrenal Gland
Cushing's Syndrome
Hypercortisolism
Causes of ________ ?

- High-dose glucocorticoid use (Most common iatrogenic cause)
- Adrenal tumors
- Pituitary tumors
Hypercortisolism
Manifestations of _______ ?

- Fat deposition
- protruding abdomen "buffalo hump" "moon face"
- muscle wasting and weakness
- thin extremities
Hypercortisolism
Excess production of mineralcorticoid hormone (aldosterone) by adrenal cortex.
Primary aldosteronism
Causes of _______ ?

(primary) - defect or tumor of adrenal
(secondary) - CHF
- Cirrhosis of liver
- Nephrotic syndrome
Primary aldosteronism
Clinical manifestations of _______ ?

- Hypertension
- decrease K+
- hypernatremia
Primary aldosteronism
Autoimmune disorder; 90% of gland destroyed before symptomatic.
Addison's Disease
Addison's Disease
Hypofunctioning of Adrenal Gland
Risk factors for ________ ?

- history of other endocrine disorders
- sudden cessation of glucocorticoids if taken > 3 weeks
- Tuberculosis
- Adrenalectomy
- Primary vs. Secondary -> life long tx
Addison's Disease
Clinical Manifestations of ________ ?

- Anorexia
- weight loss
- N/V
- Myalgia
- arthralgia
- orthostatic hypotension
- hyponatremia
- hyperkalemia
Addison's Disease
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.
Adrenal Crisis (Addisonian Crisis)
Inadequate or lack of insulin resulting in hyperglycemia
Diabetes
Types of Diabetes (8)
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
Insulin Dependent Diabetes
Type I Diabetes (IDDM)
- 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
IDDM
Non-insulin Dependent Diabetes
Type II Diabetes (NIDDM)
- 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
NIDDM
Clinical manifestations of _______ ?

- polyuria
- polydipsia
- polyphagia
- dry flushed skin
- confusion
- Kussmaul resp.
- N/V
- fruity breath
- lethargy - coma
NIDDM
Routine Monitoring Lab Test
- fasting blood glucose
- Hgb A1C - measures glucose control over time
- urine glucose & ketones
- urine protein
S&S of _______ ?

- pallor
- diaphoresis
- hunger
- nausea
- anxiety
- irritability
- difficulty concentrating
- decreased LOC - coma
Hypoglycemia
Acute complications of Diabetes (3)
- Hypoglycemia
- Diabetic Ketoacidosis
- Hyperosmolar Coma (HHNK)
- 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
Diabetic Ketoacidosis
Diabetic Ketoacidosis occurs with which diabetes?
Type I
Clinical manifestations of _______ ?

- slow onset
- polyuria
- polydypsia
- N/V
- fatigue progressing to coma
Diabetic Ketoacidosis
Extreme hyperglycemia and serum osmolality.
Hyperosmolar Coma (HHNK)
Hyperosmolar Coma (HHNK) occurs with which diabetes?
Type II
Occurs with
- acute pancreatitis
- severe infections / MI
- hyperthyroidism
- hyperalimentation
- Type II diabetes
Hyperosmolar Coma (HHNK)
Clinical manifestations of ________ ?

- dehydration
- neurological symptoms (seizures)
- excessive thirst
Hyperosmolar Coma (HHNK)
Complications of Diabetes
- Metabolic syndrome
- Microvascular
- Macrovascular
- increased triglycerids
- decreased HDL
- HTN
- CHD (coronary artery disease)
- increased waist ratio
Metabolic syndrome
- Capillary basement membrane thickening
- Diffuse glomerular sclerosis
- Nodular glomerulosclerosis
- Leading cause of ESRD
- First manifestation of microalbuminemia
Nephropathy
- Leading cause of blindness
- Abnormal retinal permeability
- Microaneurysms
- Neovascularization
- Hemorrhage
- scarring
- retinal detachment
- on exam hemorrhages & exudates
Retinopathy
What are the two Microvascular Diabetes complications?
1. Nephropathy
2. Retinopathy
What are the two Macrovascular Diabetes complications?
1. Cardiovascular
2. Neuropathy
Diabetes appears to act as an amplifier of CV risk, multiplying the impact of underlying risk factors.
Cardiovascular diabetes complications
- Hyperlipidemia
- HTN (very important risk factor) - Particularly true for microvascular complications
- CVA, CAD, PVD
- Hyperlipidemia
Cardiovascular diabetes complications
- decreased sensation
- peripheral pulses
- "stocking ang glove"
- can affect cranial nerves
- diabetic foot leading cause of non traumatic amputation
- More at risk for infection
Peripheral Neuropathic diabetes complications
- Impotence
- gastroparesis
Autonomic Neuropathic diabetes complications
Age related changes (diabetes)

- Other chronic illnesses cause problems.
Elderly
Age related changes (diabetes)

- usually type I
- diet challenges
- puberty
Child
What hormone corresponding to adrenergic receptors (SNS) causes vasodilation in kidneys, heart, and viscera
Dopamine
What adrenergic receptor (SNS) causes
- vasoconstriction of blood vessels
- decreased renin
- glycogenolysis/gluconeogenesis
- GU contraction
- Uterine contraction
- Myadriasis
Alpha 1 Receptors
What controls involuntary responses in smooth muscle and secretory glands & visceral organs
- Functions to maintain homeostasis
- Responds to stress and repair tissues.
Autonomic Nervous System (ANS)
What causes:
- "fight or flight" / stress state (adrenergic response)
- sympathetic neurotransmitters
- catecholamines (epinephrine, norepinephrine, dopamine)
Sympathetic Nervous System (SNS)
What does mnemonic SLUDGE stand for?
S alivation
L acrimation
U rinary incontinence
D iarrhea
G I cramps
E mesis
What action is the mnemonic SLUDGE describing?
PNS Acetylcholine action
What is responsible for:
- Rest and Digestion / Calming (cholinergic response)
Parasympathetic Nervous System (PNS)
What is the primary cholinergic neurotransmitter and where is it active?
Acetylcholine (ACh), active with the PNS. (75% nerve fibers in vagus nerve.)
What adrenergic receptor (SNS) causes:
- increased HR
- increased myocardial contraction
- increased automaticity
- increased rate of conduction
- increased renin
Beta 1 Receptors
What adrenergic receptor (SNS) causes:
- bronchodilation
- vasodilation
- decreased GI motility
- gluconeogenesis/glucogenolysis
- GU relaxation
- uterine relaxation
Beta 2 Receptors
What adrenergic receptor (SNS):
- inhibits release of norepinephrine
- inhibits receptory
Alpha 2 Receptors
What system regulates the body levels of thyroid hormone?
hypothalamic-pituitary-thyroid feedback system
What hormone causes these actions?

- constricts bronchioles
- decreases HR
- vasodilation
- increased GI motility
- constricts pupils
- contracts bladder
Actions of Acetylcholine (ACh)
What are the two main pancreas secretions?
- insulin (b cells)
- glucagon (a cells)
which adrenergic receptors (SNS) inhibit release of norepinephrine; (inhibitory receptor)
Alpha 2 receptors
The actions below are from what hormone?

- provides for glucose storage
- prevents fat breakdown into ketones (acids)
- increases protein synthesis
Insulin (b cells)
The actions below are from what hormone?

- breakdown of glycogen via glycogenolysis
- synthesis of glucose via gluconeogenesis
- increased fat & protein breakdown
Glucagon (a cells)