Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
63 Cards in this Set
- Front
- Back
|
Bottom line patho dealing with endocrine relates to either:
|
Hormone levels
-too much -too little Problem with receptor or organ |
|
|
Closer look to elevated or depressed hormone levels
|
Elevated or depressed hormone levels
-failure of feedback system -dysfunction of endocrine gland -secretory cells are unable to produce, obtain, or convert hormone precursors -the endocrine gland synthesizes or releases excessive amounts of hormone -increased hormone degradation or inactivation -ectopic (from somewhere else) hormone release |
|
|
Closer look at receptor/target cell failure
|
-receptor-associated disorders
-decrease in number of receptors -impaired receptor function -presence of antibodies against specific receptors -antibodies that mimic hormone action -unusual expression of receptor function |
|
|
Two types of feedback:
|
negative feedback: endocrine cell to target cell and is then inhibited (most common)
positive feedback: endocrine cell to target cell and then cycle continues (breastfeeding and child labor) |
|
|
Hypothalamic-pituitary system
|
can do blood tests for anterior pituitary and hypothalamus to investigate
|
|
|
Posterior pituitary linked with..
|
posterior pituitary hardwired to hypothalamus (HTO) and there are nerves that allow this communication to occur
|
|
|
After nerve travels from HTO to posterior pituitary what happens?
|
hormones transfer from posterior pituitary to responding organ
|
|
|
Mechanisms of patho posterior pituitary-typical problems
|
Damage to structures
-surgical, injury, tumor Hormone from somewhere else -tumor, medication Something wrong with responding organ -autoimmune |
|
|
2 key diseases of the posterior pituitary
|
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
diabetes insipidus (DI)***** -these are basically opposite problems -this is common in endocrine issues (hyper/hypo issues) b/c endocrine system needs things just right |
|
|
SIADH-what is it?
|
let the name help you know what is going on
-inappropriate = too much -too much what? ADH -ADH prevents diuresis, helps body retain water..too much ADH for some reason --can be from another (ectopoic) source i.e. tumor --can also be from pituitary sx and moving of gland --can be from meds, some can stimulate release of ADH |
|
|
SIADH - how does ADH work?
What is the body at risk for in this condition? |
ADH works by preventing the reabsorption of water into the kidney
-normally kidney pulls water back -when ADH is too high the kidney will reabsorb more water, so more water is in the body b/c you have more reabsorption of the water -concentrated urine released, so at risk for: --dilutioal hyponatremia-not losing salt but blood diluted b/c of water retention |
|
|
*********What are some causes of diabetes inspidus?
|
not enough ADH
-not enough ADH, not enough water reabsorbed into body, excreted in urine instead, larger body of water in urine, diluted Causes: -damage to HTO or posterior pituitary structures: clot at pituitary, infection, head trauma *******Nephrogenic: -problem is with kidney -not enough response to ADH -have enough ADH around but kidney doesn't respond, usually a problem with receptor.. -can happen bc of genetic abnormalities of receptor where it changes and ADH doesn't bind, can happen b/c of various renal disease-pylo cystic, or drugs |
|
|
What are some results of DI?
|
polyuria and polydipsia b/c dehydrated
hypernatremia b/c losing a lot of water relative to salt, not b/c of excess salt |
|
|
Now to anterior pituitary:
General on frequent mechanisms of patho anterior pituitary (normal) |
anterior pituitary-usually have HTO release releasing hormone which is how HTO communicates with anterior pituitary
-which then releases stimulating hormone to endocrine gland -from endocrine gland hormone goes to responding organ -more involved than posterior pituitary -if something goes awry at beginning of chain/algorithm everything down is screwed up -if something is wrong with responding organ-no response -there are lots of feedback loops and structures |
|
|
Anterior pituitary-common problems
|
-more structures can be more complicated
structures Typical problems -Damage to structures --surgical, injury, tumor -Hormone from somewhere else --tumor, medication -Something wrong wtih responding gland or organ --autoimmune |
|
|
Thyroid problem: normal chain
|
HTO releases thyroid releasing hormone to anterior pituitary
Anterior pituitary releases thyroid stimulating hormone to endocrine gland Endocrine gland releases thyroid hormone to responding organ -i.e. low thyroid-may not be the thyroid, may be releasing hormone, stimulating hormone, actual hormone itself |
|
|
Anterior pituitary
thyroid-different hormones involved |
TRH (releasing hormone)
TSH (stimulating hormone) TH (thyroid hormone-T3 and T4) -all of these involve feedback loops |
|
|
Anterior pituitary: hyperthyroid-too much ____
reasons sx |
Hyperthroidism:
too much thyroid hormone, thyroxine Common Causes -extra stimulation -extra thyroid gland -idiopathic Common Sx (same regardless of reason) -revved up-lose weight, eat more, anxious, heart palpitations, diarrhea, sweaty palms -goiter-enlargement of thyroid gland in neck -opthalmopathy-expolamus -can have bone loss b/c reabsorption of bone calcium-risk for osteoporosis |
|
|
Hyperthyroidism labs:
______ too high ____ & ______ too low |
Thyroid hormone too high
TRH & TSH too low |
|
|
Hyperthyroidism
Give an example of ectopic source of hormone |
Graves Disease
Autoimmune where antibodies stimulate thyroid hormone as they look so similar to hormone -IgG antibodies |
|
|
Hyperthyroidism: Graves Disease: Multisystem
& patho sum |
Multisystem, possibly containing
1) hyperthyroidism 2) diffuse thyroid enlargement (goiter) 3) ophthalmopathy 4) dermapathy (swelling and redness) -IgG immunoglobin G antibodies or Thyroid Stimulating Immunoglobim (TSI) bind to TSH receptors in the thyroid gland -hyperfunction of thyroid gland lead to suppression of TSH and TRH b/c of normal negative feedback of TH |
|
|
Hyperthyroidism:
What is Nodular Thyroid Disease |
Toxic Multinodular Goiter
-have extra thyroid hormone around and get thyroid nodules that produce extra TH..often a normal body state that requires elevated TH (puberty, pregnancy) -but after situation resolves thyroid can continue to have nodules that release TH autonomously (regardless of TSH and TRH) -often fizzle out with time |
|
|
Hyperthyroidism: What is thyrotoxic criss?
|
a.k.a. thyroid storm
-huge load of thyroid hormone introduced to body -often spontaneous, idiopathic -can be r/t infx, trauma, MI, DKA, PE Super high levels of TH can cause: -tachy, N/V, confusion, psychosis |
|
|
Hypothyroidism:
____ is low _____ & _____ too high |
Hypothyroidism
TH is too low TRH and TSH too high |
|
|
Hypothyroidism: 3 causes
|
Hypothyroidism Causes
1) autoimmune (Hashimotos) 2) Not enough TH produced by thyroid gland 3) No thyroid gland present (Congenital) Subacute Thyroiditis -inflammation (post viral infection?) Postpartum thyroiditis |
|
|
Hypothyroidism-common sx
|
low gear
changes in hair-dry, loss dry skin constipation fatigue not tolerating cold well |
|
|
Hypothyroidism-most common cause
|
Hashimotos Disease (autoimmune)
-instead of stimulating thyroid, antibodies are destroying thyroid -antithyroid immunoglobin causes damage to thyroid and over time thyroid stops producing enough thyroid hormone, so slow worsening of thyroid |
|
|
Hypothyroidism- subacute
|
Subacyte thyroiditis
-inflammation (post viral infection)? -upper res maybe, thyroid becomes inflamed, infx causes thyroid gland to release a lot of thyroid hormone so not enough in gland anymore and ur in hypothyroid state, happens until thyroid recovers and release thyroid hormone, first hyper-used up by organs in body then hypo, sometimes go back to nml sometimes remain hypothyroid, don't often feel hyperthyroid state and those sx |
|
|
Hypothyroid-postpartum?
|
Postpartum Thyroiditis
-pregnancy can make thyroid go hyper or hypo, common after pregnancy a couple months later |
|
|
Hypothyroidism-congenital?
|
Congenital = no thyroid gland
no thyroid formation in fetus, developmental issue, fetus ok b/c of maternal thyroid, but after birth lose it, can lead to MR b/c need thyroid hormone for brain development -more sleeping, weight gain, constipation |
|
|
Patho of Hashimoto's
|
immune system antibodies attack thyroid cells causing them to dysfunction
|
|
|
What is the parathyroid?
|
little glands on thyroid gland, little yellow ones,
parathyroid hormone-one cause of problems is thyroid surgery, hard to save parathyroid gland |
|
|
What is the role of Parathyroid Hormone?
|
pth has imp role in Ca regulation, all about Ca levels
-doesnt care about how strong bones are, just how much Ca is in blood. -pth to get ca in blood takes it from your bones -also causes kidney to reabsorb Ca and stimulate synthesis of vit d which helps Ca to be absorbed in gut |
|
|
What is calcitonin? What does it have to do with PTH?
|
dont confuse with pth
- calcitonin likes decreasing calcium in blood and putting it in bone so does the opposite of PTH -works on osteoclasts |
|
|
What are the two types of hyperparathyroidism? Just list.
|
Hyperparathyroidism
-primary -secondary |
|
|
What loop is PTH?
Primary Hyperparathyroidism what is it? |
PTH has negative feedback loop
Primary Hyperparathyroidism primary -excess secretion of PTH from one or more parathyroid glands: feedback loop ddoesnt matter, just keeps making more pth increasing serum Ca, stops responding to elevation in serum Ca and further increases it **hypercalcemia-doesnt care how high keeps making more hormone resulting in higher calcium in blood |
|
|
What is secondary hyperparathyroidism?
|
Secondary Hyperparathyroidism?
-increases in PTH secondary: b/c chronic condition, chronic condition is the primary position ur having secondary, common-f/ renal failure and malabsorption, pt responds appropriately by increasing release of pth attempts to increase serum calcium, low serum Ca to begin with-pt releases more pth which attempts to increase serum Ca -no hypercalcemia; renal-not good Ca reabsorption or Vit D processing, chronic low Ca causes pt gland to work releasing more pth |
|
|
What is hypoparathyroidism?
|
-Abnormally low PTH levels
-Usually caused by parathyroid damage in thyroid sx -not enough Ca, lose the whole process, often f/ loss of parathyroid gland during thyroid sx, thyroidectomies a lot of monitoring with Ca levels, gland is not present to release pth to increase serum Ca |
|
|
What is the adrenal gland?
What are the components? |
adrenal gland-located on top of kidney
-has two parts to it: cortex and medulla, function independently of each other, a little interaction -adrenal cortex-mineralcorticoids (aldosterone), androgens, estrogens, glucorticoids (cortisol) -medulla-catecholamines (Epi and Norepinephrine) |
|
|
What is cortisol? How is cortisol developed?
|
Cortisol (glucocorticoids) f/ adrenal cortex of adrenal gland
-various factors influence cortisol release-pain, stress, sleep, trauma Developed: -Hypothalamus converts Releasing Hormone to Corticotropin Releasing Factor (CRF) to anterior pituitary -In anterior pituitary: stimulating hormone to adrenocorticotropic hormone (ACTH) to endocrine gland -In endocrine gland of adrenal cortex hormone turns to end hormone of CORTISOL -Goes to responding organs |
|
|
What problems can occur with cortisol? Just list
|
Too high
Too low |
|
|
Alterations of cortisol: what does too high entail?
|
High: excess ACTH
-from pituitary (which makes ACTH) -from another source |
|
|
Alterations of Cortisol: too low
|
Too low:
-low ACTH: not enough acth-therefore low cortisol release -may also have autoimmune situation |
|
|
What is Cushing Syndrome?
|
Cushing syndrome-collection of sx, excessive release of cortisol
-can have cushings f/ cushings disease (excess release of ACTH f/ pituitary) Other causes: -f/ adrenal tumor -ectopic source of acth: lung CA also releases ACTH -meds- corticosteroids, prednisone |
|
|
******What are symptoms of Cushing?
|
Think about what cortisol does in body-involved with stress, infection, immunity
-Altered carb metabolism: cortisol likes to help gluconeogenesis-increases it, wants to make more glucose in body d/t stress, glucose f/ a different source-lipid, protein -Fat deposits: buffalo hump, moon face, truncal obesity -Others: protein wasting, frail bones, hyperpigmentation, mental status change, hair growth/acne, oligomenorrhea |
|
|
What is hypocorticolism? What are the two types-just list
|
Hypocorticolism-low cortisol
Primary Secondary |
|
|
What is primary hypocortisolism?
|
Primary hypocortisolism is low cortisol
Primary Secondary |
|
|
******What is primary hypocortisolism?
|
Primary Hypocortisolism:
primary aka ****addison disease-***autoimmune issue, elevated ACTH but low cortisol, pituitary seds out ACTH trying to get adrenal gland to make cortisol but it doesnt, probably b/c of antibodies destroying ****adrenal cortex so cant make enough cortisol, also antibodies against 21 hydrroxylase-imp enzyme to make cortisol, anterior pit working right responding to situation of low cortisol by making more acth, gland itself not able to do that b/c its being destroyed or process is interrupted, could also be f/ infx or dk why |
|
|
****Primary Hypocortisolism? Bottom line?
|
Autoimmune
-autoimmune against adrenal cortex -antibodies against 21-hydroxylase |
|
|
Main difference between primary and secondary hypocortisolism?
|
Primary Hypocortisolism: elevated ACTH but low corticosteroid
Secondary Hypocortisolism: low ACTH and low corticosteroid |
|
|
What is secondary hypocortisolism?
|
Low ACTH and low corticosteroid?
-pituitary hypofunction -panhypopituitary -other sources of cortisol removed: cortisol secreting tumor or exogenous glucocorticoids |
|
|
What are symptoms of hypocortisolism?
|
-hypoglycemia b/c not the gluconeogenesis
-fatigue -weight loss -low blood pressure -cardiac insufficiency |
|
|
What releases aldosterone?
What are two kinds of hyperaldosteronism? |
Remember: adrenal gland:
1) adrenal cortex: -glucocorticoids (cortisol) -mineralcorticoids (aldosterone) -adrenal androgens and estrogens so..Aldosterone is also released by adrenal cortex 2) Adrenal Medulla -Catacholimines-epi and norepi 2 kinds of hyperaldosteronism? -primary -secondary Problems: |
|
|
Closer look at primary hyperaldosterinism..
|
Primary Hyperaldosteronism
-excessive aldosterone from abnormality in adrenal cortex (adrenal cortex just making too much aldosterone): causes may be tumor, idiopathic overgrowth of adrenal cortex, tumors elsewhere on body producing aldosterone |
|
|
Closer look at secondary hyperaldosteronism...
|
Excessive aldosterone from extraadrenal source
-increased renin and activation of angiotensin II --low blodo volume, dehydration, shock, renal stenosis, renin secreting tumors |
|
|
What does aldosterone do?
What changes do you see with hyperaldosteronism? |
Aldosterone increases sodium reabosrption and water reabsorption (causes body to reatain the water, sodium moving into bloodstream and k moves out): Fluid/electrolyte changes:
-K loss -hypertension |
|
|
What is the other component of adrenal cortex? What happens when they are hypersecreted?
|
Adrenal Androgens and estrogens
-adrenal tumors -cushing syndrome -feminization: hypersecretion of estrogen; female sex characteristics develop -Virilization: hypersecretion of androgens; male sex characteristics develop |
|
|
What is other part of adrenal gland, besides adrenal cortex?
What does it entail? What is an alteration? |
Adrenal gland: adrenal cortex and adrenal medulla
Adrenal medulla contains catecholamines (epi and norepi) Hyperfunction of adrenal medulla is possible |
|
|
*****What are symptoms of adrenal medulla hyperfunction?
|
-Mostly norepinephrine released however can have both norepinephrine and epinephrine
-diaphoresis, tachycardia, palpitations, HA, HTN |
|
|
What is hyperfunction of anterior pituitary?
|
generally involves an adenoma and may lead to hypersecretion of the hormone produced by the adenoma and hyposecretion of another hormone b/c of the compressive effects of the tumor
|
|
|
What is hypofunction of of the anterior pituitary?
|
Highly variable and depend on which hormones are affected-if all hormones are absent, panhypopituitarism develops, including cortisol deficiency from lack of ACTH, thyroid deficiency from lack of TSH, DI from lack of ADH, gonadal failure and secondary sex characteristics loss from no FSH and LH
|
|
|
************Too much growth hormone?
|
In adults-acromegaly
*******In kids where epiphyseal plates have not yet closed-gigantism |
|
|
What is prolactin?
|
Prolactin is the hormone of lactation and is secreted by the pituitary gland, a small structure located within the brain. It is normally elevated in pregnant and lactating women.
-There are other conditions that can cause prolactin to be higher then normal, including pituitary tumor or disease, disease of the hypothalamus and kidney disease. Certain medications can also raise prolactin levels |
