Chapter 22 Alterations Of Hormonal Regulation

Front 1

Which laboratory values would be expected in an individual with SIADH?
a. serum sodium = 150 mEq/L and urine
hypoosmolality
b. serum potassium = 5 mEq/L and serum
hypoosmolality
c. serum sodium = 120 mEq/L and urine
hypoosmolality
d. serum potassium = 3 mEq/L and serum
hyperosmolality

Back 1

c. serum sodium = 120 mEq/L and urine
hypoosmolality

Front 2

Hypopituitarism in an adult male likely includes all of the following except:
a. dwarfism.
b. impotence.
c. muscular mass decrease.
d. skin pallor.

Back 2

a. dwarfism.

Front 3

Excessive secretion of GH in an adult may cause:
a. acromegaly.
b. giantism.
c. hypoglycemia.
d. decreased metabolic rate.

Back 3

a. acromegaly.

Front 4

A manifestation shared by both diabetes mellitus and diabetes insipidus is:
a. elevated blood and urine glucose values.
b. inability to produce ADH.
c. inability to produce insulin.
d. polyuria.
e. elevated blood urine and ketone body values.

Back 4

d. polyuria.

Front 5

The manifestations of hyperthyroidism include all of the following except:
a. diarrhea.
b. constipation.
c. heat intolerance.
d. weight loss.
e. wakefulness.

Back 5

b. constipation.

Front 6

Hypothyroidism crisis is:
a. myxedema coma.
b. Addison disease.
c. Cushing disease.
d. Graves disease.
e. cretinism.

Back 6

a. myxedema coma.

Front 7

Graves disease is:
a. hyperthyroidism.
b. associated with autoimmunity.
c. manifested by ophthalmopathy.
d. All of the above are correct.

Back 7

d. All of the above are correct.

Front 8

Inadequate levels of THs at birth may cause: a. mental retardation.
b. immediate death.
c. thyroid crisis.
d. myxedema.
e. dwarfism.

Back 8

a. mental retardation.

Front 9

Hyperparathyroidism causes:
a. increased osteoclastic activity.
b. decreased plasma calcium.
c. increased absorption of phosphorus from the GI tract.
d. hypocalcemia.

Back 9

a. increased osteoclastic activity.

Front 10

A manifestation of hypocalcemia is: a. myopathy.
b. lethargy.
c. hypertension.
d. tetany.
e. bone cysts.

Back 10

d. tetany.

Front 11

What is the most common cause of acromegaly?
a. anterior pituitary adenoma
b. overproduction of ACTH
c. overproduction of TSH
d. pituitary atrophy

Back 11

a. anterior pituitary adenoma

Front 12

If a 19-year-old woman were suffering from shortness of breath, weight loss, excessive sweating, exophthalmos, and irritability, which hormone would you expect to find elevated in her serum?
a. cortisol
b. thyroxine
c. ACTH
d. 17-ketosteroid

Back 12

b. thyroxine

Front 13

A 24-year-old woman with a history of "juvenile- onset" diabetes is found in a stuporous state. She is hypotensive and has cold, clammy skin. What is the likely etiology of her condition?
a. hyperglycemia
b. insulin shock
c. renal failure
d. peripheral neuropathy

Back 13

b. insulin shock

Front 14

A 10-year-old boy was brought into the emergency room comatose, suffering from metabolic acidosis with a blood glucose level of 800 mg/dL. The most probable disease causing his condition is:
a. cretinism.
b. type 1 diabetes mellitus.
c. type 2 diabetes mellitus.
d. GDM.

Back 14

b. type 1 diabetes mellitus.

Front 15

Your neighbor, not previously diagnosed as a diabetic, has gained 80 pounds in the past year and is able to produce some insulin. Her fasting blood glucose value is always elevated. She is being treated with oral insulin-stimulating drugs. Your neighbor is most likely suffering from:
a. diabetes insipidus.
b. type 1 diabetes mellitus.
c. type 2 diabetes mellitus.
d. GDM.

Back 15

c. type 2 diabetes mellitus.

Front 16

Common symptoms and signs of diabetes mellitus include all of the following except:
a. hyperglycemia.
b. blurred vision.
c. increased muscle anabolism.
d. persistent infection.
e. polyuria.

Back 16

c. increased muscle anabolism.

Front 17

Which laboratory finding is inconsistent with a diagnosis of absolute insulin deficiency?
a. FBS (fasting blood sugar) of 90 mg/dL
b. ketonuria
c. blood glucose level of 210 mg/dL after 1 hour following ingestion of 100 g glucose
d. decreased serum insulin level
e. All of the above are consistent with type 1
diabetes mellitus.

Back 17

a. FBS (fasting blood sugar) of 90 mg/dL

Front 18

Common complications of diabetes mellitus include all of the following except:
a. retinopathy.
b. peripheral neuropathy.
c. nephropathy (kidney disease).
d. None of the above is common.
e. All of the above are common.

Back 18

e. All of the above are common.

Front 19

An individual with type 1 diabetes mellitus experiences hunger, lightheadedness, headache, confusion, and tachycardia while performing cross-country running. The likely cause of these manifestations is:
a. hyperglycemia.
b. eating a snack before running.
c. hypoglycemia because of running.
d. Both a and b are correct.
e. None of the above is correct.

Back 19

c. hypoglycemia because of running.

Front 20

Which is/are expected during hyperinsulinism?
a. excess insulin
b. high serum glucose
c. epinephrine release
d. All of the above are correct.
e. Both a and c are correct.

Back 20

e. Both a and c are correct.

Front 21

Long-term corticosteroid therapy may cause which of the following? (More than one answer may be correct.)
a. delayed wound healing
b. osteoporosis
c. peptic ulcers
d. hyperkalemia

Back 21

a. delayed wound healing, b. osteoporosis,
c. peptic ulcers

Front 22

Which electrolyte alteration occurs in Addison disease?
a. hypokalemia
b. hypernatremia
c. hyponatremia
d. hypocalcemia

Back 22

c. hyponatremia

Front 23

A benign tumor of adrenal glands that causes hypersecretion of aldosterone is:
a. Addison disease.
b. pheochromocytoma.
c. Gushing disease.
d. Cushing syndrome.
e. Conn disease.

Back 23

e. Conn disease.

Front 24

Hypersecretion of aldosterone

Back 24

d. hypernatremia

Front 25

Hypersecretion of glucocorticoids

Back 25

b. hyperglycemia or osteoporosis

Front 26

SIADH - ADH excess

Back 26

Water retention, serum hyponatremia
and hyposmolarity, concentrated urine, confusion, lethargy, muscle excitability

Front 27

Diabetes insipidus - ADH deficiency, kidney unable to respond to ADH

Back 27

Polyuria, polydipsia, nocturia, dilute urine, dry mucous membranes

Front 28

Hypercortisolism

Back 28

Hypokalemia; hypernatremia; hypertension; hyperglycemia; increased truncal, facial, cervical adipose tissue; muscle wasting; osteoporosis; collagen loss (weakened skin, purple striae); and immunosuppression

Front 29

Hypocortisolism

Back 29

Hyperkalemia; hyponatremia; hypotension; hypoglycemia; hypoaldosteronism; weakness; fatigue; gastrointestinal disturbances; and skin hyperpigmentation

Front 30

Fluid and electrolyte imbalances

Back 30

Addison disease, Cushing disease, Conn disease, diabetes insipidus, SIADH, hypoparathyroidism, hyperparathyroidism

Front 31

Cardiovascular dysfunction

Back 31

Addison disease, hyperthyroidism, pheochromocytoma, diabetes mellitus

Front 32

General growth alterations

Back 32

Dwarfism, giantism, acromegaly

Front 33

Reproductive irregularities

Back 33

Precocious puberty, adrenogenital syndrome, gynecomastia

Front 34

Altered glucose metabolism

Back 34

Addison disease, Cushing disease, diabetes mellitus

Front 35

Metabolic rate abnormalities

Back 35

Hyperthyroidism, hypothyroidism, cretinism, myxedema

Front 36

A major risk factor for Type 2 diabetes is:
A- Obesity
B- Alcohol ingestion
C- Glucose resistance
D- coronary artery disease

Back 36

OBESITY leads to type 2 diabetes.
-Glucose resistance is the pathogenesis not the etiology/risk factor.
-Coronary artery disease is a macrovascular complication, not a risk factor

Front 37

Symptoms of diabetes include:
A- pimples, pallor and poor sight
B- Polyuria, polydipsia, and polyphagia
C- HTN, headache, and halitosis
D- Onchomycosis, osteoarthritis, and otitis media

Back 37

B- Polyuria, polydipsia, and polyphagia

Front 38

The nurse notes the lab values on Mr. Merckx: TSH - high, T4 - low. A disease process that may cause these lab results is:
A: cushing's disease
B: Addison's disease
C: Graves disease (hyperthyroidism)
D: Hashimoto's thyroiditis (hypothyroidism)

Back 38

D - Hashimotos thyroiditis, or hypothyroidism. Mechanism is related to the negative feedback control of hormone release. When T4 is not produced in hypothyroidism, more TSH is secreted from the pituitary in attempt to stimulate thyroid production.

Front 39

Mrs. Froom is a 65 y.o. female who states she feels very cold. She has non-pitting edema and HR is 50. The nurse understands that:
A- These are symptoms of Cushing's syndrome and Cortisol treatment should be immediately held.
B- The patient is at risk for a myocardial infarction.
C- The patient is in menopause and FSH/LH are dropping
D- The patient has symptoms of hypothyroidism

Back 39

D - Patient has Sx of hypothyroidism. Cold intolerance and bradycardia are cardinal findings. Non pitting edema is myxedema.

Front 40

What are the causes of hormonal alterations or endocrine dysfunction?

Back 40

-Gland malfunction (Excessive, or Insufficient function, changing hormone levels) "Primary disorder.
-Feedback mechanisms fail
-Ectopic hormone production
-Target cells don't respond
-Alterations in hypothalamic/pituitary system (secondary disorder)

Front 41

When target cells don't respond appropriately hormonal alterations can occur. What causes the target cells to loose their ability to respond?

Back 41

-Change in receptors or not enough receptors
-Loss of intracellular response to receptor activation

Front 42

What is the major disease of the posterior pituitary and what are the clinical manifestations?

Back 42

-Diabetes Insipidus a disorder of Insufficient ADH (Antidiuretic Hormone) resulting in excessive loss of urine (water loss).
-Clinical manifestations: Polyuria (excessive urine), Polydipsia (excessive thirst) due to body dehydration.

Front 43

What are the major causes of Diabetes Insipidus?

Back 43

Tumor or surgery closed head injury, or lack of nephron response(can be acquired or genetic).

Front 44

What is a complication for patients who have Diabetes Insipidus?

Back 44

Patients whith Diabetes Insipidus tend to have excessive urination. When they don't consume enough liquids to keep up with their urination amounts, they run the risk of having dehydration or hypernatremia.

Front 45

How do you treat diabetes insipidus?

Back 45

Desmopressin

Front 46

The anterior pituitary secretes Growth Hormone. What happens when there is a deficiency of GH in children?

Back 46

An insufficient amount of growth hormone results in Dwarfism (hypopituitary)

Front 47

What is the result of the anterior pituitary secreting excessive amounts of growth hormone?

Back 47

High levels of growth hormone is normally caused by a benign pituitary adenoma and causes giantism in children and acromegaly (change in bone structure) in adults.

Front 48

The pituitary Thyroid-Stimulating Hormone (TSH) stimulates what?

Back 48

TSH is released by the anterior pituitary and it stimulates the thyroid to make thyroid hormone.

Front 49

What does the thyroid (TH) do?

Back 49

Actions of (TH) thyroid hormone include increasing/decreasing cell metabolism and cardiovascular effects.

Front 50

What are the 2 forms of Thyroid Hormone (TH)?

Back 50

T3 is the active form that works on breaking down food and T4 is the inactive form making up 90% of the hormone form.

Front 51

Iodine is needed to synthesize Thyroid Hormone. What is the result of an iodine deficiency?

Back 51

Hypothyroidism.

Front 52

What are the clinical manifestations of Hyperthyroidism?

Back 52

Thin hair, Large eyes due to eyelid malfunction, enlarged thyroid, always feeling hot, weight loss due to high metabolism, tachycardia.

Front 53

How do you diagnose Hyperthyroidism?

Back 53

Low TSH (Thyroid Stimulating Hormone)
-High T4 and T3 levels (Thyroid Hormones)

Front 54

How do you treat Hyperthyroidism?

Back 54

Medications to inhibit (stop) thyroid production
-Radioactive iodine to kill gland
-Thyroidectomy

Front 55

What is graves disease?

Back 55

It is a hyperthyroid (autoimmune) disease caused from the thyroid gland making excessive T3 and T4 due to antibodies stimulating thyroid receptors.

Front 56

Hypothyroidism is the most common thyroid disorder. What is the most common cause?

Back 56

Autoimmune thyroiditis (Hashimoto disease) or from loss of thyroid tissue/thyroidectomy

Front 57

How do you diagnose Hypothyroidism?

Back 57

TSH (Thyroid Stimulating Hormone) levels are increased.
-T3 and T4 levels (Thyroid Hormones) are decreased.

Front 58

What are the clinical manifestations of Hypothyroidism?

Back 58

-Feeling cold all the time
-Low metabolism (feeling slow)
-Weight gain
-Feeling tired
-Heart Rate becomes Bradycardic
-Goiters

Front 59

How do you treat Hypothyroidism?

Back 59

-Thyroid hormone replacement
-Levothyroxine (Synthroid)
-Thyroid meds can take up to 6 weeks to work

Front 60

What are the Life Threatening clinical manifestations of hyperthyroidism?

Back 60

-Occurs with increased physiological stress: Hyperthermiafast heart rate, arrhythmias, heart failure, delirium.
-Possible death w/i 48 hours.

Front 61

What are the Life Threatening clinical manifestations of hypothyroidism?

Back 61

Myxedema (swelling of handsface, feet) from prolonged/untreated hypothyroidism, decreased Level of Consciousness (LOC), hypothermia w/o shivering, bradycardia, and hypoglycemia.
-Possible death w/i 48 hours.

Front 62

What is the parathyroid hormone (PTH) responsible for?

Back 62

(PTH) is responsible for serum calcium regulation and it causes release of calcium from bones.

Front 63

What is Hyperparathyroidism?

Back 63

Greater than normal secretion of the parathyroid hormone and hypercalcemia (excessive calcium).

Front 64

What is the eitology (cause) of Hyperparathyroidism?

Back 64

The most common cause of hyperparathyroidism is an adenoma of the parathyroid gland leading to an increase in hormone secretion.
-High calcium levels indicate a problem.

Front 65

When does Hypoparathyroidism occur and what is the result?

Back 65

Normally occurs due to damage damage of the parathyroid during a thyroidectomy. It can result in kidney stones and bone fractures from lack of calcium uptake.

Front 66

Where are the adrenal glands located?

Back 66

They look like little pyramids that sit on top of the kidneys.

Front 67

A disorder of the adrenal cortex is hypercortisolism. What disesase does this cause?

Back 67

Cushings disease or Cushings Syndrome.

Front 68

What does ACTH (Adrenocorticotropic Hormone) do?

Back 68

ACTH (Adrenocorticotropic Hormone) stimulates the adrenal cortexwhich stimulates secretion on glucocorticoids such as cortisol or mineralcorticoids such as aldosterone and sex hormones.

Front 69

The adrenal cortex secretes glucocorticoids and mineralcorticoids. Name a glucocorticoid and a mineralcorticoid.

Back 69

-Glucocorticoid: Cortisol
-Mineralcorticoid: Aldosterone

Front 70

Cortisol is a glucocorticoid secreted by the adrenal cortex what does it do?

Back 70

-Increases glucose availability
-Decreases immune response

Front 71

Aldosterone is a mineralcorticoid secreted by the adrenal cortex what does it do?

Back 71

Regulates salt and water balance via renin-angiotensin-aldosterone system.

Front 72

What are the sex hormones secreted by the adrenal cortex?

Back 72

-Androgens
-Estrogens

Front 73

Sugar, Salt, and Sex refers to which gland?

Back 73

The adrenal cortex :)

Front 74

Cushings Syndrome is a hypercortical disease of the adrenal gland. What is it?

Back 74

Cushings Syndrome is a result of chronic exposure to excess cortisol like Hydrocortisone for example.

Front 75

Cushings Disease is a hypercortical disease of the adrenal gland. What is it?

Back 75

Cushings Disease is caused by excess cortisol secretion from overproduction of pituitary ATCH (Adrenocorticotropic Hormone) due to a pituitary tumor.

Front 76

What are the clinical manifestations of Cushings Syndrome/Disease?

Back 76

Weight gain in face trunk, and abdomen, increase in facial hair (hirsutism), thin skin, extremely frail, decreased muscle mass, hyperglycemia/diabetes (Glucose intolerance due to insulin resistance), increases susceptibility to infections.

Front 77

What is the treatment of Cushings Syndrome/Treatment?

Back 77

Surgery radiation, or medication based on the cause of the disorder. Without treatment, death occurs w/i 5 years.

Front 78

Adrenocortical hypofunction (insufficient cortisol from adrenal gland) result in what disease?

Back 78

Addison's disease which is can be an autoimmune process or caused by chronic infections such as TB.

Front 79

What are the clinical manifestations of Addison's disease caused by an Adrenocortical hypofunction?

Back 79

Low Cortisol: Weakness and easy tiredness.
Low Aldosterone: Hypotension (Low BP) low NA (sodium), fluid loss, and shock.

Front 80

What is secondary hypocortisolism?

Back 80

A result from prolonged administration of glucocorticoids (steroid usage) that suppress ACTH secretion and cause adrenal hypertrophy. Symptoms mimic Addison's Disease.