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80 Cards in this Set

  • Front
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Endocrine - Intro
-The endocrine system is an integrated communication and coordination system that enables reproduction, growth and development, and regulation of energy.
-Together the endocrine system, central nervous system and the immune system regulate homeostasis and control body reactions to internal and external environments
Example
Stress response is a response of the central nervous system. A message is sent to the adrenal medulla to secrete catecholamines that inhibit insulin secretion so the liver can produce glucose for the stress response.
Endocrine A & P review
-The endocrine system is composed of glands that secrete hormones, the chemical messengers designed to activate specific target tissues.
-The endocrine glands include the hypothalmus, pituitary, thyroid, parathyroid, adrenals, pancreas, ovaries, testes, pineal, and thymus glands.
Hormones - Endocrine
-Hormones are secreted in small controlled amounts and carried in the blood stream to specific receptor sites.
-Hormone – a chemical substance synthesized and secreted by a specific organ that acts on a specific target. Daylight reaction
-The targets for these messengers are very specific. -
-They have a lock and key receptor site so only certain hormones stimulate certain target tissues. – TSH can not stimulate ???
-Control physiological activities related to reproduction, response to stress and injury, electrolyte balance, energy metabolism, growth, maturation and aging
Endocrine Hormones 2
-Modulated by circadian rhythm – hormones fluctuate predictably during a 24 hr period. Ex cortisol rises early in the day and declines toward evening and rises again toward the end of the sleep cycle. Growth hormone secretion peaks during sleep.
-Catecholamines are hormones when secreted by the adrenal medulla and neurotransmitters when they are transmitting impulses between nerve cells in the brain. If it is in the blood stream it is a hormone, if it is traveling across a synapse it is a neurotransmitter.
Negative Feedback Loop for Endocrine Hormones
-Hormone secretion is regulated by feedback. A negative feedback loop operates like a thermostat.
-High levels of circulating hormone cause the target organ to stop secreting the hormone.
-Low levels stimulate hormone synthesis and secretion.
Structures of the Endocrine system
-Hypothalmus
-Pituitary anterior and posterior
-Thyroid
-Parathyroid
-Adrenal gland
Hypothalmus
-The most central part of the diencephalon area of the brain.
-Along with the pituitary gland integrate communication between the nervous and endocrine systems.
-Coordinates endocrine, nervous system, and the complex responses such as fear, anger, and pleasure.
-Receives messages from the internal environment, brain stem, limbic system and stimulates or inhibits the synthesis or release of anterior pituitary hormones.
-Two major hormones synthesized in the hypothalamus are antidiuretic hormone (ADH, vasopressin) and oxytocin. ADH and oxytocin are sent to the posterior pituitary gland where they are stored.
-Abnormalities occur with over secretion or undersecretion of the hormones.
Pituitary (Hypophsis)
-Located in the sella turcia at the base of the brain above the splenoid bone.
-A round structure 1.27 cm (1/2 inch) in diameter.
-Master gland so it secretes hormones that stimulate other glands. It is connected to the hypothalamus by the infundibular (hypophyseal) stalk.
-Anterior and posterior pituitary
Pituitary - con't
-Anterior
-80% of the pituitary:
-Produces following hormones
-Follicle stimulating hormone (FSH)
-Lutenizing hormone (LH)
-Prolactin
-Adrenocorticotropic hormone (ACTH)
-Thyroid stimulating hormone (TSH)
-Growth hormone (GH) or somatotropin
-Posterior
-An extension of the hypothalamus
-Secretes Antidiuretic hormone (ADH), vasopressin
oxytocin
Dysfunction of the Anterior Pituitary
-Underproduction of growth hormone results in dwarfism

-Overproduction of growth hormone in children produces gigantism. Persons may reach 7-8 feet in height. Affected persons are usually weak and lethargic.

-Gigantism is the result of excessive growth hormone secretion that begins in young children or adolescents. It is a very rare disorder.
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Giantism
One of the most famous giants was a man named Robert Wadlow. He weighed 8.5 pounds at birth, but by 5 years of age was 105 pounds and 5 feet 4 inches tall. Robert reached an adult weight of 490 pounds and 8 feet 11 inches in height. He died at age 22.
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Acromegaly
Over production of growth hormone in adults after the growth plates have sealed
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Acromegaly (con't)
-Occurs in the 3rd and 4th decades of life.
-Rare condition occurring in 60/1 million cases.
-Characterized by excessive skeletal growth in feet, hands, brow ridge, jaw, nose, chin and some organs of the body. Hoarseness and sleep apnea can occur if soft tissue enlargement present.
-Accompanied by severe headaches, visual disturbances (tumor presses on the optic nerve). Assessment of visual fields may indicate loss of color discrimination, diplopia, blindness of a visual field.
-Growth hormone eventually antagonizes the action of insulin and patient develops diabetes.
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Acromegaly (con't)
-Assessment and diagnosis – Unusual growth pattern in child out of proportion to parent’s size.
-In adults frequent changes in ring size, shoe size, or glove size.
-Assess visual fields
-CT or MRI scan to locate pituitary tumor.
-Blood assay for hormone levels, assess target organs like thyroid and adrenals.
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Surgical management Acromegaly
-Transphenoid hypophysectomy
-Removal of the pituitary tumor or part of the pituitary through a transphenoid approach. Incision is made beneath the upper lip and into the nasal cavity.
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Post operative care
-Avoid blowing nose, vigorous coughing, or valsalva’s maneuver to prevent spinal fluid leaks.

-Frequent gentle oral care (avoid damage to suture line).

-HOB elevated 30 degrees to promote drainage of surgical site.

-Mild analgesic for HA

-Change drip pad under nose as needed.

-Test nasal drainage for GLU (> 30mg/dl ) CSF leak.

-Monitor I&O and urine specific gravity for diabetes insipidus (DI).
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Complication Diabetes Insipidus
-Dysfunction of the posterior pituitary and lack of ADH.
-Characterized by large volumes of dilute urine 800-900 ml over 2 hrs.
-Urine specific gravity of 1.001-1.005.
-Pt experiences thirst and can rapidly dehydrate.
-Limiting fluid intake does not correct the condition.
-Monitor fluid balance.
-If pituitary gland is removed the patient will require ongoing hormone replacement ADH, cortisol, and thyroid for life.
-Treatment: replace fluid through NS infusion, PO fluid and administer ADH (vasopressin injections).
-May be used in nasal form desmopressin (DDAVP) one or two sprays every 12-24 hrs.
-Vasopressin tannate in oil every 24-96 hrs. Warm medication and shake before administering.
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Disorders of the posterior pituitary
-Syndrome of inappropriate ADH (SIADH)
-Abnormal production of ADH so patients cannot excrete dilute urine.
-Patients retain fluid and develop sodium deficiency (hyponatremia).
-Can occur with bronchial tumors, but most common in head injury, craniotomy.
-Treatment is fluid restriction to give the kidneys time to excrete free water. May take 1-3 days to correct. Diuretics can be given along with fluid restriction.
-Monitor I&O daily weight, urine and blood electrolytes, and neuro status.
-S/S hyponatremia
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Thyroid Function
-The thyroid is a butterfly shaped organ located in the lower neck anterior to the trachea. It consist of two lateral lobes connected by a bridge across the middle called an isthmus.
-Blood flow to the thyroid is 5 times greater than the liver. Because of the high metabolic rate of the gland.
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Thyroid Function (con't)
-Functions of the thyroid include production of thyroid hormone thyroxine (T4), triiodothyroxime (T3), and calcitonin.
-T3 and T4 are amino acids that are bound to iodine. T3 has three iodine molecules, T4 has four. The major use of iodine in the body is thyroid function. Iodine is ingested in the diet.
-Production of T3 and T4 is controlled by TSH (thyrotropin). Thyrotropin is produced in the anterior pituitary.
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Thyroid hormone negative feedback loop
-Negative feedback loop. If thyroid hormone concentration in the blood is low, the pituitary sends more TSH, which stimulates the release of T3 and T4. Most important function of thyroid hormone are metabolism and growth.

-Assessment blood levels of T4 and TSH. Low T3 and T4 can indicate dysfunction of the thyroid gland, or dysfunction of the pituitary gland in producing TSH.
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Dysfunction of the thyroid gland
-Hypothyroidism
-Occurs 5 times more often in women than men. Usually between the ages of 30-60.
-In children can stunt growth
-In adults manifest as lethargy, slow mentation, generalized slowing of body functions, subnormal body temperature, bradycardia, weight gain, cold, face expressionless, skin thickened, subdued emotional responses, slow speech, constipation, extreme fatigue, hair loss, brittle nails, dry skin, numbness and tingling of the fingers, voice may be husky and hoarse, amenorrhea, and loss of libido.
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Myxedema coma
-Myxedema: critical low levels of thyroid hormone affects all body systems.

-S/S hypothermia, unconscious state, ***important to note per Ms. Schulter... increased sensitivity to narcotics and sedatives, decreased respiratory drive, CO2 retention, cardiovascular collapse and shock.

-Treatment thyroid hormone replacement. Synthroid based on patient’s TSH levels. Use with caution in diabetes may increase blood glucose levels. Effects may be increased with dilantin and tricyclic antidepressants.

-Caution when normal metabolism resumes may increase myocardial oxygen demand resulting in acute MI.

-Hashimoto’s disease is a type of hypothyroidism characterized by autoimmune dysfunction of the thyroid gland.
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Hyperthyroidism
(Graves Disease)
-Second most common endocrine disorder after diabetes

-Results from excessive output of thyroid hormone

-Affects women 8 times more than men

-Onset between 2nd and 4th decade

-Also known as thyrotoxicosis S/S nervousness, hyperexcitability, irritability, apprehension, cannot sit still, palpitations, rapid pulse, poor heat tolerance, perspire excessively, skin flushed (salmon colored), warm, moist, soft, exophthalmos (bulging eyes), increased appetite, amenorrhea, and change in bowel function, systolic hypertension , heart failure.
Elderly may report dry skin and priritis.
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Assessment for Hyperthyroidism
-Enlarged thyroid gland

-Elevated T4

-Elevated I 123 uptake by the thyroid
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Treatment of Hyperthyroidism
-Radioactive iodine therapy can be used to destroy thyroid cells. Most of the iodine that enters the body is concentrated in the thyroid.
-A radiologist administers a single oral dose and over several days thyroid cells that pick up radioactive iodine are destroyed.
-Patients may experience a transient elevation of thyroid hormone initially.
-Patients may need thyroid replacement for life after procedure.
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Treatment of Hyperthyroidism (con't)
-Antithyroid medication: Propucil, PTU or Tapazole are the most common. Blocks the production of T3 and T4.

-Subtotal thyroidectomy: removal of about 5/6 of the thyroid gland.
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Thyroid Storm
-Severe sudden onset hyperthyroidism
-High fever > 101.3
-Extreme tachycardia
-Exaggerated symptoms of hyperthyroidism usually centered around one system
-Cardiovascular – chest pain, dyspnea, palpitations, edema
-GI – diarrhea, abdominal pain, weight loss
-Neurological – Altered mental status, psychosis, coma
precipitated by stress, infection, thyroid surgery, diabetes, acidosis, pregnancy, abrupt withdrawal of thyroid medications, vigorous palpation of thyroid.
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Thyroid storm Treatment
-Manage temperature: hyperthermia blanket, ice packs, Tylenol

-Manage tachycardia: Propranolol, digoxin, cardiac monitor prevent cardiovascular collapse.

-Oxygen with humidification

-D5W IV fluids to replace glycogen stores used up in hyperdynamic state

-PTU to block thyroid hormone
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Dysfunction of the thyroid
-Goiters: abnormal swelling of the neck seen in iodine deficient diets. Iodine is necessary for thyroid hormone production. Decreased hormone production causes the pituitary to increase production of TSH stimulating the thyroid gland to hypertrophy.

-WHO recommends iodizing salt to 1 part in 100,000 to prevent goiter. US iodizes salt to 1 part in 10,000 in salt.
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Thyroid cancer
-Requires surgical removal.
-Post operative care
-High calorie, high protein diet due to hypermetabolism.
-Check surgical dressing and reinforce as needed.
-Bleeding can occur on side and back of neck.
-Tightness in dressing could indicate hematoma.
-Assess airway and breathing, pulse, BP, pain.
-Treat pain with narcotic analgesic
-Support head with hands when sitting up.
-Encourage to rest voice, note any voice changes.
-Tracheostomy tray at bedside for emergencies.
-Check temp every 4 hours – first sign of thyroid storm
-Monitor calcium levels: Calcium Gluconate at the bedside
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Parathyroid gland
-Small oval structures arranged in pairs behind each thyroid lobe. There are four in total.
-Secretes parathyroid hormone (PTH). Regulates blood calcium levels. Acts on bone, kidneys, and GI track. PTH stimulates bone reabsorption and inhibits bone formation releasing calcium and Phosphate into the blood.
-Works on a negative feedback loop. Has no hypothalmus or pituitary control.
Parathyroid gland (con't)
-Hypoparathyroidism sometimes occurs as a result of accidental removal during thyroid surgery or interruption in blood flow during neck surgery.
-Decreased serum calcium levels cause tetany.
-S/S of tetany tingling of the lips, fingertips, and feet, increased muscle tension leading to stiffness. Painful tonic spasms of smooth and skeletal muscle.
-Chvostek’s sign: spasm of the muscles of the face elicited by tapping over the facial nerve.
-Trousseau’s sign: carpopedal spasm elicited by inflating a blood pressure cuff on the upper arm for 1-5 minutes.
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Chvostek’s sign
Spasm of the muscles of the face elicited by tapping over the facial nerve.
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Trousseau’s sign
Carpopedal spasm elicited by inflating a blood pressure cuff on the upper arm for 1-5 minutes.
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Adrenal Function and Dysfunction
-There are two adrenal glands one on top of each kidney.
-The hypothalmus secretes corticotropin releasing hormone (CRH).
-The pituitary secretes ACTH which stimulates the adrenal cortex to secrete cortisol.
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Adrenal medulla
-10-20 % of the gland.
-Secretes catecholamine epinephrine needed for the fight or flight response, increasing blood flow to vital tissues and decreasing blood flow to nonvital tissues.
-Catecholamines also increase the release of fatty acids, increasing basal metabolic rate and increasing blood glucose levels.
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Adrenal cortex
-80-90% of the gland produces three hormones essential for life
-Glucocorticoids, mineralcorticoids, and androgens.
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Hormones of the adrenal cortex
-Glucocorticoids: affect metabolism and are given to patients to control the inflammatory response.
--Side effects of glucocorticoids are elevated blood glucose, osteoporosis, peptic ulcer disease, poor wound healing, and muscle wasting.
--Administering glucocorticoids inhibits the natural function of the adrenal cortex. Sudden withdrawal can result in acute adrenal insufficiency.

-Mineral corticoids: control fluid and electrolyte balance. Aldosterone acts on renal tubules to promote reabsorption of Na and water and the excretion of K and H ions.

-Androgens: sex hormones, responsible for secondary sex characteristics and sex drive in females.
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Cancer of the adrenal medulla
-Pheochromocytoma: a benign tumor causing sympathetic nervous system oversensitivity.

-S/S hypertension, headache, diaphoresis, palpitations, and elevated blood sugar.

-Five H’s hypertension, headache, hyperhidosis, hypermetabolism, hyperglycemia.

-Nursing care bedrest, HOB elevated, transfer to ICU for nipride drip. BP may be as high as 250/150 mm hg.

-Surgical removal of tumor
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Adrenocortical insufficiency
-Addison’s disease

-Most common cause is steroid use.

-Even 2-4 weeks may suppress adrenal cortex.

-S/S muscle weakness, anorexia, GI symptoms, fatigue, emaciation, dark pigmentation of skin, knuckles, knees, elbows, hypotension.

-Hypoglycemia, hyponatremia, hyperkalemia, depression, emotional liability, apathy, and confusion.
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Skin, nail, and gum pigmentation in Addison’s
Picture in lecture notes:
-patient may have been treated many years ago for pulmonary TB

-Generalised skin pigmentation (in a Caucasian patient) but especially the deposition in the palmer skin creases, nails and gums
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Addisonian Crisis
-S/S cyanosis, circulatory collapse, pallor, apprehension, rapid weak pulse, rapid respirations and decreased blood pressure.

-Medical management – monitor vital signs, recumbent position with legs elevated.

-Administer hydrocortisone (Solu Cortef) IV followed by D5W.

-May require cardiovascular support with dopamine.
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Adrenal Overproduction
-Overactive adrenal function or steroid use can cause Cushing’s syndrome.
-May be caused by a pituitary tumor over secreting ACTH.
-S/S weight gain in trunk, face, and cervical area, fluid retention, glucose intolerance, muscle wasting, osteoporosis, easy bruising (thin skin), delayed healing, mood disturbances, bronzing of the skin, hypertension, acne, virilization in women, gynecomastia in men, moon face, purple striatea on abdomen and breast, or buttocks, hypokalemia, buffalo hump.
-Treatment surgery if pituitary or adrenal tumor and steroid replacement for life.
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Cushing's Syndrome
Pictures in Lecture notes
-Buffalo Hump
-Moon Face