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91 Cards in this Set
- Front
- Back
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Are all hormones secreted from the pituitary produced there?
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No
A few hormones are produced in the hypothalamus |
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The hypothalamus controls some functions through ___________ pathaways, especially to the posterior pituitary, where ______ and _______ are storeed
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neural
ADH (vasopressin) oxytocin |
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They hypothalamus regulates some function through hormonal control over the ________ __________
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anterior pituitary
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Where are trophic hormones secreted from
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anterior pituitary
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tropic hormones have various targets... which include
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adrenal cortex
thyroid gland gonads |
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Hypothalamic hormones also stimulate the anterior pituitary to secrete ________ hormones
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effector
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example of an effector hormone
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human growth hormone (HGH)
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Endocrine disorders can be a problem caused by :
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1. a defective gland
2. a defect of a releasing hormone 3. a defect of a trophic hormone 4. a defect of an effector hormone 5. defective target tissue |
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Simple Feedback Mechanism
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the level of one substance regulates secretion of a hormone
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low serum calcium stimulates the parathyroid gland to secrete PTH while a high serum calcium level inhibits PTH secretion.
example of?? |
Simple Feedback Mechanism
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complex feedback mechanism
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secretion of hypothalamic corticotropin-releasing hormone stimulates the pituitary to secrete corticotropin which in turn stimulates the adrenal gland to secrete cortisol. Elevated cortisol levels inhibit corticotropin secretion by inhibiting corticotropin-releasing hormone secretion
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possible causes of endocrine pathology
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1. failed feedback system
2. feedback system that responds to the wrong feedback signal 3. insufficient production of a hormone 4. excessive production of a hormone 5. inactivation of a hormone by antibodies before any response on effector tissue could occur 6. abnormal target cell response |
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Receptor-Associated Alterations have been associated with
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water-soluble hormones(peptides)
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Receptor associated alterations involve:
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1. Fewer receptors = diminished hormone-receptor binding
2. Impaired receptor function = insensitivity to the hormone 3. Presence of antibodies against specific receptors = reduces available binding or mimics hormone action 4. Unusual expression of a receptor function |
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______________ ______________ involve the inadequate synthesis of a second messenger, such as cAMP
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Intracellular Alterations
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How do intracellular alterations occur?
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1. Faulty response of target cells and failure to generate the required second messenger
2. Abnormal response of the target cell to the second messenger and failure to express the usual hormonal effect |
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Pathologies involving _____-_______ ___________ are less common, but may fool the Dr. who doesn't see these aberrations often
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lipid-soluble hormones
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it involves hypersecretion of glucocorticoids by the adrenal gland, which produces a characteristic moon face and truncal and neck fat pad deposits
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Cushing's Syndrome
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Cushing's syndrome can be classified as either:
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ACTH-dependent
ACTH-independent |
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ACTH-dependent Cushing's
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75-80% of cases
also called cushing's disease usually caused by and ACTH-secreting tumor Tumor may be a pituitary ademona or ectopic |
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ACTH-independent Cushing's
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20-25% of cases
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About ___% of ppl w/untreated Cushing's die w/in ___yrs from overwhelming infection, suicide, complications, and severe hypertensive dx
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50
5 |
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-Anterior pituitary hormone excess
-autonomous, ectopic corticoptropin secretion by a turmor outside the pituitary (usually malignant, often oat cell carcinoma of the lung) -excessive glucocorticoid administration, including prolonged use |
Causes of Cushing's
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What are the complications of Cushing's?
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osteoporosis
increased susceptibility to infection hirsutism ureteral calculi metastasis of malignant tumors |
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S/S of Cushing's depend on?
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degree/duration of hypercortisolism, presence of absence of androgen excess, and additional tumor-related effects
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clinical effects of Cushing's may be?
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diabetes, muscle weakness, purple striae, facial plethora (edema & blood vessel distension), fat pads above clavicles, buffalo hump, truncal obesity, poor wound healing, spontaneous ecccymosis, peptic ulcer, irritability, HA, HTN, infection, fluid retention, kidneystones, hirsuitism, sexual dysfunction, decreased libido
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a transient or permanent disturbance of water metabolism that results in excretion of excessive amounts of diluted urine. It may be pituitary (central), renal (nephrogenic), or intake regulated (primary).
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Diabetes Insipidus
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Causes of Diabetes Insipidus
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1. Acquired, familial, idiopathic, neurogenic, or nephrogenic
2. Associated with stroke, hypothalamic or pituitary tumors, and cranial trauma or surgery 3. Certain drugs, such as lithium, phenytoin, or alcohol. 4. X-linked recessive trait 5. Irradiation of the pituitary 6. Infiltrative metastatic diseases |
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More than 50% of diabetes insipidus cases are ___________
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idiopathic
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central DI begins when some form of brain injury reduces the amount of _____
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ADH
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a decrease in the amount of ADH leads to a decrease in _________ __________ of the distal collecting tues, allowing dilute urine to be excreted
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hyroosmotic permeabiltiy
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Excretion of dilute urine causes a slight dehydration, and increase in ________ __________, and stimulation of ________
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plasma osmolality
thirst |
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As a person with DI continues to drink more, input matches output while _______ ________ stabilizes at a higher than normal level
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osmotic pressure
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With nephrogenic DI, the kidneys become _____ ________ and hydroosmotic permeability is _______ .. and has the same results as central DI
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ADH resistant
reduced |
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_________ ___________ is caused by excessive water intake, either bc of severe cognitive defect of bc the thrist regulator has been disrupted by disease or trauma
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primary polydipsia
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DI is the result of a deficiency of circulating ______ or from renal resistance to this hormone
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ADH (vasopressin)
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pituitary DI is caused by
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a deficiency of vasopressin
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nephrogenic DI is caused by
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the resistance of renal tubules to vasoprssin
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DI is characterized by _______ fluid intake and _________ _________
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excessive
hypotonic polyuria |
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Complications with DI
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hydroureter, hydronephrosis, dilation of the urinary tract, severe dehydration, shock and renal failure if dehydration is severe
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2 cardinal signs of DI
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polydipsia - fluid intake of 5-20L/day caused by stimulation of the thirst mechanism
polyruria- urine output of 2-20L in a 24hr period ... dilute urine output caused by insufficient ADH |
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other S/S of DI
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nocturia, fatigue, low urine specific gravity, changes in level of consciousness (from CNS dehydration), hypotension and tachycardia (from decrease in vascular volume-fluid loss), HA, visual disturbances (electrolyte disturbance), abdominal fullness, anorexia, and wt loss, due to continuous fluid consumption
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a disease characterized by persistent hyperglycemia caused by insufficient insulin production or resistance to the metabolic action of insulin. Generally classified as insulin-dependent (IDDM, type I), non-insulin-dependent (NIDDM, type II), or secondary DM
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Diabetes Mellitus
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Type I also called
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absolute insulin insufficiency
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Type II is also called
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insulin resistance w/ varying degrees of insulin secretory defects
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secondary forms of DM arise from:
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pregnancy (gestational diabetes), pancreatic disease, hormonal or genetic problems, and chemical.
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onset of Type I DM usually occurs before age ____ , the pt is usually ____ and requires exogenous insulin & dietary management to achieve control
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30 (but can occur @ any age)
thin |
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Onset of Type II DM usually occurs in _______ adults after age ____
treated w/ ______ & ________ in combo w/ various oral antidiabetics. @ times tx may include ______ |
obese
40 diet and exercise insulin |
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DM occurs if the body cannot produce insulin in ______ or if it is unable to use the insulin produced _______
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Type I
Type II |
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In both type I and II the result is ___________ and impaired glucose transport
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hyperglycemia
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type I is characterized by a __________ predisposition, this in combo w/unknown factor = ongoing autoimmune process that systematically destroys the ______ _____ in the pancreas = interfering w/ the body's ability to produce _______
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genetic
beta cells insulin |
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type II involves either a defect in the insulin release sites in the ________ or a resistance to the action of ________
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pancreas
insulin |
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Both type I and II the result is interference w/ _______ ________ across the cell membranes in peripheral muscle & adipose tissue, leading to faulty _______ & ________ production
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glucose transport
oxidation energy |
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w/ DM metabolism of _______, ________, ________ is impaired as are storage of glycogen in the muscle and liver... and storage of ______ ______ & triglycerides in adipose tissue
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fat, carbs, and protien
fatty acids |
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In DM as the _______ levels rise, renal tubules fail to reabsorb all of the _______, leading to glucosuria and osmotic diuresis w/ H2O & electrolyte loss through the urine
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glucose
glucose |
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Neuropathies in DM are caused by
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hyperglycemia damaging myelin nerve coverings
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Causes of DM
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1. Environment (infection, diet, toxins, stress)
2. Heredity 3. Lifestyle changes in genetically susceptible persons 4. Pregnancy |
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S/S of DM
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Polyuria and polydipsia
Anorexia Weight loss Headaches, fatigue, lethargy, reduced energy levels Muscle cramps, irritability, and emotional lability Vision changes Numbness and tingling Abdominal discomfort due to autonomic neuropathy Nausea, diarrhea, constipation due to dehydration and electrolyte imbalance Slow-healing skin infections or wounds Recurrent candidal infections of the vagina or anus |
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Complications associated w/ DM
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microvascular disease
Dyslipidemia macrovascular disease (CAD, CVA, peripheral) diabetic ketoacidosis hyperosmolar hyperglycemic nonketotic syndrome excessive wt gain skin ulcerations chronic renal failure |
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a syndrome (or metabolic imbalance) initiated by excessive production of thyroid hormones that results in multiple-system abnormalities ranging from mild to severe
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hyperthyroidism
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most common form of hyperthyroidism is?
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Graves' disease
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graves' disease is often called
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thyrotoxicosis
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Cause of hyperthyroidism
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-unclear
possibly autoimmune origin w/ a genetic component |
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Graves' dx occurs about ___x more often in women than men.. and is seen in about ___% of american females
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8
2 |
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Ages of American women w/highest incidence of Graves?
only about 5% of pts are younger than age |
30-60
15 |
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pathophys of hyperthyroidism...
thyroid hormones are stimulatory = excess production of these produces __________ |
hypermetabolism
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In hyperthyroidism the increased function of involved organ is mediated by increased activity of both the _____________ and ___________ nervous systems
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neuromuscular
sympathetic |
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w/ hyperthyroidism the body tries to compensate for this increased ________ ________, certain variables are increased : cardiac output, peripheral blood flow, body temp, and respiratory rate
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metabolic activity
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The increased demands placed on the body w/ hyperthyroidism eventually leads to
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organ failure
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Causes of hyperthyroidism
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1. excessive intake of iodine or stress
2. defect in suppressor-cell function = permitting production of autoantibodies 3. increaed incidence of monzygotic twins ( possibly hereditary factor) 4. meds such as lithium and amidarone 5. sometimes coexists w/ other endocrine disorders 6. stress such as surgery, infection, toxemia of pregnancy or diabetic ketoacidosis 7. toxic nodules or tumors |
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S/S of hyperthyroidism
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1.Enlarged thyroid (goiter) resulting from increased stimulation of the thyroid gland or a response to increased metabolic demand.
2. nervousness caused by hypermetabolic state 3. heat intolerance and sweating caused by hypermetabolic state and subsequent increase in vasodilation 4. weight loss despite increased appetite resulting from hypermetabolic state 5. frequent bowel movements resulting from sympathetic nervous stimulation 6. tremor and palpitations caused by increased sympathetic NS activity 7. exophthalmos |
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other S/S of hyperthyroidism
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1.Difficulty concentrating due to accelerated cerebral function
2. excitability or nervousness 3. fine tremor, shaky handwriting, clumsiness 4. moist, smooth, warm, flushed skin 5. fine, soft hair 6. premature patchy graying and increased hair loss in both genders 7. systolic HTN, tachycardia, full bounding pulse, cardiomegaly, increased cardiac output & blood volume, some arrhythmias 8. increased resp rate, dyspnea on exertion |
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If thyrotoxicosis escalates to "thyroid storm what may occur?
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Extreme irritability
hypertension marked tachycardia vomiting stupor |
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If thyroid storm is left untreated
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1. High fever (up to 106 degrees)
2. vascular collapse, hypotension, angine, pulmonary edema 3. tremors, confusion, delirium, psychosis, stupor, coma, death |
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complications of hyperthyroidism
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Muscle wasting, atrophy, and paralysis
visual loss or diplopia heart failure, arrhythmias hypoparathyroidism after surgical removal of thyroid hypothyroidism after radioactive treatment |
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patients w/ hyperthyroidism require vigilant care, especially if they are _________ or demonstrate abnormalities in cardiac, electrolyte, respiratory, or metabolic functions
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pregnant
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a clinical state resulting from a deficiency of thyroid hormones. It results from hypothalamic, pituitary, or thyroid insufficiency or resistance to thyroid hormones. It can progress to life-threatening myxedema coma
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Hypothyroidism
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hypothyroidism is more common in ________
in the US there is an increasing rate in ppl ages ___-___ |
females
40-50 |
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Causes of hypothyroidism
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Inadequate production of thyroid hormone, usually after thyroidectomy or radiation therapy or due to inflammation, chronic autoimmune thyroiditis (Hashimoto’s disease) or such conditions as amyloidosis or sarcoidosis.
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in hypothyroidism, when thyroid hormone is inadequate, a general ________ of most cellular enzyme systems & oxidative processes results = reducing the _______ ________ of the cells
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depression
metabolic activity |
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in hypothyroidism, the depression of cellular activity = a reduction in ________ consumption, which decreases ________ production , and lessens body heat
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oxygen
energy |
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in hypothyroidism when tissues are infiltrated by mucopolysaccharids, ___________ is deposited in epidermal layers, __________ stimulation is decreased, protein effusion collects in the pericardial plueral sacs, and proteinaceous ground substances are deposited in tissues
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catotene
adrenergic |
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S/S of Hypothyroidism
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S/S are often insidious at onset
fatigue, lethargy mild weight gain cold, pale, dry, rough hands and feet reduced attention span slowed speech loss of initiative swelling in extremities and around eyes, eyelids, and face menstrual irregularities muscle aches and weakness, joint aches and stiffness decreased pulse and BP depression and paranoia |
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a complication of hypothyroidism:
a life-threatening complication .. requires immediate treatment |
myxedema coma
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other complications w/ hypothyroidism
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Ischemic ht disease
CHF pleural and pericardial effusion deafness psychosis anemia |
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How hypothyroidism affects cardiovascular system
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decreased cardiac output, slow pulse, cardiomegaly, fluid retention.
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How hypothyroidism affects GI system
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unexplained wt gain, constipation, anorexia, abdominal distension, possible megacolon
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How hypothyroidism affects genitourinary system
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menorrhagia, decreased libido, possible infertility
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How hypothyroidism affects integumentary system
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decreased sweating, epidermis thins, hyperkeratosis, increased dermal glycoaminoglycan content traps water and gives rise to skin thickening without pitting (myxedema), dry flaky inelastic skin, hair patterns and eyebrows change, dry brittle nails
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How hypothyroidism affects musculoskeletal system
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ataxia, nystagmus, delayed reflexes
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How hypothyroidism affects neurologic system
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weakness, fatigue, forgetfulness, sensitivity to cold, decreased mental stability. Myxedema coma is the most lethal outcome
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