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36 Cards in this Set
- Front
- Back
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what hormones are released by the Anterior Pituitary and their functions in general
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FSH
LSH >- stimulate reproductive hormones ACTH - stimulates adrenal cortex to produce cortisol TSH - stimulates thyroid to produce TH Prolactin - stimulates milk production GH or somatotropin - growth of tissues and long bones, metabolism, energy |
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what hormones are released by the posterior pituitary and their functions in general
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oxytocin - uterine contraction and milk let down
ADH/vassopressin - prevents water loss at kidney level |
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what hormones are released by the parathyroid glands and their functions in general
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PTH - responsible for Ca and P metabolism
- causes Ca to resorb from bone/kidneys/GI - causes phosphate excretion from kidney and absorption from GI |
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what hormones are released by the pancreas and their functions in general
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islets of langerhans release the
Glucagon - raises blood glucose Insulin - lowers blood glucose |
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what hormones are released by the adrenal cortex and their functions in general
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mineralocorticoids (aldosterone) - resorbs Na and excrete K from kidney. regulates BP
glucocorticoids (cortisol) sex steroids (androgens and estrogens) |
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what hormones are release by the adrenal medulla and their functions in general
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catecholamines (epinephrine and norepinephrine)
- fight or flight |
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hyperthyroidism
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etiology: autoimmune (graves)/genetic
prev: more common in women pathology: secreting adenoma (benign) in thyroid gland OR autoimmune (graves) OR iatrogenic (caused by syntheitc TH given to pt with hypothyroidism CM: -mild goiter -elevated metabolism -periarthritis and myopathy (proximal mm weakness, pain, reduced ROM) -Exopthalmos (graves only) - eyes buldge out. caused by antibodies affecting the soft tissue behind the eye -psychiatric (mood, activity) - cardiac disease -thyroid storm (fever, tachycardia, delirium, dehydration, extreme irritability) DX: history and exam, radioactive iodine - scan -hi TH and lo TSH = cause at thyroid gland, not pituitary -hi TH, and hi TSH = cause from secreting adenoma at pituitary gland TX: -antithyroid meds (methimazole) -radioactive iodine - kills thyroid gland and use chronic TH replacement -surgery to remove thyroid with chronic TH replacement prognosis: -better with mild dz, small goiter, and early Tx -lifetime f/u important -opthalmologic sx may require radia |
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hypothyroidism
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incidince:
more common in females -familial prevalence -most common thyroid disease Etiology: -primary form = idiopathic -secondary form = pituitary/HT cause -autoimmune = hashimoto's thyroiditis casues inflammation of thyroid gland and damage to tissue CM: -slowed metabolism -ptosis = droopy eyelids -myxedema = very low levels of TH causes nonpitting edema due to changes in proteins in tissues. and can lead to coma Dx: hi TH, lo TSH = pituitary gland works but thyroid cant make it due to iodine deficiency or autoimmune death of gland (hashiotos thyroiditis) Tx: -thyroid hormone replacement (synthroid) prognosis: -depends on severity and duration -myxedema can lead to coma and death if not tx |
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what are the reasons you can get a goiter
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-by iodine deficiency
-by inflammation (hashimotos or graves) -tumor -by over stimulation of thyroid |
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thyroditis
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usually non infectious
usually hashimotos |
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thyroid tumors
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-rarely malignant
-risk factors include radiation to head and neck - hard painless nodule - when malignant they have good prognosis except anapastic thyroid cancer which mastisizes quickly |
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hyperparathyroidism
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etiology:
-primary cause is if the gland itself has a problem like adenoma or hyperplasia -secondary cause is from renal failure -tertiary cause is from dialysis CM: -causes osteoporosis: presents as pathologic fractures -hypercalcemia: too much calcium causes ulcers and pancreitis -kidney injury: nephrolithiasis Dx: -high PTH, High calcium, low phosphate, low bone density Tx: -surgical removal of parathyroid tumors -drugs to lower blood calcium (hydration, diuretics) |
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hypoparathyroidism
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etiology:
-most commonly iatrogenic : doctor takes too much parathyroid glands out for hyperparathyrectomy DX: -low PTH, lo calcium, hi phosperous CM: -neuromuscular irritability and tetany/ physical irritability of nerves TX: -calcium to prevent convulsions |
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adrenal insufficiency
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etiology
-primary cause is the gland itself addisons disease -secondary cause is from anteriorpituitary: HT or AP tumor, adenohypophysectomy (no AP), hypopituitarism of any cause, withdrawl from corticosteroids CM: acute crises initiated by stressors. surgery, pregnancy, trauma, infection, missed medication, salt loss from profuse diaphoresis with head or exercise SX: hypoglycemia, weakness or fatigue, hypotension, weight loss, nausea/vomitting -high ACTH from pituitary, especially in adison's dz, stimulates melanocytes and pigmentation -hypoaldosteronism, fluid/electrolyte imbalance can have dehydration, hyponatremia, hypotensive shock Dx: low cortisol, high ACTH TX: corticosteroids (prednisone) mineralocorticoids (fludrocortisone) |
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cushings disease vs. cushings syndrome
contrast and compare |
hypercortisolism due to ACTH secretion from pituitary adenoma
hypercortisolism from any cause such as iatrogenic, ectopic ACTH production (lung tumors- small cell ca or oat cell) both have same symptoms: central obesity, striae, poor wound healing, thin skin, osteoporosis, buffalo hump, moon facies |
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type 1 DM only
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juvenile onset
no insulin or ineffective insulin insulin dependent=requires exogenous insulin no insulin Pathology: generally AI attack against islet cells in pancreas RF: weak genetic component CM: weight loss blurred vision ketoacidosis TX: treat ketoacidosis by prevention - hydration and insulin |
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type 2 DM only
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non insulin dependent
most common caused by insulin resistance and inadequate insulin response RF: age, ethnicity - black, native amer, hisp, azn family hx - genetic component strong obesity - fat cells respond more poorly as they get a larger SA because the same # of receptors Hs of gestational diabetes CM: blood lipid abnormalities Chronic CM: hyperglycemic, hyperosmolar, non-ketotic coma -leads to dehydration/osmotic diuresis -vascular collapse and cardiac failure (hypertension/shock) -polyphagia, polydypsia, polyuria, abdominal pain, coma TX: -with insulin -electrolyte replacement -fluids -oral hypoglycemics (glipizide, metformin, rosiglitazone, etc) -diet exercise and weight loss -anticholesterol meds -antihypertesnive meds -foot care TX: -dialysis or kidney transplant -vascular surgery -coronary bypass -asprin -foot wound care -amputation -pancreas transplant |
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both type I and type II
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insulin deficiency causes hyperglycemia
-causes damage to tissues and organs; mostly eyes, kidneys, nn, hear, by, etc most common endocrine disorder leading cause of blindness and renal failure in adults hyperglycemia polyuria polydipsia atherosclerosis -retinopathy -nephropathy -neropathy (sam) -coronary artery dz -peripheral vascular dz (ulcers, gangrene, infection, esp feet) -cerebrovascular dz immune -impaire wound healing -infection risk -poor circulation -imparired immune function musculoskeletal -carpal tunnel -contractures -arthritis -limited joint mobility -hyperostosis of spine (excessive bone depostion) -osteoporosis/fractures insulin treatment hyperglycemia -fasting blood glucose -clucose tolerance test (given glucose, check glucose levels at certain intervals) -hemoglobin A1C (hg gets modified by increased glucose over long per of time - reversible) -urine ketones Prognosis -tight glucose control is best predictor of longer survival -poor control can lead to complications and death (m |
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fluid and electrolyte balance
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needed for homeostasis
-osmotic pressure -anion-cation balance -electrolyte concentrations -acid base balance -fluid and electrolyte or acid base imbalances can be caused by numerous diseases -can lead to significant cardiac of neurologic symptoms like arythemia |
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acid base balance
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normal ph is 7.4
-controlled by lungs, kidneys and buffers in blood -disturbance leads to acidosis or alkalosis |
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phenyketonuria
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autosomal (non sex chromosome) recessive defect in metabolism of amino acid phenylalanine
SX: untreated leads to menat retardation, tremors, poor motor coordination, excessive perspiration, seizures, etc Tx: phe restriction - avoid it in the diet |
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porphyria
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a family of diseases where some or most are hereditary, others are acquired
abnormalities in synthesis of heme - porphorin ring with iron in middle accumulation of porphyrins and precursors leads to neurologic sx, abdominal pain, skin manifestations, photosensitivity, psychiatric sx. various drugs and chemicas trigger acute attacks in susceptivle individuals DX: increased porphoryn or precursors in blood and urine - that are normally not there tx: depends on specific type of porphyria |
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hyperpituitarism
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over-secretion of pituitary hormones
caused by: -benign pituitary adenoma -ectopic production of pituitary hormones (from small cell lung ca or oat cell ca) - can produce ACTH and sometimes ADH SX: associated with pit adenoma: -depends on hypersecreted hormone -visual field and acuity deficits as tumor enlarges and bilateral hemianopsia |
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bitemporal hemianopsias
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classic with pituitary adenoma
-because tumor pushes on the optic chiasm -pituitary adenoma pushes on the center of the optic chiasm where most of the nasal retinal fibers run - which perceive the temporal visual field |
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pituitary adenoma symptoms
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1. hypersecretion by tumor of GH, prolactin, or ACTH (sx depends on hormone)
2. pituitary hypofunction - not by tumor but by GH, TSH, FSH/LH, ACTH 3. stalk effect: increase in prolactin secretin by the normal pituitary gland bc dopamine from HT cant get down to the pit to inhibit 4. visual symptoms: associated with size -acuity - clairty/resolution, blurry -visual field - part of visual field becomes blind |
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GH secreting adenoma
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-giantism - children before closure of epiphyses of long bones, rapid growth
acromegaly (adult) --adult, slow onset --bone/tissue thickening and hypertrophy (face, jaw, hands, feet) (carpal tunnel syndrome) (cardiac disease) --30-50 |
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ACTH secreting adenoma
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-cushings disease
-hypercortisolism -Sx: -central obesity, buffalo hump, moon facies, striae, poor wound healing, thing hair, muscle weakness, osteoporosis, bone and back pain, hypertension and cardiac disease |
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prolactinoma
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prolactin releasing prolactin in the ant pit
SX: -amenorrhea -galactorrhea (milk production) -gynecomastia (enlargement of breast tissue) -impotence in men |
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TSH secreting adenoma
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secondary hyperthyroidism
-rare |
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FSH and LH secreting adenoma
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impotence or sterility
-amenorrhea -rare |
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non secreting adenomas or non functional adenomas
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most common types
-no secretion -hypopituitarism -visual changes -can get hyperprolactinemia due to stalk effect |
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Dx of pituitary adenoma
Tx of pituitary adenoma |
mri of brain and blood levels of pituitary hormones
Tx: transsphenoidal surgical removal primary treatment -dopamine agonists for prolactinomas -mimic DA (bromocriptine, cabergoline) - not used for prolactinomas -somatostatin analogs for GH adenomas (octreolide) |
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tx of pipanhypopituitarism
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all hormones are low
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hypopituitarism
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causes:
-injury to pituitary or hypothalamus -pituitary tumor compressing normal gland -postpartum hemorrhage -reversible functional disorders (starvation, anorexia nervosa, anemia) CM: -depend on age (dwarfism or cretinism in children-GH and TSH) -decreases in children - dwarfism -greater than 75% of gland must be destroyed to show sx's -adrenocortical insufficiency (hypoglycemia, anorexia, nausea, abdominal pain, hypotension) -hypothyroidism (TSH) -gonadal failure (FSH/LH) TX: -remove causative tumor -lifetime replacement of hormones |
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what hormones are released from the posterior pituitary
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oxytocin and ADH
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diabetes insipidis
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hypofunction of the posterior pituitary
- low leveles of ADH - causes: -injury to or neoplasm of hypothalamus or pituitary -surgery -head trauma SX: -kidney fails to reabsorb water -dilute urine, polyuria, polydipsia, nocturia, dehydration, hypermatremia Tx: -ddAVP (pitressin) - asynthetic ADH -water hydration |
