Endocrine disorders

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Endocrine disorders
2014-10-27 01:42:24
Thyroid adrenal hypothalamus pituitary

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  1. What are the main action of the thyroid gland?  What are the 2 active hormones?
    • Stimulation of energy use, heart, and promotion of growth and development. 
    • Triiodothyronine (T3)-- synthetic T3 is liothyronine. 
    • Thyroxine T4 tetraiodothyronine-- Synthetic T4 is levothyroxine.
  2. Regulation of thyroid function?
  3. Hypothyroidism? diseases? Clinical Manifestations? Causes? treatment?
    • Severe deficiency of thyroid hormone. 
    • Myxedema (adults): rare but serious from persistently low thyroid production by ilness/rapid withdrawal of thyroid medication/surgery. 
    • TX: levothyroxine (synthroid), glucose and corticosteroids. 
    • Cretinism (infants). 
    • CM: weight gain, cold and dry skin, lethargy and fatigue, intolerance to cold, brittle hair or loos of hair. 
    • Causes: Malfunction of the thyroid, Hashimoto's disease-chronic autoimmune thyroiditis, insufficient iodine in the diet, surgical removal of the thyroid and destruction of thyroid with radioactive iodine. (in adults) insufficient secretion of TSH and TRH. 
    • TX: Therapeutic strategy and lifelong replacement therapy (levothyroxine (T4) and Liothyronine (T3)).
  4. hypothyroidism in lifespan issues? pregnancy and infants?
    • Pregnancy: in frist trimester can result in permanent neuropsychologic deficits in the child. 
    • Infants: may be permanent or transient, can cause retardation and derangement of growth.
  5. Levothyroxine (synthroid)? half-life? TU? AE? checks? DI?
    • it is the synthetic preparation of thyroxine (T4) and drug of choice for hypothyroidism. 
    • Conversion to T3. 
    • Half-life: 7days. 
    • TU: hypothyroidism. Should be taken on empty stomach in the morning at least 30 mins before breakfast. 
    • AE: Tachycardia, angina, tremors, can intensify effects of warfarin. 
    • Checks: T3, T4, and TSH for therapeutic levels. 
    • DI: drugs that reduce or accelerate the absorption, Warfarin, catecholamines.
  6. Forms of hyperthyroidism?
    • Grave's disease
    • Toxic diffuse goiter or plummer's disease.
    • Thyrotoxic crisis (thyroid storm)
  7. Grave's disease? CM? TX?
    • Most common form of hyperthyroidism. 
    • affects women 20-40 yrs. 
    • Causes exophthalmos (abnormal protrusion of the eyeball or eyeball)
    • CM: tachycardia, dysrhythmia, angina, appetite increased, weight loss. 
    • TX: surgical removal of thyroid tissue, destruction of thyroid tissue with radioactive iodine, methimazole or propylthiouracil.
  8. What is thyrotoxicosis? exophthalmos?
    • Another name for hyperthyroidism. 
    • Abnormal protrussion of the eyeball or eyeballs.
  9. Toxic diffuse goiter or plummer's disease?
    • Similar clinical manifestations as Grave's disease. 
    • Treatment is similar to Grave's disease.
  10. Thyrotoxic Crisis (thyroid storm) CM?
    • Major surgery or severe intercurrent illness. 
    • CM: Profound hyperthermia, Tachycardia, restless, agitation, tremor. 
    • TX: potassium iodise, PTU, beta blocker, sedation, cooling, glucocorticoids, IV fluids. 
    • *Could infect WCB.
  11. Propylthiouracil (PTU)
    AE: agranulocytosis (deficiency of granulocytes), hypothyroidism, pregnancy and lactation.
  12. Radioactive Iodine-131? Half-life? TX? TU? Candidates? MOA?
    • Radioactive isotope of stable iodine, emits gamma and beta rays. 
    • HL: 8 days.
    • TX: 2-3 months for full effect. 
    • TU: used in Grave's disease. 
    • Candidates: Pts over the age of 30. 
    • MOA: produces clinical remission with destruction of thyroid gland.
  13. Nonractive Iodine? TU? AE? DON'T NEED TO KNOW IT.
    • Strong iodine solution (lug's solution). 
    • TU: used to suppress thyroid function in preparation for thyroidectomy. 
    • AE:
  14. What do the adrenal cortex hormones affect?
    • Maintenance of glucose availability. 
    • Regulation of water and electrolyte balance. 
    • Development of sex characteristics. 
    • Life-preserving response to stress.
  15. What are the classes of steroid hormones from the adrenal cortex?
    • Glucocorticoids. 
    • Mineralocorticoids. 
    • Androgens.
  16. What are 2 most familiar forms of adrenocortical dysfunction?
    • Crusing's syndrome: adrenal hormone excess. 
    • Addison's disease: adrenal hormone deficiency.
  17. Negative feedback regulation of glucocorticoids synthesis and secretion.
  18. What do mineralocorticoids do? example.
    • Influence renal processing of sodium, potassium, and hydrogen. 
    • EX: aldosterone. 
    • Promotes sodium and potassium hemostasis. 
    • Maintains intravascular volume. 
    • Harmful cardiovascular effects with high levels. 
    • Regulated by RAAS.
  19. Adrenal androgens?
    • Androstenedione. 
    • Minimal physiological effect at normal levels. 
    • In excess (congenital adrenal hyperplasia) --> excess of the androgens, sex characteristics in early age (kind of a rare thing) most of the time is a tumor growth. 
    • Responsible for how we look like.
  20. Cushing's syndrome? causes? CM? TX?
    • Adrenal hormone excess. 
    • Causes: hypersecrition of ACTH (adrenocorticotropic hormone) or/and glucocorticoids. 
    • Administering glucocorticoids in large doses. 
    • CM: Obesity.
    • hyperglycemia, hypernatremia (electrolyte probs), HTN.
    • Hypokalemia, hypocalcemia.
    • TX: Carcinoma/adenoma: surgical removal of adrenal gland.
    • replacement therapy with glucocorticoids and mineralocorticoids -- for Bilateral adrenalectomy.
    • Drugs are adjunct for surgical treatment.
    • beta blockers (to calm them down).
    • * This is the main reason why glucocorticoids should start high and slowly go down.
  21. Primary huperaldosteronism? Causes? TX?
    • Excessive secretion of aldosterone. 
    • Causes: Hypokalemia (low potassium), metabolic alkalosis, HTN. 
    • TX: surgery or aldosterone antagonist (spironolactone). 
    • *Aldosterone keeps homeostasis b/t potassium (hypokalemia) and sodium (hyponatremia)
  22. Addison's disease? CM and causes? TX?
    • Adrenal hormone insufficiency (primary adrenocortical insufficiency). 
    • CM and causes: weakness and hypotension. 
    • Hypoglycemia, hyponatremia, hypotension. 
    • Hyperkalemia, hypercalcemis. 
    • Increased pigmentation of skin and mucous membranes. 
    • TX: Replacement therapy with adrenocorticoids. 
    • Hydrocortisone is the drug of choice. Both glucocorticoids and mineralcorticoids.
  23. Acute adrenal insufficiency (adrenal crisis)? CM? Causes? TX?
    • It is when they are not producing adrenal hormones at all. 
    • CM: hypotension, dehydration, weakness, lethargy, GI symptoms (vomiting and diarrhea). 
    • Causes: adrenal failure, pituitary failure, inadequate doses of corticosteroid or abrupt withdrawal. 
    • TX: rapid replacement of fluid, salt, and glucocorticoids (hydrocortisone).
    • Glucose: normal saline with dextrose bc of the hypoglycemia.
  24. What are the glucocorticoids employed for 2nd and 3th adrenocortical insufficiency? TU?
    • -SONE suffix.
    • Hydrocortisone, dexamethasone, prednisone.
    • TU: Five entire rose at bedtime (high level during sleep, peak at waking time). 
    • Doses for endocrine disorder are much smaller than for nonendocrine disorders. 
    • Increase dosage in time of stress.
  25. Hydrocortisone? TU? AE?
    • Synthetic steroid w structure identical to cortisol (it could be considered as a glucocorticoid). 
    • TU: adrenal insufficiency, allergic rxn to inflammation, and Cancer. 
    • AE: Adrenal suppression, and cushing's disease.
  26. Fludrocortisone (florinef)? TU? AE?
    • Potent mineralocorticoid. 
    • TU: addison's disease, primary hypoaldosteronism, congenital adrenal hyperplasia. 
    • AE: HTN, edema, Cardiac enlargement, hypokalemia (low potassium).
  27. Dexamethasone? TU?
    • Synthetic steroid, primarily glucocorticoids properties; very little mineralcorticoid activity. 
    • Overnight dexamethasone test to diagnose cushing's syndrome.