Card Set Information

2010-12-03 01:28:55

Endocrine disorders
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  1. Glands
    Synthesize & release hormones
  2. Hormones
    • send out regulatroty information to cells and organs
    • work with nervous system to maintain communication and control
    • affect only target cells with specific receptors
    • eliminated via excretion by kidneys or are deactivated by liver and/or cellular mechanisms
  3. Diabetes Mellitus
    • A dysfunction of the pancreas (most common endocrine disorder)
    • #1 cause of blindness, Causes 50% of ESRD, chronic hyperglycemia, metabolism disturbance, Atherosclerotic (CAD, CVA)
  4. Insulin
    • Increases glucose transport: Involved in glycogen synthesis (the form in which glucose is stored for use as fuel)
    • Increases lipid protein and cholesterol synthesis
    • Only hormone that decreases blood glucose
  5. glucagon
    hormone that stimulates the conversion of glycogen in the liver back to glucose (opposite of insulin)
  6. Glucocorticoids
    A general class of adrenal cortical hormones that give rise to or directly produce glucose (opposite of insulin)
  7. Diagnosis of Diabetes
    • Fasting Glucose >125 mg/dL
    • Random Glucose >200 mg/dL
  8. Prediabetes
    • Impaired fasting glucose: fasting glucose >105 & <125 mg/dL
    • Impaired glucose tolerance: abnormal response to oral glucose tolerance test where 2 hour glucose is >140 & <200 mg/dL (many are obese, 10-25% will convert to type II diabetes in 10 yrs)
  9. Gestational diabetes
    • glucose intolerance caused by high levels of estrogen and growth hormone
    • test: 1 or 3 hour post prandial glucose values
  10. Type 1 diabetes
    • Absolute insulin deficiency (insulin dependent DM) (juvenile onset diabetes)
    • Autoimmune Destruction of beta cells
    • genetic factors may play a part
    • 80-90% of islet (pancreas beta) cells destroyed when symptomatic
    • Increased levels of glucagon
  11. signs of type I DM
    • hyperglycemia
    • glucose in urine
    • proteins and fats break down due to lack of insulin, results in weight loss and/or ketoacidosis (^ ketones in circulation)
    • Polyuria: Glucose spilling form blood to urine and taking water (K, Na, phospates) whth it
    • Polydipsia (often drinking): Glucose levels are high in blood and lost in urine. excess fluid loss.
    • polyphagia (often eating): all cells need insulin to transport glucose besides brain kidneys and RBC's. they induce hunger
    • sweet or fruity odor to breath (ketones)
  12. Diabetic ketoacidosis
    • may be life threatening
    • abnormal fat and protein metabolism
    • low body K+: when treated with insulin K moves back into cells, can become hypokalemic
    • Sweet/fruity breath (ketones)
    • Fat is poorly oxidized because fat needs glucose to oxidize properly
    • Kusmaul breathing during metabolic acidosis (blowing off CO2 to compensate, hyperglycemia)
  13. Type II DM
    • NIDDM (Non-insulin dependent DM)(Adult onset Diabetes)
    • Genetic predisposition, ^Native americans, hispanics, & blacks, 10* greater with obesity
    • Combination of insulin insensitivity, weak secretion due to beta cell responsiveness, and abnormal glucagon secretion (insulin resistance^ with obesity)
    • Pancreatic changes (amyloid deposits) lead to beta cell destruction
    • Lipid accumulation in pancreas impairs insulin secretion
  14. signs of type II DM
    • Pruritis
    • recurrent infections (skin/yeast)
    • visual changes
    • paresthesias (numbness tingling extremities)
    • fatigue
    • overweight with hyperlipidemia (high cholesterol)
    • poly -uria -dipsia -phagia
  15. HHNC
    • Hyperosmolar Hyperglycemic Nonketotic Syndrome
    • uncommon but high mortalilty rate
    • occurs in compromised individuals
    • osmotic diuresis from increased serum glucose (>600 mg/dL) lack of thirst and/or functional inability to obtain H20
    • Hyperosmolality combined with dehydration creates confusion lethargy fever hypotension shock
    • Nonketotic because there is enough isulin to prevent fat and protein catabolism
    • carefully rehydrate (cerebral edema)
  16. Hyperlipidemia
    • High cholesterol
    • with damage to basement membrane leads to atherosclerotic diseases
    • Microangiopathy usually
    • Retinopathy
    • Atherosclerosis: CAD PVD CVA
    • Neropathy: loss of sensation in extremeties
    • Renal cells with basement membrane changes from nephrotic syndrome (eventual renal failure)
  17. Hemoglobin A1C
    • A hemoglobin molecule with glucose attached
    • Goal <6.5
  18. Insulin treatment
    • injections 2-4 * per day + monitoring
    • Fever, stress, infection, pregnancy, surgery, and hyperthyroidism ^ insulin requirements
    • Liver disease, hypothyroidism, vomiting, and renal disease may decrease insulin requirements
  19. Hypoglycemia
    • Most commonly due to excess insulin
    • CNS can only use glucose for metabolism (pallor, tremor, anxiety, tachycardia, dizziness, hunger, seizures) (coma when glucose 45-65 mg/dL)
    • Give orange juice, sugar, or IV dextrose, cake icing
  20. Adrenal Gands
    • Medulla: core of the adrenal gland, Bodys main souce for catecholamines
    • Cortex: Sythesizes corticoseroid hormones from chosesterol (glucocorticoids, mineralcorticoids, sex hormones)
  21. Mineralcorticoids
    The most potent is Aldosterone: responsible for electrolyte balance
  22. Glucocorticoids
    • control and regulate: aldosterone, renin, angiotensin, sex hormones, hypothalamic-pituitary-adrenal gland axis with negative feedback
    • ^ hepatic gluconeogenesis and glycogen breakdown
    • ^ protein catabolism
    • ^ lipolysis
    • Suppresses inflammation and immune system
    • critical for stress response
    • can cause insomnia/psychosis
    • inhibits osteoblast (bone reabsorbtion)
  23. Causes Cushings Disease
    • Glucocorticoid excess
    • causes excess ACTH secretion by a tumor outside of the pituitary, adrenal neoplasms, administration of Glucocorticoids (80%)
  24. Cushing's symptoms
    • increase protein catabolism: thin skin atrophy of limb muscles, increased bruising, stretch marks
    • lipid deposition: pendolous abdomen, moon face, buffalo hump
    • poor wound healing
    • glucose intolerance or diabetes
    • hypertension
    • osteoporosis
    • psychiatric disturbances
  25. Causes of Addisons Disease
    • Glucocorticoid Deficit
    • Autoimmune: primary inability for adrenal to produce and secrete hormones
    • Inadequate stimulation of adrenal glands: disruption of feedback regulation
  26. Symptoms Addisons Disease
    • Hyperkalemia, hyponatremia
    • hypertension, shock
    • nausea, vomiting, abdominal tenderness
    • weakness, anorexia, weight loss
    • fever
  27. treatment of addisons
    • replacement of glucocorticoids with dietary modifications
    • at least 150 mEq of sodium daily with increased sodium during periods of ^sweating or diarrhea
  28. Thyroid diseases controlled by
    Hypothalamus pituitary axis, trh, and tsh
  29. Hypothyroidism
    • deficient production of thyroid
    • causes: congenital defects, defective hormone synthesis (autoimmune, iodine deficiency), radiation, aging
    • Child: severe mental retardation
    • Adult: if longstanding results in myxedema ( altered composition of dermis & other tissues)
    • Symptoms: slow reflexes, mentation decreased motor activity, cold intolerance, weight gain, thick puffy skin, constipation
    • treatment: thyroid hormone, iodized salt
  30. Hyperthyroidism
    • Causes: graves disease, toxic multinodular goiter, thyroid adenoma
    • symptoms: weight loss, tachycardia (atrial arhythmias), heat insensitivity, sweating, nervousness, insomnia, dearrhea
    • treatment: antithyroid drugs, radiation, subtotal thryroidectomy