Nurs 337 - Exam 3 (Endocrine Disorders)

What are 4 General Problems That Can Cause Endocrine Disorders?

1) problem w/ the endocrine gland (hypo vs. hypersecretion)

2) problem w/ the hormone itself

3) problem w/ the target cell

4) problem w/ receptors on the target cell

What are 2 Diseases of the Posterior Pituitary Gland?

1) Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): hypersecretion of ADH

2) Diabetes Insipidus: hyposecretion of ADH

What are 3 Manifestations of SIADH?

1) water retention & cerebral edema

2) hyponatremia (low blood sodium level)

3) serum hypoosmolality (diluted blood = low solute concentration)

What are 3 Treatments for SIADH?

1) Fluid restriction

2) ADH receptor antagonist

3) Loop diuretics (kidneys make more urine)

What is the Most Common Cause of SIADH? (elevated levels of ADH)

cancer

Why Would SIADH Cause More Concentrated Urine?

more ADH causes less urine formation. Water stays in the blood/body and less water in urine means it will be more concentrated

Why Would SIADH Cause Hyponatremia?

ADH causes less urine formation. Water stays in the blood/body and more water in blood means Na+ will be lower

Diabetes Insipidus Would Cause What 2 Issues?

1) polyuria (large amounts of dilute urine)

2) polydipsia (excessive thirst)

What are 3 Causes of Diabetes Insipidus?

1) Neurogenic (insufficient amounts of ADH): head trauma, brain surgery, tumor

2) Nephrogenic (inadequate response to ADH): lithium, hyperglycemia

3) Psychogenic

What are 3 Manifestations of Diabetes Insipidus?

1) more urine production

2) hypernatremia (high blood sodium level)

3) serum hyperosmolality (concentrated blood = high solute concentration)

What are 2 Diseases of the Anterior Pituitary?

1) Acromegaly (hypersecretion of growth hormone during adulthood)

2) Gigantism (hypersecretion of growth hormone in children/adolescents)

What is a Common Cause of Acromegaly and Gigantism?

pituitary adenoma (benign pituitary gland tumor) affecting growth hormone levels

What are Common Neurological Problems Associated with a Pituitary Adenoma?

vision problems

What is the Pathophysiology of Acromegaly and Gigantism?

Excess of insulin-like growth factor (IGF-1) caused by: a) excess growth hormone (GH) b) excess growth hormone releasing hormone (GHRH)

What Test Can Be Done to Diagnose Acromegaly/Gigantism?

measure IGF-1 and GH levels

The 2 Main Types of Hypo/Hyperthyroidism Talked About in Class Ultimately Arise due to _______________?

Autoimmunity to the Thyroid gland

Explain the Steps that Lead to Hyperthyroidism

autoimmunity to thyroid gland → antibody-mediated autoimmunity → thyroid gland stimulation → Grave's disease

→ hyperthyroidism

Explain the Steps that Lead to Hypothyroidism

autoimmunity to thyroid gland → cellular autoimmunity → thyroid gland destruction → Hashimoto thyroiditis → hypothyroidism

What is Grave's Disease? What is the Cause? What is the Result?

an autoimmune disease caused by antibodies binding to TSH receptors on Thyroid gland (Result: hypersecretion of thyroid hormones = hyperthyroidism)

When a Patient Has Grave's Disease Will They Have Elevated/Lowered Levels of: thyroid hormones, thyroid stimulating hormone, tetraiodothyronine

Thyroid Hormones (T₃/T₄): elevated

TSH: lowered levels (body decreases TSH in response to the rise in T₃/T₄)

Tetraiodothyronine: elevated

Grave's Disease Affects More Men or Women? What Age Range?

typically affects women between 20-40

What are 9 Signs of Grave's Disease (Hyperthyroidism)?

1) bulging eyes

2) increased heart rate & cardiac output

3) weight loss

4) heat intolerance (hot skin)

5) amenorrhea (lack of menstruation)

6) high metabolic rate

7) loose stool

8) tremor

9) hyperreflexia

What is Thyrotoxic Crisis AKA Thyroid Storm?

a dramatic increase in thyroid hormone levels, which can be fatal

What is Hashimoto's Thyroiditis?

an autoimmune disease in which antibodies destroy cells of the thyroid gland (Result: less thyroid hormone produced = hypothyroidism)

What are 7 Signs of Hashimoto's Thyroiditis (Hypothyroidism)?

1) myxedema (edema on front of legs)

2) decreased heart rate & output

3) weight gain

4) cold intolerance (cold skin)

5) slow metabolic rate

6) lethargy

7) decreased mental acuity

The Most Common Type of Hypothyroidism in the U.S. is _____________? The Most Common Type of Hypothyroidism in the World is _____________?

U.S: hashimoto's thyroiditis

World: iodine deficiency

How Does Iodine Deficiency Cause Hypothyroidism?

an iodine deficiency causes decreased synthesis of thyroid hormone (T₃ & T₄)

What is Cretinism? What Can Cause It?

congenital (infants) hypothyroidism which can be caused by iodine deficiency during pregnancy

What is a Goiter?

an enlarged thyroid gland

T/F: Goiters can develop in both hypothyroidism & hyperthyroidism

true

What are 3 Effects Insulin Has On Fat?

1) increased glucose uptake

2) increased lipogenesis

3) decreased lypolysis

What are 3 Effects Insulin Has On Muscle?

1) increased glucose uptake

2) increased protein synthesis

3) increase glycogen synthesis

What are 3 Effects Insulin Has On the Liver?

1) increased lipogenesis

2) increased glycogen synthesis

3) decreased gluconeogenesis (making glucose out of noncarbs)

What are the 2 Main Types of Diabetes Mellitus?

1) Type I (insulin-dependent): defect in insulin secretion (beta cells in pancreas are damaged)

2) Type II (non-insulin-dependent): defect in insulin action/insulin resistance (receptors, or insulin molecule defect)

What are 2 Other Types of Diabetes?

1) maturity onset diabetes of youth - MODY (age < 30)

2) gestational diabetes mellitus (a form of type II diabetes)

What is Maturity Onset Diabetes of Youth? (MODY) What is the Pattern of Inheritance?

What: beta cells aren't making enough insulin (not autoimmune)

Inheritance: autosomal dominant

What is Gestational Diabetes Mellitus?

hyperglycemia during pregnancy because of insulin resistance

What are 4 Potential Problems for a Baby Whose Mother Has Gestational Diabetes Mellitus?

1) large baby

2) premature birth

3) hypoglycemia

4) could develop type II diabetes later in life

T/F: Gestational diabetes mellitus is a type of Type II diabetes mellitus

true

T/F: Hyperglycemia is seen in both Type I and Type II diabetes mellitus

true

What Causes the Chronic Microvascular and Macrovascular Complications of Diabetes Mellitus?

hyperglycemia

What are 4 Types of Tissues that can Transport Glucose in the Absence of Insulin?

1) CNS

2) kidney

3) myocardium

4) gut

What are 3 Tests Used to Diagnose Diabetes Mellitus?

1) Fasting Plasma Glucose

2) Oral glucose tolerance test

3) Hemoglobin A1c (glycated hemoglobin = glucose bound to hemoglobin)

What is the Normal Blood Sugar Level

80-120 mg/dL

What are 4 Diagnostic Criteria for Diabetes Mellitus? (Fasting Plasma Glucose, 2-hr Plasma Glucose, Random Plasma Glucose, Hemoglobin A1c)

1) Fasting Plasma Glucose: 126 mg/dL or more

2) 2-hr Plasma Glucose: 200 mg/dL or higher during a oral glucose tolerance test

3) Random Plasma Glucose: 200 mg/dL or higher in patient with symptoms of hyperglycemia

4) Hemoglobin A1c: 6.5% or higher

What is the Purpose of a Glycated Hemoglobin (A1c) Test?

monitoring long-term blood glucose control (2-3 months)

List 8 Manifestations of Diabetes Mellitus. Describe Each

1) hyperglycemia (high glucose level in blood)

2) glucosuria (high glucose level in urine)

3) polyuria (large amount of dilute urine b/c glucose in urine pull more water into urine)

4) polydipsia (excessive thirst b/c of water loss )

5) polyphagia (excessive hunger b/c cells are not taking in glucose so they still need energy)

6) weight loss (body breaks down fats & muscles)

7) fatigue (cells lack energy b/c glucose can't be absorbed)

8) dehydration (more frequent urination = dehydration)

What are 3 Manifestations of Hyperglycemia?

1) blurred vision (high blood sugar damages vessels in eye)

2) lower extremity paresthesia (nerves damaged by high blood sugar)

3) yeast infection

What is the Most Common Cause of Type I Diabetes Mellitus?

immune destruction of the pancreas beta cells that produce insulin

What is a Treatment for Type I Diabetes Mellitus?

insulin injections

T/F: Type I diabetes mellitus is more common in children & young adults

true

What are 2 Causes of Type II Diabetes Mellitus?

1) insulin resistance by target cells

2) beta cells not secreting enough insulin

T/F: Many people with Type II diabetes are asymptomatic and remain undiagnosed for years

true

What are 6 Major Risk Factors of Type II Diabetes Mellitus?

1) Obesity

2) Hypertension

3) Age > 45

4) Family History

5) lack of physical activity

6) history of gestational diabetes

What are 3 Treatments for Type II Diabetes Mellitus?

1) Diet (increase fiber; decrease lipids & simple carbs)

2) Exercise (reduces blood glucose levels)

3) Medication (stimulate beta cells to produce more insulin) (oral medication to lower blood sugar)

What are 2 Acute Complications of Type I Diabetes Mellitus?

1) hypoglycemia [insulin shock] (injecting too much insulin)

2) diabetic ketoacidosis

What is 1 Acute Complication of Type II Diabetes Mellitus?

1) Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNK)

What are 3 Chronic Complications of Diabetes Mellitus?

1) pregnancy complications (spontaneous abortion)

2) infection

3) cataracts

What is 1 Cause of Hypoglycemia/Insulin Shock Seen as an Acute Complication of Type I Diabetes Mellitus?

1) injecting too much insulin

How Does Diabetes Mellitus Cause Ketoacidosis Seen as an Acute Complication of Type I Diabetes Mellitus??

insufficient insulin in blood → hyperglycemia → body isn't able to use glucose for energy → body breaks down lipids for energy → ketone bodies are released → ketones make blood more acidic → ketoacidosis

What are 4 Signs of Diabetic Ketoacidosis?

1) dehydration

2) electrolyte imbalances (neurological problems)

3) Kussmaul's breathing (fast, deep breathing)

4) fruity smelling breath (acetone breath)

What are 4 Manifestations of Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNK)?

1) hyperglycemia

2) severe dehydration

3) electrolyte imbalances (neurological problems)

4) CNS depression

T/F: HHNK is more common in older patients

true

What are 7 Vascular Problems Caused By Diabetes Mellitus?

1) heart attack

2) stroke

3) atherosclerosis

4) peripheral vascular disease

5) nephropathy (damages kidneys)

6) retinopathy (damages eyes)

7) neuropathy (damages nerves)

What are 2 General Adrenal Cortex Disorders?

1) Hypercortisolism

2) Hypocorticolism

What are 2 Hypercortisolism Disorders? Describe Each

1) Cushing's Disease: excess adrenocorticotropic hormone (ACTH)

2) Cushing's Syndrome: chronic excess cortisol (glucocorticoid) due to any reason

What are 2 Hypocortisolism Disorders? Describe Each

1) Primary Adrenal Insufficiency (Addison's Disease): deficiency of adrenocorticoid secretions (corticosteroid s)

2) Secondary Hypocortisolism: decreased ACTH; adrenal atrophy

What are 5 Signs of Cushing's Syndrome?

1) thinning hair

2) moon face

3) buffalo hump

4) obesity in trunk

5) hypertension

What are 2 Causes for Addison's Disease? Which One is Most Common

1) autoimmune disorder

2) adrenal gland damaged by hemorrhage or infection

What are 4 Signs of Addison's Disease?

1) anorexia

2) hypotension

3) hyponatremia

4) hyperkalemia

What is a Common Cause of Secondary Hypocortisolism?

prolonged exposure to glucocorticoid drugs