Endocrine Disorders and Diabetes: Nursing Review & Key Concepts

Paracrine vs. Autocrine (Simple Difference)"

"Paracrine = acts on NEIGHBORING cells (like talking to a neighbor).Autocrine = acts on the SAME cell that released it (talking to yourself)."

"Negative Feedback Loop (The Endocrine Thermostat)"

"Works just like a home AC: When hormone levels get high enough in the blood, the brain stops sending stimulation to shut it off and maintain balance."

"Anterior vs. Posterior Pituitary (Where do hormones come from?)"

"Anterior Pituitary = ACTUALLY MAKES its own hormones (GH, TSH, ACTH, FSH, LH, Prolactin).Posterior Pituitary = ONLY STORES hormones made by the hypothalamus (ADH and Oxytocin)."

"Primary vs. Secondary vs. Tertiary Endocrine Disorders"

"Primary = Problem is in the TARGET GLAND itself (e.g., thyroid or adrenal gland is damaged).Secondary = Problem is in the PITUITARY (wrong amount of stimulating hormone).Tertiary = Problem is in the HYPOTHALAMUS."

"Prolactinoma (Most common pituitary tumor)"

"A benign tumor that makes too much prolactin.• Women: Milk leakage without pregnancy (galactorrhea), missed periods (amenorrhea), infertility.• Men: Low sex drive (decreased libido) and erectile dysfunction."

"Hypopituitarism: Which hormone is lost FIRST?"

"Growth Hormone (GH) is lost first! Remember: 70% to 90% of the pituitary must be destroyed before symptoms even show up."

"Growth Hormone Deficiency in Children"

"Causes short stature with normal body proportions, normal intelligence, and an immature 'baby-doll' face. Treated with synthetic growth hormone shots."

"Growth Hormone Deficiency in Adults"

"Causes loss of lean muscle mass, increased belly fat, weak bones (osteopenia), high cholesterol, and low energy."

"Gigantism vs. Acromegaly"

"Gigantism = Too much GH BEFORE growth plates close in childhood -> grows abnormally TALL. Acromegaly = Too much GH AFTER growth plates close in adulthood -> bones get WIDER (large jaw, big hands/feet, prominent brow, deep voice)."

"Precocious Puberty (Why does it cause short adult height?)"

"Puberty starts way too early. Kids grow really fast in elementary school, but their bone growth plates fuse early, so they end up SHORT as adults."

"What do Thyroid Hormones (T3 and T4) do?"

"They set the body's METABOLIC SPEED. More T3/T4 = faster metabolism (burns fuel faster, creates heat). Less T3/T4 = slower metabolism."

"Hypothyroidism (Slow Metabolism) - Symptoms"

"Everything slows down: Weight gain, extreme fatigue, feeling cold (cold intolerance), constipation, dry brittle hair, slow heart rate (bradycardia), puffy face."

"Hashimoto's Thyroiditis"

"The #1 cause of hypothyroidism. It is an AUTOIMMUNE disease where the body's antibodies attack and destroy the thyroid gland."

"Primary Hypothyroidism: What do the labs look like?"

"High TSH and Low T3/T4.

(The pituitary is shouting 'TSH' at the top of its lungs

but the broken thyroid cannot respond)."

"Levothyroxine (Synthroid) - Golden Nursing Rules"

"Take first thing in the morning (6:00 AM) on an EMPTY STOMACH with a full glass of water.Wait at least 4 hours before taking vitamins iron, or calcium antacids."

"Myxedema Coma (Medical Emergency)"

"Severe, life-threatening hypothyroidism.Signs: Dangerously low body temp (hypothermia)slow breathing (hypoventilation), low blood pressure, and coma. Treat with IV thyroid hormone and gentle warming."Signs: Dangerously low body temp (hypothermia) slow breathing (hypoventilation), low blood pressure, and coma. Treat with IV thyroid hormone and gentle warming."

"Hyperthyroidism (Fast Metabolism) - Symptoms"

"Everything speeds up: Weight loss despite eating more, feeling hot (heat intolerance), sweating, fast heart rate (tachycardia), anxiety, hand tremors, diarrhea, and bulging eyes (exophthalmos)."

"Graves' Disease"

"The #1 cause of hyperthyroidism. An autoimmune disorder where abnormal antibodies stimulate the thyroid to pump out too much hormone. Hallmark sign: Bulging eyes (exophthalmos)."

"Hyperthyroidism: What do the labs look like?"

"Low TSH and High T3/T4.(The blood is flooded with T3/T4 so the pituitary shuts off TSH completely)."

"Thyroid Storm (Thyrotoxic Crisis) - Why is Aspirin FORBIDDEN?"

"A life-threatening surge of thyroid hormones causing extreme fever, dangerously fast heart rate, and delirium.NEVER give Aspirin! Aspirin kicks thyroid hormone off binding proteinsmaking the storm even worse. Use cooling blankets, beta blockers, and acetaminophen instead."

"What do Aldosterone and Cortisol do?"

"Aldosterone = Saves Sodium (Na+) and Water, dumps Potassium (K+) into urine (maintains BP).Cortisol = The stress hormone; raises blood sugar breaks down protein/fat, and suppresses inflammation."

"Addison's Disease (Adrenal Insufficiency) - Memory Trick"

"Addison's = You need to 'ADD' hormones because adrenal hormones are DOWN. Signs: Low Sodium Low Blood Pressure, High Potassium, Low Blood Sugar, extreme fatigue, and bronze/tanned skin."

"Why do Addison's Disease patients have Bronze Skin?"

"The pituitary tries to help by pumping out tons of ACTH. ACTH shares a precursor with melanin-stimulating hormone, causing dark bronze pigmentation in skin creases and gums."

"Addisonian Crisis (Acute Adrenal Crisis)"

"Life-threatening sudden collapse triggered by stress, infection, or suddenly stopping steroid meds.Signs: Severe vomiting critical drop in blood pressure (shock), dehydration. Treat fast with IV Normal Saline, IV Glucose (D5W), and IV Hydrocortisone!"

"Cushing's Syndrome (Too Much Cortisol) - Memory Trick"

"Cushing's = Think 'CUSHION' of extra fat and hormones.Signs: Moon face (round face)Buffalo hump (fat on back of neck), big belly (truncal obesity), skinny arms and legs, purple stretch marks (striae), high blood sugar, and easy bruising.

"What is the most common cause of Cushing's Syndrome?"

"Taking long-term prescription steroid medications (exogenous corticosteroids like Prednisone) for conditions like asthma or rheumatoid arthritis."

"What is the ONLY hormone that LOWERS blood sugar?"

"INSULIN! It acts like a key that unlocks cells so glucose can enter and be used for energy.

All counter-regulatory hormones (Glucagon

Epinephrine, Cortisol, GH) RAISE blood sugar."

"Normal vs. Diabetic Fasting Blood Glucose Numbers"

"• Normal = Under 100 mg/dL• Prediabetes = 100 to 125 mg/dL• Diabetes = 126 mg/dL or higher (on two separate tests)"

"Hemoglobin A1C (What does it measure?)"

"Measures average blood sugar over the past 2 to 3 months (the lifespan of a red blood cell).• Normal = Below 5.7%• Diabetes = 6.5% or higher"

"Type 1 vs. Type 2 Diabetes (Basic Difference)"

"Type 1 = NO insulin is made (autoimmune attack destroys pancreatic beta cells). Needs lifelong insulin shots.Type 2 = Insulin RESISTANCE (the body makes insulin, but cells don't respond well to it). Strongly linked to obesity and lifestyle."

"The 3 P's of Diabetes (And why they happen)"

"1. Polyuria = Peeing a lot (sugar spills into urine and pulls water with it by osmosis).2. Polydipsia = Drinking a lot (thirst from losing all that water).3. Polyphagia = Eating a lot (cells are starving because sugar can't get inside without insulin)."

"Diabetic Ketoacidosis (DKA) - Who gets it and why?"

"Mainly occurs in Type 1 Diabetes when there is zero insulin.Cells starveso the body breaks down fat for energy -> produces acidic KETONES. Signs: Blood sugar > 250Kussmaul breathing (deep/rapid to blow off acid), fruity acetone breath, ketones in urine, metabolic acidosis."

"Hypoglycemia (Low Blood Sugar) - Rule of Thumb"

"Blood glucose < 70 mg/dL.Memory Trick: 'Cold and clammy give some candy!'Signs: Shakiness sweating, fast heart rate, headache, confusion. Treat immediately with 15 grams of fast-acting sugar (juice, candy, glucose tabs)."

"Somogyi Effect vs. Dawn Phenomenon (How to tell them apart)"

"Both cause high blood sugar in the morning, but:• Somogyi Effect = Blood sugar DIPS low at 2:00-3:00 AM, causing a rebound high. Fix: DECREASE bedtime insulin or eat a bedtime snack.• Dawn Phenomenon = Blood sugar is normal at 3:00 AM, then morning hormones raise it. Fix: INCREASE bedtime insulin."

"Earliest Sign of Diabetic Kidney Damage (Nephropathy)"

"Microalbuminuria (tiny amounts of protein leaking into the urine). Patients with diabetes should have their urine checked for protein every year."

"Why do Diabetic Foot Ulcers happen?"

"Combination of Neuropathy (loss of feeling/pain sensation, so cuts go unnoticed) and Peripheral Vascular Disease (poor blood flow, so wounds cannot heal and easily get infected)."

"General Adaptation Syndrome (GAS) - The 3 Stages of Stress"

"1. Alarm Stage = Fight-or-flight triggered; epinephrine and cortisol surge.2. Resistance Stage = Body tries to adapt and cope with ongoing stress.3. Exhaustion Stage = Body's resources run out; leads to wear-and-tear, illness, and disease."

"Why does Stress raise Blood Sugar?"

"During stress, the body releases cortisol and epinephrine to provide fast energy to muscles and the brain. In hospitalized or diabetic patients, stress causes significant hyperglycemia."

"PTSD (Post-Traumatic Stress Disorder) - Hallmark Triad"

"1. Intrusion = Flashbacks, intrusive memories, nightmares.2. Avoidance = Staying away from triggers, emotional numbness.3. Hyperarousal = Constantly on edge, exaggerated startle reflex, insomnia, irritability."