Endocrine
Functions of Endocrine System:
Pituitary Gland
Anterior Lobe
Influences sexual development, thyroid function, adrenocortical function
Regulates ______________
Posterior Lobe
Stimulates reabsorption of water and elevates _______________
Stimulates release of __________& ______________ to contract during labor and delivery
Pineal Gland
Helps regulate the release of gonadotropin
Controls body pigmentation
Main function is circadian rhythm.
Thyroid Gland
Vital role in metabolism
Regulates body’s metabolic processes
Influences bone & calcium metabolism
Helps maintain plasma calcium homeostasis
Parathyroid Gland
Maintenance of normal serum calcium level
Role in metabolism of ____________
Pancreas (Islets of Langerhans)
Regulates blood glucose levels
Plays vital role in metabolism of carbohydrates, proteins, and fats
Adrenal Glands
Adrenal Cortex
Regulates CHO metabolism, anti-inflammatory effect
Helps body cope with stress → cortisol
Regulates water and electrolyte balance → aldosterone
Promotes development of male characteristics → androgens
Adrenal Medulla
Synthesizes, secretes, and stores catecholamines
Ovaries → Promote growth, development, and maintenance of female sex organs
Testes → Promote growth, development, and maintenance of male sex organs
Control of the Endocrine System
The endocrine and nervous systems regulate metabolic activities
Negative feedback system
Positive feedback may be in a negative feedback loop
Blood clotting
Child birth
Some hormones act as antagonists such as:
Calcitonin and parathyroid hormone
Insulin and glucagon
Most often controlled by negative feedback mechanisms
Endocrine and nervous systems work together to regulate metabolic activities
Complex system for some hormones
Secretion may be controlled by more than one mechanism
Rate and timing of secretion may vary
Cyclic patterns
Endocrine Diseases
All disorders reflect impaired control or feedback
Hyperplasia
Hypertrophy
Atrophy
Excess hormone levels
Tumor produces high levels
Excretion by liver or kidney is impaired
Congenital condition produces excess hormone
Deficit of hormone or reduced effects
Tumor produces too little hormone.
Inadequate tissue receptors present
antagonistic hormone production is increased.
Malnutrition
________________, surgical removal of gland
Congenital deficit
Diagnostic tests
Blood tests
Check serum hormone levels
Radioimmunoassay
Immunochemical methods
__________________ tests
Stimulation or suppression tests
Scans, ultrasounds, magnetic resonance imaging (MRI)
_________________
Treatment
Deficit may be treated with ________________________ therapy.
Excessive secretion may be treated with
Medications
Surgery
Radiation
Diabetes Mellitus
What is it?
Diabetes mellitus: basic problem is ______________ insulin effects in receptor tissues
Deficit of insulin secretion
Production of insulin ___________________________________
Diabetes results in abnormal carbohydrate, _______________, and fat metabolism.
Some tissues can transport glucose in the absence of insulin:
CNS, kidney, myocardium, gut, and skeletal muscle
Skeletal muscle can partially meet tissue needs without insulin
Type I
AKA IDDM (______________________ diabetes mellitus)
____________________________________ destruction of beta cells in pancreas
Insulin replacement therapy is required
Acute onset in _________________ and _______________________
Not linked to ____________________
Genetic factors may play a role
Metabolic changes
Catabolism of _______________ and ______________________
Excessive amounts of fatty acids and metabolites
________________________ in the blood
__________________
_________________ serum bicarbonate
___________________ in pH of body fluids
Ketoacids excreted in urine
Decompensated metabolic acidosis
Type II
AKA NIDDM (_____________________________________ diabetes mellitus)
_______________ hypoglycemic medications may be used.
Caused by ___________________ production of insulin and/or increased resistance by body cells to insulin
Onset is __________ and insidious and usually in _____________ age
Associated with ____________________
Component of metabolic __________________
Increasing incidence in ________________ and young adults
May be controlled by adjusting:
__________________ intake
Increase body’s use of glucose
That is, with ______________________
Reducing insulin _____________________________
Stimulating the beta cells of the pancreas to produce more insulin
Monitoring blood glucose levels as ordered
Medication to stimulate the beta cells of the pancreas to produce more insulin
If insulin-dependent- proper administration of insulin to maintain glucose levels in normal range
Routine follow-up and blood testing
Initial Stage
Insulin deficit
Results in _______________________ transportation and use of glucose in many cells
Blood glucose levels rise (_______________________________)
Excess glucose found in _____________________
Large urine volume
Fluid loss through urine, resulting in ___________________
Dehydration causes _______________________
General manifestations
Insulin deficit results in decreased transportation and use of glucose in many cells.
____________________________: excess hunger
Fatigue
Blood glucose levels rise – hyperglycemia
Excess glucose in urine – glucosuria
Dehydration results from hyperosmolar filtrate (leads to __________)
____________________________: excess urination (amounts voided)
____________________________: excess thirst
Diagnosis
Patient history
_______________________________________
______________________________________
Hemoglobin A1C (glycosylated hemoglobin test)- for ________________________________
Urinalysis (glucose, ketones)
Blood insulin levels
________________________ exam
Treatment
Maintenance of blood glucose levels in normal range
Helps to reduce complications
Routine follow-up and blood testing
Diet and exercise
Diet containing:
Increased ________________
Reduced lipids and simple carbohydrates
Exercise reduces blood glucose as skeletal muscle uses glucose.
Reduce insulin resistance by reducing _______ to normal range.
Type 1: Insulin replacement
If require insulin: proper administration of insulin to maintain glucose levels in normal range
Type 2: Oral medication (oral hypoglycemic)
Reduce blood glucose levels
Medication to stimulate the beta cells of the pancreas to produce more __________________
Complications
Complications are directly related to _________________ and _________________ of abnormal blood glucose levels.
Complications may be acute or chronic
Many factors lead to fluctuations in serum glucose levels.
Variations in diet and _______________ use
Change in physical activity
____________
____________
Acute complications
Hypoglycemia (insulin shock)
More common with ______________________________________ treatment
Can occur because of excess _________________________________ drugs
Excess insulin in circulation
Glucose deficit in blood
Can be life-threatening or cause brain damage if untreated
Often follows strenuous exercise
__________________
______________
_________________ meal after taking insulin
Disorientation and change in behavior
May appear impaired
Anxiety or decreased responsiveness
Decreased blood glucose level
Decreased ____________, increased _____________
Decreasing level of __________________________
Emergency Treatment for Hypovolemic shock (to prevent ___________________ damage):
If conscious, immediately give sweet fruit juice, honey, candy or sugar
If unconscious, give nothing by mouth; IV glucose 50% is required.
Diabetic ketoacidosis
Occurs in _______________________________ clients
More commonly seen in type ___ diabetes
Result of insufficient insulin in blood
High blood glucose levels
Mobilization and use of lipids to meet cellular needs result in production of ketoacids
May be initiated by ________________ or ________________
May result from error in dosage, infection, change in diet, alcohol intake, or exercise
______________________
Thirst, dry, rough oral mucosa
Warm, __________ skin
Blood pressure is _______________ as the vascular volume decreases
_____________________ (________________ urine output)
Indicates that compensation mechanisms to conserve fluid in the body are taking place
Rapid, ____________________ respirations (Kussmaul respirations)
________________________ breath (a sweet, fruity smell)
Metabolic acidosis
May lead to loss of consciousness
_______________ imbalances
Abdominal cramps, nausea, vomiting, lethargy, weakness
Treatment
_______________________ administration
Replacement of fluid and electrolytes
HHNK: Hyperglycemic hyperosmolar nonketotic
Occurs in type __ diabetes
Insidious in onset and diagnosis may be missed
Often occurs in ____________ clients and assumed to be ___________________impairment
Results in severe _______________________ and electrolyte imbalances
Hyperglycemia
Severe dehydration
Increased ___________________
Loss of ______________
Increased heart rate and respirations
Electrolyte imbalances result in:
Neurologic deficits
____________________________
Difficulties with ____________
Abnormal _____________
Chronic complications
Vascular problems
Increased incidence of ______________________
Changes may occur in small and large arteries.
Obstruction or rupture of small capillaries and arteries
Tissue necrosis and loss of function
Neuropathy and loss of sensation
Retinopathy – leading cause of blindness
Chronic renal failure – degeneration in glomeruli of kidney
Result of abnormal lipid levels
High incidence of ________________________, strokes, peripheral vascular disease
May result in ulcers on feet and legs – slow healing
Frequent infections and gangrenous ulcers
Amputation may be necessary.
Peripheral neuropathy
common complication due to __________ in microcirculation to peripheral nerves
Impaired sensation, numbness, tingling, weakness, muscle wasting
Infections
Common and often more severe in diabetics
Infections in feet and legs due to vascular and neurologic impairment
Fungal infections common
Candida
Vagina and/or oral cavity
Urinary tract infections
Dental caries
Gingivitis and periodontitis
Cataracts
Opacity of lens in eye
Related to abnormal metabolism of glucose
Pregnancy-related
Complications to both mother and fetus may occur.
Increased incidence of spontaneous abortions
Infants born to diabetic mothers
_____________ size and weight for date
May experience _________ glycemia in first hours postnally
Gestational Diabetes Mellitus
Onset:
Signs and symptoms
Detected between _____ and _____ weeks of ___________________
Poly________
Poly_______________
Poly________________
__________________ screening
Etiology
Destruction of insulin by _________________
Increased maternal insulin production cause increased placental production of human placental lactogen (hPL)
Fetus gets glucose from mother, so balance with insulin is impaired
Elevated estrogen and progesterone levels ______________ the action of insulin
Risk factors
Family history of DM
______________
Over age of 25
Treatment
Diet
Exercise
Insulin (oral hypoglycemics are ______________________)
Prognosis
Risk of _________________________________
Often neonate is _____________________________
Often neonate has _________________ glycemia
_____________% will develop type _____ DM within _________ years of GDM
Thyroid Gland disorders:
Usually involve:
Production (over or under) of:
T4 (thyroxine)
Triiodthyronine (T3)
Mass lesions
Goiter
Enlargement of thyroid gland (___________________________)
_________________ goiter
Hypothyroid condition in regions with low iodine levels in soil and food
______________________
Foods that contain elements to block synthesis of triiodothyronine (T3) and thyroxine (T4)
______________ goiter
Results from hyperactivity of thyroid gland
Signs and symptoms
_______________ of thyroid gland
Asymptomatic early
As increase in size
Dyspnea
Difficulty swallowing
Dizziness (_____________)
Hyperthyroidism
Grave’s disease
Occurs when entire thyroid gland hypertrophies
Related __________________ factor
Hypermetabolism and _____________________ stimulation of SNS (sympathetic)
T3 and T4 are _________________
Signs and symptoms
Increased ________________________________
Sweating
Soft, silky hair and skin
Reduced ______________
________________________
__________ activity
Weight _______________, despite ___________________ appetite
Excessive _______________
Tremor
Loss of hair
Intolerance to ____________
Thryotoxicosis
Exophthalmos (________________ protrusion of __________)
Presence of protruding, staring eyes, decreased blink and eye movement
Result of increased tissue ____________ in the orbit
May result in visual impairment
Treatment
Radioactive iodine
Surgical removal of gland
Anti-thyroid drugs
Hypothyroidism
T3 and T4 are ______________
Iodine deficit
Hashimoto thyroiditis
Autoimmune disorder
Tumor
Surgical removal or treatment of gland
Manifestations
Goiter if cause is endemic iodine deficiency
Intolerance to cold
Increased _______________
Lethargy and fatigue
Decreased appetite
Cretinism
Develops in _____________ or early childhood
Thyroid gland is absent or thyroid hormone is not synthesized by thyroid gland
Results in ______________ stature and severe cognitive deficits
_______________________ fail to develop
Growth, physical, mental capabilities retarded
Lack of muscle tone=inability to __________________
Untreated congenital hypothyroidism
May be related to ________________ deficiency during pregnancy
Myxedema
Severe untreated hypothyroidism
Older child and adult
May have slowing of physical and mental activity
May appear as ______________________
As levels of T4 decrease, rapid onset
Menorrhagia
Skin dry and scaly
Face bloated, tongue ______________, eyelids puffy
Muscular weakness, excessive tiredness, fatigue
Weight ____________
Hair loss
Constipation
Intolerance to ____________
Speech slow and slurred
Mental ___________________
Myxedema ______________: acute hypotension, hypoglycemia, and hypothermia results in loss of consciousness, life-threatening if untreated
Treatment for BOTH cretinism and myxedema
__________________________ medication