endocrine (ch. 40 and 41) patho

grave's disease

- autoimmune disorder manifesting as state of hyperthyroidism (w/ goiter, restlessness, ocular problems) - abnormal stimulation of thyroid gland, normal TSH receptors

what are the risk factors for gestational diabetes?

- family history - prior stillbirth or spontaneous abortion - prior birth with fetal anomaly or large-for-gestational age infant - obesity - advanced maternal age - five or more pregnancies

addison's disease

- glucocorticoid insufficiency - anorexia, weight loss, nausea, diarrhea, hyponatremia, hyperkalemia

functions of the endocrine system (4)

- growth and development - sex differentiation - metabolism -adaptation to changing environment

diagnostic criteria for metabolic syndrome

- obesity - high levels of plasma triglycerides - low levels of HDLs - hypertension - systemic inflammation (CRP) - abnormal fibrinolysis - abnormal function of vascular endothelium

forms of cushing syndrome (3)

- pituitary form (excess ACTH produced by pituitary tumor) - adrenal form (caused by adrenal tumor) - ectopic form (non pituitary ACTH secreting hormone)

anterior pituitary gland cells (5)

- somatotrophs - thyrotrophs - corticotrophs - gonadotrophs - lactotrophs

what are the 2 major functions of thyroid hormone?

1. increase metabolism and protein synthesis 2. growth and development in children, including mental development and attainment of sexual maturity

what are the 3 actions of insulin?

1. promotes glucose uptake by target cells and provides for glucose storage as glycogen 2. prevents fat and glycogen breakdown 3. inhibits gluconeogenesis and increases protein synthesis note- glucagon, not insulin, promotes glycogenolysis

A male client has been diagnosed with a low sperm count. Which endocrine imbalances could contribute to this condition? Select all that apply. A. lack of FSH B. excess calcitonin C. insufficient androgens D. excess thyroid hormone E. increased growth hormone

A and B: lack of FSH and insufficient androgen FSH from the anterior pituitary stimulates production as do androgens from the testes. Androgens from the adrenal cortex are converted to testosterone in the male. Thyroid hormone plays an indirect role- insufficient thyroid could lead to a low sperm count

A client has been diagnosed with dysfunction of the anterior pituitary gland. The nurse is aware that which hormones will likely be affected? Select all that apply. A. ACTH B. TSH C. GH D. LH E. ADH F. norepinephrine

A. ACTH B. TSH C. GH D. LH ADH is produced in the posterior pituitary and norepinephrine is produced in the adrenal medulla

Growth hormone exerts its effects on the body in many ways. Which of these are effects of GH? Select all that apply. A. enhances fatty acid mobilization B. increases insulin levels C. facilitates the rate of protein synthesis D. decreases ACTH production E. decreases use of fatty acids for fuel

A. enhances fatty acid mobilization B. increases insulin levels C. facilitates the rate of protein synthesis

A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus? Select all that apply. A. onset before age 20 B. HgbA1C 7.5% (.07) C. autoimmune beta cell damage D. abrupt onset of symptoms E. insulin not needed for management

A. onset before age 20 C. autoimmune beta cell damage D. abrupt onset of symptoms (A1C would be elevated in uncontrolled diabetes of any type- normal is below 5.7%)

A student nurse is taking a test on the endocrine system. From the list of clinical manifestations, she needs to select the ones she would see in hypothyroidism. Which answers should she select? Select all that apply. A. weight gain despite loss of appetite B. nervousness with fine muscle tremors C. course, brittle hair D. heat intolerance E. puffy face with swollen eyelids

A. weight gain despite loss of appetite C. course, brittle hair E. puffy face with swollen eyelids

primary adrenal cortical insufficiency

ACTH elevated dye to lack of feedback inhibition (ex. Addison's)

The nurse is assessing a client with thyrotoxicosis and the nurse is explaining how the thyroid gland is stimulated to release thyroid hormones. The nurse should describe what process?

Action of releasing hormones from hypothalamus The synthesis and release of anterior pituitary hormones are largely regulated by the action of releasing or inhibiting hormones from the hypothalamus, which is the coordinating center of the brain for endocrine activity such as thyroid activity.

Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the production of cortisol drops. This is an example of which endocrine disorder? A. primary B. secondary C. tertiary D. somatic

B. secondary in secondary disorders, the target gland is essentially normal, but defective levels of stimulating hormones or releasing factors from the pituitary system alter its function

How can a secondary disorder of endocrine function be best described? A. they occur in the target gland responsible for producing the hormone B. the target organ is normal, but its function is altered by stimulating hormones C. they come from the target organ before it becomes dysfunctional D. they occur from the hypothalamic dysfunction that causes under stimulation of the target organ

B. the target organ is normal, but its function is altered by stimulating hormones

The results of a 44-year-old obese man's recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which pathophysiologic process underlies the client's new diagnosis?

Beta cell exhaustion due to long-standing insulin resistance *Beta cell destruction in the absence of an autoimmune reaction is associated with type 1b diabetes, while autoimmune processes contribute to type 1a diabetes.

what is true of hormones? A. a single hormone can exert various effects in different tissues B. a single function can be regulated by several hormones C. both D. neither

C. both

With complaints of fatigue, sensitivity to cold, dry skin and weight gain, X's healthcare team suspects primary hypothyroidism. Which lab results would the nurse expect to see if the healthcare team's hypothesis is correct? A. decreased TSH only B. elevated TSH, T3 and T4 C. elevated TSH and decreased T4 D. decreased TSH, T3 and T4

C. elevated TSH and decreased T4 primary endocrine disorder- affects hormones secreted from target gland, while pituitary tropic hormone (TSH) is normal or elevated in response to decreased T4

When comparing the endocrine and nervous system functions, the nurse knows that the endocrine system: Select all that apply. A. sends signals to neurons over a short distance to muscles B. responds to neurotransmitter molecules within milliseconds C. releases hormones into the blood that is transported throughout the body D. glands are widely scattered throughout the body E. takes longer to respond to innervations but has prolonged actions when they arrive

C. releases hormones into the blood that is transported throughout the body D. glands are widely scattered throughout the body E. takes longer to respond to innervations but has prolonged actions when they arrive

What best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system?

the pituitary gland communicates with the adrenal cortex through the release of ACTH

hormones secreted by thyroid

T3 and T4

intracrine signaling

act inside the cell that produced it

autocrine signaling

act on cell from which they were produced (ex. insulin released from pancreatic beta cells)

paracrine signaling

act on nearby cells (ex. sex steroids on ovary)

A 48-year-old male client diagnosed with type 2 diabetes presents with the following:• Blood glucose level of 46 mg/dL (2.55 mmol/L)• Very lethargic• Has cool, clammy skin. What is the most appropriate intervention?

administer injectable glucagon insulin would be used to treat hyperglycemia

hormones secreted by adrenal cortex

aldosterone (mineralocorticoid) and cortisol (glucocorticoid)

Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?

beta blocker

A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves disease. Which treatment would the nurse most likely anticipate providing for the client?

beta-adrenergic blocking medications (beta blockers) to reduce sympathetic nervous stimulation

acromegaly

bones increase in size- typically affects hands, feet and face will have increased production of GH in response to glucose (normally glucose causes decrease in GH secretion)

what best defines a hormone?

chemical messenger that controls the flow of information among the different tissues and organs of the body

signs and symptoms of hypopituitarism

chronically unfit, weakness, fatigue, loss of appetite, sexual function impairment, cold intolerance

gluconeogenesis

convert amino acids, lactate and glycerol into glucose

A client experiences an increase in cortisol as a result of Cushing disease. Which hormonal responses demonstrate the negative feedback mechanism?

decreased ACTH ACTH manufactured by the anterior pituitary gland would normally stimulate the release of cortisol, but with the increase of cortisol produced by the secreting tumor, enough cortisol already floods the system that there should be a reduction in the ACTH level.

type 1 diabetes

deficiency of insulin, usually due to autoimmune disease that destroys pancreatic beta cells

acute complications of diabetes

diabetic ketoacidosis, hyperosmolar hyperglycemic state, hypoglycemia

goiter

enlarged thyroid gland (no T3 or T4 made)

The endocrine system is closely linked with the nervous system. Which neurotransmitter can also act as a hormone?

epinephrine other examples- dopamine, oxytocin, and somatostatin

hormones secreted by adrenal medulla

epinephrine and norepinephrine

Which hormone is secreted based on a cyclic rather than a diurnal manner?

follicle stimulating hormone (FSH)

secondary endocrine disorders

function of target gland altered by defective levels of stimulating hormones or releasing factors from pituitaru

A 62-year-old man who is overweight has just been diagnosed with type 2 diabetes. The nurse educator is instructing him in the ways his diabetes can be controlled. The nurse should initially prioritize which action?

helping the client make meaningful changes to his diet and activity level

normal lab values relating to diabetes

hemoglobin A1C- less than 6% fasting plasma glucose (FPG)- less than 100 mg/dL or less than 140 mg/dL 2 hours after oral glucose tolerance test (GTT) ketones- none

Describe the function of hormones.

hormones function as modulators of cellular and systematic responses (do not initiate)

coordinating center for endocrine system integrates endocrine, behavioral and autonomic (involuntary) nervous system functions controls the release of pituitary hormones

hypothalamus

An infant whose mother had myxedema during the pregnancy has failed to meet standards for growth and is developmentally delayed. Which hormonal imbalance is this child exhibiting?

hypothyroidism

negative feedback

increase in hormone levels signals to the target cell to DECREASE hormone levels

positive feedback

increase in hormone levels signals to the target cell to INCREASE hormone levels

X's lab work indicates low levels of cortisol, ACTH and ACTH releasing hormone. What level of endocrine disorder does this illustrate? primary, secondary or tertiary

tertiary low levels of cortisol (from the gland), ACTH (from the pituitary) and ACTH releasing hormone (from the hypothalamus)

type 2 diabetes

insulin resistance and/or relative deficiency of insulin

metabolic syndrome

insulin resistance syndrome- cluster of conditions that raises risk of heart disease, stroke and diabetes

chronic complications of diabetes

micro/macro vascular complications, foot ulcers, neuropathies

signs and symptoms of cushing syndrome

moon face, muscle wasting, buffalo hump, osteoporosis, hypokalemia

An older adult woman is brought to the emergency department by her family. They relate to the nurse that the client has had mental status changes and cannot remember her grandchildren's names. They go on to say that she is intolerant of cold and is lethargic. On physical examination, the nurse notes that the client has a husky voice, her face is puffy around the eyes, and her tongue appears to be enlarged. What diagnosis would the nurse suspect?

myxedema As a result of myxedematous fluid accumulation, the face takes on a characteristic puffy look, especially around the eyes. The tongue is enlarged, and the voice is hoarse and husky.

A client with diabetes mellitus arrives at the hospital with a blood glucose level of 639 mg/dL (35.46). What assessment data would indicate type 2 diabetes mellitus rather than type 1?

negative ketones in urine

down-regulation

number of receptors decreases with rise in hormone levels

up-regulation

number of receptors increases with increase in hormone levels (cell becomes more sensible to hormone- more activity)

primary endocrine disorders

originate in the target gland

hormone secreted by parathyroid

parathyroid hormone (PTH)

Secondary diabetes occurs because of disorders that produce hyperglycemia by stimulating the hepatic production of glucose or decrease the cellular use of glucose. Which disorders can be causes of secondary diabetes?

pheochromocytoma and Cushing syndrome

"master gland"- controls function of most other endocrine glands

pituitary

clinical manifestations of diabetes (3)

polyuria, polydipsia, polyphagia (excessive urination, thirst, hunger)

corticotriphs

produce adrenocorticotropic hormone (ACTH)- impacts cortisol levels (glucocorticoid)

gonadotrophs

produce gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH) for gonad function

somatotrophs

produce growth hormone (GH) for body growth and metabolism

lactotrophs

produce prolactin for breast growth and milk production

thyrotrophs

produce thyroid stimulating hormone (TSH) for thyroid gland function

trophic hormones

produced by anterior pituitary- affects growth, function or nutrition of other endocrine cells

neuroendocrine signaling

produced within a neuron and then travels to target cell

exocrine pancreas

produces enzymes to help with digestion

cortisol (glucocorticoid)

regulating metabolic function and controlling inflammatory process

The nurse cares for a client with type 2 diabetes. The nurse determines the client is at highest risk for foot ulcer formation based on which assessment findings?

report of decreased sensation and cool, pale feet

tertiary endocrine disorders

result from hypothalamic dysfunction- both pituitary and target organ are affected as a result

secondary adrenal cortical insufficiency

result of hypopituitarism or removal of pituitary gland

X's lab results show low thyroid hormone levels and elevated cortisol levels. TSH and ACTH levels are also low. Which level of endocrine disorder does this illustrate? primary, secondary or tertiary?

secondary abnormal hormone levels from two different glands (thyroid and adrenal)

X experienced damage to the pituitary gland due to a tumor, and ACTH stimulation ceased. Without ACTH to stimulate the adrenal glands, production of cortisol decreased. Which level of endocrine disorder does this illustrate? primary, secondary or tertiary

secondary because pituitary gland is involved, but adrenal gland is healthy (LOF due to lack of pituitary stimulus)

endocrine pancreas

sends out hormones to control blood glucose levels

aldosterone (mineralocorticoid)

sodium, potassium and water balance

The nurse cares for a client with severe chronic obstructive pulmonary disease who has been taking oral steroids for several years. Which response in the client's endocrine control will the nurse expect?

suppression of the client's hypothalamic-pituitary-target cell system

hypoglycemia signs and symptoms

sweating, nervousness, hunger, confusion, tremors, LOC leading to seizures, death, coma, "cold and clammy"

A client with long-standing type 2 diabetes is surprised to see high blood sugar readings while recovering from an emergency surgery. Which factor may have contributed to the client's inordinately elevated blood glucose levels?

the stress of the event caused the release of adrenal cortical hormones

The nurse is caring for an older adult client who is being treated for primary hypothyroidism. The medication therapy includes a "go low and go slow" regimen. What is the importance of this medication regimen for this client?

there is a risk of inducing acute coronary syndromes in the older client if a more rapid correction of thyroid levels is used

what is the best definition of a primary endocrine disorder?

they originate in the target gland responsible for producing the hormone

hyperglycemia signs and symptoms

thirsty, frequent urination, fatigue, blurred vision, n/v, weight loss, warm, dry, flushed skin

signs and symptoms of thyroid storm

very high fever, extreme cardiovascular effects (tachycardia, CHF, angina), severe CNS effects (agitation, restlessness, delirium)

Which factors contribute to the severe hyperglycemia that precipitates hyperglycemic hyperosmolar state (HHS)?

water loss causing dehydration

signs and symptoms of hypothyroidism

weight gain, swelling, cold, weak, coarse/dry skin and hair, bradycardia

signs and symptoms of hyperthyroidism

weight loss, anxiety, tachycardia, heat intolerance, thin/silky hair