Chapter 24 Endocrine Disorders

Thyrotoxic Crisis (Thyroid Storm)

-An acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones -Develops mostly in undiagnosed or partially treated person with hyperthyroidism and usually is precipitated by infection, trauma, or emergency surgery

Mary reports that she is taking no medications. Which medications may cause adrenal insufficiency? NSAID's Corticosteroids Anti-histamines Diuretics Beta-blockers

Corticosteroids Corticosteroid usage, especially for longer periods, can suppress normal cortisol production by the adrenal glands. In this case, ACTH levels are also reduced due to the negative feedback by the corticosteroids. The other medications listed do not affect adrenal gland synthesis of cortisol.

The hypothalamic-pituitary-end organ progression of hormones is best represented by _____________. Cortisol - corticotropin-releasing factor - adrenocorticotropic hormone Cortisol - adrenocorticotropic hormone - corticotropin-releasing factor Corticotropin-releasing factor - cortisol -- adrenocorticotropic hormone Adrenocorticotropic hormone - corticotropin-releasing factor - cortisol Corticotropin-releasing factor - adrenocorticotropic hormone - cortisol

Corticotropin-releasing factor - adrenocorticotropic hormone - cortisol

A disorder of the anterior pituitary resulting in elevated adrenocorticotropic hormone is known as ____________. Cushing's syndrome Addison's disease Cushing's disease pheochromocytoma acromegaly

Cushing's disease

Which signs or symptoms would result from syndrome of inappropriate antidiuretic hormone? Select all that apply. Thirst Fatigue Polyuria Dehydration Hypervolemia

Fatigue Hypervolemia

The most common cause of thyroid hyperfunction is ______________. Hashimoto's thyroiditis. a tumor of the pituitary. Graves' disease. elevated TSH. autoimmune attack of thyroid hormone-producing cells.

Graves' disease.

A patient was recently admitted with primary hyperparathyroidism. Which of the following laboratory values would you expect to see? Select all that apply. Decreased parathyroid hormone Increased serum calcium Increased parathyroid hormone Increased serum phosphate Decreased serum calcium

Increased serum calcium Increased parathyroid hormone

After checking the thyroid hormone levels in the laboratory report of a patient suspected to have an endocrine disorder, the nurse concludes that the patient has secondary hypothyroidism. Which findings support the nurse's conclusion? Select all that apply. Low T4 levels Low thyroid-stimulating hormone levels High thyroid-stimulating hormone levels Normal T3, T4 levels Normal T3, low T4 levels

Low T4 levels Low thyroid-stimulating hormone levels

(low cortisol, low aldosterone, elevated ACTH, low blood glucose, low serum sodium, elevated serum potassium, normal calcium, normal PTH.) Which of the following most likely causes Mary's low blood glucose? Reduced aldosterone Elevated ACTH Low serum sodium Low cortisol Increased serum potassium

Low cortisol Cortisol is a glucose-sparing hormone, meaning it works to keep blood glucose levels elevated. With inadequate cortisol, blood glucose levels may fall. Neither aldosterone nor ACTH directly affect blood glucose levels.

Which of the following laboratory values indicate a primary disorder of the thyroid gland? -Low thyrotropin-releasing hormone, low thyroid-stimulating hormone, high thyroid hormone -Low thyrotropin-releasing hormone, low thyroid-stimulating hormone, low thyroid hormone -High thyrotropin-releasing hormone, high thyroid-stimulating hormone, high thyroid hormone -Normal thyrotropin-releasing hormone, normal thyroid-stimulating hormone, normal thyroid hormone -Low thyrotropin-releasing hormone, high thyroid-stimulating hormone, high thyroid hormone

Low thyrotropin-releasing hormone, low thyroid-stimulating hormone, high thyroid hormone

Does the posterior pituitary produce hormones?

No! It STORES and RELEASES hormones (ADH and oxytocin) that are produced by the hypothalamus

To determine if a patient is suffering from pheochromocytoma, which laboratory values would you examine? Cortisol Parathyroid hormone Aldosterone Adrenocorticotropic hormone Norepinephrine

Norepinephrine

hypothalamic-pituitary-hormone axis

The regulatory link between the hypothalamus, pituitary gland and endocrine target organ this fundamental control system exists with all endocrine organs

Syndrome of inappropriate antidiuretic hormone (SIADH)

a common condition in patients who sustain brain injury or those who undergo neurosurgery for brain disorders. characterized by hyponatremia and hypoosmolality of the blood that result from excessive secretion or action of ADH causes excess water reabsorption into the bloodstream. This excess water creates hypervolemia, dilutional hyponatremia and highly concentrated urine

Empty sella syndrome

a condition caused by compression of the pituitary gland by brain tissue herniation, is also a cause of hypopituitarism

diabetes insipidus (DI)

a disorder of hypopituitarism that originates in the posterior pituitary where antidiuretic hormone (ADH) is not secreted, or there is a resistance of the kidney to ADH the body loses high amounts of water in the urine, causing polyuria and highly dilute urine. The bloodstream loses water, which concentrates its sodium content, causing hypernatremia, polyuria, dilute urine, and dehydration

Panhypopituitarism

a rare disorder, is the complete loss of all the pituitary hormones.

Struma ovarii

a teratoma composed primarily of thyroid tissue an uncommon syndrome where thyroid tissue develops within specific types of tumors of the ovary: dermoid tumors, or ovarian teratomas. The thyroid tissue can secrete excessive amounts of thyroid hormone and produce thyrotoxicosis

Primary hyperparathyroidism is most commonly caused by ______________. a tumor of the parathyroid glands a tumor of the anterior pituitary elevated serum calcium levels excess adrenocorticotropic hormone secretion kidney failure

a tumor of the parathyroid glands

exophthalmos

abnormal protrusion of the eyeball termed Graves' ophthalmopathy

Graves' disease

an autoimmune disease that causes overproduction of thyroid hormone. autoantibodies form that mimic TSH. These autoantibodies excessively stimulate the thyroid gland to release elevated levels of thyroxine

Graves' disease

an autoimmune disorder caused by autoantibodies against the thyroid gland there is an enhanced sensitivity to the activity of the sympathetic nervous system neurotransmitters (catecholamines). Patients are at risk for cardiac arrhythmias, such as atrial fibrillation and the development of heart failure

Goiter

an enlargement of the thyroid gland with or without symptoms of thyroid dysfunction

Hyperthyroidism (thyrotoxicosis)

an excessive secretion of the thyroid hormones T3 and T4 most common etiology is Graves' disease

hypophysis (pituitary gland) has two distinct sections 1) 2)

anterior pituitary (adenohypophysis) posterior pituitary (neurohypophysis)

Hyperfunction of the ________________ that results in excess growth hormone may cause ___________. hypothalamus; acromegaly anterior pituitary; acromegaly posterior pituitary; acromegaly anterior pituitary; Graves' disease hypothalamus; Graves' disease

anterior pituitary; acromegaly

Secondary hyperparathyroidism may result from _______________. Select all that apply. a tumor of the anterior pituitary gland. any disorder that causes hypocalcemia. a tumor of the parathyroid gland. suppressed parathyroid hormone secretion. failure of the kidneys to reabsorb calcium.

any disorder that causes hypocalcemia. failure of the kidneys to reabsorb calcium.

Mineralocorticoids

assist in fluid and electrolyte balance Mainly aldosterone

myxedema

caused by extreme deficiency of thyroid secretion

The adrenal gland consists of two parts: 1) 2)

cortex medulla

The adrenal cortex secretes:

corticosteroids, also called glucocorticoids; androgens; and mineralocorticoids, mainly aldosterone

Clinical presentation hypopituitarism in the neonate and infant include:

dwarfism, developmental delay, various visual and neurological symptoms, seizure disorder, and a number of congenital malformations.

The adrenal medulla secretes 1) 2)

epinephrine and norepinephrine

Acromegaly is caused by __________________. excess antidiuretic hormone deficient antidiuretic hormone excess growth hormone excess cortisol excess thyroid hormone

excess growth hormone

parathyroid glands

four pea-sized glands nestled within the thyroid tissue of the neck. The glands produce and secrete PTH in response to a low serum calcium level. PTH promotes calcium reabsorption in the renal tubules and the release of calcium from bone. It also promotes vitamin D production by the kidney, which helps to maintain normal calcium levels within the body.

anterior pituitary hormones

growth hormone (GH) prolactin (PRL) adrenocorticotropic hormone (ACTH) thyroid-stimulating hormone (TSH) follicle-stimulating hormone (FSH) luteinizing hormone (LH)

Cretinism

he result of thyroid hormone deficiency during embryonic development and early neonatal life. The child exhibits short stature, intellectual disability, and other metabolic disorders

In Cushing's syndrome, a ____________ adrenal gland causes elevated levels of _____________. hypoactive; adrenocorticotropic hormone hyperactive; adrenocorticotropic hormone hypoactive; cortisol hyperactive; norepinephrine hyperactive; cortisol

hyperactive; cortisol

If thyrotropin-releasing hormone, from the hypothalamus, and thyroid-stimulating hormone, from the anterior pituitary, are both lower than normal and thyroid hormone levels are elevated, the thyroid gland is demonstrating ___________________. normal function hypofunction hyperfunction

hyperfunction

If thyrotropin-releasing hormone and thyroid-stimulating hormone levels are high and thyroid hormone levels are below normal, then the hypothalamus is demonstrating ________________, the anterior pituitary is demonstrating _____________, and the thyroid gland is demonstrating ________________. hyperfunction, hyperfunction, normal function hyperfunction, hyperfunction, hypofunction hypofunction, hypofunction, hypofunction normal function, normal function, normal function normal function, normal function, hyperfunction

hyperfunction, hyperfunction, hypofunction

Gigantism

hypersecretion of growth hormone from the anterior pituitary before puberty, leading to abnormal overgrowth of body tissues

hyperparathyroidism

hypersecretion of the parathyroid glands, usually caused by an adenoma S/S related to excessive levels of calcium (muscle weakness, poor concentration, neuropathies, hypertension, kidney stones, metabolic acidosis, osteopenia, pathological fractures, and constipation.)

Increasing corticotropin-releasing factor levels will likely ___________________. Select all that apply. decrease adrenocorticotropic hormone levels increase thyroid hormone levels increase cortisol levels increase adrenocorticotropic hormone levels inhibit anterior pituitary activity

increase cortisol levels increase adrenocorticotropic hormone levels

Graves' disease ________________. Select all that apply. is an autoimmune condition of the posterior pituitary. is a form of hyperthyroidism. causes weight gain, bradycardia, and fatigue. results in elevated thyroid hormones. is a neurogenic disorder.

is a form of hyperthyroidism. results in elevated thyroid hormones.

Pheochromocytoma __________________. Select all that apply. is a tumor of the adrenal medulla. results in elevated cortisol levels. mimics Addison's disease. results in reduced norepinephrine levels. may cause elevated heart rate and blood pressure.

is a tumor of the adrenal medulla. may cause elevated heart rate and blood pressure.

secondary hypoparathyroidism

lack of pituitary parathyroid-stimulating hormone can occur because of any primary disease that causes hypercalcemia. The high calcium levels send feedback to the pituitary gland to diminish parathyroidstimulating hormone

Hypoparathyroidism

most often is caused by trauma or inadvertent damage or removal of the parathyroid glands during thyroid surgery

acromegaly

occurs in adults where excessive GH stimulates a gradual growth of certain bones such as the jaw, hands, and feet develop slowly and gradually, taking years to decades to become apparent

Hypothyroidism

occurs when there are insufficient levels of the thyroid hormones T3 and T4

Hypopituitarism causes

pituitary adenoma Sheehan syndrome Empty Sella syndrome brain injury or surgery Pituitary apoplexy radiation

Sheehan's syndrome

pituitary ischemia and infarction that develops after childbirth because of severe hemorrhage widespread endocrine gland failure because of the many tropic hormones that originate in the pituitary effects include adrenal insufficiency, hypothyroidism, amenorrhea, diabetes insipidus (DI), and inadequate lactation

Destruction or removal of the parathyroid glands will cause _________________. primary hyperparathyroidism pheochromocytoma secondary hypoparathyroidism primary hypoparathyroidism Cushing's disease

primary hypoparathyroidism

Central diabetes insipidus _________________. Select all that apply. causes increased blood glucose. is another form of diabetes. results in excess water retention. Is caused by over secretion of ADH. results in increased urine production.

results in increased urine production.

Because polyuria and dehydration occur in both DM and DI, it is important to measure __________________ to differentiate DM from DI

serum glucose Serum glucose is elevated in DM, but not in DI.

Corticosteroids (Glucocorticoids)

ssist the body in dealing with stress they stimulate gluconeogenesis to increase blood sugar, mobilize fat stores, and break down proteins long-term secretion of corticosteroids has negative effects on the body, such as suppression of the immune system and breakdown of bone.

hyperpituitarism

state of excessive pituitary gland activity Pituitary adenoma is the most common cause of hyperpituitarism.

tropic hormones

substance release by anterior pituitary gland that targets an endocrine organ

Goitrogens

substances that interfere with the utilization of iodine or the function of the thyroid gland Ex: lithium, phenytoin, and rifampin (pts taking these need to have thyroid hormone levels monitored)

Increasing cortisol levels will _____________________. stimulate adrenocorticotropic hormone production stimulate corticotropic-releasing factor production suppress posterior pituitary activity suppress adrenocorticotropic hormone secretion stimulate posterior pituitary secretions

suppress adrenocorticotropic hormone secretion

Iodine is an integral constituent of __________ hormone

thyroid

Hypopituitarism

tropic hormone production is reduced and, in turn, target gland hormone production is decreased. Normally, low levels of target gland hormone feedback to the pituitary gland increases tropic hormone production. However, in hypopituitarism, the pituitary gland is dysfunctional and the response is absent or inadequate. This results in secondary failure of the target endocrine glands.

A patient with central diabetes insipidus _________________. will likely have edema. will have increased urine output. will have a higher than normal metabolism. will drink less water than normal. will have elevated antidiuretic levels.

will have increased urine output.

What is another name for Mary's condition (Primary Adrenal Insufficiency)? Addison's disease Cushing's disease Cushing's syndrome

Addison's Disease Addison's disease is a form of primary adrenal insufficiency. Remember, in Addison's disease, more adrenal hormones need to be "added." Cushing's disease and Cushing's syndrome are adrenal excess diseases.

Mary presents in your office with the unusual complaint of being "more tan" than expected based on her self-report sun exposure. Follow up questions reveal that Mary has been experiencing severe fatigue, dizziness upon standing, and an overall feeling that "something is wrong." You examine Mary and order blood tests.The test results show the following abnormalities: low cortisol, low aldosterone, elevated ACTH, low blood glucose, low serum sodium, elevated serum potassium, normal calcium, normal PTH. Mary is taking no medications. Which of the following conditions is most likely based on Mary's laboratory results? Primary hyperparathyroidism Adrenal excess Secondary hyperparathyroidism Adrenal insufficiency Primary hypoparathyroidism

Adrenal insufficiency Mary's laboratory results indicate normal PTH and calcium levels, so issues with the parathyroid gland can be ruled out. Low cortisol and elevated ACTH levels are associated with adrenal insufficiency. Elevated cortisol is a sign of adrenal excess.

This or That? For each item, drag and drop the correct disease, disorder, or description. Thyroid Stimulating Hormone (TSH) Anterior pituitary gland Thyroid gland

Anterior pituitary gland The anterior pituitary gland is responsible for producing TSH. The thyroid gland is responsible for producing T3 and T4.

Can you differentiate the various pituitary and thyroid disorders? For each disorder, drag and drop the characteristics that apply to the disorder to the box. Posterior Pituitary Hypofunction Decreased urine osmolarity Sudden onset of symptoms including chest pain and tearing sound Decreased ADH levels Polyuria Traumatic brain injury Central diabetes insipidus Pituitary adenomas

Decreased ADH levels Polyuria Decreased urine osmolarity Central diabetes insipidus The posterior pituitary releases the hormones ADH and oxytocin. Central diabetes insipidus is a condition in which ADH is not produced at sufficient levels or the kidneys are unable to respond to ADH. Inadequate ADH results in polyuria and dilution of the urine, decreasing urine osmolarity.

Can you differentiate the various pituitary and thyroid disorders? For each disorder, drag and drop the characteristics that apply to the disorder to the box. Anterior Pituitary Hypofunction Decreased tropic hormones Polyuria Traumatic brain injury Increased end organ activity Pituitary adenomas Sheehan's syndrome Cretinism in infants

Decreased tropic hormones Pituitary adenomas Traumatic brain injury Sheehan's syndrome The anterior pituitary secretes tropic hormones, so any hypofunction of the anterior pituitary causes a reduction in one or more of these hormones. Traumatic brain injury may damage the anterior pituitary, causing a reduced performance of the gland. Sheehan's syndrome is a specific example of anterior pituitary hypofunction resulting from ischemia to the gland during childbirth. Pituitary adenomas, which may compromise function of one of more cell types of the anterior pituitary, may also result in hypofunction. Polyuria is associated with abnormalities of the posterior pituitary and cretinism is a due to hypofunction of the thyroid gland.

Which of the following laboratory values may lead you to believe a patient has Cushing's syndrome? Select all that apply. Elevated adrenocorticotropic hormone Elevated cortisol Elevated norepinephrine Reduced cortisol Reduced adrenocorticotropic hormone

Elevated adrenocorticotropic hormone Elevated cortisol

Can you differentiate the various pituitary and thyroid disorders? For each disorder, drag and drop the characteristics that apply to the disorder to the box. Posterior Pituitary Hyperfunction Myxedema Excess water reabsorption Exophthalmos Decreased plasma osmolarity Prolactinomas SIADH

Excess water reabsorption Decreased plasma osmolarity SIADH When the poster pituitary demonstrates increased function, excess water reabsorption may result due to elevated ADH levels. Such elevations in ADH occur in the disease syndrome of inappropriate antidiuretic hormone, SIADH. Additional fluid volume in the body will dilute particles in the plasma, reducing plasma osmolarity. Myxedema and exophthalmos are associated with thyroid, not posterior pituitary disorders. Prolactinomas are a condition of the anterior pituitary.

Can you differentiate the various pituitary and thyroid disorders? For each disorder, drag and drop the characteristics that apply to the disorder to the box. Thyroid Hypofunction Hashimoto's Thyroiditis Primary represented by high T3 and T4 and low TSH Graves' disease Polyuria Slow reflexes Primary represented by low T3 and T4 and high TSH Cretinism in infants

Hashimoto's Thyroiditis Cretinism in infants Slow reflexes Primary represented by low T3 and T4 and high TSH Hashimoto's thyroiditis, an autoimmune condition, is the most common form of thyroid hypofunction. Because thyroid hormones affect the nervous system, lack of sufficient hormones may result in slow reflexes. Primary forms of hypothyroidism are due to problems within the thyroid gland itself. In this case, TSH, the signal from the anterior pituitary, is elevated, while T3 and T4 levels remain low. High levels of thyroid hormone represent hyperfunction, no hypofunction. Graves' disease is an example of thyroid hyperfunction. Cretinism is a specific form of thyroid hypofunction which occurs in infants.

Hypofunction of an endocrine gland is associated with which of the following? Select all that apply. Graves' disease Syndrome of inappropriate antidiuretic hormone Hashimoto's thyroiditis Central diabetes insipidus Acromegaly

Hashimoto's thyroiditis Central diabetes insipidus

Lee, age 45, recently received a phone call from his physician who was concerned about some laboratory values obtained at a recent appointment, specifically extremely elevated serum calcium levels. Which of the following disorders may result in a pronounced elevation in serum calcium? Hypoparathyroidism Hyperparathyroidism Adrenal insufficiency Adrenal excess

Hyperparathyroidism Parathyroid hormone, secreted by the parathyroid glands, elevates serum calcium levels. His elevated calcium levels are due to hyperparathyroidism. The adrenal glands do not regulate serum calcium levels.

Which of the following would you expect to see in a patient suffering from Addison's disease? Hypoglycemia Elevated serum calcium Elevated norepinephrine Elevated cortisol Elevated blood pressure

Hypoglycemia

Which of the following conditions do you also suspect Mary may experience? Weight gain Hypotension Diabetes mellitus Insulin resistance Dyspnea

Hypotension Both aldosterone and cortisol, which are low in Mary, help maintain blood pressure. Without adequate levels of these hormones, a patient may experience hypotension. Aldosterone stimulates sodium and water reabsorption, maintaining blood volume and blood pressure. Cortisol is a vasoconstrictor, which also helps maintain blood pressure.

Corticotropin-releasing factor is produced by which tissues? Select all that apply. Adrenal glands Anterior pituitary Hypothalamus Ovaries Testes

Hypothalamus

What explains Mary's "tan" appearance? Reduced blood glucose activates melanocytes Increased ACTH leads to increased melanocyte-stimulating hormone (MSH) Decreased cortisol stimulates pigment production Reduced aldosterone activates melanocyte-stimulating hormone

Increased ACTH leads to increased melanocyte-stimulating hormone (MSH) In Mary's case, reduced cortisol causes an elevation in ACTH. As precursor molecule for ACTH also contains melanocyte-stimulating hormone (MSH). As more ACTH is formed, so is more MSH, which in turn activates melanocytes leading to a tanned appearance.

Can you differentiate the various pituitary and thyroid disorders? For each disorder, drag and drop the characteristics that apply to the disorder to the box. Thyroid Hyperfunction Increased HR and tremors Secondary represented by high T3 and T4 and high TSH Secondary represented low T3 and T4 and low TSH Hashimoto's Thyroiditis Heat sensitivity Central diabetes insipidus Thyrotoxicosis

Increased HR and tremors Thyrotoxicosis Heat sensitivity Secondary represented by high T3 and T4 and high TSH Thyrotoxicosis is an elevation in thyroid hormones. Thyroid hormones, T3 and T4, increase metabolic rate, which may cause an individual to be warm and intolerant to heat. The heart and nervous system are sensitive to thyroid hormones, so elevation of these hormones may cause elevated heart rate and tremors. Secondary thyroid hyperfunction is due to an elevation in the anterior pituitary hormone, TSH, stimulating overproduction of thyroid hormone. Thus, TSH, T3, and T4 are all elevated in secondary forms of hyperfunction. Hashimoto's thyroiditis is associated with hypofunction of the thyroid gland. Central diabetes insipidus is a condition of the posterior pituitary.

Can you differentiate the various pituitary and thyroid disorders? For each disorder, drag and drop the characteristics that apply to the disorder to the box. Anterior Pituitary Hyperfunction Pituitary adenomas Decreased plasma osmolarity Increased end organ activity Decreased end organ activity Increased tropic hormones Prolactinomas Weight gain

Pituitary adenomas Increased end organ activity Prolactinomas Increased tropic hormones Tropic hormones are produced by the anterior pituitary, so hyperfunction of this gland causes an elevation in one or more of these hormones. Elevated tropic hormones will in turn increase end organ activity. Prolactinomas are the most common form of anterior pituitary hyperfunction. Changes in plasma osmolarity are associated with the posterior, not anterior, pituitary. Weight gain is common in hypothyroidism.

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Mr. Ruiz is experiencing reduced ACTH and elevated cortisol. PRIMARY SECONDARY TERTIARY

Primary A primary disorder occurs when the problem is in the end organ. In this example, the adrenal cortex is not receiving a signal to produce cortisol, as shown by reduced ACTH from the anterior pituitary. However, the adrenal cortex is continuing to produce cortisol despite a lack of signal.

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Ms. Lee is experiencing elevated TSH and reduced thyroid hormone levels. PRIMARY SECONDARY TERTIARY

Primary When TSH is elevated, but thyroid hormone levels remain low, this is a primary disorder. The thyroid glands are the problem. They are receiving a signal to produce thyroid hormone, but are unable to respond.

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Mr. Thompson's adrenal problem originates in adrenal cortex. PRIMARY SECONDARY TERTIARY

Primary When the hormonal abnormality originates in the organ itself, it is considered a primary disorder.

Based on Mary's laboratory results (low cortisol, low aldosterone, elevated ACTH, low blood glucose, low serum sodium, elevated serum potassium, normal calcium, normal PTH.), which form of adrenal insufficiency does Mary have? Primary adrenal insufficiency Secondary adrenal insufficiency Tertiary adrenal insufficiency

Primary adrenal insufficiency Mary's condition is a result of a problem in the adrenal glands not being able to produce cortisol. The adrenal glands are receiving a signal from the anterior pituitary, shown by the elevated ACTH; however, the glands are incapable of responding to this signal. A tertiary condition is a problem in the hypothalamus, and Mary's problem is located within the adrenal glands.

Endocrine dysfunction can also be referred to as a primary, secondary, or tertiary disorder What are the differences between the three?

Primary disorder: dysfunction caused by the endocrine gland itself. Secondary disorder: dysfunction caused by abnormal pituitary activity. Tertiary disorder: dysfunction caused by a hypothalamic origin.

At his follow-up examination, Lee's laboratory values revealed elevated serum PTH, elevated serum calcium, and reduced serum phosphorus. What form of hyperparathyroidism does Lee exhibit? Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism

Primary hyperparathyroidism Primary hyperparathyroidism is a disorder in the parathyroid glands themselves. The laboratory values indicate disruption of normal parathyroid function, as elevated serum calcium usually negatively feedback to the parathyroid glands, suppressing PTH release. In this instance, the parathyroid glands are no longer responding as expected to the calcium signal. Secondary hyperparathyroidism is elevated PTH levels as a result of some other organ, not the parathyroid glands, experiencing dysfunction. For example, if the kidneys are unable to reabsorb calcium, PTH levels remain elevated.

Had Lee been experiencing primary hypoparathyroidism, instead of primary hyperparathyroidism, what laboratory results would you expect? Elevated PTH, elevated calcium, elevated phosphorus Elevated PTH, reduced calcium, elevated phosphorus Reduced PTH, elevated calcium, elevated phosphorus Reduced PTH, reduced calcium, elevated phosphorus

Reduced PTH, reduced calcium, elevated phosphorus Hypoparathyroidism indicates reduced, not elevated, PTH levels. As PTH increases serum calcium levels, a reduction in PTH results in lower than normal calcium levels. Phosphorus levels are often opposite calcium levels. As calcium levels decline, phosphorus levels increase.

(low cortisol, low aldosterone, elevated ACTH, low blood glucose, low serum sodium, elevated serum potassium, normal calcium, normal PTH.) What factor is likely playing a role in Mary's abnormal serum sodium and potassium levels? Elevated ACTH Reduced cortisol Reduced aldosterone Normal PTH

Reduced aldosterone Aldosterone is released from the adrenal cortex and targets the kidneys. Aldosterone stimulates sodium reabsorption and potassium secretion by the kidneys. Without adequate aldosterone, sodium is excreted in the urine, while potassium is reabsorbed.

Endocrine laboratory values reveal your patient has a tumor of the anterior pituitary. This tumor secretes excess adrenocorticotropic hormone, which stimulates cortisol by the adrenal gland. What type of endocrine dysfunction does your patient have? Primary Secondary Tertiary

Secondary

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Ms. Wallace's adrenal problem originates in the pituitary gland. PRIMARY SECONDARY TERTIARY

Secondary A secondary condition arises when the hormonal signaling problem occurs in the pituitary gland.

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Mr. Wilson is experiencing elevated ACTH and elevated cortisol. PRIMARY SECONDARY TERTIARY

Secondary A secondary disorder arises from improper signaling from the anterior pituitary. Normally, elevated cortisol levels should suppress further secretion of ACTH by the anterior pituitary. In a secondary disorder, the anterior pituitary no longer responds appropriately to this signal.

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Ms. Ang is experiencing low CRF, elevated ACTH, and elevated cortisol. PRIMARY SECONDARY TERTIARY

Secondary Problems in the anterior pituitary result in secondary disorders. In this case, the anterior pituitary is not responding correctly to signals from other glands. Elevated cortisol normally negatively feedbacks and reduces ACTH. Low CRF indicates the anterior pituitary is not being signaled to produce more ACTH. Despite this, the anterior pituitary is continuing to produce elevated ACTH levels, which in turn cause elevated cortisol levels.

Which of the following may also result in a "tanned" appearance? Primary adrenal excess Secondary adrenal excess Hypothyroidism Hyperparathyroidism

Secondary adrenal excess Secondary adrenal excess refers to a problem in the anterior pituitary, the organ that synthesizes ACTH. In secondary adrenal excess, ACTH is elevated, along with its precursor molecule, which contains melanocyte-stimulating hormone.

Excess antidiuretic hormone is associated with which of the following conditions? Central diabetes insipidus Graves' disease Hashimoto's thyroiditis Syndrome of inappropriate antidiuretic hormone Acromegaly

Syndrome of inappropriate antidiuretic hormone

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Mrs. Smith is experiencing elevated TRH, elevated TSH, and elevated thyroid hormones. PRIMARY SECONDARY TERTIARY

Tertiary A tertiary disorder is a problem in signaling from the hypothalamus. In this case, the hypothalamus is over producing TRH, which stimulates TSH, which in turn stimulates the thyroid gland. In a normal response, elevated thyroid hormones would negatively feedback and suppress TRH from the hypothalamus.

choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder. Mrs. Jacobi's adrenal problem originates in the hypothalamus. PRIMARY SECONDARY TERTIARY

Tertiary Endocrine disorders originating in the hypothalamus are tertiary disorders.

pituitary gland

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.

Hormones of the thyroid gland

Thyroxine (T4) Triiodothyronine (T3) Calcitonin

Immunoassays or blood levels of hormones are the most important diagnostic tool in endocrine disorders. T/F

True

Which of the following are keys to understanding endocrine dysfunction? Select all that apply. Understanding normal function of the gland Understanding hypofunction Understanding the location of the dysfunction Understanding if the disorder is primary, secondary, or tertiary Understanding hyperfunction

Understanding normal function of the gland Understanding hypofunction Understanding the location of the dysfunction Understanding if the disorder is primary, secondary, or tertiary Understanding hyperfunction

The nurse finds decreased T3 and T4 hormone levels in the laboratory report of a patient diagnosed with an endocrine disorder. What specific characteristics does the nurse expect to find? Select all that apply. Weight gain Decreased heart rate Feeling cold Fatigue Weight loss

Weight gain Decreased heart rate Feeling cold Fatigue