Endocrine System HESI review

hyperthyroidism diagnostic tests

TSH assay and t3 (decreased TSH & increased T3 level indicate hyperthyroidism)

thyroid stimulating hormone and follicle stimulating hormone are released by:

anterior pituitary gland

side effects of androgen therapy

baldness, gynecomastia, and acne

which organs have both alpha and beta receptors?

bladder and pancreas

blood glucose testing vs urine glucose testing

blood glucose monitoring is more accurate rationale: urine testing provides indirect measure that can be influenced by kidney fx and the amount of time urine is retained in the bladder

its actions are opposite to that of parathyroid hormone

calcitonin rationale: reduces serum calcium levels, whereas parathyroid hormone increases serum calcium levels; calcitonin is secreted by parafollicular cells of the thyroid gland; it decreases calcium and phosporus levels by decreasing boe resorption. calcitonin works along with parathyroid hormone to maintain calcium levels in blood

acromegaly

caused by hyperpitutarism; symptoms include thickened lips, coarse facial features, and lower-jaw protrusion

growht hormone deficiency

causes decreased muscle strength and decreased bone density

ADH deficiency

causes excessive urine output and a low urine specific gravity

priority after thyroidectomy

checking vital signs every 2 hours after they stablize (observe for thyroid storm, hemorrhage, resp. obstruction)

hyperpigmentation or "bronzing"

classic sign of addisons disease

how to prevent infections with DM

control BG with diet, exercise, and medication

hormone formed from cholesterol

cortisol (secreted by the adrenal cortex) rationale: all lipid-soluble hormones are synthesized from cholesterol; all water-soluble hormones are formed from amino acids (insulin, prolactin, and growth hormone); insulin is secreted by the pancreas; prolactin and growth hormone are also secreted by the pituitary gland

which statement is true regarding cortisol?

cortisol stimulates gluconeogenesis rationale: coritsol maintains BG concentration by stimulating the liver for gluconeogenesis. gluconeogenesis involves formation of glucose from amino acids and fatty acids. cortisol mobilizes free fatty acids and inhibits protein synthesis. the blood levels of cortisol increase in stressful conditions

specific gravity of pts with DI

decreased specific gravity, usually less than 1.005

medical condition that could most probably result in clients developing primary diabetes insipidus (DI)

defect in hypothalamus (thirst center) rationale: meningitis or brain tumor could interfere with the synthesis, transport, or release of ADH and cause CENTRAL DI; lithium therapy affects the renal response to ADH and results in NEPHROGENIC DI, or drug-related DI

drug-induced hormonal imbalance with demeclocycline

diabetes insipidus - can interfere with the response of the kidneys to ADH

ecchymosis (brusie)

discoloration of skin due to rupture of blood vessels beneath the skin

skin condition with hypothyroidism

dry skin (caused by decreased function of sebaceous glands); pale

target tissue of sympathetic effectors

epi and NE

neuromusuclar manifestation observed in client with adrenal insufficiency?

fatigue

hypoglycemia

fatigue, weakness, nervousness, increased perspiration

which hormones are released by the anterior pituitary gland?

follicle stimulating hormone, thyroid stimulating hormone

complication of decreased glucose tolerance in pt with DM

frequent yeast infections

grades of goiters

grade 0: goiter is invisible or impalable grade 1: goiter mass moves up while swallowing and is palpable; goiter mass is invisible while neck is in normal position grade 2: goiter is asymmetrical

hormone overproduction associated with carpel tunnel syndrome

growth hormone

autoimmune disorder where immune system attacks the thyroid gland

hasimotos disease

bromocriptine, used to treat hyperpituitarism, may cause:

headaches, gastric irritation, and orthostatic hypotension

primary causes for adrenal insufficiency

hemorrhage, TB, AIDS, metastatic cancer

cushing syndrome

hirsutism, round face, buffalo hump rationale: hirsutism is caused by excess adrenocortical activity; a moon face results from accumulation of adipose tissue associated with hypercortisolim; a buffalo hump results from an accumulation of adipose tissue associated with hypercortisolism. hypercortisolim increases gluconeogenesis, causing hyperglycemia

cushings disease

hypersecretion of adrenocorticotropic hormone weight gain, truncal obesity, buffalo hump, moond face; DM, muscle wasting, osteoporosis, ecchymosis, and slow healing of wounds

cardiovascular manifestations observed in client with adrenal insufficiency ?

hyponatremia

clinical manifestation of vasopressin deficiency

hypotension rationale: vasopressin regulates fluid level and blood pressure.

clinical manifestations of lutenizing and follicle stimulating hormone deficiences

impotence, amenorrhea, and decreased libido

client with head injury producing clear, colorless urine

inadequate ADH secretion - can be caused by head trauma, water is not conserved by the body and excess amounts of urine are produced

thyroid storm (severe hyperthyroidism)

increased heart rate, increased temperature, increased resp rate, increased BP rationale: thyroid storm is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby casued tachycardia. because of the increased metabolic rate associated with thyroid storm, body temp will increase; resp rate and bp will increase to meet body's oxygen needs

signs of DI

increased thirst, increased urination, deficiency of ADH, and urine osmolarity less than 100 mOsm/kg

effects of parathyroid hormone on bones for maintenance of calcium balance

increases net release of calcium into extracellular fluid rationale: paraythyroid hormone affects target tissues such as bone, kidney, and GI tract. the effects of PTH on bones will be associated with the increase in the net release of Ca+ into extracellular fluid; the kidneys are responsible for increasing bicarb and sodium excretion; PTH on GI tract would show effects such as enhanced absorption of calcium and phosphorus. kidneys are responsible for increased resabsorption of calcium and magnesium

lipid-soluble hormones (i.e., estrogen, aldosterone, and hydrocortisone) have receptors where?

inside the target cell

target tissue for parathyroid hormone

intestines

fluid imbalance due to DM

intracellular to intravascular as a result of hyperosmolarity rationale: the osmotic effect of hyperglycemia pulls fluid from the cells, resulting in cellular dehydration.

cells that produce insulin and glucagon

islet cells

cancer associated with AIDS

kaposi sarcoma

sweet frutiy odor of urine

ketoacidosis - may result from uncontrolled diabetes

which element excessively accumulates in the blood to precipitate signs and symptoms associated a diabetic coma?

ketones as a result of rapid fat breakdown, causing acidosis rationale: ketones are produced when fat is broken down for energy

how may hypothroidism develop after subtotal thyroidectomy?

less thyroid tissue is available to supply thyroid hromone after surgery

which organ has only alpha receptors?

liver

bromocriptine mesylate for hyperpituitarism

low dose of drug should be given while initiating therapy

clinical manifestation of adrenocorticotropic hormone

malaise and lethargy

hormones released by hypothalamus

melanocyte-inhibiting hormone, corticotropin-releasing hormone, growth hormone-releasing hormone

which hormones are secreted by the hypothalamus

melanocyte-inhibiting hormone, corticotropin-releasing hormone, growth hormone-releasing hormone

nurse's priority action immediately thyroidectomy postop

monitor the trachea for deviation to the right or left rationale: imminent sign of airway compression

progessive disease involing destruction of myelin sheath, leading to nerve damage

multiple sclerosis

surgical procedure performed to treat HYPERPITUITARISM due to pituitary gland tumors

nasal hypophysectomy

how to find out composition of thyroid nodule

needle biospy - used to aspirate the contents of thyroid nodules to study the composition and ascertain the need for further surgical interventions

DM2

negative for ketones, positive for glucose

mild form of hypocalcemia

numbness/tingling sensation around the mouth or hands and feet

which glands secrete hormones that regulate metabolism of carbs, proteins, and fats?

pancreas, thyroid gland, adrenal cortex rationale: pancrease secretes insulin and glucagon, which affects body's metabolism. the thyorid gland secretes thyroid hormones T3 and T4 that regulate metabolism. coritsol is a glucocorticoid secreted by the adrenal cortex that affects the metabolism; adrenal medulla secretes catecholamines which DO NOT affect metabolism. hormones secreted by the parathyroid gland mainly regulate calcium and phosphorus metabolism

cells that produce thyrocalcitonin hormone

parafollicular cells - helpsi in the regulation of serum calcium levels

overproduction hormone associated with hyperparathyroidism

parathyorid hormone

which gland secretes calcitonin?

parathyroid gland

hyperreflexia is a sign of decifiency of which hormone

parathyroid hormone (hypoparathyoridism)

hyperkalemia and ECG tracing monitor

peaked T waves and widened QRS complexes

which gland secretes melatonin?

pineal gland (melatonin regulates circadian rhythm and reproductive system at the onset of puberty)

cells that produce growth hormone, prolactin, and adrenocorticotropic hormone

pituitary cells

condition that results in elevated serum adrenocorticotropic hormone and urine cortisol levels?

pituitary cushing's syndrome

secondary cause of adrenal insufficiency

pituitary tumors; postpartum pituitary necrosis

clinical manifestations of DM

polyuria, polydipsia, polyphagia

hormone that has both inhibiting and releasing action

prolactin

hormones secreted by the anterior pituitary gland

prolactin, corticotropin, melanocyte-stimulating hormone

anterior pituitary gland releases:

prolactin, growth hormone, lutenizing hormone

insulin requirements post op

remain elevated from emotional and physical stress

thyroid-stimulating hormone deficiency

results in hirsutism and menstrual abnormalities

exocrine gland

salivary gland rationale: exocrine glands are glands with ducts that produce enzymes but NOT HORMONES. these glands secrete enzymes into ducts. endocrine glands are ductless glands that produce hromones that are secreted into the blood (i.e., thyroid, pituitary, and parathyroid glands)

abdominal manifestations observed in clients with adrenal insufficiency?

salt cravings and weight loss

severe hypocalcemia

seizures, hand spasms, severe muscle cramps

small cell carcinoma of the lung & SIADH

seizures, vomiting, oliguria rationale: cancerous cells of small cell lung cancer can produce ADH, which causes fluid retention, resulting in increased blood volume and decreased urine volume. fluid retention associated with SIADH can cause cerebral edema, resulting in confusion and seizures. fluid retention resulting in hyponatermia causes nausea and vomitings.

hemorrhage-associated hypopituitarism after delivery of a child

sheehans syndrome

diagnostic test to help identify abormalities of the sella turcica in hyperpituitarism?

skull x-ray

inhibits the secretion of growth hormone

somatostatin

which hormone is released from the pancreas

somatostatin - hormone produced by the pancreas that inhibits the release of insulin and glucagon

two releasing hormones

somatotropin and gonadotropin

best indication that DM is successfully managed

stablization of serum glucose

instructions for urine endocrine testing

store the urine specimen in cooler with ice, after the bladder is empty, and time after initial void

after subtotal thyoridectomy for a tumor, what do you do if a pt complains of "funny, jittery feelings?"

test for chvostek and trousseau signs and notify PCP of complaints rationale: these symptoms may indicate impending hypocalcemic tetany, a complication after removal of parathyroid tissue during a thyroidectomy.

which organ has only beta-1 receptors?

the heart (increase heart rate and contractility)

endocrine system

the hormones of the endocrine system exert their action by 'lock and key' mechanism rationale: the hormones recgonize and adhere only to specific receptor sites on the target tissue. the glands of the endocrine system are DUCTLESS and secrete hormones that are carried via the blood circulation. salivary glands and lacrimal glands are secretory glands.

excessive secretion of growth hormone

thickened lips, joint pain, coarse facial features (acromegaly) - caused by pituitary gland hyperfunction leading to excessive secretion of growht hormone

exophlthalos is a classic sign of hormone alteration?

thyroid (hyperthyroidism)

why exercise with DM

to improve the cellular uptake of glucose rationale: exercise increases the metabolic rate and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. regular vigorous exercise increases cell sensitivity to insulin.

cushing syndrome

truncal obesity, sleep disturbance, thin arms and legs (caused by protein catabolism which causes muscle wasting), hypertension

how to reduce complications of decreased estrogen (menopause)

walk 30 minutes per day, perform weight-beating activities, urinate immediately after sex rationale: because decreased ovarian production of estrogen leads to low bone density, regular exercises are advised, such as walking for 30 minutes per day and performing weight-bearing activities; decreased estrogen increases risk of cystitis; therefore, female clients are advised to to urinate after sex

self teaching for bilateral adrenalectomy

yearly flu vaccine, call healthcare provider if 3lb increase/week, visit hospital frequently for lifelong hormonal therapy, immediately notify provider if fever presents

hormones secreted by the posterior pituitary gland

ADH & oxytocin

chronological events of ADH secretion stimulated by plasma osmolarity

1. decrease in extracellular fluid 2. plasma osmolarity increases 3. osmoreceptors are activated 4. ADH is released 5. water is reabsorbed from renal tubules (urine more concentrated)

positive results for suppression test for hyperpituitarism

6ng/ml rationale: when the growth hormone level in suppression test is above 5ng/ml, this indicates a positve results = hyperpitutarism.

overproduction hormone associated with SIADH

ADH

what indicates cerebrospinal leakage?

a yellow edge around nasal discharge ("halo sign")

diabetic ketoacidosis

acetone breath, decreased arterial carbon dioxide level, and decreased arterial bicarb level

what is the most probable cause for Conn's syndrome?

adrenal adenoma rationale: conn's syndrome is primary hyperaldosteronism. excessive secretion of aldosterone by the adrenal glands due to an adrenal adenoma results in conn's syndrome. certain types of hyperaldosteronism that are diagnosed in childhood have genetic causes. high levels of angiotensin II that are stimulated by high levels of plasma renin are a cause for secondary hyperaldosteronism.

cells that produce cortisol and aldosterone

adrenal cells

condition that is caused by chronic steriod use; the pt will have increased urine cortisol and decreased ACTH levels

adrenal cushing's syndrome

which gland secretes androgens, corticosterioids, and catecholamines?

adrenal gland

addison disease

adrenal insufficiency hypotension, dehydration, hypoglycemia, hyperpigmentation of the skin

which hormone deficiency reduces growth of axillae and pubic hair in females?

adrenocorticotropic hormone

hypokalemia inhibits the synthesis of which hormone?

aldosterone

overproduction hormone associated with conn's syndrome

aldosterone

target tissue for growth hormone

all body cells

parathyroid hormone

allows calcium to be reabsorbed in the kidney tubules; PTH increases serum calcium levels. PTH activates vitamin D in the kidneys, which increases the absorption of calcium and phosphorus from the intestines. secretion of PTH increases calcium levels. PTH regulates calcium and phosphorous metabolism by acting on the GI tract, bones, and kidneys

water-soluble hormones (i.e. adrenaline) have receptors where?

on the surface of target cells

posterior pituitary gland releases:

oxytocin

target tissue of mammary gland

oxytocin