Endocrine Disorders

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is a protein (or protein-based molecule) that speeds up a chemical reaction in a living organism

enzyme

Somatomedins -

insulin-like polypeptides made by the liver and some fibroblasts and released into the blood when stimulated by somatotropin. They cause sulfate incorporation into collagen, rNA, and dNA synthesis, which are prerequisites to cell division and growth of the organism.

Insulin,

is a hormone secreted by the beta cells of the pancreas that controls the metabolism and cellular uptake of sugars, proteins, and fats.

Glucagon

has a major role in maintaining normal concentrations of glucose in blood, and is often described as having the opposite effect of insulin. Released by alpha cells

Delta Cells

secrete somatostatin which inhibits secretion of both insulin and glucagon

Maturity-onset diabetes of the young (MODY)

is a rare form of juvenile diabetes mellitus, defined by early onset, absence of ketosis, non-insulin-dependent diabetes and autosomal dominant inheritance , onset <25y/o.

Diabetes Types

DM Type I: genetic, no insulin production
DM Type II: aquire, inadequate insulin production or insulin resistance
Gestational: during pregnancy
MODY: Type II for fat kids

DM Triad

polyphagia, polydipsia, polyuria

DM hallmark

hyperglycemia

Blood sugar spills over into the kidney when it reaches mg/dL?

180

Normal fasting glucose

between 70-110 (non fasting 140-200)

DM type I

acute onset, ketoacidosis, weakness, "unwell", hyperventilation, ketones on breath, days to weeks of weight loss, 3 P's, Lethargy

glycosylated hemoglobin

lab test used to determin long term glucose control

Insulin Preperations

rapid action: regular
Intermediate action: Semilente
Prolonged Action: Ultralente

Oral hypoglycemics in DM I?

Never

the most common cause of legal blindness in the age group 20 to 65)

diabetic retinopathy -

Diabetic Ketoacidosis (DKA)

the patient is glucose starved at the cellular level, and he has switched to ketone metabolism, which leads to an acidic state. Hyperglycemia, hypovolemia, polydipsia/uria, NV, dehydrated, Ketotic breath, Kussmaul's resp, altered LOC

DKA Tx Priorities

Fluid deficit, Potassium Def, Insulin Def

Hyperosmolar Hyperglycemic State

severe hyperglycemia, hyperosmolarity, and a relative lack of ketonemia. It is typically found in a debilitated patient with poorly controlled or undiagnosed type II diabetes mellitus (DM), limited access to water, and commonly, a precipitating medical event. Subtle vitals changes, profound shock/coma, focal neuro changes, can be seen in non-diabetic (i.e. stroke, burn MI)

Insulin shock-hypoglycemia

excess insulin with a glucose deficit (ie missed meal, increased exercise), light headed, diplopia, confusion, frank coma, tachycardia, pale, diaphoretic, LOC, seizurs etc

Insulin shock-hypoglycemia Tx

If alert oral glucose, if not IV D50W

The oral glucose tolerance test (OGTT)

is given to pregnant women at 28 weeks gestation to test for gestational diabetes.

Thyroid feedback loop

hypothalmus, pituitary, thyroid (T3 and T4)

MCC thyroid disorder, hyper or hypo?

Hyper

Hyperthyroidism

can cause nervousness, irritability, increased perspiration, intolerance to heat, fatigue, difficulty sleeping, a fast heartbeat, irregular menstrual periods in girls, and muscle weakness. People with this problem might lose weight even though they're eating more than usual. The eyes may feel irritated or look like they're staring. Sometimes the tissues around the eyes become inflamed and swollen, and the eyes appear to bulge out, decreases TSH, Triad: skin, eyes, heart

Graves' disease

is an immune system disorder (antibody complexes attach the thyroid g. & similar tissue) that results in the overproduction of thyroid hormones (hyperthyroidism), esp. under 40 y/o. Pretibial myxedema, exopthalmos,

exopthalmos

bug eyes

Thyroid Storm

extremely exagerated signs of hyperthyroidism, triggered by surgery or other thyroid Tx's, main S&S extreme weight loss >40lbs, high fever, tachycardia, vomiting, diarrhea, dehydration, delerium

Thyroid Storm Tx

Preventative: beta blocker lower HR, APAP lowers fever (no ASA)

Hypothyroidism

increased TSH, failure of the gland after an autoimmune attack (Hashimoto's thyroiditis), hoarseness, cold intolerance, weight gain, goiter, coarse brittle hair, non-pitting puffiness, "Queen Ann's Sign" (loss of lateral aspect of eyebrom), basically the opposite of hyperthyroidism, cretinism

Hypothyroid Cretinism

signs seldom apparent at birth, delayed closure of fontanels, failure to thrive, protuberant abd, Dry skin, dwarfism, flattened broad nose, derived from the French "chretien," meaning Christian or Christ-like, and was applied to these unfortunates because they were considered to be so mentally retarded as to be incapable of sinning!"

Hypothyroid DOC

levothyroxine (Synthroid), iodized salt in deficient areas

Goiter

associated with overproduction of thyroid hormone or malignancy. The thyroid can become very large so that it can easily be seen as a mass in the neck. Complications can include airway compromise and a superior vena cava syndrome. These patients will typically complain of a cough, a slight change in voice, or nighttime choking episodes because of the way that the gland compresses the trachea while sleeping.

hypercalcemia

"stones, bones, groans, and moans," kidney stones, weakened bones (brown tumors), weight loss/abd pain, depression fatigue, arthralgias, pathologic Fx, primary parathyroidism, excess exo/edogenous vit D, symptom of HPT

Cushing's disease

describes the condition resulting from too much exposure to steroid hormones. The commonest cause of it is the usage of synthetic steroids. The excess production of ACTH by a tumor in the pituitary gland is the next most common cause. increased cortisol, moon face, buffalo hump, hirsutism, truncal obesity w/ extremity wasting

Disorders of the Adrenal gland (3)

Cushing's disease, Addison's disease/crisis, Pheochromocytoma

Addison's disease

occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone. The disease is also called adrenal insufficiency, or hypocortisolism. "the unforgiving master...", fatigue, weakness, weight loss, hyperpigmentation, Kennedy had it, managed w/ oral hydrocortisone

Cortex hormones

"salt, sugar, sex" mineralcorticoids(aldosterone), glucocorticoids(cortisol), androgens

Medulla hormones

catecholamines (epi, norepi)

Addison crisis

can begin with sudden penetrating pain in the lower back, abdomen, or legs, severe vomiting and diarrhea leading to dehydration, low blood pressure, loss of consciousness. Left untreated crisis can be fatal. Disease symptoms progress slowly, they are usually ignored until a stressful event like an illness or an accident causes them to become worse=crisis.

Pheochromocytoma

tumor in adrenal gland medulla, hypersecretes its product, the catecholamines epinephrine and norepinephrine, accounts for less than 1% of HTN, HTN is paroxysmal, Headache, profuse sweating, palpitations, and apprehension, often with a sense of impending doom, are common. Pain in the chest or abdomen may be associated with nausea and vomiting. Pallor or flushing may occur. The blood pressure is elevated, often to alarming levels, and is usually accompanied by tachycardia.

Pheochromocytoma Tx

Beta blockade, then Alpha blockade, definitive+surgery

Posterior Pituitary Disorders (2)

Too much ADH= syndrom of inappropriate ADH (SIADH)
Too Little ADH= Diabetes insipidus

SIADH

too much ADH, oliguria, HTN, no evidence of shock, euvolemic hyponatremia, Tx: water restriction,

Diabetes insipidus

there is not enough ADH being secreted, polyuria, polydipsia, Tx: ADH/desmopressin

Anterior Pituitary Disorders

adenomas: growth hormone secreting tumor or Proclactinoma

Dwarfism

GH deficiency

Excessive Growth hormone

In children: effects linear bone growth, gigantism,
In adults: growth plates fused, enlargement of hands, feet, skull, slow onset, changes not noticed by patient, excessive sweating, Complications: HTN, DM, cardio, sleep apnea, calcinosis, osteoporosis

Prolactinoma

MCC pituitary tumor, causes milk production and severe menses in non-preg females and decreased libido, impotence, and milk/breast production in men

Prolactinoma Tx

only pituitary tumor for which Tx is primarily medical, DOC bromocriptine, surgery if symptoms persist

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