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2024 BIO230 Module 5 Study
Guide
Chapter 16 Endocrine System Disorders
- Identify the primary effect of these pituitary gland hormones: a. Growth hormone Stimulates protein synthesis b. ACTH Stimulates adrenal cortex to secrete cortisol c. TSH Stimulates thyroid gland d. FSH Women – stimulates growth of ovarian follicles and estrogen secretion; Men – stimulates sperm production e. ADH Increases reabsorption of water by kidney f. Oxytocin Stimulates contraction of uterus after delivery and stimulates ejection of breast milk during lactation
- Identify the primary effect of these pancreas hormones. a. Insulin Transport of glucose and other substances into cells; lowers blood glucose level b. Glucagon Glyconeolysis in liver; increases blood glucose levels.
- Identify the primary effect of these adrenal hormones. a. Aldosterone Increases sodium and water reabsorption by the kidney b. Cortisol Anti-inflammatory and decreases immune response; catabolic effect on tissues; stress response c. Norepinephrine General vasoconstriction
- Why is it beneficial for more than one hormone to control certain body functions, such as blood pressure? Multiple hormones can provide better control of an activity and if there is impairment of one hormone, others can take over.
- Explain the effect(s) adenomas may have upon hormone levels. An adenoma is a benign tumor, and is often secretory, causing excess hormone to be released. They can also have a destructive effect on the gland, which would cause a hormonal
deficit, so there could be either too much, or too little hormone. An adenoma of the pituitary will also
remove within a given time, excess ketones accumulate in the blood (ketoacidosis) and are excreted in the urine (ketonuria). As dehydration progresses, the kidney is unable to excrete all ketones, they accumulate in the blood, binding with bicarbonate until it is depleted, and then the pH of the body fluids becomes acidotic, which can be life threatening
- Why are diet and exercise prescribed for the management of diabetes? Diet determines the amount of glucose taken into the body. Foods which rapidly increase blood glucose have a high glycemic index and should be avoided; these are sugars (sweets and desserts) and concentrated carbohydrates like breads, pasta, rice, potatoes. Foods with a low glycemic index contain more fiber and do not cause rapid spikes in blood glucose (and are thus more desirable than those with a high glycemic index). Regular, moderate exercise not only helps with weight management it also improves the use of glucose by muscles (remember, skeletal muscles don’t need as much insulin to use glucose as other cells). However, excessive exercise can reduce blood glucose to the level of hypoglycemia, so if prolonged exercise is planned, a pre-exercise snack is advised.
- Why are diabetics at risk for hypoglycemia? What are signs and symptoms of hypoglycemia? Even though hyperglycemia (elevated blood sugar) is the prevailing sign of diabetes, because of the problem with sugar regulation diabetics are also at risk for hypoglycemia (low blood sugar). Hypoglycemia occurs as the body’s reaction to an excess of insulin that causes a quick drop in the blood glucose. Hypoglycemia may follow strenuous activity, changes in food intake or insulin doses that cause a lack of glucose. The lack of glucose affects the nervous system and causes symptoms in the person such as poor concentration, slurred speech, lack of coordination, increased heart rate, pale moist skin, anxiety, and tremors.
- What is the treatment for hypoglycemia? Hypoglycemia can be fatal, thus the term “shock”. If the person is still conscious, ingestion of sugar will (briefly) help. Sweetened fruit juice, honey, candy, sugar, or regular soda are often used. Many diabetics or those prone to hypoglycemia carry glucose tablets or jelly with them. It’s important to recognize that sugars are quickly metabolized and hypoglycemia may recur. A few peanut butter crackers will often provide enough protein to normalize blood glucose, and should be encouraged, but only AFTER normalizing blood glucose with a quickly-absorbed sugar. If the person is unconscious don’t attempt to give them anything by mouth. Call 911 instead because they are going to need intravenous glucose.
- DKA is a complex and emergent condition. What is the cause? Results from insufficient insulin, which causes high blood glucose levels and mobilization of lipids. Predisposing factors: Infection or stress, which increases insulin demand by the body. May also result from overindulgence in food or alcohol or missed dose of insulin.
- List the clinical manifestations of DKA. Thirst, dry, rough oral mucosa, warm, dry skin, rapid, but weak pulse, low blood pressure, and oliguria (indicates compensation mechanisms to conserve fluid). Ketoacidosis leads to rapid, deep respirations (Kussmaul), acetone breath, lethargy and decreased responsiveness (indicating
depression of the CNS). As ketoacids accumulate in the blood they bind with available bicarbonate ions; this reduces
- Describe how gigantism and acromegaly differ. Giantism – Tall stature results from excess GH prior to puberty and fusion of epiphyses. Acromegaly - Excess GH secretion after epiphyses close, often caused by an adenoma. Bone then becomes broader and heavier, soft tissues grow, resulting in enlarged hands and feet, a thicker skull, and altered facial features. Arthritis or bone overgrowth can occur. GH also affects glucose metabolism and insulin effectiveness, and usually results in diabetes. HTN and CV disease often develop as well. A protruding mandible (prognathia) or jaw and large tongue (macroglossia) is common
- What condition is the result of insufficient ADH? What are the clinical manifestations? Diabetes insipidus - Polyuria, with large volumes of dilute urine, and thirst Severe dehydration
- What condition is the result of excess ADH? What are the clinical manifestations? Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Severe hyponatremia, which causes mental confusion and irritability Hypertension
- What is a goiter? A goiter is an enlargement of the thyroid gland that is often visible on the neck. A goiter is caused by various thyroid conditions. endemic goiter- occurs from a dietary deficiency of iodine. Iodine is normally used by the thyroid to synthesize the production of thyroid hormones called T3 and T4. The deficiency leads to low thyroid production and then thyroid stimulating hormone (TSH) levels increase to compensate causing hypothyroidism. The use of iodized salt has decreased this problem. Toxic goiter is a type of a goiter caused from hyperthyroidism. This goiter occurs when there is a condition that causes an overproduction of TSH and produces a large nodular gland.
- Hyperthyroidism a. Are T3 and T4 levels high or low? High b. Is metabolic rate high or low? High c. What are clinical manifestations? Heat intolerance, flushed, warm skin, exophthalmos, tachycardia, increased blood pressure, restlessness, tremors, weight loss, but increased appetite d. What is the etiology of Graves Disease? It is an autoimmune disorder
- Hypothyroidism a. Are T3 and T4 levels high or low? Low b. Is metabolic rate high or low? Low c. What are clinical manifestations? Cold intolerance with cool, pale skin, edema, bradycardia, enlarged heart, lethargy, slowed mental function, weight gain in spite of decreased appetite.
d. What is the etiology of Hashimoto thyroiditis? Also an autoimmune disorder.
- What is a pheochromocytoma, what does it cause, and how can it be treated? Pheochromocytoma is a benign tumor of the adrenal medulla that secretes epinephrine and norepinephrine. It causes hypertension, headache, heart palpitations, sweating, and intermittent or constant anxiety and can be cured with surgical removal of the tumor.
- Use the table to compare Cushing Syndrome and Addison’s Disease. Cushing Syndrome Addison’s Disease Etiology Caused by an excess of glucocorticoids, possibly from an adenoma, of the adrenal or pituitary gland, an ectopic carcinoma, or iatrogenic conditions, such as large intake of glucocorticoids Caused by a deficiency of adrenocortical secretions, glucocorticoids, mineralocorticoids, and androgens due to an autoimmune reaction. The gland may be destroyed by hemorrhage, meningococcal infection, viral tubercular, or histoplasmosis infection, or a destructive tumor. Pathophysiology Glucocorticoids are essential for the stress response and perform important functions in the body, but in excess they produce multiple, undesirable effects Damage from autoimmune destruction results in low glucocorticoid levels and high ACTH and CRH levels Manifestations, Signs & Symptoms Mood face, heavy trunk with fat accumulation at the back of the neck (buffao hump), while extremities appear thin and wasting), fragile skin that may have red streaks, increased hair growth (hirsutism), increased gluconeogenesis and insulin resistance, which may lead to glucose intolerance Retention of sodium and water, leading to HTN, edema, and possible hyperkalemia Suppressed immune and inflammatory responses, with atrophy of lymphoid tissue, predisposing them to infection Stimulation of erythrocyte production Emotional lability and euphoria Decreased blood glucose levels, poor stress response, fatigue, weight loss, anorexia, nausea, diarrhea, frequent infections, low serum sodium, decreased blood volume (from mineralocorticoid/aldosterone deficit), decreased body hair (lack of androgens) and hyperpigmentation of the extremities, skin creases, buccal mucosa and tongue (due to increased ACTH resulting from low cortisol secretion) Potential Complications Catabolic effects such as osteoporosis and decreased protein synthesis, which will delay healing Diabetes mellitus Risks for infections Reduced ability to respond to stress Cardiac arrhythmias and heart failure Treatment(s) Identify and treat the underlying cause Replacement therapy with necessary
well as itching, burning, soreness and nail thickening, pitting, and ridges. For some, arthritis develops, and they have swollen stiff joints. keratinocytes with increased cellular proliferation. Scleroderm a Hard, shiny, tight, immovable skin, which predisposes the person to ulcerations and impaired movement. May be systemic, affecting the microcirculation of multiple organs, causing kidney and/or respiratory failure and/or intestinal obstruction. While the cause is unknown, it is characterized by increasing collagen deposits in the arterioles and capillaries, which reduces blood flow to the skin and internal organs. Collagen deposits, inflammation, and fibrosis develops in the skin (and affected body organs). Varies widely and is based upon specific manifestations the severity of the disease. Cellulitis Infection of the dermis and subcutaneous tissue, usually secondary to injury, boil, or an ulcer, most frequently on the lower trunk and legs. Those with reduced circulation or who are immunocompromised are at greater risk. The affected area is swollen, red, painful, and may have red streaks running along the proximal lymph vessels of the affected area Infection is often caused by Staphylococcus aureus, or Streptococcus Systemic antibiotics are usually required. Analgesics are used for pain. Impetigo Highly contagious infection with red, pruritic vesicles which rupture to form yellow-brown crusts. Lesions may weep a honey-colored liquid. Often caused by Staphylococcus aureus, or group A beta-hemolytic streptococci. Easily spread to others by contact with hands, eating utensils, towels, or equipment. Antibiotic treatment, and close monitoring of response as some strains of the organisms have developed resistance to antibiotics. Herpes Simplex Initially, a burning or tingling sensation along a nerve that then develops into a painful vesicle which ruptures to form a crust, which then usually heals within 2
- 3 weeks. Type 1 (HSV-1) occurs on or near lips and type 2 (HSV-2) on genitals. The virus is spread by direct contact. The primary virus exposure may be asymptomatic, but the virus remains in a latent stage in the sensory nerve ganglion of the trigeminal nerve until it is reactivated, and a lesion develops. Recurring lesions may be triggered Topical antiviral creams.
by infection, sun exposure, or stress. Tinea A fungal, superficial infection which can affect multiple areas of the body. Tinea capitis is a scalp infection, Tinea corporis is commonly called “ringworm” and can occur anywhere on the body, Tinea pedis is commonly called “athlete’s foot” and Tinea unguium affects the nails, usually of the toes. Appearance varies based upon location. On scalp, a bald patch, with erythema and scaling is common. On the skin, pruritis is common as is a round, erythematous ring of vesicles or papules with a clear center. On the feet, the skin between the toes becomes inflamed, pruritic, and painful and there may be a foul odor. In the nails, the nail becomes thick, dark and cracks easily. Fungi live off of dead, keratinized cells of the epidermis. Antifungal medications, usually designed for the specific area affected. Scabies Appears as light brown lines, often with small vesicles, surrounded by erythema, most often in the areas between fingers, the wrists, inner surfaces of the elbow, and waistline area. Inflammation and pruritis occurs. Skin invasion by a mite, the female burrows into the epidermis, lays eggs, and the larvae emerge and migrate to the skin’s surface, and then burrow back into the skin in search of nutrients. Spread by close contact. Antifungal medication. Pediculosis Appears as a macule of papule that is highly pruritic, which leads to scratching and skin excoriations. May occur anywhere on the body or be limited to hair. Small parasites feed off of human blood and attach themselves to hair, skin, or pubic area. Female ice lay eggs on hair shafts, cementing their eggs firmly to the hair close to the scalp. The egg (nit) appears as a small, whitish shell attached to the hair. After hatching the baby louse bites the human to obtain blood for survival. Topical medications, which can usually be obtained OTC. Hair infestation requires meticulous removal of eggs with a fine- toothed comb. All clothing, linen, other items in close contact (stuffed animals, etc) must also be treated to avoid re-infestation. Squamous Slow-growing and painless, Squamous cell is a Surgical removal of the tumor,
can increase significantly within an hour of pupil dilation, blocking drainage of fluid, creating an acute glaucoma and sudden increase in intraocular pressure. cells, which causes cellular ischemia and damage. This damage affects anterior portion of the retina first, impacting the receptor cells for peripheral vision, but over time if the pressure continues to increase, more of the retina, as well as the optic nerve will become damaged. This damage is irreversible and will eventually result in blindness. Manifestations, Signs & Symptoms As intraocular pressures can rise rapidly, eye pain, nausea, and headache, as well as blurred vision occurs. The cornea may appear to bulge and be cloudy. The pupil is dilated and unresponsive to light. An acute episode may be triggered by pupil dilation, which can be caused by certain drugs, stress, or prolonged periods in a dark room. Onset is insidious and initial symptoms is increased intraocular pressure. Routine screening tests are recommended to measure pressures for early detection because loss of peripheral vision may not be noticed until substantial vision is (permanently) lost. As pressures increase over time, corneal edema and altered light refraction lead to blurred vision and the appearance of “halos” around lights. Mild eye discomfort can occur as the corneal pain receptors are stimulated by increased pressures. Potential Complications Permanent damage and blindness. Permanent damage and blindness Diagnosis is Made by Tonometry (measurement of intraocular pressures) Tonometry (measurement of intraocular pressures) Treatment(s) Surgical removal of part of the iris to open a passage for drainage of fluid into the canal of Schlemm. Surgery may be accomplished via laser iridotomy. Medication, administered via eyedrops instilled several times a day, to reduce secretion of aqueous humor or constrict the pupil. Some drugs may also reduce intraocular pressure. If the eye doesn’t respond to drug therapy, surgery may be needed to deepen the anterior chamber and increase aqueous humor drainage.
- Describe the etiology, manifestations, and treatment for conjunctivitis. Conjunctivitis is a superficial inflammation or infection of the conjunctiva lining of the eyelids and sclera covering. Allergens, bacteria, viruses, or irritating chemicals can cause inflammation. Manifestations are redness, itching, excessive tearing, and a watery discharge. Staphylococcus aureus infection will cause the discharge to be purulent; this condition is often called “Pink Eye” and is highly contagious. Antibiotic treatment is required to prevent corneal damage and contagion. Other sources of infection can be touching the eye with contaminated fingers, makeup, or other substance. During birth, a newborn’s eyes may also be exposed and contract, sexually transmitted disease (Chlamydia, gonorrhea, etc), causing infective conjunctivitis. Newborns are routinely treated with eye drops at birth (in hospitals) to prevent this source of
infection.
visual field becoming “black”. with exudate, in which neovascularization If separation continues untreated, the retina will die from lack of nutrients. occurs, with the formation of abnormal, leaky blood vessels, which rapidly destroy the retina. Both types prevent nutrients from passing from the choroids to the retina. Manifestations, Signs & Symptoms Blurred vision that progresses over the visual field and becomes darker with time. The rate of development may be so slow that the person doesn’t notice it until significant vision loss has occurred.
PAINLESS
May see light or dark floating spots in the visual field Development of a dark or blind spot, which will increase in size with time Some describe “seeing a dark curtain” drawn across their visual field. Blindness will develop if untreated Central vision (with high acuity) becomes blurred and then lost. Depth perception is also impaired. Diagnosis is Made by Ophthalmoscopic exam and visual acuity testing Ophthalmoscopic exam and visual acuity testing. Testing of visual fields and angiography. Treatment(s) The damaged lens can be surgically removed and replaced by an artificial intraocular lens, restoring clear vision. Surgical or laser treatment, as soon as possible to close any holes and reattach the retinal in proper position against the choroid to restore nutrition to the retinal cells before irreversible damage occurs. There is NO treatment to reverse vision that is lost. Nutritional intake (or supplements) high in vitamin, mineral, antioxidants, and zinc may help reduce the risk of dry AMD. If it is wet AMD, medications and/or laser therapy may help seal leaky vessels.
- Explain how conductive hearing loss differs from sensorineural hearing loss and give an example of each. Conductive loss occurs when sound transmission is blocked in the external or middle ear structures, such as by wax accumulation, foreign object in the external canal, scar tissue or adhesions that impair function of the tympanic membrane or ossicles. Sensorineural loss is due to damage to the organ of Corti or auditory nerve such as from infections (rubella, influenza, or herpes viruses), head trauma, or other neurologic disorder that affects the auditory nerve or temporal lobe.
- Use the table to compare otitis media and Meniere’s syndrome. Otitis Media Meniere’s Syndrome
Etiology Inflammation due to allergies, or an An inner ear or labyrinth disorder, usually infection, of the middle ear cavity. affecting only one ear and occurring in 30-50 year olds Predisposing Factors Infants and young children are more prone because their auditory canal is shorter, wider, and at a right angle to the nasopharynx where respiratory secretions can easily flow. Infants also spend more time lying down, which permit reflux of fluid into the ear. Changes in barometric pressure, stress, or other condition that increases blood flow to the ear may trigger an attack. Pathophysiology Upper respiratory infections often spread to the ear, where inflammatory exudate becomes trapped. Gastric reflux can also easily enter the ear of infants who are fed while in a supine position Excessive endolymph develops intermittently, as an “attack” which stretches the membranes and interferes with functioning of the hair cells in the cochlea and vestibule. Rupture of the labyrinth membrane can permit perilymph to mix with endolymph, and increase fluid volume for a period of time (minutes to hours). Manifestations, Signs & Symptoms It may be asymptomatic, but is often painful (otalgia). The tympanic membrane appears red and bulging. Infants and young children may tug at their ear. Mild hearing loss and a sense of fullness/congestion is common. If infected, fever and nausea may be present. If pressure builds the tympanic membrane may rupture, in which case purulent drainage may be seen in the external ear canal. Membrane rupture often relieves the pain that was caused by tympanic membrane pressure. During an attack, severe vertigo, tinnitus, unilateral hearing loss, nausea, sweating, feeling of pressure in the ear, and nystagmus, which also causes an inability to focus. Potential Complications Recurrent infections may cause hearing loss, development of scar tissue on the tympanic membrane, adhesions or damage to the ossicles, mastoiditis, and/or cholesteatoma (mass of epithelial cells in the middle ear that can erode the ossicles). Repeated attacks can cause permanent damage to the hair cells, resulting in permanent hearing loss and vertigo. Diagnosis is Made by Otoscopic exam Electronystagmography, electrocochleography, fluid and balance testing
- Infants and young children are predisposed to otitis media because…. their auditory canal is shorter, wider, and at a right angle to the nasopharynx where respiratory secretions can easily flow (as compared to that of an older child and adult). Infants also spend more time lying down, which permits more reflux of fluid into the ear.
- Ear infections can lead to permanent hearing loss because…. scar tissue can develop on the tympanic membrane, adhesions can develop, the ossicles can become damaged, and/or mastoiditis or a cholesteatoma may form (mass of epithelial cells in themiddle ear that can erode the ossicles).
- Explain why Meniere’s Syndrome causes both hearing loss and vertigo. Meniere’s syndrome is characterized by excessive endolymph fluids in the inner ear, which negatively affects functioning of both the cochlea and semicircular canals. The semicircular canals, and the receptor hair cells of the inner ear are responsible for balance and equilibrium. The hair cells of the cochlea are responsible for converting stimuli into nerve impulses, so impairment limits nerve impulses conducted to the temporal lobe for sound interpretation.
