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Patho Test 4: Endocrine Disorders
(Davis)
What do Endocrine function and dysfunction revolve around? - Correct
answer regulation of hormones. If the endocrine system is working properly, the body's
hormones remain in balance. But if the endocrine system is experiencing dysfunction, the body could be suffering from hormone deficiency, hormone excess, or hormone resistance. What are the three keys to understanding disorders of the endocrine system? -
Correct answer 1. Understanding normal functioning
- Understanding hypofunction versus hyperfunction
- Understanding how to use the location of the dysfunction to determine if the dysfunction is primary, secondary, or tertiary. The regulatory link that keeps the body's hormones in balance is the negative feedback
system of _________. - Correct answer the hypothalamic-pituitary-endocrine gland
axis
How does the the feedback system works like a running relay team? - Correct
answer when one of the endocrine glands receives a particular hormone, that gland
instructs another hormone to take the baton and depart for the next gland in the cycle...and so on. The feedback system enables the endocrine system to send hormones when and where they're needed. Explain what happens when the hypothalamus receives a signal, how does it translate
it? - Correct answer hypothalamus receives signals that the body has extra
metabolic needs. To meet these needs, the hypothalamus secretes a hormone, corticotropin-releasing factor, which, in turn, stimulates the pituitary gland. The pituitary gland secretes another hormone, adrenocorticotropic hormone, and this stimulates the adrenal gland to secrete yet another hormone, cortisol. As levels of cortisol rise, the pituitary senses the increased level and shuts off stimulus to the adrenal
What are two results of the negative feedback system failing? - Correct
answer hypofunction or hyperfunction
What is the different between hypofunction or hyperfunction? - Correct answer In
hypofunction, an endocrine gland secretes an inadequate amount of hormone. In hyperfunction, an endocrine gland secretes an excessive amount of hormone.
What tells you if the dysfunction is primary, secondary or tertiary? - Correct
answer The location.
Explain what happens in primary disorder? - Correct answer the endocrine gland
itself causes dysfunction, as in hypothyroidism due to autoimmune destruction of the thyroid gland
Explain what happens in secondary disorder? - Correct answer the pituitary gland
causes the dysfunction, as in hypothyroidism due to a lack of secretion of thyroid- stimulating hormone by the pituitary.
And in tertiary disorder, what is the issue? - Correct answer the hypothalamus is the
root.
Adrenal problem originates in adrenal cortex is what type of disorder? - Correct
answer Primary, When the hormonal abnormality originates in the organ itself, it is
considered a primary disorder.
Adrenal problem originates in the hypothalamus. - Correct answer Tertiary,
Endocrine disorders originating in the hypothalamus are tertiary disorders.
Adrenal problem originates in the pituitary gland. - Correct answer A secondary
condition arises when the hormonal signaling problem occurs in the pituitary gland.
Elevated TSH and reduced thyroid hormone levels. - Correct answer 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.
Reduced ACTH and elevated cortisol. - Correct answer 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.
Elevated TRH, elevated TSH, and elevated thyroid hormones. - Correct answer 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.
Elevated ACTH and elevated cortisol. - Correct answer A secondary disorder arises
from improper signaling from the anterior pituitary. Normally, elevated cortisol levels
If the anterior pituitary dysfunctions, it experiences either. - Correct
answer hypofunction or hyperfunction
In hypofunction what happens? - Correct answer if the under-produced hormone
targets a gland that itself produces hormones, the result is a decrease in end-organ hormone production. If the anterior pituitary is unable to produce adrenocorticotropic hormone, known as
ACTH, - Correct answer then the ACTH is not present to stimulate the adrenal gland
to produce the hormone cortisol; in this case, levels of both ACTH and cortisol will be low.
Hyperfunction of hormones - Correct answer Hyperfunction of hormones may also
cause serious dysfunction. For example, adenomas that cause an increase in growth hormone secretion can lead to acromegaly and even gigantism due to the increased growth hormone production. \When healthy, the posterior pituitary stores and releases the hormones __________ &
_________. The disorders of the posterior pituitary involve _________. - Correct
answer anti-diuretic hormone and oxytocin, both of which are created within the
hypothalamus. ADH What two disorders of the posterior pituitary store result from fluctuating levels of ADH—
and both result in fluctuating water levels in the body. - Correct answer central
diabetes insipidus and syndrome of inappropriate antidiuretic hormone, which is known as SIADH.
Central diabetes insipidus occurs when - Correct answer there is a lack of secretion
of ADH from the posterior pituitary. This causes the nephron of the kidney to resist reabsorbing water from the tubule fluid, resulting in dehydration, increased urine output, and possible neurological problems, among other issues.
Overproduction of ADH occurs in ___________. - Correct answer SIADH. In this
disorder, the increased release of ADH stimulates the reabsorption of water at the collecting duct of the nephron, causing the kidneys to retain more water. Where is the thyroid gland, what hormones does it produce? What do they regulate?
What do they experience? - Correct answer Located in the neck area, the thyroid
gland produces the hormones T3 and T4 in response to thyroid-stimulating hormone from the anterior pituitary. In turn, these hormones, which affect almost every cell in the body, regulate the body's metabolism. And like the hormones of the pituitary gland, they too can experience hypofunction and hyperfunction.
In hypothyroidism - Correct answer There are insufficient levels of T3 and T4. This
can cause a variety of symptoms, including weight gain, decreased heart rate, fatigue and confusion, and feelings of being cold. The autoimmune condition Hashimoto's thyroiditis, in which thyroid cells are attacked, thereby limiting the amount of hormone they can produce, is the most common cause of hypofunction of the thyroid gland.
Hyperfunction of the thyroid gland - Correct answer in which there are excessive
amounts of T3 and T4, results in many of the opposite signs and symptoms, including weight loss, increased heart rate, tremors, and feeling too warm. Graves' disease, an autoimmune condition that activates thyroid-stimulating hormone receptors, is the most common cause of thyroid hyperfunction.
Anterior Pituitary Hypofunction - Correct answer 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.
Posterior Pituitary Hyperfunction - Correct answer 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.
Thyroid Hyperfunction - Correct answer 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
Posterior Pituitary Hypofunction - Correct answer 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.
PTH dysfunctions come in two forms: - Correct answer either a primary condition,
which is a problem with PTH itself, or a secondary condition due to a problem with calcium levels. Primary hypoparathyroidism is due ___________. What does lack of PTH results in?
What happens in secondary hypoparathyroidism? - Correct answer to the
destruction or removal of the PTH glands, which can happen during thyroid surgery. Lack of PTH results in hypocalcemia and hyperphosphatemia. Secondary hypoparathyroidism occurs with any disorder that causes hypercalcemia. Hypercalcemia suppress PTH.
main cause of primary hyperparathyroidism - Correct answer Tumors of the
parathyroid gland. Elevated PTH results in high calcium levels and low phosphate levels. Diseases such as kidney failure, which lower calcium levels, may result in secondary hyperparathyroidism.
The adrenal gland consists of two parts: - Correct answer the cortex and medulla.
The cortex produces mineralcorticoids such as aldosterone, glucocorticoids, such as cortisol, and androgens. The adrenal cortex is stimulated by corticotropin-releasing hormone, known as CRH, from the hypothalamus and adrenocorticotropic hormone, known as ACTH, from the anterior pituitary. The adrenal medulla, on the other hand, produces epinephrine and norepinephrine. The medulla releases these stress hormones in response to sympathetic nervous system activation.
One rare form of adrenal insufficiency is - Correct answer Addison's disease. Think:
"Add for Addison's. Adrenal cortex hormones need to be added." This primary insufficiency normally results from autoimmune destruction of the adrenal cortex. Decreased cortisol causes hypoglycemia, whereas decreased aldosterone results in decreased sodium and increased potassium levels. Reduced water and sodium may result in hypotension. Reduced androgens may suppress libido in women. Because cortisol and aldosterone production are suppressed, CRH and ACTH levels increase to stimulate the adrenal glands.
Secondary adrenal insufficiency is due to ____________. - Correct answer a
pituitary disorder in which not enough ACTH is produced.
Adrenal excess appears in both - Correct answer Cushing's disease and Cushing's
syndrome. In these conditions, an excess of adrenal cortex hormones is produced. Think — "Cushing's means there is a 'cushion' of extra adrenal cortex hormones." In a particular form of this excess, Cushing's disease, the problem is not in the adrenal cortex itself, but rather in the anterior pituitary, as it produces excess ACTH. In Cushing's disease, a tumor of the pituitary gland produces elevated ACTH from the
anterior pituitary. Elevated ACTH stimulates cortisol, which increases blood glucose levels and suppresses wound healing. Fat deposition is also altered, and the individual might experience a "moon face" and "buffalo hump" appearance. Hyperpigmentation also occurs as ACTH is linked to melanocyte-stimulating hormone. In Cushing's syndrome, there is a hyperactive adrenal gland. Cortisol is high, while ACTH is low, trying to suppress adrenal activity. Prolonged use of corticosteroids can result in Cushing syndrome.
Adrenal excess is also a hallmark of _______________. - Correct
answer pheochromocytoma, a disorder of the adrenal medulla. In pheochromocytoma,
epinephrine and norepinephrine levels elevate, resulting in high heart rate and blood pressure. Which of the following disorders may result in a pronounced elevation in serum
calcium? - Correct answer 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. laboratory values revealed elevated serum PTH, elevated serum calcium, and reduced
serum phosphorus. What form of hyperparathyroidism is this? - Correct
answer 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. been experiencing primary hypothyroidism, instead of primary hyperparathyroidism,
what laboratory results would you expect? - Correct answer 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. 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. Which condition would cause these? Based on laboratory results,
which form of adrenal insufficiency? What is another name for this disease? - Correct
answer Adrenal insufficiency; 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.
Primary hyperparathyroidism is most commonly caused by ______________. -
Correct answer a tumor of the parathyroid glands
Destruction or removal of the parathyroid glands will cause _________________. -
Correct answer primary hypoparathyroidism
In Cushing's syndrome, a ____________ adrenal gland causes elevated levels of
_____________. - Correct answer hyperactive; cortisol
Which of the following would you expect to see in a patient suffering from Addison's
disease? - Correct answer Hypoglycemia
To determine if a patient is suffering from pheochromocytoma, which laboratory values
would you examine? - Correct answer Norepinephrine
