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  1. Causes of hormonal alterations
    • target cell fails to respond to hormone
    • receptor-associated disorders
  2. Receptor associated disorders
    • decreased # of receptors
    • defective hormone-receptor binding
    • impaired receptor functioning/insensitivity to hormone
    • presence of antibodies against receptors that decrease available sites or mimic hormone action
  3. What type of disorder may involve inadequate synthesis of second messenger, such as cAMP, needed to signal intracellular events
    intracellular disorders
  4. Target cell response for lipid soluble hormones (such as TH) occurs _______ often than water-soluble hormones (insulin)
  5. diseases of post. pituitary are usually r/t
    abnormal ADH secretion
  6. SIADH is characterized by
    high levels of ADH w/o normal physiologic stimulus for its release
  7. SIADH is associated with several forms of __________ because...
    • cancer
    • eptopic secreation of ADH by tumor cells
  8. main features of SIADH
    • water retention and solute loss (especially Na+)
    • leads to HYPOnatremia and HYPOosmalality 
    • Na+< 130
    • thirst, impaired taste, anorexia, DOE, fatigue,dulled consiousness
  9. diabetes insipidus is r/t
    insufficiency of ADH that leads to polyuria and polydipsia
  10. What happens in the neurogenic form of diabetes insipidus
    organic leasion of hypothalamus or posterior pituitary interferes with ADH synthesis, transport, or release
  11. Diabetes insipidus risk factors
    history of head injury, pituitary tumor, or craniotomy
  12. treatment for diabetes insipidus
    • vasopressin
    • DDAVP
  13. s&s of diabetes insipidus
    • up to 20L urine/day
    • low specific gravity 
    • low osmolarity
    • hypovolemia
    • increased thirst
    • tachycardia
    • low bp
  14. Nursing care for diabetes insipidus
    • monitor fluids
    • replace fluids
    • check neuro stats and vitals
    • check mucus membranes
  15. what causes the nephrogenic form of diabetes insipidus
    insensitivity of renal tubules to ADH, particullarly the collecting tubules
  16. excessive urine output and low urine osmolality after a dehydration or water restriction test may require
    ADH replacement with synthetic vasopressin
  17. Hypofunction of pituitary results from
    • infarction of the gland
    • removal or dstruction 
    • space-occupying pituitary adenomas or aneurysms compressing secreting pituitary cells
  18. what gland is extremely vascular and vulnerable to infarction
  19. hyperfunction of pituitary caused by
    adenoma composed of secretory pituitary cells
  20. panhypopituitarism
    all hormones absent.
  21. panhypopituitarism results in
    • cortisol deficiency (no ACTH)
    • thyroid deficiency (no TSH)
    • diabetes insipidus (no ADH)
    • gonadal failure, loss of secondary sex characteristics, loss of libido (no FSH, LH)
    • social withdrawl, fatigue, loss of motivation, osteoporosis (GH deficiency in adults)
  22. pituitary adenomas causing hyperpituitarism are usually
    benign and slow growing tumors
  23. acromegaly in adults R/T
    excess GH
  24. giantism in children whose epiphyseal plates have not closed r/t
    excess GH
  25. prolactinomas related to
    excessive gh
  26. most common form of hyperthyroid
    graves disease
  27. hyperthyroid is likely associated with
    autoimmune abnormalities
  28. opthalmopathy occurs in what percent of hyperthyroid cases
  29. diffuse toxic goiter enlarges in response to
    increased demand for TH
  30. thyroid storm can cause death within _______ w/o treatment
    48 h
  31. Subacute thyroiditis
    • nonbacterial inflammation preceded by viral infection 
    • hypo
  32. autoimmune thyroiditis is also known as
    hashimoto disease
  33. hashimoto disease
    thyroid destoryed by circulating thyroid antibodies and infiltration of lymphocytes
  34. subclinical hypothyroidism
    elevated TSH with normal TH
  35. myxedema
    • sign of sever or longstanding adult hypothyroid
    • connective fibers separated by increaseing amount of protein and mucopolysaccharides wich binds water causing nonpitting edema (esp around eyes)
  36. thyroid carcinoma
    most common endocrine malignancy but relatively rare
  37. hypothyroidism in infants b/c of absent thyroid tissue and hereditary defects in TH synthesis is what
  38. if cretinism goes untreated
    MR and stunted growth
  39. hypothyroidsm is difficult to id at birth but some symptoms are
    • high birth weight
    • low T 
    • delayed BM
    • neonatal jaundice
  40. failed feedback mechanisms that cause increased PTH which causes hypercalcemia and decreased phosphate
    primary hyperparathyroidism
  41. compensatory response to chronic hypocalcemia
    secondary hyperparathyroidism
  42. loss of Ca+ with renal failure leads to increased secretion of
  43. causes excessive osteoclastic and osteolytic activity that results in bone resorption
  44. what is associated with insulin resistance, kidney stones, gi disturbances, muscle weakness, lethargy, dehydration
  45. hypoparathyroidism is most commonly caused by
    damage during thyroid surgery
  46. hypocalcemia causes
    • tetany
    • muscle spasms
    • hyperreflexia
    • clonic-tonic convultions
    • laryngeal spasms
    • death
  47. Type 1 DM
    • lack of insulin 
    • excess glucose
    • most common dx in whites
    • peaks at 12 years
  48. heterogenous for HLA-DR3 and DR4 increases risk of type 1 dm
    20-40 times
  49. which diabetes is ketosis prone
    type 1
  50. decreased use of glucose accumulates in blood and releases in urine during
    type 1 dm
  51. greatest risk factor of diabetes
  52. mass and number of beta cells decreased in
    diabetes type 2
  53. hypoglycemic insulin shock level
    below 60
  54. DKA values
    bg above 250
  55. cushing syndrome
    excessive levels of circulating levels of cortisol
  56. cushings disease
    pituitary-dependent hypercortisolism due to an ACTH-secreating pituitary tumor
  57. without treatment, approx ______ of people with cushings die within 5 years b/c of
    • 50%
    • infection, suicide, HTN, atherosclerotic complications
  58. Conn disease is
    primary aldosteronism
  59. most common cause of Conn diseae
    benign, single adenoma followed by multiple tumors or hyperplasia
  60. symptoms of Conn disease
    • HTN hypokalemia
    • renal K+ wasting, neuromuscular manifestations
  61. hypocortisolsim
    inadequate stimulation of adrenals by ACTH or inablitiy of adrenals to produce and secrete cortisol
  62. elevated serum ACTH levels with inadequate output
    Addison disease
  63. phenochromocytoma causes
    • hypersecretion of adrenal medulla
    • excess production of epinephrine and norepi
    • autoimmune function of tumor
    • symptoms of persistant fight or flight
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