Adult II- Exam 6 Endocrine

• Mood
• Development
• Growth
• Metabolism
• Reproduction
• everything!

• Pituitary
• Thyroid
• Thymus
• Parathyroid
• Adrenal
• Testes
• Ovaries
• pancreas

• “The Master Gland” because it also influences secretions of hormones from other endocrine glands
• Pea-sized in the center of the brain
• Divided into two sections: anterior and posterior
• Controlled by the hypothalamus

• Anterior
• Posterier
• controlled by hypothalamus

• FSH(follicle- stimulating hormone)
• LH (luteinizing hormone)
• Prolactin
• ACTH (adrenocorticotropic hormone)
• TSH (thyroid stimulating hormone)
• GH (growth hormone- “somatotropin)

• ADH (anti-diuretic hormone)
• Oxytocin

• regulates bp helps kidneys control amount of sodium and water in body and also affects amount of urine
• low ADH=high urine output and vice versa

• ACTH over-section= Cushing’s syndrome
• GH over-secretion= (high somatotropin), Acromegaly
• GH under-secretion= Dwarfism

ADH under- secretion: Diabetes insipidus

• Excess secretion of ACTH
• High levels of circulating cortisol

• Buffalo hump on neck
• “Moon face”
• Central obesity (more abdomen)
• Disproportionately thin extremities compared to trunk
• Altered sleep pattern (excessive fatigue)
• Weakness
• Skin: thinning & stretch marks

• Surgery if caused from tumor (pituitary, adrenal)
• radiation/chemo
• Hormone-inhibiting drugs
• Reducing steroid use

• Disorder relating to under-secretion (low) ADH
• Diabetes insipidus is NOT related to diabetes mellitus

• Kidney dysfunction
• Head trauma/brain surgery
• Infection

• Excessive thirst
• High urine output (very diluted)

• Replace ADH (synthetic hormone called desmopressin)
• 6L or more a day
• urine specific gravity will be low

• Butterfly-shaped gland in the neck, anterior to trachea
• Metabolism can speed up/slow down pending thyroid function

• Control metabolic activity
• Ensure normal growth
• Help body use energy
• Affect every cell in the body

• TSH (thyroid stimulating hormone) – actually produced by pituitary
• T3 (triiodothyronine)
• T4 (thyroxine)
• Calcitonin (thyrocalcitonin)
• Thyroglobulin (precursor for T3 & T4, NOT as effective to measure thyroid function itself)

0.4-4.0

260-480

5.4-11.5

• TSH
• T3
• T4

• Radioactive iodine uptake scan
• Thyroid scan
• ultrasound

Fine needle aspiration

• Radioactive iodine injected
• Measurement taken of how much iodine is absorbed (reuptake) by thyroid

• Used when thyroid nodule present & need to determine if malignant or benign
• Isotope given to pt (typically thallium)
• Nodule is labeled “hot” or “cold” r/t how much isotope is absorbed
• “hot” nodules take up excessive thyroid hormones
• “cold” nodules take up less isotope
• Nodule on thyroid is determined to be benign or malignant

normal thyroid scan

cold nodule thyroid scan

hot nodule thyroid scan

graves disease/hyperthyroidism

• Assess pt allergies- contrast dye, iodine, or shellfish
• Avoid any meds with iodine prior to testing (24h)
• If radioactive isotope injected, need radioactive precautions

• 1. Avoid pregnant women and children for 5 days post scan
• 2. Avoid sharing utensils/cups/personal items with others
• 3. Avoid intercourse (prolonged exposure)
• 4. Avoid becoming pregnant for 6-12 months
• 5. Avoid public spaces
• 6. Stay 6ft or greater away from others
• 7. Shower daily & wash hands often
• 8. Launder and dishwashing needs to be separate
• 9. Flush the toilet twice after use to avoid second hand exposure

• TSH (thyroid stimulating hormone)
• Weight change is the first sign of thyroid dysfunction and TSH is the most common lab first ordered
• TSH produced in pituitary and then stimulates thyroid to produce T3 & T4
• T3 & T4 then stimulate the metabolism of almost every tissue in the body

0.4-4.0

High levels of TSH (greater than 4.0)

• Low levels of TSH (less than 0.4)
• or undetectable

• Underactive thyroid
• “Hashimoto’s disease”
• Most common cause is autoimmune
• can also be related to iodine deficiency, treatment for HYPERthyroidism and medications (ie lithium)
• Life-long condition requiring life-long treatment
• Treatment is with medication called levothyroxine

• thyroid hormone replacements
• synthetic T4 that metabolizes in the body replacing thyroxine that your body cannot produce
• take medication in the morning 30-1hr before meal

• TSH above normal
• Periorbital edema- swelling of the eyes
• Brain fog
• Fatigue/depression
• Cold intolerance
• Basal low temperature
• Weight gain
• Dry skin
• Hair loss
• Bradycardia
• Goiter-thyroid getting larger to try and soak up as much iodine it can

• Hashimoto’s thyroiditis
• Myxedema

• Body makes antibodies that attack thyroid cells (auto-immune)
• Exaggerated hypothyroidism symptoms

• Extremely low thyroid hormone levels
• Can be life-threatening
• Respiratory depression → alveolar hypoventilation → CO2 retention → coma → death if left untreated
• Treatment is IV infusion of thyroid hormone

Iodine is important to the thyroid for the production and synthesis of thyroid hormones.

• fish
• dairy
• eggs
• iodized salt
• seaweed

• Overactive thyroid
• “Grave’s disease”
• Most common cause is autoimmune
• Can also be related to cancer, a tumor, radiation exposure, or medications with iodine such as amiodarone
• Treatment goal is to decrease symptoms

• exophthalmos- very bulging eyes
• warm/hot skin
• excessive sweating
• nervousness
• hyperactivity
• heat intolerance
• tachycardia
• goiter
• weight loss

• Inhibit synthesis of thyroid hormones
• Control symptoms
• Surgical removal

• Inhibit synthesis of thyroid hormones
• Drug taken up by thyroid → destroys thyroid glands → reduces thyroxine → reduces size of thyroid gland
• Drug can destroy partial or whole thyroid gland
• If drug destroys whole gland, will need to take levothyroxine for a lifetime
• After ingestion, takes about 2-3 months for hyperthyroidism to be controlled

• Risk of hypothyroidism as side effect
• Contraindicated in pregnant women (will destroy fetal thyroid)
• Cannot get pregnant within 6 months of taking drug
• Radioactive precautions

• beta-blockers
• Propylthiouracil (PTU)
• Methimazole

• Offer significant symptomatic relief, specifically anxiety & tachycardia
• Propranolol

• Blocks T4 to T3
• Inhibits production of new thyroid hormone
• used when we cannot tolerate methimazole with greater side effects

• Treats excessive thyroid hormone
• Inhibits the incorporation of iodine into thyroglobulin
• needs to be taken at the same time everyday

• Removal of all or part of thyroid gland
• Incision is made on anterior neck, 2 fingers breadths above sternal notch

• Thyroid crisis
• Hypocalcemia
• Respiratory distress
• Nerve damage

• Nausea
• High temperature
• Tachycardia
• restlessness

• Tetany
• Muscle spasm/twitching
• Tx: calcium gluconate

• Incision close to trachea
• Swelling puts pressure & limits air flow
• Keep supplies stocked post-op in case of emergency!-intubation kit, suction, oxygen and gauze to see how much drainage and blood is coming out

• Difficulty speaking is typical first sign
• Nerves cut during procedure

• Goiter
• Thyroid tumor
• Thyroid storm

• Bulge in neck from overactive thyroid
• Most common type caused by lack of iodine

• Benign or malignant
• Labeled as a goiter if externally visible

• Severe hyperthyroidism from untreated or undertreated hyperthyroidism
• Life-threatening if not treated
• Symptoms include fever, delirium, tachycardia (>130 bpm), fever, exacerbated hyperthyroidism symptoms

• Both a lymphatic organ and endocrine gland
• Makes and trains special WBCs called T-cells
• Thymus is only active until puberty, then is replaced by fat over years (75 years)
• All t-cells are produced throughout life, but at a decreased rate after puberty
• Bone marrow also creates T-cells, so not all on thymus

• 4 small glands posterior to the thyroid
• not part of the thyroid

• regulate calcium and phosphorus- helps keep normal levels of these electrolytes
• Excretes parathyroid hormone (PTH)

8.8-10.4

2.7-4.5

• Increased PTH
• Increased calcium absorption from bone, kidney, intestine
• Raises serum calcium & lowers serum phosphorus
• Weakened bones, kidney stones, brain & heart dysfunction

Enlargement of parathyroid glands or tumor

Conditions that cause decreased calcium levels (renal disease, low vitamin D) stimulate parathyroid gland & over time, develops into hyperparathyroidism

• most have NO symptoms
• fatigue
• irritability
• kidney stones-flank pain
• osteoporosis
• N/V/Constipation
• ulcers
• cardiac dysrhythmias

• Calcium - elevated
• Phosphorus- decreased
• Sulkowitch test- urine test to measure Ca+ excreted
• X-rays (osteoporosis, Ca+ in bones)
• EKG (cardiac dysrhythmias)
• Ultrasound
• MRI
• Biopsy

• Surgery- remove partial or full parathyroid
• Exercise
• Diet- avoid excess calcium intake
• Hydration- increase fluid intake
• Constipation treatment
• Mobility support
• Vitamin D supplements if low
• Medication- calcimimetics (etelcalcetide)

• kale
• corn
• non-citrus fruits
• whole grains

• Decreased PTH
• Decreased calcium absorption in bone, kidneys, intestine
• Lowers serum calcium and raise serum phosphorus
• Weakened bones, tetany, brain & heart dysfunction

• Accidental removal during thyroidectomy/ neck surgery *most common
• Genetic abnormalities
• Autoimmune
• Atrophy
• Trauma
• Low magnesium- because it blocks the release of parathyroid hormone

• Tetany
• Tingling lips, fingers and toes
• Dry, coarse skin and hair
• muscle cramps
• teeth/bone malformation
• memory loss
• headache
• facial twitching

involuntary contraction in muscles of hand and wrist after inflating BP cuff

percuss on facial nerve on the cheek and you get contraction upwards

• Calcium- decreased
• Phosphorus- elevated
• Trousseau sign
• Chvostek sign
• X-rays
• EKG
• Ultrasound
• MRI
• Biopsy

• Goal: increase calcium
• High calcium & vitamin D diet
• Medication (calcitriol, calcium gluconate, calcium chloride)
• Mobility support
• Vitamin D supplement, if needed

• Located superior to kidneys
• Comprised of 2 parts: cortex(outside) & medulla(inside)
• Medulla responsible for secreting epinephrine, norepinephrine
• Produce hormones that regulate metabolism, immune system
• Regulate blood pressure, response to stress, other essential functions

• Produces spermatozoa
• Luteinizing hormone (LH) stimulates testes to make testosterone (male sex hormone)

• Pituitary produces follicle stimulating hormone (FSH) and LH which stimulate ovaries to produce 2 hormones
• 1.Estrogen: from ovary itself
• 2.Progesterone: from corpus luteum(normal cyst that happen after ovulation each month)

• Hormonal disorder that results in enlarged ovaries and small cysts on the outer edges of ovaries
• Results in having too much androgen & testosterone
• Sacs of fluid can develop can develop on the ovaries
• Result is failure to produce regular eggs or infertility

• Not well understood but combination of genetic and environmental
• Inflammation of stemming from the gut
• Insulin resistance (diabetes, pre-diabetes, metabolic syndrome)
• Fatty liver
• High cholesterol
• Sleep apnea
• Depression and anxiety
• Obesity
• Diet high in sugar, processed foods, saturated fats

• Excessive body hair-especially chin/facial hair
• Irregular periods
• Infertility
• Acne
• Mood changes
• Fatigue
• Insulin resistance
• Low sex drive
• Pelvic pain r/t ovarian cysts
• Weight gain

• Birth control- does NOT cure, only treats symptoms
• Diabetic medication -for insulin resistance
• Change in diet- can cure
• Herbal and naturopathic remedies
• Weight loss
• Exercise
• Probiotics

• avoid fatty foods, saturated fats, red meats, processed meats and foods and high in sugar foods
• DO EAT: fatty fish, dark red fruits and berries, paleo and mediterranean diet!

• Abdominal organ responsible for aiding in digestion
• Produces insulin
• Produces hormones that regulate metabolism, digestion
• Produces pancreatic and other digestive enzymes
• These enzymes (& insulin) break down protein, carbs, fats

• Diabetes breaks down into types- Type 1, Type 2, Gestational
• Conditions that will result in diabetes without intervention- Pre-diabetes, Metabolic syndrome (“insulin resistance”)

• Chronic condition affecting how the body breaks down sugar (carbs)
• Pancreas produces insulin which acts as the “key” to unlock the cells to accept sugar
• The sugar breaks down by utilizing insulin to then enter the cell and act as energy
• If process does not work correctly (diabetes), sugar is left in blood stream, unable to be used/broken down as cellular energy

• Autoimmune destruction of beta cells in pancreas
• 5-10% of diabetic patients have type 1
• Beta cells are responsible for producing and sorting insulin
• Essentially, the pancreas is not secreting enough or any insulin
• Linked genetically
• Typically diagnosed in childhood
• Insulin-dependent
• Higher risk for DKA compared to type 2 diabetes

• Pancreas is either not secreting enough insulin or cells are not accepting insulin (“insulin resistance”), or a combination of both
• Essentially, slow progression of insulin tolerance
• Links to genetics but is mostly lifestyle and diet related
• Typically diagnosed in adulthood
• Starts off as NOT insulin-dependent but turns into insulin dependence if uncontrolled over time
• 90-95% of diabetic patients in America have Type 2

• Placental hormones can cause insulin resistance
• If gestational diabetes, 50% will develop DM2 later in life
• Glucose testing occurs at 24-28 weeks pregnant

• Obesity
• Prior gestational diabetes
• Family hx diabetes
• Previous child >9lbs
• Not being physically active
• Having pre-diabetes prior to pregnancy

• Higher than normal blood sugars but not high enough for diabetes diagnosis
• More than ⅓ Americans are prediabetic
• More than 80% are unaware they are prediabetic
• A1C level of 5.7-6.4 is considered prediabetes
• If left untreated, prediabetes will turn into DM2

• “Insulin resistance syndrome”
• Cluster of conditions that raises risk of DM, heart disease, stroke

• Obesity
• Central obesity
• Hypertension
• High cholesterol
• High fasting glucose:

• Prevention from turning into further disease
• Diet control
• Weight reduction
• Smoking cessation
• Medications

• “Hemoglobin A1C”
• Blood test measuring blood sugars over 3-month time span- life span of RBC is 3 mo sugar loves RBC
• Normal value less than 5.7
• Pre-diabetes 5.7-6.4
• Diabetes 6.5 or greater
• if you are diabetic the goal is to keep it less than 7

• Family history
• Obesity- especially central
• Poor diet (processed foods/high carbohydrates)
• race/ethnicity- African American and Hispanic are at increased risk
• Hypertension
• Hypercholesterolemia
• Low socioeconomic status- poor food availability and expensive to eat healthy
• Increased age (>45 y/o)
• Physical inactivity
• History of insulin resistance or PCOS
• Smoking history

• 3 P’s-Polyphagia (eating too much), Polydipsia (drinking too much), Polyuria (peeing too much)
• Fatigue- tired because you cannot use the glucose for energy
• Losing weight without trying
• Slow-healing sores
• Dry, itchy skin
• Neuropathy (n/t in hands and feet)
• Blurred or worsening vision- diabetic retinopathy

• Retinopathy
• neuropathy/ nerve damage
• Nephropathy & CKD
• Heart disease
• Gum disease
• Non-healing wounds, can lead to amputation
• Miscarriage
• DKA
• Depression
• Stroke
• death

• Diabetic ketoacidosis
• When cells don’t get glucose needed for energy, body breaks down fat as fuel which produces ketones
• Ketones build up in body & create acidosis (acidic)- metabolic acidosis
• DKA can develop slowly but once vomiting occurs, can develop in hours
• Ultimately results in death if no intervention

• 3 P’s
• High blood sugar
• Ketones present in urine

• Extreme fatigue
• N/V/ abd pain
• Fruity odor on breath
• Difficulty breathing
• Difficulty focusing
• Coma
• death

• IV insulin gtt
• Hourly glucose checks
• Hydration
• Potassium replacement

• Preventative care- Skin, Eye, Dental
• Weight reduction
• Nutrition
• Exercise
• Medication
• Education!

• Counting carbs- should be about 45 carbs or less per meal
• All foods fall into 3 categories: proteins, carbs , & fats
• Green leafy vegetables
• Raw fruits/vegetables
• Avoid processed foods
• Avoid over consumption of high carb or starchy foods
• Best diets: paleo & mediterranean

• Insulins
• Metformin
• Glypizide, glyburide, gliclazide, glimepiride
• Pioglitazone, rosiglitazone
• Semaglutide (Ozempic)
• Tirzepatide (Mounjaro)
• Many!

• Insulin aspart (Novolog)
• Insulin lispro (Humalog)
• Insulin glulisine (Apidra)
• Onset 15-30mins, Peak 1hr, duration 3-5hrs

• Insulin regular (Humulin R, Novolin R)
• onset 30-60min
• peak 2-4hr
• duration 5-7hr

• Insulin Isophane (NPH, Humulin N, Novolin N, ReliOn N)
• onset 1-2hr
• peak 4-12 hr
• duration 18-24hr

• Insulin detemir (Levemir)
• Insulin glargine (Lantus)
• Onset gradual after 24hr
• Peak- 6-8(Levemir) no peak for glargine
• Duration to 24hr

• Cannot do teaching all at once
• Starts on day one of diagnosis
• How to test blood sugar with glucometer
• Symptoms of hypo/hyper glycemia
• How to treat a low blood sugar
• Insulin administration
• Insulin pump changeout and management
• Exercise
• Stress management
• Daily foot examination
• Lab interpretation & expectations
• Follow up for supplies, disease management, nutritionist

• how to treat a low blood sugar!
• because they're going to die much faster from low not high blood sugar