Endocrine

Synthesize & release hormones

• send out regulatroty information to cells and organs
• work with nervous system to maintain communication and control
• affect only target cells with specific receptors
• eliminated via excretion by kidneys or are deactivated by liver and/or cellular mechanisms

• GLUCOSE INTOLERANCE
• A dysfunction of the pancreas (most common endocrine disorder)
• #1 cause of blindness, Causes 50% of ESRD, chronic hyperglycemia, metabolism disturbance, Atherosclerotic (CAD, CVA)

• Increases glucose transport: Involved in glycogen synthesis (the form in which glucose is stored for use as fuel)
• Increases lipid protein and cholesterol synthesis
• Only hormone that decreases blood glucose

hormone that stimulates the conversion of glycogen in the liver back to glucose (opposite of insulin)

A general class of adrenal cortical hormones that give rise to or directly produce glucose (opposite of insulin)

• Fasting Glucose >125 mg/dL
• Random Glucose >200 mg/dL

• Impaired fasting glucose: fasting glucose >105 & <125 mg/dL
• Impaired glucose tolerance: abnormal response to oral glucose tolerance test where 2 hour glucose is >140 & <200 mg/dL (many are obese, 10-25% will convert to type II diabetes in 10 yrs)

• glucose intolerance caused by high levels of estrogen and growth hormone
• test: 1 or 3 hour post prandial glucose values

• Absolute insulin deficiency (insulin dependent DM) (juvenile onset diabetes)
• Autoimmune Destruction of beta cells
• genetic factors may play a part
• 80-90% of islet (pancreas beta) cells destroyed when symptomatic
• Increased levels of glucagon

• hyperglycemia
• glucose in urine
• proteins and fats break down due to lack of insulin, results in weight loss and/or ketoacidosis (^ ketones in circulation)
• Polyuria: Glucose spilling form blood to urine and taking water (K, Na, phospates) whth it
• Polydipsia (often drinking): Glucose levels are high in blood and lost in urine. excess fluid loss.
• polyphagia (often eating): all cells need insulin to transport glucose besides brain kidneys and RBC's. they induce hunger
• sweet or fruity odor to breath (ketones)

• may be life threatening
• abnormal fat and protein metabolism
• low body K+: when treated with insulin K moves back into cells, can become hypokalemic
• Sweet/fruity breath (ketones)
• Fat is poorly oxidized because fat needs glucose to oxidize properly
• Kusmaul breathing during metabolic acidosis (blowing off CO2 to compensate, hyperglycemia)

• NIDDM (Non-insulin dependent DM)(Adult onset Diabetes)
• Genetic predisposition, ^Native americans, hispanics, & blacks, 10* greater with obesity
• Combination of insulin insensitivity, weak secretion due to beta cell responsiveness, and abnormal glucagon secretion (insulin resistance^ with obesity)
• Pancreatic changes (amyloid deposits) lead to beta cell destruction
• Lipid accumulation in pancreas impairs insulin secretion

• Pruritis
• recurrent infections (skin/yeast)
• visual changes
• paresthesias (numbness tingling extremities)
• fatigue
• overweight with hyperlipidemia (high cholesterol)
• poly -uria -dipsia -phagia

• Hyperosmolar Hyperglycemic Nonketotic Syndrome
• uncommon but high mortalilty rate
• occurs in compromised individuals
• osmotic diuresis from increased serum glucose (>600 mg/dL) lack of thirst and/or functional inability to obtain H20
• Hyperosmolality combined with dehydration creates confusion lethargy fever hypotension shock
• Nonketotic because there is enough isulin to prevent fat and protein catabolism
• carefully rehydrate (cerebral edema)

• High cholesterol
• with damage to basement membrane leads to atherosclerotic diseases
• Microangiopathy usually
• Retinopathy
• Atherosclerosis: CAD PVD CVA
• Neropathy: loss of sensation in extremeties
• Renal cells with basement membrane changes from nephrotic syndrome (eventual renal failure)

• A hemoglobin molecule with glucose attached
• Goal <6.5

• injections 2-4 * per day + monitoring
• Fever, stress, infection, pregnancy, surgery, and hyperthyroidism ^ insulin requirements
• Liver disease, hypothyroidism, vomiting, and renal disease may decrease insulin requirements

• Most commonly due to excess insulin
• CNS can only use glucose for metabolism (pallor, tremor, anxiety, tachycardia, dizziness, hunger, seizures) (coma when glucose 45-65 mg/dL)
• Give orange juice, sugar, or IV dextrose, cake icing

• Medulla: core of the adrenal gland, Bodys main souce for catecholamines
• Cortex: Sythesizes corticoseroid hormones from chosesterol (glucocorticoids, mineralcorticoids, sex hormones)

The most potent is Aldosterone: responsible for electrolyte balance

• control and regulate: aldosterone, renin, angiotensin, sex hormones, hypothalamic-pituitary-adrenal gland axis with negative feedback
• ^ hepatic gluconeogenesis and glycogen breakdown
• ^ protein catabolism
• ^ lipolysis
• Suppresses inflammation and immune system
• critical for stress response
• can cause insomnia/psychosis
• inhibits osteoblast (bone reabsorbtion)

• ADRENAL GLAND DISEASE
• Glucocorticoid excess
• causes excess ACTH secretion by a tumor outside of the pituitary, adrenal neoplasms, administration of Glucocorticoids (80%)

• increase protein catabolism: thin skin atrophy of limb muscles, increased bruising, stretch marks
• lipid deposition: pendolous abdomen, moon face, buffalo hump
• poor wound healing
• glucose intolerance or diabetes
• hypertension
• osteoporosis
• psychiatric disturbances

• ADRENAL GLAND DISEASE
• Glucocorticoid Deficit
• Autoimmune: primary inability for adrenal to produce and secrete hormones
• Inadequate stimulation of adrenal glands: disruption of feedback regulation

• Hyperkalemia, hyponatremia
• hypertension, shock
• nausea, vomiting, abdominal tenderness
• weakness, anorexia, weight loss
• fever

• replacement of glucocorticoids with dietary modifications
• at least 150 mEq of sodium daily with increased sodium during periods of ^sweating or diarrhea

Hypothalamus pituitary axis, trh, and tsh

• deficient production of thyroid
• causes: congenital defects, defective hormone synthesis (autoimmune, iodine deficiency), radiation, aging
• Child: severe mental retardation
• Adult: if longstanding results in myxedema ( altered composition of dermis & other tissues)
• Symptoms: slow reflexes, mentation decreased motor activity, cold intolerance, weight gain, thick puffy skin, constipation
• treatment: thyroid hormone, iodized salt

• Causes: graves disease, toxic multinodular goiter, thyroid adenoma
• symptoms: weight loss, tachycardia (atrial arhythmias), heat insensitivity, sweating, nervousness, insomnia, dearrhea
• treatment: antithyroid drugs, radiation, subtotal thryroidectomy