Endocrine (test 11)

• Pituitary gland gets smaller

• hormones decrease (some)

• changes in sensitivity to insulin

• baseline glucose increases Medications used to treat hormone issues need lowered doses for older adults

-thyroxine (T4)

• triiodothyronine (T3)

• Calcitonin (stops bone breakdown to lower calcium levels in body)

On the back of the thyroid (in the neck)

In the brain

On the kidneys

In the neck

• Parathyroid hormone (PTH). Increases blood calcium by breaking down bones, increases calcium absorption in digestive tract, decreases calcium lost in urine. (by removing phosphorus)

*** release of this hormone is dependant on if calcium levels are high or low. Low calcium signals PTH to be released****

doughnut

jelly

• Mineralocorticoids (aldosterone) which increases sodium and water that the body holds on to

• Glucocorticoids (cortisol) which raises glucose and lowers inflammation

• androgens and estrogens which work with ovaries or testes

• Epinephrine/norepinephrine (fight or flight response, increases HR, BP, RR)

• triggered by sympathetic NS

• converting iodine into thyroid hormones (T4, T3) (T4 gets converted to T3)

• requires protein for this conversion

If a hormone level is low, a signal will be sent to release more hormone until it is normal. The opposite is also true, if a hormone is high, a signal will be sent to stop releasing said hormone

• Anterior Pituitary (AP) and posterior pituitary (PP)

• AP: growth hormone

• AP: thyroid stimulating hormone

• AP: follicle stimulating hormone (follicles in ovaries, spermatogenesis in men)

• AP: adrenocorticotropic hormone (ACTH) (cortisol secretion)

• AP: Luteinizing hormone (LH) (ovulation, progesterone, testosterone)

• AP: prolactin (milk production)

PP: ADH (increases kidney water and sodium absorption) PP: oxytocin (uterine contractions, milk ejection)

• ensure drainage is bloody/mucus, NOT clear and watery which could indicate cerebral spinal fluid leak

• do NOT increase ICP, no sneezing, coughing, leaning over

Prolactin

• could indicate tumor of pituitary

8-10

2.8-4.5

• NOT during OB or lactation

• Small amount of radioactive iodine put into body to see if thyroid takes it in (assess thyroid function)

• if the hormone problem is leading to suspected dysrhythmias of the heart

• headache

• visual changes

Gigantism in kids (same characteristics as acromegaly) acromegaly in adults (large head, hands,feet)

• no periods

• abnormal lactation

• hair loss + impotence in males

Small stature, bone breakdown

infertility/sterility

• peeing all the time

• large amounts of diluted urine

• caused by too little ADH

• Opposite of diabetes insipidus

• too much ADH

• not urinating enough or at all

Enlargement of the thyroid gland

• can be caused by not enough iodine in diet (teach patient to increase salt!!)

• may also be caused by not enough protein in diet

• can also be caused by lack of TH (thyroid hormone), Ca, nodules

• TRH

• TSH

• T3

• T4

• antibody titers

• give through a straw (stains teeth otherwise)

• give well diluted

• too much T3 and T4 circulating blood

• LOW TSH because body is trying to slow thyroid production

• graves disease causes this often times

• everything speeds up, metabolism, heart rate, ect.

• weight loss

• anxiety

• tremors

• tachycardia

• amenorrhea ( older adults may have CP, SOB, palpitations)

• Methimazole

• surgery/ablation (watch for thyroid storm/crisis after surgery, which is when manipluation of the thyroid causes increased levels of t4)

• Autoimmune disorder

• causes hyperthyroidism

• causes destruction and enlargement of thyroid so hormones spill out

bulging of eyeballs, common with graves disease

Removal of thyroid, usually a last resort due to risk of

• hemorrhage

• loss of parathyroid

• thyroid storm/crisis Post op: high fowler's, neutral head

When manipulation of the thyroid causes release of T4

• common during surgery to remove thyroid

• S/S include sudden high fever, pulse increase, RR increase

• LOW T3 and T4

• HIGH TSH (body trying to get thyroid to produce more)

• body processes slow down

• hashimotos is common cause

• Weight gain

• Constipation

• hair loss

• bradycardia

• low iodine

• Levothyroxine (Synthroid)

• Armor (pig hormone!!)

• take on empty stomach

• take at same time each day

• may take 6-8 weeks to see improvement

• lifelong therapy, do not stop taking

• too little parathyroid hormone

• usually caused by trauma or surgery to remove thyroid causing accidental damage

• cases low calcium, high phosphorus S/S: numbness, tingling, tatany, convulsions

• too much parathyroid hormone High calcium, low phosphorus

• S/S lethargy, confusion, nausea, arrhythmias, bone fractures

(Adrenal disorder)

• decrease in adrenal cortex function, less cortisol

• S/S: low BP, arrhythmias, low sodium, too much potassium, weakness, hypoglycemia

Addison's disease with another stressor such as infection

• can be caused by stopping steroids too fast

• can cause death, shock

• too many hormones from adrenal cortex

• can be r/t long term steroid use S/S: buffalo hump, moon face, bruising, big body and skinny arms, abnormal hair

10

Below 5.6: normal 5.7-6.4: pre DM 6.4: DM

• Destruction of pancreas beta cells

• no insulin is produced

• requires insulin to survive

• Insulin resistance, bodies receptors do not respond to insulin

• may need insulin eventually

• Mix of type 1 and type 2 DM (can be called 1.5)

• partial failure of beta cells, AND insulin resistance

• positive test for islet cell antibodies

• cluster of conditions that increase risk for CAD, stroke, DM

• cluster of conditions include: high B/P, high blood sugar, high high HDL, abd fat

• Genes (people closer to you in family tree)

• race: (Type 1 more common in whites) (Type 2 more common in native americans, blacks)

• continued stress

• viral infection triggering type 1

• apple body shape

• obesity

• hyperglycemia (very high)

• polyuria, polydipsia (excessive thirst)

• weight loss

• blurry vision

• excessive hunger

• weight gain

• slow healing

• fatigue

• Diet

• exercise (lowers insulin resistance)

• if pre diabetic exercise and diet can stop you from getting full diabetes

• helps control type 2 DM and reduce insulin needs

Metformin

• Lowers A1C

• lowers liver release of glucose

• increases sensitivity to insulin DO NOT USE WITH CIRRHOSIS OR GFR less than 30

Gliptins

• controls hormones that control glucose and insulin

• lowered absorption of CHO in gut

Ends in glutides

• stimulates insulin production

Aspart (NovoLOg), Lispro (Humalog)

• acts in 15 min

• peaks in 1-3 h

• lasts 3-5 h

Regular insulin (humulin, novolin)

• onset in 30 min

• peaks in 2-4 h

• lasts 5-8 h

(NPH, lente) Onset: 1h Peaks in 4-12 h Lasts 24 h

Glargine (lantus) Onset: 2-4 h Peaks in: n/a Lasts 24 hours

clear to cloudy

• Abdomen

• thighs, arms buttocks most slow

Lower it

• lower insulin dose slightly if exercising

• More common in type 1

• sugar gets too high for too long, body breaks down fat which produces ketones causing acidosis

• causes metabolic acidosis, electrolyte imbalance and dehydration

• high RR

• fruity breath

• ketones in urine

• glucose in urine

• dry MM

• low B/P

• dehydration

More common in type 2 DM, same as DKA but for type 2

• s/s same as DKA but with more neurologic symptoms

• more deadly than DKA

• NOT breaking down fat like with DKA so no ketones in urine

-Naturally higher glucose in the AM

hypoglycemia

• blindness

• kidney failure

• amputation

morning

• gets lower throughout the day

• when testing cortisol levels must test 2-3 times in 24 h

-Over 126= bad

• over 100 = pre DM

• random over 200 = bad