Endocrinology
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Transcript of Endocrinology
EndocrinologyEndocrinology
SectionsSections
Anatomy and Physiology Endocrine Disorders and
Emergencies
Anatomy and Physiology Endocrine Disorders and
Emergencies
Anatomy & Anatomy & PhysiologyPhysiology Endocrine Glands
Have systemic effects. Act on specific target
tissues in specific ways.
May have single or multiple targets.
Disorders Disorders result
from over- or underproduction of hormone(s).
Endocrine Glands Have systemic effects. Act on specific target
tissues in specific ways.
May have single or multiple targets.
Disorders Disorders result
from over- or underproduction of hormone(s).
HypothalmusHypothalmus Located deep within the cerebrum.
Some cells relay messages from the autonomic nervous system to the central nervous system.
Other cells respond as gland cells to release hormones.
Located deep within the cerebrum. Some cells relay messages from the autonomic nervous system
to the central nervous system. Other cells respond as gland cells to release hormones.
Posterior PituitaryPosterior Pituitary
Diabetes Insipidus Oxytocin and Pregnancy
Diabetes Insipidus Oxytocin and Pregnancy
Anterior PituitaryAnterior Pituitary
Thyroid GlandThyroid Gland
Hyperthyroidism & Hypothyroidism Hyperthyroidism & Hypothyroidism
Parathyroid GlandParathyroid Gland
Thymus GlandThymus Gland
PancreasPancreas Combination
Organ Exocrine tissues
called acini secrete digestive enzymes into the small intestine.
Endocrine tissues secrete hormones.
Glycogenolysis. Gluconeogenesis.
Combination Organ Exocrine tissues
called acini secrete digestive enzymes into the small intestine.
Endocrine tissues secrete hormones.
Glycogenolysis. Gluconeogenesis.
PancreasPancreas
Adrenal GlandAdrenal Gland Adrenal Medulla
Inner segment of adrenal gland. Closely tied to autonomic nervous system.
Adrenal Cortex Outer layers of endocrine tissue, which secrete
steroidal hormones.
Adrenal Medulla Inner segment of adrenal gland. Closely tied to autonomic nervous system.
Adrenal Cortex Outer layers of endocrine tissue, which secrete
steroidal hormones.
Adrenal GlandAdrenal Gland
GonadsGonads Female
Ovaries
Male Testes
Female Ovaries
Male Testes
Pineal GlandPineal Gland Located in the roof of the thalamus.
Related to the body’s “biological clock.” Implicated in Seasonal Affective Disorder.
Located in the roof of the thalamus. Related to the body’s “biological clock.” Implicated in Seasonal Affective Disorder.
Placenta Releases hCG throughout gestation
Digestive Tract Gastrin and secretin
Heart ANH
Kidneys Renin
Placenta Releases hCG throughout gestation
Digestive Tract Gastrin and secretin
Heart ANH
Kidneys Renin
Other Organs withOther Organs withEndocrine ActivityEndocrine Activity
Disorders of the Pancreas Disorders of the Thyroid Gland Disorders of the Adrenal Glands
Disorders of the Pancreas Disorders of the Thyroid Gland Disorders of the Adrenal Glands
Endocrine Disorders Endocrine Disorders and Emergenciesand Emergencies
Disorders of the Disorders of the PancreasPancreas
Diabetes Mellitus Glucose Metabolism
Metabolism• Anabolism & catabolism
Diabetes Mellitus Glucose Metabolism
Metabolism• Anabolism & catabolism
Disorders of the Disorders of the PancreasPancreas
Insulin is required for glucose metabolism• Presence of enough insulin to meet cellular needs.• Ability to bind in a manner to stimulate the cells
adequately. When unable to obtain energy from glucose, the
body begins to use fatty stores.• Ketones and ketosis.
Regulation of Blood Glucose Hypoglycemia and hyperglycemia Role of pancreas, liver, and kidneys Osmotic diuresis and glycosuria
Insulin is required for glucose metabolism• Presence of enough insulin to meet cellular needs.• Ability to bind in a manner to stimulate the cells
adequately. When unable to obtain energy from glucose, the
body begins to use fatty stores.• Ketones and ketosis.
Regulation of Blood Glucose Hypoglycemia and hyperglycemia Role of pancreas, liver, and kidneys Osmotic diuresis and glycosuria
Diabetes MellitusDiabetes Mellitus Type I Diabetes Mellitus
Also called juvenile or insulin-dependent diabetes mellitus (IDDM).
Characterized by low production of insulin.• Closely related to heredity.
Results in pronounced hyperglycemia.• Symptoms of untreated Type I DM include polydipsia,
polyuria, polyphagia, weight loss, and weakness.
• Untreated or noncompliant patients may progress to ketosis and diabetic ketoacidosis.
Type I Diabetes Mellitus Also called juvenile or insulin-dependent diabetes
mellitus (IDDM). Characterized by low production of insulin.
• Closely related to heredity.
Results in pronounced hyperglycemia.• Symptoms of untreated Type I DM include polydipsia,
polyuria, polyphagia, weight loss, and weakness.
• Untreated or noncompliant patients may progress to ketosis and diabetic ketoacidosis.
Diabetes MellitusDiabetes Mellitus Type II Diabetes Mellitus
Also called adult-onset or non-insulin-dependent diabetes mellitus (NIDDM).
Results from decreased binding of insulin to cells.• Related to heredity and obesity.• Accounts for 90% of all diagnosed diabetes patients.• Less risk of fat-based metabolism.
Results in less-pronounced hyperglycemia.• Hyperglycemic hyperosmolar nonketotic acidosis.• Managed with dietary changes and oral drugs to stimulate
insulin production and increase receptor effectiveness.
Type II Diabetes Mellitus Also called adult-onset or non-insulin-dependent
diabetes mellitus (NIDDM). Results from decreased binding of insulin to cells.
• Related to heredity and obesity.• Accounts for 90% of all diagnosed diabetes patients.• Less risk of fat-based metabolism.
Results in less-pronounced hyperglycemia.• Hyperglycemic hyperosmolar nonketotic acidosis.• Managed with dietary changes and oral drugs to stimulate
insulin production and increase receptor effectiveness.
Diabetic Diabetic EmergenciesEmergencies
Diabetic Diabetic EmergenciesEmergencies
Blood Glucose Blood Glucose DeterminationDetermination
Choose a vein, and prep the site.Choose a vein, and prep the site.
Blood Glucose Blood Glucose DeterminationDetermination
Perform the venipuncture.Perform the venipuncture.
Blood Glucose Blood Glucose DeterminationDetermination
Place a drop of blood on the reagent strip. Activate the timer.Place a drop of blood on the reagent strip. Activate the timer.
Blood Glucose Blood Glucose DeterminationDetermination
Wait until the timer sounds.Wait until the timer sounds.
Blood Glucose Blood Glucose DeterminationDetermination
Wipe the reagent strip.Wipe the reagent strip.
Blood Glucose Blood Glucose DeterminationDetermination
Place the reagent strip in the glucometer.Place the reagent strip in the glucometer.
Blood Glucose Blood Glucose DeterminationDetermination
Read the blood glucose level.Read the blood glucose level.
Blood Glucose Blood Glucose DeterminationDetermination
Administer 50% dextrose intravenously, if the blood glucose level is less than 80 mg.
Administer 50% dextrose intravenously, if the blood glucose level is less than 80 mg.
Diabetic Diabetic EmergenciesEmergencies Diabetic Ketoacidosis
Pathophysiology Results from the body’s change to fat metabolism. Continuous buildup of ketones produces significant
acidosis.
Signs and Symptoms Extended period of onset (12–24 hours). Sweet, fruity breath odor. Potassium-related cardiac dysrhythmias. Kussmaul’s respiration. Decline in mental status and coma.
Diabetic Ketoacidosis Pathophysiology
Results from the body’s change to fat metabolism. Continuous buildup of ketones produces significant
acidosis.
Signs and Symptoms Extended period of onset (12–24 hours). Sweet, fruity breath odor. Potassium-related cardiac dysrhythmias. Kussmaul’s respiration. Decline in mental status and coma.
Diabetic Diabetic EmergenciesEmergencies Assessment and Management
Focused History & Physical Exam• Obtain SAMPLE and OPQRST histories.• Look for medical identification.
Management• Maintain airway and support breathing as indicated.• Determine blood glucose level and obtain blood sample.• If blood glucose unknown, administer 25g 50% dextrose.• Establish IV and administer normal saline per local protocol.• Monitor cardiac rhythm and vital signs.• Expedite transport.
Assessment and Management Focused History & Physical Exam
• Obtain SAMPLE and OPQRST histories.• Look for medical identification.
Management• Maintain airway and support breathing as indicated.• Determine blood glucose level and obtain blood sample.• If blood glucose unknown, administer 25g 50% dextrose.• Establish IV and administer normal saline per local protocol.• Monitor cardiac rhythm and vital signs.• Expedite transport.
Diabetic Diabetic EmergenciesEmergencies Hyperglycemic Hyperosmolar
Nonketotic (HHNK) Coma Pathophysiology
Found in Type II diabetics. Results in blood glucose levels up to 1000mg/dL. Insulin activity prevents buildup of ketones. Sustained hyperglycemia results in marked
dehydration.• Often related to dialysis, infection, and medications.
Very high mortality rate.
Hyperglycemic Hyperosmolar Nonketotic (HHNK) Coma Pathophysiology
Found in Type II diabetics. Results in blood glucose levels up to 1000mg/dL. Insulin activity prevents buildup of ketones. Sustained hyperglycemia results in marked
dehydration.• Often related to dialysis, infection, and medications.
Very high mortality rate.
Diabetic Diabetic EmergenciesEmergencies Signs & Symptoms
Gradual onset over days. Increased urination and thirst, orthostatic
hypotension, and altered mental status.
Assessment & Management Difficult to distinguish from diabetic ketoacidosis in
the prehospital setting. Treatment is identical to diabetic ketoacidosis.
Signs & Symptoms Gradual onset over days. Increased urination and thirst, orthostatic
hypotension, and altered mental status.
Assessment & Management Difficult to distinguish from diabetic ketoacidosis in
the prehospital setting. Treatment is identical to diabetic ketoacidosis.
Diabetic Diabetic EmergenciesEmergencies Hypoglycemia
Pathophysiology True medical emergency resulting from low blood
glucose levels; rarely seen outside diabetics. By the time signs and symptoms develop, most of
the body’s stores have been used. Diabetics with kidney failure are predisposed to
hypoglycemia.
Hypoglycemia Pathophysiology
True medical emergency resulting from low blood glucose levels; rarely seen outside diabetics.
By the time signs and symptoms develop, most of the body’s stores have been used.
Diabetics with kidney failure are predisposed to hypoglycemia.
Diabetic Diabetic EmergenciesEmergencies Signs & Symptoms
Altered mental status with rapid onset• Frequently involves combativeness.
Diaphoresis and tachycardia Hypoglycemic seizure and coma
Assessment and Management Focused History & Physical Exam
• Obtain SAMPLE and OPQRST histories.
• Look for medical identification.
Signs & Symptoms Altered mental status with rapid onset
• Frequently involves combativeness.
Diaphoresis and tachycardia Hypoglycemic seizure and coma
Assessment and Management Focused History & Physical Exam
• Obtain SAMPLE and OPQRST histories.
• Look for medical identification.
Diabetic Diabetic EmergenciesEmergencies Management
• Maintain airway and support breathing as indicated.
• Determine blood glucose level and obtain blood sample.
• Establish IV access.
• If blood glucose <60mg/dL or is unknown, administer 25–50g of 50% Dextrose IV.
• If IV cannot be established, administer 0.5–1.0mg glucagon intramuscularly.
• Monitor cardiac rhythm and vital signs.
• Expedite transport.
Management• Maintain airway and support breathing as indicated.
• Determine blood glucose level and obtain blood sample.
• Establish IV access.
• If blood glucose <60mg/dL or is unknown, administer 25–50g of 50% Dextrose IV.
• If IV cannot be established, administer 0.5–1.0mg glucagon intramuscularly.
• Monitor cardiac rhythm and vital signs.
• Expedite transport.
Grave’s Disease Pathophysiology
Probably hereditary in nature. Autoantibodies are generated that stimulate thyroid
tissue to produce excessive hormone.
Signs & Symptoms Agitation, emotional changeability, insomnia, poor heat
tolerance, weight loss, weakness, dyspnea. Tachycardia and new-onset atrial fibrillation. Protrusion of the eyeballs or goiters.
Grave’s Disease Pathophysiology
Probably hereditary in nature. Autoantibodies are generated that stimulate thyroid
tissue to produce excessive hormone.
Signs & Symptoms Agitation, emotional changeability, insomnia, poor heat
tolerance, weight loss, weakness, dyspnea. Tachycardia and new-onset atrial fibrillation. Protrusion of the eyeballs or goiters.
Disorders of the Disorders of the Thyroid GlandThyroid Gland
Assessment & Management Usually arise from cardiovascular signs/symptoms.
• Manage signs and symptoms.
Thyrotoxic Crisis (Thyroid Storm) Pathophysiology
Life-threatening emergency, usually associated with severe physiologic stress or overdose of thyroid hormone.
Results when thyroid hormone moves from bound state to free state within the blood.
Assessment & Management Usually arise from cardiovascular signs/symptoms.
• Manage signs and symptoms.
Thyrotoxic Crisis (Thyroid Storm) Pathophysiology
Life-threatening emergency, usually associated with severe physiologic stress or overdose of thyroid hormone.
Results when thyroid hormone moves from bound state to free state within the blood.
Disorders of the Disorders of the Thyroid GlandThyroid Gland
Signs & Symptoms High fever (106º F or higher) Reflected in increased activity of sympathetic
nervous system.• Irritability, delirium or coma• Tachycardia and hypotension• Vomiting and diarrhea
Assessment and Management Support airway, breathing, and circulation. Monitor closely and expedite transport.
Signs & Symptoms High fever (106º F or higher) Reflected in increased activity of sympathetic
nervous system.• Irritability, delirium or coma• Tachycardia and hypotension• Vomiting and diarrhea
Assessment and Management Support airway, breathing, and circulation. Monitor closely and expedite transport.
Disorders of the Disorders of the Thyroid GlandThyroid Gland
Hypothyroidism and Myxedema Pathophysiology
Can be inherited or acquired. Chronic untreated hypothyroidism creates
myxedema.• Thickening of connective tissue in skin and other tissues.
• Infection, trauma, CNS depressents, or a cold environment can trigger progression to a myxedemic coma.
Hypothyroidism and Myxedema Pathophysiology
Can be inherited or acquired. Chronic untreated hypothyroidism creates
myxedema.• Thickening of connective tissue in skin and other tissues.
• Infection, trauma, CNS depressents, or a cold environment can trigger progression to a myxedemic coma.
Disorders of the Disorders of the Thyroid GlandThyroid Gland
Signs & Symptoms Fatigue, slowed
mental function Cold intolerance,
constipation, lethargy
Absence of emotion, thinning hair, enlarged tongue
Cool, pale doughlike skin
Coma, hypothermia, and bradycardia
Signs & Symptoms Fatigue, slowed
mental function Cold intolerance,
constipation, lethargy
Absence of emotion, thinning hair, enlarged tongue
Cool, pale doughlike skin
Coma, hypothermia, and bradycardia
Disorders of the Thyroid Disorders of the Thyroid GlandGland
Assessment and Management Focus on maintaining ABCs. Closely monitor cardiac and pulmonary status. Establish IV access, but limit fluids. Expedite transport.
Assessment and Management Focus on maintaining ABCs. Closely monitor cardiac and pulmonary status. Establish IV access, but limit fluids. Expedite transport.
Disorders of the Disorders of the Thyroid GlandThyroid Gland
Hyperadrenalism (Cushing’s Syndrome) Pathophysiology
Often due to abnormalities in the anterior pituitary or adrenal cortex.
May also be due to steroid therapy for nonendocrine conditions such as COPD or asthma.
Long-term cortisol elevation causes many changes.• Atherosclerosis, diabetes, hypertension• Increased response to catecholamines• Hypokalemia and susceptibility to infection
Hyperadrenalism (Cushing’s Syndrome) Pathophysiology
Often due to abnormalities in the anterior pituitary or adrenal cortex.
May also be due to steroid therapy for nonendocrine conditions such as COPD or asthma.
Long-term cortisol elevation causes many changes.• Atherosclerosis, diabetes, hypertension• Increased response to catecholamines• Hypokalemia and susceptibility to infection
Disorders of the Disorders of the Adrenal GlandAdrenal Gland
Signs & Symptoms Weight gain “Moon-faced”
appearance Fat
accumulation on the upper back
Skin changes and delayed healing of wounds
Mood swings Impaired
memory or concentration
Signs & Symptoms Weight gain “Moon-faced”
appearance Fat
accumulation on the upper back
Skin changes and delayed healing of wounds
Mood swings Impaired
memory or concentration
Disorders of the Thyroid Disorders of the Thyroid GlandGland
Assessment & Management Support ABCs. Use caution when establishing IV access. Report any observations indicative of Cushing’s
Syndrome to the receiving facility.
Adrenal Insufficiency (Addison’s Disease) Pathophysiology
Due to destruction of the adrenal cortex. Often related to heredity. Stress may trigger Addisonian crisis.
Assessment & Management Support ABCs. Use caution when establishing IV access. Report any observations indicative of Cushing’s
Syndrome to the receiving facility.
Adrenal Insufficiency (Addison’s Disease) Pathophysiology
Due to destruction of the adrenal cortex. Often related to heredity. Stress may trigger Addisonian crisis.
Disorders of the Disorders of the Adrenal GlandAdrenal Gland
May be related to steroid therapy.• Sudden withdrawal can trigger Addisonian crisis.
Signs & Symptoms Progressive weakness, fatigue, decreased appetite,
and weight loss Hyperpigmentation of skin and mucous membranes Vomiting or diarrhea Hypokalemia and other electrolyte disturbances Unexplained cardiovascular collapse
May be related to steroid therapy.• Sudden withdrawal can trigger Addisonian crisis.
Signs & Symptoms Progressive weakness, fatigue, decreased appetite,
and weight loss Hyperpigmentation of skin and mucous membranes Vomiting or diarrhea Hypokalemia and other electrolyte disturbances Unexplained cardiovascular collapse
Disorders of the Disorders of the Adrenal GlandAdrenal Gland
Assessment and Management Maintain ABCs. Closely monitor cardiac and pulmonary status. Obtain blood glucose level and treat for
hypoglycemia if present. Establish IV and provide aggressive fluid
resuscitation. Expedite transport.
Assessment and Management Maintain ABCs. Closely monitor cardiac and pulmonary status. Obtain blood glucose level and treat for
hypoglycemia if present. Establish IV and provide aggressive fluid
resuscitation. Expedite transport.
Disorders of the Disorders of the Adrenal GlandAdrenal Gland
SummarySummary
Anatomy & Physiology Endocrine Disorders and
Emergencies
Anatomy & Physiology Endocrine Disorders and
Emergencies