Javern M.

Supnet RN

1. Describe primary and secondary endorcrine disorders

Answer:

2. List effectrs of excessive secretion of growth hormone on different organ/systems

Answer:

3. Discuss the clinical features of follicle stimulating horrmone and lutenizing hormones

Answer:

4. Describe diabetes insipidus include the following:

A. Etiology

B. Signs and Symptoms

C. Pathophysiology

D. Diagnostics

E. Medical Intervention

F. Nursing Intervention

5. Compare and Contrast the hypo and hyper state of thyroid function.

Answer :

A. Hyperthyroidism - (overactive thyroid) occurs when your thyroid gland produces too much
of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing
unintentional weight loss and a rapid or irregular heartbeat.
Symptoms

 Unintentional weight loss, even when your appetite and food intake stay the same or
increase

 Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute

 Irregular heartbeat (arrhythmia)

 Pounding of your heart (palpitations)

 Increased appetite

 Nervousness, anxiety and irritability

 Tremor — usually a fine trembling in your hands and fingers

 Sweating

 Changes in menstrual patterns

 Increased sensitivity to heat

 Changes in bowel patterns, especially more frequent bowel movements

 An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck

 Fatigue, muscle weakness

 Difficulty sleeping

 Skin thinning

 Fine, brittle hair

Graves' ophthalmopathy

Sometimes an uncommon problem called Graves' ophthalmopathy may affect your eyes, especially if
you smoke. This disorder makes your eyeballs protrude beyond their normal protective orbits when
the tissues and muscles behind your eyes swell. Eye problems often improve without treatment.

Signs and symptoms of Graves' ophthalmopathy include:

 Dry eyes

 Red or swollen eyes

 Excessive tearing or discomfort in one or both eyes

  Light sensitivity, blurry or double vision, inflammation, or reduced eye movement

 Protruding eyeballs

Causes

Thyroid gland

Hyperthyroidism can be caused by a number of conditions, including Graves' disease, Plummer's

disease and thyroiditis.

Your thyroid is a small, butterfly-shaped gland at the base of your neck, just below your Adam's apple.
The thyroid gland has an enormous impact on your health. Every aspect of your metabolism is
regulated by thyroid hormones.

Your thyroid gland produces two main hormones, thyroxine (T4) and triiodothyronine (T3), that
influence every cell in your body. They maintain the rate at which your body uses fats and
carbohydrates, help control your body temperature, influence your heart rate, and help regulate the
production of protein. Your thyroid also produces a hormone that helps regulate the amount of
calcium in your blood (calcitonin).

Reasons for too much thyroxine (T4)

Normally, your thyroid releases the right amount of hormones, but sometimes it produces too much
T4. This may occur for a number of reasons, including:

 Graves' disease. Graves' disease is an autoimmune disorder in which antibodies produced by

your immune system stimulate your thyroid to produce too much T4. It's the most common
cause of hyperthyroidism.

 Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter or Plummer's

disease). This form of hyperthyroidism occurs when one or more adenomas of your thyroid
produce too much T4. An adenoma is a part of the gland that has walled itself off from the rest
of the gland, forming noncancerous (benign) lumps that may cause an enlargement of the
thyroid.

 Thyroiditis. Sometimes your thyroid gland can become inflamed after pregnancy, due to an
autoimmune condition or for unknown reasons. The inflammation can cause excess thyroid
hormone stored in the gland to leak into your bloodstream. Some types of thyroiditis may
cause pain, while others are painless.

Risk factors
Risk factors for hyperthyroidism include:

A. A family history, particularly of Graves' disease

B. Female sex

C. A personal history of certain chronic illnesses, such as type 1 diabetes, pernicious anemia and
primary adrenal insufficiency

Hyperthyroidism can lead to a number of complications:

A. Heart problems. Some of the most serious complications of hyperthyroidism involve the
heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation that
increases your risk of stroke, and congestive heart failure — a condition in which your heart
can't circulate enough blood to meet your body's needs.

B. Brittle bones. Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis).
The strength of your bones depends, in part, on the amount of calcium and other minerals they
contain. Too much thyroid hormone interferes with your body's ability to incorporate calcium
into your bones.

C. Eye problems. People with Graves' ophthalmopathy develop eye problems, including
bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Untreated,
severe eye problems can lead to vision loss.

D. Red, swollen skin. In rare cases, people with Graves' disease develop Graves' dermopathy.
This affects the skin, causing redness and swelling, often on the shins and feet.

E. Thyrotoxic crisis. Hyperthyroidism also places you at risk of thyrotoxic crisis — a sudden
intensification of your symptoms, leading to a fever, a rapid pulse and even delirium. If this
occurs, seek immediate medical care.

B. Hypothyroidism - Hypothyroidism (underactive thyroid) is a condition in which your thyroid

gland doesn't produce enough of certain crucial hormones.

Hypothyroidism signs and symptoms may include:

 Fatigue

 Increased sensitivity to cold

 Constipation

 Dry skin

 Weight gain
  Puffy face

 Hoarseness

 Muscle weakness

 Elevated blood cholesterol level

 Muscle aches, tenderness and stiffness

 Pain, stiffness or swelling in your joints

 Heavier than normal or irregular menstrual periods

 Thinning hair

 Slowed heart rate

 Depression

 Impaired memory

 Enlarged thyroid gland (goiter)

Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism
may be due to a number of factors, including:

 Autoimmune disease. The most common cause of hypothyroidism is an autoimmune

disorder known as Hashimoto's thyroiditis. Autoimmune disorders occur when your immune
system produces antibodies that attack your own tissues. Sometimes this process involves your
thyroid gland.

 Over-response to hyperthyroidism treatment. People who produce too much thyroid

hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid
medications. The goal of these treatments is to get thyroid function back to normal. But
sometimes, correcting hyperthyroidism can end up lowering thyroid hormone production too
much, resulting in permanent hypothyroidism.

 Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt
hormone production. In that case, you'll need to take thyroid hormone for life.

 Radiation therapy. Radiation used to treat cancers of the head and neck can affect your
thyroid gland and may lead to hypothyroidism.

 Medications. A number of medications can contribute to hypothyroidism. One such

medication is lithium, which is used to treat certain psychiatric disorders. If you're taking
medication, ask your doctor about its effect on your thyroid gland.
Hypothyroidism may result from one of the following:

 Congenital disease. Some babies are born with a defective thyroid gland or no thyroid gland.
In most cases, the thyroid gland didn't develop normally for unknown reasons, but some
children have an inherited form of the disorder. Often, infants with congenital hypothyroidism
appear normal at birth. That's one reason why most states now require newborn thyroid
screening.

 Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary
gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign
tumor of the pituitary gland.

 Pregnancy. Some women develop hypothyroidism during or after pregnancy (postpartum

hypothyroidism), often because they produce antibodies to their own thyroid gland. Left
untreated, hypothyroidism increases the risk of miscarriage, premature delivery and
preeclampsia — a condition that causes a significant rise in a woman's blood pressure during
the last three months of pregnancy. It can also seriously affect the developing fetus.

 Iodine deficiency. The trace mineral iodine — found primarily in seafood, seaweed, plants
grown in iodine-rich soil and iodized salt — is essential for the production of thyroid hormones.
Too little iodine can lead to hypothyroidism, and too much iodine can worsen hypothyroidism
in people who already have the condition.

6. Discuss the pathophysiology of Graves’ Disease

Answer:

Graves’s Disease results from the production of thyroid-stimulating immunoglobulins (TSI) by

stimulated B lymphocytes. These immunoglobulins bind to the thyroid stimulating hormone (TSH)
receptor to mimic the action of TSH, resulting in follicular cell growth, an increase in vascularity and
the excessive synthesis and secretion of thyroud hormone.

Auto antibodies (TSI, TBII, TGI) target and bind to TSH receptors > Antibodies act like TSH
(thyrotropin), causing excessive release of t3 and t4 into the blood. > This spike in Thyroid hormone
release, cause TSH level to decrease (negative feedback) > Exopthalmos is caused by antibodies
attacking the eye muscle fibroblasts, forcing a change into adipose tissue. > The resulting adipose
tissue builds up, exerting a pressure behind eyes. > Pressure build up constricts draining veins,
resulting edema. > The increases in appetite and weight loss, the heat intolerance and diaphoresis,
are caused by the Thyroid hormones increasing the Basal Metabolic Rate. > Hyperactivity and
Fatigability occurs as Thyroxine overstimulates the motor end plate of the neuromuscular junction.
7. Discuss the pathophysiology of Cushing syndrome

Answer :

Normally, The hypothalamus secretes corticotropin releasing hormone or (CRH) which stimulates the
Pituitary gland to secretes Adrenocorticotropic hormone or (ACTH). ACTH stimulates adrenal cortex
and releases corticosteroids (Cortisoland aldosterone and sex hormoes) this is what we called
negative feedback.

In Cushing’s we have increase secretion of cortisol After production the cortisol is carried to different
parts of the body by cortisol binding protein, almost 90% of cortisol binds to these (CBG) protein and
has a bioavailability of 60% to 100%. Synthetic corticosteroids have varying bioavailability and
potency, but all affect similar pathways. It is a catabolic hormone which is released under stressful
conditions. The excess of cortisol results in an increased rate of gluconeogenesis, glycogenolysis and
increases insulin resistance. Cortisol is a steroid hormone, and it directly affects the transcription and
translation of enzyme proteins involved in the metabolism of fats, glycogen, proteins synthesis and
Kreb's cycle. It promotes the production of free glucose in the body, elevating glucose levels, while
simultaneously increasing insulin resistance. The destruction of protein yields amino acids which are
used in gluconeogenesis. The prolonged catabolism of proteins causes purplish striae of the torso,
osteoporosis and poor wound healing. All these processes involve collagen which is a three amino
based protein. High cortisol levels also cause immune disruptions; this hormone leads to a decrease in
lymphocyte levels and increases the neutrophils. It causes detachment of marginating pool of
neutrophils in the bloodstream and increases the circulating neutrophil levels although there is no
increased production of the neutrophils. This mechanism explains the typical picture of raised TLC
where there is decreased lymphocyte number and increased neutrophils.