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| Inhibiting and Releasing Factors | ||
| Trophins | ||
| T4, T3, Calcitonin | ||
| PTH (parathyroid hormone) | ||
| glucagon; insulin | ||
| Cortisol | ||
| Catecholamines (epinephrine and norepinephrine) | ||
| target cell | ||
| hyperfunction | ||
| hypofunction | ||
| receptor-associated | ||
| water-soluble | ||
| 1) decrease in receptor number; 2) impaired receptor function; 3) presence of antibodies against specific receptors; 4) unusual expression of receptor function (tumor cells) | ||
| in the posterior pituitary: SIADH, diabetes insipidus; in the anterior pituitary: hypo/hyperthyroidism, Addison's, Cushing's | ||
| Syndrome of Inappropriate ADH | ||
| increase | ||
| infection; trauma; tumors | ||
| dilutional hyponatremia; natriuresis; urine osmolality that is greater than the serum osmolality; increase in water retention without peripheral edema; decrease in renin and aldosterone | ||
| increase in BP; initially increase in thirst; muscle cramps; dyspnea; confusion; convulsions | ||
| increased; increased; low | ||
| excretion | ||
| Diabetes Insipidus | ||
| neurogenic; nephrogenic; psychogenic | ||
| excretion of large amounts of dilute urine; dehydration; increased sodium levels | ||
| polyuria; polydipsia (icy drinks); decrease in urine specific gravity | ||
| congenital defects or loss of thyroid tissue after hyperthyroid treatment; post thyroidectomy; defective hormone synthesis resulting in autoimmune thyroiditis, endemic iodine deficiency or antithyroid drugs | ||
| related to either pituitary or hypothalamic failure | ||
| Hypothyroidsm | ||
| deficient | ||
| associated with cardiovascular effects, hyperlipidemia, neurologic effects, or emotional effects | ||
| hypometabolic state that occurs insidiously over months or years | ||
| lowers | ||
| low BMR (basal metabolic rate); lethargy; weight gain; dry, coarse skin; cold intolerance; constipation; slow reflexes; depression | ||
| myxedema- thickening of dermis and other tissues and nonpitting edema | ||
| Myxedema | ||
| hoarseness and slurred speech | ||
| hypotension; hypoventilation; acidosis; hypothermia | ||
| diminished levels of consciousness, hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, and lactic acidosis | ||
| Graves Disease | ||
| high | ||
| antibodies; TH (thyroid hormone) | ||
| adrenergic stimulation; increased metabolism; immunologic stimulation of diffuse goiter; ocular changes | ||
| tachycardia; palpitations; nervousness; tremor; increased BP | ||
| excessive thyroid hormone increases oxygen consumption and produces metabolic changes in protein metabolism | ||
| SNS hypersensitivity and changes involving orbital contents with ocular muscle enlargement | ||
| thyroid storm | ||
| spontaneously | ||
| hyperthermia; tachydysrhythmias; agitation; delirium | ||
| normal | ||
| Addison's Disease | ||
| decrease production/release of corticosteroids result in decreased Na and glucose and increased K, ACTH, and MSH (in the serum) | ||
| progressive weakness; weight loss; hypoglycemia; hypotension; GI symptoms such as nausea, vomitting, and diarrhea | ||
| stress | ||
| Cushing's Syndrome | ||
| exogenous corticosteroids; hypersecretion of ACTH from the pituitary gland; adrenal tumors | ||
| increase in ACTH leads to increased Na and glucose and decreased K in the serum | ||
| buffalo hump; moon face; truncal obesity; hyperglycemia; hypertension; purple striae; osteoporosis; poor wound healing; gastric ulcers | ||
| too much cortisol weakening the muscles, leading the muscles to open and release amino acids | ||
| Diabetes Mellitus | ||
| type 1; type 2; gestational; drug-induced; Cushing's syndrome | ||
| Hyperglycemia | ||
| metabolic syndrome | ||
| glucagon | ||
| polyuria; polydipsia; polyphagia; weight loss; fatigue; increased infections | ||
| Polyuria | ||
| Polydipsia | ||
| Polyphagia | ||
| Weight loss | ||
| Fatigue | ||
| unknown but believed to be autoimmune and has genetic susceptibility | ||
| genetics --> long preclinical period --> immunologically-mediated destruction of beta cells --> insulin deficiency --> chronic hyperglycemia | ||
| insulin shock | ||
| pallor; cool; diaphoresis (ANS response); increased HR; decreased BP; headache; hunger; confusion; seizures; coma | ||
| DKA (diabetic ketoacidosis) | ||
| increases; decreases | ||
| Somogyi phenomenon | ||
| hypoglycemia; stress response; hyperglycemia | ||
| Dawn phenomenon | ||
| GH; muscle | ||
| hereditary (90%) and environmental factors, the most powerful being obesity | ||
| obesity; increased BMI; positive family history; ethnic minority; metabolic syndrome; smoking | ||
| Insulin is less effective in facilitating the entry of glucose into liver, skeletal muscles, and adipose tissue. | ||
| 1) abdominal obesity (waist circumference >35 in in women, >40 in in men); 2) triglycerides >150 mg/dL; 3) HDL <50 mg/dL in women, <40 mg/dL in men; 4) blood pressure >130/85 mmHg; 5) fasting plasma glucose >100 mg/dL | ||
| beta cell failure (either decrease in or abnormal function); insulin resistance; increased hepatic glucose dysfunction; decreased gut incretins | ||
| receptors | ||
| glycogen | ||
| nonspecific, slow onset, insidious; overweight; fatigue; glucosuria; hyperlipidemia; recurrent infections; prolonged wound healing; visual changes; paresthesias | ||
| hyperosmolar hyperglycemic nonketotic syndrome | ||
| Poor glucose control causes high levels of serum glucose. These high serum levels cause water to leave the cells, resulting in high serum osmotic pressures. In the kidneys, filtering of glucose and causes water to be loss in the urine, leading to severe dehydration, low blood volume and low perfusion pressures. | ||
| macrovascular disease | ||
| gangrene and amputation | ||
| microvascular disease | ||
| diabetic nephropathy | ||
| decreased plasma oncotic pressure, fluid overload, hypertension | ||
| uremic signs --> lethargy, acidosis, anemia, hypertension | ||
| diabetic retinopathy | ||
| glycosylated; hypoxia | ||
| rapidly proliferate | ||
| abnormal chemotaxis and defective phagocytosis | ||
| vascular wall changes |
