Endocrine 2 2

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diagnosis of thyroid abnormality or thyroid mass made by: taking mendical history and PE
examine neck lift chin asked to swallow helps feel thyroid and any mass
tests for thyroid could include: ultrasound exam of neck and thyroid

Bolld tersts of thyroid function

radioactive thyroid scan

fine needle aspiration biopsy

chest X-ray

CT or MRI scan
measurement of Serum**** Thyroid Hormones

T4 by RIA radioimmunoassay
referred as: T7
resin T3 uptake RT3u has been done to correct for meds birth control hormones seizure meds cardiacc drugs or aspirin may alter T4 test
T4 reflects amount of thyroxine (80% of thryoid hormone produced overall function) in blood: if no thyroid meds test good measures of thyroid function
Measurement of Serum Thyroid Hormones T3 by RIA 20% triiodothyronine (but 4 times more powerful) sometimes high levels of: T3 but normal levels of T4
measurement of both hormones more accurate evaluation
Thyroid Binding Globulin******
thyroid hormones in blood attached to protein called thyroid binding globulin TBG if an excess or deficiency of protein: alters T4/3 MEASUREMENT DOES NOT AFFECT ACTION OF HORMONE
normal thyroid function but unexplained high or low T4/3 may be: due to increase or decrease of TBG
direct measurement of TBG can be done
Excess or low levels sometimes hereditary misdiagnosed but have no problem need no treatment
measurement of Pituitary *******Production of TSH
by IRMA immunoradiometric assay: low levels less than 5 units of TSH is proper
early hypothyroidism TSH elevated but: T4/3 may be within normal range
rise in TSH represents pituitary gland's response to drop in thyroid hormone
first indication of thryoid gland failure
TSH ususally used in combo with: T4 RIA and T3 RIA
TSH normally low when thyroid functioning failure of TSH to rise when: circulating thyroid hormones low indication of impaired pituitary funcion
TRH test (TSH test eliminated TRH test) injection after shot: too much thyroid hormone (thyroxine triiodothyronine) will not show rise in TSH when given TRH detects early hyperthyroidism
Too much response to TRH (TSH rises +40) may be hypothyroid
iodine uptake scan******* measures how much iodine is taken up by thryoid gland (RAI uptake)
given dose of radioactive iodine emptystomach: iodine concentrated in thyroid gland or excreted in urine in few hours
amount of iodine in thyroid gloand measured by Thyroid Uptake
if taking meds will not take as much iodine because thyroid is turned off not functiong
hypothyroid usually takes up: too little iodine
hyperthyroid take up too much iodine
thyroid scan *******taking picture radioisotope let thyroid gland concentrate isotope usually done with iodine uptake test: thyroid hormone ha
thyroid scan done with technetium can be cancerous all scans done now with: radioactive iodine
two types of thyroid scans camara scan CRT scanner computerized Rectilinear Thyroid scanner: camera gamma fixed position viewing entire thyoid gland at once 5-10 min
CRT scanner: improves clarity and enhances thyroid nodules
measures thyroid function and size square cm and weight in grams
CRT improves rewsults of thyroid biopsy accurate sizing of gland aids to see if growing or smaller
knowing weight more accurate radioactive treatment with Graves' disease
thyroid scans used for: identifying nodules determining if hot or cold
measuring size of goiter prior to treatment
follow-up of thyroid cancer patients after surgery
locating thyroid tissue outside the neck base of tongue or chest
thyroid ultrasound high frequency sound waves botains image of thyroid gland identifies nodules tells if: nodule solid or fulid filled cyst not benign or malignant
allows accurate measurement
sids in performing thyroid needle biopsy if nodule cannot be felt
thyroid antibodies body produces antibodies to bacteria some people have antibodies against their own thyroed tissue known as: Hashimoto's Thyroiditis
when Hashimoto's thyroiditis presents as thyroid nodule rather thatn diffuse goiter thyroid antibodies may not be present
thyroid needle biopsy: reliable test to differentiate cold nodule (cancer)from cold nodule that is benign provide definitive info in 75% of nodules biopsied
hot nodules: rarely canceous
tremors and palpitations excess thyroid improved in hours by meds called: beta-blockers propranolol Inderal do not cure or decrease prevents symptoms
hyperthyroidism thyroiditis: beta blockers may be only treatment rewquired
Graves' disease or taoxic nodular goiter: antithyroid meds prevents thyroid producing hormones
methimazole propylthiouracil PTU will not make hormones
antithyroid drugs work in: few weeks side effects rash itching fever liver inflammation defiiency wbcs stop call doc if yellowing of skin high fever ssevere sore throat
radioactive iodine perm treatment of hyperthyroidism: thyroid cells only cells ability absorrb iodine thyroid cells damaged killed
radioiodine taken by: mouth 1-2 months gone from body few days majority cured single dose side effect underactiviity thyroid gland not enough hormone hypothyroiditis
surgical removal all or part can be done usually: removes love of thyroid gland containing lump and isthmus maybe frozen section surgery not frequent
ereason surgery not used frequently: because common forms of hyperthyroidism result of overproduction form entire gland Grave's disease
when entire thyroid gland removed: higher risk of low blood calcium po
after surgery may need: thyroid meds calcium replacement
23 hour stay or outpatient stay sometimes under a local: less complaints
down side of surgery: risk of injury to voice box recurrent laryngeal nerve less than 1%
when hypothyroidism occurs after treatment of hyperthyroid gland treated with: levothyroxine replaces thyroid hormones deficiency one pill safely taken
lump in thyroid or diffused enlargement goiter therapy is: suppression attempt shrinkage 3-6 months if lump continues to grow recommend removal of lump
lump in thyroid maybe fine-needle asperation biopsy: safe painless
hypodermic needle passed into lump few times samples of tissues taken will defferentiate a benign or malignant thyroid mass
Parathyroid glands: small behind thyroid pea sized mustard yellow regulate calcium level not related to thyroid
single major disease of parathyroid glands is: overactivity one or more calcium imbalance hyperparathyroidism
control calcium between 8.5-10.5
parathyroid glands reponsible for: how strong and dense bones are calcium primary element causes muscles to contract, conduction of electrical currents along nerves
when calcium levels drop below 8.5 hands may: cramp or tingle too high calcium-feel run down sleep poorly irritable decrease in memory
parathyroid glands small, vascular detect amount of calcium in blood make more or less: paratyroid hormone PTH
too much PTH bones release calcium into blood not enough calcium in bones osteopenia and osteoporosis
lining of intestine becomes efficient at abdorbing calcium: normally found in our diet
normal bone marrow has small holes with it but bones with osteoporosis will have: much larger holes
bone formation rapid in fetus and infant slows unetil age 11 females and 12 boys: aduilt levels of bone mass acheived by 18 small amount added until 28
estrogens and testosterone important to: growth hormone
parathyroid glanfds regulate calcium by: how much calcium is aborbed from diet how much secreted by kidneys how much is stored in bones
many pounds of calcium in bones
overactive parathyroid glands loss of calcium from bones: hyperparathyroidism
bones slose density and hardness

osteoporosis bigger holes in it because calcium dissolved and put into blood stream (excess parathyroid hormone advaced age lack of estrogen
continued disssolving of central bone: bone pain weakening of spinal colum walking hunched over older people
ADRENAL GLANDS: orange colored ****on top of both kidneys triangular 1/2x3inches
medulla center
cortex outer
some reasons for surgical removal: tumors of adrenal cortex overproduce hormones

tumors of adrenal medulla overproduce adrenaline(pheochromocytoma)

most solid tumors greater than 4 cm

primary cancers of adrenal

any size adrenal mass causes symptoms flank pain or tenderness

EXCLUSION IS WHEN CANCER HAS BEEN SPREAD FROM ANOTHER ORGAN TO ADRENAL METATASTIC
responsible for producing epinephrine and noreepinephrine(adrenaline): adrenal medulla*****
adrenal cortex produces other hormones necessary for fluid and electrolyte salt balance: cortisone****** aldosterone
adrenal cortex also makes: sex hormones *****
PANCREAS 2 FUNCTIONS: PRODUCE PANCREATIC ENDOCRINE HORMONES INSULIN AND GLUCAGON

PRODUCE PANCREATIC DIGESTIVE ENZYMES
endocrine pancreas: insulin somastostatin gatrin glucagon
maintains sugar and salt balance in bodies
digesstive portion of pancreass: 90% total cell mass
digestive (exocrine)pancreas
responsible digestive enzymess secreted into ilntesstines break down food
panccreatic enzymes digest: proteins fats carbos into smaller molecules intestines absorb
pancreas lies next to duodenom first part of small intestine after stomach size of pancreas: banana stepped on curve ssame length width thickness
yellow tube running through middle of pancreas is pancreatic duct drains: all digestive enzymes from pancreatic cells into duodenum mix with food
5% pancreatic mass comprised of endocrine cells clustered look like islands of cells called: Pancreatic Islets
within Islets cells make specific pancreatic endocrine hormones
cells within islets called Pancreatic Islet Cells
pancreatic islets scattered throughout pancreas encocrine glands secrete: hormones into bloodstream surrounded by blood vessels
purpose of endocrine cells make hormones secreted into blood stream where: they gain accrss to other cells very far away goal making those cells respond in specific fashion
diabetes=hyperglycemia=elevated ****blood glucose (sugar)most common endocrine disorder 16 mill AFAm Hisp Nat Am affects: kidneys*** eyes heart blood vessels nerves
type 1 insulin deficiency****
less common younger***** pancreatic islets stop producing insulin needed
weight loss: Type 2 insulin resistance
TYPE 1 700,000***** 10% americans
autoimmune disorder islet cells of pancreas enemy tissues foreign genetic viral infection mumps rubella cytomegalovirus measles influenza encephalitis polio Epstein-Barr average age 14: Hereditary Tendencies type 1 less likely affect more than one family member 4%parents 6% siblings
TREATMENT type1 injecting insulin ****in fat not pill juices in stotmach destroy because it is a protien hormone or digestive part of pancreas would digest insulin protein molecule: Type 2 middle age adult onset diabetes overwieght gradual onset hereditary lack of insulin activity
type 2 most common 1% Japan 40%Pima indians arizona recent change of food intake whites 1-2% but obesity promotes type2: type 2 hereditary 38% ****siblings 90-100% twins
CAUSEs of type 2
multifactorial
antibodies to islet cells low levels of insulin
body wants blood glucose maintained narrow range INSULIN GLUCOGEN DO THIS (Hormones) secreted by islet cells in pancreas: INSULIN SECRETED BY BETA CELLSISLET CELLS OF PANCREAS
stimulus for insulin secretion HIGH blood glucose
when blood glucose falls insulin secreted by islets goes down insulin effects muscle red blood and fat cells these cells absorb glucose lowering high blood glucose into normal: glucagon SECRETED BY ALPHA cells of pancreatic islets oposite insulin
blood glucose high no glucagon blood glucose goes LOW between meals during exercise more glucagon secreted
glucagon effect on liver so liver releases glucose stored in cells into blood stream increasing blood glucose: glucagon induces liver to make glucose out of building blocks from other nutrients e.g. protein
bodies desires blood glucose maintained between 70mg/dL -110mg/dL (milligrams glucose ion 100 milliliters of blood): Below 70 hypoglycemia******* above 110 can be normal after meal
need to test while fasting
after eating below 180
above 180=hyperglycemia too much glucose in blood: 2 blood sugar measurements above 200 ater drinking sugar-water glucose tolerance test =diabetes
4 X-Ray tests for glandular tumors (mass): ULTRASOUND***
fastest cheapest kidneys and adrenals least accurate sound waves
CT SCAN CAT very accurate ***adrenal gland abdominal structuress tumors 30 min. X-ray: MRI SCAN MR or NMR similar to CT one hour magnetic fields ****pictures pheochromocytomas enhance almost like biopsy accuracy
MIBG SCAN only detects presence and location**** of adrenal pheochromocytomas no other tyipe of adrenal tumor muclear medicine scan: MIBG special radioactive dye given concentrates in hyperactive endocrine tissue can be seen on x-ray one hour a day for 3-4 dayis
sestamibi scan makes hyperactive parathyroids radioactive to be seen on special x-ray film: MIBG shows pheos
ACROMEGALY=extremities enlargement=PITUITARY GLAND excess***** growth hormone GH affects: middle-aged adults serious illnesss and death treatable
abnormal growth of hands and feet facieal features brow and lower jaw nasal bone spacing of teeth
arthritis from overgowth of bone thick skin lips nose tongue liver spleen kidneys and heart diabetes mellitus hypertension cv dissease
ADDISON'S DISEASE=adrenal glands do not produce cortisol aldosterone 1 in 100,000********: weight loss fatigue low blood pressure dark skin
CHRONIC ADRENAL INSUFFICIENCY OR HYPERCORTISSOLISM
ADRENAL INSUFFICIENCY=underproducton adrenal corticosteroid homones decreased function of adrenal cortex******: weakness fatigue ab pain nausea dehydration dark skin treatment corticosteroid hormones
CUSHING'S SYNDROME=excessive adrenal secretion glucocorticoid *****homones if from tumor in pituitary excess corticotropin adrenals excess corticosteroids or children from large doses of synthetic corticosteriod drugs prednisone: obesity growth failure muscle weakness easy bruising acne high blood pressure psychological changes treatment surgery rad therapy chemo hormone produc-blocking drugs
CYSTIC FIBROSIS=mucus secretions**** airway gi tract ducts of pancreas bile ducts liver male urogenital tract lung: CF alters chemical props of mucus instead of protecting tissues will obstruct ducts and airways causing tissue damage
DIABETES INSIPIDUS***** 1=inadequate amounts antidiuretic hormone produced by pituitary gland: kidney cannot concentrate urine=excessive urination thirst fluid flood sodium level imbalances inherited or tumors or injuries ro pituitary or hypothalamus treatment antiiuretic hormone intranassally pill or injection
DIABETES MELLITUS TYPE 1=pancreas fails produce insulin *****treatment regular injections: excessive thirst hunger urination weight loss kidney problems pain nerve damage blindnesss coronarpy stroke
DIABETES MELLITUS TYPE 2=unable to respond to insulin normally treatment diet exercise oral meds injections: overweight symptoms same as type 1
GIGANTISM=TOO much growth hormone children: make bones and body parts grow caused by pituitary tumor treatment remove tumor******
GROWTH HORMONE DEFICIENCY=pituitarpy gland fails normal amounts growth hormone*********: hypoglycemia low blood sugar occur occur in children infants
HYPERTHYROIDISM=THYROID HORMONES in blood ****TOO HIGH children and teens caused by Graves' disease autoimmune disorder antibodies in immune system stimulate thyroid gland overactive: weight loss snervousness tremor excessive sweating increased heart rate blood pressure protruding eyes swelling in neck controlled by meds or removal/destruction of thyroid gland rad treatments
HYPOTHYROIDISM=levels thyroid hormones in blood low****** children Hashimoto's thyroiditis autoimmune processs damages sthyroid blocks hormone: infants can be born with absent or underdeveloped thyroid gland fatigue slow heart rate dry skin weight gain constipation slow growth delayed puberty treatment oral thyroid hormone replacement
PRECOCIOUS PUBERTY****=PITUITARY HORMONES STIMULATE gonads produce sex hormones prematurely: body changes soccur abnormally young age meds suppress secretion of pituitary hormones gonadotropins
PROLACTINOMA=benign tumor of pituitary gland hormone prolactin ****8most common tumor e: too much prolactin in blood hyperprolactinemia or pressure of tumor on tissues
prolactin stimulates breast to produce milk
INSULIN=HORMONE protein secreted by cells in pancreas islet cells (digestive enzymes others) when carbs(sugars)absorbed in intestines insulin secreted by pancreas in response (cell has sinsulin attached to surface activates cell to absorb glucose from bl: no insulion state of starvation cannot access calories in glucose need for injections of insulin
insulin resistance TYPE 2 DIABETES insuloin in blood even to higher than normal respond slow to insulin cannot absorb sugar molecules: INSULINE FIRST HORMONE IDENTIFIED LATE '20s tying string around pancratic duct of dogs weeks later pancreas digestive cells gone only pancreatic islets then isolated protein=insulin
Banting and Best
first insulin came from cows and pigs pancreatic islets and insulin protein isolated from slaughtered animals: bovine and porcine insulin purified bottled and sold 1980s human insulin lowest allergic reaction
human genes for insulin protein ccloned put in bacteria, bacteria makes human insulin: RAPID-ACTING INSULINS: HUMULIN R lletin Regular Novolion R

Intermediate Acting: lletin NPH Lente L Humulin L

Long-Acting: Ultralente, Humulin U
Mixtures of NPH reg insulin: Humulin 50/50 Humulin 70/30 Novolin 70/30
Oral antidiabetic hypoglycemic drugs: (not insulin not for type 1): DYMELOR DIABINESE GLUCOTROL DIAbETA MICRONASE TOLINASE ORINASE GLUCOPHAGE
DRUGS FOR HYPOTHYROIDISM contain T3 T4: dessiccated liver
levothyroxine ****Synthroid
Cytomel
Thyrolar T3-4
Triostat injectate
DRUGS FOR HYPERTHYROIDISM inhibit production T3-4 in thyroid gland: propylthiouracil******
Tapazole
DRUGS FOR PITUITARY GLAND secretes growth hormones inhibit skeletal growth in children: somatropin
DRUGS FOR DIABETES INSIPIDUS pituitary gland secretes vasopressin, inhibits excretion of water by kidneys vasopressin=ADH antidiuretic hormone: lack of ADH results in diabetes insipidus
ADH********

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