quizlet endocrine

• Patho of Diabetes


  disorder of carbohydrate metabolism, characterized by high glucose levels resulting from the body's inability to produced or utilized insulin
• How many types of Diabetes?

  4 types

  -Type 1 DM

  -Type 2 DM

  -Gestational DM

  -Specifics types of DM due to other causes
• Normal range of diabetes

  60-100ish
• Epidemiology of diabetes


  -30.3 million Americans (9.4%); increased prevalence w/ age ( 25% of ppl that are ≥65 y.o have it)
• Major Risk for diabetes

  obesity & sedentary life style
• What races have highest incidences for diabetes?

  -Hispanics

  -African Americans

  -Alaskan Natives

  -American Indians
• Physiology of glucose production

  -primary energy source

  -large molecule, needs insulin to facilitate its diffusion

  -once cells absorbed, it can be use for energy production, stored as glycogen, or converted into fat
• who produces insulin?


  beta cells of the Islet of Langerhans
• where is glycogen most abundant at when stored?

  liver & muscle cells
• Glycogenesis


  formation of glycogen from glucose
• Glycogenolysis


  breakdown of glycogen to glucose
• Glucagon


  -produced by Alpha cells of Islets

  -counteract insulin (when sugar levels are low, glucagon tells the liver to breakdown glycogen)
• Somatostatin


  -produced by delta cells of Islets

  -slows GI tract to prolong absorption
• what does incretin do?

  -stimulates secretion of insulin
• what do all this hormone do?

  -GH (growth hormone), cortisol, epinephrine, progesterone, and estrogen


  increase insulin secretion or glucose stimulus for insulin
• Type 1 DM - definition

  autoimmune destruction of beta cells, leading to a lack of insulin
• Type 1 DM - epidemiology

  -peak onset between at age 11-13 y.o

  -more common in whites (1.5-2x)

  -genetics factor

  -normal weight or underweight

  -DKA can be life threatening (can be saved w/ quick action)
• Type 1 DM - sx

  -Polydipsia (excessive thirst)

  -Polyuria (excessive urination)

  -Polyphagia (excessive hunger)

  -Weight loss

  -Fatigue

  -Recurrent infections

  -Blurred vision

  -Genital pruritus (fungal/candidal growth)
• Type 2 DM - definition

  Insulin resistance with eventual insulin deficiency

  OR

  secretory defect along with insulin resistance
• Type 2 DM - risk increase

  -age

  -obesity

  -lack of physical activity
• Type 2 DM - epiemiology

  -90-95% of those w/ DM

  -risks increases after age 40

  -AFRICAN AMERICAN ARE THE HIGHEST AT RISK (he said this)

  -high in many traditionally hunter gather groups (native americans/American indians)
• What is diabesity?


  obesity, diabetes, chronic inflammatory processes

  (Type 2 DM caused by obesity)
• How to diagnose DM?

  1) fasting blood sugar

  -pre diabetes: 100-125 mg dl

  -diabetes: 126 mg/dl or greater

  2)hemoglobin

  -pre diabetes: 5.7 to 6.4%

  -diabetes: 6.5% or greater
• Metabolic syndrome


  Three or more of the following:

  - Waist circumference > 40 inches (M), 35 inches (F)

  - Triglycerides > 150 mg/dL

  - HDL cholesterol < 40 mg/dL (M), < 50 mg/dL (F)

  - Blood pressure > 130/85 mmHg

  - Fasting glucose > 100 mg/dL

  Increases risk of cardiovascular disease
• Gestational DM - epidemiology

  -affects 4% of pregnant women

  -increases in hormones (estrogen) increase insulin resistance

  -increased insulin produced by the mother does not cross the placenta, elevated glucose does

  -may lead to a bigger baby >9lbs

  -neonates are born with excessive insulin, hypoglycemia, and risk for obesity
• Gestational DM risk factors for mothers

  -HTN

  -obesity (BMI >30)

  -Hx of GDM in previous pregnancy

  -strong family hx of DM

  -urine positive for glucose in prenatal visit

  -previous big baby (9lbs)

  -unexplained still birth in past

  -previous delivery of infant w/ birth defect

  
  

  many women who develop GDM have no risk factors
• URGENT Complications of DM

  Hypoglycemia

  -low blood sugar levels

  -excess exogenous insulin, inadequate food intake, excessive physical activity

  Diabetic ketoacidosis (DKA)

  -ASSOCIATE DKA W/ TYPE 1 DM

  -severe shortage of insulin, leading to a build up of ketones in bloodstream

  Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)

  -very high blood sugar levels(hyperglycemia) and dehydration w/o significant ketone production

  -ASSOCIATE W/ TYPE 2 DM
• Hypoglycemia sx


  blood glucose <70 mg/dL

  -sweating

  -hunger

  -dizziness

  -nervousness

  -confusion

  -seizures

  -headache

  -heart palpitations
• Diabetic Ketoacidosis (DKA)


  -serum glucose >250 mg/dL

  -serum bicarbonate <18 mmol/dL

  -serum pH <7.30

  -presence of an anion gap

  -presence of urine and serum ketones
• Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)

  -serum glucose >600 mg/dL

  -serum bicarbonate >15 mmol/dL

  -serum pH >7.30

  -serum osmolality >320 mOsm/L

  -Absence or few small amount of ketones
• Long term complications of diabetes

  Vascular

  -accelerates atherosclerosis, CAD, CVA, PAD, retinopathy, nephropathy

  -endothelium is activated and injured

  Neuropathies (don't always feel chest pain from a heart attack)

  Impaired immunity and wound

  -immunosuppression

  Reproductive

  -vaginitis (inflammation or irritation of vagina), balanitis (inflammation of the head of the penis)

  -GDM

  Psychological

  -anxiety

  -depression

  -eating disorder

  Microalbuminuria progressing to end-stage renal disease
• Endocrine signaling


  (1)Stimulation --> (2)hypothalamus --> (3)pituitary --> (4)trophic hormones --> (5)organ
• What affects regulation of hormone release?

  Chemical factors

  -blood glucose

  -calcium level

  Endocrine factors

  -endocrine gland controlling another

  Neural control

  -complex interaction btw nervous system and various endocrine glands
• Pituitary gland


  -know as the master gland

  -pea sized

  -serves as the coordinating center for the endocrine system

  -anterior pituitary: adenohypophysis (produces and releases various hormones)

  -posterior pituitary: neurohypophysis (stores and releases hormones from the hypothalamus)
• Negative feedback: shuts down signaling


  maintains balance of hormones in the body

  
  

  examples:

  -regulation of thyroid hormones by the hypothalamus and pituitary gland

  -the control of blood glucose levels by insulin and glucagon

  -the regulation of cortisol secretion by the hypothalamic-pituitary-adrenal (HPA) axis.

  
• Hypothalamic & pituitary hormones & their target organs


  he said is really important to understand this image

  
• Anterior pituitary hormones


  -Follicle stimulating hormone/ Luteinizing hormone (FSH/LH): Regulate reproductive processes such as ovulation and sperm production.

  -Thyroid stimulating hormone (TSH): Stimulates thyroid gland to produce thyroid hormones, regulates metabolism

  -Adrenocorticotropic hormone (ACTH): Stimulates the adrenal glands to produce cortisol, which helps regulate stress response and metabolism.

  -Prolactin: Stimulates milk production in mammary gland after childbirth

  -Growth hormone (GH): Stimulates growth, cell reproduction, and regeneration
• Posterior pituitary hormones


  -Antidiuretic hormone (ADH): also known as vasopressin, it helps regulate water balance in the body by controlling the reabsorption of water by the kidneys. It reduces the amount of water lost in urine, helping to maintain proper hydration levels

  -Oxytocin: stimulating uterine contractions during childbirth and promoting milk ejection during breastfeeding
• Pituitary hormones picture


  he didn't include the MSH hormone

  
• Endocrine dysfunction: three types

  -hormone deficiency

  -hormone excess

  -hormone resistance