NR I507 IFINAL IEXAM ISTUDY IGUIDE
ENDOCRINE
• Endocrine, Inervous Iand Iimmune Isystems Iwork Itogether Ito Iregulate Iresponses Ito Iinternal
Iand Iexternal Ienvironment
• Hormone Irelease Iis Iregulated Iby:
o Chemical Ifactors I(BGL, ICa Ilevels)
o Endocrine Ifactors I(cortisol)
o Neural Icontrol- IANS Istimulates
• Negative Ifeedback- IMOST ICOMMON, Ioccurs Iwhen Ia Ichanging Ichemical, Ineural Ior
Iendocrine Iresponse IDECREASES Isynthesis Iand Isecretion Iof Ihormone
• Positive Ifeedback Ioccurs Iwhen Ia Ineural, Ichemical, Ior Iendocrine Iresponse IINCREASES
Isynthesis Iand Isecretion Iof Ihormone.
o Also Ioccurs Iwhen Iincreased Ihormone Ilevel Ifurther Iincreases Isynthesis Iand
Isecretion Iof Ithat Isame Ihormone
o Ex- Icyclic Irise Iof Iestradiol Ilevels
• Hormone Ireceptors Iof Itarget Icells Ihave I2 Ifunctions
o Recognize Iand Ibind Iwith Ihigh Iaffinity Ito Itheir Iparticular Ihormones
o Initiate Isignal Ito Iappropriate Iintracellular Ieffectors
o The Isensitivity Ior Iaffinity Iof Ithe Itarget Icell Ito Ia Iparticular Ihormone Iis Ir/t Ithe
Iconcentration Iof Ireceptors Ifor Icell- Imore Ireceptors= Imore Isensitive Ito Istimulating
Ieffects Iof Ihormone
• High Iconcentrations Iof Ihormone Idecrease Ithe Inumber Ior Iaffinity Iof Ireceptors Iper Icell=
IDOWNREGULATION
o The Icell Ican Iadjust Iits Isensitivity Ito Ithe Iconcentration Iof Isignaling Ihormone
o Receptors Ion Iplasma Imembrane Iare Icontinuously Isynthesized Iand Idegraded Iso
Ichanges Iin Ireceptor Iconcentration Imay Ioccur Iwithin Ihours
Thyrotoxicosis
• Condition Ithat Iresults Ifrom Iany Icause Iof Ian Iincreased Iamt Iof ITH Ilevels
• HYPERthyroidsm= Iform Iof Ithyrotoxicosis Iwhich Iexcess Iamts Iof ITH Iare Isecreted
• Thyrotoxicosis Iand Ihyperthyroidism Iused Iinterchangeably
• More Iprevalent Iin Iwomen Iand Iiodine-deficient Igeographical Iareas
• Diseases Ithat Icause Iprimary Ihyperthyroidism= IGraves’ Idisease, Itoxic Imultinodular Igoiter,
Itoxic Iadenoma
• Secondary- Iless Icommon Iand Icaused Iby ITSH-secreting Ipituitary Iadenomas
• S/S Iare Iattributable Ito Imetabolic Ieffects Iof Iincreased Icirculating Ilevels Iof ITH
o Increased Imetabolic Irate Iwith Iheat IINTOLERANCE
o Thin Ihair, Iexophthalmos, Inormal Ior Ienlarged Ithyroid I(goiter), Itachycardia I(HF),
Iwt Iloss, Idiarrhea, IN/V, Iwarm Iskin, Isweaty Ipalms, Ihyperreflexia, Ipretibial
Imyxedema, Irestlessness, Iinsomnia, Ifatigue, Itremor
• Treatment= Iantithyroid Idrug Itherapy, Iradioactive Iiodine, Isurgery. IMajor Icomplication Iof
Ihyperthyroidism Itx= Ihypothyroidism
Thyrotoxic Icrisis I(Thyroid IStorm)
, • Rare Ibut Idangerous Iworsening Iof Ithyrotoxic Istate
• Death Ican Ioccur Iin I48 Ihrs Iwithout Itreatment
• Spontaneous, Ioccurs Iin Iindividuals Iwho Ihave Iundiagnosed Ior Ipartially Itreated Isevere
Ihyperthyroidism Iand Iare Isubjected Ito Iexcessive Istress Ifrom Iother Icauses I(infection, Ipulm
& ICV Idisease, Itrauma, Iburns, Iseizures, Isurgery, IOB Icomplications, Iemotional Idistress,
Idialysis)
• S/S Icaused Iby Isudden Irelease Iof IT4 Iand IT3 Iexceeding Imetabolic Idemands
• S/S= Ihyperthermia, Itachycardia Iesp. Iatrial Idysrhythmias, Ihigh-output IHF, Iagitation,
Idelirium, IN/V/D
• Tx= Idrugs Ithat Iblock ITH Isynthesis, Ibetablockers Ifor ICV Isymptoms, Icorticosteroids,
Iiodine
Hypothyroidism
• Results Ifrom Ideficient Iproduction Iof ITH- Imost Icommon Id/o Iof Ithyroid Ifn
• More Icommon Iin Iwomen Iand Ielderly- Iprimary I=99% Iof Iall Icases
• S/S= Ilow Ibasal Imetabolic Irate- Icold Iintolerance, Ilethargy, Itiredness, Ilow Ibody Itemp,
Ibradycardia, Idiastolic IHTN. IDecrease Iin ITH Ican Ilead Ito Iexcessive ITSH Iproduction I
Igoiter
• Diagnosis Iis Imade Iby Imeasurement Iof Iincreased ITSH Iand Idecreased ITH
• Hormone Ireplacement Iwith Ilevothyroxine Iis Itreatment
Hypoparathyroidism
• Abnormally Ilow IPTH Ilevels
• Most Icommonly Icaused Iby Idamage Ito Ior Iremoval Iof Iparathyroid Iglands Iduring Ithyroid
Isurgery
• Occurs Ibecause Iof Ithe Ianatomic Iproximity Iof Iparathyroid Iglands Ito Ithe Ithyroid
• Also Iassoc. Iwith Igenetic Isyndromes, Iincluding Ifamilial Ihypoparathyroidism Iand
IDiGeorge Isyndrome
• Pathophys- Ia Ilack Iof Icirculating IPTH Icauses Idepressed Iserum ICa Ilevels Iand Iincreased
Iphosphate Ilevels
o In Iabsence Iof IPTH, Ireabsorption Iof ICa Ifrom Ibone Iand Iregulation Iof ICa
Ireabsorption Iby Irenal Itubules Iis Iincreased Icausing Idecreased Irenal
IphosphateIexcretion I Ihyperphosphatemia
• S/S= Iperioral Inumbness, Iparesthesia, Itingling, Itetany, Ihyperreflexia, Itonic-clonic Iseizures
Cushing’s ISyndrome
• Disorder Iof Iadrenal Icortex
• Syndrome Irefers Ito Iclinical Imanifestations Iresulting Ifrom Ichronic Iexposure Ito Iexcess
Iendogenous Icortisol, Imore Icommon Iin Iwomen
• Disease Irefers Ito Iexcess Iendogenous Isecretion Iof IACTH I(Corticotropin)
• ACTH-dependent Ihypercortisolism Iresults Ifrom Ioverproduction Iof Ipituitary IACTH Iby
Ipituitary Iadenoma
• Cushing-like Isyndrome Imay Idevelop Ias Ia Iside Ieffect Iof Ilong-term Iuse Iof Iglucocorticoids
• Pathophys- Iexcess IACTH Istimulates Iexcess Iproduction Iof Icortisol I Iloss Iof Ifeedback
Icontrol Iof IACTH Isecretion
, o Secretion Iof Iboth Icortisol Iand Iadrenal Iandrogens Iis Iincreased Iand Icorticotropin
Ireleasing Ihormone Isecretion Iis Iinhibited
• S/S-
o Weight Igain Imost Icommon Ifeature, Ir/t Iaccumulation Iof Iadipose Itissue Iin Itrunk,
facial Iand Icervical Iareas I(moon Iface, Ibuffalo Ihump, Itruncal Iobesity)
o Glucose Iintolerance I IDM
o Muscle Iwasting- Id/t Icatabolic Ieffects Iof Icortisol Ion Iperipheral Itissues
o Osteoporosis
o Purple Istriae Ion Itrunk Id/t Iweakened Iskin Itissues
o AMS, Iirritability, Idepression
• Diagnosis Iincludes Iurinary Iand Iserum Icortisol, Iserum IACTH Iconcentration
MUSCULOSKELETAL
Appendicular Iskeleton
• Consists Iof I126 Ibones Ithat Imake Iup Iupper Iand Ilower Iextremities, Ishoulder Igirdle, Ipelvic
Igirdle
• Long Ibones I(femur, Ihumorous), Iflat Ibones I(ribs, Iscapulae), Ishort Ibones I(wrist, Iankle)
Iirregular I(vertebrae, Imandible, Ifacial Ibones)
Muscle IContraction
• Specific Iintracellular Ireceptors Iwithin Ithe Isarcoplasmic Ireticulum Icalled Iryanodine
Ireceptors I(RyRs) Iare Ithe Iprimary Iion Ichannels Ithat Icontrol ICa Irelease
o Largest Iknown Iion Ichannels Iallowing Ifor Irapid Imovement Iof ICa
o Ca Iis Iion Ithat Iinitiates Imuscle Icontraction
Growth Iof ILong IBones Iin IChildren
I
• Growth Iin Ilength Iof Ilong Ibones Ioccurs Iat Iphyseal Iplate Ithrough Iendochondral Iossification
• Cartilage Icells Iat Ithe Iepiphyseal Iplate Imultiply Iand Ienlarge
• Growth Iin Idiameter Iof Ibone Ioccurs Iby Ideposition Iof Inew Ibone Ion Ian Iexisting Ibone
Isurface
• Peak Ibone Imass Iachieved Iby Imiddle Ito Ilate I20s
• Children Iw IVitD Ideficiencies Ihave Ihigh Iincidence Iof Ifracture
GENITOURINARY
Impact Iof IBPH Ion Iurinary Isystem
• Prostatic Itissue Icompresses Iurethra Iwhere Iit Ipasses Ithrough Iprostate Iurinary Ifrequency,
Idelay Iin Istarting Iurination, Idecrease Iforce Iof Istream
• Over Itime Ithe Ibladder Ican’t Iempty Iall Iurine I Ilong-term Iurine Iretention I Ioverflow
Iincontinence
Diet Iand IPrevention Iof IProstate ICA
• Nutrients Iin Iepidemiology Iinclude Icarotenoids, Ifat, Ivit IE, ID, ICa, Iselenium
• Total Ifat Iintake, Ianimal, Isaturated Ifat, Ired Imeat I& Idairy I= Iincreased Irisk
ENDOCRINE
• Endocrine, Inervous Iand Iimmune Isystems Iwork Itogether Ito Iregulate Iresponses Ito Iinternal
Iand Iexternal Ienvironment
• Hormone Irelease Iis Iregulated Iby:
o Chemical Ifactors I(BGL, ICa Ilevels)
o Endocrine Ifactors I(cortisol)
o Neural Icontrol- IANS Istimulates
• Negative Ifeedback- IMOST ICOMMON, Ioccurs Iwhen Ia Ichanging Ichemical, Ineural Ior
Iendocrine Iresponse IDECREASES Isynthesis Iand Isecretion Iof Ihormone
• Positive Ifeedback Ioccurs Iwhen Ia Ineural, Ichemical, Ior Iendocrine Iresponse IINCREASES
Isynthesis Iand Isecretion Iof Ihormone.
o Also Ioccurs Iwhen Iincreased Ihormone Ilevel Ifurther Iincreases Isynthesis Iand
Isecretion Iof Ithat Isame Ihormone
o Ex- Icyclic Irise Iof Iestradiol Ilevels
• Hormone Ireceptors Iof Itarget Icells Ihave I2 Ifunctions
o Recognize Iand Ibind Iwith Ihigh Iaffinity Ito Itheir Iparticular Ihormones
o Initiate Isignal Ito Iappropriate Iintracellular Ieffectors
o The Isensitivity Ior Iaffinity Iof Ithe Itarget Icell Ito Ia Iparticular Ihormone Iis Ir/t Ithe
Iconcentration Iof Ireceptors Ifor Icell- Imore Ireceptors= Imore Isensitive Ito Istimulating
Ieffects Iof Ihormone
• High Iconcentrations Iof Ihormone Idecrease Ithe Inumber Ior Iaffinity Iof Ireceptors Iper Icell=
IDOWNREGULATION
o The Icell Ican Iadjust Iits Isensitivity Ito Ithe Iconcentration Iof Isignaling Ihormone
o Receptors Ion Iplasma Imembrane Iare Icontinuously Isynthesized Iand Idegraded Iso
Ichanges Iin Ireceptor Iconcentration Imay Ioccur Iwithin Ihours
Thyrotoxicosis
• Condition Ithat Iresults Ifrom Iany Icause Iof Ian Iincreased Iamt Iof ITH Ilevels
• HYPERthyroidsm= Iform Iof Ithyrotoxicosis Iwhich Iexcess Iamts Iof ITH Iare Isecreted
• Thyrotoxicosis Iand Ihyperthyroidism Iused Iinterchangeably
• More Iprevalent Iin Iwomen Iand Iiodine-deficient Igeographical Iareas
• Diseases Ithat Icause Iprimary Ihyperthyroidism= IGraves’ Idisease, Itoxic Imultinodular Igoiter,
Itoxic Iadenoma
• Secondary- Iless Icommon Iand Icaused Iby ITSH-secreting Ipituitary Iadenomas
• S/S Iare Iattributable Ito Imetabolic Ieffects Iof Iincreased Icirculating Ilevels Iof ITH
o Increased Imetabolic Irate Iwith Iheat IINTOLERANCE
o Thin Ihair, Iexophthalmos, Inormal Ior Ienlarged Ithyroid I(goiter), Itachycardia I(HF),
Iwt Iloss, Idiarrhea, IN/V, Iwarm Iskin, Isweaty Ipalms, Ihyperreflexia, Ipretibial
Imyxedema, Irestlessness, Iinsomnia, Ifatigue, Itremor
• Treatment= Iantithyroid Idrug Itherapy, Iradioactive Iiodine, Isurgery. IMajor Icomplication Iof
Ihyperthyroidism Itx= Ihypothyroidism
Thyrotoxic Icrisis I(Thyroid IStorm)
, • Rare Ibut Idangerous Iworsening Iof Ithyrotoxic Istate
• Death Ican Ioccur Iin I48 Ihrs Iwithout Itreatment
• Spontaneous, Ioccurs Iin Iindividuals Iwho Ihave Iundiagnosed Ior Ipartially Itreated Isevere
Ihyperthyroidism Iand Iare Isubjected Ito Iexcessive Istress Ifrom Iother Icauses I(infection, Ipulm
& ICV Idisease, Itrauma, Iburns, Iseizures, Isurgery, IOB Icomplications, Iemotional Idistress,
Idialysis)
• S/S Icaused Iby Isudden Irelease Iof IT4 Iand IT3 Iexceeding Imetabolic Idemands
• S/S= Ihyperthermia, Itachycardia Iesp. Iatrial Idysrhythmias, Ihigh-output IHF, Iagitation,
Idelirium, IN/V/D
• Tx= Idrugs Ithat Iblock ITH Isynthesis, Ibetablockers Ifor ICV Isymptoms, Icorticosteroids,
Iiodine
Hypothyroidism
• Results Ifrom Ideficient Iproduction Iof ITH- Imost Icommon Id/o Iof Ithyroid Ifn
• More Icommon Iin Iwomen Iand Ielderly- Iprimary I=99% Iof Iall Icases
• S/S= Ilow Ibasal Imetabolic Irate- Icold Iintolerance, Ilethargy, Itiredness, Ilow Ibody Itemp,
Ibradycardia, Idiastolic IHTN. IDecrease Iin ITH Ican Ilead Ito Iexcessive ITSH Iproduction I
Igoiter
• Diagnosis Iis Imade Iby Imeasurement Iof Iincreased ITSH Iand Idecreased ITH
• Hormone Ireplacement Iwith Ilevothyroxine Iis Itreatment
Hypoparathyroidism
• Abnormally Ilow IPTH Ilevels
• Most Icommonly Icaused Iby Idamage Ito Ior Iremoval Iof Iparathyroid Iglands Iduring Ithyroid
Isurgery
• Occurs Ibecause Iof Ithe Ianatomic Iproximity Iof Iparathyroid Iglands Ito Ithe Ithyroid
• Also Iassoc. Iwith Igenetic Isyndromes, Iincluding Ifamilial Ihypoparathyroidism Iand
IDiGeorge Isyndrome
• Pathophys- Ia Ilack Iof Icirculating IPTH Icauses Idepressed Iserum ICa Ilevels Iand Iincreased
Iphosphate Ilevels
o In Iabsence Iof IPTH, Ireabsorption Iof ICa Ifrom Ibone Iand Iregulation Iof ICa
Ireabsorption Iby Irenal Itubules Iis Iincreased Icausing Idecreased Irenal
IphosphateIexcretion I Ihyperphosphatemia
• S/S= Iperioral Inumbness, Iparesthesia, Itingling, Itetany, Ihyperreflexia, Itonic-clonic Iseizures
Cushing’s ISyndrome
• Disorder Iof Iadrenal Icortex
• Syndrome Irefers Ito Iclinical Imanifestations Iresulting Ifrom Ichronic Iexposure Ito Iexcess
Iendogenous Icortisol, Imore Icommon Iin Iwomen
• Disease Irefers Ito Iexcess Iendogenous Isecretion Iof IACTH I(Corticotropin)
• ACTH-dependent Ihypercortisolism Iresults Ifrom Ioverproduction Iof Ipituitary IACTH Iby
Ipituitary Iadenoma
• Cushing-like Isyndrome Imay Idevelop Ias Ia Iside Ieffect Iof Ilong-term Iuse Iof Iglucocorticoids
• Pathophys- Iexcess IACTH Istimulates Iexcess Iproduction Iof Icortisol I Iloss Iof Ifeedback
Icontrol Iof IACTH Isecretion
, o Secretion Iof Iboth Icortisol Iand Iadrenal Iandrogens Iis Iincreased Iand Icorticotropin
Ireleasing Ihormone Isecretion Iis Iinhibited
• S/S-
o Weight Igain Imost Icommon Ifeature, Ir/t Iaccumulation Iof Iadipose Itissue Iin Itrunk,
facial Iand Icervical Iareas I(moon Iface, Ibuffalo Ihump, Itruncal Iobesity)
o Glucose Iintolerance I IDM
o Muscle Iwasting- Id/t Icatabolic Ieffects Iof Icortisol Ion Iperipheral Itissues
o Osteoporosis
o Purple Istriae Ion Itrunk Id/t Iweakened Iskin Itissues
o AMS, Iirritability, Idepression
• Diagnosis Iincludes Iurinary Iand Iserum Icortisol, Iserum IACTH Iconcentration
MUSCULOSKELETAL
Appendicular Iskeleton
• Consists Iof I126 Ibones Ithat Imake Iup Iupper Iand Ilower Iextremities, Ishoulder Igirdle, Ipelvic
Igirdle
• Long Ibones I(femur, Ihumorous), Iflat Ibones I(ribs, Iscapulae), Ishort Ibones I(wrist, Iankle)
Iirregular I(vertebrae, Imandible, Ifacial Ibones)
Muscle IContraction
• Specific Iintracellular Ireceptors Iwithin Ithe Isarcoplasmic Ireticulum Icalled Iryanodine
Ireceptors I(RyRs) Iare Ithe Iprimary Iion Ichannels Ithat Icontrol ICa Irelease
o Largest Iknown Iion Ichannels Iallowing Ifor Irapid Imovement Iof ICa
o Ca Iis Iion Ithat Iinitiates Imuscle Icontraction
Growth Iof ILong IBones Iin IChildren
I
• Growth Iin Ilength Iof Ilong Ibones Ioccurs Iat Iphyseal Iplate Ithrough Iendochondral Iossification
• Cartilage Icells Iat Ithe Iepiphyseal Iplate Imultiply Iand Ienlarge
• Growth Iin Idiameter Iof Ibone Ioccurs Iby Ideposition Iof Inew Ibone Ion Ian Iexisting Ibone
Isurface
• Peak Ibone Imass Iachieved Iby Imiddle Ito Ilate I20s
• Children Iw IVitD Ideficiencies Ihave Ihigh Iincidence Iof Ifracture
GENITOURINARY
Impact Iof IBPH Ion Iurinary Isystem
• Prostatic Itissue Icompresses Iurethra Iwhere Iit Ipasses Ithrough Iprostate Iurinary Ifrequency,
Idelay Iin Istarting Iurination, Idecrease Iforce Iof Istream
• Over Itime Ithe Ibladder Ican’t Iempty Iall Iurine I Ilong-term Iurine Iretention I Ioverflow
Iincontinence
Diet Iand IPrevention Iof IProstate ICA
• Nutrients Iin Iepidemiology Iinclude Icarotenoids, Ifat, Ivit IE, ID, ICa, Iselenium
• Total Ifat Iintake, Ianimal, Isaturated Ifat, Ired Imeat I& Idairy I= Iincreased Irisk
