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1. What is the difference between Cushing disease and Cushing Syndrome?

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1. What is the difference between Cushing disease and Cushing Syndrome?

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Disease: excess endogenous secretion of ACTH

Syndrome: Chronic exposure to excess cortisol regardless of the cause

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2. What are the hormones affected? What are possible causes?

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2. What are the hormones affected? What are possible causes?

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ACTH and cortisol, T4, T3 and TCH causes are unknown but if there are causes it would be a tumor

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- Diurnal secretion patterns of ACTH and cortisol are lost
- Excess  ACTH stimulates excess production of cortisol resulting in loss of feedback control of ACTH
- Cortisol and adrenal androgens production is increased
- Cortisol releases from tumour exceeding normal cortisol levels form adrenal cortex , producing hypercortisolism

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1. What is Diabetes Mellitus? What are the hormones affected?

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1. What is Diabetes Mellitus? What are the hormones affected?

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A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Hormones affected;
- Beta cells

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10. D.K. should be aware of the potential acute and long term complications of diabetes mellitus. What are they? 

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10. D.K. should be aware of the potential acute and long term complications of diabetes mellitus. What are they? 

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Acute: diabetic ketoacidosis, hyperosmolar hyperglycaemic non-ketotic coma, hypoglycaemia.
Chronic: cardiovascular and peripheral vascular disease, retinopathy, nephropathy and neuropathy.
infection (they are harder to treat)

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8. What range of blood glucose should she be advised to aim for?

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8. What range of blood glucose should she be advised to aim for?

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3.6-6.9 mmol/L

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1)What is Addison disease? What are the hormones affected? What are possible causes?

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1)What is Addison disease? What are the hormones affected? What are possible causes?

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Addison disease, also called adrenal insufficiency, is an uncommon disorder that occurs when your adrenal gland produces too little cortisol and, often, too little aldosterone.
Addison's disease is caused by an autoimmune response, which the body attacks the outer portion of the adrenal glands, where cortisol and aldosterone are made. Other common causes are Infection (tuberculosis, HIV/AIDS), cancer cells, bleeding into the adrenal glands, Amyloidosis and the surgical removal or the adrenal glands.

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4. Identify and explain the common manifestations of Cushings

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4. Identify and explain the common manifestations of Cushings

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Wt gain
Moon face, buffalo hump, trunk obesity
Glucose intolerance because of cortisol induced insulin resistance and increased gluconeogenesis and glycogen storage by liver (cortisol is a glucocorticoid/steroid that plays a role in controlling blood sugar levels)

- Retention of sodium and water
1. edema
2. hypertension
3. hypokelemia

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5. What would you expect the lab results to look like if the patient has Cushings?

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5. What would you expect the lab results to look like if the patient has Cushings?

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• Laboratory tests

– Serum TSH

• Determines cause of hypothyroidism

– Free T4

– Serum T3

– Serum T4

– TRH stimulation test

• ↑ in TSH after TRH injection suggests hypothalamic dysfunction.

• No change after TRH injection suggests anterior pituitary dysfunction.
- Low potassium levels
- High neutrophils
- Glucose intolerance
- High cortisol levels
- Calcium levels

- Urine blood test in a 24 hour period
- Saliva test (at different periods of the day)

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if an adrenal carcinoma develops or has developed, this can result in voice changes, hairline recession, and hypertrophy of the 🤬.

If not treated, potential complications include:
Heart attack and stroke
Blood clots of the legs and lungs
- Infections
- poor stress response
Bone loss and fractures (osteoporosis)
High Blood Pressure
Unhealthy Cholesterol levels
Depression or other mood changes
Memory loss or trouble concentrating
Insulin resistance and prediabetes
Type 2 Diabetes

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Graves disease is primary hyperthyroidism. The thyroid is telling T4 and T3 to elevate even though it is already elevated.
Autoimmune disorder
Supresses TRH/TSH
Increase in uptake of iodine

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9. D.K.'s health care provider plans to routinely monitor glycosylated hemoglobin levels (HbA1C). What information can be gained from this laboratory test? 

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9. D.K.'s health care provider plans to routinely monitor glycosylated hemoglobin levels (HbA1C). What information can be gained from this laboratory test? 

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HbA1C measures the amount of blood sugar (glucose) attached to hemoglobin over 3 months. If the result is high it is a sign of diabetes; if diabetes is already diagnosed it can help monitor your condition and glucose. Looking for less than 7%

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7. What immediate and long-term therapy will D.K. need to manage her disorder?

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7. What immediate and long-term therapy will D.K. need to manage her disorder?

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Immediate - lower blood glucose levels, hydration
Long-term therapy - dietary education, exercise, and implementation of insulin therapy

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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).

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

2. Rapid heartbeat (tachycardia)

3. Irregular heartbeat (arrhythmia)

4. Pounding of your heart (palpitations)

5. Increased appetite

6. Changes in bowel patterns, especially more frequent bowel movements

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

8. Fatigue, muscle weakness

9. Difficulty sleeping

10. Skin thinning

11. Fine, brittle hair

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Heart problem, brittle bones, eye problems, red swollen skin

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 car

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What is hypothyroidism? What is Hashimoto disease? What hormones are effected? What are the possible causes? 

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What is hypothyroidism? What is Hashimoto disease? What hormones are effected? What are the possible causes? 

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Low functioning thyroid gland. Autoimmune disease that destroys the thyroid gland decreasing production. The hormones effected is T3 and T4. Possible causes are autoimmune, postpartum thyoiditis. Subacute thyroiditis

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2. Compare and contrast type 1 & type 2 diabetes mellitus. Include age of onset and whats happening in the body in your discussion. What are the possible causes? 

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2. Compare and contrast type 1 & type 2 diabetes mellitus. Include age of onset and whats happening in the body in your discussion. What are the possible causes? 

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Type 1 Diabetes:
Age of onset?

Usually begins before 40 years of age, although occasionally people have been people diagnosed at an older age.

Possible causes?

Environmental factors that have been implicated include exposure to certain medications, foods, and viruses.

What’s happening in the body?

Cellular immunity and humoral immunity are stimulated, resulting in beta cell destruction and apoptosis. The destruction of beta cells results from lymphocytes and macrophages infiltration of the islets, resulting in release of inflammatory cytokines, activation of T Helper and T cytotoxic lymphocytes, and death of Islet  beta cells. beta cell destruction also is mediated by the production of autoantibodies against Islet cells, insulin, glutamic acid decarboxylase, and other cytoplasmic proteins. Insulin synthesis declines and hyperglycemia develops over time.

Type 2 Diabetes:
Age of onset?

You can develop type 2 diabetes at any age, even during childhood. However, type 2 diabetes occurs most often in middle-aged and older people. You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight or obese.

Possible Causes?

Obesity results in increased serum levels of leptin and decreased levels of adiponectin. These changes are associated with inflammation and decreased insulin sensitivity.

Elevated levels of serum free fatty acid and intracellular deposits triglycerides and cholesterol are also found in obese individuals. These changes interfere with intracellular insulin signalling, decrease tissue response to insulin, alter and creating action, and promote inflammation.

Inflammatory cytokines are released from  intra-abdominal adipocytes or adipocyte associated  mononuclear cells and induce insulin resistance and are cytotoxic to beta cells.

What's happening in the body?

The muscles and liver that normally take up blood sugar and use it for energy begin to lose their sensitivity to the hormone insulin, a condition known as insulin resistance. The excess blood sugar in diabetes can wreak havoc on blood vessels all over the body and cause complications.

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6. What are the potential complications?

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6. What are the potential complications?

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One of the potential complications is a myxedema coma. myxedema coma is described as a diminished level of consciousness caused by severe hypothyroidism. this is considered a medical emergency. The manifestations include: hypothermia without shivering, hypoventilation, hypotension, hypoglycemia, and lactic acidosis.
Another potential complication could be a goitre, which is essentially a benign tumour on the thyroid gland. this could result in a restricted airway if it grows too large.

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The thyroid gland is not producing T3 or T4. Leading to decreased metabolism, sleep deprivation, low RR, heart rate, production of fat. Multiple systems

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Explain manifestations? What other clinical findings would be indicative of hypothyroidism? 

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Explain manifestations? What other clinical findings would be indicative of hypothyroidism? 

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Fatigue, low RR, Weight gain, menses issues, mental slowness, memory loss and lipids level

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hair loss, constipation, cold intolerance, muscle weakness, bradycardia, puffy face, coarse hair.

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type 1

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Lab values show elevated TSH and Low T4. What does that mean?

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Lab values show elevated TSH and Low T4. What does that mean?

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There is a Primary issue with the thyroid, TSH means that the pit gland is working but the thyroid

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What sources of fatigue is the NP looking for with the CBC, T4 and TSH.

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What sources of fatigue is the NP looking for with the CBC, T4 and TSH.

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5. What are the potential acute complications? Compare and contrast diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS).

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5. What are the potential acute complications? Compare and contrast diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS).

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Hyperglycemia
Hypoglycemia – Low blood sugar. Results in clumsiness, trouble talking, confusion, loss of consciousness, seizures and can lead to death. Symptoms include a feeling of hunger, sweating, shakiness, and weakness.

Diabetic ketoacidosis (DKA) – This is a serious complication of type 1 diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body cannot produce enough insulin and this results in rapid fat breakdown and production of ketones.

Hyperosmolar hyperglycemic syndrome (HHS) – This occurs in type 2 diabetes. There is no ketoacidosis as insulin is present in the body preventing rapid fat breakdown, but the cells are resistant to insulin, causing a hyperglycemia. This can lead to severe dehydration and coma.

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weight loss: due to body burning fat and muscle for energy
polyuria: due to glucose in urine
Increased hunger: due to decreased sugar to tissues causes lack of energy= increases hunger
fatigue: poor use of food

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6. D.K. needs to understand the signs and symptoms of hypoglycemia so that she can quickly intervene to prevent life-threatening complications. How can she recognize hypoglycemia and what should she do when it occurs?

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6. D.K. needs to understand the signs and symptoms of hypoglycemia so that she can quickly intervene to prevent life-threatening complications. How can she recognize hypoglycemia and what should she do when it occurs?

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Manifestations: sweating, shaking, tachycardia, weakness, nausea, feeling "jittery"
What to do: Eat sugar food or drink sugary liquid (juice) for immediate action and follow with complex carbohydrate
Prevention: Frequent blood glucose monitoring (throughout day and ac)

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4. The patient's laboratory values show an elevated TSH and low T4, What does this mean?

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4. The patient's laboratory values show an elevated TSH and low T4, What does this mean?

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This show's a primary thyroid dysfunction.

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any age, even during childhood. However, type 2 diabetes occurs most often in middle-aged and older people. You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight or obese.

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the tissues around the eye become inflammed. Edema of the obital cavity

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Goiter- will stay maintained
Eyes
Heart palpitations
- may use other medications to help symptoms
Menses

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She has developed a goiter, which is due to the excessive amounts of thyroid hormones that have developed and caused by hyperthyroidism
Triggered by altered thyroid hormone
Becomes hyperplastic which causes the goiter

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Temp, HR increase
Inhanced hyperthyroidism

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Vitals, appetite, weight.
Integumentary: skin, hair, nails, facial flushing
Throat: goitre
Neurologic: irritable, nervousness
Eyes: Exophthalmos
Gastrointestinal: nausea, vomiting, diarrhea