Download - Endocrine System
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Endocrine System
I’m hot, I’m cold, I’m fast, I’m slow.
EMT-Paramedic Program
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The System Itself
• The other regulating system of the body– Closely linked to nervous
system
• Uses glands and tissues• Via hormones, the
system regulates:– growth– the use of foods for energy– pH of body fluids– fluid balance– reproduction– provides resistance to stress
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Hormones
• Chemical messengers to either:– Body organs– Tissues– Or Both
• Binding depends on:– Quantity – Quality of receptor
sites
• They may be divided into three groups:– Amines
• Tyrosine, epi, norepi
– Proteins• amino acids; insulin, GH,
calcitonin, ADH, oxytocin
– Steroids• cholesterol; cortisol,
aldosterone, estrogen, progesterone, and testosterone
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Hormone Secretion
• Negative feedback mechanism
• Endocrine glands respond to blood level changes or other hormones present
• Secretion of hormone until stimulus is negated or changed
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Exocrine Glands – Ducted Gland
• Release chemicals nearby tissues through a duct
• Salivary glands
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Endocrine Glands – Ductless Glands
• Release chemicals directly into blood
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Gland Effects
• Exocrine glands – tend to be localized
• Endocrine glands – tend to be widespread
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Pituitary “Master Gland”
• Posterior holds hypothalamus hormones ADH and oxytocin
• Anterior produces GH, TSH, ACTH, prolactin, FSH, LH
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Specific Hormones
• ADH – maintains BP by
reabsorption of water by kidney tubules and vasoconstriction
• Oxytocin– stimulates
contraction of uterus and release of milk
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Specific HormonesThyroid Stimulating Hormone
Growth Hormone
Adrenocorticotropic Hormone
Anterior Pituitary
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Anterior Pituitary
• These hormones primarily regulate other endocrine glands; rarely a factor in endocrine emergencies.
• TSH – (Thyroid-stimulating hormone) - stimulates thyroid to release hormones, = increased metabolic rate. (Critical for survival).
• GH – (Growth hormone) - adults; decrease glucose use, increase consumption of fats for energy
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Anterior Pituitary
• ACTH – (Adrenocorticotropic hormone) - stimulates growth of the adrenal cortex & release of corticosteroids
• FSH – (Follicle stimulating hormone) - ovarian release
• LH – (Luteinzing hormone) - ovarian release– Estrogen and progesterone
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Thyroid Gland
• Produces:– T4 - Thyroxine– T3 – Triiodothyronine
• Contain Iodine• Regulate energy
production & growth– Calcitonin –
• Regulates calcium• Maintains strong
bones…– Also feeds back
through pituitary
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Parathyroid Glands
• “Pair-a-thyroids?” • Produces parathyroid
hormone– Also involved in
calcium & blood phosphate levels
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Disorders Associated with Thyroid Gland• Issues directly associated with gland
– Tumor• Pituitary malfunction indirectly affecting• Hypothyroidism (Myxedema)• Hyperthyroidism
(Grave’s Disease)– Thyrotoxicosis– Thyrotoxic Crisis
(Thyroid Storm)
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Hypothyroidism
• Inadequate levels of thyroid hormones
• Most common cause for primary
hypothyroidism is chronic lymphocytic
thyroiditis (Hashimoto’s); more
common in women. Can also be
caused by iodine deficiency, surgery.
Usually have a small goiter.
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Hypothyroidism (Myxedema)
• Sx: decreased metabolic rate, facial bloat, weakness, cold intolerance, lethargy, altered mental status, slowed speech, oily skin and hair, hair loss, weight gain.
• Levothyroxine is drug of choice.• Patients may be difficult to wean from
a ventilator after anesthesia.
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Myxedema Coma
• Trauma, emergency surgery, severe infection may be poorly tolerated and lead to myxedema coma.
• Rare disorder, characterized by hypo-ventilation, hypotension, hypothermia, hyponatremia, hypoglycemia.
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Hyperthyroidism
• A toxic condition characterized by tachycardia, nervous symptoms, increased metabolism secondary to hyperactivity of the thyroid.
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Hyperthyroidism (Thyrotoxicosis)• Excessive circulating thyroid hormone.
• Graves disease; Most common cause (95%)
• Familial, 6X more common in females and relatively often in elders. Best clinical marker; ophthalmopathy.
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Hyperthyroidism (Thyrotoxicosis)
• Sx: nervousness, diarrhea, insomnia, fatigue, dyspnea, A-fib w/o cardiac hx., tachycardia, HTN, heat intolerance, weight loss, exophthalmos, hair loss, palpitations, amenorrhea, edema of hands and face.
• Elders; wasting with none of classic S/S, serious cardiac symptoms.
• Younger adults; nervous system symptoms
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Hyperthyroidism (Thyrotoxicosis)• Tx: Propranolol decreases many sx
rapidly.
• Diltiazem (calcium channel antagonist) if propranolol is contraindicated.
• Iodide is effective for thyroid storm or prep. for thyroid surgery - short term tx.
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Disorders of the Thyroid Gland
• Thyroid Storm– Severe Tachycardia, Dysrhythmias– Heart Failure– Shock– Hyperthermia– Restlessness, Agitation & Paranoia– Abdominal pain– Delirium, Coma
• What else does this look like?• What could help you distinguish?• Danger in becoming a cynic?
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Adrenal Glands
Each adrenal has:
Cortex -Aldosterone-Cortisol
Medulla -Epinephrine-Norepinephrine
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Adrenal cortex
• Secretes 3 classes of hormones - all steroid hormones
• Glucocorticoids (95%) (Cortisol)– Release = increased glucose blood levels and
other functions i.e., Anti-inflammatory and immune suppression - released in response to stress, trauma, serious infection.
• Mineralocorticoids– Play an important role in regulating concentration
of potassium and sodium
• Androgenic hormones– Cause masculinization
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Trouble Associated with Adrenal Gland
Cushing’s Syndrome– ACTH Levels too
high• Enlarges adrenal
gland– May be associated
with pituitary tumor
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Disorders Associated with Adrenal Glands
Addison’s Disease– Deficiency of cortisol & aldosterone– Slow, gradual onset– Progressive
• Fluid volume deficit• Hyperpigmentation (bronze)• Anorexia• Hypotension
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Adrenal Gland Disorders
Addisonian Crisis– Acute episode preceded by:
• Physical or emotional stress– Surgery– Alcohol intoxication– Trauma– Infection– Hypoglycemia
– Adrenal cortex cannot comply with body’s increased demand
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Gonads
• Endocrine glands associated with reproduction
• Ovaries produce eggs - controlled by FSH & LH from anterior pituitary, also manufactures estrogen and progesterone - several functions; sexual development, preparation of uterus for implantation
• Testes - produce sperm, manufacture testosterone - promote male growth and masculinization. Controlled by anterior pituitary hormones FSH and LH.
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Ovaries
Secrete
– Estrogen
– Progesterone
progesterone
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Testes
Secrete
– Testosterone
– Inhibin
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Pancreas
• U R&L Q• Islets of
Langerhans– Produce Glucagon
& Insulin
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Pancreatic Hormones
• Glucagon – Alpha Cells– stimulates liver to change
glycogen to glucose– raises blood glucose
levels• Insulin – Beta Cells
– lowers blood glucose levels by increasing transport of glucose into the cells
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Glucose/Dextrose (D-glucose)
• An intermediate in metabolism of carbohydrates
• The most important carbohydrate, and is formed during digestion; absorbed from intestines into blood of portal vein; in passage through liver, is converted into glycogen
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Glucose
• May be:– Used immediately – Stored in muscles– Stored in fat
• Brain cannot store it’s food– Requires continuous circulating volume– Reason neuro s/s develop quickly
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Disorders Associated with Pancreatic Dysfunction
Diabetes Mellitus
– Hyperglycemia
– Hypoglycemia
– DKA
– HHNK
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Diabetes Mellitus
• 16 million in U.S. & rising• 3 diagnostic types:
– IDDM Type I– NIDDM Type II– Other (Secondary) DM
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Diabetes Mellitus
• IDDM type 1• Most commonly occurs in children and
young adults– Genetic predisposition; Immune mediated
destruction of insulin-producing cells
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Diabetes Mellitus
• NIDDM type II– Usually occurs after age 30. – A strong genetic
predisposition is evident but pathogenesis is different.
– Most individuals obese– Resistance to insulin action is
present. – Exogenous insulin not
required.
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Promotion of Hyperglycemia
• Increased dietary intake (esp. carbohydrates)
• Limitation of physical activity
• Reduction of hypoglycemic therapy
• Limitation of endogenous insulin production– Pancreatic diseases– Drug treatment– Electrolyte disorders
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Diabetes Mellitus
• Other (secondary) DM– Associates hyperglycemia to another
cause including:• Pancreatic disease/Pancreatectomy• Drugs or chemical agents• Others too
• Gestational diabetes– Develops during pregnancy and resolves
with birth but increased risk of DM later.
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Development of Insulin Resistance
• Infection• Inflammation• Myocardial ischemia or infarction• Trauma• Surgery• Emotional stress• Pregnancy• Drug treatment
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S/S of Hyperglycemia/Insulin Insufficiency or Resistance
• Polyuria
• Polydipsia
• Nocturia
• Weight Loss
• Fatigue
• Blurred vision
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Control
• Oral
• Transplant– Islet cells– Pancreas
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Oral Hypoglycemic Drugs
Metformin 500-1000 mg PO tid
Avandia 4 mg PO qd
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Insulin
Insulin Route Onset Peak Duration
Novolog
Aspart
SQ 15 min 1-3 hr 3-5 hr
Humalog
Lispro
SQ 15 min 30-90 min 3-5 hr
Regular IV 10-30 min 15-30 min 30-60 min
Humulin Regular
SQ 30-60 min 2-4 hr 5-7 hr
NPH SQ 3-4 hr 6-12 hr 18-24 hr
Lantus Glargine
SQ 1.1 hr None 24 hr
70/30 NPH/regular
SQ 30 min 4-8 hr 24 hr
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Diabetic Ketoacidosis
• A result of severe insulin insufficiency
and an excess of glucagon. Type I
• Common causes:
– Interruption of insulin therapy
– Stress, infection
– Non-compliance frequently a factor
• Onset slow, from 12-24 hours.
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Diabetic Ketoacidosis
• Transition from glucose to lipid metabolism– Forms ketones & increase to toxic levels
(diuresed)– Metabolic Acidosis
• Symptoms • Causes severe osmotic diuresis and
severe dehydration• Tx: Requires close monitoring
– Draw red-top– Give IV fluids (Typically 3-5 L Low)– Consider thiamine
• All vitamins & Electrolytes grossly deranged
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Non-Ketotic Hyperglycemic Hyperosmolar Coma (HHNK)
• Complication of Type II – Typically preceded by infection &/or
diuretics– Hyperglycemic state causes
hyperosmolar diuresis– Pronounced volume loss (Towards 10L)
• CBG (PG) levels 1000 & higher• Only mild metabolic acidosis
– Non-Ketotic– Many electrolytes within normal levels
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Hypoglycemia
• Common causes– Excessive insulin– Stress– Overexertion– Infection– Under eating
• Symptoms• Treatment
– O2, IV, CBG (Red Top), 50% dextrose IV
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Endocrine Summary
• A VERY complicated system
• A specialty of it’s own
• Much of EMS treatment is symptom oriented
• Much of care is cause oriented– Important distinction