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  • August 11, 2024
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  • 2024/2025
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  • chapter 22 alterations of hormonal regulation

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Chapter 22: Alterations of Hormonal Regulation
-2x as common in those w/ diabetes
-survival rate for people w/ diabetes after a massive stroke is typically shorter than for a person w/o
diabetes

risk factors:
-hypertension
-hyperglycemia
-hyperlipidemia
-thrombosis
-sleep apnea

-aggressive management of blood pressure, hyperglycemia, & lipidemia - ✔✔stroke

-absence of selective pituitary hormones or complete failure of all pituitary hormone functions
-pituitary is vascular & therefore vulnerable to ischemia & infarction - ✔✔anterior pituitary:
hypopituitarism

-acute complication of DM
-hypoglycemia w/ rebound hyperglycemia
%


-counter-regulatory hormones cause gluconeogenesis
-most common in persons w/ type 1 diabetes mellitus & in children - ✔✔somogyi effect

-acute complication of DM
-hyperglycemic hyperosmolar state (HHS)
-life-threatening
-precipitated by infections, medications, nonadherence to diabetes tx, or coexisting disease
-usually associated w/ type 2 DM
-some insulin deficiency
-fluid deficiency
-elevated glucose levels - ✔✔hyperosmolar hyperglycemic nonketotic syndrome

-acute complications of DM
-an absolute or relative deficiency of insulin & an increase in insulin counter-regulatory hormones
-most common type in type 1 DM
-precipitating factors: infection, trauma, surgery, or myocardial infarction
-increased fat mobilization w/ the release of fatty acids, leading to DKA - ✔✔diabetic ketoacidosis
(DKA)

,-acute complications of DM
-early morning glucose elevation w/o noctural hypoglycemia
-related to nocturnal GH elevation
-tx: alter timing & dose of insulin - ✔✔Dawn Phenomenon

-acute complications of DM
-lowered plasma glucose level
-insulin shock/reaction - ✔✔hypoglycemia

-ADH level = abnormally high
-causes: ectopic secretion of ADH; post-surgical & with some cancers
-water retention: ADH action on renal collecting ducts increases their permeability to water
-normal renal, adrenal, & thyroid function must exist w/ high ADH level - ✔✔syndrome of
inappropriate antidiuretic hormone (SIADH) secretion

-adrenal medulla hyperfunction
-caused by tumors derived from chromaffin cells of adrenal medulla
-secrete catecholamines - ✔✔pheochromocytomas

-affects both adults & children
-genetic, epigenetic, & environmental interactions (must be genetically predisposed)
%


-insulin resistance & decreased insulin secretion by beta cells - ✔✔type 2 diabetes mellitus

-age
-obesity
-hypertension
-physical inactivity
-family history
-metabolic syndrome: central obesity, dyslipidemia, prehypertension, & elevated fasting blood glucose
level - ✔✔what are risk factors for type 2 diabetes mellitus?

-all hormones affected
-ACTH deficiency = cortisol deficiency
-TSH deficiency = altered metabolism
-FSH & LH deficiency = lack of secondary sex characteristics
-GH deficiency = lack of growth in children - ✔✔anterior pituitary: panhypopituitarism

-antidiuretic hormone effects: too little
-examples of diseases: diabetes insipidus (neurogenic, nephrogenic, dipsogenic) - ✔✔posterior
pituitary disease: hypofunction?

, -antidiuretic hormone effects: too much
-examples of diseases: syndrome of inappropriate antidiuretic hormone (SIADH) secretion -
✔✔posterior pituitary disease: hyperfunction?

-autoimmune disease
-type II hypersensitivity
-develops autoantibodies - ✔✔Graves disease

-autosomal recessive disorder
-enzyme for cortisol biosynthesis is deficient - ✔✔congenital adrenal hyperplasia

-conditions that cause alterations in pituitary or hypothalamic functioning
-alters TSH or thyrotropin-releasing hormone (TRH) production - ✔✔what are secondary alterations
of thyroid function?

-Conn disease
-primary aldosteronism
-abnormality of adrenal cortex - ✔✔primary hyperaldosteronism

-cushing disease
%


-secondary hyperthyroidism
-secondary hypothyroidism - ✔✔what are three disorders caused by a problem in the anterior
pituitary gland?

-decrease in number of receptors
-impaired receptor function
-presence of antibodies against specific receptors
-antibodies that mimic hormone action
-unusual expression of receptor function - ✔✔what are receptor-associated disorders?

-dysfunction of endocrine pancreas affects metabolism of fat, protein, & carbohydrates
-hyperglycemia due to defects in insulin secretion, insulin action, or both - ✔✔diabetes mellitus

-dysfunction or disease of thyroid gland
-alters thyroid hormone (TH) production - ✔✔what are primary alterations of thyroid function?

-enlarged tongue
-interstitial edema
-increase in size & function of sebaceous & sweat glands

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