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USU: MSN 570 WEEK 5
Hypothalamus
Characteristics
Anterior Pituitary Stimulated Through the Hypophyseal Portal
GHRH
GnRH
TRH
PIF
CRF Released During Stress
Posterior Pituitary Stimulated Through Neural Control
CRF (CRH) acts on Anterior Pituitary Gland to Release ACTH
Cortisol Released
Androgens Released
Adrenal Medulla
Epinephrine & Norepinephrine
2 mins
Adrenal Gland (Advanced)
Characteristics
Adrenal Cortex
Zona Glomerulosa
Aldosterone
Zona Fasciculata
Cortisol
Zona Reticularis
Androgens
Adrenal Medulla
Chromaffin Cells
Epinephrine & Norepinephrine
2 mins
Peptide Hormones
Characteristics
Fast-Acting and Short-Lived
Bind To Cell Membrane Receptors
Stimulate Secondary Messengers
Amino Acid-Derived
Examples
Insulin
Parathyroid Hormone (PTH)
Vasopressin
Oxytocin
2 mins
Steroid Hormones
Characteristics
Nuclear Membrane
Long-Lived and Slow-Acting
Cholesterol-Derived
Intracellular Receptors
DNA Transcription
Examples
Testosterone
Aldosterone
Estrogen
Cortisol
2 mins
Pancreas
Characteristics
Acinar Cells Release Digestive Enzymes
Ductal Epithelial Cells Release Bicarbonate
Islets of Langerhans
Beta Cells Release Insulin
Alpha Cells Release Glucagon
Delta Cells Release Somatostatin
Somatostatin Inhibits Alpha and Beta Cells
3 mins
Testes
Characteristics
FSH Stimulates Sertoli Cells
Inhibin B Release
LH Stimulates Leydig Cells
Leydig Cells Secrete Testosterone
Testosterone Causes Male Development
2 mins
Insulin Synthesis
Synthesis
Preproinsulin
Rough Endoplasmic Reticulum
Proinsulin
Golgi Body
Beta Cells Release Insulin
Beta Cells Release C-peptide
Clinical Relevance
Insulinoma
Sulfonylureas
Surreptitious Insulin Use
2 mins
Ovulatory Hormones I - Follicular Phase
Characteristics
0-14 Days
GnRH Stimulates FSH and LH
Follicle Secretes Estrogen
Negative Feedback from Estrogen
Increased Estrogen Leads to Positive Feedback
FSH and LH Surge
LH Spike Leads to Ovulation
2 mins
Ovulatory Hormones II - Luteal Phase
Days 15-28
Corpus Luteum
Secretes Progesterone
Negative Feedback inhibits FSH and LH
No pregnancy forms Corpus Albicans
Stops Estrogen Secretion
Endometrial Sloughing - Menses
GnRH secretion produces new follicular phase
2 mins
Thyroid Nodule Assessment
Initial Tests
Thyroid-Stimulating Hormone (TSH)
Ultrasound
Normal / Elevated TSH
Fine Needle Aspiration
Most Accurate Test
Decreased TSH
Radioactive Iodine Uptake (RAIU)
Hot Nodules Rarely Malignant
Free T3 and T4
Considerations
Repeat Ultrasound 6 -18 Months
2 mins
Thyroid Function Screening Tests
If TSH High
Free T4 (FT4)
If TSH Low
Free T4 (FT4) and T3 (Triiodothyronine)
Consider Serum Total T4 (Thyroxine)
Considerations
Only Total T4 Increases in Pregnancy
T4 is Converted to T3
Avoid for Inpatient Screening
2 mins
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)
Pathophysiology
Hypersecretion of ADH
Increased Sensitivity to ADH
Signs & Symptoms
Serum Hypoosmolality
Coma and Seizure
Dilutional Hyponatremia
Cramps and Tremors
Euvolemia
Change in LOC
2 mins
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pharmacologic Interventions
Diuretics
Hypertonic IV Fluids
Demeclocycline
Tolvaptan and Conivaptan
1 min
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Nonpharmacologic Interventions
Monitor Serum and Urine Osmolality
IandOs with Daily Weights
Restrict Fluid Intake
Monitor Cardiovascular and Neurological Status
Seizure Precautions
2 mins
Subacute Lymphocytic Thyroiditis
Etiology
Drugs
Autoimmune Disorders
Postpartum Thyroiditis
Clinical Features
Hyperthyroidism and Hypothyroidism
Painless Thyroid
Diagnosis
Thyroid Function Tests
Elevated ESR
Decreased Radioactive Iodine Uptake (RAIU)
Lymphocytic Infiltrate
Treatment
Beta Blockers
Levothyroxine
Avoid Antithyroid Drugs
3 mins
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