ENDOCRINE SYSTEM

PITUITARY GLAND

•Anterior•TSH•ACTH•MSH•GH•Endorphins•Prolactin•Gonadotropin

•Posterior•ADH•Oxytocin

PARATHYROID GLAND

•Ca•Parathormone

ADRENAL/SUPRA-RENAL GLAND•Adrenal cortex•Mineralcorticoid•Glucocorticoid

•Adrenal medulla•Emergency hormones

THYROID GLAND•Needs Fe and tyramine•Thyroxine (T4)•T3; calcitonin•Goiter•Poor iodine•Goitrogenic foods•Stress•T3, T4 assay; thyroid scan; BMR

Goiter •Non-toxic•Simple, colloid, euthyroid•Poor iodine•Dysphagia, dyspnea•Mgt• Supplements• Thyroidectomy

•Toxic•Hyper, thyrotoxicosis, Grave’s•S/sx• Talk rapidly•Heat intolerance•Diaphoresis• Skin moist; salmon• v/s, appetite, peristalsis• Amenorrhea• Fine tremors• Insomnia• Exophthalmos

Goiter •(+) Von Graeffe’s sign•Blindness, ulceration•Mgt•65-68 deg F•X station•Change linens, gowns• Inc. everything•Drugs

•Radioactive cocktail•Surgery

Thyroid Storm

•Low TH•FEVER•Mgt:•Cortisone

Thyroidectomy

•GA•5/6•Collar line/ curve linear•Reverse Trendelenberg; semi-Fowler’s, neck with pillows

•Cx•Hemorrhage•Tetany•Laryngeal nerve injury•Respi. Obstruction•Thyroid storm crisis•Hypothyroidism

PANCREAS

•Alpha cells – glucagon•Beta cells – insulin•Delta cells – inhibits both

Diabetes Mellitus

•IDDM•Absolute absence

•DDM•Deficiency

Diagnostics

•Benedict’s test•Blood chem•FBS•PPBS•OGTT

DM

•Hyperglycemia•Vasculopathies•Neuropathy•Retinopathy•Nephropathy•MI

How to Control

•Diet•DM 1 – enough cal to maintain normal GnD•DM 2 – control•60 – CHO•12-15 – CHON•20-25 – fats

•Exercise •OHA•Sulfonylurea•Biguanides

•Worse•Sick/infected•Upset•Stress

•Insulin•Rapid – Humalog•O – 5-10min•P – 1 H•D – 3 H

•Short – Humulin R•30m-1H•2-4 H•4-6 H

• Intermediate – NPH, H N, Lente•3-4H•4-14 H•16-20 H

•Long – H U, Ultralente•6-8 H•12-16 H•20-30H

Complications •Lipodystrophy•Hypoglycemia•HA•Blurring of vision•Confusion•diaphoresis

•Pallor•Palpitation•Tachycardia•Tremors•Food craving

Emergent MGT•Home•10-15 g fast-acting glucose• 4 oz fruit juice• 3 oz softdrink• 4 cubes sugar• 6-10 hard candies• 3 pcs Graham• 6 pcs salted crackers• 5 ml honey/syrup

•Hospital•50% glucose/IV

•Home •Glucagon 0.5 + 1 mg SQ/IM