The endocrine system
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The Endocrine System. Consists of glands and other structures that produce hormones which are released into the circulatory system. The Endocrine System. Consists of glands and other structures that produce hormones which are released into the circulatory system

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The Endocrine System

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The endocrine system

The Endocrine System

  • Consists of glands and other structures that produce hormones which are released into the circulatory system


The endocrine system1

The Endocrine System

  • Consists of glands and other structures that produce hormones which are released into the circulatory system

  • Regulation is established through hormones affecting target tissue


Regulation

Regulation

  • Homeostatsis is achieved through feedback mechanisms

  • Negative feedback – negates change to bring levels back to normal


Pituitary gland

Pituitary Gland

  • Regulates other endocrine glands as well as other body activities


Different hormones different signals

Anterior

pituitary

Hypo-

thalamus

-

-

Negative

feedback

Negative

feedback

Thyroid

hormones

osmolality

TSH

ADH

Thyroid

gland

Water

absorption

+

+

Para-

thyroids

-

Negative

feedback

-

Pancreas

Negative

feedback

calcium

Insulin

PTH

Glucose

Bone, GIT

& Kidney

Liver, fat

& muscle

+

+

Different hormones, different signals


Growth hormone

Growth Hormone

  • Non-endocrine related disorders can also cause growth delay:

    • Intrauterine growth retardation, chromosomal defects, abnormal growth of cartilage or bone, poor nutrition, variety of systemic diseases


Growth hormone1

Growth Hormone

  • Deficiency of endogenous growth hormone causes growth retardation

  • Growth delay may be caused by

    • Family growth patterns, genetic disorders, malnutrition, systemic or chronic illness, psychosocial stress, or a combination of these

    • Endocrine deficiency, or problems with thyroxine, cortisol, insulin, or GH


Growth hormone2

Growth Hormone

  • Release of GH is stimulated by the release of GHRF secreted by the hypothalamus

  • GH is inhibited by

    • Glucocorticoids

    • Obesity

    • Depression

    • Progesterone

    • Hypokalemia

    • Altered thyroid function


Synthetic human growth hormones

Drug List

Synthetic Human Growth Hormones

  • somatrem (Protropin)

  • somatropin (Humatrope)


Growth hormone3

Growth Hormone

  • The younger the patient at time of treatment the greater the height that may be achieved

  • Little response is seen after age 15-16 in boys and 14-15 in girls


Thyroid gland

Thyroid Gland

  • Produces hormones (T3 and T4) that stimulate metabolic activity of body tissues

  • Hypothalamus and pituitary glands work together to release TSH

  • TSH stimulates T3 and T4 release


Thyroid hormone feedback loop

Thyroid Hormone Feedback Loop

  • Thyroid hormones build up in the blood

  • Signals are sent to the hypothalamic-pituitary axis that adequate levels have been met

  • TSH levels decrease


Feedback

Negative

feedback

-

Anterior

pituitary

Thyroid

hormones

TSH

Thyroid

gland

+

Feedback


Hypothyroidism

Hypothyroidism

  • Production of thyroid hormones is below normal

  • Cretinism occurs in children at birth due to inadequate maternal iodine intake

    • Can cause mental retardation, thick tongue, lethargy, lack of response, short stature – can be corrected if treated


Primary and secondary disorders

Primary

Thyroid

disease

Secondary

Thyroid

disease

Primary and secondary disorders


Hypothyroidism symptoms

Apathy

Constipation

Decreased heart rate

Depression

Dry skin, nails, and scalp

Easy fatiguing

Enlarged thyroid

Lowered voice pitch

Myxedema

Puffy face

Reduced mental acuity

Swelling of eyelids

Tongue enlarged and thickened

Weight gain

Hypothyroidism Symptoms


Causes of hypothyroidism

Causes of Hypothyroidism

  • Autoimmune destruction of the gland

  • Radioactive iodine therapy

  • Surgical removal of the gland


Treatment for hypothyroidism

Treatment for Hypothyroidism

  • Thyroid replacement therapy

    • Should not be used to treat obesity


Agents for hypothyroidism

Drug List

Agents for Hypothyroidism

  • levothyroxine, T4 (Levothroid, Levoxyl, Synthroid)

  • liothyronine, T3 (Cytomel)

  • liotrix (Thyrolar)

  • thyroid (Armour Thyroid)


Levothyroxine t 4 levothroid levoxyl synthroid

levothyroxine, T4 (Levothroid, Levoxyl, Synthroid)

  • Used for chronic therapy

  • Can be cardiotoxic

  • Alters protein binding of other drugs

  • Should not switch brands once stabilized


Levothyroxine dispensing issues

levothyroxine Dispensing Issues

  • Can be cardiotoxic; report any of the following:

    • Chest pain, increased pulse, palpitations, heat intolerance, excessive sweating

Warning!


Levothyroxine dispensing issues1

levothyroxine Dispensing Issues

  • Look-alike and Sound-alike Drugs:

    • levothyroxine (thyroid replacement)

    • levofloxacin (antibiotic)

Warning!


Hyperthyroidism

Hyperthyroidism

  • Excessive thyroid hormone

  • Most common cause is Grave’s disease

  • Other causes:

    • Excessive exogenous iodine

    • Thyroid nodules

    • Tumor in the pituitary causing overproduction of TSH


Symptoms of hypterthyroidism

Symptoms of Hypterthyroidism

  • Decreased menses

  • Diarrhea

  • Exophthalmos

  • Flushing of the skin

  • Heat intolerance

  • Nervousness

  • Perspiration

  • Tachycardia

  • Weight loss


Agents for hyperthyroidism

Drug List

Agents for Hyperthyroidism

  • methimazole (Tapazole)

  • propylthiouracil, PTU

  • radioactive iodine, 131I


Discussion

Discussion

What are the treatment options for hyperthyroidism?


Discussion1

Discussion

What are the treatment options for hyperthyroidism?

Answer: in children: surgery and hormone replacement; adults: surgery or medications


Diabetes hypoglycemic agents

Diabetes/Hypoglycemic Agents

  • In the islets of Langerhans, in the pancreas, there are two primary specialized cells

  • Alpha Cells

  • Beta Cells


Hypoglycemic agents

Hypoglycemic Agents

  • In the islets of Langerhans, in the pancreas, there are two primary specialized cells

  • Alpha Cells

    • Produce glucagon and raise blood glucose levels

  • Beta Cells


Hypoglycemic agents1

Hypoglycemic Agents

  • In the islets of Langerhans, in the pancreas, there are two primary specialized cells

  • Alpha Cells

    • Produce glucagon and raise blood glucose levels

  • Beta Cells

    • Produce insulin and lower blood glucose levels


Insulin

Insulin

  • Helps cells burn glucose for energy

  • Works with receptors for glucose uptake

  • Enhances transport and incorporation of amino acids into protein

  • Increases ion transport into tissues

  • Inhibits fat breakdown


Diabetes

Diabetes

  • Caused by inadequate secretion or utilization of insulin

  • Leads to excessive blood glucose levels

  • Normal: 100 mg/dL


Type i diabetes

Type I Diabetes

  • Occurs most commonly in children and young adults

  • Average age of diagnosis is 11 or 12

  • Patients are insulin dependent and have no ability to produce insulin on their own

  • May be due to an autoimmune response

  • Type I accounts for 5-10% of diabetic population


Type ii diabetes

Type II Diabetes

  • Affect 80-90% of diabetics

  • Most patients are over 40 and more women than men are affected

  • Could be caused by insulin deficiency or insulin receptor resistance

  • Many of these patients are overweight and can treat their diabetes with weight loss


Gestational diabetes

Gestational Diabetes

  • Occurs during pregnancy

  • Increases risk of fetal morbidity and death

  • Onset is during the 2nd and 3rd trimesters

  • Can be treated with diet, exercise, and insulin

  • 30-40% of women with gestational diabetes will develop type II in 5-10 years


Secondary diabetes

Secondary Diabetes

  • Caused by medications

    • Oral contraceptives

    • Beta blockers

    • Diuretics

    • Calcium channel blockers

    • Glucocorticoids

    • phenytoin

  • May return to normal when drug is stopped


Symptoms of diabetes

Symptoms of Diabetes

  • Frequent infections

  • Glycosuria

  • Hunger

  • Increased urination and nocturia

  • Numbness and tingling

  • Slow wound healing

  • Thirst

  • Visual changes

  • Vomiting

  • Weight loss, easy fatigability, irritability, ketoacidosis


Complications of diabetes

Complications of Diabetes

  • Retinopathy leading to blindness

  • Neuropathy

  • Vascular problems can lead to inadequate healing which could lead to amputation

  • Dermatologic involvement

  • Nephropathy is the primary cause of end-stage renal disease


Lack of insulin activity

Lack of Insulin Activity

  • Diabetics cannot use glucose therefore their bodies metabolize fat

  • Gluconeogenesis is the formation of glucose from protein and fatty acids

  • Fatty acid is oxidized into ketones


Ketones

Ketones

  • Strong acids

  • Cause the body pH to drop

  • Excreted in the urine or eliminated through respiration

  • Causes a fruity acetone smell on the breath that can be mistaken for alcohol


Treating diabetes

Treating Diabetes

  • Treatment consists of diet, exercise, and medications

  • Blood glucose monitoring must be done regularly throughout the day

  • Type II diabetics may be able to control the disease through diet and exercise alone


Treatment for type ii

Treatment for Type II

  • Lifestyle changes

  • Oral monotherapy

  • Combination oral therapy

  • Oral drug plus insulin

  • Insulin only


General treatment guidelines

Attention to diet

Blood pressure control

Compliance with medications

Control of hyperlipidemia

Daily foot inspections

Increased physical activity

Recognizing hypoglycemia

Blood glucose testing

Monitoring in the Dr’s office

Patient education

Prompt treatment of infections

Setting goals

General Treatment Guidelines


Drug for lower extremity diabetic ulcers

Drug List

Drug for Lower Extremity Diabetic Ulcers

  • becaplermin gel (Regranex)


Insulin1

Insulin

  • Administered subcutaneously due to degradation in the GI tract

  • Different types of insulin have different onset of action times and duration of action times


Insulin duration of action

Insulin Duration of Action


Insulin dispensing issues

Insulin Dispensing Issues

  • It is very easy to grab the wrong insulin in the refrigerator

  • Always double-check yourself

  • They look exactly alike

Warning!


Insulin administration sites should be rotated

Insulin administration sites should be rotated


Hypoglycemia

Hypoglycemia

  • Blood glucose levels of <70 mg/dL

  • Can be caused by

    • Skipping meals

    • Too much exercise

    • Poor medication regimen

    • Certain drugs


Signs symptoms of hypoglycemia

Confusion

Double vision

Headache

Hunger

Numbness and tingling in mouth and lips

Nervousness

Palpitations

Sweating

Thirst

Visual disturbances

Weakness

Signs & Symptoms of Hypoglycemia


Human insulins

Drug List

Human Insulins

  • NPH isophane insulin (Humulin N)

  • insulin aspart (NovoLog)

  • insulin glargine (Lantus)

  • insulin lispro (Humalog)

  • regular insulin (Humulin R)


Insulin lispro humalog

insulin lispro (Humalog)

  • Rapid-onset insulin

  • Can be injected immediately before or after meals

  • May be used with a pump


Insulin aspart novolog

insulin aspart (NovoLog)

  • Rapid-acting insulin analog

  • Each dose should be administered before meals

  • May be used with a pump


Insulin glargine lantus

insulin glargine (Lantus)

  • Synthetic long-acting insulin

  • Absorbed slowly and works over a 24-hour time period

  • Works similarly to physiologic insulin release


Human insulins mixtures

Drug List

Human InsulinsMixtures

  • insulin aspart w/ protamine-insulin aspart (NovoLog Mix 70/30)

  • insulin lispro w/ protamine-insulin lispro (Humalog Mix 75/25)

  • insulin with zinc (lente) (Humulin L)

  • NPH-regular insulin (Humulin 70/30)


Oral hypoglycemic agents first generation sulfonylureas

Drug List

Oral Hypoglycemic Agents First- Generation Sulfonylureas

  • chlorpropamide (Diabinese)

  • tolbutamide


Oral hypoglycemic agents second generation sulfonylureas

Drug List

Oral Hypoglycemic AgentsSecond-Generation Sulfonylureas

  • glimepiride (Amaryl)

  • glipizide (Glucotrol, Glucotrol XL)

  • glyburide (DiaBeta, Glynase, Micronase)


Glipizide glucotrol glucotrol xl

glipizide (Glucotrol, Glucotrol XL)

  • Taken with breakfast

  • Promotes insulin release from beta cells

  • Increases insulin sensitivity


Glipizide dispensing issues

glipizide Dispensing Issues

  • Look-Alike and Sound-Alike Drugs

    • Glucotrol

    • Glucotrol XL

Warning!


Glipizide dispensing issues1

glipizide Dispensing Issues

  • Look-Alike and Sound-Alike Drugs

    • glipizide (Glucotrol, Glucotrol XL)

    • glyburide (DiaBeta, Glynase, Micronase)

Warning!


Oral hypoglycemic agents

Drug List

Oral Hypoglycemic Agents

Enzyme inhibitors:

  • acarbose (Precose)

  • miglitol (Glyset)

    Biguanide:

  • metformin (Glucophage, Riomet)


Metformin glucophage riomet

metformin (Glucophage, Riomet)

  • Decreases intestinal absorption of glucose and improves insulin sensitivity

  • Has an effect on serum lipid levels

  • Best candidates are overweight diabetics with high lipid profile


Oral hypoglycemic agents glitazones thiazolidinediones

Drug List

Oral Hypoglycemic Agents Glitazones/Thiazolidinediones

  • pioglitazone (Actos)

  • rosiglitazone (Avandia)


Pioglitazone actos

pioglitazone (Actos)

  • Depends on the presence of insulin

  • Liver enzymes should be carefully monitored

  • May be taken without regard to food


Rosiglitazone avandia

rosiglitazone (Avandia)

  • Increases insulin sensitivity in muscle and adipose tissue

  • Can be taken without regard to food


Oral hypoglycemic agents m eglitinides

Drug List

Oral Hypoglycemic Agents Meglitinides

  • nateglinide (Starlix)

  • repaglinide (Prandin)


Oral hypoglycemic agents combinations

Drug List

Oral Hypoglycemic Agents Combinations

  • glipizide-metformin (Metaglip)

  • glyburide-metformin (Glucovance)

  • rosiglitazone-metformin (Avandamet)


Discussion2

Discussion

What does a diabetic have to be concerned with in relation to diet?


Discussion3

Discussion

What does a diabetic have to be concerned with in relation to diet?

Answer: Eating at the same time everyday; to limit sugar intake by reading package labels


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