Endocrine Emergencies

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Produces and secretes chemical messengers called hormones
glands

The main function of the endocrine system
to maintain homeostasis and promote permanent structural changes

Excrete chemicals for elimination
exocrine glands

Examples of exocrine glands
sweat glands, salivary glands, liver

Secrete or release chemicals that are used inside the body
endocrine glands

How do hormones act on the body’s cells?
by increasing or decreasing the rate of cellular metabolism

Agonists
Molecules that bind to a cell’s receptor and trigger a response by that cell; they produce some kind of action or biologic effect

Antagonists
molecules that bind to a cell’s receptor and block the action of agonists

Two main functions of target cells
to recognize and bind to their particular hormones and to initiate an appropriate signal

The most important method by which hormonal secretion is maintained within a physiologic range
negative feedback

Occurs when normal cell signaling is interrupted and positive feedback is given
disease

The major components of the endocrine system
hypothalamus, pituitary, thyroid, parathyroid, adrenals, and reproductive organs (gonads)

The primary link between the endocrine and nervous systems
hypothalamus

A small region of the brain (not a gland) that contains several control centers for the body functions and emotions
hypothalamus

“The master gland”
pituitary gland

This gland’s secretions control and regulate the secretions of other endocrine glands
pituitary gland

The two lobes of the pituitary gland
anterior and posterior

The six hormones produced and secreted by the anterior pituitary gland
growth hormone, thyroid-stimulating hormone, adrenocorticotropin hormone, and three gonadotropic hormones

The 2 hormones secreted by the posterior pituitary gland
ADH and oxytocin

The body’s major metabolic hormone which stimulates energy production in cells, which increases the rate at which cells consume oxygen and use carbohydrates, fats, and proteins
thyroxine

An important component of thyroxine; thyroxine cannot be produced without this
iodine

Secreted by the thyroid gland; helps to maintain normal calcium levels in the blood
calcitonin

The hormones secreted by the adrenal glands
epinephrine, norepinephrine, corticosteroids, catecholamines, cortisol, aldosterone

The 2 hormones secreted by the thyroid gland
thyroxine and calcitonin

Acts as an antagonist to calcitonin
parathyroid hormone (PTH)

This hormone is secreted when calcium blood levels are low
parathyroid hormone (PTH)

How does parathyroid hormone work?
it stimulates the bone-dissolving cells to break down bone and release calcium into the bloodstream

The two parts of the adrenal glands
adrenal medulla and adrenal cortex

Regulate the body’s metabolism, its balance of salt and water, the immune system, and sexual function
corticosteroids

Catecholamines
epinephrine and norepinephrine; assist the body in coping with physical and emotional stress by increasing the heart and respiratory rates and the blood pressure

Stimulates most body cells to increase their energy production
cortisol

What does aldosterone do?
stimulates the kidneys to reabsorb sodium from the urine and excrete potassium by altering the osmotic gradient in the blood; increases both blood volume and blood pressure

What effects does norepinephrine have?
raises blood pressure by causing blood vessels and skeletal muscles to constrict

Responsible for the secretion of digestive enzymes
pancreas

The main hormones that the islets of Langerhans secrete
glucagon and insulin; both responsible for the regulation of blood glucose levels

How does glucagon work?
when it enters the bloodstream, it stimulates the liver to change glycogen into sugar and secrete it into the bloodstream, where cells can use it for energy

The ONLY hormone that decreases blood glucose levels
insulin

The most important androgen in men
testosterone

Regulate body changes with sexual development (puberty)
androgens

What are endocrine emergencies usually due to?
failure of normal hormone production, excessive hormone production, failure of feedback inhibition systems

The primary fuel for cellular metabolism
glucose

This disease is characterized by an inability to sufficiently metabolize glucose
Diabetes mellitus

Why does diabetes occur?
Either because the pancreas does not produce enough insulin or because the cells do not respond to the effects of the insulin that is produced

Type 1 diabetes
generally strikes children as opposed to adults (juvenile diabetes); Most patients do not produce insulin at all and require daily injections of supplementary, synthetic insulin throughout their lives to control blood glucose

Complications of diabetes
kidney problems, nerve damage, blindness, heart disease, and stroke

Type 2 diabetes
(adult-onset); blood glucose levels are elevated; the pancreas actually produces enough insulin but the body cannot effectively utilize it

The more common type of diabetes
type 2

Symptoms of type 2 diabetes
fatigue, nausea, frequent urination and thirst, unexplained weight loss, blurred vision, frequent infections and slow healing of wounds,

What will happen if the level of glucose in the blood drops dramatically?
the brain will starve; trembling, rapid heart rate, sweating, hunger, headache, mental confusion, memory loss, incoordination, slurred speech, irritability, dilated pupils, seizures, coma

What is normal blood glucose?
70-120mg/dL

When does hypoglycemia occur?
when blood glucose levels drop to 45mg/dL or less

Why should you make sure that you have a good IV line before giving D50?
because D50 is both hypertonic and acidic and it can do a lot of damage if it infiltrates out of the vein and enters the surrounding tissue

What is the dosage of D50?
12.5-25g slow IV

One of the classic symptoms of diabetes mellitus
hyperglycemia

Management for diabetes in the field
ABCs, oral glucose if the patient is alert and can swallow, D50 in an IV if the patient cannot swallow

Common early signs of hyperglycemia
frequent and excessive thirst and urination

What can hyperglycemia be caused by?
excessive food intake, insufficient insulin doses, infection or illness, injury, surgery, and emotional stress

If left untreated, what will hyperglycemia progress to?
diabetic ketoacidosis (DKA)

What happens in DKA?
Because the body cannot utilize glucose, it turns instead to other sources of energy-principally fat. The metabolism of fat generates acids and ketones as waste products.

Signs and symptoms of DKA
polyuria, polydipsia, polyphagia, nausea and vomiting, tachycardia, deep rapid respirations (Kussmaul respiratons), warm and dry mucous membranes, fruity odor on the breath from ketones

Excessive urine output
polyuria

Excessive eating
polyphagia

Excessive thirst
polydipsia

Kussmaul respirations
deep, rapid respirations seen in DKA; the body’s attempt to compensate for acidosis by blowing off excess carbon dioxide

A blood glucose of higher than what could indicate DKA?
300mg/dL

What are the goals of treating DKA in the prehospital setting?
begin rehydration and correct the patient’s electrolyte and acid-base abnormalities

Treatment of DKA in the field
start an IV and infuse up to 1L of NS , monitor cardiac rhythm, sodium bicarb may be needed if the patient has sharply peaked T waves

HHNC
hyperosmolar hyperglycemic nonketotic coma

This condition is characterized by hyperglycemia, hyperosmolarity, and an absence of significant ketosis
HHNC or HONK

Treatment for HONK/HHNC in the prehospital setting
ABCs, establish an IV, give a bolus of 500mL of NS, administer 25g of D50 if blood glucose levels are low

What is the primary role of cortisol?
to assist with the body’s response to stress

Regulates and maintains the salt and potassium balance in the blood
aldosterone

Caused by atrophy or destruction of both adrenal glands, leading to deficiency of all the steroid hormones produced by these glands
primary adrenal insufficiency (Addison’s disease)

What is the most common cause of an Addisonian crisis?
steroid withdrawal

What is the primary manifestation of adrenal crisis?
shock

Caused by an excess of cortisol production by the adrenal glands or by excessive use of cortisol or other similar steroid hormones
Cushing’s syndrome

Myxedema
adult hypothyroidism

Symptoms of hypothyroidism
fatigue, feeling cold, weight gain, dry skin, and sleepiness

An extreme manifestation of untreated hypothyroidism that is accompanied by physiologic decompensation
myxedema coma

A toxic condition caused by excessive levels of circulating thyroid hormone
thyrotoxicosis

The most common cause of hyperthyroidism
Grave’s disease

What may cold, dry skin indicate?
overdose of sedative drugs or alcohol

What may hot, dry skin suggest?
fever, heat stroke

What may cold, clammy skin suggest?
shock or severe hypoglycemia (as from insulin reaction)

What may hypertension and bradycardia suggest?
increased ICP

This gland’s secretions control or regulate the secretions of other endocrine glands
pituitary gland

Primary adrenal insufficiency that is caused by atrophy or destruction
Addison’s disease

Caused by an excess of cortisol production by the adrenal glands or by excessive use of cortisol or other similar (glucocorticoid) hormones
Cushing’s Syndrome

The outer part of the adrenal glands that produces corticosteroids
adrenal cortex

Where are the adrenal glands located?
above the kidneys

Hormone that targets the adrenal cortex to secrete cortisol (a glucocorticoid)
adrenocorticotropic hormone (ACTH)

Hormones that regulate the body’s metabolism, the balance of salt and water in the body, the immune system, and sexual function
corticosteroids

Hormones produced by the adrenal medulla that assist the body in coping with physical and emotional stress by increasing the heart and respiratory rates and the blood pressure
catecholamines (epi and norepi)

Stimulates the breakdown of glycogen to glucose; produced by the pancreas and is vital to the control of the body’s metabolism and blood sugar level
glucagon

Characterized by hyperglycemia, hyperosmolarity, and an absence of significant ketosis
HHNC/HONK

Condition in which the pancreas produces enough insulin but the body can’t effectively utilize it
insulin resistance

A specialized group of cells in the pancreas where insulin and glucagon are produced
islets of Langerhans

Hormone that regulates the production of both eggs and sperm, as well as production of reproductive hormone
luteinizing hormone (LH)

Tissues to which hormones are directed to act on
target tissues

A rare, life-threatening condition that may occur in patients with thyrotoxicosis. This condition is usually triggered by a stressful event or increased volume of thyroid hormones in the circulation
thyroid storm

What is insulin responsible for?
the removal of glucose from the blood for storage as glycogen, fats, and proteins

What causes diabetes mellitus?
the pancreas does not produce enough insulin or the cells do not respond to the effects of insulin that is produced

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