17 Endocrine System

Prefixes

eu- (good, normal)

hypo- (below, under, deficient)

hyper- (above, excessive)

oxy- (rapid, sharp, acid)

para- (around, beside, beyond, abnormal)

pan- (all, total)

poly- (many or much)

syn- (joined, together)

tetr- (four)

tri- (three)

Combining Forms

acr/o (extremities, height)

aden/o (gland)

adren/o (adrenal glands)

adrenal/o (adrenal glands)

calc/i (calcium)

cortic/o (cortex, outer layer of a body organ)

dips/o (thirst)

glyc/o (sugar)

endocrin/o (endocrine)

home/o (sameness)

kal/i (potassium)

myx/o (mucus)

natr/o (sodium)

parathyroid/o (parathyroid gland)

phys/o (growing)

pituitar/o (pituitary gland)

somat/o (body)

thyr/o (thyroid gland)

thyroid/o (thyroid gland)

Suffixes

-drome (run, running together)

-ectomy (excision, cut out)

-emia (in the blood)

-ia (conditon of, abnormal state, diseased state)

-ism (state of)

-itis (inflammation)

-logist (specialist or physician who studies and treats)

-logy (study of)

-megaly (enlarged, enlargement)

-oid (resembling)

-oma (tumor)

-pathy (disease)

-plasia (condition of, formation, development, growth)

-tomy (incision, cut into)

Apply the rules of medical language to pronounce, break into word parts, and define the following terms.

Label each word part by using the following abbreviations:

P = Prefix
WR = Word Root
CV = Combining Vowel
S = Suffix
CF = Combining Form

Example: osteoarthropathy (ä-stē-ō-är-THROP-ă-thē) – disease of bone and joint

WR     CV    WR     CV     S

oste / o / arthr / o /pathy

     CF               CF

Practice pronouncing and defining these commonly abbreviated endocrine system terms.

ACTH (adrenocorticotropic hormone)

ADH (antidiuretic hormone)

DI (diabetes insipidus)

DKA (diabetic ketoacidosis)

DM (diabetes mellitus)

FBS (fasting blood sugar)

FNA (fine needle aspiration)

FSH (follicle-stimulating hormone)

GH (growth hormone)

HbA1C (glycosylated hemoglobin)

LH (luteinizing hormone)

PRL (prolactin)

RAIU (radioactive iodine uptake)

Thyroid Profile (T4, T3, and TSH)

T4 (thyroxine level)

T3, (triiodothyronine level)

TSH (thyroid stimulating hormone)

Sort the terms from the word lists above into the following categories.

• Disease and Disorder (terms describing any deviation from normal structure and function)
• Diagnostic (terms related to process of identifying a disease, condition, or injury from its signs and symptoms)
• Therapeutic (terms related to treatment or curing of diseases)
• Anatomic (terms related to body structure)

Use terms related to the endocrine system.

Label the following endocrine system anatomy.

adrenal glands | ovaries (female) | pancreas | parathyroid glands (on posterior side of thyroid) | pineal gland | pituitary gland | testes (male) | thyroid cartilage of the larynx | thalamus | thymus | thyroid gland | trachea | uterus

Place the following medical terms in context to complete the scenario below.

antibodies | conjunctival | discontinue | elevated | medications | menstrual | palpitations | side effects

ENDOCRINE SYSTEM – CONSULTATION REPORT

PATIENT NAME: Jane SMITH
AGE: 26
SEX: Female
DATE OF CONSULTATION: January 15, 2020
CONSULTING PHYSICIAN: Mary Johnstone, MD, Internal Medicine

REASON FOR CONSULTATION: Hyperthyroidism; Graves disease.

HISTORY: Around 2 months ago she started noticing ________ and peripheral tremor. She was feeling more anxious and edgy. She had a 10-pound weight loss despite eating well. She was having some heat intolerance and diarrhea, and her ________ cycles were irregular. She also noticed her eyes were different.

She went to see her family doctor who did lab work and was found to have a TSH suppressed with a free T4 around 40 and free T3 around 10. She then had a 24-hour thyroid uptake and scan that was abnormal with a 24-hour of 70 and a diffuse pan with a homogeneous pattern percentage in keeping with Graves disease. Her TSI was ________ at around 30.

PHYSICAL EXAMINATION: On physical exam her blood pressure was 140/60, heart rate was 120 with regular rhythm. She had mild proptosis with no infection of the ________ area. Normal eye movement. No pretibial myxedema. She had a diffuse goiter of around 60 g with no murmur and no nodularity. No abnormal lymphadenopathies. There was a positional tremor. Her weight was 90 pounds.

SOCIAL HISTORY: Jane has no significant past medical history. She is finishing her fourth year in biological studies. She is also working on a part-time basis. She is not aware of a family history of thyroid disease. She is currently on no medications. She is a smoker, around 15 cigarettes a day. She rarely drinks alcohol. She denies marijuana use.

SUMMARY: Jane presents with Graves disease. She has hyperthyroidism positive ________ and an increased thyroid uptake and a thyroid scan in keeping with her condition.

We talked about different repair options. We discussed Tapazole versus radioactive iodine. We discussed the pros and cons of each treatment option. She preferred to start on Tapazole. We talked about the potential ________ of these medications including the risk of rash, increasing liver enzymes, and the rare risk of agranulocytosis. I explained to her that if she has a mild or high fever, she should have her CBC checked through the ER, and if there is evidence of a granulocytosis, she cannot resume Tapazole. Usually Tapazole is well tolerated.

PLAN: I have started her on Tapazole 30 mg, and she will repeat lab work in a month and see me at that point. I explained to her that usually 8-18 months of treatment are necessary. Response varies from patient to patient. Frequent levels are necessary to adjust the ________ according to response.

If she has side effects to Tapazole or there is no response, or she is experiencing regular flares, then she should ________ the use of the Tapazole. Other options such as radioactive viral can be considered. I would not favour radioactive iodine in her case as she is a smoker and that she has had a mild ophthalmopathy. Radioactive iodine can worsen ophthalmopathy, therefore it should be avoided in smokers.

We talked about the importance of discontinuing smoking as it can worsen the disease.

________________________________
Mary Johnstone, MD, Internal Medicine

Place the following medical terms in context to complete the scenario below.

congestive | diabetes | diuretics | edema | metabolic | neuropathy | palpitations | pulses | rhythms | sugars | vascular disease

ENDOCRINE SYSTEM – CONSULTATION REPORT

PATIENT NAME: Margaret JONES
SEX: Female
AGE: 56
DATE OF CONSULTATION: January 15, 2020
CONSULTING PHYSICIAN: Mary Johnstone, MD, Internal Medicine

REASON FOR CONSULTATION: Type 2 diabetes.

HISTORY: I saw Margaret as a follow up today in regards to poorly controlled type 2 ________ . She is reluctant to make any changes in her current medications. She is very afraid of side effects of all her medications. She has not been testing her blood sugar but is planning to start doing it again.

Unfortunately, Mary did not do lab work prior to seeing me. I do not have an updated lab work for at least 2 years. It is very difficult to assess her ________ control without any information.

She continues to be sedentary, but she tells me she has no chest pain or shortness of breath when doing the chores around the house or going up or down the stairs. She denies of orthopnea, ankle swelling, ________, presyncope or syncope.

PAST MEDICAL HISTORY
1. Type 2 diabetes diagnosed 2009. Advanced microvascular complications including non-proliferative retinopathy. Nephropathy with significant microalbuminuria. No ________ . Positive coronary artery disease and peripheral vascular disease. Poor control for several years.

2. Coronary artery disease. CABG 4 in 2019. LIMA to LAD SVG to OM and RCA. Grade 2 left ventricular function. Previous episodes of ________  heart failure preserved ejection fraction with regular admissions due to volume overload.

3. Hypertension.
4. Hypercholesterolemia.
5. Smoker.
6. Alcohol, 5-8 beers a week.
7. Obesity.
8. Peripheral vascular disease, femoral popliteal bypass in 2017.

MEDICATIONS
Aspirin 81 g q.d..
Bisoprolol 5 mg q.d.
Ramipril 20 mg q.d.
Rosuvastatin 20 mg q.d.
Invokana 300 mg q.d.
Tresiba 20 units q.d.
Metformin 1 b.i.d.
Ozempic 1 mg q.wk.

PHYSICAL EXAMINATION: On physical exam her weight was 100 kg. Blood pressure 160/70, heart rate 88/min. Sa and S2 were heard in 4 areas with regular ________ . There is a 2/6 systolic murmur best heard in aortic area with no radiation. Strong carotid pulses and radial ________. JVP was 3 cm above sternal angle. Lungs were clear. There was bilateral leg ________ with venous changes in keeping with venous stasis dermatitis. Abdomen was soft, no evidence of ascites. No focal findings.

SUMMARY: Margaret has a history of poorly controlled type 2 diabetes and today is very difficult to assess her metabolic control as I do not have any information as she is not checking her blood ________ and has not had lab work for several years. She tells me she is compliant with her plan.

She also has a history of coronary artery disease and currently has no exertional symptoms. There is no evidence of significant volume overload, but she has a history of recurrent admissions due to congestive heart failure preserved ejection fraction. She is currently not on ________ and I do not think that needs to be restarted. She should continue on the combination of ACE inhibitors, beta-blockers, antiplatelets, and high intensity setting therapy.

PLAN: I asked her to do lab work and come back to see me to reassess if her treatment plan is adequate. We talked about the importance of quitting smoking. Smoking is associated with increased risk of further coronary events and progression of her peripheral ________.

________________________________
Mary Johnstone, MD, Internal Medicine

Test your knowledge by answering the questions below.

1. Secrete hormones that travel through a duct to the target organs
2. Include sebaceous glands and sweat glands
3. Secrete chemical messengers that travel in the bloodstream
4. Release neurotransmitters into the junction between two neurons (synaptic cleft)

1. Endocrine
2. Neuron
3. Paracrine
4. Autocrine

1. A condition marked by high levels of thyroid hormones that results in weight loss, profuse sweating, and increased heart rate
2. A condition marked by low levels of thyroid hormones that results in weight gain, cold sensitivity, and reduced mental activity
3. A condition marked by a disorder of the pancreas, resulting in high levels of glucose in the blood
4. A condition marked by a disorder of the thyroid gland, resulting in hyperthyroidism

1. The distance travelled by hormones is always short
2. The glands release their secretions through ducts
3. Hormones are secreted into the extracellular fluid
4. The response time is always fast