Question 1 of 5

Corticotropin-releasing factor is produced by which tissues? Select all that apply.

Adrenal glands
Anterior pituitary
Hypothalamus
Ovaries
Testes

Hypothalamus

Question 2 of 5

Increasing corticotropin-releasing factor levels will likely ___________________. Select all that apply.

decrease adrenocorticotropic hormone levels
increase thyroid hormone levels
increase cortisol levels
increase adrenocorticotropic hormone levels
inhibit anterior pituitary activity

increase cortisol levels
increase adrenocorticotropic hormone levels

Question 3 of 5

Increasing cortisol levels will _____________________.

stimulate adrenocorticotropic hormone production
stimulate corticotropic-releasing factor production
suppress posterior pituitary activity
suppress adrenocorticotropic hormone secretion
stimulate posterior pituitary secretions

stimulate corticotropic-releasing factor production

Question 4 of 5

If thyrotropin-releasing hormone and thyroid-stimulating hormone levels are high and thyroid hormone levels are below normal, then the hypothalamus is demonstrating ________________, the anterior pituitary is demonstrating _____________, and the thyroid gland is demonstrating ________________.

hyperfunction, hyperfunction, normal function
hyperfunction, hyperfunction, hypofunction
hypofunction, hypofunction, hypofunction
normal function, normal function, normal function
normal function, normal function, hyperfunction

hyperfunction, hyperfunction, normal function

**hyper, hyper, hypo

Question 5 of 5

After checking the thyroid hormone levels in the laboratory report of a patient suspected to have an endocrine disorder, the nurse concludes that the patient has secondary hypothyroidism. Which findings support the nurse's conclusion? Select all that apply.

Low T4 levels
Low thyroid-stimulating hormone levels
High thyroid-stimulating hormone levels
Normal T3, T4 levels
Normal T3, low T4 levels

Low T4 levels
High thyroid-stimulating hormone levels

Question 1 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Mr. Thompson's adrenal problem originates in adrenal cortex.
PRIMARYSECONDARYTERTIARY

PRIMARY

CORRECT. When the hormonal abnormality originates in the organ itself, it is considered a primary disorder.

Question 2 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Mrs. Jacobi's adrenal problem originates in the hypothalamus.
PRIMARYSECONDARYTERTIARY

TERTIARY

CORRECT. Endocrine disorders originating in the hypothalamus are tertiary disorders.

Question 3 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Ms. Wallace's adrenal problem originates in the pituitary gland.
PRIMARYSECONDARYTERTIARY

SECONDARY

CORRECT. A secondary condition arises when the hormonal signaling problem occurs in the pituitary gland.

Question 4 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Ms. Lee is experiencing elevated TSH and reduced thyroid hormone levels.
PRIMARYSECONDARYTERTIARY

PRIMARY

CORRECT. When TSH is elevated, but thyroid hormone levels remain low, this is a primary disorder. The thyroid glands are the problem. They are receiving a signal to produce thyroid hormone, but are unable to respond.

Question 5 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Mr. Ruiz is experiencing reduced ACTH and elevated cortisol.
PRIMARYSECONDARYTERTIARY

PRIMARY

CORRECT. A primary disorder occurs when the problem is in the end organ. In this example, the adrenal cortex is not receiving a signal to produce cortisol, as shown by reduced ACTH from the anterior pituitary. However, the adrenal cortex is continuing to produce cortisol despite a lack of signal.

Question 6 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Mrs. Smith is experiencing elevated TRH, elevated TSH, and elevated thyroid hormones.
PRIMARYSECONDARYTERTIARY

TERTIARY

CORRECT. A tertiary disorder is a problem in signaling from the hypothalamus. In this case, the hypothalamus is over producing TRH, which stimulates TSH, which in turn stimulates the thyroid gland. In a normal response, elevated thyroid hormones would negatively feedback and suppress TRH from the hypothalamus.

Question 7 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Mr. Wilson is experiencing elevated ACTH and elevated cortisol.
PRIMARYSECONDARYTERTIARY

SECONDARY

CORRECT. A secondary disorder arises from improper signaling from the anterior pituitary. Normally, elevated cortisol levels should suppress further secretion of ACTH by the anterior pituitary. In a secondary disorder, the anterior pituitary no longer responds appropriately to this signal.

Question 8 of 8

For each question, choose whether the symptoms indicate a primary, secondary, or tertiary endocrine disorder.

Ms. Ang is experiencing low CRF, elevated ACTH, and elevated cortisol.
PRIMARYSECONDARYTERTIARY

SECONDARY

CORRECT. Problems in the anterior pituitary result in secondary disorders. In this case, the anterior pituitary is not responding correctly to signals from other glands. Elevated cortisol normally negatively feedbacks and reduces ACTH. Low CRF indicates the anterior pituitary is not being signaled to produce more ACTH. Despite this, the anterior pituitary is continuing to produce elevated ACTH levels, which in turn cause elevated cortisol levels.

Question 1 of 5

Which of the following are keys to understanding endocrine dysfunction? Select all that apply.

Understanding normal function of the gland
Understanding hypofunction
Understanding the location of the dysfunction
Understanding if the disorder is primary, secondary, or tertiary
Understanding hyperfunction

Understanding normal function of the gland
Understanding hypofunction
Understanding the location of the dysfunction
Understanding if the disorder is primary, secondary, or tertiary
Understanding hyperfunction

Question 2 of 5

The hypothalamic-pituitary-end organ progression of hormones is best represented by _____________.

Cortisol - corticotropin-releasing factor - adrenocorticotropic hormone
Cortisol - adrenocorticotropic hormone - corticotropin-releasing factor
Corticotropin-releasing factor - cortisol -- adrenocorticotropic hormone
Adrenocorticotropic hormone - corticotropin-releasing factor - cortisol
Corticotropin-releasing factor - adrenocorticotropic hormone - cortisol

Corticotropin-releasing factor - adrenocorticotropic hormone - cortisol

Question 3 of 5

If thyrotropin-releasing hormone, from the hypothalamus, and thyroid-stimulating hormone, from the anterior pituitary, are both lower than normal and thyroid hormone levels are elevated, the thyroid gland is demonstrating ___________________.

normal function
hypofunction
hyperfunction

hyperfunction

Question 4 of 5

Endocrine laboratory values reveal your patient has a tumor of the anterior pituitary. This tumor secretes excess adrenocorticotropic hormone, which stimulates cortisol by the adrenal gland. What type of endocrine dysfunction does your patient have?

Primary
Secondary
Tertiary

Secondary

Question 5 of 5

Which of the following laboratory values indicate a primary disorder of the thyroid gland?

Low thyrotropin-releasing hormone, low thyroid-stimulating hormone, high thyroid hormone
Low thyrotropin-releasing hormone, low thyroid-stimulating hormone, low thyroid hormone
High thyrotropin-releasing hormone, high thyroid-stimulating hormone, high thyroid hormone
Normal thyrotropin-releasing hormone, normal thyroid-stimulating hormone, normal thyroid hormone
Low thyrotropin-releasing hormone, high thyroid-stimulating hormone, high thyroid hormone

Low thyrotropin-releasing hormone, low thyroid-stimulating hormone, high thyroid hormone

Endocrine function and dysfunction revolve around the regulation of hormones. If the endocrine system is working properly, the body's hormones remain in balance. But if the endocrine system is experiencing dysfunction, the body could be suffering from hormone deficiency, hormone excess, or hormone resistance.

There are three keys to understanding disorders of the endocrine system:

Understanding normal functioning
Understanding hypofunction versus hyperfunction
Understanding how to use the location of the dysfunction to determine if the dysfunction is primary, secondary, or tertiary.
Let's start our survey of the endocrine system by examining how the system regulates hormones when it is healthy and functioning properly. The regulatory link that keeps the body's hormones in balance is the negative feedback system of the hypothalamic-pituitary-endocrine gland axis. This sounds more complicated than it actually is. At its core, the feedback system works like a running relay team: when one of the endocrine glands receives a particular hormone, that gland instructs another hormone to take the baton and depart for the next gland in the cycle...and so on. The feedback system enables the endocrine system to send hormones when and where they're needed.

To explain further, let's go for a run. As you run, the hypothalamus receives signals that the body has extra metabolic needs. To meet these needs, the hypothalamus secretes a hormone, corticotropin-releasing factor, which, in turn, stimulates the pituitary gland. The pituitary gland secretes another hormone, adrenocorticotropic hormone, and this stimulates the adrenal gland to secrete yet another hormone, cortisol. As levels of cortisol rise, the pituitary senses the increased level and shuts off stimulus to the adrenal gland.

Unfortunately, this negative feedback system can fail, and when it does it results in dysregulation of hormones. When this occurs, it can result in either hypofunction or hyperfunction. In hypofunction, an endocrine gland secretes an inadequate amount of hormone. In hyperfunction, an endocrine gland secretes an excessive amount of hormone.

The last key to understanding endocrine dysfunction is knowing exactly where the dysfunction is taking place. The location of the dysfunction tells you whether or not the dysfunction is a due to a primary, secondary, or tertiary disorder. In primary disorder, the endocrine gland itself causes dysfunction, as in hypothyroidism due to autoimmune destruction of the thyroid gland. In secondary disorder, the pituitary gland causes the dysfunction, as in hypothyroidism due to a lack of secretion of thyroid-stimulating hormone by the pituitary. And in tertiary disorder, the hypothalamus is the root.

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