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Endocrine System Diseases. Introduction to Human Diseases: Chapter 14. Endocrine System Terminology. Endocrine Exocrine Hormone Target organ Hypersecretion Hyposecretion. Pituitary Gland Diseases. Hyperpituitarism Hypersecretion of growth hormone (GH) by the pituitary Gigantism

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Endocrine System Diseases

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Endocrine system diseases

Endocrine System Diseases

Introduction to Human Diseases:

Chapter 14


Endocrine system terminology

Endocrine System Terminology

  • Endocrine

  • Exocrine

  • Hormone

  • Target organ

  • Hypersecretion

  • Hyposecretion


Pituitary gland diseases

Pituitary Gland Diseases

  • Hyperpituitarism

    • Hypersecretion of growth hormone (GH) by the pituitary

  • Gigantism

    • GH hypersecretion during puberty and growth years

      • Person is very tall, proportioned normally

  • Acromegaly

    • GH hypersecretion during adulthood

    • Disfiguring overgrowth of bones & soft tissues


Hyperpituitarism

Hyperpituitarism

  • Other aspects:

    • Gigantism:

      • Fairly abrupt onset

      • Non-life threatening

      • Growth up to 6 inches/yr

    • Agromegaly:

      • Gradual onset

      • Decreases life expectancy

      • Headache, sinus problems, skin changes, paresthesias, joint pain, visual disorders


Hypopituitarism

Hypopituitarism

  • Deficiency of any or all of the pituitary hormones

  • Usually involve GH and gonadotropin

    • LH, FSH, Prolactin, Oxytocin

  • Less commonly involved:

    • ACTH and TSH

  • Panhypopituitarism:

    • All hormones are deficient


Hypopituitarism1

Hypopituitarism

  • S/S: varies with hormone deficiency and age of disease onset

    • In childhood: S/S are dwarfism and delayed development of 2ndary sexual characteristics

    • In adults: S/S are amenorrhea, infertility, lowering of testosterone levels, libidy, hair loss.

    • ACTH & TSH deficiency: general S/S: fatigue, pallor, anorexia, poor stress response


Hypopituitarism2

Hypopituitarism:

  • Treatment: hormone replacement


Diabetes insipidus

Diabetes Insipidus

  • Hyposecretion of vasopressin

    • ADH (antidiuretic hormone)

  • S/S: extreme polyuria, thirst, very dilute urine produced, leads to dehydration

  • Etiology: anything that destroys the pituitary or idiopathic

  • Treatment: fluid replacement, hormone replacement (tablet, nasal spray)


Thyroid gland diseases

Thyroid Gland Diseases

  • Goiter

    • Enlargement or hyperplasia of thyroid gland

  • Simple goiter

    • Goiter not caused by infection, tumor, other hypo- or hyperthyroid condition

    • More common in females

    • Sporadic and endemic types


Goiter

Goiter

  • Sporadic type

    • Ingestion of certain foods, drugs (goitrogens)

  • Endemic type

    • Diet deficiency of iodine

  • Etiology: hyperplasia due to inability to make sufficient T3 and T4, compensation

  • Treatment: T3 or T4 or iodine replacements, surgery, dietary changes


Thyroiditis

Thyroiditis

  • Inflammation of thyroid gland

  • Females more than males

  • Etiology & types:

    • Autoimmune

      • Antibodies to thyroid hormones

      • Myxedema, Grave’s disease

      • Hashimoto’s thyroiditis (lymphocytes infiltrate)

    • Subacute granulomatous

      • Follows an infection (mumps, influence, adenovirus)

    • Miscellaneous

      • Bacterial infections (TB, syphilis, suppurative)


Thyroiditis1

Thyroiditis

  • S/S: may have no symptoms or thyroid enlargement, pain and dysphagia

  • Autoimmune thyroiditis = most common type, common in females

  • Treatment varies with type:

    • Hormone replacement, steroid, antibiotics, anti-inflammatories, pain meds


Grave s disease

Grave’s Disease

  • Hyperthyroidism

    • Grave’s disease is most common hyperthyroid disease

  • Hypersecretion of T3 and T4

  • May cause thyrotoxicosis

    • Diffuse effect, multiple symptoms

  • Females mostly, 30-40 YOA

  • Etiology:

    • Genetic or immunologic


Grave s disease1

Grave’s Disease

  • S/S:

  • Thyrotoxicosis

    • Anxiety, insomnia, heat intolerance, sweating, muscle wasting, weight loss, tachycardia, hypertension

    • Thyroid storm: critical episode of thyrotoxicosis

  • Ophthalmopathy: exophthalmos (protrusion of eyeballs, “frightened” appearance)

  • Dermopathy: thickened skin on legs/feet (“orange skin”

  • Exacerbations & remissions


Grave s disease2

Grave’s Disease

  • Treatment:

    • Varies with disease severity & patient age

    • Antithyroid drugs, surgery, radioactive iodine therapy


Hypothyroidism

Hypothyroidism

  • Hyposecretion of thyroid hormones

  • More common in women, esp. over 40 YOA

  • Two versions:

    • Cretinism

      • Congenital form

    • Myxedema

      • Starts in childhood or adulthood


Hypothyroidism1

Hypothyroidism

  • Etiology:

    • Dietary, metabolic, iatrogenic, congenital, inflammatory, chronic autoimmune

  • S/S:

    • Children: growth retardation, delayed sexual development, impaired intelligence

    • Adults: cold intolerance, fatigue, constipation, weight gain, anorexia, dry skin, brittle hair &nails, cardiomegaly, myxedema coma

  • Treatment: Hormone replacement meds


Parathyroid diseases

Parathyroid Diseases

  • Hyperparathyroidism

  • Affects women more than men (2:1)

  • Excessive secretion of PTH by gland causes abnormalities of calcium (Ca++) and phosphates (PO4--)

  • Effects:

    • Hypercalcemia (most important effect)

    • hypophosphatemia


Hyperparathyroidism hypercalcemia

Hyperparathyroidism/Hypercalcemia

  • Primary disease: parathyroid adenoma

  • Secondary disease: chronic RF, calcium deficient diet, calcium malabsorption

    • Any condition that tends to reduce circulating levels of calcium

  • S/S: many patients are asymptomatic

    • Brittle bones, arthralgias, calcium renal stones, polyuria, nausea, vomiting, fatigue, muscle weakness or atrophy, cardiac arrythmias


Hyperparathyroidism

Hyperparathyroidism

  • Treatment:

    • Surgical removal of gland(s)

    • Increasing fluid & sodium intake

    • Meds that increase calcium excretion

    • Treatment varies with the etiology, primary or secondary


Hypoparathyroidism

Hypoparathyroidism

  • Undersecretion of PTH by gland

    • Hypocalcemia

    • Excessive calcium deposition into bones

  • Etiology: iatrogenic (surgical) or inherited

  • S/S: paresthesias of extremities, muscle cramps (tetany), depresion, irritability, laryngospasm, seizures, brittle nails, hair loss


Hypoparathyroidism1

Hypoparathyroidism

  • Treatment:

    • Vitamin D and calcium supplements

    • Periodic lab tests to determine serum levels

    • High calcium, low phosphorus diet


Adrenal disease

Adrenal Disease

  • Cushing’s Syndrome:

    • Hypersecretion of hormones by the adrenal cortex

    • Cortisol excess

    • More common in women

    • May be due to:

      • Oversecretion of ACTH

      • Benign or malignant neoplasm of adrenal cortex

      • Iatrogenic (prolonged steriod treatment)


Cushing s disease

Cushing’s Disease

  • S/S:

    • “moon facies”, truncal obesity with thin limbs, “buffalo hump”, decreased glucose tolerance, muscle weakness, hypertension, anxiety, depression

  • Treatment:

    • Surgery for tumor removal, drug or radiation to decrease ACTH secretion


Other adrenal diseases

Other Adrenal Diseases

  • Addison’s Disease

    • Hyposecretion of adrenal cortex hormones

    • Decreased ability to handle physiological stress

    • Low BP, increased temperature

  • Pheochromocytoma

    • Tumor of adrenal medulla

    • Secretes catecholamines

      • Epinephrine

      • Norepinephrine

      • Like SNS, increases blood pressure, heart rate, skin flushing


Diabetes mellitus

Diabetes Mellitus

  • Chronic carbohydrate metabolism disorder due to insulin deficiency or inadequate insulin utilization by cells

  • Insulin

    • Pancreatic endocrine secretion (hormone)

    • Made by islet of Langerhans

    • Lowers serum glucose level

    • Allows cellular uptake and use of glucose


Diabetes mellitus dm

Diabetes Mellitus (DM)

  • Disorder characterized by:

    • Hyperglycemia

    • Ketosis (ketones in the blood)

    • Acidosis (excess hydrogen ions in the blood)

    • Ketoacidosis


Diabetes mellitus1

Diabetes Mellitus

  • Types of DM:

    • Type 1 (juvenile onset)

      • Immune-mediated absence of insulin

      • Often seems to appear abruptly & emergently

    • Type 2 (adult onset)

      • Able to make insulin

      • Often obesity related

    • Gestational (GDM)

      • Occurs during pregnancy & resolves after delivery

      • 25% risk of DM development later in life

      • Tend to have large babies (over 9 lbs)


Diabetes

Diabetes:

  • Etiology:

    • Autoimmune, genetic, pancreatic disorders, drugs, tumors, Cushing’s, cells become insensitive to insulin in some

  • S/S:

    • Three P’s: polyuria, polydipsia, polyphagia

    • Increased susceptibility to infections & vascular diseases, retinopathy, renal failure


Diabetes1

Diabetes:

  • Treatment:

    • Type 1: insulin administration

    • Type 2: diet & exercise

      • Oral hypoglycemics

      • insulin


Diabetic emergencies

Diabetic Emergencies:

  • Insulin shock (severe hypoglycemia)

  • Diabetic Ketoacidosis

    • Severe hyperglycemia & ketoacidosis

    • Altered mental status, possible coma

    • Severe dehydration


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