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Endocrine Pathology

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  1. Endocrine Pathology

  2. Endocrine pathology in a nutshell problem up here problem down here

  3. Endocrine pathology in a nutshell Problem: too much too little

  4. Endocrine Pathology Organs • Pituitary • Thyroid • Adrenals • Pancreas Diseases Non-neoplastic  too much hormone  too little hormone Neoplastic  benign  malignant

  5. Pituitary Introduction Hyperpituitarism Hypopituitarism

  6. Pituitary gland

  7. Anterior and posterior pituitary

  8. Anterior pituitary

  9. Posterior pituitary

  10. Pituitary Introduction Anterior pituitary (adenohypophysis) • GH, ACTH, TSH, LH, FSH, and prolactin. • Controlled by hypothalamus. • Most problems happen here.

  11. Pituitary Introduction Posterior pituitary (neurohypophysis) • oxytocin, ADH (vasopressin) • hypothalamus makes them • posterior pituitary stores them

  12. Pituitary Introduction Oxytocin • labor • milk let-down • cuddling (after orgasm) • monogamy (vole studies) • trust (investment experiment) • female bonding (UCLA study)

  13. www.verolabs.com

  14. Hyperpituitarism • Definition: too much anterior pituitary hormone(s) • Most common cause: pituitary adenoma • Pituitary adenoma symptoms: • None, for a while • Endocrine abnormalities • Mass effects • Many types

  15. Pituitary adenoma

  16. Hyperpituitarism • Produces gigantism or acromegaly • Other findings • diabetes mellitus • hypertension • arthritis • gastrointestinal carcinoma • Lab findings •  GH (spurts) •  IGF-I (better) • GH unresponsive to glucose Growth Hormone Adenoma

  17. Adult male with gigantism

  18. 12 year old male with gigantism

  19. Tallest man in the world in 2008

  20. Tallest man in the world in 2009

  21. Tallest man in the world for 2010 Guinness Book

  22. Fezzik, Inigo Montoya, and Vizzini

  23. Andre the Giant

  24. Andre the Giant

  25. Acromegalic facial features

  26. Acromegaly: development over time

  27. Hyperpituitarism • Prolactinoma • ACTH-producing • FSH-LH-producing • TSH-producing • Non-functioning Other Pituitary Adenomas

  28. Surgical removal of pituitary adenoma

  29. Hypopituitarism • Definition: too little anterior pituitary hormone(s) • Causes • Pituitary destruction • Ischemic necrosis • Pituitary apoplexy • Symptoms usually insidious • Dwarfism • Loss of libido, menstrual abnormalities • Hypothyroidism • Adrenal insufficiency

  30. Thyroid Pathology

  31. Thyroid Introduction Hyperthyroidism Hypothyroidism Non-neoplastic diseases Neoplasms

  32. Normal thyroid follicles

  33. TRH 2° TSH hormone synthesis thyroid growth 1°

  34. Thyroid Hormone • Most thyroid hormone is bound. • Only the free form is active! • Thyroid hormone • binds to nuclear receptors • changes gene expression • increases carb and fat breakdown • stimulates protein synthesis • Result: increased basal metabolic rate.

  35. Thyroid Lab Tests

  36. Thyroid Lab Tests TSH T4

  37. Endocrine pathology in a nutshell problem up here problem down here

  38. Endocrine pathology in a nutshell problem up here problem down here

  39. Thyroid Lab Tests TSH low normal high primary hypothyroidism 2° or 3° hypothyroidism low * T4 subclinical hyperthyroidism subclinical hypothyroidism normal euthyroidism primary hyperthyroidism 2° or 3° hyperthyroidism high *

  40. Thyroid Lab Tests TSH low normal high primary hypothyroidism 2° or 3° hypothyroidism low * T4 subclinical hyperthyroidism subclinical hypothyroidism normal euthyroidism primary hyperthyroidism 2° or 3° hyperthyroidism high *

  41. Thyroid Lab Tests TSH low normal high primary hypothyroidism 2° or 3° hypothyroidism low * T4 subclinical hyperthyroidism subclinical hypothyroidism normal euthyroidism primary hyperthyroidism 2° or 3° hyperthyroidism high *

  42. Thyroid Lab Tests TSH low normal high primary hypothyroidism 2° or 3° hypothyroidism low * T4 subclinical hyperthyroidism subclinical hypothyroidism normal euthyroidism primary hyperthyroidism 2° or 3° hyperthyroidism high *

  43. Thyroid Lab Tests TSH low normal high primary hypothyroidism 2° or 3° hypothyroidism low * T4 subclinical hyperthyroidism subclinical hypothyroidism normal euthyroidism primary hyperthyroidism 2° or 3° hyperthyroidism high *

  44. Thyroid Lab Tests TSH low normal high primary hypothyroidism 2° or 3° hypothyroidism low * T4 subclinical hyperthyroidism subclinical hypothyroidism normal euthyroidism primary hyperthyroidism 2° or 3° hyperthyroidism high *

  45. cardiac: rapid pulse, arrythmias neuromuscular: tremor, emotional lability eye: lid lag skin: warm, moist gastrointestinal: diarrhea skeletal: osteoporosis thyroid storm:  thyroid hormone Hyperthyroidism A hypermetabolic state caused by  thyroid hormones.

  46. Lid lag

  47. slowing of mind and body myxedema: deepened voice cardiac: slow pulse gastrointestinal: constipation skin: dry, cool, pale cold intolerance delayed reflexes myxedema coma Hypothyroidism A hypometabolic state caused by ↓ thyroid hormones.