Endocrine System Diseases

1. Endocrine System Diseases Introduction to Human Diseases: Chapter 14

2. Endocrine System Terminology • Endocrine • Exocrine • Hormone • Target organ • Hypersecretion • Hyposecretion

3. 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

4. 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

5. 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

6. 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

7. Hypopituitarism: • Treatment: hormone replacement

8. 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)

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. Grave’s Disease • Treatment: • Varies with disease severity & patient age • Antithyroid drugs, surgery, radioactive iodine therapy

16. Hypothyroidism • Hyposecretion of thyroid hormones • More common in women, esp. over 40 YOA • Two versions: • Cretinism • Congenital form • Myxedema • Starts in childhood or adulthood

17. 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

18. 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

19. 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

20. Hyperparathyroidism • Treatment: • Surgical removal of gland(s) • Increasing fluid & sodium intake • Meds that increase calcium excretion • Treatment varies with the etiology, primary or secondary

21. 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

22. Hypoparathyroidism • Treatment: • Vitamin D and calcium supplements • Periodic lab tests to determine serum levels • High calcium, low phosphorus diet

23. 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)

24. 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

25. 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

26. 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

27. Diabetes Mellitus (DM) • Disorder characterized by: • Hyperglycemia • Ketosis (ketones in the blood) • Acidosis (excess hydrogen ions in the blood) • Ketoacidosis

28. 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)

29. 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

30. Diabetes: • Treatment: • Type 1: insulin administration • Type 2: diet & exercise • Oral hypoglycemics • insulin

31. Diabetic Emergencies: • Insulin shock (severe hypoglycemia) • Diabetic Ketoacidosis • Severe hyperglycemia & ketoacidosis • Altered mental status, possible coma • Severe dehydration