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Alterations of Hormonal Regulation

Alterations of Hormonal Regulation. Chapter 21. Elevated or Depressed Hormone Levels. Failure of feedback systems Dysfunction of an endocrine gland Secretory cells are unable to produce, obtain, or convert hormone precursors

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Alterations of Hormonal Regulation

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  1. Alterations of Hormonal Regulation Chapter 21

  2. Elevated or Depressed Hormone Levels • Failure of feedback systems • Dysfunction of an endocrine gland • Secretory cells are unable to produce, obtain, or convert hormone precursors • The endocrine gland synthesizes or releases excessive amounts of hormone • Increased hormone degradation or inactivation • Ectopic hormone release

  3. Target Cell Failure • Receptor-associated disorders • Decrease in number of receptors • Impaired receptor function • Presence of antibodies against specific receptors • Antibodies that mimic hormone action • Unusual expression of receptor function

  4. Hormone Delivery

  5. Alterations of the Hypothalamic-Pituitary System

  6. Diseases of the Posterior Pituitary • Syndrome of inappropriate antidiuretic hormone secretion (SIADH) • Hypersecretion of ADH • For diagnosis, normal adrenal and thyroid function must exist • Clinical manifestations are related to enhanced renal water retention, hyponatremia, and hypoosmolarity

  7. Diseases of the Posterior Pituitary • Diabetes insipidus • Insufficiency of ADH • Polyuria and polydipsia • Partial or total inability to concentrate the urine • Neurogenic • Insufficient amounts of ADH • Nephrogenic • Inadequate response to ADH

  8. Diseases of the Anterior Pituitary • Hypopituitarism • Pituitary infarction • Sheehan syndrome • Hemorrhage • Shock • Others: head trauma, infections, and tumors

  9. Diseases of the Anterior Pituitary • Hypopituitarism • Panhypopituitarism • ACTH deficiency • TSH deficiency • FSH and LH deficiency • GH deficiency

  10. Diseases of the Anterior Pituitary • Hyperpituitarism • Commonly due to a benign, slow-growing pituitary adenoma • Manifestations • Headache and fatigue • Visual changes • Hyposecretion of neighboring anterior pituitary hormones

  11. Diseases of the Anterior Pituitary • Hypersecretion of growth hormone (GH) • Acromegaly • Hypersecretion of GH during adulthood • Gigantism • Hypersecretion of GH in children and adolescents

  12. Hypersecretion of Growth Hormone (GH)

  13. Diseases of the Anterior Pituitary • Hypersecretion of prolactin • Caused by prolactinomas • In females, increased levels of prolactin cause amenorrhea, galactorrhea, hirsutism, and osteopenia • In males, increased levels of prolactin cause hypogonadism, erectile dysfunction, impaired libido, oligospermia, and diminished ejaculate volume

  14. Alterations of Thyroid Function • Hyperthyroidism • Thyrotoxicosis • Graves disease • Pretibial myxedema • Hyperthyroidism resulting from nodular thyroid disease • Goiter • Thyrotoxic crisis

  15. Thyrotoxicosis (Graves’ Disease)

  16. Alterations of Thyroid Function • Hypothyroidism • Primary hypothyroidism • Subacute thyroiditis • Autoimmune thyroiditis (Hashimoto disease) • Painless thyroiditis • Postpartum thyroiditis • Myxedema coma • Congenital hypothyroidism • Thyroid carcinoma

  17. Hypothyroidism

  18. Alterations of Parathyroid Function • Hyperparathyroidism • Primary hyperparathyroidism • Excess secretion of PTH from one or more parathyroid glands • Secondary hyperparathyroidism • Increase in PTH secondary to a chronic disease • Hypoparathyroidism • Abnormally low PTH levels • Usually caused by parathyroid damage in thyroid surgery

  19. Type 1 Diabetes Mellitus • Demonstrates pancreatic atrophy and specific loss of beta cells • Macrophages, T and B lymphocytes, and natural killer cells are present • Two types • Immune • Nonimmune

  20. Type 1 Diabetes Mellitus • Genetic susceptibility • Environmental factors • Immunologically mediated destruction of beta cells • Manifestations • Hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, and fatigue

  21. Type 1 Diabetes Mellitus

  22. Type 1 Diabetes Mellitus

  23. Dysfunction of the Pancreas • Type 2 diabetes mellitus • Maturity-onset diabetes of youth (MODY) • Gestational diabetes mellitus (GDM) • Common form of diabetes mellitus type 2 • Insulin resistance

  24. Type 2 Diabetes Mellitus

  25. Acute Complications of Diabetes Mellitus • Hypoglycemia • Diabetic ketoacidosis • Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) • Somogyi effect • Dawn phenomenon

  26. Diabetic Ketoacidosis

  27. Chronic Complications of Diabetes Mellitus • Hyperglycemia and nonenzymatic glycosylation • Hyperglycemia and the polyol pathway • Protein kinase C • Microvascular disease • Retinopathy • Diabetic nephropathy

  28. Diabetic Nephropathy

  29. Chronic Complications of Diabetes Mellitus • Macrovascular disease • Coronary artery disease • Stroke • Peripheral arterial disease • Diabetic neuropathies • Infection

  30. Diabetic Amputation

  31. Diabetic Neuropathy

  32. Alterations of Adrenal Function • Disorders of the adrenal cortex • Cushing disease • Excessive anterior pituitary secretion of ACTH • Cushing syndrome • Excessive level of cortisol, regardless of cause

  33. Cushing Disease

  34. Alterations of Adrenal Function • Disorders of the adrenal cortex • Hyperaldosteronism • Primary hyperaldosteronism (Conn disease) • Secondary hyperaldosteronism

  35. Primary Hyperaldosteronism

  36. Alterations of Adrenal Function • Disorders of the adrenal cortex • Adrenocortical hypofunction • Primary adrenal insufficiency (Addison disease) • Idiopathic Addison disease • Secondary hypocortisolism

  37. Alterations of Adrenal Function • Disorders of the adrenal cortex • Hypersecretion of adrenal androgens and estrogens • Feminization • Virilization

  38. Virilization

  39. Alterations of Adrenal Function • Disorders of the adrenal medulla • Adrenal medulla hyperfunction • Caused by tumors derived from the chromaffin cells of the adrenal medulla • Pheochromocytomas • Secrete catecholamines on a continuous or episodic basis

  40. Pheochromocytoma

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