Endocrine System Diseases Introduction to Human Diseases: Chapter 14

Endocrine System Terminology Exocrine Hormone Target organ Hypersecretion Hyposecretion

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 Other aspects: Gigantism: Agromegaly: 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 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

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

Hypopituitarism: Treatment: hormone replacement

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 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 Sporadic type Endemic 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 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)

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 Hyperthyroidism Hypersecretion of T3 and T4 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 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 Disease Treatment: Varies with disease severity & patient age Antithyroid drugs, surgery, radioactive iodine therapy

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

Hypothyroidism Etiology: S/S: Treatment: Hormone replacement meds 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 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 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 Treatment: Surgical removal of gland(s) Increasing fluid & sodium intake Meds that increase calcium excretion Treatment varies with the etiology, primary or secondary

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

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

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 S/S: Treatment: “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 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 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) Disorder characterized by: Hyperglycemia Ketosis (ketones in the blood) Acidosis (excess hydrogen ions in the blood) Ketoacidosis

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: Etiology: S/S: 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

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

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