1 Alterations of Hormonal Regulation Chapter 21

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 4 Hormone Delivery

Mosby items and derived items © 2006 by Mosby, Inc. 5 Alterations of the Hypothalamic- Pituitary System

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 8 Diseases of the Anterior Pituitary  Hypopituitarism Pituitary infarction  Sheehan syndrome  Hemorrhage  Shock Others: head trauma, infections, and tumors

Mosby items and derived items © 2006 by Mosby, Inc. 9 Diseases of the Anterior Pituitary  Hypopituitarism Panhypopituitarism  ACTH deficiency  TSH deficiency  FSH and LH deficiency  GH deficiency

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 12 Hypersecretion of Growth Hormone (GH)

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 14 Alterations of Thyroid Function  Hyperthyroidism Thyrotoxicosis Graves disease  Pretibial myxedema Hyperthyroidism resulting from nodular thyroid disease  Goiter Thyrotoxic crisis

Mosby items and derived items © 2006 by Mosby, Inc. 15 Thyrotoxicosis (Graves’ Disease)

Mosby items and derived items © 2006 by Mosby, Inc. 16 Alterations of Thyroid Function  Hypothyroidism Primary hypothyroidism  Subacute thyroiditis  Autoimmune thyroiditis (Hashimoto disease)  Painless thyroiditis  Postpartum thyroiditis  Myxedema coma Congenital hypothyroidism Thyroid carcinoma

Mosby items and derived items © 2006 by Mosby, Inc. 17 Hypothyroidism

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 20 Type 1 Diabetes Mellitus  Genetic susceptibility  Environmental factors  Immunologically mediated destruction of beta cells  Manifestations Hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, and fatigue

Mosby items and derived items © 2006 by Mosby, Inc. 21 Type 1 Diabetes Mellitus

Mosby items and derived items © 2006 by Mosby, Inc. 22 Type 1 Diabetes Mellitus

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 24 Type 2 Diabetes Mellitus

Mosby items and derived items © 2006 by Mosby, Inc. 25 Acute Complications of Diabetes Mellitus  Hypoglycemia  Diabetic ketoacidosis  Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)  Somogyi effect  Dawn phenomenon

Mosby items and derived items © 2006 by Mosby, Inc. 26 Diabetic Ketoacidosis

Mosby items and derived items © 2006 by Mosby, Inc. 27 Chronic Complications of Diabetes Mellitus  Hyperglycemia and nonenzymatic glycosylation  Hyperglycemia and the polyol pathway Protein kinase C  Microvascular disease Retinopathy Diabetic nephropathy

Mosby items and derived items © 2006 by Mosby, Inc. 28 Diabetic Nephropathy

Mosby items and derived items © 2006 by Mosby, Inc. 29 Chronic Complications of Diabetes Mellitus  Macrovascular disease Coronary artery disease Stroke Peripheral arterial disease  Diabetic neuropathies  Infection

Mosby items and derived items © 2006 by Mosby, Inc. 30 Diabetic Amputation

Mosby items and derived items © 2006 by Mosby, Inc. 31 Diabetic Neuropathy

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 33 Cushing Disease

Mosby items and derived items © 2006 by Mosby, Inc. 34 Alterations of Adrenal Function  Disorders of the adrenal cortex Hyperaldosteronism  Primary hyperaldosteronism (Conn disease)  Secondary hyperaldosteronism

Mosby items and derived items © 2006 by Mosby, Inc. 35 Primary Hyperaldosteronism

Mosby items and derived items © 2006 by Mosby, Inc. 36 Alterations of Adrenal Function  Disorders of the adrenal cortex Adrenocortical hypofunction  Primary adrenal insufficiency (Addison disease) Idiopathic Addison disease  Secondary hypocortisolism

Mosby items and derived items © 2006 by Mosby, Inc. 37 Alterations of Adrenal Function  Disorders of the adrenal cortex Hypersecretion of adrenal androgens and estrogens  Feminization  Virilization

Mosby items and derived items © 2006 by Mosby, Inc. 38 Virilization

Mosby items and derived items © 2006 by Mosby, Inc. 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

Mosby items and derived items © 2006 by Mosby, Inc. 40 Pheochromocytoma