1. Alterations of Hormonal Regulation
Chapter 18

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

3. Elevated or Depressed Hormone Levels
Increased hormone degradation or inactivation
Ectopic hormone release

4. Target Cell Failure Cell surface 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
Intracellular disorders
Circulating inhibitors

5. Hormone Delivery

6. Alterations of the Hypothalamic-Pituitary System

7. 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 hypo-osmolality

8. 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, tumer or closed head injury
Nephrogenic- renal tubuals not responding or drug induced
Inadequate response to ADH
Psychogenic- chronid indigestion

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

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

11. Diseases of the Anterior Pituitary
Hyperpituitarism
Commonly caused by a benign slow-growing pituitary adenoma
Manifestations
Headache and fatigue
Visual changes
Hyposecretion of neighboring anterior pituitary hormones

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

13. Diseases of the Anterior Pituitary
Hypersecretion of growth hormone (GH)

14. 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

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

16. Alterations of Thyroid Function
Hyperthyroidism

17. Thyrotoxicosis (Graves Disease)

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

19. Hypothyroidism

20. Hypothyroidism

21. 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

22. Alterations of Parathyroid Function
Hypoparathyroidism
Abnormally low PTH levels
Usually caused by parathyroid damage in thyroid surgery

23. 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

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

25. 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

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

27. Diabetic Ketoacidosis

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

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

30. 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

31. Cushing Disease

32. Cushing Disease

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

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

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

36. Virilization

37. 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