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

2. Endocrine System Terminology
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: 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

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 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

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 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, 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: 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

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: 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

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: 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

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