1.  Endocrine Pathology Susan Nordin MD 11/3/11

2. Overview – Pathologies  Diabetes Mellitus – Separate Lecture  Disorders of the Pituitary Gland  Disorders of the Thyroid & Parathyroid  Disorders of the Adrenals  Disorders of the ovaries or testes  Thermoregulation and Environmental Conditions  Metabolic Disorders

3. Introduction – Endocrine System  Maintain equilibrium  Regulate functions of organ systems, through hormones  Reproductive  Growth & Development  Defense against stressors  Blood Glucose levels  Core body Temp  Blood pressure and heart rate  Water & electrolyte balance  Metabolism

4. Anatomy

5. Glands  Hypothalamus-  Releasing hormones which stimulate the pituitary  Dopamine which inhibits the pituitary production of prolactin  Pituitary Gland- Anterior and Posterior  Anterior: 6 hormones: ACTH, TSH, LH, FSH, PRL, GH  Posterior: 2 hormones: Oxytocin and ADH  Thyroid: Thyroxine  Parathyroid: Parathyroid hormone (PTH) and Calcitonin  Adrenal Glands: Cortisol, aldosterone, epinephrine  Pancreas and Gut: Insulin and glucagon and gut hormones  Ovaries/Testes: Estrogen, Progesterone and testosterone

6. Anatomy

7. Feedback loops

9. Body Function Regulation  Body Energy  Body Temperature  Body Fluid  Hormone response to Exercise

10. Common Signs & Symptoms  Fatigue/lethargy  Skin changes (dryness)  Orthostatic hypotension  Hypertension  Flushing/Sweating  Weight changes  Confusion/Mental Status Changes  Tremor  Lactation  Tachycardia/bradycardia  Diarrhea/Constipation  Heat or Cold intolerance  Muscle Weakness/Atrophy/Pain  Gynecomastia  Irregular menstrual cycles/Impotence  Abnormal hair growth  Polyphagia/polydipsia/polyuria  Weight changes

11. Disorders of the Pituitary Gland  Anterior Pituitary Disorders can cause:  Adrenal, Thyroid, Gonad, Lactation, Growth problems  Posterior Pituitary Disorders can cause:  Diabetes Insipidus (can’t concentrate urine)

12. Thyroid and Parathyroid Gland Disorders  Hyperthyroidism  Grave’s Disease  Hypothyroidism  Hyperparathyroidism The Parathyroids regulate Calcium

13. Disorders of the Adrenals  Addison’s Disease : Decreased production of adrenal hormones (Cortisol/Aldosterone)  Cushing’s Syndrome : Increased production of adrenal hormones (cCortisol/Aldosterone)  Pheochromocytoma : Produces epinephrine

14. Thermoregulation/Environmental  Heat Cramps  Heat Syncope  Heat Exhaustion  Heat Stroke  Exertional Hyponatremia  Frostbite  Hypothermia  Altitude Sickness

15. Metabolic Disorders  Gout  Metabolic Bone Disease  Osteoporosis  Paget Disease

16. The Tired Athlete  Psychological Profile of Athletes – Separate Lecture  Depression (SIGECAPS)  Endocrine Disorders  Infections  Anemia

17. I’m Still Tired Infections  Skin/Wound Infections  Blisters, puncture wounds, lacerations  Worsening of an underlying process due to continued training during viral illness:  Pneumonia, Pericarditis, Myocarditis, Sepsis  STI’s  Foodborne illness causing diarrhea  Viral infections like MONO, parvovirus  Tickborne illnesses (LYME, Anaplasmosis)

18. Still Tired Anemia  Fatigue usually with exertion  Pallor  Headache  Elevated heart rate  Glossitis  Poor immunity/frequent illness  Pica

19. Classification of Anemia Pathologic/Cause  Blood Loss  Acute or Chronic  Impaired Production  Aplastic anemia, or anemia associated with disease  Impaired DNA synthesis (B12/Folate)  Impaired hemoglobin synthesis (Iron, and thalassemia)  Increased Destruction  Hemolysis: Can be related to intrinsic defects, medications, infections, immune mediated

20. Classification of Anemia Morphologic/Shape  Microcytic (MCV is <80)  Hypochromic  Most commonly iron deficiency  Normocytic (MCV is 80-100)  Normochromic  Can be from chronic disease, dilution, destruction, acute loss  Macrocytic (MCV is >100)  Usually B12 or Folate deficiency

21.  Chronic Causes  Menses  GI blood loss (Crohn’s, ulcers, ischemia)  Microtrauma on the soles of the feet (marathon runners) Anemia Blood Loss

22. Impaired Production Ineffective Erythropoiesis  Iron deficiency  Defective hemoglobin synthesis  Vitamin B12 deficiency  Defective DNA synthesis  Nuclear maturation defect  Nutritional deficiency in strict vegans possible  Acid suppression with medications can cause poor absorption  Folic acid deficiency  Usually from poor nutrition, similar effects to B12 deficiency

23. Anemia  Think about elevation  S/S:  At Risk Population: Nutrition!

24. Laboratory Finding  Hct (Hematocrit) (%)  women 36-48 men 40-52  Hb (Hemoglobin) (g/dl) Normal is 12-16  Anemic when < 12 g/dl  MCV (Mean Corpuscular Volume)  Normal is 80-100  60-70 = Microcytic100+ = Macrocytic  RBC (Red blood cell) count  women 4.0-5.4 men 4.5-6.0  Anemia = low hemoglobin

25. Iron Deficiency Anemia - Treatment  3-6 mg per kg of body weight of elemental iron  http://www.cdc.gov/nutrition/everyone/basics/vitamins/ir on.html http://www.cdc.gov/nutrition/everyone/basics/vitamins/ir on.html  Better with vitamin C on an empty stomach  Frequent monitoring

26. Sports Anemia  Dilutional pseudoanemia  Will not respond to tx with iron  Normal MCV & ferritin  No affect of performance  Would not expect it to cause symptoms

27. How to Assess Patients  HISTORY, HISTORY, HISTORY  Cover all organ systems (ROS)  Physical Exam – General Affect, Appearance  Labs