diseases of the endocrine system
DESCRIPTION
Diseases of the endocrine system. Review hormones. Anterior pituitary GH TSH ACTH FSH LH Prolactin MSH Posterior pituitary Vasopressin (ADH) Oxytocin Thyroid T3, T4 Parathyroid PTH Adrenal cortex Aldosterone Cortisone Androgens, estrogens, progestins. Review. - PowerPoint PPT PresentationTRANSCRIPT
Anterior pituitary GH TSH ACTH FSH LH Prolactin MSH
Posterior pituitary Vasopressin (ADH) Oxytocin
Thyroid T3, T4
Parathyroid PTH
Adrenal cortex Aldosterone Cortisone Androgens, estrogens, progestins
Adrenal Medulla Catecholamines: epinephrine, norepinephrine
Pancreas Insulin Glucagon
Ovaries Estrogens Progesterone
Testes Testosterone
Thymus Thymosin – promotes development of immune cells – gone
in adulthood due to atrophy Pineal gland
melatonin
Mainly increase in hGH Chronic and progessive
Increase hGH in childhood S/S
Proportional increase in size because epiphyseal closure has not occurred yet
Abnormal and accelerated growth Often caused by an adenoma (cancer) Dx: CT and blood levels of hGH Tx: radiation or surgery usually
Increase hGH in adulthood S/S
Overgrowth of face, hands, and feet Overgrowth of soft tissues
Dx and Tx same as gigantism
Hypopituitarism in childhood Underdevelopment of the body often
caused by lack of hGH Many causes Tx: hormone replacement when needed
Not same as diabetes you hear about from the media
Disturbance of water metabolism S/S
Polyuria, polydipsia, signs of dehydration, such as dry mucous membranes, hypotension, dizziness, constipation, and poor skin turgor
Tx: replacement DDAVP (desmopressin acetate)
High T3, T4 production Low TSH levels S/S
Tachycardia, nervousness, excitability, insomnia, weight loss, tremor, loss of hair.
In advanced, exophthalmos (outward protusion of eyes)
Sudden exacerbation can indicate life-threatening condition, such as thyrotoxicosis (thyroid storm)
Dx: TSH, T3, and T4 levels. If concerns, thyroid scan
Tx: B-blocker for tachycardia PTU or Tapazole to stop thyroid production Radioactive Iodine for curative measures
Will “kill” the thyroid Will need thyroid replacement afterwards for life NEVER performed if pregnant because will
destroy mother’s and child’s thyroid
Graves disease Form of hyperthyroidism Body produces antibodies against thyroid,
which connect and mimic TSH causing large increase.
Thyroid will eventually “burn out” over time causing hypothyroidism
Can form a goiter
Low T3, T4 High TSH levels S/S:
Dry skin, fatigue, weakness, weight gain, loss of hair, constipation, intolerance to cold
Dx: TSH levels Tx: Levothyroxine (synthroid) for life Severe cases cause Myxedema
Cretinism Hypothyroidism in infancy S/S
Mental and growth retardation, stocky stature with protruding abdomen, lack of muscle tone contributing to inability to stand or walk, slow to smile in infancy
Part of Metabolic screening required at birth
Hard, painless lump or nodule on thyroid. Some exhibit dysphagia or hoarseness
Causes high blood calcium S/S:
Muscle weakness and paralysis, heart conduction problems, kidney stones, breakdown of bones causing increase risk for fractures
Dx: High PTH, calcium, chloride, and alkaline
phosphatase. Low serum phosphorus.
Tx: depends on cause
Causes low blood calcium S/S:
Hypocalcemia, overstimulation of skeletal muscle, numbness, tingling, muscle spasms
Dx: Low serum calcium High serum phosphate
Tx: depends on cause. Calcium and Vit D supplementation
High cortisol levels S/S:
Fatigue, weakness, changes in body appearance, weight gain.
Fat deposits on scapular area (buffalo hump) and abdomen. Moon face. Acne
Hypertension, edema, hyperlipidemia, osteoporosis, atherosclerosis, diabetes mellitus
Increase risk of infection due to suppression of immune response
Excessive hair growth, amenorrhea, impotence
Low to none aldosterone and cortisol Several symptoms including
hyperkalemia Tx: replacement of hormones
Either inadequate production of insulin by the pancreas or faulty utilization of insulin by the cells.
S/S: Polydipsia, polyuria, fatigue, weight loss,
hyperglycemia Several forms including
Insulin dependent diabetes mellitus (IDDM) (Type 1)
Non-insulin dependent diabetes mellitus (NIDDM) (Type 2)
Gestational diabetes
Insulin is secreted by the pancreas, connects to different cells on receptors causing glucose to go from the blood into the cell. As a result, blood glucose levels decrease.
If enough insulin is not released, then glucose will remain elevated in the blood
If the receptors are not working well, the insulin will not work causing the blood glucose levels to remain high
If glucose cannot get into the cells, then another source must be used, which is fat and protein, resulting in production of waste products called ketones. Ketones increase the acidity of the blood (lower pH). They also produce a fruity odor on the breath.
Atherosclerosis resulting in MI and CVA Retinopathy resulting in blindness Neuropathy Renal failure Delayed healing More prone to infection PVD resulting in foot ulcers
Usually in childhood Often antibodies destroy B-cells of
pancreas resulting in no insulin production
Tx: insulin replacement
Usually in adulthood but seen now in obese children
Patient often overweight or a family Hx Produces enough insulin but receptors
are not responding appropriately Tx: oral medications first, then insulin
Fasting blood sugar over 126 on two separate occasions results in a diagnosis
Fasting blood sugar between 101-125 is considered glucose intolerance
A1C Blood test measures how sugars have been
running for past 3 months Depending on source, A1C should be <7.0 or
<6.5 A non-diabetic will have an A1C <6.0
Yearly eye exams #1 cause of blindness
Foot exams #1 cause of amputations
Cholesterol Blood pressure Smoking Micro-protein in urine once/year
#1 cause of kidney failure
Sulfonylureas Glipizide, glyburide, amaryl Increases insulin release Side effect of hypoglycemia
Metformin Increases receptor response Side effect of GI disturbance
Thiazolidinediones (TZD) Actos, Avandia Increases number of receptors Side effect of edema – not to be used in CHF
Several different forms including long-acting and short-acting
Required to be injected Lantus most common long-acting
Lasts 24 hours Won’t cause hypoglycemia in most cases
Diabetic education Nutritional education Education on how to use meters Regular checking sugars Weight loss for type 2
Diabetes occurring during pregnancy Important to monitor closely Make cause large babies Usually resolves after delivery but not
always Some oral medications may be used but
not all Usually requires insulin
S/S Sweating, nervousness, weakness, hunger,
dizziness, trembling, headache, palpitations, confusion, abnormal behavior, coma
Brain’s fuel source is glucose – cannot use fat or glycogen, so low sugar causes CNS symptoms
Most commonly drug-induced Insulin, sulfonylureas, alcohol, excessive exercise,
ect… Tx: increase glucose and correct underlying cause If idiopathic, then diet modification. No
medications for long-term Tx