Download - Endocrine system diseases
Endocrine System Diseases
Introduction to Human Diseases:Chapter 14
Endocrine System Terminology
• Endocrine• Exocrine• Hormone• Target organ• Hypersecretion• Hyposecretion
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
Hyperpituitarism
• Other aspects:– Gigantism:
• 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
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
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
Hypopituitarism:
• Treatment: hormone replacement
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)
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
Goiter
• Sporadic 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
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)
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
Grave’s Disease
• Hyperthyroidism– Grave’s disease is most common hyperthyroid disease
• Hypersecretion of T3 and T4• May cause thyrotoxicosis
– Diffuse effect, multiple symptoms• Females mostly, 30-40 YOA• Etiology:
– Genetic or immunologic
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
Grave’s Disease
• Treatment:– Varies with disease severity & patient age– Antithyroid drugs, surgery, radioactive iodine
therapy
Hypothyroidism
• Hyposecretion of thyroid hormones• More common in women, esp. over 40
YOA• Two versions:
– Cretinism• Congenital form
– Myxedema• Starts in childhood or adulthood
Hypothyroidism
• Etiology:– 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
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
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
Hyperparathyroidism
• Treatment:– Surgical removal of gland(s)– Increasing fluid & sodium intake– Meds that increase calcium excretion– Treatment varies with the etiology, primary or
secondary
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
Hypoparathyroidism
• Treatment:– Vitamin D and calcium supplements– Periodic lab tests to determine serum levels– High calcium, low phosphorus diet
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)
Cushing’s Disease
• S/S:– “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
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
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
Diabetes Mellitus (DM)
• Disorder characterized by:– Hyperglycemia– Ketosis (ketones in the blood)– Acidosis (excess hydrogen ions in the blood)– Ketoacidosis
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)
Diabetes:
• Etiology:– 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
Diabetes:
• Treatment:– Type 1: insulin administration– Type 2: diet & exercise
• Oral hypoglycemics• insulin
Diabetic Emergencies:
• Insulin shock (severe hypoglycemia)• Diabetic Ketoacidosis
– Severe hyperglycemia & ketoacidosis– Altered mental status, possible coma– Severe dehydration