Endocrine Diseases1

8/13/2019 Endocrine Diseases1

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Endocrine Diseases

Endocrine Sys:

Hypercorticism(Cushings Disease)

Gigantism Acromegaly

Type ofDisease Hyperpituitarism

Pathology

Oerproduction of !CTH from pituitary Oer production of "H ina child

Oerproduction of "H in an adult

CausePituitary: Tumor or hyperplasia #unctioning adenoma (Tumor) of anterior pituitary

Signs $Symptoms Hirtuism% masculini&ation'irili&ation (indicatie of adrenal

tumor due to androgens)% striae% central oesity% roundface% hyperpigmentation (indicatie of pit or ectopicproduction of !CTH)% seere proimal myopathy%psychological disturances% osteoporosis% uffalo hump%D*% HT+% facial plethora% acne% menstrual disorders

Eunuchoid haitus%elongated arms and legs%deficient genital andsecondary secharacteristics

Course facial features% prominent eyero,%massie scalloped tongue% myopathy% nereentrapment% prognathism% spade-shaped handand feet% osteoporosis% HT+% hypertrophiediscera

DiagnosisHypo.alemia% al.alosis% C/H assay (differentiateCushing Ds from ectopic !CTH)

cortisol

"H 0eel "H leel

TreatmentSurgical remoal of producing tumor

High doses of hydrocortisone 1 day prior to surgery and233mg continuous 45 on the day of surgery

4atrogenic Cushings Disease: Hydrocortisone 133mg6D% metyrapone (*etopirone)% !minogluthemide(Cytadren) in comination ,' 7etocona&ole

88Octreotide (Sandostatin)9romocriptine (Parlodel)

DiseaseProlactinoma

(!menorrhea-"alactorrhea Syndrome)

88most common functional pituitary tumor88

Simmonds Disease(Pituitary Cacheia)

Panhypopituitarism

Craniopharyngioma


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Type ofDisease Hyperpituitarism Hypopituitarism

PathologyOerproduction of prolactin nderproduction of pituitary tropic

hormonesPressure on pituitary thusdecreasing output of tropichormones

Cause

#unctioning adenoma of anterior pituitary Destruction of pituitary glandfrom:

Causes: postpartumemoli% surgery% tumoror T9

+on-secretory adenoma*etastases to pituitary

!d;acent tumor placing pressure

on pituitary4nfarction after deliery4nflammatory "ranulomatous Ds

!utoimmune pituitary destruction4rradiationEmpty Sella Tursica S4nfiltration: sarcoidosis%

histocytosis% hemachromatosis

Lesions of Hypothalamusfrom:Craniopharyngioma%"lioma"erminoma

5estigial remnants of /ath.espouch form slo, gro,ing cystitumors along craniopharyngeacanal

Signs $Symptoms


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PathologyEnlargement of pituitary during pregnancy follo,ed ysudden hypotension precipitates necrosis leading todecreased pituitary secretionORD4C% caernous sinus thromosis% D*

nderproduction of !DH Oerproduction of !DH

Cause

Sudden infarction of anterior loe due to hemorrhageor shoc. during deliery or traumatic aortion

!c>uired:Compressionor destructionofhypothalamusO/ posteriorpituitary yinflammatoryand infiltratielesions%tumors%radiation%trauma orsurgery

88Cranial:familial

4ntracranial trauma (hemorrhage)% infection(meningitis)% cytotoic drugsOREctopic !DH secretion

Signs $Symptoms #ailure of lactation% gonadotropic deficiency% !CTH%

TSH% *SH deficiency

Empty sella turcica

0arge olumes of dilute urine(polyuria)% ecessie thirst(polydipsia)% andhypernaturemia% prefer icecold ,ater

Diagnosis


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Cause

1? Deficiency of thyroid tissue: agenesis or hypoplasia% surgery% radiation@? "oiter: iodine deficiency% goitrogenic agents% Hashimotos Thyroiditis2? Hypothalamic lesions and hypopituitarismA? Peripheral resistance to thyroid hormones

1? !utoimmune disease of humoraland C*4

@? #amilial2? H0! D/B

**Most common form of

hypothyroidism**

Signs $Symptoms

#ailure of normal mental and odily deelopment% shortstature% ,ide-set eyes% protuberant tongue% dry s.in%coarse facial features

+eurologic: spasticity deafness% seere mentalretardation

Cold% lethargic% mentallydull% coarse features% puffys.in% hair loss%accumulation of mucinousground sustance ,ithindermis (myedema)

C5S: cardiomegaly%radycardia

C+S: mental slo,ing%stupor% coma

#eatures of hypothyroidism% progressiepainlessmoderate enlargement of thyroid

4ncreased incidence of lymphoma

Often associated ,ith other autoimmunedisorders (S0E% /!% "raes Ds)

DiagnosisfT2 and fTA% sTSH B (ecept hypothalamic lesions and hypopituitarism) Test for !

TSH% TAES/

Treatment

0eothyroine (TA) (Synthroid)T must start ,'in @-2mo to reerse s

0eothyroine (TA) (Synthroid)4nfants (1-mo) 1-1?Bmg

!dult ?31mg/echec. after -F ,ee.s

Suacute "ranulomatous Thyroiditis(De6uerains Thyroiditis)

Post Partum Thyroiditis(PPT)

(Silent Thyroiditis)

Suclinical Hypothyroidism

Type of Disease

Hypothyroidism

Pathology"ranulomas deelop in thyroid gland resultingin enlargement

Cause

ncertain% iral infection suggested ncertain% response topregnancy

Hashimotos% T "raes Ds% 0ithium%inade>uate thyroid replacement% 4odine-containing r% pulsatile TSH% !drenalinsufficiency% drugs% TSH producing tumor

Signs $ Symptoms

Painfulenlargement of thyroid% self limited ds% NONPainfulenlargement some asymptomatic% Some symptomatic:


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recoery in aout 2- months

Phase 4: hyperthyroid% to nl TSH% fT2$TA%

/!4

Phase 44: T2$TA% TSH% /!4

Phase 444 : TSH% T2% TA ,nl

of thyroid% self limited ds

Phase 4: hyperthyroid% to

nl TSH% fT2$TA% /!4

Phase 44: T2$TA% TSH%

/!4

Phase 444 : TSH% T2% TA ,nlCan mimic pp depression

cardiac% lipid% neuroehaior (esp?depression)

DiagnosisTSHTA

/!4

TSH% nl TA% fTA

Treatment

Hyperthyroid state: s:eta-loc.ers!s: monitorHypothyroid state:S: 0eothyroine for = 1@ mo?

!s: monitor

T symptomatic as ,ell as asymptomatic,' 0eothyroine/echec. ,ee.s


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*ultinodular "oiter(Plummers Ds)

"raes Disease(Toic Diffuse "oiter)

**Most common form ofhyperthyroidism**

Diffuse +ontoic "oiter(Simple "oiter)

Type of DiseaseHyperthyroidism

Pathology

4rregular nodular enlargement of thyroid dueto distended follicles ,ith mar.ed colloidaccumulation% firosis% hemorrhage

Ecessie stimulation ythyroid stimulatingimmunogloulins

Diffuse enlargement of thyroid

CauseTransformation from long-standing Simple"oiter

ncertain% proaly causedy immunologic mechanismand defect in !g-specificsuppressor T-cells

!ssociated ,' H0!-D/2and autoimmune Ds (S0E%Hashimotos Disease)

4odine deficiency due to:1? Deficiency in food and ,ater@? "oitrogens2? Physiologic demand

Signs $ Symptoms

*ight e s-free

Complication include: pressure on trachea%esophagus occasional Ostruction of S5C ,'retrosternal etension of goiter?

#eatures ofhyperthyroidism:nerousness% restlessness%emotional laility%tachycardia% palpitations%arrythmias% dyspnea% heatintolerance% s,eating%fatigue% tremor% hair loss% lid

lag and stare% atrialfirillation% thyromegaly%eophthalmos

Thyroid Storm

Self limited in 23G

Diffuse enlarged thyroid

Diagnosis

fT2 $ fTA% sTSH

T2/4!% Thyroid ! fT2 $ fTA% TSH

Treatment

Propylthiouracil*ethima&ole

8/adioactie iodide

Propylthiouracil*ethima&ole8/adioactie iodide

Surgery: SutotalThyroidectomy


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Suclinical Hyperthyroidism Primary Hyperparathyroidism

**most common cause ofhypercalcemia

Secondary Hyperparathyroidism

Type of DiseaseHyperthyroidism Hyperparathyroidism

PathologyCompensatory hyperplasia in response tohypocalemic state

CauseEuthyroid "raes% autonomousadenoma% Ecessie TH/ T% ThyroidHormone suppressie therapy

Parathyroid adenomaCarcinomahyperplasia

88Chronic renal failure*alasorption S5it D deficiency

Signs $ Symptoms!symptomatic or symptomatic: atrialfirillation% osteoporosis Osteitis #irosa Cystica (cysts

formed from resorption of Ca =leads to pathologic f and9ro,n tumorsI) 9O+ES+ephrolithiasis% gallstones =STO+ESPancreatitis = "/O+ESPeptic lcers = *O+ES

!ssoc? ,' *E+

Diagnosis

+l fTA% #T4% T2/4!TSH

serum Ca (2 consec?TestsJunless 1@)

serum phosphate

PTH

urinary Ca in @Ahr urine

!0P

c!*P in serum or urine

radiograph (find ro,n turmors)

serum Caserum phosphate

PTH

!0P

Treatment

4f on suppression therapy: /

!s: repeat TSH 2-mo%

@Ahr /!4 = if use eta loc.er or

antithyroid r

C! or adenoma: surgery

!cute Ds: ecretion ,' saline $ furosemide% *ithramycin% Calcitonin%

Diphosphates% Hydrocortisone% "allium +itrate*oderate Ds : hydration% diuresis% phosphates% calcitonin% indocin% !S!% DisodiumEtdronateCrisis: hopitli&ation% hydration *ithramycin% Disodium Etidronate


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Hypoparathyroidism

885E/K /!/E888

Thyroid Cancer

Type ofDisease Hypoparathyroidism Papillary(most commom)% #ollicular% mied% anaplastic%

medullary (can e assoc ,' *E+)

Pathology4nade>uate secretion of PTH or end-organ resistance

Cause

4diopathic% post surgical% radiation therapy% autoimmune ds% parathyroidaplasia associated ,' Di"eorges

/ecurrent thyroid C!% h of radiation eposure

Signs $Symptoms

Seere cases: cardiac arrhythmias% tetany% intracranial pressure ,'

papilledema% cataracts% diarrhea% epilepsy% Trousseaus Sign% numness%tingling% Cheste. sign

5aryDysphagia% hoarseness% firm and immoile nodules%cerical lymphadenopathy

Suspect nodules in males A3 and females B3 and !00nodules in children

Diagnosis

Serum Ca

phosphate leelsPTH

sTSH% !% Tg (L in malignancy)

Thyroid scan (cold nodules)%Calcitonin leel'S#+! iopsy

Treatment

Thyroidectomy (suspect !!% compression% cosmetic)/4!(inoperale% residual ds in nec.% inasion%metastasis)ChemotherapyTA suppressie therapy of TSH


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Disease

Cushing SyndromeConns Syndrome

(Primary Hyperaldosteronism)

Type of DiseaseHyperadrenalism

Pathology

88Pituitary: Tumor or hyperplasia (Cushing Disease)

!drenal: Tumor

Ectopic production of !CTH or C/H (usually carcinoid tumor of lung or pancreas)

4atrogenic

4ncreased leels of cortisol and aldosterone may result in hypertension% so fre>uentmonitoring of 9P is a nursing priority?

Hypersecretion of aldosterone

CauseOerproduction of !CTH from pituitary(Cushing Ds) ORoerproduction of C/# fromhypothalamus OR ectopic !CTH production OR!drenal tumor producing cortisol

88!drenocortical adenomaHyperplasiaCarcinoma (rarely)

Signs $Symptoms

Hirtuism% masculini&ation'irili&ation (indicatie of adrenal tumor due to androgens)%striae% central oesity% round face% hyperpigmentation (indicatie of pit or ectopicproduction of !CTH)% seere proimal myopathy% psychological disturances%osteoporosis% uffalo hump% D*% HT+%facial plethora% acne% menstrual disorders%ruising% CH#% edema% polyuria% polydipsia

Polyuria% polydypsia% muscle ,ea.ness% rena7 loss

H"N but hyporeninemia(due to feedac.from aldosterone)

Diagnosis

Hypo.alemia% al.alosis% C/H assay (differentiate Cushing Ds from ectopic !CTH)

(pituitary or ectopic) or (adrenal adenoma) !CTH depending on cause% or *SH depending on cause%

serum and @Aurine cortisol% serum glucose

Deamethasone Suppression Test

Pituitary */4 to confirm

!ldosterone leel

/enin 0eel*etaolic al.alosisEessie 7 in urine

serum 7

Saline Suppression Test

CT % then 5enous'!rterial sampling

Treatment

Surgical remoal of producing tumor% irradiation or resection of hyperplastic adrenalsHigh doses of hydrocortisone 1 day prior to surgery and 233mg continuous 45 on theday of surgery

4atrogenic Cushings Disease: Hydrocortisone 133mg 6D% metyrapone (*etopirone)%!minogluthemide (Cytadren) in comination ,' 7etocona&ole

Spironolactone (!ldactone)Or Diuretics


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Disease

"lucocorticoid /emediale!ldosteronism

("/!)

!drenogenital Syndrome Secondary !drenal 4nsufficiency

Type of Disease

Hyperadrenalism Hypoadrenalism

PathologyHypersecretion ofaldosterone'glucocorticoidsuppression

!ongenitalAdrenalHyperplasia(C!H): inornen&yme defect,hich inhiits

cortisol thus

!CTH causingadrenalhyperplasia andoerproduction ofandrogens

Adrenal#irili$ation:Tumor orhyperplasiaresulting in anoerproductionof androgens

Decreased production of !CTH

Cause!nl hyrid gene results instimulation of aldosterone y

!CTH

Congenital !drenocortical%hyperplasia%adenoma orcarcinoma

Destructie pituitary or lesions of the hypothalamus

Signs $Symptoms HT+ Present M rith

,' irili&ation of

female

Salt ,asting

5irili&ation offemale

Diagnosis

aldosterone leel

cortisol leel

!CTH

cortisol leel

androgens

!CTH

cortisol leel

nl aldosterone

TreatmentDeamethasone gien to predisposedmother to preent fetus from genitaldeformation

45 Hydrocortisone*ineralcorticoids

Corticotropin (only parenteral)Hydrocortisone (oral)


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Disease!ddisons Disease

(Primary !drenocortical 4nsufficiency)Pheochromocytoma

Type of DiseaseHypoadrenalism Ds of Hypersecretion of the !drenal *edulla

PathologyDestruction of adrenal corte resulting in cortisol production and

aldosterone

Tumor arising from chromaffin cells of adrenal medullasecreting catecholamines(outside the adrenals: paragangliomas)

Cause8884diopathic adrenalitis (autoimmune)8T98Histoplasmosis

!myloidosis% metastatic carcinoma% hemochromatosis

(all resulting in damage to the pituitary or hypothalamus)

Sporatic#amilial

Some associated ,' *E+ 44% *E+ 444

Signs $ Symptoms!cute: rapid progression% shoc.% septicemia%%aterhouse&'riderichsen% D4C ,',idespread hemorrhage in s.in and organs%dehydration% hypotension% ,ea.ness%hypothermia% ad pain% +'5

Chronic: insidiousonset% malaise% ,eightloss% hypotension% lossof ody hair% menstrualirregularities% s.inhyperpigmentation%,ea.ness% fatigue%anoreia% "4 s%saltcraings% posturalhypotension

4diopathic often assoc?,' other autoimmunediseases

Paroysmal or sustained HT+% angina% cardiacarrhythmias leading to CH#% flushing% diaphoresis%palpitations% +'5 tachycardia%

Episodic H!% s,eating% aniety% tremor% isualdisturances% ringing in ears% papilledema% heartmurmurs% cardiomegaly

Diagnosis

cortisol

+aL

glucose

7L

!CTH

catecholamines in serum and urine

Presence of 5*! (5anillylmandelic acid)in @Aurine

88pathnomonic*/4 to confirm

TreatmentAcute:

!ortisol133mg 45 6 -Funtil stale

/educe oer Bd to maintenance dose ofB3mg'd(# salineGlucose

!hronic:Hydrocortisone @3-23mg 6D@'2 gien in am1'2 gien in afternoon

#ludrocortisone

!lpha adrenergic loc.ers ,' 9eta 9loc.ers

Surgery


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Disease"anglioneuroma' +eurolastoma Type 4 Diaetes *ellitus Type 44 Diaetes *ellitus

Type of DiseaseDs of Hypersecretion of the !drenal *edulla *etaolic Disorder of the Pancreas

Pathology"anglioneuroma9enign tumor of ganglion cells

+eurolastomaHighly malignanttumor fromneural crest

! against eta cells destroyislet cells resulting in adecreased production ofinsulin

Target tissue deelops insulin resistance

CauseTumor 4mmune

5iral (Cac.sac.ie 5irus =molecular mimecry)

"enetic (lin.ed to H0!D/2$A on Chromosome)

Oereating% Oesity% "enetics (largepredisposition)/is. factors: aging% sedentary lifestyle

Signs $Symptoms

+eurolastoma: common in childhood% adominalmass% anemia% feer% ,t loss

Commonly metastasi&es to one of s.ull and orit(Hutchison-type)To lier (Pepper Syndrome)

Onset early in life% ut canoccur at any time%


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Type of Disease

Pathology

Cause

Signs $Symptoms

Diagnosis

Treatment


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Risk for fluid deficit----Addisions Disease & sweating profusely

Dehydratuionrestlessness

Fluid loss during severe diarrhea---reduced urine output vloume r/t AD secretion whichis stimulated!

Documents

Endocrine Diseases1