Endocrine System Pathophysiology

7/21/2019 Endocrine System Pathophysiology

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Elevated or Depressed Hormone

Levels

Failure of feedback systems Dysfunction of an endocrine gland Secretory cells are unable to produce,

obtain, or convert hormone precursors The endocrine gland synthesizes or

releases ecessive amounts of hormone

!h "# $lterations of Hormonal %egulation


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Elevated or Depressed Hormone

Levels &cont'd(

)ncreased hormone degradation or

inactivation Ectopic hormone release


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Target !ell Failure

!ell surface receptor*associated disorders+ Decrease in number of receptors )mpaired receptor function

resence of antibodies against specificreceptors$ntibodies that mimic hormone action -nusual epression of receptor function

)ntracellular disorders !irculating inhibitors


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$lterations of the

Hypothalamic*ituitary System


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Diseases of the osterior ituitary

Syndrome of inappropriate antidiuretic

hormone secretion &S)$DH( Hypersecretion of $DH

For diagnosis, normal adrenal and thyroidfunction must eist

!linical manifestations are related to enhanced

renal .ater retention, hyponatremia, and hypo*

osmolality


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Diseases of the osterior ituitary

&cont'd(

Diabetes insipidus )nsufficiency of $DH olyuria and polydipsia

artial or total inability to concentrate the urine /eurogenic0 )nsufficient amounts of $DH

/ephrogenic0 )nade1uate response to $DH

sychogenic 2anifestations are related to enhanced .ater

ecretion, hypernatremia, and hyper*osmolality


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Diseases of the $nterior ituitary

&cont'd(

Hypopituitarism ituitary infarction

0 Sheehan syndrome0 Hemorrhage

0 Shock 3thers+

0 Head trauma0 )nfections0 Tumors


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&cont'd(

Hypopituitarism &cont'd( anhypopituitarism

0 $!TH deficiency0 TSH deficiency

0 FSH and LH deficiency0 4H deficiency


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&cont'd(

Hyperpituitarism !ommonly caused by a benign slo.*gro.ing

pituitary adenoma

2anifestations+0 Headache and fatigue0 5isual changes0 Hyposecretion of neighboring anterior pituitary

hormones


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&cont'd(

Hypersecretion of gro.th hormone &4H($cromegaly

0 Hypersecretion of 4H during adulthood 4igantism

0 Hypersecretion of 4H in children and adolescents


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&cont'd(

Hypersecretion of prolactin !aused by prolactinomas

0 )n females, increased levels of prolactin causeamenorrhea, galactorrhea, hirsutism, and osteopenia

0 )n males, increased levels of prolactin causehypogonadism, erectile dysfunction, impaired libido,

oligospermia, and diminished e6aculate volume


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$lterations of Thyroid Function Hyperthyroidism

Thyrotoicosis 4raves disease

0 retibial myedema Hyperthyroidism resulting from nodular thyroid

disease0 4oiter 2anifestations related to hypermetabolic state Thyrotoic crisis


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$lterations of Thyroid Function

Hypothyroidism rimary hypothyroidism

0 Subacute thyroiditis0 $utoimmune thyroiditis &Hashimoto disease(

0 ainless thyroiditis0 ostpartum thyroiditis0 2anifestations due to hypometabolic state0 2yedema coma

!ongenital hypothyroidism

Thyroid carcinoma


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2anifestations of Thyroid $lterations


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$lterations of arathyroid Function

Hyperparathyroidism rimary hyperparathyroidism

0 Ecess secretion of TH from one or moreparathyroid glands

Secondary hyperparathyroidism0 )ncrease in TH secondary to a chronic disease

2anifestations+0 Hypercalcemia0 Hypophosphatemia0 Hypercalciuria+ kidney stones0 athologic fractures


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$lterations of arathyroid Function

&cont'd(

Hypoparathyroidism$bnormally lo. TH levels -sually caused by parathyroid damage in

thyroid surgery 2anifestations+0 Hypocalcemia0 Hyperphosphatemia


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Type " Diabetes 2ellitus

Types+ $utoimmune &type "$( /onautoimmune &type "7(

ancreatic atrophy and specific loss ofbeta cells8 hyperglycemia .hen #9:*;9:

cells lost 2acrophages, T* and 7*lymphocytes, and

natural killer cells are present $lterations in insulin, amylin, glucagon


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Type " Diabetes 2ellitus &cont'd(

4enetic susceptibility Environmental factors )mmunologically mediated destruction of

beta cells 2anifestations+

Hyperglycemia olydipsia

olyuria olyphagia


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Dysfunction of the ancreas

Type = diabetes mellitus 2aturity*onset diabetes of youth &23D>( 4estational diabetes mellitus &4D2(

!ommon form of diabetes mellitus type =0 )nitial insulin resistance0 Later loss of beta cells0 Diagnosis &fasting glucose, postprandial glucose,

$"c(

0 2anifestations &non*specific(+ fatigue, pruritus,recurrent infections, visual changes, or symptoms of

neuropathy8 often over.eight, dyslipidemic,

hyperinsulinemic, and hypertensive


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$cute !omplications of Diabetes

2ellitus

Hypoglycemia Diabetic ketoacidosis &Type )( Hyperosmolar hyperglycemic nonketotic

syndrome &HH/?S( &Type ))( Somogyi effect Da.n phenomenon


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Diabetic ?etoacidosis


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!hronic !omplications of Diabetes

2ellitus

Hyperglycemia and nonenzymatic

glycosylation Hyperglycemia and the polyol path.ay

rotein kinase ! 2icrovascular disease

%etinopathy Diabetic nephropathy


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!hronic !omplications of Diabetes

2ellitus &cont'd(

2acrovascular disease !oronary artery disease Stroke

eripheral arterial disease Diabetic neuropathies )nfection


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$lterations of $drenal Function

Disorders of the adrenal corte+ !ushing disease

0 Ecessive anterior pituitary secretion of $!TH !ushing syndrome

0 Ecessive level of cortisol, regardless of cause


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!ushing Disease


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Disorders of the adrenal corte Hyperaldosteronism

0 rimary hyperaldosteronism &!onn disease(0 Secondary hyperaldosteronism


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&cont'd(

Disorders of the adrenal corte &cont'd($drenocortical hypofunction

0 rimary adrenal insufficiency &$ddison disease( )diopathic $ddison disease

0 Secondary hypocortisolism


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&cont'd(

Disorders of the adrenal corte

&cont'd( Hypersecretion of adrenal

androgens and estrogens0 Feminization0 5irilization


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Disorders of the adrenal medulla$drenal medulla hyperfunction

0 !aused by tumors derived from the chromaffin cellsof the adrenal medulla

heochromocytomas0 Secrete catecholamines on a continuous or episodic

basis

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Endocrine System Pathophysiology