HMM 4401–Endocrine and obesity

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Mission

Blefjell hospital offers emergency and elective care and diagnostics in internal medicine, psychiatry, orthopedics and general surgery. Gynecological and obstetric services are differentiated between thethree units; Kongsberg, Notodden and Rjukan.Private practice specialists offer services in eye diseases, ear, nose and throat diseases, pediatrics etc. Diagnostic services to in- and outpatients include clinical labs, X-ray departments, physical therapy and a patient support unit (LMS)

Kongsberg

Sigdal

Rollag

Øvre Eiker

Flesberg

Nore og

Uvdal

Notodden

Nome

Bø

Sauherad

Tinn

Hjartdal

Seljord

Kviteseid

Tokke

Vinje

Blefjell hospital is a community hospital caring for the inhabitants of 16 municipalities.

Municipalities

Main endocrine diseases

• Heard of any endocrine or hormone diseases• Know any hormones?

The endocrine systems

• Not one system but many• Liver is an exocrine gland

• Has duct system to channel prduct• Thyroid is an endocrine gland

• Blood transports hormones to target• Endocrine systems are complex and give many

strange and rare diseases

Main endocrine diseases

• Heard of any endocrine or hormone diseases• Know any hormones?

Function of the endocrine system

• What is a metaphor for some of the endocrine systems?• Pituitary gland• Thyroid and parathyroid• Pancreas (alpha and beta)• Adrenals• Ovaries• Testes

Function of the endocrine system

• What do some of the endocrine systems do?• Pituitary gland – grand master, director• Thyroid - metabolism• parathyroid – calcium and bone• Pancreas (alpha and beta) diabetes, blood glucose• Adrenals –Salt and mineral balance, cushing disease• Ovaries – female charachteristics, fertility • Testes – male charachteristics, fertility

Function of hypothalamus - pituitary

• Brain controlseverything!

• Sends signals- chemicals-to pituitary

• Pituitary stimulateor stop the “real”producer

• Blood lever of hormone decide stimulation

Function continued – many hormones

• Brain controlseverything!

• Antidiuretic• Cortisol• Endorphins• Growth hormone• Oxytocin• Prolactin• Luteinizing hormone• Thyroid

Function continued

• Brain controlseverything!

• Remember any hormones??

Function continued – thyrotixicosis or “high metabolism”

• Brain has lostcontrol!

• Thyroid isproducing without control

Function of thyroid – if too hing

Function of thyroid – if too high!

• Fast pulse• High blood pressure• Warm• Nervous• Increased appetite and

weight loss• Bulging eyes• diarrhea

Function of thyroid – if too low

• Low metabolism• Cold, always freezing, • Low pulse• Depressed, apathy

• Eat little, still over weight• Dry hair and skin• Tired• Hoarse voice• Constipation

Function of Adrenals

• Addisons disease: too little corticosteroids, loose salt

Low blood pressure

Fatigue

Death

Shock

Lack of stress response

Function of Adrenals

• Cushing disease: Too much corticosteroids, retain salt

Function of the endocrine system

• What do some of the endocrine systems do?• Pituitary gland – grand master, director• Thyroid - metabolism• parathyroid – calcium and bone• Pancreas (alpha and beta) diabetes, blood glucose• Adrenals –

• Salt and mineral balance, cushing disease• Adrenalin, stress, fight and fligth

• Ovaries – female charachteristics, fertility • Testes – male charachteristics, fertility

Function continued – many hormones

• Brain controlseverything!

• Antidiuretic• Cortisol• Endorphins• Growth hormone• Oxytocin• Prolactin• Luteinizing hormone• Thyroid

Complex systems and diagnosis

Diabetes

Diabetes

• Pancreas make insulin

• Too little insulin compared to body’s need = diabetes

• What is the difference between diabetes type 1 and 2?

Impaired glucose tolerance –metabolic syndrome

• Too

Diabetes – common disease

• Blood sugar too high• Fasting > 7,8 mmol• Non-fasting > 11 mmol• Repeated measurements if doubt• Give glucose and monitor response

• Causes: • Too much sugar• Too little insulin• Too many cells to cover with insulin

Diabetes – complications

• Blood vessels – heart disese, stroke, impotence• Eyes – retinopathy, poor vision, blindness• Kidney – poor function, kidney failure, transplantation• Nerves – neuropathy, walking on pillow, pain• Autonomic nerve system –

• poor regulation of blood pressure and GI-system

• Skin – sores, infection, poor healing• Blood – reduced immune system• Connective tissue – thickens, contracts

What is atherosclerosis?

What is atherosclerosis, step by step

Eyes

GI-system

Diabetes and blood glucose

Practical work• Measure blood sugar – before and after you eat or drink!

Diabetes and blood glucose

• Look at different insulin pens• If you lack insulin you must inject with meals• 1,2 ,3, multi or pump• Even children can do this!

Metabolic syndrome

• Heigth in cm• Weight in kg – but adjust for number given

Metabolic syndrome

• Heigth in cm• Weight in kg with +-• Waist – hip ratio• What is normal weight• How can we get a comparable number?

• Is 90 kg too much – what is relevant• Muscle, fat, height, bone ??

Metabolic syndrome

• How get a comparable number?

• BMI – calculate the groups’ manipulated BMI

Obestiy and nutrition

• Look at heights and weights, any obese??• Any underweight??

Calories come from food, ? per gram??

• Sugar, starch, carbohydrates• Protein• Alcohol• Fat

• Man is able to starve, • constructed for hunger, • gain weight easily

Calories per gram??

• Sugar, starch, carbohydrates 4 kcal/g• Protein 4 kcal/g• Alcohol 7,2 kcal/g• Fat 9 kcal/g

Vitamins

Role of Vitamins in Health and Disease

VitaminBiochemical

Function DeficiencyPrevention/Treatme

nt

Niacin NAD, NADP component Pellagra Hypercholesterolemi

a

B6Transamination

cofactor Convulsions Carpal tunnel syndrome

B12Transmethylation

cofactor Anemias Cognitive dysfunction

Folic acid

Single carbon transport

Megaloblasticanemia

Hyperhomocysteinemia

C Hydroxylation cofactor Scurvy Oxidative stress

D Calcium transport Rickets Osteoporosis

E Antioxidant Hemolytic anemia Relative anergy

Weight reduction with low calorie dietsseldom lasting weight loss

Operationto lose weight

Gastric banding

Gastric bypass

Take away intestine

Jaw closure

Baloons in stomach

Etc etc

Malnutrition even in Norway, USA

Percentage of Individuals with Diets that Meet the RDA: Problem Minerals

Mineral Population Meeting

RDA, % Groups at Highest Risk for Not Meeting RDA

Calcium 13.5-25.3 Females (12-70+) Phosphorus 33.7 Females (12-19)

Magnesium 17.9-33.5 Males (12-29, 50+), females (12-70+)

Iron 22.1-27.7 Females (12-49)

Zinc 12.4-32.7 Children (1-5), males (40+), females (6+)

Future advances

• Even more specific and costly intervention• Genetic therapy• Infection/Antibiotic theories• Immunology – tailor made medication• More technology• Better decentralized care and diagnostics• MRI, PET scan, etc.

Summary

• Endocrinology a complex subject• Many rare disases• Diabetes common life style disease• Tailor made medication• Life long diseases• Sometimes surgery, often medicine

Summary obesity

• Western affluent societies, major problem• Becoming world wide disease• Children and youngsters• Complicates all other diseases• Equipment must be larger• Beds must tolerate more kg• Personell must have lifting devices• Ambulances more muscle to lift person • Etc etc.• Few easy cures