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