Chapter 21 Endocrine Problems-

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Chapter 21 Endocrine Problems-

  1. 1. Alterations of Hormonal Regulation Chapter 21
  2. 2. Elevated or Depressed Hormone Levels <ul><li>Failure of feedback systems </li></ul><ul><li>Dysfunction of an endocrine gland </li></ul><ul><li>Secretory cells are unable to produce, obtain, or convert hormone precursors </li></ul><ul><li>The endocrine gland synthesizes or releases excessive amounts of hormone </li></ul><ul><li>Increased hormone degradation or inactivation </li></ul><ul><li>Ectopic hormone release </li></ul>
  3. 3. Target Cell Failure <ul><li>Receptor-associated disorders </li></ul><ul><ul><li>Decrease in number of receptors </li></ul></ul><ul><ul><li>Impaired receptor function </li></ul></ul><ul><ul><li>Presence of antibodies against specific receptors </li></ul></ul><ul><ul><li>Antibodies that mimic hormone action </li></ul></ul><ul><ul><li>Unusual expression of receptor function </li></ul></ul>
  4. 4. Hormone Delivery
  5. 5. Alterations of the Hypothalamic-Pituitary System
  6. 6. Diseases of the Posterior Pituitary <ul><li>Syndrome of inappropriate antidiuretic hormone secretion (SIADH) </li></ul><ul><ul><li>Hypersecretion of ADH </li></ul></ul><ul><ul><li>For diagnosis, normal adrenal and thyroid function must exist </li></ul></ul><ul><ul><li>Clinical manifestations are related to enhanced renal water retention, hyponatremia, and hypoosmolarity </li></ul></ul>
  7. 7. Diseases of the Posterior Pituitary <ul><li>Diabetes insipidus </li></ul><ul><ul><li>Insufficiency of ADH </li></ul></ul><ul><ul><li>Polyuria and polydipsia </li></ul></ul><ul><ul><li>Partial or total inability to concentrate the urine </li></ul></ul><ul><ul><li>Neurogenic </li></ul></ul><ul><ul><ul><li>Insufficient amounts of ADH </li></ul></ul></ul><ul><ul><li>Nephrogenic </li></ul></ul><ul><ul><ul><li>Inadequate response to ADH </li></ul></ul></ul>
  8. 8. Diseases of the Anterior Pituitary <ul><li>Hypopituitarism </li></ul><ul><ul><li>Pituitary infarction </li></ul></ul><ul><ul><ul><li>Sheehan syndrome </li></ul></ul></ul><ul><ul><ul><li>Hemorrhage </li></ul></ul></ul><ul><ul><ul><li>Shock </li></ul></ul></ul><ul><ul><li>Others: head trauma, infections, and tumors </li></ul></ul>
  9. 9. Diseases of the Anterior Pituitary <ul><li>Hypopituitarism </li></ul><ul><ul><li>Panhypopituitarism </li></ul></ul><ul><ul><ul><li>ACTH deficiency </li></ul></ul></ul><ul><ul><ul><li>TSH deficiency </li></ul></ul></ul><ul><ul><ul><li>FSH and LH deficiency </li></ul></ul></ul><ul><ul><ul><li>GH deficiency </li></ul></ul></ul>
  10. 10. Diseases of the Anterior Pituitary <ul><li>Hyperpituitarism </li></ul><ul><ul><li>Commonly due to a benign, slow-growing pituitary adenoma </li></ul></ul><ul><ul><li>Manifestations </li></ul></ul><ul><ul><ul><li>Headache and fatigue </li></ul></ul></ul><ul><ul><ul><li>Visual changes </li></ul></ul></ul><ul><ul><ul><li>Hyposecretion of neighboring anterior pituitary hormones </li></ul></ul></ul>
  11. 11. Diseases of the Anterior Pituitary <ul><li>Hypersecretion of growth hormone (GH) </li></ul><ul><ul><li>Acromegaly </li></ul></ul><ul><ul><ul><li>Hypersecretion of GH during adulthood </li></ul></ul></ul><ul><ul><li>Gigantism </li></ul></ul><ul><ul><ul><li>Hypersecretion of GH in children and adolescents </li></ul></ul></ul>
  12. 12. Hypersecretion of Growth Hormone (GH)
  13. 13. Diseases of the Anterior Pituitary <ul><li>Hypersecretion of prolactin </li></ul><ul><ul><li>Caused by prolactinomas </li></ul></ul><ul><ul><ul><li>In females, increased levels of prolactin cause amenorrhea, galactorrhea, hirsutism, and osteopenia </li></ul></ul></ul><ul><ul><ul><li>In males, increased levels of prolactin cause hypogonadism, erectile dysfunction, impaired libido, oligospermia, and diminished ejaculate volume </li></ul></ul></ul>
  14. 14. Alterations of Thyroid Function <ul><li>Hyperthyroidism </li></ul><ul><ul><li>Thyrotoxicosis </li></ul></ul><ul><ul><li>Graves disease </li></ul></ul><ul><ul><ul><li>Pretibial myxedema </li></ul></ul></ul><ul><ul><li>Hyperthyroidism resulting from nodular thyroid disease </li></ul></ul><ul><ul><ul><li>Goiter </li></ul></ul></ul><ul><ul><li>Thyrotoxic crisis </li></ul></ul>
  15. 15. Thyrotoxicosis (Graves’ Disease)
  16. 16. Alterations of Thyroid Function <ul><li>Hypothyroidism </li></ul><ul><ul><li>Primary hypothyroidism </li></ul></ul><ul><ul><ul><li>Subacute thyroiditis </li></ul></ul></ul><ul><ul><ul><li>Autoimmune thyroiditis (Hashimoto disease) </li></ul></ul></ul><ul><ul><ul><li>Painless thyroiditis </li></ul></ul></ul><ul><ul><ul><li>Postpartum thyroiditis </li></ul></ul></ul><ul><ul><ul><li>Myxedema coma </li></ul></ul></ul><ul><ul><li>Congenital hypothyroidism </li></ul></ul><ul><ul><li>Thyroid carcinoma </li></ul></ul>
  17. 17. Hypothyroidism
  18. 18. Alterations of Parathyroid Function <ul><li>Hyperparathyroidism </li></ul><ul><ul><li>Primary hyperparathyroidism </li></ul></ul><ul><ul><ul><li>Excess secretion of PTH from one or more parathyroid glands </li></ul></ul></ul><ul><ul><li>Secondary hyperparathyroidism </li></ul></ul><ul><ul><ul><li>Increase in PTH secondary to a chronic disease </li></ul></ul></ul><ul><li>Hypoparathyroidism </li></ul><ul><ul><li>Abnormally low PTH levels </li></ul></ul><ul><ul><li>Usually caused by parathyroid damage in thyroid surgery </li></ul></ul>
  19. 19. Type 1 Diabetes Mellitus <ul><li>Demonstrates pancreatic atrophy and specific loss of beta cells </li></ul><ul><li>Macrophages, T and B lymphocytes, and natural killer cells are present </li></ul><ul><li>Two types </li></ul><ul><ul><li>Immune </li></ul></ul><ul><ul><li>Nonimmune </li></ul></ul>
  20. 20. Type 1 Diabetes Mellitus <ul><li>Genetic susceptibility </li></ul><ul><li>Environmental factors </li></ul><ul><li>Immunologically mediated destruction of beta cells </li></ul><ul><li>Manifestations </li></ul><ul><ul><li>Hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, and fatigue </li></ul></ul>
  21. 21. Type 1 Diabetes Mellitus
  22. 22. Type 1 Diabetes Mellitus
  23. 23. Dysfunction of the Pancreas <ul><li>Type 2 diabetes mellitus </li></ul><ul><ul><li>Maturity-onset diabetes of youth (MODY) </li></ul></ul><ul><ul><li>Gestational diabetes mellitus (GDM) </li></ul></ul><ul><ul><li>Common form of diabetes mellitus type 2 </li></ul></ul><ul><ul><ul><li>Insulin resistance </li></ul></ul></ul>
  24. 24. Type 2 Diabetes Mellitus
  25. 25. Acute Complications of Diabetes Mellitus <ul><li>Hypoglycemia </li></ul><ul><li>Diabetic ketoacidosis </li></ul><ul><li>Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) </li></ul><ul><li>Somogyi effect </li></ul><ul><li>Dawn phenomenon </li></ul>
  26. 26. Diabetic Ketoacidosis
  27. 27. Chronic Complications of Diabetes Mellitus <ul><li>Hyperglycemia and nonenzymatic glycosylation </li></ul><ul><li>Hyperglycemia and the polyol pathway </li></ul><ul><ul><li>Protein kinase C </li></ul></ul><ul><li>Microvascular disease </li></ul><ul><ul><li>Retinopathy </li></ul></ul><ul><ul><li>Diabetic nephropathy </li></ul></ul>
  28. 28. Diabetic Nephropathy
  29. 29. Chronic Complications of Diabetes Mellitus <ul><li>Macrovascular disease </li></ul><ul><ul><li>Coronary artery disease </li></ul></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Peripheral arterial disease </li></ul></ul><ul><li>Diabetic neuropathies </li></ul><ul><li>Infection </li></ul>
  30. 30. Diabetic Amputation
  31. 31. Diabetic Neuropathy
  32. 32. Alterations of Adrenal Function <ul><li>Disorders of the adrenal cortex </li></ul><ul><ul><li>Cushing disease </li></ul></ul><ul><ul><ul><li>Excessive anterior pituitary secretion of ACTH </li></ul></ul></ul><ul><ul><li>Cushing syndrome </li></ul></ul><ul><ul><ul><li>Excessive level of cortisol, regardless of cause </li></ul></ul></ul>
  33. 33. Cushing Disease
  34. 34. Alterations of Adrenal Function <ul><li>Disorders of the adrenal cortex </li></ul><ul><ul><li>Hyperaldosteronism </li></ul></ul><ul><ul><ul><li>Primary hyperaldosteronism (Conn disease) </li></ul></ul></ul><ul><ul><ul><li>Secondary hyperaldosteronism </li></ul></ul></ul>
  35. 35. Primary Hyperaldosteronism
  36. 36. Alterations of Adrenal Function <ul><li>Disorders of the adrenal cortex </li></ul><ul><ul><li>Adrenocortical hypofunction </li></ul></ul><ul><ul><ul><li>Primary adrenal insufficiency (Addison disease) </li></ul></ul></ul><ul><ul><ul><ul><li>Idiopathic Addison disease </li></ul></ul></ul></ul><ul><ul><ul><li>Secondary hypocortisolism </li></ul></ul></ul>
  37. 37. Alterations of Adrenal Function <ul><li>Disorders of the adrenal cortex </li></ul><ul><ul><li>Hypersecretion of adrenal androgens and estrogens </li></ul></ul><ul><ul><ul><li>Feminization </li></ul></ul></ul><ul><ul><ul><li>Virilization </li></ul></ul></ul>
  38. 38. Virilization
  39. 39. Alterations of Adrenal Function <ul><li>Disorders of the adrenal medulla </li></ul><ul><ul><li>Adrenal medulla hyperfunction </li></ul></ul><ul><ul><ul><li>Caused by tumors derived from the chromaffin cells of the adrenal medulla </li></ul></ul></ul><ul><ul><ul><ul><li>Pheochromocytomas </li></ul></ul></ul></ul><ul><ul><ul><li>Secrete catecholamines on a continuous or episodic basis </li></ul></ul></ul>
  40. 40. Pheochromocytoma

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