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Jodi and Jenna's Presentation

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  • 1. Jodi-Ann Paragon-Singh Jenna Pair Endocrine Pathology
  • 2. Table of Contents
    • Pancreas
        • Diabetes
        • Insulinoma
    • Pituitary
        • Diabetes Insipidus
        • Gigantism
    • The Gonads
        • Male Hypogonadism
        • Androgenic Aplopecia
        • Post-partum Depression
    • The Adrenal Gland
        • Congenital Adrenal Hyperplasia
        • Conn’s Syndrome
  • 3.
    • Thyroid Gland
        • Grave’s Disease
        • Hashimoto’s Disease
    • Parathyroid Gland
        • Hyperparathyroidism
        • Hypoparathyroidism
    • Environmental Endocrinology
  • 4. The Pancreas
    • Organ underneath the stomach
    • Regulates hunger and blood sugar levels
    • Remember:
        • Endocrine vs. Exocrine tissues
        • Islets of Langerhans
        • alpha beta and delta cells,
        • glucagon, insulin and somatostatin.
  • 5. Disorders of the Pancreas: Diabetes
    • Body does not produce or properly use insulin
    • Glucose moves from the blood stream to the body’s cells via insulin
    • Two main types of diabetes:
        • TYPE 1: The immune system attacks pancreatic β cells; the pancreas produces little or no insulin
        • TYPE 2: Body becomes resistant to the effects of insulin
    • Gestational Diabetes
  • 6.
    • Symptoms include polydipsia, polyuria, extreme weight loss, excessive hunger. Irritability and blurry vision
    • Treatment includes using insulin, controlling the patient’s diet, transplantation
    • Ketoacidosis, hyperglycemia, hypoglyciemia
  • 7. Insulinomas
    • Tumor deriving from the pancreatic islet cells; over secretion of insulin
    • Which cell type is causing the tumor????
    • Common cause of hypoglycemia
    • Rare and often benign
    • Persons with Multiple Endocrine Neoplasia Type I (MEN 1) are at risk for developing this condition
    • Symptoms include low glucose levels, increased insulin levels, anxiety, hunger, dizziness and loss of consciousness
    • Treatment includes surgically removing the tumor or using drugs to suppress insulin secretion
  • 8. The Pituitary Gland
    • The pituitary gland secretes many hormones that collectively influence all cells and virtually affect all physiological processes.
    • Pituitary Hormones:
      • Growth Hormone (GH)
      • Adrenocorticotrophic Hormone (ACTH)
      • Thyroid Stimulating Hormone (TSH)
      • Prolactin
      • Leuteinizing Hormone (LH)
      • Follicle Stimulating Hormone (FSH)
      • Vasopressin (Antidiuretic hormone)
      • Oxytocin
  • 9. Diabetes Insipidus (DI)
    • DI is unrelated to diabetes mellitus. It is a rare disease that causes frequent urination (polyuria) and polydipsia.
    • What causes DI?
      • Central DI - most common. Results from pituitary damage that disrupts storage and release of vasopressin.
        • Damage to the pituitary gland can be from head injuries, neurosurgery, genetic disorders. Pituitary tumors can also cause central DI.
        • Remember: Vasopressin stimulates the reuptake of water in the kidney
  • 10. Symptoms and Treatment of DI
    • Symptoms:
      • Excessive thirst
      • Large amounts (~15 quarts a day) of dilute, colorless urine
      • Dehydration that leads to rapid heart rate, low blood pressure and shock
      • Uncontrollable bladder at night (bedwetting)
    • Treatment:
      • Desmopressin by injection, nasal spray or pill.
        • Synthetic analog of vasopressin that has minimal vasoconstrictive properties.
          • Prevents water excretion
  • 11. Gigantism
    • Gigantism is abnormally large growth during childhood due to excessive growth hormone before the growth plates have closed.
    • What causes gigantism?
      • Most common case- benign tumor on pituitary gland
      • Carney complex- syndrome characterized by endocrine over activity.
      • Multiple endocrine neoplasia (MEN) I- inherited disorder in which one or more endocrine glands are overactive or form a tumor.
  • 12. Symptoms of Gigantism
    • Child will grow in height and the muscles and organs will grow to support the enlarged body.
    • Delayed puberty
    • Double vision and difficultly with peripheral vision
    • Frontal bossing- unusually large forehead
    • Increased sweating
  • 13. Treatment of Gigantism
    • Surgery if the pituitary tumor has well defined borders
    • In cases when surgery is not an option, medication is the treatment of choice:
      • Somatostatin analogs and dopamine agonists- reduce GH release
      • Pegvisomant- blocks effect of GH
    • Interesting Fact:
      • Robert Wadlow weighed 8.5 lbs at birth. By age 5 he was 105 lbs and 5 feet 4 inches tall. Robert reached an adult weight of 490 lbs and 8 feet 11 inches in height. He died at age 22.
  • 14. The Gonads
    • Testes in males and ovaries in females
    • Creates egg cells and sperm cells
    • GnRH (Hypothalamus)  LH and FSH (pituitary)  testosterone and estradiol
    • Remember menstrual cycle
  • 15. Male Hypogonadism
    • Testosterone is not produced or secreted
    • When can you get this condition?? From birth or later in life? Congenital or acquired?
    • Two types:
        • Primary- primary testicular failure
        • Secondary- indicates a problem with the pituitary or hypothalamus
    • Symptoms depend on the stage of life when the condition develops
    • FETAL DEVELOPMENT: may present “genetic” males with female genitals, undistinguishable genitals or underdeveloped male genitals
    • PUBERTY: may present decreased development of muscle mass, no deep voice development, impaired growth of body hair, penis and testicles
    • ADULTHOOD: erectile dysfunction, infertility, decrease in body hair, muscle mass and bone mass. Some symptoms are similar to menopause symptoms (hot flashes, fatigue, decreased sex drive etc.)
  • 16. Androgenic alopecia
    • Affects both males and females
    • More common in males; male pattern baldness
    • caused by genetic and environmental factors
    • Genetic sensitivity of hair follicles to DHT (causes them to shrink); 5α-reductase
    • Males with androgenic alopecia typically have lower levels of total testosterone, increased levels of unbound testosterone and higher levels of total free androgens.
    • Treatment includes using 5α-reducatse inhibitor and hair transplantation
  • 17. Postpartum Depression
    • Not the “baby blues”- mild mood disturbance a few weeks after delivering due to low hormone levels
    • Postpartum depression is not distinguishable from other psychiatric disorders, but it is said to be caused by the dramatic decrease in estrogen and progesterone levels. Thyroid hormone levels are also hypothesized to decrease significantly in patients.
    • Women who suffer from premenstrual syndrome (PMS), previous depression, and lack emotional support tend to be at a higher risk for developing postpartum depression
  • 18.
    • Symptoms include depressed mood, tearfulness, inability to enjoy pleasurable activities, trouble sleeping, fatigue, appetite loss, suicidal thoughts, feelings of inadequacy as a parent, and impaired concentration
    • Affects 10-20% of all mothers within the first few months of delivery
    • In addition to support groups and physiological help, medical treatments, such as antidepressants and hormone therapies, may be effective.
  • 19. The Adrenal Gland
    • Synthesizes and secretes steroid hormones and catecholamines.
    • Cortex  steroid hormones
      • Cortisol keeps glucose levels high in the bloodstream, anti-inflammatory and immunosuppressive properties.
      • Aldosterone is involved in sodium homeostasis.
      • Androgens regulate structure and function of male sex organs and development of male secondary characteristics.
    • Medulla  catecholamines
      • Epinephrine and Norepinephrine are released in response to stress (fight-or-flight response).
  • 20. Congenital Adrenal Hyperplasia
    • Congenital Adrenal Hyperplasia is an inherited (autosomal recessive) disorder.
      • Adrenal Glands do not produce enough cortisol and aldosterone, but too much androgens.
      • Classical CAH- more severe & begins in early fetal life
      • Nonclassical CAH- late onset. Partial enzyme deficiency.
    • What causes CAH?
      • Mutation in gene that codes for enzymes necessary to synthesize cortisol and aldosterone.
      • 95% of cases are due to lack of 21-hydroxylase.
        • Remember: 21-hydroxylase is necessary for the production of both cortisol and aldosterone.
  • 21. No 21-hydroxylase—no cortisol or aldosterone, but more androgens.
  • 22. Symptoms of CAH
    • Classical CAH:
      • Girls:
        • Abnormal growth of clitoris
        • Masculinization of other genital-urinary structures
        • Abnormal menstrual periods
        • Excessive body and facial hair growth
        • Severely affected girls may be mistaken for boys at birth
      • Boys:
        • No genital malformations at birth, but excess androgens cause unusually fast body growth- may enter puberty as early as 2-3 years of age.
      • Boys and Girls:
        • Early puberty and short adult height
        • Severe cases  uncontrolled loss of salt, which can lead to condition called adrenal crisis and death.
    • Nonclassical CAH:
      • Premature development of pubic hair, unwanted body hair, severe acne
      • 10-15% of women may suffer from fertility problems
  • 23. Treatment of CAH
    • Standard medical treatment:
      • Glucocorticoid medication
      • Fludrocortisone, which mimics aldosterone and retains salt
    • Prenatal Therapy for CAH:
      • Reduces secretion of androgens from female fetus’ adrenal gland
  • 24. Conn’s Syndrome
    • Conn’s syndrome is a disease of the adrenal gland characterized by excessive production of aldosterone (hyperaldosteronism).
    • What causes Conn’s Syndrome?
      • Adenoma (benign tumor) on the adrenal gland
        • 50-60% cases
      • Idiopathic (unknown cause) hyperaldosteronism
        • 40-50% cases
  • 25. Symptoms and Treatment of Conn’s Syndrome
    • Remember: Aldosterone increases resorption of sodium in the kidney and increases renal excretion of potassium.
    • Symptoms:
      • Hypertension
      • Decreased potassium in the blood due to increased excretion of potassium in the urine. Decreased potassium causes:
        • Tiredness, muscle weakness, polyuria
    • Treatment:
      • Conn’s Syndrome due to tumor  remove the adrenal gland
      • Idiopathic Hyperaldosteronism  control high blood pressure and low potassium levels:
        • Sodium restricted diet and exercise
        • Angiotensin II blockers
  • 26. Angiotensin II Blocker Less angiotensin II = less aldosterone
  • 27. The Thyroid Gland
    • Thyroid Gland synthesizes and secretes the hormones T3 and T4.
    • Thyroid Hormones are required for normal growth and development, tissue differentiation and regulation of metabolic rate.
    • Regulation of Thyroid Hormones:
      • Thyroid Stimulating Hormone (TSH) from anterior pituitary
  • 28. Grave’s Disease
    • Grave’s disease is an autoimmune disorder that occurs when the body’s immune system attacks the thyroid gland and causes it to produce too much thyroid hormone (hyperthyroidism).
      • Most common cause of hyperthyroidism in the United States.
      • Affects about 5 in every 10,000 people in the United States.
    • What causes Grave’s Disease?
      • Antibody called thyroid-stimulating immunoglobulin (TSI) is produced
        • TSI mimics TSH and causes thyroid gland to over produce thyroid hormones.
  • 29. Thyroid-Stimulating Immunoglobulin Normal Thyroid Gland TSI binding to TSH receptor and activating it
  • 30. Symptoms of Grave’s Disease
    • Exophthalmos- protruding eyes
    • Anxiety and irritability
    • Increased heart rate
    • Increased sweating
    • Increased body temperature
    • Weight loss
  • 31. Treatment of Grave’s Disease
    • Anti-thyroid hormone medication
      • Methimazole
    • Beta blockers can control symptoms, such as increased heart rate
      • Atenolol
    • Radioactive iodine can cure disease, but often leads to permanent damage of the thyroid
      • Radioactive iodine is taken up by thyroid gland and destroys it
      • Thyroid hormone medications will have to be taken
    • Surgery- thyroidectomy
      • Not preferred solution because can damage parathyroid glands
  • 32. Hashimoto’s Disease
    • Hashimoto’s Disease is an autoimmune disorder that occurs when the immune system attacks the thyroid gland and causes it NOT to make enough thyroid hormone.
    • What causes Hashimoto’s Disease?
      • Antibodies that act against thyroid gland are produced- cause thyroid gland to become swollen
      • Thyroiditis impairs ability of the thyroid to produce thyroid hormones (hypothyroidism)
  • 33. Symptoms & Treatment of Hashimoto’s Disease
    • Symptoms:
      • Enlargement of thyroid gland (goiter)
      • Trouble swallowing
      • Mild weight gain
      • Fatigue and sluggishness
      • Intolerant to cold
      • Constipation
      • Trouble concentrating
    • Treatment:
      • Daily use of synthetic
      • thyroid hormone to restore
      • normal levels of TH.
      • Levothyroxine- identical toT4
  • 34. Parathyroid Glands
    • Parathyroid Glands are important in regulation of calcium levels in the blood
      • Parathyroid Hormone : increases blood calcium levels
      • Calcitonin : decreases blood calcium levels
      • Vitamin D : increases blood calcium levels
  • 35. Hyperparathyroidism
    • Hyperparathyroidism is overactive parathyroid glands, which lead to over production of parathyroid hormones.
      • Increased levels of calcium in the blood stream
    • What causes hyperparathyroidism?
      • Primary hyperparathyroidism - result of parathyroid gland disease
        • Parathyroid tumor (adenoma) that secretes hormone with no proper regulation
        • Parathyroid gland hyperplasia
      • Secondary hyperparathyroidism - some disease outside the parathyroid glands causes over production of PTH
        • Kidney disease: kidneys don’t reabsorb calcium
        • Rickets: Vitamin D deficiency
  • 36. Symptoms and Treatment of Hyperparathyroidism
    • Symptoms:
      • Increased thirst and urine due to increased calcium excretion
      • Kidney stones
      • Thinning bones (osteoporosis)
      • Nausea, vomiting and loss of appetite.
    • Treatment:
      • Primary Hyperparathyroidism - surgery to remove parathyroid glands
        • Cures disorder in 95% of operations
      • Secondary Hyperparathyroidism - treat underlying problem
        • Kidney failure- can’t make active form of Vitamin D3 so calcium is not reabsorbed
          • Causes over secretion of PTH
          • Active Vitamin D3 medication to decrease PTH secretion
        • Calcimimetics- drugs that turn off PTH secretion
  • 37. Kidney Failure- can’t convert 25-hyroxyVitaminD3 into the active form. Therefore, no calcium is reabsorbed. Blood calcium levels decrease and there is over secretion of PTH.
  • 38. Hypoparathyroidism
    • Hypoparathyroidism is a condition that occurs when the body secretes abnormally low levels of parathyroid hormones (PTH).
      • Leads to low levels of calcium in the blood
    • What causes hypoparathyroidism?
      • Acquired hypoparathyroidism
      • Hereditary hypoparathyroidism
      • Autoimmune disease
      • Radioactive iodine (hyperthyroidism treatment)
      • Low magnesium levels
  • 39. Symptoms and Treatment of Hypoparathyroidism
    • Symptoms:
      • Tingling or burning fingertips and toes
      • Muscle cramps
      • Dry, coarse skin
      • Patchy hair loss
    • Treatment:
      • Restore body’s calcium to normal levels
        • Calcium carbonate and vitamin D supplements
      • Hypoparathyroidism due to low levels of magnesium is treated with magnesium supplements
  • 40. Environmental Endocrinology
    • Nature vs. nurture dilemma
    • This field studies the effects of one’s surroundings on hormone levels and the endocrine system as a whole
    • The lunar calendar and the menstrual cycle
    • dichlorodiphenyltrichlorethane (DDT) and the male reproductive system
    • Hormones in food production