This presentation discusses adrenocortical hypofunction, specifically focusing on primary and secondary adrenal insufficiency. It begins by outlining the learning objectives and providing definitions. It then describes the causes, signs and symptoms, diagnosis, and treatment of primary adrenal insufficiency, including Addison's disease and crisis. Secondary adrenal insufficiency is explained as resulting from hypothalamic-pituitary dysfunction. Treatment involves replacing glucocorticoids and mineralocorticoids through medications like hydrocortisone and fludrocortisone.
Graves' disease is the most common cause of hyperthyroidism. It is an autoimmune disorder where antibodies stimulate the thyroid gland to overproduce thyroid hormones. This causes a rapid heart rate, weight loss, eye changes, and enlarged thyroid gland. Treatment options include anti-thyroid medications to block hormone production, radioactive iodine therapy to destroy thyroid cells, or surgery to remove most of the thyroid gland. Long term treatment is needed to prevent recurrence of hyperthyroidism.
Diffuse toxic goiter, also known as endemic goiter, is an autoimmune disease characterized by overproduction of thyroid hormones causing damage to organs like the nervous and cardiovascular systems. It is caused by iodine deficiency in the environment, especially in soil and water. People in iodine-deficient areas can develop an enlarged thyroid gland with a reduction in its function over time, along with symptoms like difficulty swallowing and changes to heart function. Treatment options include thyroid drugs, surgery to remove part of the thyroid gland, and preventing future cases by providing iodized salt and foods to populations.
Addison's disease is a rare condition caused by insufficient production of hormones by the adrenal glands. It results in a decrease in glucocorticoids and mineralocorticoids. Symptoms include chronic fatigue, weight loss, and hyperpigmentation. While current treatment replaces the missing hormones, research aims to regenerate damaged adrenal cortex cells through stem cell stimulation in order to cure the disease.
This document discusses Graves' disease, a common cause of hyperthyroidism. It covers the pathogenesis, presentation, evaluation and management of Graves' disease. Key points include: Graves' disease is an autoimmune disorder causing hyperthyroidism in 70-80% of cases. It presents with a diffuse goiter and may involve the eyes or skin. Evaluation involves thyroid function tests and autoantibody tests. Management involves antithyroid medications like carbimazole or propylthiouracil. Radioactive iodine or surgery are options for relapses or non-responders. Care must be taken in managing Graves' disease during pregnancy to avoid complications for the mother and fetus.
The document provides an outline on the physiology and causes of hyperthyroidism, also known as thyrotoxicosis. It discusses the thyroid gland, thyroid hormone synthesis and regulation, clinical features of Graves' disease and toxic multinodular goiter, diagnosis of hyperthyroidism, and management approaches including antithyroid drugs, radioactive iodine therapy, surgery, and novel minimally invasive therapies. It also covers thyroid storm as a life-threatening emergency characterized by abrupt release of thyroid hormones.
The document discusses diseases of the parathyroid glands, including hyperparathyroidism and hypoparathyroidism. It covers the physiology and functions of the parathyroid glands and parathyroid hormone. It describes the etiology, pathogenesis, and classification of primary, secondary, and tertiary hyperparathyroidism. The clinical features of hyperparathyroidism are also outlined.
Adrenal disorders involve deficiencies or excesses of hormones produced by the adrenal glands. Primary adrenal insufficiency, such as Addison's disease, results from damage to the adrenal cortex and insufficient production of cortisol and aldosterone. Symptoms include fatigue, weight loss, and low blood pressure. Treatment involves replacing the deficient hormones through medications. Yoga practices like breathing exercises, stretches, and meditation can help manage stress and symptoms.
A 39-year-old male with a history of diabetes presented with abdominal pain, vomiting, lethargy, and dehydration. On examination, he had diffuse abdominal tenderness but no guarding or rigidity, and normal bowel sounds. He had been non-compliant with his insulin regimen. The most likely diagnosis is diabetic ketoacidosis.
A 62-year-old male diabetic presented with fever, right upper quadrant pain, and tachycardia. CT showed findings consistent with emphysematous cholecystitis.
A 42-year-old male diabetic with poor glucose control presented with facial asymmetry and was found to have right facial nerve palsy, suggesting an
Graves' disease is the most common cause of hyperthyroidism. It is an autoimmune disorder where antibodies stimulate the thyroid gland to overproduce thyroid hormones. This causes a rapid heart rate, weight loss, eye changes, and enlarged thyroid gland. Treatment options include anti-thyroid medications to block hormone production, radioactive iodine therapy to destroy thyroid cells, or surgery to remove most of the thyroid gland. Long term treatment is needed to prevent recurrence of hyperthyroidism.
Diffuse toxic goiter, also known as endemic goiter, is an autoimmune disease characterized by overproduction of thyroid hormones causing damage to organs like the nervous and cardiovascular systems. It is caused by iodine deficiency in the environment, especially in soil and water. People in iodine-deficient areas can develop an enlarged thyroid gland with a reduction in its function over time, along with symptoms like difficulty swallowing and changes to heart function. Treatment options include thyroid drugs, surgery to remove part of the thyroid gland, and preventing future cases by providing iodized salt and foods to populations.
Addison's disease is a rare condition caused by insufficient production of hormones by the adrenal glands. It results in a decrease in glucocorticoids and mineralocorticoids. Symptoms include chronic fatigue, weight loss, and hyperpigmentation. While current treatment replaces the missing hormones, research aims to regenerate damaged adrenal cortex cells through stem cell stimulation in order to cure the disease.
This document discusses Graves' disease, a common cause of hyperthyroidism. It covers the pathogenesis, presentation, evaluation and management of Graves' disease. Key points include: Graves' disease is an autoimmune disorder causing hyperthyroidism in 70-80% of cases. It presents with a diffuse goiter and may involve the eyes or skin. Evaluation involves thyroid function tests and autoantibody tests. Management involves antithyroid medications like carbimazole or propylthiouracil. Radioactive iodine or surgery are options for relapses or non-responders. Care must be taken in managing Graves' disease during pregnancy to avoid complications for the mother and fetus.
The document provides an outline on the physiology and causes of hyperthyroidism, also known as thyrotoxicosis. It discusses the thyroid gland, thyroid hormone synthesis and regulation, clinical features of Graves' disease and toxic multinodular goiter, diagnosis of hyperthyroidism, and management approaches including antithyroid drugs, radioactive iodine therapy, surgery, and novel minimally invasive therapies. It also covers thyroid storm as a life-threatening emergency characterized by abrupt release of thyroid hormones.
The document discusses diseases of the parathyroid glands, including hyperparathyroidism and hypoparathyroidism. It covers the physiology and functions of the parathyroid glands and parathyroid hormone. It describes the etiology, pathogenesis, and classification of primary, secondary, and tertiary hyperparathyroidism. The clinical features of hyperparathyroidism are also outlined.
Adrenal disorders involve deficiencies or excesses of hormones produced by the adrenal glands. Primary adrenal insufficiency, such as Addison's disease, results from damage to the adrenal cortex and insufficient production of cortisol and aldosterone. Symptoms include fatigue, weight loss, and low blood pressure. Treatment involves replacing the deficient hormones through medications. Yoga practices like breathing exercises, stretches, and meditation can help manage stress and symptoms.
A 39-year-old male with a history of diabetes presented with abdominal pain, vomiting, lethargy, and dehydration. On examination, he had diffuse abdominal tenderness but no guarding or rigidity, and normal bowel sounds. He had been non-compliant with his insulin regimen. The most likely diagnosis is diabetic ketoacidosis.
A 62-year-old male diabetic presented with fever, right upper quadrant pain, and tachycardia. CT showed findings consistent with emphysematous cholecystitis.
A 42-year-old male diabetic with poor glucose control presented with facial asymmetry and was found to have right facial nerve palsy, suggesting an
Addison disease is caused by primary adrenocortical deficiency due to destruction of the adrenal cortex, most commonly from autoimmune disease or tuberculosis. It presents with weakness, weight loss, hyperpigmentation, and hypotension due to glucocorticoid and mineralocorticoid deficiency. The diagnosis is made by demonstrating a subnormal response on ACTH stimulation testing with failure to increase cortisol levels above the normal range.
The document discusses pheochromocytoma, a rare tumor of the adrenal glands that secretes excess catecholamines. It causes high blood pressure, headaches, increased heart rate and metabolic changes. Diagnosis involves testing urine and plasma catecholamine levels. Treatment includes alpha-blockers to lower blood pressure before surgery to remove the tumor. Nursing care focuses on monitoring vital signs and blood pressure to prevent hypertensive crises before and after surgery.
The prevalence of well-documented, permanent adrenal insufficiency is 5 in 10,000 in the general population. Hypothalamic-pituitary origin of disease is most frequent, with a prevalence of 3 in 10,000, whereas primary adrenal insufficiency has a prevalence of 2 in 10,000. Approximately one-half of the latter cases are acquired, mostly caused by autoimmune destruction of the adrenal glands; the other one-half are genetic, most commonly caused by distinct enzymatic blocks in adrenal steroidogenesis affecting glucocorticoid synthesis (i.e. congenital adrenal hyperplasia.)
Adrenal insufficiency arising from suppression of the HPA axis as a consequence of exogenous glucocorticoid treatment is much more common, occurring in 0.5–2% of the population in developed countries.
Hyperaldosteronism is a disease caused by problems in the adrenal glands which produce steroid hormones including aldosterone. Aldosterone controls sodium and potassium levels in the blood, and its overproduction leads to high blood pressure by retaining salt and losing potassium. Primary Hyperaldosteronism is caused by a problem within the adrenal glands such as a benign tumor or adrenal hyperplasia, while Secondary is caused by something outside the glands like medications or other medical conditions. Symptoms include high blood pressure and issues from low potassium levels. The condition is diagnosed through blood and imaging tests and treated by addressing its underlying cause through medication or surgery.
Hyperthyroidism is a condition where the thyroid gland produces excess thyroid hormones, causing a hypermetabolic state known as thyrotoxicosis. The most common cause is Graves' disease, an autoimmune disorder. Symptoms include weight loss, rapid heartbeat, sweating and irritability. Diagnosis involves blood tests to check thyroid hormone levels and treatment options include antithyroid medications, radioactive iodine therapy or surgery. Left untreated, hyperthyroidism can lead to complications affecting various body systems and organs.
Graves disease is an autoimmune disorder where the immune system attacks the thyroid gland, causing it to overproduce thyroid hormones. This leads to an enlarged thyroid and hyperthyroidism. Symptoms include bulging eyes, increased appetite with weight loss, heat intolerance, and hyperactivity. The condition is caused by antibodies that mimic TSH, stimulating excess thyroid hormone release. With treatment like antithyroid drugs, radioiodine therapy, or surgery, the prognosis is generally positive, but without treatment there are long term health risks.
Disorder of Adrenal Gland: Adrenal insufficiencyPratap Tiwari
This document discusses adrenal insufficiency (also known as Addison's disease), which can be primary, secondary, or tertiary. Primary adrenal insufficiency is caused by damage or disease of the adrenal glands and can result from autoimmune disease, infections, tumors, or hemorrhage. Secondary adrenal insufficiency is caused by interference with ACTH production in the pituitary gland, while tertiary is caused by interference with CRH production in the hypothalamus. Symptoms include fatigue, gastrointestinal issues, electrolyte imbalances, and hyperpigmentation. Diagnosis involves tests to evaluate cortisol levels and response to ACTH stimulation. Treatment consists of replacing glucocorticoids like hydroc
Thyroiditis refers to an inflammation of the thyroid gland. The gland is located in the front of your neck and controls your metabolism by releasing a series of hormones.
- A 55-year-old male presented with 3 weeks of weakness, fatigue, and weight loss. Physical exam found him to be thin and lean with oral pigmentation.
- Labs found leukopenia, a positive PPD test, low cortisol, increased ACTH, and a normal chest x-ray.
- The final diagnosis was tuberculosis adrenalitis, which had caused primary adrenal insufficiency.
Hypothyroidism is the failure of the thyroid gland to produce enough hormones. It can cause hypertension, dyslipidemia, infertility and other issues if untreated. It is most common in females and prevalence increases with age. Thyroid dysfunction is more common in diabetics than the general population. Screening is recommended for diabetics and those with risk factors like autoimmune disease or family history. A TSH test is used to diagnose, and levothyroxine replacement is the standard treatment, with dosage based on weight. Subclinical hypothyroidism may also be treated in high risk groups.
Toxic nodular goiter, also known as Plummer's disease, is a multinodular goiter associated with hyperthyroidism caused by excess thyroid hormone production from autonomous thyroid nodules. It is the second most common cause of hyperthyroidism after Graves' disease. Iodine deficiency can lead to the development of nodules within an enlarged thyroid gland, or goiter, and some of these nodules become functionally autonomous due to mutations in genes regulating thyroid hormone production. Patients present with symptoms of hyperthyroidism and may have an enlarged thyroid gland with multiple irregular nodules visible on ultrasound. Treatment involves anti-thyroid medications or surgery to remove the overactive nodules.
The document discusses the complications of diabetes mellitus, including both acute and chronic complications. Acute complications involve alterations in blood sugar levels, leading to hypoglycemia or hyperglycemia events like diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome. Chronic complications affect the macrovasculature (large blood vessels) like atherosclerosis, and the microvasculature (small blood vessels) of tissues like the eyes and kidneys. Precise management of blood sugar levels can help prevent both acute and chronic complications of diabetes.
Thyroiditis is inflammation of the thyroid gland that can cause abnormal thyroid hormone levels. There are several types of thyroiditis including Hashimoto's (the most common autoimmune form), subacute, post-partum, silent, and forms induced by drugs, radiation, or infection. Symptoms vary depending on thyroid hormone levels and include fatigue, weight changes, nervousness, and neck tenderness. Treatment involves medications, steroids, thyroid hormone replacement, or surgery in rare cases. Complications can include hypothyroidism or airway obstruction.
The document discusses diabetes mellitus (DM), including its classification into types 1 and 2, gestational diabetes, and other types. It covers the anatomy and functions of the pancreas, which produces insulin and digestive enzymes. Diagnostic criteria for DM include hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance tests. Complications of uncontrolled DM are also mentioned. Treatment involves lifestyle changes, insulin therapy, and managing comorbidities.
Uremic encephalopathy occurs when toxins that are normally cleared by the kidneys build up in the bloodstream due to kidney failure. It causes a range of neurological symptoms from mild issues like fatigue to severe problems like seizures and coma. The condition develops when kidney function declines to the point that creatinine clearance levels fall below 15 mL/min. While the exact cause is unknown, it involves the accumulation of various toxins in the brain that disrupts cell metabolism and function. Prompt treatment with dialysis or kidney transplantation can reverse the neurological symptoms.
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
This document provides an overview of adrenal hypofunction (adrenal insufficiency). It discusses primary and secondary adrenal insufficiency, their causes including autoimmune disease and infections, and clinical manifestations such as hyperpigmentation and electrolyte imbalances. Addison's crisis is described as a life-threatening exacerbation. Diagnosis involves ACTH stimulation tests. Treatment involves hydrocortisone replacement and monitoring mineralocorticoid levels. Isolated hypoadrenalism and pseudohypoaldosteronism are also summarized.
DEFINITION
• Myxedema coma is a rare life-threatening condition.It is the decompensated state of severe hypothyroidism in whichthe patient is hypothermic and unconscious.The condition occurs most often among elderly women in the winter months and appears to be precipitated by cold.
• Myxedema coma, occasionally called myxedema crisis, is a rare life- threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy.
• Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism which refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area.
- A 40-year-old patient presented with low-grade fever, coughing up blood, and weight loss. Tests showed signs of tuberculosis (TB) and the patient was started on anti-TB drugs. However, the patient died suddenly after 3 days of treatment.
- Addison's disease is a condition caused by insufficient production of hormones by the adrenal glands. It was first described by Dr. Thomas Addison in the 19th century. Common causes include autoimmune disease and TB infection of the adrenal glands.
- Without treatment, Addison's disease can cause low blood pressure, low blood sugar, high potassium levels, and even death. Treatment involves replacing glucocorticoid and
The document describes Waterhouse-Friderichsen syndrome (WFS), which is defined as adrenal gland failure caused by hemorrhaging into the adrenal glands due to severe bacterial infection, most commonly by Neisseria meningitidis bacteria. WFS is characterized by petechial rashes, fever, septic shock, and disseminated intravascular coagulation. It typically affects infants and children under 10 years old. Treatment involves antibiotics, adrenal hormone replacement, and managing shock. Two case studies are presented of patients who died from WFS caused by group A streptococcus and Streptococcus pneumoniae respectively.
Waterhouse–Friderichsen syndrome (WFS) is defined as adrenal gland failure due to bleeding into the adrenal glands, most commonly caused by the bacterial infection meningococcus. It typically occurs in infants and children under 10 years old. Clinically, it presents with a sudden high fever, rash, shock, and disseminated intravascular coagulation. The adrenal glands hemorrhage and lead to adrenal insufficiency. Treatment involves antibiotics, adrenal support with hydrocortisone, and managing shock. Prevention includes routine meningococcal vaccination in certain groups.
Addison disease is caused by primary adrenocortical deficiency due to destruction of the adrenal cortex, most commonly from autoimmune disease or tuberculosis. It presents with weakness, weight loss, hyperpigmentation, and hypotension due to glucocorticoid and mineralocorticoid deficiency. The diagnosis is made by demonstrating a subnormal response on ACTH stimulation testing with failure to increase cortisol levels above the normal range.
The document discusses pheochromocytoma, a rare tumor of the adrenal glands that secretes excess catecholamines. It causes high blood pressure, headaches, increased heart rate and metabolic changes. Diagnosis involves testing urine and plasma catecholamine levels. Treatment includes alpha-blockers to lower blood pressure before surgery to remove the tumor. Nursing care focuses on monitoring vital signs and blood pressure to prevent hypertensive crises before and after surgery.
The prevalence of well-documented, permanent adrenal insufficiency is 5 in 10,000 in the general population. Hypothalamic-pituitary origin of disease is most frequent, with a prevalence of 3 in 10,000, whereas primary adrenal insufficiency has a prevalence of 2 in 10,000. Approximately one-half of the latter cases are acquired, mostly caused by autoimmune destruction of the adrenal glands; the other one-half are genetic, most commonly caused by distinct enzymatic blocks in adrenal steroidogenesis affecting glucocorticoid synthesis (i.e. congenital adrenal hyperplasia.)
Adrenal insufficiency arising from suppression of the HPA axis as a consequence of exogenous glucocorticoid treatment is much more common, occurring in 0.5–2% of the population in developed countries.
Hyperaldosteronism is a disease caused by problems in the adrenal glands which produce steroid hormones including aldosterone. Aldosterone controls sodium and potassium levels in the blood, and its overproduction leads to high blood pressure by retaining salt and losing potassium. Primary Hyperaldosteronism is caused by a problem within the adrenal glands such as a benign tumor or adrenal hyperplasia, while Secondary is caused by something outside the glands like medications or other medical conditions. Symptoms include high blood pressure and issues from low potassium levels. The condition is diagnosed through blood and imaging tests and treated by addressing its underlying cause through medication or surgery.
Hyperthyroidism is a condition where the thyroid gland produces excess thyroid hormones, causing a hypermetabolic state known as thyrotoxicosis. The most common cause is Graves' disease, an autoimmune disorder. Symptoms include weight loss, rapid heartbeat, sweating and irritability. Diagnosis involves blood tests to check thyroid hormone levels and treatment options include antithyroid medications, radioactive iodine therapy or surgery. Left untreated, hyperthyroidism can lead to complications affecting various body systems and organs.
Graves disease is an autoimmune disorder where the immune system attacks the thyroid gland, causing it to overproduce thyroid hormones. This leads to an enlarged thyroid and hyperthyroidism. Symptoms include bulging eyes, increased appetite with weight loss, heat intolerance, and hyperactivity. The condition is caused by antibodies that mimic TSH, stimulating excess thyroid hormone release. With treatment like antithyroid drugs, radioiodine therapy, or surgery, the prognosis is generally positive, but without treatment there are long term health risks.
Disorder of Adrenal Gland: Adrenal insufficiencyPratap Tiwari
This document discusses adrenal insufficiency (also known as Addison's disease), which can be primary, secondary, or tertiary. Primary adrenal insufficiency is caused by damage or disease of the adrenal glands and can result from autoimmune disease, infections, tumors, or hemorrhage. Secondary adrenal insufficiency is caused by interference with ACTH production in the pituitary gland, while tertiary is caused by interference with CRH production in the hypothalamus. Symptoms include fatigue, gastrointestinal issues, electrolyte imbalances, and hyperpigmentation. Diagnosis involves tests to evaluate cortisol levels and response to ACTH stimulation. Treatment consists of replacing glucocorticoids like hydroc
Thyroiditis refers to an inflammation of the thyroid gland. The gland is located in the front of your neck and controls your metabolism by releasing a series of hormones.
- A 55-year-old male presented with 3 weeks of weakness, fatigue, and weight loss. Physical exam found him to be thin and lean with oral pigmentation.
- Labs found leukopenia, a positive PPD test, low cortisol, increased ACTH, and a normal chest x-ray.
- The final diagnosis was tuberculosis adrenalitis, which had caused primary adrenal insufficiency.
Hypothyroidism is the failure of the thyroid gland to produce enough hormones. It can cause hypertension, dyslipidemia, infertility and other issues if untreated. It is most common in females and prevalence increases with age. Thyroid dysfunction is more common in diabetics than the general population. Screening is recommended for diabetics and those with risk factors like autoimmune disease or family history. A TSH test is used to diagnose, and levothyroxine replacement is the standard treatment, with dosage based on weight. Subclinical hypothyroidism may also be treated in high risk groups.
Toxic nodular goiter, also known as Plummer's disease, is a multinodular goiter associated with hyperthyroidism caused by excess thyroid hormone production from autonomous thyroid nodules. It is the second most common cause of hyperthyroidism after Graves' disease. Iodine deficiency can lead to the development of nodules within an enlarged thyroid gland, or goiter, and some of these nodules become functionally autonomous due to mutations in genes regulating thyroid hormone production. Patients present with symptoms of hyperthyroidism and may have an enlarged thyroid gland with multiple irregular nodules visible on ultrasound. Treatment involves anti-thyroid medications or surgery to remove the overactive nodules.
The document discusses the complications of diabetes mellitus, including both acute and chronic complications. Acute complications involve alterations in blood sugar levels, leading to hypoglycemia or hyperglycemia events like diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome. Chronic complications affect the macrovasculature (large blood vessels) like atherosclerosis, and the microvasculature (small blood vessels) of tissues like the eyes and kidneys. Precise management of blood sugar levels can help prevent both acute and chronic complications of diabetes.
Thyroiditis is inflammation of the thyroid gland that can cause abnormal thyroid hormone levels. There are several types of thyroiditis including Hashimoto's (the most common autoimmune form), subacute, post-partum, silent, and forms induced by drugs, radiation, or infection. Symptoms vary depending on thyroid hormone levels and include fatigue, weight changes, nervousness, and neck tenderness. Treatment involves medications, steroids, thyroid hormone replacement, or surgery in rare cases. Complications can include hypothyroidism or airway obstruction.
The document discusses diabetes mellitus (DM), including its classification into types 1 and 2, gestational diabetes, and other types. It covers the anatomy and functions of the pancreas, which produces insulin and digestive enzymes. Diagnostic criteria for DM include hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance tests. Complications of uncontrolled DM are also mentioned. Treatment involves lifestyle changes, insulin therapy, and managing comorbidities.
Uremic encephalopathy occurs when toxins that are normally cleared by the kidneys build up in the bloodstream due to kidney failure. It causes a range of neurological symptoms from mild issues like fatigue to severe problems like seizures and coma. The condition develops when kidney function declines to the point that creatinine clearance levels fall below 15 mL/min. While the exact cause is unknown, it involves the accumulation of various toxins in the brain that disrupts cell metabolism and function. Prompt treatment with dialysis or kidney transplantation can reverse the neurological symptoms.
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
This document provides an overview of adrenal hypofunction (adrenal insufficiency). It discusses primary and secondary adrenal insufficiency, their causes including autoimmune disease and infections, and clinical manifestations such as hyperpigmentation and electrolyte imbalances. Addison's crisis is described as a life-threatening exacerbation. Diagnosis involves ACTH stimulation tests. Treatment involves hydrocortisone replacement and monitoring mineralocorticoid levels. Isolated hypoadrenalism and pseudohypoaldosteronism are also summarized.
DEFINITION
• Myxedema coma is a rare life-threatening condition.It is the decompensated state of severe hypothyroidism in whichthe patient is hypothermic and unconscious.The condition occurs most often among elderly women in the winter months and appears to be precipitated by cold.
• Myxedema coma, occasionally called myxedema crisis, is a rare life- threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy.
• Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism which refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area.
- A 40-year-old patient presented with low-grade fever, coughing up blood, and weight loss. Tests showed signs of tuberculosis (TB) and the patient was started on anti-TB drugs. However, the patient died suddenly after 3 days of treatment.
- Addison's disease is a condition caused by insufficient production of hormones by the adrenal glands. It was first described by Dr. Thomas Addison in the 19th century. Common causes include autoimmune disease and TB infection of the adrenal glands.
- Without treatment, Addison's disease can cause low blood pressure, low blood sugar, high potassium levels, and even death. Treatment involves replacing glucocorticoid and
The document describes Waterhouse-Friderichsen syndrome (WFS), which is defined as adrenal gland failure caused by hemorrhaging into the adrenal glands due to severe bacterial infection, most commonly by Neisseria meningitidis bacteria. WFS is characterized by petechial rashes, fever, septic shock, and disseminated intravascular coagulation. It typically affects infants and children under 10 years old. Treatment involves antibiotics, adrenal hormone replacement, and managing shock. Two case studies are presented of patients who died from WFS caused by group A streptococcus and Streptococcus pneumoniae respectively.
Waterhouse–Friderichsen syndrome (WFS) is defined as adrenal gland failure due to bleeding into the adrenal glands, most commonly caused by the bacterial infection meningococcus. It typically occurs in infants and children under 10 years old. Clinically, it presents with a sudden high fever, rash, shock, and disseminated intravascular coagulation. The adrenal glands hemorrhage and lead to adrenal insufficiency. Treatment involves antibiotics, adrenal support with hydrocortisone, and managing shock. Prevention includes routine meningococcal vaccination in certain groups.
Adrenal gland disorders occur when the adrenal glands do not function properly and can be caused by problems in the adrenal glands themselves or other regulating glands. Some examples of adrenal disorders discussed in the document include Addison's disease, Cushing's syndrome, congenital adrenal hyperplasia, and pituitary tumors. Treatment for these disorders aims to replace missing hormones and address underlying causes through medications, diet changes, and surgery.
The adrenal glands sit above the kidneys and are composed of an outer adrenal cortex and inner adrenal medulla. The adrenal cortex produces mineralocorticoids like aldosterone in the zona glomerulosa, glucocorticoids like cortisol in the zona fasciculata, and androgens in the zona reticularis. The adrenal medulla produces epinephrine and norepinephrine. Disorders of the adrenal glands include Cushing's syndrome, congenital adrenal hyperplasia, and Addison's disease. These conditions are treated through medications, surgery, or lifestyle changes to manage hormone levels.
1. The document discusses disorders of the adrenal gland including anatomy, histology, functions, and various disorders affecting the adrenal cortex and medulla.
2. Key disorders covered include Cushing's syndrome, primary hyperaldosteronism, adrenocortical carcinoma, congenital adrenal hyperplasia, adrenal insufficiency, pheochromocytoma, neuroblastoma, and ganglioneuroma.
3. Diagnosis and treatment approaches are summarized for each disorder, including the role of surgery, particularly laparoscopic adrenalectomy.
Este documento resume la patología de la insuficiencia adrenal aguda causada por una infección meningocócica severa. Explica que es una rara complicación que ocurre cuando hay sangrado dentro de las glándulas suprarrenales, lo que lleva a una insuficiencia adrenal. Describe la fisiopatología de cómo la bacteria Neisseria meningitidis causa una septicemia que daña los vasos sanguíneos y lleva a coagulación intravascular diseminada, anemia hemolítica microangiopática y sangrado. Finalmente
1) Pyogenic meningitis is an inflammation of the membranes surrounding the brain and spinal cord caused most commonly by bacterial infection in infants and young children.
2) The causative agents vary by age but include Escherichia coli, Group B Streptococci, Staphylococcus aureus, and Listeria monocytogenes in infants under 2 months. Haemophilus influenzae type b and Streptococcus pneumoniae are common causes in children from 2 months to 2 years.
3) Clinical features include fever, irritability, vomiting, seizures, and bulging fontanelle. Diagnosis involves lumbar puncture to examine cerebrospinal fluid for presence of bacteria, white blood cells and
Acute bacterial (Pyogenic) meningitis - Dr. S. Srinivasan, Professor of Pedi...pediatricsmgmcri
This document discusses acute bacterial meningitis in children. It begins with definitions and descriptions of the common causative bacteria for both neonatal and post-neonatal meningitis. It then covers risk factors, pathogenesis, symptoms and signs, investigations including lumbar puncture findings, treatment, and complications. The document is from a lecture on acute bacterial meningitis for undergraduate medical students, given by Dr. S. Srinivasan, Professor of Pediatrics.
Scurvy is a condition caused by a lack of vitamin C in the diet, which was common among sailors deprived of fresh foods. Symptoms include discomfort, tiredness, joint pain, swollen gums, and wounds healing slowly. The only cause is a diet lacking in vitamin C, and stress increases vitamin C utilization. Oranges, limes, and other citrus fruits are high in vitamin C to treat and prevent scurvy.
Pernicious anemia is a type of vitamin B12 deficiency caused by failure of gastric parietal cells to produce intrinsic factor needed for B12 absorption. It is an autoimmune disease where antibodies are produced against intrinsic factor or parietal cells. Common symptoms include fatigue, weakness, weight loss, gastrointestinal issues, and neurological problems. Diagnosis involves blood tests showing low B12 levels, elevated methylmalonic acid and homocysteine, and high mean corpuscular volume. Treatment is lifelong vitamin B12 supplementation through injection or nasal spray.
The adrenal glands sit atop the kidneys and are composed of an outer cortex and inner medulla. The cortex produces cortisol and aldosterone, while the medulla produces epinephrine and norepinephrine. Adrenal gland disorders occur when the glands do not function properly, such as Cushing's syndrome which results from excess cortisol production, congenital adrenal hyperplasia where the glands do not produce enough hormones, and pituitary tumors affecting hormone regulation. Treatments include medication, surgery, radiation, or a combination depending on the specific disorder.
Addison's disease is a chronic condition that results from damage to the adrenal cortex, causing deficiencies in cortisol, aldosterone, androgens, and estrogens. It is rare, affecting about 1 in 100,000 people. Symptoms include fatigue, weakness, low blood pressure, and hyperpigmentation. Treatment involves replacing cortisol and mineralocorticoids. Nurses monitor for electrolyte imbalances, hypoglycemia, and educate patients on managing stress and recognizing adrenal crises.
Addison's disease, also known as adrenocortical insufficiency, is a hormonal disorder caused by destruction or dysfunction of the adrenal glands, resulting in insufficient production of cortisol and often aldosterone. It can be primary, meaning the adrenal glands are directly damaged, or secondary, when the pituitary gland or hypothalamus fails to stimulate the adrenals. Symptoms include fatigue, weight loss, low blood pressure, and hyperpigmentation. Diagnosis involves blood tests showing low cortisol and high ACTH. Treatment is lifelong corticosteroid and mineralocorticoid hormone replacement therapy. Left untreated, it can cause an Addisonian crisis with shock.
The document discusses several adrenal gland disorders including:
1. Addison's disease, which is caused by inadequate production of hormones by the adrenal glands due to problems with the pituitary gland or autoimmune destruction of the adrenal glands.
2. Cushing's syndrome, which is caused by excessive cortisol production from either benign or cancerous tumors of the adrenal glands or pituitary gland.
3. Pheochromocytoma, a rare tumor of the adrenal medulla that secretes excess catecholamines and causes symptoms like headaches and sweating.
4. Testing of the corticotropin-releasing factor is discussed as a way to diagnose hypothal
Conn's syndrome is a disease that affects the adrenal glands, causing excess production of the hormone aldosterone. It is named after endocrinologist Jerome Conn and was first described in 1955. Common symptoms include frequent urination, increased thirst, weakness, headaches, and high blood pressure. Treatment aims to lower blood pressure through removal of the adrenal gland tumor if present. All Conn's syndrome symptoms typically resolve with treatment and ongoing blood pressure management.
This lecture summary provides information about primary adrenal insufficiency, also known as Addison's disease. It discusses the causes, clinical presentation, diagnostic testing including the rapid ACTH stimulation test and lab studies, imaging, histological findings, and medical treatment including inpatient care with hydrocortisone administration for adrenal crisis. The document is intended for medical students to use for learning and education purposes.
Primary adrenal insufficiency, also known as Addison's disease, is caused by destruction or dysfunction of the adrenal cortex resulting in deficiencies of glucocorticoids and mineralocorticoids. Thomas Addison first described the clinical presentation in 1855. It most commonly presents with hyperpigmentation, dizziness, weakness, and weight loss. Diagnosis involves tests showing a lack of response to ACTH stimulation and electrolyte abnormalities. Treatment is lifelong glucocorticoid and mineralocorticoid hormone replacement to prevent adrenal crises.
Adrenal cortical disorders can cause hyperfunction or hypofunction of the adrenal cortex. Adrenal cortical hyperfunction includes Cushing syndrome, Conn syndrome (hyperaldosteronism), and adrenogenital syndrome. Cushing syndrome is caused by excessive glucocorticoids and results in adrenal cortical hyperplasia. Hyperaldosteronism can be primary or secondary and is characterized by autonomous overproduction of aldosterone. Adrenal cortical hypofunction includes primary adrenocortical insufficiency, which can be acute or chronic, and secondary adrenocortical insufficiency caused by pituitary or hypothalamic disorders. Primary chronic hypofunction includes autoimmune adrenalitis causing Addison's disease.
The document discusses various endocrine disorders of the adrenal glands including:
1. Pheochromocytoma, a neuroendocrine tumor originating from chromaffin cells that secretes excess adrenaline and noradrenaline.
2. Primary hyperaldosteronism or Conn's syndrome, caused by increased aldosterone secretion primarily from an adrenal adenoma or bilateral adrenal hyperplasia, leading to hypertension and hypokalemia.
3. Cushing's syndrome, caused by prolonged exposure to elevated glucocorticoids, either endogenous from an ACTH-secreting pituitary adenoma or exogenous administration, resulting in obesity, hypertension and immunosuppression.
Adrenal cortical disorders can cause hyperfunction or hypofunction of the adrenal cortex. Adrenal cortical hyperfunction includes Cushing syndrome, Conn syndrome (hyperaldosteronism), and adrenogenital syndrome. Cushing syndrome is caused by excessive glucocorticoids and results in adrenal cortical hyperplasia. Conn syndrome is characterized by autonomous overproduction of aldosterone and is commonly caused by an aldosterone-producing adrenal adenoma. Adrenal cortical hypofunction includes primary adrenocortical insufficiency (Addison's disease) and secondary adrenocortical insufficiency caused by decreased ACTH stimulation of the adrenals. Primary adrenocortical insufficiency is often auto
A 12-year-old girl presented with abdominal discomfort and weight loss. On examination, she showed signs of pigmentation in her skin and mucous membranes. Addison's disease is adrenocortical insufficiency caused by destruction or dysfunction of the adrenal cortex, affecting glucocorticoid and mineralocorticoid function. The most common cause is idiopathic autoimmune adrenocortical insufficiency, accounting for over 80% of cases, resulting from autoimmune destruction of the adrenal cortex. Left untreated, Addison's disease can cause an Addisonian crisis and death.
This document discusses Adrenal Insufficiency and Cushing's Syndrome. It covers the epidemiology, types, causes, clinical features, tests, and treatment of both primary and secondary adrenal insufficiency. It also discusses the causes, symptoms, signs, and tests used to establish and determine the cause of Cushing's Syndrome. Treatment options are also summarized for different conditions, including surgery, medications, and hydrocortisone replacement therapy.
re-view of physiology of adrenal cortex. congenital adrenal hyperplasia. Disorder of adrenocortical insufficiency - primary and secondary adrenocortical insufficiency.pathology of primary insufficiency. hypoaldosteronism. ACTH stimulation test.
multi day ACTH stimulation test.
This document discusses adrenal insufficiency and its causes, presentation, diagnosis, and management. It can be primary or secondary. Primary adrenal insufficiency, also known as Addison's disease, is caused by destruction of the adrenal cortex leading to deficiencies in glucocorticoids, mineralocorticoids, and sex steroids. Its hallmark symptoms include fatigue, gastrointestinal issues, hyperpigmentation, and electrolyte abnormalities. Secondary adrenal insufficiency spares mineralocorticoid function and can result from pituitary or hypothalamic disease. Diagnosis involves ACTH and cortisol testing, and treatment is glucocorticoid and mineralocorticoid replacement.
This document provides information on diseases of the adrenal cortex and medulla. It discusses the anatomy and histology of the adrenal glands and their regulation. It then describes specific adrenal disorders including Cushing's syndrome, primary aldosteronism, adrenal insufficiency, incidental adrenal masses, and their causes, clinical features, diagnosis, and treatment. Diseases are summarized with their predominant hormonal abnormalities and management approaches.
This document provides definitions for over 100 medical terms beginning with A-D. Some key terms defined include:
- ACTH, which is a hormone that stimulates the adrenal glands.
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- Anemia, which is a low red blood cell or hemoglobin level. There are many types such as iron deficiency anemia.
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This document discusses diseases of the adrenal cortex, including hyperadrenalism and hypoadrenalism. It describes three hyperadrenal clinical syndromes caused by excess production of cortisol, mineralocorticoids, or androgens. Cushing syndrome is discussed in depth, outlining its causes such as Cushing disease and ectopic ACTH secretion. Hyperaldosteronism and adrenogenital syndromes are also summarized. Hypoadrenalism includes primary and secondary causes, with Addison disease and acute adrenal crisis covered as examples of primary hypoadrenalism.
The document provides details on the structure and function of the adrenal glands, including the different hormone producing zones of the cortex and the role of the medulla. It discusses various pathological conditions that can affect the adrenal glands, such as Cushing's syndrome resulting from corticosteroid overproduction and Addison's disease caused by corticosteroid deficiency. The significance of adrenal tumors like pheochromocytomas is also covered.
This document provides information on disorders of the adrenal gland. It begins with the anatomy and embryology of the adrenal glands. It then discusses the histology and functions of the adrenal cortex and medulla. Some key conditions covered include Cushing's syndrome, hyperaldosteronism, congenital adrenal hyperplasia, and adrenocortical insufficiency. Specific lesions like adrenocortical adenomas and carcinomas are also described.
This document summarizes hereditary hemolytic anemias caused by abnormalities in the red blood cell membrane, specifically hereditary spherocytosis and elliptocytosis. It describes the pathophysiology as defects in membrane proteins like spectrin or ankyrin that cause unstable membranes. Clinical features include anemia, splenomegaly, jaundice and gallstones. Laboratory findings show microspherocytes on blood smear and increased osmotic fragility. G6PD deficiency and pyruvate kinase deficiency are also summarized as enzymatic causes of hemolytic anemia that present with hemolysis when exposed to oxidative stress or inability to generate ATP respectively.
Pathology of Endocrine system
Endocrine pathology is the subspecialty of diagnostic pathology which deals with the diagnosis and characterisation of neoplastic and non-neoplastic diseases of the endocrine system
The adrenal glands produce important hormones like cortisol and aldosterone. Diseases can cause too much or too little hormone production. Cushing syndrome is caused by excessive cortisol and has symptoms like weight gain and high blood pressure. It can be due to pituitary tumors, ectopic ACTH tumors, or adrenal tumors. Primary hyperaldosteronism is caused by excessive aldosterone and causes low potassium and high blood pressure. Androgen excess from adrenal or gonadal tumors can virilize females or cause precocious puberty in males.
Cushing's syndrome is caused by excessive cortisol production and can be due to exogenous sources, a pituitary adenoma, or an adrenal tumor. The most common signs are truncal obesity, high blood pressure, and diabetes. Diagnosis involves tests that check for failure to suppress cortisol levels with dexamethasone. Determining the cause involves additional tests like ACTH levels and imaging. Treatment depends on the underlying cause but may include surgery, medication, or adrenalectomy. Addison's disease is a rare condition of adrenal insufficiency that can result in pigmentation, low blood pressure, and hypoglycemia. Pheochromocytoma is a tumor of the adrenal medulla that secretes catechol
This document discusses several lipid storage diseases including Tay-Sachs disease, Gaucher's disease, Niemann-Pick disease, and Fabry's disease. [1] These diseases arise from deficiencies in specific lysosomal enzymes, leading to accumulation of enzyme substrates in tissues. [2] They are inherited autosomally recessive except for Fabry's disease which is X-linked. [3] The document provides details on the genetic causes and clinical manifestations of each disease.
This document discusses various neuroendocrine emergencies including pituitary apoplexy, myxedema coma, thyroid storm, adrenal crisis, hypercalcemia, hypocalcemia, and hyperglycemic emergencies. Pituitary apoplexy is caused by hemorrhage or infarction of the pituitary gland and presents with sudden severe headache, visual changes, and pituitary hormone deficiencies. Myxedema coma and thyroid storm are life-threatening complications of hypothyroidism and hyperthyroidism respectively that require prompt diagnosis and treatment with thyroid hormones, glucocorticoids, and supportive care. Adrenal crisis occurs in patients with primary or secondary adrenal insufficiency due to inadequate cortisol response to stress
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
3. learning Objectives
At the end of these presentation learners expected
to:-
Know the pathophysiology of adrenal insufficiency.
Identify the cause of adrenal insufficiency.
List the clinical manifestation of adrenal
insufficiency
Explain Addison's crisis
Know pathophysiology of isolated hypoadrenalism
Know the treatment modalities
Adrenal Insufficiency 3
4. Endocrine Abnormalities
Endocrine abnormality expressed by hypersecretion or
hyposecretion of hormone.
Primary disorder-result from the gland it self.
Secondary disorder-the problem result from other
organ or target tissue.
Adrenal Insufficiency 4
5. Cause Of Endocrine Abnormalities
Metabolic factors.
Physical damage
Congenital problems.
Genetic abnormalities.
Adrenal Insufficiency 5
6. Adrenal Insufficiency
Definition
Adrenal insufficiency is a condition in which the
adrenal gland is not able to function well enough to
produce the amount of all corticosteroid hormones
which the body needs.
Adrenal Insufficiency 6
7. Cont’d
According the site of problem
primary adrenal insufficiency.
Secondary adrenal insufficiency.
- Primary Adrenal insufficiency- The gland it self is
damaged.
- Secondary adrenal insufficiency-The gland
healthy but lacks hormonal stimulation
Adrenal Insufficiency 7
8. Primary Adrenal insufficiency
Addison's disease
- it occurs when 90% of the adrenal gland is destroyed.
- is a relatively uncommon disorder that occurs in people
of all ages and both sexes.
- characterized by decreased mineralocorticoid,
glucocorticoid, and androgen secretion.
Adrenal Insufficiency 8
9. cont’d
Cause
1. idiopathic Autoimmune Adrenalitis
The most common type.
Atrophy of adrenal cortex due to autoimmune
diseases, the adrenal medulla is intact.
Accounts 70% of the Addison’ s disease.
15% of patients with Addison's disease have an
associated autoimmune disease , graves disease being
the most common
Adrenal Insufficiency 9
10. Cont’d
Idiopathic autoimmune Addison disease may occur in isolation
or in association with other autoimmune phenomena such as:
- Schmidt syndrome: The association of Addison disease and
Hashimoto thyroiditis.
- polyglandular autoimmune syndrome type 1:
The association of Addison disease with hypoparathyroidism and
mucocutaneouscandidiasis.
o It may have an autosomal recessive mode of inheritance. It has
no human leukocyte antigen (HLA) associations.
Adrenal Insufficiency 10
11. Cont’d
- polyglandular autoimmune syndrome type2:
The association of Addison disease with type 1
diabetes mellitus and Hashimoto thyroiditis or
Graves disease.
Adrenal Insufficiency 11
13. Cont’d
Hematogenous spread of the M.tuberculosis from
else where in the body to the adrenal gland cause-
initial enlarged with extensive epitheloid
granulomas then followed by degeneration of the
adrenal gland.
Both cortex and adrenal medulla is affected.
Fibrosis follows the adrenal become smaller with
calcification of 50% evident.
Adrenal Insufficiency 13
16. Cont’d
Intra adrenal bleeding- cause necrosis of the
adrenal may occur in severely sick patient, with
underlying infection, trauma, or coagulopathy.
- cause of severe septicemia, particularly in children
in whom a common cause is infection with
Neisseria Meningitidis.
when caused by meningococci,the association with
adrenal insufficiency is know as the Waterhouse
Friederichsen syndrome.
Adrenal Insufficiency 16
17. WATERHOUSE-FRIDERICHSEN SYNDROME
• Acute, bilateral hemorrhagic infarction of the adrenals.
• Occurs secondary to shock and DIC, in a septicemic
infection. Endotoxic hemorrhaging.
Tiny fibrin thrombi occlude the vessels going to the adrenal
glands ------> infarction.
Neisseria Meningitidis is the most common agent causing
the infection.
Also Pneumococci, Staph, Strep, Haemophilus,
Diphtheria. Herpes Virus can cause it.
Complete and sudden collapse of cortical function
SYMPTOMS: like symptoms of shock ,infection and DIC
(petechia, thrombocytopenia, increased PT and PTT).
Adrenal Insufficiency 17
19. Cont’d
4. congenital and genetic abnormalities
A. congenital Adrenal Hypoplasia (CAH)
It is an X-linked disorder comprising congenital
adrenal insufficiency and hypogonadotrophic
hypogonadism.
caused by mutations in the NROB1 gene.
DAX-1 gene- a member of the nuclear receptor family
that is expressed in the adrenal cortex, gonads, and
hypothalamus.
Adrenal Insufficiency 19
20. Cont’d
Mutations in another transcription factor
steroidogenic factor-1—may also result in
adrenal insufficiency due to lack of development
of a functional adrenal cortex.
CAH may also occur in association with glycerol
kinase deficiency and muscular dystrophy.
Adrenal Insufficiency 20
21. Cont’d
B.Adrenoleukodystrophy
An inherited metabolic disorder resulting in
accumulation of very-long-chain fatty acids
(VLCFA) in tissues including the brain and adrenal
cortex, resulting in:
Progressive demyelination of cerebral white matter
Adrenal insufficiency
o Only males have the fully expressed condition and
carrier females are usually normal.
Adrenal Insufficiency 21
22. Pathogenesis
Accumulation of VLCFA
VLCFA esterified to
cholesterol, making
cholesterol unavailable as a
steroid/hormone precursor
Adrenocorticalcells with
these inclusions have
decreased mitochondrial and
microsomalenzyme activity
Over time these cells atrophy,
further deteriorating
adrenocorticalfunction
Adrenal Insufficiency 22
23. Cont’d
C.Familial glucocorticoid deficiency (FGD)
inherited unresponsiveness to ACTH.
It is a rare autosomal recessive cause of
hypoadrenalism .
Usually presents in childhood.
The renin-angiotensin-aldosterone axis is intact.
children usually present either with neonatal hypoglycemia
or later with increasing pigmentation, often with enhanced
growth velocity.
Two types-type 1 variant-25% of the case.
- type 2 variant .
Adrenal Insufficiency 23
24. cont’d
D. Allgrove syndrome: congenital adrenocortical
unresponsiveness to ACTH typically presents in
childhood with failure to thrive, features of
adrenocortical insufficiency and hypoglycemia.
- disease to chromosome 12q13 but the responsible gene
is unknown.
Adrenal Insufficiency
24
25. Secondary Adrenal insufficiency
Loss of hypothalamic-pituitary function and deficiency
of ACTH.
Will usually have deficiencies of other gland regulated
by hypothalamic-pituitary system.
Aldosterone secretion may continue intact.
Adrenal Insufficiency 25
26. Cont’d
Problems in hypothalamus or pituitary
⇓
plasma levels of ACTH low.
⇓
unable to stimulate the zona fasiculate and zona
reticularies of adrenal cortex.
⇓
cortisol levels low.
Adrenal cortices do response to exogenous ACTH.
Adrenal Insufficiency 26
27. Cont’d
Cause
1. Sudden cessation of exogenous glucocorticoid
therapy.
Abrupt withdrawal of corticosteroids is a very common
cause of secondary acute adrenal insufficiency.
chronic exogenous glucocorticoid
⇓
Suppresses diurnal CRH/ACTH release
both time- and dose-related
reversible
recovery may take up to long time
Adrenal Insufficiency 27
28. STEROID THERAPY
STEROID LEVELS
PITUITARY GLAND IS INHIBITED TO REALEASE
ACTH
ENDOGENOUS CORTISOL
PRODUCTION & ADRENAL ATROPHY
RELEASE BY ADRENAL CORTEX
Adrenal Insufficiency 28
29. Cont’d
2. Pan- Hypopituitarism
reflect inadequate ACTH production from the anterior
pituitary gland.
In many of these, other pituitary hormones are
deficient in addition to ACTH, so that the patient
presents with partial or complete hypopituitarism.
Adrenal Insufficiency 29
31. Signs & Symptoms
1. Hyper Pigmentation of skin & mucous membrane
due to excess ACTH secretion because of cortisol
deficiency.
- ACTH causes pigmentation by its melanocyte
stimulating action. on the sun exposed areas of the skin,
extensor surface,knuckles,elbows and knees.
2.Vitiligo is also common in auto Immune Addison's
disease due to destruction of melanocyte.
31
Adrenal Insufficiency
33. Cont’d
2.Electroliyte and acid – base balance
abnormalities.
Hyponatremia.
Hyperkalemia and metabolic acidosis
Hypercalcemia.
Adrenal Insufficiency 33
34. Cont’d
3.Dehydretion with loss of sodium
- As ECF becomes depleted.
- plasma volume fall.
- COP decreased.
4.Muscle weakness.
Adrenal Insufficiency 34
35. Cont’d
5. Decreased cardiac output & decreased workload of the
heart leading to decrease in size of the heart.
6. Hypoglycemia.
7. Inability to withstand any type of stress like physical,
mental, even exposure to mild stress, trauma.
8.Decreased pubic and axillary hair in women.
9.Nausea,vomiting and diarrhea.
Adrenal Insufficiency 35
37. Cont’d
Primary vs. secondary adrenal hypo function
primary secondary
Site=adrenal site=hypothalamus-pituitary
↑ACTH ↓ACTH
↑pigmentation ↓pigmentation
weight loss weight change vary
No change in GH and ↓GH and gonadotropins
Gonadotropins.
Deficient in all corticosteroids other adrenal hormones normal or
slightly↓
No response to exogenous ACTH sluggish response to
exogenousACTH.
37
Adrenal Insufficiency
38. Diagnosis
1.ACTH stimulation test
A. Blood and/or urine cortisol levels are measured.
B. Administration of synthetic ACTH.
C. Cortisol measurement in blood is repeated 30 to 60
minutes after an IV ACTH injection.
In healthy person rise in blood and urine cortisol levels
In adrenal insufficiency respond poorly or do not
respond at all.
Adrenal Insufficiency 38
39. Cont’d
2.insulin-induced hypoglycemia test
A. Blood measure of glucose and cortisol level.
B. An injection of fast acting insulin.
C. Blood glucose and cortisol levels are measured at
30,45 and 90 minutes after the insulin injection.
The normal response is -↓blood glucose level
-↑cortisol level.
Adrenal Insufficiency 39
40. Addison’s crisis
A life treating emergency of exacerbate adrenal
insufficiency of undiagnosed patient during facing
stress full conditions.
symptoms are intensified. Nausea, vomiting, and
abdominal pain may become intractable.
In all patients in addisonian’s crisis, a precipitating
cause should be identify.
Adrenal Insufficiency 40
41. Addison's Crisis
Clinical Presentation
Life-threatening emergency
May be primary or secondary
HYPOTENSION
Typically resistant to catecholamine and IVF
resuscitation
Adrenal Insufficiency 41
42. cont’d
Abrupt adrenal failure usually from gland
hemorrhage or thrombosis
Anticoagulation
DIC
Sepsis
Usually have abdominal and flank pain
Adrenal Insufficiency 42
43. Cont’d
Catastrophic HPA axis failure
Head injury
Hemorrhage of pituitary adenoma
Post-partum herniation (Sheehan syndrome)
Usually neurological deficits, headaches, visual field
cuts and diabetes insipidus.
Adrenal Insufficiency 43
44. Treatment Modalities
Different treatment regimes.
Emergency treatments
maintenance therapy.
Replacement of glucocorticoids and mineralo
corticoids.
Adrenal Insufficiency 44
45. Treatment of Addison's crisis
hydrocortisone 50-100 mg every 6-8 hours
intravenous fluids
dextrose
search for precipitating cause
Adrenal Insufficiency 45
46. Treatment
Patients with symptomatic adrenal insufficiency, should be
treated with hydrocortisone or cortisone therapy.
The usual initial dose is 25 mg of hydrocortisone (divided
into doses of 15 and 10 mg)
37.5 mg of cortisone (divided into doses of 25 and 12.5 mg)
The daily dose may be decreased to 20 or 15 mg of
hydrocortisone as long as the patient remains
asymptomatic.
Adrenal Insufficiency 46
47. Treatment chronic AI
hydrocortisone 12-15 mg in one or divided doses
titrate to lowest tolerated dose
consider mineralocorticoid ( fludrocortisone ) if
primary AI. in a single daily dose of 50 to 200 µg, as
a substitute for aldosterone.
Adrenal Insufficiency 47
48. Cont’d
o The dose can be guided by measurements of blood
pressure, serum potassium, and plasma renin
activity, which should be in the upper-normal .
double or triple the dose of hydrocortisone
temporarily whenever they have any febrile illness
or injury.
Adrenal Insufficiency 48
49. Hypoaldosteronism
Secondary hypoaldosteronism (hyporeninism
hypoaldosteronism)
Inadequate stimulation of the zona gromulesa of the
adrenal cortex despite intact adrenal cortex.
CAUSE
Hyporeninism, as an inherited biosynthetic defect.
postoperatively following removal of aldosterone-
secreting adenomas.
during protracted heparin administration.
Renal insufficiency .
Adrenal Insufficiency 49
50. pseudohypoaldosteronism
An inherited disease characterized by severe neonatal
salt wasting, hyperkalemia, metabolic acidosis, and
unresponsiveness to mineralocorticoid hormone
action.
The disease can be due to a loss-of-function mutation in
the mineralocorticoid receptor .
Adrenal Insufficiency 50
51. References
1.Williams text book of endocrinology,11th Edition
2.Ganong’s review of medical physiology,23th
Edition.
3. Harrison’s principles of internal medicine.16th
edition.
4. Guyton Text book of medical physiology,11th
edition
5. Internet websites.
Adrenal Insufficiency 51