The document discusses several endocrine diseases and disorders including: - Gigantism and acromegaly, which are caused by excess growth hormone secretion from pituitary tumors in childhood and adulthood respectively. - Addison's disease, which occurs when the adrenal glands do not produce enough cortisol and aldosterone hormones. - Cretinism, a condition of stunted growth caused by untreated congenital hypothyroidism from iodine deficiency or thyroid gland defects. - Graves' disease, an autoimmune disorder causing hyperthyroidism from overactive thyroid hormone production. - Hypothyroidism, an underactive thyroid that does not produce enough thyroid hormones to

2. Endocrine Diseases
 Your endocrine system includes eight major glands
throughout your body, such as the thyroid gland,
pituitary gland, adrenal gland, and pancreas. This
system affects growth and development,
metabolism, sexual function, and mood.
 If your hormone levels are too high or too low, you
may have an endocrine disease or disorder.
Endocrine diseases and disorders also occur if your
body does not respond to hormones the way it is
supposed to.

4.  Gigantism is a serious condition that is nearly always caused
by an adenoma, a tumor of the pituitary gland. Gigantism
occurs in patients who had excessive growth hormone in
childhood. The pituitary tumor cells secrete too much growth
hormone (GH), leading to many changes in the body.
What causes gigantism?
A pituitary gland tumor is almost always the cause of gigantism.
The pea-sized pituitary gland is located at the base of your brain.
It makes hormones that control many functions in your body.
Some tasks managed by the gland include:
•temperature control
•sexual development
•growth
•metabolism
•urine production
When a tumor grows on the pituitary gland, the gland makes far
more growth hormone than the body needs.

5. Recognizing the signs of gigantism
If your child has gigantism, you may
notice that they’re much larger than
other children of the same age. Also,
some parts of their body may be larger
in proportion to other parts. Common
symptoms include:
• very large hands and feet
• thick toes and fingers
• a prominent jaw and forehead
• coarse facial features
The symptoms your child has may depend
on the size of the pituitary gland tumor. As
the tumor grows, it may press on nerves in
the brain. Many people experience
headaches, vision problems, or nausea
from tumors in this area. Other symptoms
of gigantism may include:
• excessive sweating
• severe or recurrent headaches
• weakness
• insomnia and other sleep disorders
• delayed puberty in both boys and girls
• irregular menstrual periods in girls
• deafness

6. How is gigantism treated?
Surgery
Removing the tumor is the preferred treatment for gigantism if it’s the underlying cause.The
surgeon will reach the tumor by making an incision in your child’s nose. Microscopes or small
cameras may be used to help the surgeon see the tumor in the gland. In most cases, your child
should be able to return home from the hospital the day after the surgery.
Gamma knife radiosurgery
Gamma knife radiosurgery is an option if your child’s doctor believes that a traditional surgery isn’t
possible.
The “gamma knife” is a collection of highly focused radiation beams. These beams don’t harm the
surrounding tissue, but they’re able to deliver a powerful dose of radiation at the point where they
combine and hit the tumor. This dose is enough to destroy the tumor.
Gamma knife treatment takes months to years to be fully effective and to return the levels of growth
hormone to normal. It’s performed on an outpatient basis under general anesthetic.
However, since the radiation in this type of surgery has been linked to obesity, learning disabilities,
and emotional issues in children, it’s usually used only when other treatment options don’t work.

7. Acromegaly
Acromegaly is a disorder that occurs when your body
makes too much growth hormone (GH). Produced
mainly in the pituitary gland, GH controls the physical
growth of the body. In adults, too much of this hormone
causes bones, cartilage, body organs, and other tissues
to increase in size.

8. Symptoms
 A common sign of acromegaly is
enlarged hands and feet. For
example, you may notice that you
aren't able to put on rings that used
to fit, and that your shoe size has
progressively increased.
 Acromegaly may also cause
gradual changes in your face's
shape, such as a protruding lower
jaw and brow bone, an enlarged
nose, thickened lips, and wider
spacing between your teeth.
 Because acromegaly tends to
progress slowly, early signs may
not be obvious for years.
Sometimes, people notice the
physical changes only by
comparing old photos with newer
ones.
Enlarged hands and feet
Enlarged facial features, including the facial
bones, lips, nose and tongue
Coarse, oily, thickened skin
Excessive sweating and body odor
Small outgrowths of skin tissue (skin tags)
Fatigue and joint or muscle weakness
Pain and limited joint mobility
A deepened, husky voice due to enlarged
vocal cords and sinuses
Severe snoring due to obstruction of the
upper airway
Vision problems
Headaches, which may be persistent or
severe
Menstrual cycle irregularities in women
Erectile dysfunction in men
Loss of interest in sex

9. Causes
 Acromegaly occurs when the pituitary gland produces too
much growth hormone (GH) over a long period of time.
 The pituitary gland is a small gland at the base of your
brain, behind the bridge of your nose. It produces GH and a
number of other hormones. GH plays an important role in
managing your physical growth.
In adults, a tumor is the most common cause of too much GH production:
•Pituitary tumors. Most acromegaly cases are caused by a noncancerous (benign) tumor (adenoma)
of the pituitary gland. The tumor produces excessive amounts of growth hormone, causing many of the
signs and symptoms of acromegaly. Some of the symptoms of acromegaly, such as headaches and
impaired vision, are due to the tumor pressing on nearby brain tissues.
•Nonpituitary tumors. In a few people with acromegaly, tumors in other parts of the body, such as the
lungs or pancreas, cause the disorder. Sometimes, these tumors secrete GH. In other cases, the
tumors produce a hormone called growth hormone-releasing hormone (GH-RH), which signals the
pituitary gland to make more GH.

11. What is the difference between acromegaly and
gigantism?
• Acromegaly and gigantism are both conditions that result from excess
growth hormone (GH). The difference is in who the conditions affect —
adults develop acromegaly, whereas children develop gigantism.
• In children, gigantism occurs when they experience excess GH before the
growth plates in their bones fuse (before the end of puberty). This causes
them to grow very tall. Gigantism is more rare than acromegaly. Some
healthcare providers refer to gigantism as pediatric acromegaly.
• Once your growth plates have fused, excess GH causes acromegaly. In this
case, you don’t grow in height, but the excess GH affects your bones’ shape
and your organ size as well as other health factors.

12. Addison's disease
 Addison's disease, also called adrenal insufficiency, is an uncommon illness that occurs when the
body doesn't make enough of certain hormones. In Addison's disease, the adrenal glands make
too little cortisol and, often, too little of another hormone, aldosterone.
 Addison's disease can affect anyone and can be life-threatening. Treatment involves taking
hormones to replace those that are missing.
Symptoms
Addison's disease symptoms usually happen slowly,
often over months. The disease can move so slowly
that people who have it may ignore the symptoms at
first.
Symptoms may include:
Extreme fatigue
Weight loss and loss of appetite
Areas of darkened skin
Low blood pressure, even fainting
Salt craving
Low blood sugar, also called hypoglycemia
Nausea, diarrhea or vomiting

14. Causes
 Addison's disease is caused by damage to the adrenal glands.
The adrenal glands sit just above the kidneys. As part of the
endocrine system, they make hormones that affect almost
every organ and tissue in the body. Damage to these glands
results in too little of the hormone cortisol and, often, the
hormone aldosterone.
Complications
•Addisonian crisis. If you have untreated Addison's disease, you may develop an addisonian crisis as
a result of stress on the body, such as injury, infection or illness. Typically, the adrenal glands make two
or three times the usual amount of cortisol in response to physical stress. With adrenal insufficiency,
not being able to increase the amount of cortisol made as a result of stress can lead to an addisonian
crisis.
•An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of
sugar and high blood levels of potassium. It requires immediate medical care.
•Other autoimmune diseases. People with Addison's disease often have related autoimmune
diseases.

15. Primary adrenal insufficiency
Sometimes, the outer layer of the
adrenal glands, known as the cortex,
is damaged. Then it can't make
enough hormones, a condition called
primary adrenal insufficiency. This is
usually the result of an autoimmune
disease, in which the body attacks
itself. People with Addison's disease
are more likely than are other people
to have another autoimmune disease
as well.
Other causes of adrenal gland failure
may include:
•Tuberculosis
•Other infections of the adrenal
glands
•Spread of cancer to the adrenal
glands
•Bleeding into the adrenal glands
Secondary adrenal insufficiency
The pituitary gland makes a hormone called
adrenocorticotropic hormone
(ACTH). ACTH in turn causes the adrenal
cortex to make its hormones. Having pituitary
tumors that aren't cancer, inflammation and
pituitary surgery can cause the pituitary gland
to make too little ACTH.
Most symptoms of secondary adrenal
insufficiency are similar to those of primary
adrenal insufficiency. However, people with
secondary adrenal insufficiency don't have
darkened skin and are less likely to have
severe dehydration or low blood pressure.
They're more likely to have low blood sugar.
A temporary cause of secondary adrenal
insufficiency occurs when people who take
corticosteroids, such as prednisone, to treat
conditions such as asthma or arthritis, stop
taking the medicine suddenly rather than
tapering off.

16. Menopause
Menopause is not a disease or disorder. This time in a woman's life is often full of
other transitions in addition to physical ones: Women may be caring for aging parents or
relatives, supporting their children as they move into adulthood, or taking on new
responsibilities at work.

20. Cretinism
Cretinism is a condition of severely stunted physical and mental growth
due to untreated congenital deficiency of thyroid hormones (congenital
hypothyroidism). Congenital hypothyroidism can be endemic, genetic, or
sporadic.
Cretinism types
Congenital Cretinism
•Incidence is 1:3000 to 1:4000 in an iodine-deficient
endemic area.
•It can be caused due to a defect in the genes encoding
various enzymes involved in thyroid hormone synthesis
such as thyroglobulin, iodotyrosine deiodinase and also
thyroid-stimulating hormone (TSH). This type of
hypothyroidism is also called congenital hypothyroidism,
non-goitrous (CHNG).
Endemic Cretinism
•For adults, the normal recommended dietary intake of iodine is 150 μg
/ day.
•This type of cretinism often occurs in children who live in the
geographical settings where iodine is deficient and it is not corrected
by either supplementing iodine or thyroid hormone to regain normal
thyroid hormone levels during early life.
•Mostly, the mother of endemic cretinism children had been affected
with hypothyroidism during pregnancy (Maternal hypothyroidism).

21. Causes
There are two main reasons for cretinism:
Lack of thyroid gland and failure of the thyroid gland to produce thyroid hormone (congenital cretinism or congenital
iodine deficiency syndrome).
Iodine deficiency in the diet (Endemic cretinism).
In children, hypothyroidism is the cause of cretinism. Total T4 and T3 level may be normal due to increased TBG
(Thyroxine binding globulin). The elevated level of TBG may be due to maternal hyperestrogenism. The lack of
feedback mechanisms will also give an elevated TSH level.
Neonatal cretinism may also be caused by maternal hypothyroidism. Hypothyroidism may result from the treatment
of hyperthyroidism using antithyroid drugs or radioactive iodine.

22. Symptoms
Signs of cretinism or congenital hypothyroidism in a newborn include:
•lack of weight gain
•stunted growth
•fatigue, lethargy
•poor feeding
•thickened facial features
•abnormal bone growth
•mental retardation
•very little crying
•excessive sleep
•constipation
•yellowing of the skin and whites of the eyes (jaundice)
•floppiness, low muscle tone
•hoarse voice
•unusually large tongue
•swelling near the navel (umbilical hernia)
•cool, dry skin
•pale skin
•swelling of the skin (myxedema)
•swelling in the neck from an enlarged thyroid gland (goiter)

23. Prevention
Congenital hypothyroidism is typically seen in developing countries where iodine deficiency is
common. Adults can prevent iodine deficiency by getting the Institute of Medicine’s recommended
dietary allowance (RDA) of 150 micrograms of iodine per day. One teaspoon of iodized salt contains
about 400 micrograms of iodine.
Because an iodine deficiency in pregnancy can be dangerous to the growing baby, pregnant women
are advised to get 220 micrograms of iodine daily.
Treatment
•Once diagnosed, treatment should be started within 1-2 weeks of life.
•Treatment should be started before the onset of symptoms, if developmental abnormalities and mental retardation start to appear,
it will not reverse even with thyroid hormone replacement therapy.
•The recommended dose is 10 to 15 μg per kg of body weight. The dose should be increased as the age progresses.
•Everyday treatment with thyroxine should be initiated as early as possible as mental retardation that has ensued already is only
partially reversible. With early treatment, physical development and growth can be revived and mental retardation can be checked.

24. Cretinism and Dwarfism
Cretinism and dwarfism are two conditions resulting from deficiency and medical disorder. While Dwarfism is the
state of being dwarf, cretinism is the condition of dwarfism showing signs of mental retardation. The causative is
the deficiency of thyroid hormone. Cretinism on the other hand is usually a congenital condition.

26. Graves: Disease

29. Hypothyroidism
What is hypothyroidism? Hypothyroidism, also called underactive thyroid, is when the thyroid gland doesn't
make enough thyroid hormones to meet your body's needs. The thyroid is a small, butterfly-shaped gland in
the front of your neck.

30. Types

33. Toxic Multinodular Goiter