Pathophysiology endocrine disorders nursery.

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•DR. Hanan A. Mubarak, B.M.B.ch, M.Sc., M.D
•Professor, Faculty of medicine, Cairo university

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Disorders of GH secretion
[1] Deficiency of GH : Pituitary Dwarfism
• It is caused by decreased GH secretion before puberty
• Characters & features:
1) Decreased growth
A- Arrested skeletal growth.
B- Symmetrical growth retardation: the height = span &
the distance from crown to symphysis = distance
from symphysis to toes
C- Retardation of soft tissue growth
2) No mental retardation : dwarf may be very intelligent.
3) Sexually normal

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Pituitary Dwarfism

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Disorders of GH secretion
[2] Gigantism:
• Increase GH before the closure of epiphysis of long
bone (before puberty)
• Features:
Overgrowth of all bones leading to tall individual (2 – 2.1
meter long):
growing period is lengthened, giant may continue to gro
w till time of death..
Overgrowth of soft tissue: Visceromegaly
Hypogonadism due to pressure on cells that secrete gonadotropi
ns .
Hyperglycemia: pituitary diabetes.

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• If too little is secreted
, dwarfism occurs; if
too much, gigantism
is the result. It

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Disorders of GH secretion
[3] Acromegalv:
• Increase GH after closure of epiphysis (after puberty). Features:
Overgrowth of bones: the bones become more thicker.
a- Overgrowth of bones of hands & feet.
b- Overgrowth of vertebrae → bowing of spines or kyphosis
c- Overgrowth of skull: large & elongated.
- Supra-orbital ridges are prominent
- Nasal bones: thick
- Overgrowth of mandible → protrusion of
mandible → separation of teeth.
Overgrowth of soft tissues (organomegaly) & muscles
Hyperglycemia and diabetes mellitus
Vision disturbances

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• In the photographs, we see a wom
an at 16, 33 and 52 years of age
who has a condition caused by ex
cessive secretion of growth hormo
ne during adulthood. This conditio
n is characterized by disproportion
ate growth in the jaw, hands and n
ose

14. Disorders of Thyroid Hormone Secretion
• It may be hypofunction (hypothyroidism) or
hyperfunction (hyperthyroidism)
• Each is either:
 Primary: of thyroid origin
 Secondary: of pituitary origin
 Tertiary : of hypothalamic origin

15. HYPERTHYROIDISM
Most common cause –
Grave’s disease
Autoimmune disease where
thyroid-stimulating
immunoglobulin (TSI)
is produced
erroneously
Is not subject to the
negative feedback
mechanism

16. Hyperthyroidism (thyrotoxicosis)
•It occurs in adults due to excessive secretion of thyroid hormones
** Grave's disease:
 Autoantibodies are formed against thyroid gland
TSH receptors: TSH-R (stimulatory) Ab
 These antibodies continuously stimulate the thyroid
gland to produce T3 and T4 in excessive amounts.

17. hyperthyroidism
Characteristics:
•(1) Basal metabolic rate (BMR): increased up to + 100%
A) Decrease body weight
B) Patient cannot tolerate heat
C) Skin:
 Moist due to increase sweating
 Warm flushed due to VD of cutaneous capillaries

18. (2) CNS:
A) Nervousness & irritability
B) lnsomnia
C) Hyperreflexia
D) Fine tremors of extended & abducted fingers
(3) CVS:
A) Increase heart rate & cardiac output (CO)
B) Increase systolic blood pressure due to increase stroke
volume due to increase force of contraction
C) Decrease diastolic blood pressure due to peripheral VD
due to increase metabolite
D) Increase pulse pressure (Increase systolic pressure &
decrease diastolic pressure)

19. (4) On GIT: Increase appetite (hyperphagia) &
diarrhea
(5) On Respiration: increase pulmonary ventilation
(6) ON blood: decrease cholesterol & Increase
glucose (hyperglycemia)

20. Exophthalmos →
complex water-retaining
carbohydrate are deposited
behind the eye →fluid
retention pushes eyeballs
forward (prominent feature
of Grave’s disease only).
Treatment for
hyperthyroidism is anti-
thyroid drugs.

21. (8) On eye: Exophthalmos: Protrusion of
eye balls,
Results:
 Increase intra-ocular pressure
Pressure on optic nerve → blindness
Pressure on occulomotor nerve → paralysis of
extra-ocular muscles
Diplopia

22. Hypothyroidism
Two Types:
•[A] Adult hypothyroidism: Myxoedema
•[B] Children hypothyroidism: Cretinism

23. [A] Adult hypothyroidism: Myxoedema
1) Basal Metabolic Rate (BMR): decreased down to - 50 %
A) Increase body weight
B) Patient can not tolerate cold
C) Skin: Dry, Puffy, Yellowish
- Dry: No sweat
- Puffy
- Yellow "Carotinemia" thyroid hormones are
required by liver to transform carotene to vitamin A
D) Hairs are coarse

24. - Hyporeflexia
(3) CVS:
- Slow heart rate & decrease
cardiac output
- Atherosclerosis
(4) GIT: loss of appetite & constipation
(5) Respiration:
- decrease pulmonary
ventilation
- Deep voice (hoarseness of
voice)
(6) Blood: Increase serum cholesterol
(7) Non pitting edema: due to
accumulation of myxoedmatous tissue

25. [B] Children hypothyroidism: Cretinism
•On the name of Crete Island
•Hypothyroidism since birth or early in childhood.
Characteristics:
•There is delay in all normal growth
•There is retardation of physical, mental & sexual
development.
(1) Physical growth: Dwarf
(2) Mental development: Dwarf is mentally retarded
(3)Sexual development: Delayed

26. Physical growth: Dwarf
 Cretin is short & obese as skeletal growth is more
inhibited than soft tissues growth
 Disproportionate dwarf: span is retarded more
than height (vertebrae not retarded). Umbilicus is
not central
 Delay → eruption of teeth, closure of fontanels,
sitting & walking.
 Facial features: ugly
 Eye: swollen lid with narrow palpebral fissure
 Nose: depressed nose with wide nostril
 Mouth: enlarged tongue-protruded because of
small mandible
 Skin: thick & dry
 Abdominal wall: pot belly abdomen due to
enlarged liver & viscera

27. HYPOTHYROIDISM

29. Tetany
• Definition:
It is a condition of increase neuromuscular excitability due to decrease ionized
Ca2+ . It resulted in extensive spasm of the skeletal muscle.
• Causes:
1- Hypoparathyroidism following thyroidectomy.
2- Alkalosis: by persistent vomiting, hyperventilation.
3- Renal failure: results in retention of phosphates → low Ca2+
& failure of α hydroxylation.
4- Rickets (vitamin D deficiency in children).

30. Types of tetany
Manifest tetany:
- Occurs when serum Ca2+ is below 7 mg%
- Carpopedal spasms occur in fingers & toes (accoucheur
hand).
- Laryngeal spasms and respiratory spasms leading to fatal
asphyxia.
Latent tetany (Hidden):
- Occurs when serum Ca2+ is above 7 mg% but < 9.4
mg% (7-9.4 mg%).
- It appears by tests to show increased excitability.

31. Latent tetany
tests to show increased excitability.
1- Chovstek's sign
-Tapping the skin in front of the ear → Twitching of
facial muscles (hyperexcitable facial nerve).
- A tap on the peroneal nerve at lateral aspect of
fibula below its head → dorsiflexion and abduction of the foot.
2- Trousseau sign
Occluding the circulation of the arm with the blood pressure
cuff for few minutes → carpal spasm (accoucheur hand).

32. Accoucheur hand: flexion of wrist & metacarpo-pharyngeal joints with
extension of interphalangeal joints and adduction of the thumbs in the palm.

33. Thank you