Essentials of Human Diseases and Conditions 4th edition

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Essentials of Human Diseases and Conditions 4th
edition

• Margaret Schell Frazier
• Jeanette Wist Drzymkowski

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Chapter 4Diseases and Conditions of the
Endocrine System
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Learning Objectives

• List the major glands of the endocrine system.
• Describe the importance of hormones and explain
  some of the critical body functions that they
  control.
• Explain the importance of normal pituitary
  function.
• Compare gigantism to acromegaly.

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Learning Objectives (contd.)

• Describe the condition of dwarfism and its
  etiology.
• Explain the cause of diabetes insipidus.
• Explain the treatment of a simple goiter.
• List the signs and symptoms of Graves disease.
• Distinguish between cretinism and myxedema.

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Learning Objectives (contd.)

• Explain the pathogenesis of diabetes mellitus.
• Identify the two major types of diabetes
  mellitus.
• Distinguish between diabetic coma and insulin
  shock.
• Explain the medical management of all three types
  of diabetes mellitus.

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Learning Objectives (contd.)

• Explain why hypoglycemia can be a serious medical
  condition.
• Compare the signs and symptoms of thyroid
  hypofunction with those of thyroid hyperfunction.
  
• Describe the signs and symptoms of thyroid
  malignancy. Discuss the most important prognostic
  factor.

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Chapter 4Lesson 4.1
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The Endocrine System

• uses powerful chemical messengers called hormones
  to
• maintain homeostasis
• respond to stress
• regulate essential functions
• control metabolic rate
• direct growth and development

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Major glands of the endocrine system are

• pituitary
• thyroid
• parathyroid
• adrenal
• pancreas
• ovaries/testes
• pineal
• thymus

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Major Glands of Normal Endocrine System
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Hormones are chemical messengers that

• are either amino acids (proteins) or steroids
• are secreted into the bloodstream by specialized
  glands
• target their actions to very specific tissue
  receptor sites

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Important hormones include

• insulin and glucagon
• estrogen, progesterone, and testosterone
• thyroxine, calcitonin, and thyroid stimulating
  hormone (TSH)
• vasopressin
• cortisol and cortisone
• aldosterone
• growth hormone (GH)
• follicle stimulating hormone (FSH) and
  luteinizing hormone (LH)

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Hypothalamus-Pituitary-Thyroid Gland Feedback
Mechanism
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Negative Feedback

• Hormonal secretions typically regulated by
  negative feedback information about the hormone
  level or its effect is fed back to the gland,
  which then responds accordingly

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The effect of pituitary hormones on target tissues
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Pituitary Gland Diseases

• Hyperpituitarism Chronic, progressive disease
  caused by excessive production and secretion of
  pituitary hormones, especially growth hormone
  (HGH)

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Types of Hyperpituitarism

• Gigantism increased growth hormone occurs
  prior to puberty
• Treatment focuses on reducing secreted hGH
  through radiation or surgical intervention to
  reduce pituitary size
• Acromegaly increased growth hormone occurs
  after puberty is complete
• Treatment focuses on reversing or preventing
  tumor mass effects and reducing secreted GH
  ideally through surgery with or without radiation
  to the pituitary gland.

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Hypopituitarism

• A deficiency or absence of the hormones produced
  by the pituitary gland, especially those of the
  anterior pituitary.
• The cause of hypopituitarism may be a tumor or
  the pituitary or hypothalamus. Headache and
  blindness may be symptoms of tumor compression of
  the adjacent optic nerve.
• Cause of panhypopituitarism is sometimes unknown
  it is more common in women.
• Treatment, based on patient age, severity and
  type, and underlying cause, includes removal of
  tumor and hormone replacement therapy.

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Example of Hypopituitarism

• Dwarfism abnormal underdevelopment that occurs
  in children due to decreased growth hormone
  production
• Treatment
• Somatotropin (hGH) administration
• Replacement of thyroid and adrenal hormones
• Sex hormones as puberty approaches as necessary

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Diabetes Insipidus

• A deficiency in the release of vasopressin (ADH)
  from the posterior pituitary resulting in
  excessive (polyuria) urine excretion and thirst
  (polydipsia)
• Treatment consists of vasopressin injections,
  nasal spray or oral desmopressin acetate.

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Thyroid Gland Diseases

• A group of disorders caused by increased or
  decreased amounts of thyroid hormones
• Simple goiter
• Hashimoto disease
• Hyperthyroidism/Graves disease
• Hypothyroidism
• myxedema

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Thyroid Gland Diseases Symptoms

• Hypofunction
• bradycardia
• constipation
• weight gain
• reduced alertness
• fatigue
• edema/bloating
• poor circulation
• cold intolerance
• dry skin and hair

• Hyperfunction
• tachycardia/palpitations
• diarrhea
• weight loss
• anxiety/restlessness
• fatigue
• appetite
• sweating
• heat intolerance
• hair loss

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Simple Goiter

• Enlargement of the thyroid gland usually
  palpable results from shortage of dietary iodine
• Symptoms include swollen mass (goiter) at
  anterior aspect of neck, and dyspnea and
  difficulty swallowing with further enlargement of
  goiter.
• Treatment includes one drop per week of potassium
  iodide

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Thyroid Gland Diseases Hyperthyroidism

• Graves disease diffuse goiter and
  over-production of thyroid hormone that can
  result in life-threatening condition
• Causes of Graves disease are unknown but it is
  thought to be autoimmune in nature and there is a
  strong familial predisposition for it.
• Exophthalmos, the outward protrusion of the
  eyeball, can be present with Graves disease.
  Other symptoms include rapid heartbeat, insomnia,
  and weightloss, to name a few.
• Treatment goal is to reduce thyroid hormone
  through antithyroid drugs and beta-blockers, or
  for severe cases, radioactive iodine or surgery.

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Thyroid Gland Diseases Hypothyroidism

• Cretinism a congenital condition in children in
  which the thyroid gland is absent or
  nonfunctional resulting in mental or growth
  retardation
• Treated with thyroid hormone throughout life
• Myxedema severe condition that develops in older
  child or adult can result in life-threatening
  symptoms including myxedema coma
• Symptoms include slowed metabolism, menorrhagia,
  weight gain, muscular weakness, and tiredness
  amongst others
• Treatment includes administration of
  levothyroxine sodium

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Thyroid Gland Diseases Thyroid Cancer

• Painless lump or nodule on the thyroid gland that
  is malignant.
• Treatment is usually surgery to remove the
  thyroid gland and any involved lymph nodes and
  replacement hormone.
• Anaplastic types may only be treated with
  radiation and chemotherapy to prolong survival.

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Parathyroid Gland Disease

• Hyperparathyroidism
• overproduction of PTH hormone, resulting in
  demineralization of bone and release of excess
  calcium
• symptoms include muscle atrophy, GI pain, and
  nausea amongst others
• treatment is highly individualized based on cause
  
• Hypoparathyroidism
• reduced production of PTH hormone, resulting in
  excessive calcium deposits in tissue and
  decreased circulating calcium
• treated with calcium replacement therapy with
  vitamin D (life-threatening is treated with
  calcium gluconate IV)

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Adrenal Gland Diseases

• Cushing Syndrome
• increase in adrenal cortex secretion of cortisol
• early signs and symptoms include weight gain,
  hypertension, and emotional instability
• other signs and symptoms fatigue, muscle
  weakness, change in body fat distribution, moon
  face, fluid retention, edema, excessive hair
  growth, fertility changes
• treatment depends on cause surgical removal or
  radiation of tumor or adrenal gland drug therapy
  to suppress ACTH

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Adrenal Gland Diseases (contd.)

• Addison Disease
• partial or complete failure of adrenocortical
  function
• onset usually gradual over weeks to months
• fatigue, weakness, gastrointestinal disturbances,
  weight loss, fluid and electrolyte imbalances,
  cardiovascular problems, depression, anxiety,
  bronzing of skin tone
• treatment includes replacement of natural
  hormones increased fluid intake control of salt
  and potassium intake and high carbohydrate/protei
  n diet

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Endocrine Dysfunction of Pancreas

• Diabetes Mellitus
• little or no insulin production in the pancreas
• transport of glucose to cells is impaired
• cells begin to use fats and proteins as energy
  alternative
• blood glucose levels continue to increase,
  resulting in state of hyperglycemia
• signs and symptoms include frequent thirst,
  urination, weight loss, fatigue, increased
  appetite

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Endocrine Dysfunction of Pancreas (contd.)

• Diabetes Mellitus
• Type 1 early, abrupt onset before age 30 with
  little or no insulin secreted
• Type 2 more common form with gradual onset after
  age 30, especially after age 55, with some
  pancreatic function intact

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Warning Signs and Interventions for Diabetic Coma
and Insulin Reaction
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Endocrine Dysfunction of Pancreas (contd.)

• Diabetes mellitus treatment
• Goal is to normalize blood glucose levels and
  minimize complications through
• diet control
• exercise
• frequent blood and urine testing
• insulin injections or oral hypoglycemics
• weight loss (if overweight)
• preventive health care

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Endocrine Dysfunction of Pancreas (contd.)

• Gestational diabetes mellitus (GDM)
• Type 3 decreased ability to metabolize glucose
  during pregnancy with onset around 24-28 weeks of
  gestation the condition usually disappears right
  after delivery.
• Treatment might include control of diet limited
  intake of simple sugars oral hypoglycemic
  agents insulin

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Endocrine Dysfunction of Pancreas (contd.)

• Hypoglycemia
• abnormally low blood glucose level that can be
  caused by excessive insulin secretion in the
  pancreas, fasting, or medications
• signs and symptoms sweating, nervousness,
  hunger, weakness, dizziness, headache,
  palpitations, confusion, visual disturbances
• if severe or untreated, can cause seizures,
  stupor, coma, and death
• Treatment acute requires intravenous infusion of
  glucose hormone glucagon complex
  carbohydrate/protein snack with stabilization

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Precocious Puberty

• For boys, puberty that begins before age 9
• For girls, puberty that begins before age 8
• Causes include tumors of the testes/ovaries,
  hypothalamic or pituitary dysfunction or tumors,
  and ingestion of hormones or sex steroids
• Treatment depends on cause no treatment if
  idiopathic hormone therapy to suppress sexual
  maturation until appropriate time treatment more
  invasive if cause is testicular or brain tumor