Endocrine System

1
Endocrine System
2
Components

• Pituitary
• Thyroid
• Parathyroid
• Adrenal
• Hypothalamus
• Pancreas
• Testes
• Ovaries

3
Function

• The endocrine system is ductless.
• Secretes hormones directly into the bloodstream
• One goal in mindto reach target organ or
  tissue
• The glands act together to regulate many
  functions of your body.

4
When things go amuck!

• If just one of your endocrine glands fail to work
  or hit its target..it can spell disaster.

5
What makes the glands work?

• A combination of things.
• There is a relationship between all of the
  glands, the nervous system, and the blood.
• Too much of a hormone hypersecretion
• Too little of a hormone hyposecretion
• What happens to your body in response to hyper or
  hyposecretion depends on which hormone is
  involved.

6
The glands

• Adrenal cortex
• Adrenal medulla
• Pancreas
• Parathyroid
• Anterior pituitary

• Posterior pituitary
• Testes
• Ovaries
• Thyroid

7
Pituitary (The Master Gland)

• Hyperpituitarism
• Hypopituitarism
• Diabetes insipidus

8
Hyperpituitarism

• Also known as gigantism
• Caused by an excess (hyper) secretion of GH
  (growth hormone)
• The dysfunction MUST occur BEFORE puberty to be
  called gigantismWhy?
• If it occurs AFTER puberty it is called
  acromegaly.

9
Causes of hyperpituitarism

• Adenomas in the anterior pituitary gland are
  usually to blame.
• Also possibly genetic

10
Signs and Symptoms of Hyperpituitarism

• If gigantism.excessive growth of the long bones
  and therefore an increase in height.
• If acromegalythe patients first complaint may
  be that his/her gloves or hat or shoes dont seem
  to fit anymore.
• Often complain of headaches, weakness,
  paresthesia, vision problems.

11
Diagnosing Hyperpituitarism

• The clinical picture
• A glucose suppression test for elevated GH levels
• CT/MRI to find the adenoma

12
Treatment

• Get rid of the excess GH.
• Get rid of the tumor by surgery or radiation.

13
Prognosis

• Gigantism is not usually life-threatening
• If gigantism or acromegaly are progressive before
  tx. Is sought then associated conditions can be
  life threatening. CHF, CVD, Respiratory
  complications, etc.

14
Hypopituitarism

• When GH and gonadotropin are lacking. In some
  cases ACTH and TSH as well.
• If all four are missing it is called
  panhypopituitarism.
• Problem with this condition is that many of these
  hormones stimulate the release of other hormones
  so if they are missing or lacking, the other
  hormones dont get triggered eithercascading
  effect.

15
Cause of Hypopituitarism

• Usually pituitary tumors or tumors on the
  hypothalamus.
• Maybe an infection
• Even postpartum hemorrhage of the pituitary
  gland.
• Head injuries
• Iatrogenic

16
Signs and symptoms of hypopituitarism

• Children-dwarfism
• No gonadotropinno secondary sexual
  characteristics

• Adult-amenorrhea infertility
• Men-decreased libido, loss of body hair.
• ACTH and TSH deficiencies-fatigue, anorexia, low
  tolerance to cold.

17
Diagnostic Procedures

• Clinical picture
• Blood work to measure each of the principle
  pituitary hormone levels.
• Also blood work to measure the output of the
  target glands (cortisol production by the
  adrenals)
• MRI, CTlook for tumors or lesions.

18
Treatment

• If it is missingfind it and put it back.
• Replacement therapy
• Prognosis Good with hormone replacement.
• Loss of all hormone secretions can be fatal

19
Diabetes Insipidus

• If you dont learn anything else.get this right!
• Has NOTHING to do with glucose.
• Deficient secretion of vasopressin or ADH by the
  posterior pituitary gland.

20
Signs and Symptoms

• Polyuria, polydipsia because not enough ADH is
  being secreted and this person is urinating
  EXCESSIVELY! To say the least. Whatever they
  take in has no time to go thru the kidney
  filtration system. They are losing not only
  fluid but Na and other electrolytes.
• The more ADH you have to more fluid the kidneys
  reabsorb. So no ADH..no reabsorption.

21
More S/S

• May produce from 4-16 LITERS of urine in a 24
  hour period.

22
Causes

• Idiopathic
• Tumors
• Head injuries

23
Diagnostic Procedures

• UA Colorless, odorless urine with a low levels
  of dissolved wastes.
• Dehydration testgive no fluids. Measure output
  hourly to get a baseline. Then give vasopressin
  (ADH). If the urine output decreases and there is
  an increase in dissolved wastes in the urinethey
  have DI.
• Babies.heavy diapersfrequent changings.

24
Thyroid Gland Disorders
25
Four

• Simple Goiter
• Hashimotos Disease
• Hyperthyroidism (Graves Disease)
• Hypothyroidism (Cretinism)

26
Simple Goiter

• Classic case of negative feedback.
• A goiter is an enlargement of the thyroid gland.
• A simple goiter is one not caused by infection or
  tumor.
• Some parts of the world, goiter is endemic.

27
Causes

• Firstthe thyroid gland secretes two very
  important hormones
• T3 and T4
• Triiodothyronine and Tetraiodothyronine.
• Butin order for these two hormones to be
  produced..you have to eat Mortons Iodized salt
  (or iodine)you can find in fish as well.

28
Sowhat if you dont eat Mortons?

• If you dont have iodine in your diet to make T3
  and T4, the thyroid still wants it so TSH
  (thyroid stimulating hormone) is sent to the
  thyroid and saysWake up!so the thyroid tries
  and cantso more TSH is sent out to the
  thyroidthis cycle goes on and the thyroid gets
  bigger and bigger from over stimulation without
  results

29
Signs and Symptoms

• The first complaint a patient may have is trouble
  swallowingwhy?
• Orthey may notice their neck looks bigger/strange

30
Treatment

• Dietary supplementation of iodine
• If it isnt lack of Mortons then thyroid
  suppression may be needed.
• Prognosis is good.

31
Hashimotos Disease

• Inflammatory autoimmune disease of the thyroid.
• Body attacks the thyroid gland and it is invaded
  by lymphocytes.
• There are elevated MADGE and antibodies against
  the thyroid floating around in the blood.

32
Signs and Symptoms

• Goiter
• Cold
• Fatigue
• Weight gain

33
Diagnostic Testing

• Needle biopsy
• RAIU
• Blood work

34
Hyperthyroidism

• Over secretion of thyroid hormones
• RememberT3 and T4help regulate your metabolism.
  If they are lackingmetabolism is slow and you
  are fatif they are too plentifulmetabolism is
  fast and you are skinny.

35
Numerous Problems

• Graves Disease aka hyperthyroidism
• Goiter
• Exophthalmos
• Skin lesions

36
Thyrotoxicosis

• A cluster of signs and symptoms caused by
  hyperthyroidism
• Nervousness, loss of sleep, excessive sweating,
  heat intolerance.
• Remember in hypo..it was cold intolerance.
• Wasting of muscles, decalcification of bones.
• Tachycardia, arrhythmias, cardiomegaly

37
Diagnosis

• Clinical picture
• Serum levels of T3 and T4
• RAIU

38
Prognosis

• Varies
• Potentially fatal complication Thyroid Storm is
  a severe case of thyrotoxicosis.

39
Hypothyroidism

• AKA Cretinism and/or Myxedema
• Called cretinism if it occurs at birth and is
  called Myxedema if happens in adulthood.

40
Cause

• Insufficient secretion of thyroid hormones or
  insufficient thyroid tissue ( iatrogenic or
  surgery).

41
Newborns

• Constipation
• Feeding problems
• Sleep a lot
• Slow growth
• Delayed secondary sexual characteristics
• Impaired intelligence

42
Adulthood

• Fatigue
• Constipation
• Intolerance to cold
• Muscle cramps
• Menorrhagia
• Mental clouding
• Weight gain
• Flat emotionless facial expression

43
Diagnosis

• Clinical picture
• Blood work will show low T3 and T4
• Treatment hormone replacement
• Prognosis Myxedema is a life threatening
  complication of hypothyroidismhypothermia,
  stupor.medical emergency.