Endocrine Disorders

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Endocrine Disorders
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Endocrine Glands

• Collection of glands that secrete hormones
  directly into the bloodstream.
• Adrenal glands, parathyroid glands, pancreas,
  pineal gland, pituitary gland, ovaries, testes,
  thymus gland, thyroid gland

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Thyroid Disorders
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Thyroid Gland
(Hormone.org, 2012)
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Figure 12-7 Effects of thyroxine.
(Zelman, Tompary, Raymond, Holdaway, Mulvhill,
2010)
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Thyroid

• TSH
• T3
• T4
• Disruption of hormones
• Hyperthyroidism
• Hypothyroidism

(NIDDK, 2006)
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Hyperthyroid Symptoms

• Exophthalmos
• Profuse perspiration
• Hand tremors
• Goiter
• Weight loss
• Nervousness/excitability
• Rapid pulse
• Polydipsia
• Diarrhea
• Insomnia
• Most common type Graves Disease

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• Insert Figure 12-9 Thyroid goiter. (Newscom)

(Zelman, Tompary, Raymond, Holdaway, Mulvhill,
2010)
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(No Transcript)
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Hypothyroidism

• Most common type of hypothyroidism
• Hashimotos Disease
• The thyroid doesnt make enough thyroid hormone
• Symptoms
• Fatigue, mental depression, feeling cold, weight
  gain, dry skin and hair, constipation, menstrual
  irregularities

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Thyroid Cancer

• Most people have no symptoms
• 4 types
• Papillary slow growing easily treated
  rarely fatal
• Follicular again slow growing rarely fatal
• Medullary less common more aggressive
• Anaplastic least common most aggressive

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Treatments

• Medication
• Radioactive Iodine
• Surgery
• Prevention??

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Addisons Disease

• Adrenal Insufficiency
• Adrenal glands cannot produce enough cortisol
• OR
• Pituitary gland fails to produce enough
  adrenocorticotropin (ACTH)

• Symptoms
• Chronic, worsening fatigue
• Muscle weakness
• Loss of appetite
• Weight loss
• Nausea/vomiting
• Diarrhea
• Craving for salty foods
• Low blood glucose
• Headache

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Cushings Syndrome

• Caused by prolonged exposure of the bodys
  tissues to high levels of the hormone cortisol.
• Relatively rare but risk factors
• Obesity
• Type 2 diabetes
• High blood pressure

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Cushings Syndrome

• Signs Symptoms
• Rounded face
• Upper body obesity
• Increased neck fat
• Bruise easily / poor healing
• Weakened bones
• Fatigue
• Increased thirst/urination
• Irritability / anxiety / depression

(NIDDK, 2006)
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• Insert Figure 12-11 A patient with Cushings
  syndrome (A) before and (B) after receiving
  treatment. (Sharmyn McGraw)

(Zelman, Tompary, Raymond, Holdaway, Mulvhill,
2010)
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Diabetes
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High Blood Glucose (Hyperglycemia)
In diabetes, blood glucose builds up for several
possible reasons
Liver releases too much glucose
Too little insulin is made
Cells cant use insulin well
American Diabetes Association
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Diabetes Types

• Type 1
• Pancreas makes too little or no insulin
• Beta cell destruction
• Pre-diabetes
• Gestational Diabetes

• Type 2
• Cells do not use insulin well (insulin resistant)
• Beta cell dysfunction
• Ability for pancreas to make insulin decreases
  over time

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Number of Americans withDiagnosed Diabetes,
1980-2011
Centers for Disease Control and Prevention
www.cdc.gov/diabetes/statistics
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Diabetes

• Currently affects about 29.1 million Americans of
  all ages.
• About 9.3 of the population (U.S.)
• Estimated 8 million undiagnosed
• Hispanics/Latinos about 13 diagnosed
• African Americans about 13 diagnosed
• Asian Americans about 9 diagnosed

(CDC, 2014)
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(Oregon.gov, 2015)
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Symptoms

• Increased thirst
• Increased urination
• Blurry vision
• Fatigue
• Weight loss
• Nausea and vomiting
• More frequent infections

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Diagnosis
Stage Test Test
Fasting glucose 2 hr glucose tolerance
Diabetes gt126 mg/dl gt200
Pre-diabetes lt100 gt126 mg/dl gt140 lt200
Normal 60 lt100 lt140 mg/dl
(ADA, 2015)
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Complications

• A leading cause of blindness
• Leading cause of non-accident amputations
• Kidney disease
• Nerve damage (peripheral neuropathy)
• Heart attack / stroke

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Diabetic neuropathy / gangrene
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Diabetic Retinopathy
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Treatment of Diabetes
No medication 16
Insulin only 12
Insulin and oral medication14
Oralmedication only58
National Diabetes Information Clearinghouse.
National Diabetes Statistics, 2011. Available at
http//diabetes.niddk.nih.gov/dm/pubs/statistics/
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Prevention

• The best time to plant a tree is 20 years ago.
  The second best time is now.
• Chinese Proverb
• Good news with diabetes prevention
• Small steps matter

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Cost-Effectiveness of Lifestyle Modification or
Metformin DPP

• Active interventions (vs placebo) would

Intensive Lifestyle Metformin
Delay onset oftype 2 diabetes by 11.1 years 3.4 years
Reduce incidence oftype 2 diabetes by 20 8
Increase life expectancy by 0.5 years 0.2 years
Cost per QALY 1,124 31,286
QALY Quality Adjusted Life Years
Herman WH, et al for the Diabetes Prevention
Program Research Group.Ann Intern Med.
2005142323-332.