Essentials of Human Diseases and Conditions 4 th edition

Essentials of Human Diseases Essentials of Human Diseases and Conditions and Conditions

44thth edition edition

Margaret Schell FrazierMargaret Schell Frazier

Jeanette Wist DrzymkowskiJeanette Wist Drzymkowski

Chapter 4Chapter 4Diseases and Conditions of the Endocrine Diseases and Conditions of the Endocrine

SystemSystem

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Learning ObjectivesLearning Objectives

List the major glands of the endocrine List the major glands of the endocrine system.system.

Describe the importance of hormones and Describe the importance of hormones and explain some of the critical body functions explain some of the critical body functions that they control.that they control.

Explain the importance of normal pituitary Explain the importance of normal pituitary function.function.

Compare gigantism to acromegaly.Compare gigantism to acromegaly.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Describe the condition of dwarfism and its Describe the condition of dwarfism and its etiology.etiology.

Explain the cause of diabetes insipidus.Explain the cause of diabetes insipidus. Explain the treatment of a simple goiter.Explain the treatment of a simple goiter. List the signs and symptoms of Graves’ List the signs and symptoms of Graves’

disease.disease. Distinguish between cretinism and Distinguish between cretinism and

myxedema.myxedema.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Explain the pathogenesis of diabetes mellitus.Explain the pathogenesis of diabetes mellitus. Identify the two major types of diabetes Identify the two major types of diabetes

mellitus.mellitus. Distinguish between diabetic coma and Distinguish between diabetic coma and

insulin shock.insulin shock. Explain the medical management of all three Explain the medical management of all three

types of diabetes mellitus.types of diabetes mellitus.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Explain why hypoglycemia can be a serious Explain why hypoglycemia can be a serious medical condition.medical condition.

Compare the signs and symptoms of thyroid Compare the signs and symptoms of thyroid hypofunction with those of thyroid hypofunction with those of thyroid hyperfunction. hyperfunction.

Describe the signs and symptoms of thyroid Describe the signs and symptoms of thyroid malignancy. Discuss the most important malignancy. Discuss the most important prognostic factor.prognostic factor.

Chapter 4Chapter 4Lesson 4.1Lesson 4.1

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The Endocrine SystemThe Endocrine System

uses powerful chemical messengers called uses powerful chemical messengers called hormones to:hormones to: maintain homeostasismaintain homeostasis respond to stressrespond to stress regulate essential functionsregulate essential functions control metabolic ratecontrol metabolic rate direct growth and developmentdirect growth and development

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pituitarypituitary thyroidthyroid parathyroidparathyroid adrenaladrenal pancreaspancreas ovaries/testesovaries/testes pinealpineal thymusthymus

Major glands of the endocrine system are:Major glands of the endocrine system are:

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Major Glands of Normal Endocrine Major Glands of Normal Endocrine SystemSystem

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are either amino acids (proteins) or steroidsare either amino acids (proteins) or steroids are secreted into the bloodstream by are secreted into the bloodstream by

specialized glandsspecialized glands target their actions to very specific tissue target their actions to very specific tissue

receptor sites receptor sites

Hormones are chemical messengers that:Hormones are chemical messengers that:

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Important hormones include:Important hormones include:

insulin and glucagoninsulin and glucagon estrogen, progesterone, and testosteroneestrogen, progesterone, and testosterone thyroxine, calcitonin, and thyroid stimulating hormone thyroxine, calcitonin, and thyroid stimulating hormone

(TSH)(TSH) vasopressinvasopressin cortisol and cortisonecortisol and cortisone aldosteronealdosterone growth hormone (GH)growth hormone (GH) follicle stimulating hormone (FSH) and luteinizing follicle stimulating hormone (FSH) and luteinizing

hormone (LH) hormone (LH)

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Hypothalamus-Pituitary-Thyroid Gland Hypothalamus-Pituitary-Thyroid Gland Feedback MechanismFeedback Mechanism

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Negative FeedbackNegative Feedback

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

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The effect of pituitary hormones on target The effect of pituitary hormones on target tissuestissues

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Pituitary Gland DiseasesPituitary Gland Diseases

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

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Types of HyperpituitarismTypes of Hyperpituitarism

Gigantism: increased growth hormone — Gigantism: increased growth hormone — occurs prior to pubertyoccurs prior to puberty Treatment focuses on reducing secreted hGH Treatment focuses on reducing secreted hGH

through radiation or surgical intervention to reduce through radiation or surgical intervention to reduce pituitary size pituitary size

Acromegaly: increased growth hormone — Acromegaly: increased growth hormone — occurs after puberty is completeoccurs after puberty is complete Treatment focuses on reversing or preventing Treatment focuses on reversing or preventing

tumor mass effects and reducing secreted GH tumor mass effects and reducing secreted GH ideally through surgery with or without radiation to ideally through surgery with or without radiation to the pituitary gland.the pituitary gland.

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HypopituitarismHypopituitarism

A deficiency or absence of the hormones produced A deficiency or absence of the hormones produced by the pituitary gland, especially those of the anterior by the pituitary gland, especially those of the anterior pituitary.pituitary.

The cause of hypopituitarism may be a tumor or the The cause of hypopituitarism may be a tumor or the pituitary or hypothalamus. Headache and blindness pituitary or hypothalamus. Headache and blindness may be symptoms of tumor compression of the may be symptoms of tumor compression of the adjacent optic nerve.adjacent optic nerve.

Cause of panhypopituitarism is sometimes unknown; Cause of panhypopituitarism is sometimes unknown; it is more common in women.it is more common in women.

Treatment, based on patient age, severity and type, Treatment, based on patient age, severity and type, and underlying cause, includes removal of tumor and and underlying cause, includes removal of tumor and hormone replacement therapy.hormone replacement therapy.

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Example of HypopituitarismExample of Hypopituitarism

Dwarfism:Dwarfism: abnormal underdevelopment that abnormal underdevelopment that occurs in children due to decreased growth occurs in children due to decreased growth hormone productionhormone production

TreatmentTreatment Somatotropin (hGH) administrationSomatotropin (hGH) administration Replacement of thyroid and adrenal Replacement of thyroid and adrenal

hormoneshormones Sex hormones as puberty approaches as Sex hormones as puberty approaches as

necessarynecessary

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Diabetes InsipidusDiabetes Insipidus

A deficiency in the release of vasopressin A deficiency in the release of vasopressin (ADH) from the posterior pituitary resulting in (ADH) from the posterior pituitary resulting in excessive (polyuria) urine excretion and thirst excessive (polyuria) urine excretion and thirst (polydipsia)(polydipsia)

Treatment consists of vasopressin injections, Treatment consists of vasopressin injections, nasal spray or oral desmopressin acetate.nasal spray or oral desmopressin acetate.

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Thyroid Gland DiseasesThyroid Gland Diseases

A group of disorders caused by increased or A group of disorders caused by increased or decreased amounts of thyroid hormones:decreased amounts of thyroid hormones: Simple goiterSimple goiter Hashimoto diseaseHashimoto disease Hyperthyroidism/Graves’ diseaseHyperthyroidism/Graves’ disease HypothyroidismHypothyroidism myxedemamyxedema

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HypofunctionHypofunction bradycardiabradycardia constipationconstipation weight gainweight gain reduced alertnessreduced alertness fatiguefatigue edema/bloatingedema/bloating poor circulationpoor circulation cold intolerancecold intolerance dry skin and hairdry skin and hair

HyperfunctionHyperfunction tachycardia/palpitationstachycardia/palpitations diarrheadiarrhea weight lossweight loss anxiety/restlessnessanxiety/restlessness fatiguefatigue appetiteappetite sweatingsweating heat intolerance heat intolerance hair losshair loss

Thyroid Gland Diseases SymptomsThyroid Gland Diseases Symptoms

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Simple GoiterSimple Goiter

Enlargement of the thyroid gland:Enlargement of the thyroid gland: usually usually palpable results from shortage of dietary iodinepalpable results from shortage of dietary iodine

Symptoms include swollen mass (goiter) at Symptoms include swollen mass (goiter) at anterior aspect of neck, and dyspnea and anterior aspect of neck, and dyspnea and difficulty swallowing with further enlargement of difficulty swallowing with further enlargement of goiter.goiter.

Treatment includes one drop per week of Treatment includes one drop per week of potassium iodide potassium iodide

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Thyroid Gland Diseases: HyperthyroidismThyroid Gland Diseases: Hyperthyroidism

Graves’ disease:Graves’ disease: diffuse goiter and over-production of diffuse goiter and over-production of thyroid hormone that can result in life-threatening thyroid hormone that can result in life-threatening conditioncondition Causes of Graves’ disease are unknown but it is thought to Causes of Graves’ disease are unknown but it is thought to

be autoimmune in nature and there is a strong familial be autoimmune in nature and there is a strong familial predisposition for it.predisposition for it.

Exophthalmos,Exophthalmos, the outward protrusion of the eyeball, can the outward protrusion of the eyeball, can be present with Graves’ disease. Other symptoms include be present with Graves’ disease. Other symptoms include rapid heartbeat, insomnia, and weightloss, to name a few.rapid heartbeat, insomnia, and weightloss, to name a few.

Treatment goal is to reduce thyroid hormone through Treatment goal is to reduce thyroid hormone through antithyroid drugs and beta-blockers, or for severe cases, antithyroid drugs and beta-blockers, or for severe cases, radioactive iodine or surgery.radioactive iodine or surgery.

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Thyroid Gland Diseases: HypothyroidismThyroid Gland Diseases: Hypothyroidism

Cretinism: Cretinism: a congenital condition in children in which a congenital condition in children in which the thyroid gland is absent or nonfunctional resulting the thyroid gland is absent or nonfunctional resulting in mental or growth retardationin mental or growth retardation

Treated with thyroid hormone throughout lifeTreated with thyroid hormone throughout lifeMyxedema:Myxedema: severe condition that develops in older severe condition that develops in older

child or adult; can result in life-threatening symptoms child or adult; can result in life-threatening symptoms including myxedema coma including myxedema coma

Symptoms include slowed metabolism, menorrhagia, Symptoms include slowed metabolism, menorrhagia, weight gain, muscular weakness, and tiredness weight gain, muscular weakness, and tiredness amongst othersamongst others

Treatment includes administration of levothyroxine Treatment includes administration of levothyroxine sodium sodium

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Painless lump or nodule on the thyroid gland Painless lump or nodule on the thyroid gland that is malignant.that is malignant.

Treatment is usually surgery to remove the Treatment is usually surgery to remove the thyroid gland and any involved lymph nodes thyroid gland and any involved lymph nodes and replacement hormone.and replacement hormone.

Anaplastic types may only be treated with Anaplastic types may only be treated with radiation and chemotherapy to prolong radiation and chemotherapy to prolong survival.survival.

Thyroid Gland Diseases: Thyroid Gland Diseases: Thyroid CancerThyroid Cancer

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Parathyroid Gland DiseaseParathyroid Gland Disease

HyperparathyroidismHyperparathyroidism overproduction of PTH hormone, resulting in demineralization of bone overproduction of PTH hormone, resulting in demineralization of bone

and release of excess calciumand release of excess calcium symptoms include muscle atrophy, GI pain, and nausea amongst otherssymptoms include muscle atrophy, GI pain, and nausea amongst others treatment is highly individualized based on causetreatment is highly individualized based on cause

HypoparathyroidismHypoparathyroidism reduced production of PTH hormone, resulting in excessive calcium reduced production of PTH hormone, resulting in excessive calcium

deposits in tissue and decreased circulating calciumdeposits in tissue and decreased circulating calcium treated with calcium replacement therapy with vitamin D (life-threatening treated with calcium replacement therapy with vitamin D (life-threatening

is treated with calcium gluconate IV)is treated with calcium gluconate IV)

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Adrenal Gland DiseasesAdrenal Gland Diseases

Cushing SyndromeCushing Syndrome increase in adrenal cortex secretion of cortisolincrease in adrenal cortex secretion of cortisol early signs and symptoms include weight gain, early signs and symptoms include weight gain,

hypertension, and emotional instabilityhypertension, and emotional instability other signs and symptoms: fatigue, muscle weakness, other signs and symptoms: fatigue, muscle weakness,

change in body fat distribution, moon face, fluid change in body fat distribution, moon face, fluid retention, edema, excessive hair growth, fertility retention, edema, excessive hair growth, fertility changeschanges

treatment depends on cause: surgical removal or treatment depends on cause: surgical removal or radiation of tumor or adrenal gland; drug therapy to radiation of tumor or adrenal gland; drug therapy to suppress ACTHsuppress ACTH

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Adrenal Gland Diseases Adrenal Gland Diseases (cont’d.)(cont’d.)

Addison DiseaseAddison Disease partial or complete failure of adrenocortical partial or complete failure of adrenocortical

functionfunction onset usually gradual over weeks to monthsonset usually gradual over weeks to months fatigue, weakness, gastrointestinal disturbances, fatigue, weakness, gastrointestinal disturbances,

weight loss, fluid and electrolyte imbalances, weight loss, fluid and electrolyte imbalances, cardiovascular problems, depression, anxiety, cardiovascular problems, depression, anxiety, “bronzing” of skin tone“bronzing” of skin tone

treatment includes replacement of natural treatment includes replacement of natural hormones; increased fluid intake; control of salt hormones; increased fluid intake; control of salt and potassium intake; and high and potassium intake; and high carbohydrate/protein diet carbohydrate/protein diet

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Diabetes MellitusDiabetes Mellitus little or no insulin production in the pancreaslittle or no insulin production in the pancreas transport of glucose to cells is impairedtransport of glucose to cells is impaired cells begin to use fats and proteins as energy cells begin to use fats and proteins as energy

alternativealternative blood glucose levels continue to increase, blood glucose levels continue to increase,

resulting in state of hyperglycemiaresulting in state of hyperglycemia signs and symptoms include frequent thirst, signs and symptoms include frequent thirst,

urination, weight loss, fatigue, increased appetiteurination, weight loss, fatigue, increased appetite

Endocrine Dysfunction of PancreasEndocrine Dysfunction of Pancreas

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Diabetes MellitusDiabetes Mellitus Type 1: Type 1: early, abrupt onset before age 30 with early, abrupt onset before age 30 with

little or no insulin secretedlittle or no insulin secreted Type 2:Type 2: more common form with gradual onset more common form with gradual onset

after age 30, especially after age 55, with some after age 30, especially after age 55, with some pancreatic function intactpancreatic function intact

Endocrine Dysfunction of Pancreas Endocrine Dysfunction of Pancreas (cont’d.)(cont’d.)

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Warning Signs and Interventions for Diabetic Coma and Insulin Reaction

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Diabetes mellitus treatmentDiabetes mellitus treatment Goal is to normalize blood glucose levels and Goal is to normalize blood glucose levels and

minimize complications through:minimize complications through:• diet controldiet control

• exerciseexercise

• frequent blood and urine testingfrequent blood and urine testing

• insulin injections or oral hypoglycemicsinsulin injections or oral hypoglycemics

• weight loss (if overweight)weight loss (if overweight)

• preventive health carepreventive health care

Endocrine Dysfunction of Pancreas Endocrine Dysfunction of Pancreas (cont’d.)(cont’d.)

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Gestational diabetes mellitus (GDM)Gestational diabetes mellitus (GDM) Type 3: Type 3: decreased ability to metabolize glucose decreased ability to metabolize glucose

during pregnancy with onset around 24-28 weeks during pregnancy with onset around 24-28 weeks of gestation; the condition usually disappears right of gestation; the condition usually disappears right after delivery.after delivery.

Treatment might include control of diet; limited Treatment might include control of diet; limited intake of simple sugars; oral hypoglycemic agents; intake of simple sugars; oral hypoglycemic agents; insulininsulin

Endocrine Dysfunction of Pancreas Endocrine Dysfunction of Pancreas (cont’d.)(cont’d.)

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HypoglycemiaHypoglycemia abnormally low blood glucose level that can be abnormally low blood glucose level that can be

caused by excessive insulin secretion in the caused by excessive insulin secretion in the pancreas, fasting, or medicationspancreas, fasting, or medications

signs and symptoms: sweating, nervousness, signs and symptoms: sweating, nervousness, hunger, weakness, dizziness, headache, hunger, weakness, dizziness, headache, palpitations, confusion, visual disturbancespalpitations, confusion, visual disturbances

if severe or untreated, can cause seizures, stupor, if severe or untreated, can cause seizures, stupor, coma, and deathcoma, and death

Treatment: acute requires intravenous infusion of Treatment: acute requires intravenous infusion of glucose; hormone glucagon; complex glucose; hormone glucagon; complex carbohydrate/protein snack with stabilizationcarbohydrate/protein snack with stabilization

Endocrine Dysfunction of Pancreas Endocrine Dysfunction of Pancreas (cont’d.)(cont’d.)

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Precocious PubertyPrecocious Puberty

For boys, puberty that begins before age 9 For boys, puberty that begins before age 9 For girls, puberty that begins before age 8For girls, puberty that begins before age 8 Causes include tumors of the testes/ovaries, Causes include tumors of the testes/ovaries,

hypothalamic or pituitary dysfunction or tumors, hypothalamic or pituitary dysfunction or tumors, and ingestion of hormones or sex steroidsand ingestion of hormones or sex steroids

Treatment depends on cause: no treatment if Treatment depends on cause: no treatment if idiopathic; hormone therapy to suppress sexual idiopathic; hormone therapy to suppress sexual maturation until appropriate time; treatment more maturation until appropriate time; treatment more invasive if cause is testicular or brain tumor invasive if cause is testicular or brain tumor