Disease Ch 25

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Disorders of the Endocrine System
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1

major endocrine glands

pituitary

thyroid

parathyroid

adrenal cortex and medulla

pancreatic islet

ovaries and testes

2

disorders are due to

hyper or hyposecretion of hormones

inadequate response to target tissue

disorder of signaling

3

elevated or depressed hormone levels

failure of feedback system may be due to

dysfunction of endocrine gland

altered hormone inactivation/degradation

ectopic hormone release

4

target cell failure

receptor associated disorders

decrease in number of receptors

impaired receptor function

presence of antibodies against specific receptors

antibodies that mimic hormone action

unusual expression of receptor function

5

hyposecretion of hormones

agenesis, atrophy or destruction= negative

sends to peripheral tissue which causes hypofunction of tissue

6

hypersecretion of hormones

leads to tumors and hyperplasia

incrases amount sent to peripheral tissue which causes tissue hyperfunction

7

pituitary gland

suspended by stalk from hypothalamus at base of brain

secretes tropic hormones-hormones that regulate other hormones

regulated by level or hormone produced by the target gland

negative feed back maintains uniform hormone output

8

anterior lobe hormones of pituitary gland

growth hormone

prolactin

thyroid stimulating hormone (TSH)

adrenocorticotrophic hormone (ACTH)

follicle-stimulating hormone (FSH)

lutenizinghormone (LH)

9

posterior lobe hormones of pituitary gland

antidiuretic hormone (ADH) cause more concentrated urine

oxytoci-stimulates uterine contraction and milk secretion

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hypothalamus controls what?

both lobes of the pituitary gland

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pituitary disease

most often of anterior lobe

mass such as neoplasm most common

mass effect-pressure on nearby structures ie optic chiasm, intracranial pressure

stalk effect-interference with hypothal inhibition of prolactin secretion

most common mass is an adenoma

12

hyperpituitarism

mostly due to adenomas, single cell type

more common in men

excessive hormone production, mass effect and/or stalk effect

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prolactinoma results in

galactorrhea

amenorrhea

infertility

decreased sex drive

impotence in males

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diagnosis prolactinoma

lab tests show high levels of prolactin

15

prolactinoma caused by

high dose of estrogen therapy

renal failure

thyroid gland failure

hypothalmic lesion

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growth hormone adnoma

GH overproduction leads to gigantism or acromegaly

second most commond functioning adenoma

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disease of anterior pituitary

hypersecretion of growth hormone lead to

acromegaly

gigantism

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acromegaly

hypersecretion of GH during ADULTHOOD

slowly progressive

leads to cardiac hypertrophy, hypertension, atherosclerosis, type 2 diabetes, malignancies common

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gigantism

GH hypersecretion in children and adolescents

20

manifestations of acromegaly

conective tissue proliferation-large tongue, coarse sking and hair, interstitial edema

abnormal glucose tolerance, cardiac hypertrophy, type 2

large joints and facial bones, cranium, hands and fet

protruding lower jaw and forehead

21

hypopituitarism

dcreased secretion of pituitary hormones-usually anterior

causes of failure: mass effect, brain trauma, infarction, surgical/radiotherapeutic destruction

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manifestations of hypopituitarism

target organs atrophy

hyopfunction of target organs

23

diabetes insipidus

insufficiency of ADH

polyuria and poy dipsia

partial or total inability to concentrate urine

neurogenic-insufficient amounts of ADH

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causes of diabetes insipidus

tumors

intrcranial hemorrhage

surgery

25

thyroid gland

hormone control-release T3 and T4-T4 inactive until converted to T3 in tissue

both exert negative feedback

26

hyperthyroidism caused by

overmedication in thyroid gland failure

primary cause-increased hormone due to thyroid gland disease-ie toxic goiter

secondary-increased hormone due to TSH-ie graves disease

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graves disease

80% of all hyperthyroidism

mostly women

antibody that acts like TSH

gland is diffusely enlarged and smooth

28

hyperthyroidism symptoms

overactivity of sympathetic nervous system

enlarged thyroid gland

weight loss

warm

overactive reflexes

heat intolerances

exopthalmos

29

hypothyroidism

underproduction of thyroid hormones

more common than hyper

30

causes of hypothyroidism

primary-congenital

autoimmune

acquired

31

acquired hypothyroidism

T3/4 not made due to lack of iodine

lack negative feedback to hypothalamus, so TRH and TSH continue to be made

thyroid is enlarged in response to TSH

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result of hypothyroidism

nontoxic goiter

33

neonatal hypothyroidism

hypothyroidism in infants and children due to iodine deficiency and genetic defect

congenital

34

how does neonatal hypothyroidism present itself?

cretinism-protruding belly, short stature, infertility, neurological impairment, constant fatigue, obesity

35

myxedema

severe hypothyroidism in children or adults

36

how does myxedema present itself?

constipation

hair loss

dry skin

weight gain

edma

intolerance

bradycardia

37

hashiomoto thyroiditis

chronic thyroiditis-inflammed thyroid

autoimmune disorder

presents as goiter

38

signs of hyperthyroidism

rapid pulse

increased metabolism

hyperactive reflexes

diarrhea

warm, moist skin

39

signs of hypothyroidism

slw pulse

decreased metabolism

sluggish reflexes

constipation

cold, dry skin

40

thyroid tumors types

benign adenoma

carcinoma

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thyroid tumors well-differentiated follicular and papillary carcinoma prognosis

good

treatment by surgical resection

42

thyroid tumors poorly differentiated carcinoma prognosis

poor

grows rapidly

treatment-surgery, radiation, chemo

43

medullary carcinoma of the thyroid

rare

secretes calcitonin

44

hyperparathyroidism

PTH regulates Ca+ (increases it)

eats bone away

which leaves patient with high levels of Ca+

must be surgically removed

45

primary hyperparathyroidism

important cause of hypercalcemia

"stones, bones, abdominal groans, and psychiatric moans"

elevated Ca+ levels

treatment-remove tumor

46

adrenals

paired gland above kidneys

47

hormones secreted by adrenal cortex

glucocorticoids

mineralocorticoids

aldosterone-major one

sex hormones

48

adrenal cortical insufficiency

inability to make all 3 adrenal hormones-not enough hormones

primary adrenal cortical insufficiency-Addison's disease

secondary adrenal cortical insufficiency

acute adrenal crisis

49

excessive adrenal secretion

too much hormone secretion

glucocorticoid hormone excess-Cushing syndrome

hyperaldosteronism

50

congenital adrenal hyperplasia

decreased cortisol synthesis-other hormones may be increased or decreased

51

Cushing disease

excessive anterior pituitary secretion of ACTH, ONLY ACTH

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cushing syndrome

excssive level of cortisol, regardless of cause

53

conditions causing cushing syndrome

ACTH tumor in AP

tumor of adrenal cortex

large amounts of corticoid steroid hormone treatment

malignant tumor producing ACTH

54

symptoms of cushing disease

"buffalo hump and moon face"

hypertensions-due to increased sympathetic activity

central obesity

muscle wasting

glucosuria

diabetes

55

hyperaldosteronism

excessive aldosterone causes:

hypertension, low blood Ca, low blood renin

primary-usually from cortical adenoma or hyperplasia

secondary-usually cause by impaired renal blood flow due to renal artery stenosis from athersclreosis

increase renin = increase aldosterone

56

Addison disease

primary chronic adrenal cortex failure due to deficiency of all steroid hormones

autoimmune destruction

57

clinical manifestations of Addison disease

muscle wasting

gi complaints

anorexia

increased pigmentation

hyperkalemia

hyponatremia

vascular collapse

58

overproduction of adrenal sex hormones leads to

adrenogenital syndrome=virilization- increase in masculinity=early pubery for males, enlarged clitoris for females

59

the adrenal medulla produces ___ that stimulate ____

catecholamines, sympathetic nervous system

examples of catecholamines-norepinephrine and epinephrine

60

pheochromocytoma

increased secretion fo catecholamines

61

what happens with pheochromocytoma

large CV effect

cerebral hemorrhage from hypertension

treatment-tumor resection

62

ectopic hormones

hormones secreted by nonendocrine tumors that are identical with or mimic action of true hormones

63

origin of ectopic hormones

produced by malignant tumors

especially in lungs, pancreas, kidneys, connective tissue

do not have a negative feedback loop

64

chronic stress causes

increase in cortisol which can effect food metabolism, acts as an anti-inflammatory and increases blood ressure

decrease in gonadotropic hormones=infertility