18 Diseases of the Endocrine Glands

8/12/2019 18 Diseases of the Endocrine Glands

1/47

Diseases of the Endocrine

Glands


2/47


3/47


4/47


5/47


6/47


7/47

Major Determinants of Disease

Many endocrine organs are controlled by the pituitary gland Nonendocrine conditions can cause excessive production of

endocrine hormones

Overstimulation of target organs by pituitary hormones leadsto enlargement of the target organs & overproduction of its

hormones Overproduction of endocrine hormones accounts for most of

the manifestations of endocrine disease

Overproduction of hormones may be caused by hyperplasiaor neoplasia of endocrine glands

Underproduction of hormones is usually caused by disease ofthe target organ, rather than to failure of hormone stimulation

Pituitary tumors may cause symptoms by pressing onadjacent structures (mass effect), not necessarily byproducing hormones


8/47

Pituitary Diseases

Most often anterior lobe

Mass such as a neoplasm is most commondisease

Masses have 2 consequences besides hormoneproduction mass effect

pressure on nearby structures

intracranial pressure

stalk effect interference with hypothalamic inhibition of prolactinsecretion

Most common mass is an adenoma


9/47

Hyperpituitarism

Mostly from adenomas

usually single cell type

most are functioning

secrete single hormone

more common in men

usually discrete nodules

excessive hormone

production, mass effect,

stalk effect


10/47


11/47


12/47

Growth Hormone Adenoma

2ndmost common functioning adenoma

Subtle manifestations initially

Causes gigantism

acromegaly


13/47


14/47


15/47


16/47


17/47

Sheehan Syndrome

Infarction of pituitary

in pregnancy

enlarges mostly due to

prolactin secretingcells

not enough blood

supply


18/47

Diabetes Insipidus

High output of very dilute urine

Destruction of pituitary or conditions affecting thehypothalamus

head trauma surgery

neoplasm

infarction

inflammation Genetic defects of ADH synthesis

Renal defect


19/47

Hyperthyroidism

Increased metabolic rate (thyrotoxicosis)

Causes

overmedication in thyroid gland failure

increased hormone due to thyroid gland

diseasesprimary

increased hormone due to TSH - secondary


20/47

Graves Disease

80-90% of all hyperthyroidism

One of most common autoimmune

diseases in US

Mostly women

Antibody that acts like TSH

Gland is diffusely enlarged & smooth


21/47


22/47


23/47


24/47

Hypothyroidism

Usually primary

Could by due to lack of dietary iodine


25/47


26/47


27/47

Nontoxic goiter


28/47

Nodular goiter


29/47

Thyroiditis

Inflammation of thyroid

Mostly chronic

autoimmune

Presents as goiter


30/47

Hasimoto Thyroiditis

Most common type in

US

One of most common

causes of goiter &hypothyroidism

Antibodies that block

TSH


31/47

Neoplasms of Thyroid Gland

Not common

Neoplastic masses are more likely to

be solitary masses

cold

in younger patients

in males

Most are from nodular goiter


32/47


33/47


34/47

Primary Hyperparathyroidism

Important cause ofhypercalcemia

stones, bones,

groans, & moans Most patients have

lab disease only

elevated Ca2+

&PTH


35/47

Secondary Hyperparathyroidism

Due to chronic renal failure

Hyperplasia of parathyroids induced by highblood PO4

-& decreased blood Ca2+

Clinical findings HTN

anemia

edema

low urine output Transplant usually corrects; if persists have

tertiary hyperparathyroidism


36/47

Hypoparathyroidism

Usually caused by inadvertant surgical

removal

Major abnormality is low blood Ca2+

tetany

tingling sensations

muscle spasms

seizures

Treated with vit D & Ca2+


37/47

Cushing Syndrome

Excessive

cortisol


38/47


39/47


40/47


41/47


42/47


43/47

Acute Adrenocortical Crisis

Fatal without cortisol replacement Sudden withdrawal of corticosteroid therapy

probably most common cause

drugs suppress ACTH

adrenal atrophy Bilateral acute hemorrhagic infarction of adrenal

gland most common cause is acute meningococcal

meningitis Sudden worsening of chronic adrenalinsufficiency undiagnosed patient suddenly stressed


44/47


45/47


46/47


47/47

Pheochromocytoma

Secrete catecholamines which canproduce severe HTN

Rule of 10s

10% arise outside the adrenal 10% of those in adrenal are bilateral

10% are malignant

10% arise in children 10% occur in association with other endocrineneoplasms

Documents

18 Diseases of the Endocrine Glands