Alterations of Hormonal Regulation Chapter 21 1 Elevated

Alterations of Hormonal Regulation Chapter 21 1

Elevated or Depressed Hormone Levels o o o Failure of feedback systems Dysfunction of an endocrine gland Secretory cells are unable to produce, obtain, or convert hormone precursors The endocrine gland synthesizes or releases excessive amounts of hormone Increased hormone degradation or inactivation Ectopic hormone release 2 Mosby items and derived items © 2006 by Mosby, Inc.

Target Cell Failure o Receptor-associated disorders n n n Decrease in number of receptors Impaired receptor function Presence of antibodies against specific receptors Antibodies that mimic hormone action Unusual expression of receptor function 3 Mosby items and derived items © 2006 by Mosby, Inc.

Hormone Delivery 4 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of the Hypothalamic. Pituitary System 5 Mosby items and derived items © 2006 by Mosby, Inc.

Diseases of the Posterior Pituitary o Syndrome of inappropriate antidiuretic hormone secretion (SIADH) n n n Hypersecretion of ADH For diagnosis, normal adrenal and thyroid function must exist Clinical manifestations are related to enhanced renal water retention, hyponatremia, and hypoosmolarity 6 Mosby items and derived items © 2006 by Mosby, Inc.

Diseases of the Posterior Pituitary o Diabetes insipidus n n Insufficiency of ADH Polyuria and polydipsia Partial or total inability to concentrate the urine Neurogenic o n Insufficient amounts of ADH Nephrogenic o Inadequate response to ADH 7 Mosby items and derived items © 2006 by Mosby, Inc.

Diseases of the Anterior Pituitary o Hypopituitarism n Pituitary infarction o o o n Sheehan syndrome Hemorrhage Shock Others: head trauma, infections, and tumors 8 Mosby items and derived items © 2006 by Mosby, Inc.

Diseases of the Anterior Pituitary o Hypopituitarism n Panhypopituitarism o o ACTH deficiency TSH deficiency FSH and LH deficiency GH deficiency 9 Mosby items and derived items © 2006 by Mosby, Inc.

Diseases of the Anterior Pituitary o Hyperpituitarism n n Commonly due to a benign, slow-growing pituitary adenoma Manifestations o o o Headache and fatigue Visual changes Hyposecretion of neighboring anterior pituitary hormones 10 Mosby items and derived items © 2006 by Mosby, Inc.

Diseases of the Anterior Pituitary o Hypersecretion of growth hormone (GH) n Acromegaly o n Hypersecretion of GH during adulthood Gigantism o Hypersecretion of GH in children and adolescents 11 Mosby items and derived items © 2006 by Mosby, Inc.

Hypersecretion of Growth Hormone (GH) 12 Mosby items and derived items © 2006 by Mosby, Inc.

Diseases of the Anterior Pituitary o Hypersecretion of prolactin n Caused by prolactinomas o o In females, increased levels of prolactin cause amenorrhea, galactorrhea, hirsutism, and osteopenia In males, increased levels of prolactin cause hypogonadism, erectile dysfunction, impaired libido, oligospermia, and diminished ejaculate volume 13 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Thyroid Function o Hyperthyroidism n n Thyrotoxicosis Graves disease o n Hyperthyroidism resulting from nodular thyroid disease o n Pretibial myxedema Goiter Thyrotoxic crisis 14 Mosby items and derived items © 2006 by Mosby, Inc.

Thyrotoxicosis (Graves’ Disease) 15 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Thyroid Function o Hypothyroidism n Primary hypothyroidism o o o n n Subacute thyroiditis Autoimmune thyroiditis (Hashimoto disease) Painless thyroiditis Postpartum thyroiditis Myxedema coma Congenital hypothyroidism Thyroid carcinoma 16 Mosby items and derived items © 2006 by Mosby, Inc.

Hypothyroidism 17 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Parathyroid Function o Hyperparathyroidism n Primary hyperparathyroidism o n Secondary hyperparathyroidism o o Excess secretion of PTH from one or more parathyroid glands Increase in PTH secondary to a chronic disease Hypoparathyroidism n n Abnormally low PTH levels Usually caused by parathyroid damage in thyroid surgery 18 Mosby items and derived items © 2006 by Mosby, Inc.

Type 1 Diabetes Mellitus o o o Demonstrates pancreatic atrophy and specific loss of beta cells Macrophages, T and B lymphocytes, and natural killer cells are present Two types n n Immune Nonimmune 19 Mosby items and derived items © 2006 by Mosby, Inc.

Type 1 Diabetes Mellitus o o Genetic susceptibility Environmental factors Immunologically mediated destruction of beta cells Manifestations n Hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, and fatigue 20 Mosby items and derived items © 2006 by Mosby, Inc.

Type 1 Diabetes Mellitus 21 Mosby items and derived items © 2006 by Mosby, Inc.

Type 1 Diabetes Mellitus 22 Mosby items and derived items © 2006 by Mosby, Inc.

Dysfunction of the Pancreas o Type 2 diabetes mellitus n n n Maturity-onset diabetes of youth (MODY) Gestational diabetes mellitus (GDM) Common form of diabetes mellitus type 2 o Insulin resistance 23 Mosby items and derived items © 2006 by Mosby, Inc.

Type 2 Diabetes Mellitus 24 Mosby items and derived items © 2006 by Mosby, Inc.

Acute Complications of Diabetes Mellitus o o o Hypoglycemia Diabetic ketoacidosis Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) Somogyi effect Dawn phenomenon 25 Mosby items and derived items © 2006 by Mosby, Inc.

Diabetic Ketoacidosis 26 Mosby items and derived items © 2006 by Mosby, Inc.

Chronic Complications of Diabetes Mellitus o o Hyperglycemia and nonenzymatic glycosylation Hyperglycemia and the polyol pathway n o Protein kinase C Microvascular disease n n Retinopathy Diabetic nephropathy 27 Mosby items and derived items © 2006 by Mosby, Inc.

Diabetic Nephropathy 28 Mosby items and derived items © 2006 by Mosby, Inc.

Chronic Complications of Diabetes Mellitus o Macrovascular disease n n n o o Coronary artery disease Stroke Peripheral arterial disease Diabetic neuropathies Infection 29 Mosby items and derived items © 2006 by Mosby, Inc.

Diabetic Amputation 30 Mosby items and derived items © 2006 by Mosby, Inc.

Diabetic Neuropathy 31 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Adrenal Function o Disorders of the adrenal cortex n Cushing disease o n Excessive anterior pituitary secretion of ACTH Cushing syndrome o Excessive level of cortisol, regardless of cause 32 Mosby items and derived items © 2006 by Mosby, Inc.

Cushing Disease 33 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Adrenal Function o Disorders of the adrenal cortex n Hyperaldosteronism o o Primary hyperaldosteronism (Conn disease) Secondary hyperaldosteronism 34 Mosby items and derived items © 2006 by Mosby, Inc.

Primary Hyperaldosteronism 35 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Adrenal Function o Disorders of the adrenal cortex n Adrenocortical hypofunction o Primary adrenal insufficiency (Addison disease) n o Idiopathic Addison disease Secondary hypocortisolism 36 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Adrenal Function o Disorders of the adrenal cortex n Hypersecretion of adrenal androgens and estrogens o o Feminization Virilization 37 Mosby items and derived items © 2006 by Mosby, Inc.

Virilization 38 Mosby items and derived items © 2006 by Mosby, Inc.

Alterations of Adrenal Function o Disorders of the adrenal medulla n Adrenal medulla hyperfunction o Caused by tumors derived from the chromaffin cells of the adrenal medulla n o Pheochromocytomas Secrete catecholamines on a continuous or episodic basis 39 Mosby items and derived items © 2006 by Mosby, Inc.

Pheochromocytoma 40 Mosby items and derived items © 2006 by Mosby, Inc.