4Cpd12 Endocrine1

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primary disorders

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dysfunction originating in the peripheral endocrine gland

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secondary disorders

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understimulation or overstimulation by the pituitary

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endocrine disorders (usually hypofunction) occur because of

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abnormal tissue responses to hormones

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Hyperfunction of endocrine glands

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may result from overstimulation by the pituitary but is most commonly due to hyperplasia or neoplasia of the gland itself

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or from

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Hormone excess from exogenous hormone administration.

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Tissue hypersensitivity to hormones can occur from hyperfuntion -how?

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Antibodies can stimulate peripheral endocrine glands, as occurs in hyperthyroidism of Graves' disease.

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Over production of hormones occurs in?

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response to a disease state.

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Destruction of an endocrine gland can lead to?

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hormone release

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Hypofunction of an endocrine gland can result from?

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understimulation by the pituitary

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Hypofunction originating within the peripheral gland itself?

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can result from congenital or acquired disorders

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Genetic disorders producing hypofunction can result from?

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deletion of a gene or by production of an abnormal hormone

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Several hormones require conversion to an active form after secretion from the peripheral endocrine gland - What can block this?

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Disorders such as renal disease can inhibit production of the active form of vitamin D.

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Antibodies to the circulating hormone or its receptor can?

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block the ability of the hormone to bind to its receptor.

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Disease, circulating substances, or drugs can cause?

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increased rate of clearance of hormones

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Abnormalities of the receptor?

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can also produce hypofunction.

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In the lab, measure what for endocrine?

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Free or bioavailable hormone (ie, hormone not bound to a specific binding hormone

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When to do measurements?

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set time of day, or same day in the week, depending on what type of hormone

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Hypofunction disorders are usually treated by

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replacement of the peripheral endocrine hormone regardless of whether the defect is primary or secondary

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hyperfunction disorders?

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Radiation therapy, surgery, and drugs that suppress hormone production

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As we age, most hormone levels decrease. What stays the same?

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TSH, ACTH (basal), thyroxine, cortisol (basal), 1,25-dihydroxycholecalciferol, (sometimes increases), and estradiol (in men).

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Hormones that increase as we age?

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ACTH(response to corticotropin-releasing hormone) follicle-stimulating hormone, sex-hormone binding globulin, and many more...

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what decline>

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Growth hormone, melatonin estrogen and testosterone

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Unintended Weight Loss from?

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Diabeties insipidus, hyperthyroidism

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Abnormal Skin Pigmentation from?

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Excess ACTH in Addison's, pregnancy hormone, etc

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gynecomastia is?

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Enlargement of the male breast, must be distinguished from tumors or mastitis.

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Who has gynecomastia?

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Klinefelter's syndrome, some athletes who abuse androgens and anabolic steroids, HIV-infected patients treated with highly active antiretroviral therapy (HAART

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Symptoms and Signs

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Fatty, Glandular,Pubertal gynecomastia.

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Treatment?

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Pubertal gynecomastia often resolves spontaneously within 1–2 years, surgery if severe.

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more treatment?

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painful or persistent (> 12 months) gynecomastia may be treated with a 3- to 9-month course of a selective estrogen receptor modulator (SERM; eg, raloxifene or tamoxifen).

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Erectile Dysfunction & Diminished Libido in Men may be due to?

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Psychogenic factors as well as endocrine, vascular, or neurologic abnormalities, as well as hypogonadism.

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Other causes of erectile dysfunction?

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hyperthyroidism, Addison's disease, and acromegaly, vascular dz, SSRI's and diabeties.

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Leriche's syndrome?

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Vascular claudication of the legs along with related impotence

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Cryptorchism?

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One or both testes may be absent from the scrotum at birth

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Cryptorchism should be corrected when?

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before age 12–24 months in an attempt to reduce the risk of infertility

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Bone Pain & Pathologic Fractures

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Onset of pathologic fractures at an early age is seen in osteogenesis imperfecta

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Painful bowing of the bones and pseudofractures?

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rickets or osteomalacia.

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What could cause this?

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Hyperparathyroidism, malignancy, hyperthyroidism and Cushing's syndrome

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Common cause of bone pain?

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Vitamin D defic

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Muscle Cramps & Tetany

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Usually caused by sports - if not, a very long list includes dm, periph neurop, vasc dz....

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McArdle's disease

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caused by muscle phosphorylase deficiency; presenting symptoms and signs include muscle fatigue, cramping, and high serum CK levels

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Mental changes may be a sign of what underlying endocrine disorders?

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Hypogonadism, postpartum depression, pms, hyperthyroidism

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Hypothyroidism sx?

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mental slowness, depression, and lethargy

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hypocalcemia from untreated hypoparathyroidism sx?

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intellectual deterioration.

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Hypoglycemia Sx?

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confusion, abnormal speech, and behavioral or personality changes as well as sudden loss of consciousness, somnolence and prolonged lethargy, or coma; frank psychosis can occur but is rare.

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Anterior pituitary gland function is controlled by?

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hypothalamic hormones and by direct feedback inhibition

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posterior pituitary receives antidiuretic hormone and oxytocin from?

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hypothalamus

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Hypothalamic hormones generally stimulate the anterior pituitary except for?

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dopamine, which inhibits the pituitary from spontaneously secreting PRL.

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What's PRL?

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prolactin

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Anterior Hypopituitarism?

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Loss of one, all, or any combination of anterior pituitary hormones.

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Hypopituitarism can be caused by?

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either hypothalamic or pituitary dysfunction?

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Patients with hypopituitarism may have?

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single or multiple hormonal deficiencies

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When one hormonal deficiency is discovered...?

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others must be sought.

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Mass lesions causing hypopituitarism inclcude:

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pituitary adenomas, granulomas, Rathke's cleft cysts, apoplexy, metastatic carcinomas.........

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Hypopituitarism without mass lesions may be genetic or idiopathic, or may be caused by?

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trauma, cranial radiation, surgery, encephalitis, hemochromatosis, autoimmunity, or stroke. It may also occur after coronary artery bypass grafting.

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About 25–30% of survivors of moderate to severe traumatic brain injury have?

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at least one anterior pituitary hormone deficiency

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Physiologic isolated hypogonadotrophic hypogonadism is common and occurs with?

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severe illness, malnutrition, and extreme prolonged exercise (in women). It is also commonly found among obese patients with type 2 diabetes mellitus.

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ACTH deficiency?

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reduces adrenal secretion of cortisol, testosterone, and epineph. aldosterone is ok

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Growth hormone (GH) deficiency?

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causes short stature in children; adults experience asthenia, obesity, and increased cardiac mortality.

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PRL deficiency

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inhibits postpartum lactation.

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TSH deficiency

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causes secondary hypothyroidism

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LH and follicle-stimulating hormone (FSH) deficiency

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cause hypogonadism and infertility in men and women.