Pathophysiology

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Signs of emphysema

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Signs of emphysema include pursed-lipped breathing, tachypnea,Productive cough, wheezing, barrel chest, prolonged exhalation, chronic hypoventilation central cyanosis and finger clubbing. Obstruction is worse with exhalation. The chest has increased percussion notes, particularly just above the liver, and a difficult to palpate apex beat, both due to hyperinflation. There may be decreased breath sounds and audible expiratory wheeze. In advanced disease, there are signs of fluid overload such as pitting peripheral edema. The face has a ruddy complexion if there is a secondary polycythemia. Sufferers who retain carbon dioxide have asterixis (metabolic flap) at the wrist.

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COPD

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Signs of metabolic acidosis

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Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation. Over compensation via respiratory alkalosis to form an alkalemia does not occur.

Extreme acidemia leads to neurological and cardiac complications:

Neurological: lethargy, stupor, coma, seizures.
Cardiac: arrhythmias (ventricular tachycardia), decreased response to epinephrine; both lead to hypotension (low blood pressure).

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Cushing's Syndrome

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Cushing's syndrome (also called hypercortisolism or hyperadrenocorticism) is an endocrine disorder caused by high levels of cortisol in the blood from a variety of causes, including a pituitary adenoma (known as Cushing's disease), adrenal hyperplasia or neoplasia, ectopic adrenocorticotropic hormone (ACTH) production (e.g., from a small cell lung cancer), and iatrogenic (steroid use). Normally, cortisol is released from the adrenal gland in response to ACTH being released from the pituitary gland. Both Cushing's syndrome and Cushing's disease are characterized by elevated levels of cortisol in the blood, but the cause of elevated cortisol differs between the two disorders. Cushing's disease specifically refers to a tumour in the pituitary gland that stimulates excessive release of cortisol from the adrenal gland by releasing large amounts of ACTH. In Cushing's syndrome, the pituitary gland does not respond as it should with negative feedback to high levels of cortisol, and continues to produce ACTH.

Symptoms include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity), a round face often referred to as a "moon face," excess sweating, telangiectasia (dilation of capillaries), thinning of the skin (which causes easy bruising) and other mucous membranes, purple or red striae (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders), and hirsutism (facial male-pattern hair growth). A common sign is the growth of fat pads along the collar bone and on the back of the neck (buffalo hump) (known as a lipodystrophy). The excess cortisol may also affect other endocrine systems and cause, for example, insomnia, reduced libido, impotence, amenorrhoea and infertility. Patients frequently suffer various psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety are also common.

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Wilson's Disease

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Wilson's disease or hepatolenticular degeneration is an autosomal recessive genetic disorder in which copper accumulates in tissues; this manifests as neurological or psychiatric symptoms and liver disease. It is treated with medication that reduces copper absorption or removes the excess copper from the body, but occasionally a liver transplant is required.

About half the patients with Wilson's have neurological or psychiatric problems. Most patients initially have mild cognitive deterioration and clumsiness, as well as changes in behavior. Specific neurological symptoms then follow, often in the form of parkinsonism (increased rigidity and slowing of routine movements) with or without a typical hand tremor, ataxia (lack of coordination) or dystonia (twisting and repetitive movements of part of the body). Seizures and migraine appear to be more common in Wilson's disease. Psychiatric problems due to Wilson's disease may include behavioral changes, depression, anxiety and psychosis.

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porphyria

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The hepatic porphyrias primarily affect the nervous system, resulting in abdominal pain, vomiting, acute neuropathy, seizures and mental disturbances, including hallucinations, depression, anxiety and paranoia. Cardiac arrhythmias and tachycardia (fast heart rate) may develop as the autonomic nervous system is affected. Pain can be severe and can, in some cases, be both acute and chronic in nature. Constipation is frequently present, as the nervous system of the gut is affected, but diarrhea can also occur.

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myxedema

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Myxedema (British English: myxoedema) is a skin and tissue disorder usually due to severe prolonged hypothyroidism. Hypothyroidism can be caused by atrophic disease, Hashimoto's thyroiditis, surgical removal of the thyroid, and rarer conditions. Partial forms of myxedema, especially of the lower legs (called pretibial myxedema), occasionally occur in adults with Graves' disease, a cause of hyperthyroidism; or also Hashimoto's thyroiditis without severe hypothyroidism.

Myxedema psychosis, more colloquially known as myxedema madness, is a relatively uncommon consequence of hypothyroidism, particularly Hashimoto's thyroiditis. A chronically under-active thyroid can lead to slowly progressive dementia, delirium, and in extreme cases to hallucinations, coma, or psychosis, particularly in the elderly. It was first recognized by Dr Richard Asher of London in 1949.
Treatment is via the standard treatment for hypothyroidism with thyroxine replacement. Oral T4, or in especially acute cases liothyronine, a sodium salt of T3. Hormone replacement in these patients usually reverses the psychotic symptoms, but may not help with cognitive deficits caused by changes in metabolic activity in the CNS.
The "myxedema" part of the name simply refers to the pitting edema common to hypothyroidism.

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Grave's Disease

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Graves' disease is a thyroid disorder characterized by goiter, exophthalmos, "orange-peel" skin, and hyperthyroidism. It is caused by an antibody-mediated auto-immune reaction, but the trigger for this reaction is still unknown. It is the most common cause of hyperthyroidism in the world, and the most common cause of general thyroid enlargement in developed countries.

Some of the most typical symptoms of Graves' Disease may include the following:
Palpitations, Tachycardia,
Hypertension,
Tremor, Unexplained weight loss despite increased appetite, Increased energy, Fatigue, memory lapses, diminished attention span, Decreased concentration, Nervousness, agitation, Irritability, Restlessness, Erratic behavior, Emotional lability, Brittle nails, Goiter, Protruding eyeballs (exophthalmos).

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Addison's Disease

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Addison's disease (also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids).

The most common symptoms are fatigue, muscle weakness, weight loss, vomiting, diarrhea, headache, sweating, changes in mood and personality and joint and muscle pains. Some have marked cravings for salt or salty foods due to the urinary losses of sodium. Most people with primary Addison's have darkening (hyperpigmentation) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken. This occurs because melanocyte-stimulating hormone (MSH) shares the same precursor molecule as adrenocorticotropic hormone (ACTH); an increase in ACTH production also increases MSH. In secondary and tertiary forms of Addison's, skin darkening does not occur.

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Hashimoto

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Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disease where the body's own T-cells attack the cells of the thyroid. It was the first disease to be recognised as an autoimmune disease.
This disorder is believed to be the most common cause of primary hypothyroidism in North America.

Weight gain, depression, mania, fatigue, panic attacks, bradycardia, tachycardia, high cholesterol, reactive hypoglycemia, constipation, migraines, memory loss, infertility and hair loss are a few possible symptoms.
Hashimoto's thyroiditis is often misdiagnosed as bipolar disorder and, less frequently, as anxiety disorder.