Chapter 13: Diseases

diabetes mellitus: type 1

Other names: insulin-dependent diabetes mellitus (IDDM), Juvenile-onset diabetes mellitus Onset: child, adolescent, young adult Autoimmune disorder: yes Antibodies present: yes Amount of insulin secreted: none Insulin resistance: no Body weight: normal Percentage of all diabetes: 10% Drug therapy: insulin

diabetes mellitus: type 2

Other names: non-insulin-dependent diabetes mellitus (NIDDM), Adult-onset diabetes mellitus (AODM) Onset: adult Autoimmune disorder: no Antibodies present: no Amount of insulin secreted: too little Insulin resistance: yes Body weight: obese Percentage of all diabetics: 75% Drug therapy: oral antidiabetic drugs; occasionally

diabetes mellitus: type 1.5

Other names: slow-onset type 1, Latent autoimmune diabetes in adults (LADA) Onset: adult Autoimmune disorder: yes Antibodies present: yes Amount of insulin secreted: too little Insulin resistance: no Body weight: normal percentage of all diabetics: 15% Drug therapy: insulin and oral antidiabetic

diabetic ketoacidosis (DKA)

a high level of ketones in the blood. This occurs in untreated or uncontrolled diabetes mellitus when there is no insulin to metabolize glucose for cellular energy, and the body turns to other sources of energy such as fat or protein. Body fat contains the most calories per gram, but fat does not metabolize cleanly and leaves ketones, an acidic by-product. The patient's breath has a unique "fruity" or "nail polish" odor from the high level of both glucose and ketones in the blood. A diabetic coma occurs when a very high level of ketones (which are acidic) lowers the pH of the blood to the point that chemical reactions in the body cannot occur and the patient becomes unconscious. Treatment: drug therapy with insulin

diabetic neuropathy

decreased or abnormal sensation in the extremities because of nerve damaged due to demyelination of the nerves

diabetic nephropathy

degenerative changes in the nephrons of the kidneys because of the high levels of glucose and ketones. This causes kidney failure

diabetic retinopathy

degenerative changes of the retina of the eye because of the local effect of high levels of glucose and ketones. There is formation of new, fragile blood vessels that hemorrhage easily; this cause blindness

atherosclerosis

fatty deposits and plaque formation with hardening of the arteries, which is accelerated in diabetes mellitus because of abnormalities in fat metabolism

syndrome of inappropriate ADH (SIADH)

hypersecretion of ADH. It is caused by an adenoma in the posterior pituitary gland. (It can also be caused by brain infections, multiple sclerosis, or stroke.) The high level of ADH acts on the kidneys to increase reabsorption of excess amounts of water and some sodium from the kidney tubules back into the blood. This dilutes the blood, creating a low level of sodium, and that causes headache, weakness, confusion, and eventually coma. Treatment: restriction of water intake; surgery to remove the adenoma, with radiation therapy to destroy any remaining adenoma

hyperthyroidism

hypersecretion of T3 and T4 thyroid hormones. It is caused by an adenoma (or nodule) in the thyroid gland. The high levels of T3 and T4 cause tremors of the hands, tachycardia, palpitations, restlessness, nervousness, diarrhea, insomnia, fatigue, and generalized weight loss. The thyroid gland is enlarged (a goiter) and can be felt on palpation of the neck. The eyes are dry and irritated with slow eyelid closing ("lid lag"). Graves disease- autoimmune disease in which the body produces antibodies that stimulate TSH receptors on the thyroid gland, and this increases the production of thyroid hormones. The entire thyroid gland becomes enlarged, and there is exopthalmos. Treatment: antithyroid drug to suppress the secretion T3 and T4 or surgery to remove the thyroid gland (thyroidectomy), with radiation therapy with radiation iodine to destroy the remaining thyroid gland

hyperaldosteronism

hypersecretion of aldosterone. It is caused by an adenoma in the adrenal cortex. (It can also be caused by hypersecretion of ACTH from an adenoma in the anterior pituitary gland.) A high level of adolsterone causes the reabsorption of a large amount of sodium and water from the tubules of the kidney into the blood; this causes hypertension, and there is an electrolyte imbalance and weakness as large amounts of potassium are excreted in the urine. Treatment: surgery to remove the adenoma

adrenogenital syndrome

hypersecretion of androgens. It is caused by an adenoma in the adrenal gland. In girls, the clitoris and labia enlarge and resemble a penis and scrotum. In boys, it causes precocious puberty. In adults females, it causes virilism with masculine facial features and body build, hirsutism (excessive, dark hair on the forearms and face), and amenorrhea. Treatment: surgery to remove the adenoma

precocious puberty

hypersecretion of estradiol in a female child. It is caused by an adenoma in the ovary. (It can also be caused by hypersecretion of FSH from an adenoma in the anterior pituitary gland.) The high level of estradiol causes premature development of the breasts and female secondary sexual characteristics and the onset of menstruation and ovulation. Treatment: surgery to remove the adenoma

acromegaly

hypersecretion of growth hormone during adulthood. It is caused by an adenoma in the anterior pituitary gland. Because the growth plates at the ends of the long bones have already fused, the patient cannot grow taller. Sp, the high level of growth hormone causes the facial features, jaw, hands, and feet to widen and enlarge. Treatment: drug therapy to suppress secretion of growth hormone or surgery to remove the adenoma, with radiation therapy to destroy any remaining adenoma

gigantism

hypersecretion of growth hormone during childhood and puberty. It is caused by an adenoma in the anterior pituitary gland. The high level of growth stimulates the bones and tissues to grow excessively. Treatment: drug therapy to suppress secretion of growth hormone or surgery to remove the adenoma, with radiation therapy to destroy any remaining adenoma

hyperinsulinism

hypersecretion of insulin. It is caused by an adenoma in the pancreas. The high level of insulin causes hypoglycemia (a low level of glucose in the blood). There is shakiness, headache, sweating, dizziness, and even fainting. If left untreated, hypoglycemia can progress to insulin shock and then coma as the blood glucose level becomes too low to support brain activity. Treatment: supplemental sugar drink or dextrose intravenous fluids; surgery to remove the adenoma

insulin resistance syndrome (IRS)

hypersecretion of insulin. This is not caused by an adenoma. It occurs when receptors on body cells develop a resistance and do not allow insulin to transport glucose into the cell. There is a high level of glucose remaining in the blood (hyperglycemia), and there is a high level of insulin as the pancreas continues to secrete insulin to try to lower the blood glucose level. Eventually, the pancreas is unable to produce more insulin, and the patient develops diabetes mellitus. Treatment: treat the diabetes mellitus

seasonal affective disorder (SAD)

hypersecretion of melatonin. The exact cause is not known. Melatonin is normally secreted during the night. The longer nights and decreased hours of sunshine during the winter months may disrupt the body's circadian rhythm (biological clock) and increase the secretion of melatonin. The high level of melatonin causes depression, weight gain, and increased desire for food and sleep. There is also a decreased level of neurotransmitter serotonin that affects the mood. Treatment: exposure to sunlight or to bright light from a light box (phototherapy) to suppress melatonin secretion; drug therapy with melatonin and/or an antidepressant drug (There is no specific disease associated with hyposecretion of melatonin)

pheochromocytoma

hypersecretion of norepinephrine and epinephrine because of an adenoma in the adrenal medulla. This type of adenoma has a characteristic appearance of gray-tan tissue. The high levels of norepinephrine and epinephrine cause heart palpitations, severe sweating, and headaches with severe hypertension that can cause a stroke. Treatment: surgery to remove the pheochromocytoma

hyperpituitarism

hypersecretion of one or all of the hormones of the anterior pituitary gland. It is caused by a benign tumor (adenoma) in the anterior pituitary gland. Treatment: drug therapy to surpress secretion of the hormones or surgery to remove the adenoma, with radiation therapy to destroy any remaining adenoma

hyperparathyroidism

hypersecretion of parathyroid hormone. It is caused by an adenoma in the parathyroid gland. The high level of parathyroid hormone stimulates the release of too much calcium from the bones, and the calcium level in the blood is too high (hypercalcemia). The bones become demineralized and prone to fracture. There is also muscle weakness, fatigue, and depression. Excess calcium is excreted in the urine, and this can form kidney stones. Treatment: surgery to remove the parathyroid glands

galactorrhea

hypersecretion of prolactin. It is caused by an adenoma in the anterior pituitary gland. In women, the high level of prolactin stimulates the breasts to produce milk, even though the patient is not pregnant. It also inhibits the secretion of FSH and LH and this stops menstruation. Can also occur in men who have an adenoma in the anterior pituitary gland. Treatment: drug therapy to suppress secretion of prolactin or surgery to remove the adenoma, with radiation therapy to destroy any remaining adenoma

precocious puberty

hypersecretion of testosterone in a male child. It is caused by an adenoma in the testis. (It can also be caused hypersecretion of LH from an adenoma in the anterior pituitary gland.) The high level of testosterone causes the premature development of the male secondary sexual characteristics, with development of a beard, deepening of the voice, and sperm production. Treatment: surgery to remove the adenoma

diabetes insipidus (DI)

hyposecretion of ADH. It is caused by a defect in the posterior pituitary gland, a brain infection, head trauma, and heredity. The low level of ADH decreases reabsorption of sodium and water from the kidney tubules and so excessive amounts of water are excreted in the urine (polyuria). There is also weakness (due to water loss and dehydration) and thirst, which causes an increased intake of fluids (polydispsia). Treatment: drug therapy with antidiuretic hormone

hypothyroidism

hyposecretion of T3 and T4 thyroid hormones. It is usually caused by an inadequate amount of iodine in the diet. It can also be caused by hyposecretion of TSH from the anterior pituitary gland or by treatments for hyperthyroidism that remove the thyroid gland. Another possible cause is a defect in the thyroid gland at birth that causes congenital hypothyroidism. Untreated congenital hypothyroidism results in stunted growth and development delay. Treatment: thyroid hormone supplement drug

hypoaldosteronism

hyposecretion of aldosterone. It is caused by a defect in the adrenal cortex. There is dizziness, a low level of sodium in the blood, weakness, and decreased blood pressure. Treatment: drug therapy with an aldosterone hormone drug

Addison disease

hyposecretion of cortisol. This is an autoimmune disorder in which the body produces antibodies that destroy the adrenal cortex. (It can also be caused by hyposecretion of ACTH from the anterior pituitary gland.) Also known as adrenal insufficiency. There is a low level of blood glucose, fatigue, weight loss, and decreased ability to tolerate stress, disease, or surgery. Patients have an unusual bronze color to the skin, even in areas not exposed to the sun

infertility

hyposecretion of estradiol in an adult female or an imbalance in the amount of estradiol and progesterone. (It can also be caused by a lack of FSH and LH from the anterior pituitary gland.) There is a lack of ovulation, abnormal menstruation, or a history of miscarriages. Treatment: female hormone drug

menopause

hyposecretion of estradiol in an adult female. This is a normal result of the aging process in which the ovaries secrete less and less estradiol. It can also be caused by surgical removal of the ovaries (oophorectomy) due to cancer. The resulting low level of estradiol causes vaginal dryness, thinning of the hair, and lack of sexual drive. As the hypothalamus senses a low estradiol level, it stimulates the anterior pituitary gland to secrete FSH to stimulate the ovary. These bursts of FSH cause hot flashes. Treatment: female hormone replacement therapy, but only for a limited time because these drugs cause an increased risk of breast and endometrial cancer, blood clots, stroke, heart attack, and dementia

dwwarfism

hyposecretion of growth hormone during childhood and puberty. It is caused by a defect in the anterior pituitary gland. The low level of growth hormone causes a lack of growth and short stature, but with normal body proportions. Hyposecretion in adults decreased muscle mass, fatigue, and other symptoms. Treatment: drug therapy with growth hormone

diabetes mellitus (DM)

hyposecretion of insulin. It is caused by an inability of the beta cells of the pancreas to secrete enough insulin. A person who has diabetes mellitus is a diabetic. Laypersons call it "sugar diabetes." The word mellitus means honeyed. In the past, diabetes mellitus was diagnosed of tasting the urine which had a sweet taste. Treatment: drug therapy with injections of insulin or an oral antidiabetic drug (depending on the type of diabetes mellitus); diet management, weight control, and exercise; ongoing consultation with a diabetologist physician or a certified diabetes educator (CDE)

hypopituitarism

hyposecretion of one or more of the hormones of the anterior pituitary gland. It is caused by an injury or a defect in the anterior pituitary gland. Panhypopituitarism is a hyposecretion of all of the hormones. Treatment: drug therapy to replace the hormone(s)

uterine inertia

hyposecretion of oxytocin. It is caused by a defect in the posterior pituitary gland. Before a woman gives birth, the low level of oxytocin in her blood causes weak and uncoordinated contractions of the pregnant uterus. This prolongs labor and delays the birth of the baby. After birth of the baby, the low blood level of oxytocin causes postpartum hemorrhage (the uterus does not contract, and there is hemorrhaging at the site where the placenta separated from the uterus). Treatment: drug therapy with oxytocin

hypoparathyroidism

hyposecretion of parathyroid hormone. It is caused by the accidental removal of the parathyroid glands during surgery the thyroid gland (thyroidectomy). The low level of parathyroid hormone causes the calcium level in the blood to become very low (hypocalcemia). This causes irritability of the nerves, skeletal muscle cramps, or sustained muscle spasm (tetany). Treatment: parathyroid hormone supplement drug

failure of lactation

hyposecretion of prolactin. It is caused by a defect in the anterior pituitary gland. The low level of prolactin prevents the development of the lactiferous lobules (milk glands) in the breasts during puberty, and the breasts do not make enough milk for breastfeeding after the baby is born. Treatment: none

infertility

hyposecretion of testosterone in an adult male. It is caused by failure of one or both of the testes to descend into the scrotum before birth. (It can also be cause by surgical removal of the testes due to cancer or by the lack of LH from the anterior pituitary gland.) The low level of testosterone causes too few spermatozoa to be produced. Treatment: surgery as a child to bring the testes into the scrotum to prevent infertility as an adult; androgen drug for an adult

gynecomastia

hyposecretion of testosterone in an adult male. This is a normal result of the aging process in which the testes secrete less testosterone. (It can also be caused by surgical removal of the testes due to cancer, by estrogen drug treatment for prostate cancer, by excessive alcohol consumption, or as a side effect of some drugs.) However, androgens continue to be secreted by the adrenal cortex and converted to estradiol in the blood. The low level of testosterone is no longer in balance with the level of estradiol, and this causes enlargement of the male breasts. Treatment: androgen drug; plastic surgery to decrease the breast size

goiter

is a chronic and progressive enlargement of the thyroid gland. It is also known as thyromegaly. The causes include: 1. an adenoma or nodule growing in the thyroid gland. This is known as adenomatous goiter or nodular goiter. If there are many nodules, it is a multinodular goiter. An adenoma or nodule is usually benign but can be cancerous. 2. a cancerous tumor growing in the thyroid gland. 3. chronic inflammation of the thyroid gland as seen in thyroiditis. 4. a lack of iodine in the soil, water, and diet. This causes the thyroid gland to enlarge to help it capture more iodine; this is known as a simple goiter, a nontoxic goiter, or an endemic goiter (because it occurs in people who live in an area where the soil is poor in iodine)

Hashimoto thyroiditis

is an autoimmune disorder in which the body makes antibodies against the thyroid gland, causing loss of function and replacement of the thyroid tissue with fibrous tissue. The low levels of T3 and T4 cause fatigue, decreased body temperature, dry hair and skin, constipation, and weight gain

Cushing disease and syndrome

is caused by hypersecretion of cortisol from an adenoma in the adrenal cortex. Occurs in a patient who takes corticosteroid drugs on a long-term basis. The high level of cortisol stimulates the liver to convert too much glycogen to glucose, causing a high level of glucose in the blood. This results in rapid weight gain, with deposits of fat in the face (moon face), upper back (buffalo hump), and abdomen. There is thinning of connective tissue in the skin of the face that allows the blood vessels to show through, giving a reddened appearance to the cheeks. The thinned connective tissue in the skin across the obese abdomen is stretched, causing small hemorrhages and red and purple striae. There is also a wasted appearance of the muscles in the extremities and muscle weakness because of the lack of protein synthesis. Treatment: surgery to remove the adenoma; discontinue corticosteroid drugs

thyroid carcinoma

malignant tumor of thyroid gland. There is hoarseness, neck pain, and enlargement of the thyroid gland and nearby cancerous lymph nodes. Treatment: surgery to remove the thyroid gland (thyroidectomy), with radiation therapy to destroy the remaining thyroid gland

impotence

nerve damaged and atherosclerosis of the arteries to the penis results in difficulty having an erection

gestational diabetes mellitus (GDM)

occurs only during pregnancy, when increased levels of estradiol and progesterone block the action of insulin. The pregnant woman's pancreas is temporarily unable to secrete enough insulin to meet the increased demands from the growing fetus. This type of diabetes mellitus resolves once the baby is delivered; however, many women who had GDM develop type 2 diabetes later in life

myxedema

severe hypothyroidism with swelling of the subcutaneous and connective tissues, tingling in the hands hands and feet because of nerve compression, lack of menstruation, hair loss, and enlarged heart, bradycardia, an enlarged tongue, slow speech, and mental impairment