Final exam: Disorders of Endocrine Control
In Glucocorticoid hormones excess, what is Cushing syndrome?
(hypercortisolism): -pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland -adrenal form, caused by a benign or malignant adrenal tumor -Ectopic form, non-pituitary ACTH-secreting tumor
What are the manifestations of Cushing Syndrome?
-Altered fat metabolism -muscle weakness -muscle wasting -purple striae (stretch marks) -osteoporosis -derangements in glucose metabolism -hypokalemia -gastric acid secretion -hirsutism (hairy), mild acne, and menstrual irregularities. -moon face and buffalo bump -thin parchment like skin
Name the hormones essential for normal body growth and maturation
-Growth hormone (GH) -insulin -thyroid hormone -androgens: exert anabolic growth defects
What is Precocious Puberty?
-Isosexual Precocious puberty is early activation of the hypothalamic-pituitary- gonoadal axis Results: in the development of appropriate sexual characteristics and fertility -persons with Precocious puberty usually are tall for their age as children but short as adults because of the early closure of the epiphyses.
What are the effects of Growth hormone Excess in Audults?
-Overgrowth of the cartilaginous parts of the skeleton -Enlargement of the heart and other organs of the body -Metabolic disturbances resulting in altered fat metabolism and impaired glucose tolerance. -GH exerts multiple effects on Carb metabolism, including decreased glucose uptake by tissues, increased glucose production by the Liver, and increased Insulin secretion.
What are the manifestations of hyperthyroidism?
-Thyroid storm (HR, BP, Tb, soar to high levels and is fatal if not aggressively treated). -restlessness, irritability, anxiety -wakefulness -increased cardiac output -tachycardia and palpitations -diarrhea, increased appetite -dyspnea -heat intolerance, increased sweating -thin and silky skin and hair -weight loss
List the clinical findings of Adrenal insufficiency
-anorexia and weight loss -fatigue and weakness -gastrointestinal symptoms, nausea, diarrhea -myalgia, arthralgia, abdominal pain -orthostatic hypotension -Hyponatremia -hyperkalemia -hyper pigmentation -secondary deficiency of select hormones -associated autoimmune conditions
What are the treatments for Acromegaly?
-correction of IGF-1 levels -Removing /reducing tumors producing GHRH or GH administration of drugs analogous to GHIH
What are causes of Precocious sexual development?
-idopathic -Gonadal disease -adrenal disease -Hypothalamic disease - Benign and malignant tumors of the central nervous system. Tumors- can remove inhibitory influences normally exerted on hypothalamus during development
Explain the causes of short stature
-low birth weight -Endocrine disorders: -poorly controlled diabetes -hypothyroidism -deficient IGF-1 production -chronic illness and malnutrition: -malabsorption syndromes -end stage renal disease -protein calorie malnutriton -functional endocrine disorders: -psychosocial Dwarfism -chormosomal disorders -skeletal abnormatlities -variants from normal: -genetic/constitutional
What are the manifestations of Hypothyroidism?
-mental and physical sluggishness -myxedema -somnolence (drowsiness) -decreased cardiac output, bradycardia -constipation -decreased appetite -hypoventilation -cold intolerance -coarse dry skin and hair -weight gain -hair loss in outer eyebrow
Give a profile about the growth hormone?
-produced by somatotropes in the anterior pituitary -necessary for linear bone growth in children -stimulates cells to increase in size and divide more rapidly -enhances amino acid transport across cell membranes -increases the rate at which cells use fatty acids -decreases the rate at which cells use carbohydrates
Name the pituitary target cell hormones
-serum cortisol -serum prolactin -serum thyroxine and TSH -serum testosterone (male)/serum estrogen (female) and serum LH/FSH -serum GH/insulin-like growth factor-1
What is Opthalmopathy?
Accumulation of T lymphocytes that are sensitized ti antigens along thyroid follicular cells and orbital fibroblasts that secrete cytokins. -can cause severe eye problems. -tethering of extra ocular muscles which causes bulging, visual loss, and or corneal ulceration.
What process happens to amino acids when body proteins are being broken down?
Amino acids are mobilized and transported to the liver. Where they are used in the production of glucose-gluconeogenesis.
What happens when the Thyroid hormone is low?
Bone growth and closure of epiphyseal plates is delayed
Describe Congenital Hypothyroidism and how can it occur?
Can occur due to lack of thyroid gland. Abnormal synthesis of thyroid hormone, or deficient TSH secretion. -Thyroid hormone is essential for normal growth and brain development, almost half of which occurs during the first 6 months of life -if untreated, can cause mental retardation and impairs physical growth -the manifestations of untreated are referred to as Cretinism
What is Hypothyroidism?
Decreased metabolic rate, body temp, and weight gain Accumulation of hydrophilic Mucopolysaccharide (glycosaminoglycans) substance (myxedema) in the connective tissues Elevated serum cholesterol, and inadequate iodine levels
What are causes of Acromegaly?
Excess GH and IGF-1 cause acromegaly in adults Most common cause: Somatotrope Adenoma -Benign epithelial tumor (functional) producing excess growth hormone Other causes: (smaller than 5%) -Excess secretion by GHRH by hypothalamic tumors -Ectopic GHRH secretion by non-endocrine tumors such as Carcinoid tumors or small cell lung cancers -Ectopic secretion of GH by non-endocrine tumors
Describe what Hypofunction is and its causes.
Excessive hormone production Causes: -Excessive stimulation and hyperplasia of the endocrine gland -Hormone-producing tumor of the gland
Describe how a deficiency or an excess of growth hormone in children works
GH defifiency: -interferes with linear bone growth -results in short stature or dwarfism GH excess -results in increased linear bone growth -gigantism
Explain what GnRH stimulates.
GnRH stimulates the relesase of LH + FSH. FSH + LH stimulate production of estogen and testosterone and progesterone. Use of long acting agonist of GnRH= decrease of pituitary responsiveness to GnRH. This leads to decreased secretion of GnRh and then leads to decreased release of sex steroids testoserone and estrogen.
What are the types of short stature?
Height less than 3rd percentile Genetic short stature: not disease state -be well proportional and to have a height close to the midparental height of their parents Constitutional short stature: not disease state -have moderatley short stature, thin build, delayed skeletal and sexual maturation, and absences of other causes of decreased growth Psychosocial Dwarfism: -functional hypopituitarism in some emotinally deprived children
Explain Tall stature
Height that is greater than 99 percentile. Constitutional tall stature (constitutional advancement of Growth, CAG) - a child who is taller than his or her peers and is growing at a velocity that is within the normal range for bone age -genetically tall Others: -Marfan syndrome -Endocrine causes: sexual precocity : early onset of estrogen and androgen secretion and excessive GH
What are the manifestations of Hypopituitarism?
Hypopituitarism can be congenital. -usually occurs gradually -can present as an acute and life-threatening condition Symptoms: -being chronically unfit -weakness and fatigue -loss of appetite -impairment of sexual function -cold intolerance
Describe what Hyperthyroidism is?
Increased circulating thyroid hormone. -increased metabolic rate and oxygen consumption -increased use of metabolic fuels -increased sympathetic nervous system responsiveness, insomnia, weight loss and possible muscle wasting
What is thyroid hormone production dependent on?
Iodine
What does the growth hormone do?
It induces resistance to insulin in peripheral tissues, inhibits uptake of glucose by muscle and adipose tissue
What is Graves disease?
It is a state of Hyperthyroidism, goiter an ophthalmology (less commonly, dermopathy). -An autoimmune disorder characterized by abnormal stimulation of the thyroid gland y thyroid-stimulation receptor antibodies. -causes enlargement of the thyroid and other symptoms such as exophthalmos, heat intolerance and anxiety. -familial tendency is evident
What is Addison disease? and how is it different from Cushing syndrome? What are the treatments?
It is caused by destruction of the adrenal gland and glucocorticoid insufficiency (hypocortisolism). In contrast, Cushing syndrome refers to the manifestations of Hypercortisolism from any cause. Treatments: Cortisol injections (treats symptoms not cause); anti-inflammatory drugs cause a decrease in ACTH and GH. May take months to recover.
What is Goiter?
Manifestation of hypthyroidism -decrease in idodine levels leads to a decrease in thryroid hormone. Lose negative feedback. -TSH levels are high so they continue to stimulate thyroid cells to cause hyperplasia and hypertrophy -Anything that prevents production of thyroid hormone (TH) leads to low levels of circulating TH and increased TSH, resulting in Goiter.
What are the Steroid hormones produced by the adrenal cortex?
Mineralocorticoids (aldosterone): -Function is sodium, potassium, and water balance Glucocorticoids (cortisol): -Aid in regulating the metabolic functions of the body and in controlling the inflammatory response -Essential for survival in stress situations (Gluconeogenesis, glucose conservation, increased amino acids for tissue repair). Adrenal Sex hormones (androgens): Serve mainly as source of androgens for women
Name the 4 categories of Pituitary tumors.
Primary Secondary: -Metastatic lesions Breast and lung cancer are the two most common types of cancers that metastasize to the pituitary gland Functional tumors: -secrete pituitary hormones Benign adenomas account for most of functioning anterior pituitary tumors. Nonfunctional tumors: -Do not secrete hormones
Name and explain the stages of Adrenal Cortical Insufficiency
Primary adrenal cortical insufficiency: (Addison Disease) -ACTH levels are elevated because of lack of feedback inhibition. Secondary adrenal cortical insufficiency: -Occurs as a result of hypopituitarism or because pituitary gland had been surgically removed. Acute adrenal crisis: -life-threatening situation occurs. -Lack of cortisol and is a medical emergency
Name and explain the 3 categories of Endocrine disorders.
Primary: -originate in the target gland responsible for producing the hormone (adrenal galnd) Secondary: -The target gland is essentially normal, but its function is altered by defective levels of stimulating hormones or releasing factors from the pituitary gland. Ex: adenoma Tertiary: -result from hypothalamic dysfunction -both the pituitary and target organ are under-stimulated
What are the major functions of the Thyroid hormone?
Thyroxine (T4) and triiodothyronine (T3): -control the rate of metabolism, affecting weight -can slow down or speed up your heart beat. -can raise or lower your body temp -change how fast food moves through your digestive tract -affect muscle strength -control how quickly your body replaces dying cells -Increases metabolism and protein synthesis -influence growth and development in children -mental development and attainment of sexual maturity
What is Hypofunction and what are some causes of this?
Underproduction of hormones Causes: -congenital defects -Disruption in blood flow, infection, inflammation, autoimmune responses, or neoplastic growth -Decline in function with aging -Atrophy as the result of drug therapy or unknown reasons -receptor defects
What effects can Withdrawing glucocoriticoids that have been administered for asthma or Ms have?
Withdrawing glucocorticoids that have been administered for asthma or MS can have effects. Drugs suppress HPA axis which results in adrenal cortical atrophy, loss of cortisol production.
What is the worst type of Hypopituitarism?
Worst type: deficiency in the hypocorticotropic hormone (ACTH). This leads to weakness, nausea, anorexia, fever, and postural hypotension sequence. -GH -LH- sex hormone deficiency -FSH-causes infertillity -TSH- secondary hypothyroidism -ACTH- secondary adrenal insufficiency
What are glucocorticoids?
act as anti-inflammatory agents and reduce edema of the airways -can inhibit growth at excessive levels due to antagonistic effects on GH secretion.
What is panhypopituitarism?
decreased secretion of all anterior pituitary hormones
