Endocrine
disorders
Result from
hypo or hyper secretion of a particular hormone
Anterior
pituitary
Hypo growth
hormone
childhood -
dwarf
Hyper growth
hormone
child - giant
adult - acromegaly
Posterior
pituitary
Hyposecretion of
ADH - diabetes insipidus
Thyroid gland
Hypothyroidism
child - cretinism
adult - myxoedema
Cretinism
* presents shortly after birth
* severe mental retardation
* short limbs
* course dry skin
Myxoedema
* lethargy
* psychomotor retardation
* feeling cold
* weight gain
Hyperthyroidism
Thyrotoxicosis
* increased
metabolic rate
* cardiac
arrhythmias
* restlessness
and excitability
* exophthalmos
* goitre
Thyroid
tumours
* benign
* malignant
tumours
Parathyroid gland
Hyperparathyroidism
* raised serum calcium
* renal complications
Hypoparathyroidism
* low serum calcium
* Increased muscle tone
* tetany
* cataract
* behavioural effects/dementia
Adrenal Gland
Cortex
Hypersecretion
of Glucocorticoids
Cushing's
syndrome
* excess cortisol
* weight gain - adipose deposition
affecting face, neck and trunk
* protein catabolism
* poor growth in children
* osteoporosis - often affecting vertebra
* hyperglycaemia and glucosuria
* depressed immune response
* insomnia, excitability, psychosis
Hyposecretion
of glucocorticoids
* hypoglycaemia
* muscle weakness
Excess
aldosterone
* increased reabsorption of sodium
* excessive excretion of potassium
Inadequate
aldosterone
* sodium deficiency, potassium excess
* dehydration, low BP
Hyposecretion
of cortical hormones
Addisons
disease
* weight loss
* malaise
* weakness
* depression
* GI disturbance
* diarrhoea
* vomiting
* anorexia
* dehydration
* postural hypotension
* increased skin pigmentation
* tiredness
Adrenal
Medulla
Excess
secretion
* hypertension
* hyperglycaemia
* sweating
* raised metabolic rate
Islets of
Langerhans
Clinical details of endocrine
abnormality
The Thyroid Gland
Goitre
Enlargement in thyroid gland
May press on a vital structure
Simple Goitre
Most common type
Highland areas away from sea
Lack of Iodine in diet
Found in milk, eggs, sea fish
and crops grown near the sea.
Potassium iodine 100 mg
orally/day.
Hyperthyroidism or
thyrotoxicosis
Over production of thyroid
hormone
T4 thyroxine
T3 tri-iodothyronine
Eight times more common in
females.
Often appears between 15 - 30.
Clinical Features
* Over-production
of thyroxine.
* All
the cells of the body are stimulated in to over-active.
* Nervous,
anxious and easily upset.
* Tachycardia
* Increased
heat production
* Increased
respiration
* Moist,
warm flushed skin
* Vasodilation
and tachycardia continues in sleep, (unlike
anxiety)
* Weight
loss
* Often a
moderate smooth goitre
* Possible
increased frequency of bowel activity.
* Protrusion
of the eyeballs.
* Oligomenorrhoea
Hyperthyrodism, goitre and
exophthalmos = Graves disease.
This may be familial.
The cause of exophthalmos seems
to be the presence of a thyroid stimulating substance in the blood other than
TSH.
It may be LATS (Long acting
thyroid stimulator) or HTSI (Human thyroid stimulating immunoglobulin).
Complications
* Atrial
fibrillation
* Cardiac
failure
* Thyrotoxic
crisis
Treatment.
Antithyroid drugs, radioiodine
or surgical.
Thyroid tumours
May cause up to 1 in 500 deaths
in the UK.
Benign - adenoma
Malignant - carcinoma
Usually idiopathic
Some caused by radioactive
iodine
Seen in Japanese nuclear
explosion survivors.
In hyperthyroid patients with
tumour they can be diagnosed by looking for "hot nodules" using a
radio iodine label.
Most thyroid tumours do not
show physiological activity, (ie. are non-toxic as opposed to a toxic adenoma).
Spread first to neck lymph
nodes and later by lymphatics and the bloodstream.
Treatment is by surgical
excision.
Hypothyroidism.
A deficiency in thyroxine
levels.
In adults this causes
myxoedema.
In children it causes cretinism
Cretinism
Thyroid function is essential
to normal growth and development.
mental and physical dwarf.
Classically - highland areas
A few occasional cases may be
due to a congenital disorder of the thyroid gland.
As is usual in developmental
abnormalities treatment must be started early, later treatment will not allow
the individual to catch up.
Myxoedema
Hypothyroidism which develops
after maturation.
Most common in middle aged
women.
Clinical Features
* All
mental and physical processes are slow.
* Skin is
puffy.
* Slow
speech and pulse.
* Patients
feel cold and may sit for hours by the fire.
* Blood
cholesterol is raised and atherosclerosis will develop.
The glandular tissue of the
thyroid gland is progressively destroyed, possibly by an auto-immune reaction.
Fibrous scar tissue develops.
Auto-immune - Hashimoto`s
disease.