Endocrine Flashcards
1
Q
The Endocrine System
A
The endocrine system (endo-, inside, and krinein, -to secrete)
- comprises several glands (pituitary, thyroid, parathyroid, adrenals) and
- Scattered cells in the gonads, pancreas, intestine, and other organs
2
Q
Primary function of endocrine cells
A
produce hormones
- the endocrine organs do not have ducts and so are called the “ductless” glands. Hormones are secreted into the blood or extra cellular spaces
Hormones that are released into the circulation act on distant organs (endocrine effect)
For example, pituitary hormones exert an endocrine effect on the thyroid, adrenals, or gonads
3
Q
Four major endocrine glands:
A
: the pituitary, thyroid, parathyroid, and adrenals
The pituitary, thyroid, parathyroids, and adrenals are unrelated to each other and have distinct anatomic locations
4
Q
gynaecomastia
A
men gets breasts
5
Q
Pituitary
A
- located intracranially in an indentation of the base of the cranium called the sella turcica (a Latin term -Turkish saddle)
- consists of two parts (anterior and posterior), which are connected to the hypothalamus via a stalk that contains extensions of neurons and the vessels of the pituitary portal system
The blood vessels transport-from the hypothalamus into the pituitary
-the neuroendocrine releasing factors that regulate the function of the pituitary cells
highly vascular- lots of blood vessels
6
Q
The Anterior Pituitary ( adenohypophysis )
A
consists of five distinct cell types, each of which is named according to the hormone it secretes. These hormones are:
growth hormone (GH) prolactin (PRL ) adrenocorticotropic hormone (ACTH) the gonadotropins (luteinizing hormone [LH] and follicle-stimulating hormone [FSH])- teste or ovary, testosterone- ova,estro and progesterone thyrotropic hormone (thyroid-stimulating hormone [TSH])
7
Q
Growth Hormone (GH) action and target
A
Somatomedin Synthesis º Growth Simulation
targets liver and other
8
Q
prolactin
action and target
A
lactation- targets breast
9
Q
Thyroid Stimulating Hormone (TSH)
A
action: Thyroid Hormone Synthesis &
Release
targets thyroid
10
Q
Follicle-Stimulating Hormone (FSH)
A
action -spermatogenesis, estrogen synthesis oogenesis
organ: testi
ovary
11
Q
Adrenocorticotropic Hormone (ACTH)
A
action Glucocorticoid Synthesis & Release
target adrena cortex
12
Q
Luteinizing Hormone (LH)
A
action:
Ovulation
Corpus Luteum, hence Progesterone Production
target ovary
action:
Testosterone Synthesis
target testi
13
Q
Regulation!!
A
The secretion of hormones of the anterior pituitary is regulated by
positive stimulation -exerted by the cells in the hypothalamic centers and
negative feedback inhibition -created by the hormones produced by the target endocrine cells in the thyroid, adrenals, and gonads
14
Q
The Posterior Pituitary (neurohypophysis)
which comes from anterior vs posterior
A
- release oxytocin (pitressin) and the antidiuretic hormone (ADH)
In contrast to the hormones of the anterior pituitary, which are trophic and stimulate the functions of other endocrine glands, the hormones of the posterior pituitary have no trophic functionsThese hormones act on nonendocrine cells; - oxytocin stimulates the contraction of the pregnant uterus and
- ADH promotes the reabsorption of water from the renal tubules
15
Q
THE THYROID GLAND
A
weight : 15-25 g
• derived from primitive gut
• function: storage & release of thyroid hormones
• 2 “butterfly-shaped” lobes connected by narrow band of tissue called the isthmus
-ant to lower part larynx &. Above clavicle
an endocrine gland located in the neck
- consists of two types of cells: follicular cells and C cells
Follicular cells secrete thyroid hormones (thyroxine [T4] and triiodothyronine [T3])- essential for maintaining the intermediate metabolism.
The secretion of T3 and T4 is regulated by TSH
The C cells secrete calcitonin, a polypeptide - involved in the maintenance of calcium homeostasis
The secretion of calcitonin is influenced by the concentration of calcium in serum
16
Q
Overview of Major Diseases
A
The most important diseases involving the endocrine glands present as:
- Hyperfunction
- Hypofunction
- Tumors
17
Q
hypo
A
– low or deficient; Hyper- high or excessive
18
Q
endocrine
A
- secretion into the circulation
19
Q
exocrine
A
– secretion via duct into GI system
20
Q
syndrome
A
– group of symptoms common to several diseases
21
Q
disease
A
specific cause known
22
Q
benign tumor
A
one that does not spread (metastasize)
23
Q
hypertrophy
A
– grow in size due to constant stimulus
24
Q
autonomous
A
– with no feedback control
25
primary
– disease caused within the gland
26
secondary
– caused by something external
27
tertiary
– 2ndary becomes autonomous
28
hyposecreation
agenesis, atrophy, destruction
29
hypersecreation
tumor, hyperplaisia
30
(1 of 6 comandement)
A.The Function of the endocrine gland is tightly regulated by positive and negative stimuli
dont need to know in detail
The function of the thyroid, adrenals, and gonads is regulated by the anterior pituitary, which secretes the trophic hormones TSH, ACTH, LH, and FSH.
The function of the pituitary is, in turn, regulated by the hypothalamic releasing factors (e.g., gonadotropin-releasing hormone [GnRH]).
The hormones of the peripheral target glands released into the blood have a negative inhibitory influence on the hypothalamus and the pituitary
31
2 of 6
B. Prolonged hyper stimulation by trophic hormones or metabolic signals leads not only to hyper function, but also to physical enlargement of the peripheral endocrine glands
The thyroid, when over stimulated by TSH, enlarges and becomes nodular
ACTH stimulation leads to adrenocortical hyperplasia
32
C. Hyper functioning endocrine glands may be hyperplastic or neoplastic
Hyperfunctioning endocrine glands are usually enlarged. -The enlargement may be attributable to hyperplasia (i.e., a reactive increase in cell number) or to benign or malignant tumors
33
D. Hypo function of the endocrine glands is usually attributable to the destruction of secretory cells
Destruction and loss of endocrine cells or the entire gland may be caused by several mechanisms, the most important of which are inflammation, tumors, and medical interventions
Inflammation may be caused by infectious organisms or autoimmune processes
34
E. Neoplastic or hyperplastic enlargement of the endocrine glands results in mass lesions that compress adjacent structures
Local symptoms caused by endocrine gland enlargement are most evident in diseases of the pituitary and the thyroid
Enlargement of the pituitary, which is in close proximity to the optic nerve
decussation, produces defects in the visual field (so-called bitemporal hemianopsia, or bilateral loss of peripheral [temporal] sight).
Thyroid tumors may produce a bulge on the anterior side of the neck or compress the larynx, trachea, and the nerves or blood vessels of the neck
35
F. Tumors of one endocrine gland may be associated with neoplasia and/ or hyperplasia of other glands
Multiple endocrine neoplasia (MEN) is a hereditary syndrome that occurs in at least three forms: MEN-l, MEN-2A, and MEN-2B
In MEN-l, the tumors originate from the pituitary , parathyroids, and pancreatic islets of langherhans
-
36
In MEN-2A,
the tumors include medullary carcinoma originating from C cells of the thyroid, pheochromocytoma originating from the medulla of the adrenal, and parathyroid adenoma or hyperplasia
37
MEN-2B,
, which resembles MEN-2A and has the same endocrine lesions, also includes additional multiple skin and mucosal nerve tumors. The occurrence of these familial tumors has been related to defects in tumor suppressor genes
38
Pituitary Diseases
Diseases of the pituitary are uncommon, but may present as:
Pituitary hyperfunction
Pituitary hypofunction
A localized mass lesion causing compression of the optic chiasm or the basal portion of the brain
39
Pituitary hyperfunction
Pituitary hyperfunction may present in several forms depending on which one of the five cells is hyperfunctioning. The pituitary is usually, enlarged
The enlargement may be attributable to macroscopic or microscopic adenomas, which are composed of a single cell type or several cell types
40
Most common are tumors composed of
Less common are
which is the most rare
!!!
Most common are tumors composed of lactotropic cells (also known as prolactinomas)
Less common are somatotropic and corticotropic adenomas
Tumors composed of TSH-, LH-, or FSH-secreting cells are extremely rare
41
Pituitary Hypofunction
Endocrine insufficiency of the pituitary causes hypofunction of secondary organs, which depend on trophic stimuli from the pituitary.
Pituitary hypofunction is rare, but it may be encountered in any age group.
It may involve all pituitary cells panhypopituitarism) or it may be selective-i.e., limited to one subset of anterior pituitary cells (e.g., hypogonadism secondary to the deficiency of gonadotropic cells) or posterior pituitary cells (e.g., diabetes insipidus)
42
The causes of pituitary hypofunction include:
congenital developmental defects, as in pituitary dwarfism or hypogonadism
tumors that destroy the pituitary (e.g., nonfunctioning pituitary adenoma) or the hypothalamus (e.g., craniopharyngioma or glioma)
ischemia, as in postpartum necrosis (Sheehan's syndrome )
The diagnosis of pituitary insufficiency may be suspected clinically but must be confirmed by appropriate biochemical tests, which will show hormone deficiency
43
Panhypopituitarism of adults (Simmonds'disease)
Panhypopituitarism of adults (Simmonds'disease) is marked by general weakness, cold intolerance, poor appetite, weight loss, and hypotension. Women affected by this disease do not menstruate and men suffer from impotence and loss of libido. Pituitary insufficiency of childhood results in dwarfism
44
Diabetes insipidus is marked by
diabetes mellitus is cause by sugar
Diabetes insipidus is marked by a lack of ADH secondary to destructive lesions of the hypothalamus, pituitary stalk, or posterior pituitary. It may be caused by tumors, infection of the brain or meninges, intracranial hemorrhage, or trauma involving the bones of the base of the skull. Patients with diabetes insipidus secrete large amounts (5 to 6 L/day) of hypotonic urine
45
Growth Hormone
Deficiency Syndromes:
Children: Pituitary Dwarfism
Adults: Single deficiency – None
Multiple: Hypopit Syndrome
46
growth hormose Syndromes of Excess
Children: Prepubertal- before closure of epiphyseal growth plate of long bones---longitudinal growth -Gigantism
Adults: enlargement of acral part of extremities - Acromegaly
47
Acromegaly
Sign & Sym. of Tumour: Headache, Visual Field Disturbances,
GH Excess: Acral Growth, Visceromegaly, Hypertrophy, Hypertension, Osteoporosis.
Glucose intolerance
( frank Diabetes)
48
Prolactin
| excess
Excess:
♀: Galactorrhœa (30-80%), Amenorrhoea, Oligomenorrhœa, or infertility with libido
♂: Gonadal dysfunction impotence, galactorrhœa (14-33%), Visual field disturbances (41%), Headaches.
Children: delayed or arrested puberty
49
know slide 47!!!!!!!
HORMONE HYPOFUNCTION HYPERFUNCTION
HGH Growth Failure Gigantism,
Acromegaly
TSH Hypothyroidism Hyperthyroidism
ACTH Adrenal Insufficiency CushingsDisease
LH & FSH Delayed Puberty
PROLACTIN Gynaecomastia
Impotence
Reduced Fertility
Delayed Puberty
50
Stimulation & Suppression Tests
slife 48
stimulation is used when Hypofunction is suspected
ex: Pituitary: Triple Bolus Test
ADH: Water Deprivation
GH: Insulin Hypoglycemia Adrenal: SynACTHen Test
suppresion: use when Hyperfunction is suspected
GH: Oral GTT
Adrenal: Dexamethasone Suppression
51
Thyroid Diseases
Thyroid diseases are common, but fortunately, they can be diagnosed readily and treated with very good results
Thyroid diseases present as functional disturbances (hyperfunction or hypofunction) or as mass lesions (neoplasms or non-neoplastic enlargement, known as goiter)
52
3 kinds of hyperthyroidism
Thyroid overactivity Grave’s disease, Multi-nodular goitre, Toxic adenoma, T3 toxicosis, TSH-secreting tumour (rare)
Thyroid destruction Subacute thyroiditis (acute phase), Hashimoto’s thyroiditis (acute phase)
Ectopic Thyroid Strauma Ovarii (rare), Metastatic thyroid carcinoma (rare), Exogenous Thyroxine, Thyrotoxicosis
53
Clinical Symptoms
| HYPERTHYROID
```
Heat Intolerance
Flushed Skin
Incr. Perspiration
Incr. Appetite & Food Ingestion
Muscle Wasting & Weakness
Weight Loss
```
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Clinical Symptoms
| HYPOTHYROID
Cold Intolerance
Dry & Pale Skin
Decr. Appetite &
Food Ingestion
Generalized
Weakness
Weight Gain
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Symptoms and Signs of Thyroid Dysfunction
| HYPERTHYROID
```
Restlessness
Hypermotility
Nervousness
Emotional lability
Fatigue
Exag. Reflexes
Hyperdefecation
```
56
Symptoms and Signs of Thyroid Dysfunction
| HYPOTHYROID
Apathy
Mental Sluggishness
Mental Retardation
Depressed Reflexes
Constipation
57
Thyroid Testing
Thyroid disorders are the commonest Endocrine problems
2% of women will develop thyrotoxicosis and a further 1% primary hypothyroidism
Goiter or a thyroid nodule can be found in up to 15% of the population
This frequency demands that thyroid function tests be effective and economical
58
if tsh is elevated can suspect
hypothyroid slide 56
59
slide 57!!
d
60
hyperthyroid
primary: high t4 low tsh
secondary: high t4 high tsh
61
hypothyroid
low t4 high tsh
| econdary: low t4 low tsh
62
Thyroid Neoplasms
Thyroid tumors -benign or malignant
Benign thyroid tumors are common
found in 3 – 4 percent of all adults, they are of limited clinical significance, primarily because such tumors are small
Malignant thyroid tumors are rare. Only three to four cases of thyroid cancer are diagnosed yearly per 100,000 people and less than 1000 people die of thyroid cancer yearly in the United States
63
Thyroid Carcinoma!!! 4 types
- Carcinoma of the thyroid occurs in several histologic forms, including papillary, follicular, medullary, and anaplastic carcinoma.
All of these tumors except medullary carcinomas originate from follicular cells. No risk factors for developing thyroid tumors are known. Thyroid tumors are, for unknown reasons, more common in females than males
64
Papillary carcinoma
best to get because good prognosis
- accounts for 80 percent of all malignant thyroid tumors. -It is a low-grade malignant lesion. Papillary carcinoma is a hormonally inactive tumor and usually presents as a cold nodule on radioscans. The tumor tends to metastasize to the local lymph nodes, but distant metastases are not found until late in the disease
- is four times more common in women than in men. It occurs relatively early in life and has a peak incidence in the third to fifth decade. This tumor has a very favorable prognosis; indeed, 80 percent of patients are alive 10 years after diagnosis
65
Follicular carcinoma
-is much less common than papillary carcinoma, accounting for only 15 percent of thyroid malignant diseases. Most patients are older than 40 years of age and 75 percent are female. The tumor grows more aggressively than papillarycarcinoma, but it still has a good prognosis. Overall, 65 percent of patients survive 10 years
Clinically, follicular carcinoma presents as a slowly growing nodule
66
Medullary carcinoma
-differs from other thyroid tumors in that it is derived from C cells. Like the normal C cells, medullary carcinomas produce calcitonin, a hormone involved in regulating the homeostasis of calcium
Histologically, medullary carcinoma is composed of round or oval neuroendocrine cells arranged into groups and nests
-may be inherited, and it can occur concomitantly with other endocrine tumors, such as pheochromocytoma in MEN-2
- Familial medullary carcinomas are usually discovered early and have a good prognosis if surgically removed. Sporadic tumors, which occur at 60 years of age and older, have a less favorable prognosis
c cells!
67
Anaplastic carcinoma
worst one
-is a rare tumor. It has an extremely unfavorable prognosis, and most patients die within 1 year of diagnosis
Histologically, such tumors are composed of undifferentiated, large or small tumor cells that bear no resemblance to normal thyroid cells
68
Adrenal Gland
(also known as suprarenal glands)
Situated on top of the kidneys
Adrenal cortex plays role in steroid hormones like cortisol and aldosterone
Adrenal medulla synthesizes epinephrine (adrenalin)
69
Diseases of Adrenal Cortex
```
Adrenal hyperfunction
Adrenal hypofunction
Adrenal tumors (functional or non-functional)
```
70
Adrenal Hyperfunction
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Hyperaldosteronism (Conn’s syndrome)
Hypercortisolism (Cushing’s syndrome)
Adrenogenital syndrome (Enzyme deficiency – full or partial)
```
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Adrenal Gland
Adrenal Cortex – three zones, only one under control of the pituitary ie fasciculata
Adrenal Medulla – production of catecholamines like epinephrine (adrenalin)
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Adrenal Cortex!!!!
| know the 3 zones and what they produce
Contains 3 zones
Zona glomerulosa which produces aldosterone
Zona fasciculata which produces cortisol
Zona reticularis
Diseases of each zone produce different diseases
73
Zona Fasciculata
Produces cortisol which is required for normal glucose metabolism. Lack of cortisol produces hypoglycemica (Low blood glucose)
Excess cortisol causes hyperglycemia among other things
Hypercortisolism is known as Cushings Syndrome
Hypocortisolism is known as Addison’s Disease
74
Zonal Glomerulosa
Produces aldosterone which is a mineralocorticoid. It regulates the amount of sodium!!!!!!!! present in the blood by renal mechanisms. Excessive amounts lead to hypertension.
Conn’s Syndrome – Disease caused by a tumor producing aldosterone. Cured by surgery but not easily diagnosed because it is rare and 2ndary aldosteronism is common due to kidney disease
75
causes of hypercortis
acth can be produces from tumor lung and pituitary gland
76
Conn’s Syndrome
– Disease caused by a tumor producing aldosterone. Cured by surgery but not easily diagnosed because it is rare and 2ndary aldosteronism is common due to kidney disease
77
Adrenocortical Hypofunction
| acute and chronic
Acute adrenal insufficiency
Waterhouse-Friderichsen syndrome in meningococcal sepsis
Chronic adrenal insufficiency (Addison’s disease) caused by:
Autoimmune diseases (most common!)
Tumors (bilateral metastases to adrenals)
Tuberculosis
Amyloidosis
78
cushing see!!!
acne, moon face, buffalo hump on back, osteoporosis, obesity, easy brusing
79
addison see!!!
personality changes, hyper pigmentation ( negative feed back to brain to stop acth) anorexia, adrenal hypertrophy, muscle weakness
80
Adrenal Medulla
Site of production of epinephrine (adrenalin)
Stress hormone (fight or flight)
Also released due to low glucose (hypoglycemia) to increase glucose levels
81
Tumors of the Adrenal Medulla!!!!!
Neuroblastoma—children, malignant, can cause hypertension
Pheochromocytoma—adults, mostly benign, but in 10% of cases, malignant
Vanillyl mandelic acid (VMA) (metabolic end product) found in urine—important for diagnosis
_________________________________
Note: Both neuroblastoma and pheochromocytoma may produce catecholamines and cause hypertension
82
parathyroid
The parathyroids are located in the neck, behind the thyroid
There are usually four glands, each of which is the size of a coffee bean
Parathyroid glands secrete the polypeptide parathyroid hormone, which is involved in regulating homeostasis of serum calcium and phosphate.
83
Parathyroid Glands
Important in regulation of calcium balance
Produces parathyroid hormone (PTH) Parathyroid hormone has a central role in calcium metabolism and hence bone metabolism
Tumors of the parathyroids commonly cause hypercalcemia which is associated with many problems eg osteoporosis, renal calculi, cardiac, neurological and psychiatric symptoms
84
Parathyroid Hormone
Polypeptide hormone
Secreted as a large molecule of >80 amino acids
Metabolized in the circulation to the active hormone
Active hormone has a half-life of only 5 mins
Very important role in calcium metabolism
Low blood calcium levels cause release of PTH (parathyroid hormone)
PTH causes Ca retention at the kidney and Ca release from bone. Also interacts with vitamin D for calcium regulation
85
Signs and Symptoms
stones(renal), bones, groans, moans, overtones
50% Asymptomatic
30% Bone pain
20% Renal stones
20% GI complaints, pain of the stomach and pancreas, constipation
20% CNS symptoms (fatigue, weakness)
10-20% Osteitis fibrosa cystica – decreased trabeculae. May also cause salt and pepper appearance in the skull (tiny punched out lesions)
86
Diseases of the Parathyroid Glands
Hyperparathyroidism
| Hypoparathyroidism – uncommon disorder causing low blood calcium
87
Differential Diagnosis of Hypercalcemia
Malignancy: Parathyroid related:
Solid tumors with or
without metastases Primary hyperparathyroidism
Hematological tumors Familial hypocalciuric hypercalcemia
```
Renal related: Vitamin D:
Secondary hyperparathyroidism Vitamin D intoxication( increase calcium)
Milk-alkali syndrome Sarcoidosis
Aluminum toxicity (chronic dialysis) Idiopathic Hypercalcemia of infancy
```
High Bone Turnover:
Thyrotoxicosis (increase osteoclastic activity)
Immobilisation (reduced gravity)
Thiazide diuretics (decrease calcium)
88
Prevalence of 1° HPT
Increased approximately 10 fold in last decade (automated lab techniques)
Varies considerably, depending on population studied
e.g. - Hospital inpatient – malignancy most common cause of hypercalcemia
- Healthy individual or hospital outpatient’s -1° HPT
- In total, usually 50% of new cases are asymptomatic
89
Hypoparathyroidism
Rare condition!
May be caused by developmental disorder, autoimmune disease, or inadvertent surgical removal of parathyroids
Presents with hypocalcemia, tetany, irregular heartbeat, variable neurologic symptoms from hyperexcitability to depression
90
Clinical Manifestations of Primary Hyperparathyroidism
1° HPT may present in one of three forms
Most patients have asymptomatic hypercalcemia
Insidious onset of hypercalcemia and mild non-specific symptoms such as headache, weight loss and depression
Renal colic occurs in approximately 25-35% of this group
91
Causes of Hypocalcemia
Vitamin D Related:
Dietary deficiency, malabsorption or low exposure to sunlight
Renal failure, 1a-hydroxylase deficiency or treatment with phenytoin
Parathyroid related:
Hypoparathyroidism, pseudohypoparathyroidism
Magnesium deficiency
Iatrogenic:
Massive transfusion
Other:
Neonatal hypocalcemia
Acute pancreatitis
Hyperventilation
92
Diabetes Overview
Diabetes mellitus - diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia.
It is associated with a relative or absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin.
Every few years, the diabetes community re-evaluates the current recommendations for the classification, diagnosis, and screening of diabetes, reflecting new information from research and clinical practice.
93
Overview of Major Diseases of the Pancreas
```
Diabetes mellitus
Pancreatitis
Acute pancreatitis
Chronic pancreatitis
Tumors of the exocrine pancreas
Tumors of the endocrine pancreas
```
94
Diabetes
Hyperglycemia is the problem since glucose is a poison/ toxic in high concentration
Its poisonous effects are that it is an aldehyde which can covalently attach to proteins
This protein modification can affect blood vessels (arteries) nervous tissue etc to cause atherosclerosis and neuropathies.
Aim in diabetes is to achieve euglycemia ie normal glucose levels to prevent complications
95
Diabetes Mellitus
```
Primary
Type 1 (insulin dependent)
Type 2 (non–insulin dependent)
Secondary
Pancreatic disease
Endocrine diseases
Genetic syndromes—hemochromatosis (disorder that results in too much iron being absorbed from the gastrointestinal tract), hyperlipidemia
```
96
Type 1 (insulin dependent)
Acute onset, emergency presentation
| Can present weeks to months after a viral or bacterial infection
97
Type 2 (non–insulin dependent)
Does not present acutely
Is of epidemic proportions in some populations
Has some relationship to obesity.
98
type 1 vs type 2
age of onset: 1: less than 30/ 2: more than 30 years old
speed of onet: 1: sudden/ 2: gradual
\body build: 1: normal/ 2: obeses
family history: 1:less than 20%/ 2: more than 60%
twin coincidence: 1: low/ 2: high
99
Comparison of Type 1 and Type 2 Diabetes
antibodies to islet cells: 1:++/2"-
history of islet : 1:loss of beta cells/ 2: normal
srum insulin level: 1: low/ 2: normal
treatment: 1: insulin/ 2: diet, oral, hypoglycemics; insulin
100
Diabetes Prevalence
An epidemiological model was constructed by applying age, sex, ethnic specific prevalence rates to resident populations of England at national, regional and PCT level.
The estimated prevalence of total diabetes for all people in England was 4.41% in 2001 equating to 2.168 million people.
Type 2 - 92.3%
Type 1 - 7.7%
101
diabetic coma
ketoacidosis, hyperosmolality
102
Complications of Diabetes Mellitus
```
Cardiovascular
Atherosclerosis—gangrene of extremities
Arteriolosclerosis
Kidney
Glomerulosclerosis
Pyelonephritis
Eye
Retinopathy
Cataracts
Nervous system
Cerebrovascular disease
Peripheral neuropathy
```
103
Pancreatitis
Inflammation of the pancreas
Can be acute or chronic
Acute pancreatitis is a medical emergency where the patient presents with acute abdominal pain.
104
Causes of Acute Pancreatitis
Common Causes
Alcohol
Bile stones
Unknown
```
Rare Causes
Surgery
Trauma
Drugs
Metabolic diseases
Infections
Mumps
```
105
Features and Complications of Acute Pancreatitis
```
Fat necrosis, calcifications, hypocalcemia
Ascites, sterile peritonitis
Shock
Massive necrosis—pseudocyst
Abscess formation
Chronic pancreatitis
Diabetes mellitus
```
106
Causes of Chronic Pancreatitis
Chronic alcoholism (70%)
Trauma
Systemic metabolic or endocrine disease
Unknown (20%)
107
Chronic Pancreatitis - Clinical Features
Insidious onset
Pain in upper abdomen that radiates into the back
Malabsorption caused by pancreatic insufficiency
X-ray evidence of calcifications
Secondary diabetes mellitus
108
Chronic Pancreatitis—Pathology
```
Fibrosis of pancreas
Atrophy and loss of acini
Intraductal stones
Parenchymal calcifications
Islets of Langerhans preserved, but in late stages of disease, reduced in number of replaced by fibrous tissue
```
109
Pancreatic Neoplasms
In 95% of all cases, tumors are:
Exocrine rather than endocrine
Derived from ducts rather than acini or islets
Solid rather than cystic
Malignant rather than benign
Functionally silent rather than hormonally active
110
Adenocarcinoma of the Pancreas
It is the fourth major cause of cancer death in men and fifth in women.
Each year, 25,000 new cases are reported in the United States.
Smoking increases the risk three times.
Chronic pancreatitis increases the risk two times.
It is rare before 40 years of age, but then incidence increases with age.
The prognosis is poor—most die within 2 years.
111
Carcinoma of the Pancreas—Clinical Features
Weight loss, loss of appetite, nausea
Jaundice if located in the head
Courvoisier’s sign (gallbladder distention)
Pain if tumor located in the tail
Metastases (common)—lymph nodes, liver
Endoscopic retrograde cholangiopancreatography (ERCP) with aspiration cytology important for diagnosis
112
Tumors of the Endocrine Pancreas(Islet Cell Tumors)
Insulinoma—hypoglycemia, syncope, profuse sweating, reversed by infusion of glucose
Gastrinoma—Zollinger-Ellison syndrome with multiple ulcers unresponsive to medical therapy; may be part of MEN1
Glucagonoma
Somatostatinoma
VIPoma (vasoactive intestinal peptide ) Verner Morrison syndrome,
113
130 multiple choices, 3 hours, 20-30% from pre-mid-term material
70-80% from post midterm
hormoes of anterior pitiutary/ post
thyroid carcinoma primary hypothyroids, type 1,2 diabetes, pancreatitis, regulates potassium and sodium
zona fasciculata
adrenal hypofunction: addison disease may be cause by ___
atch can also be produced by
