ENDOCRINE CONDITIONS Flashcards
1
Q
CUSHING SYNDROME - DEFINITION
A
- Cushing syndrome is an uncommon condition that happens when the body has too much of a hormone called cortisol
- Cortisol is a steroid hormone commonly called the “stress hormone”
- The adrenal glands, pituitary gland and the hypothalamus control cortisol levels
- A tumour typically causes the cortisol levels found in Cushing syndrome
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Q
CUSHING SYNDROME - CORTISOL
A
- Cortisol helps by
o Increasing heart rate
o Increasing blood pressure
o Managing blood glucose
o Managing respiration
o Increasing muscle tension - Cortisol also helps by temporarily shutting down systems that the body doesn’t need during times of increased stress, such as digestion and reproduction
- Cortisol is essential to
o Managing blood pressure
o Regulating blood sugar
o Reducing inflammation
o Forming memories
o Managing respiration
o Balancing salt in the body
o Transforming food into energy
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Q
CUSHING SYNDROME - CAUSE
A
- Too much cortisol causes Cushing syndrome
- There may be many underlying causes of high cortisol levels
o Use of glucocorticoid medications
These are often used to treat autoimmune diseases
o Pituitary tumours
o Adrenal cortical tumours
o Lung, pancreas, thyroid and thymus tumours
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Q
CUSHING SYNDROME - POPULATION AFFECTED
A
- Females aged 25 to 50
- People who take steroid medication
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Q
CUSHING SYNDROME - RISK FACTORS
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- Sex
o Females - Younger adults
o 20 – 50 - Taking oral steroids for long periods of time
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Q
CUSHING SYNDROME - CLINICAL PRESENTATION
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- Possible characteristics include
o Rapid weight gain in the face (“moon face”)
o Rapid weight gain in the abdomen, chest and back of the neck (“buffalo hump”)
o Red, round face
o Wounds that heal poorly
o Hypertension
o Excessive hair growth on the face, neck, chest, abdomen, breasts and thighs, or balding
o Diabetes
o Purple stretch marks over the abdomen
o Easy bruising on the arms and legs
o General weakness and tiredness
o Blurry vision and dizziness
o Weak muscles and thinner arms and legs
o Libido changes
o Erectile dysfunction
o Stunted growth in children
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Q
CUSHING SYNDROME - DIAGNOSIS
A
- Can be difficult to diagnose
- Often mistaken for PCOS or metabolic syndrome
- Tests
o 24-hour urinary cortisol test
o Midnight salivary cortisol test
o Low-dose dexamethasone suppression test
o Blood test – ACTH levels
o High-dose dexamethasone suppression test - Once you have been diagnosed with Cushing syndrome, the next step is to determine why
- Tests
o CT scan – abdomen and chest
o MRI – pituitary
o Bilateral inferior petrosal sinus sampling (BIPPS)
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Q
CUSHING SYNDROME - TREATMENT
A
- Type of treatment depends on the underlying cause of the high cortisol levels
- If you use glucocorticoids, you will likely have to lower the dose or be prescribed non-glucocorticoid medication
- If a tumour is causing Cushing syndrome you may need surgery or radiation
o Chemotherapy
o Medications
o Radiation
o Surgery
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Q
CUSHING SYNDROME - PREVENTION
A
- You can’t really prevent Cushing syndrome
- You need cortisol in the body, you cannot live without it so it is not really something you can prevent because too little cortisol is also a problem
- You cannot prevent a tumour that causes Cushing syndrome
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Q
CUSHING SYNDROME - PROGNOSIS
A
- Cushing syndrome is very treatable
- There is usually a cure for Cushing syndrome
- Without treatment Cushing syndrome symptoms can get worse
- If it is not treated it can be fatal
11
Q
ADDISON’S DISEASE - DEFINITION
A
- Addison’s disease is a chronic condition in which the adrenal glands don’t produce enough of the hormones cortisol and aldosterone
- The adrenal glands are small, triangle shaped glands that are located on top of each of the 2 kidneys
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Q
ADDISON’S DISEASE - CORTISOL
A
- Cortisol is a hormone that helps the body respond to stress
- It also helps to maintain:
o Blood pressure
o Heart function
o Immune system
o Blood glucose levels - Cortisol is essential for life
13
Q
ADDISON’S DISEASE - ALDOSTERONE
A
- Aldosterone is a hormone that affects the balance of sodium and potassium in the blood
- This in turn controls the amount of fluid the kidneys remove as urine
- This affects the blood volume and blood pressure
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Q
ADDISON’S DISEASE - CAUSE
A
- The most common cause is an autoimmune response, which occurs when the immune system attacks healthy tissues for an unknown reason
- With Addison’s disease the immune system attacks the outer portion of the adrenal glands where they make cortisol and aldosterone
- Symptoms don’t develop until 90% of the adrenal cortex has been damaged, which can take several months to years
- Tuberculosis used to be a major cause of Addison’s disease
- Other less common causes include
o Repeated infections – HIV/AIDS-related infections and fungal infections
o When cancer cells from another part of the body invade the adrenal glands
o Bleeding into the adrenal glands
o Surgical removal of the adrenal glands
o Amyloidosis
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Q
ADDISON’S DISEASE - POPULATION AFFECTED
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- Most common in women 30 to 50 years old
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Q
ADDISON’S DISEASE - RISK FACTORS
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- Age
o 30 – 50 - Autoimmune disease
o Type 1 diabetes
o Pernicious anaemia
o Graves’ disease
o Chronic thyroiditis
o Dermatitis herpetiformis
o Vitiligo
o Myasthenia gravis - Sex
o Women more likely - Certain genetic defects
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Q
ADDISON’S DISEASE - CLINICAL PRESENTATION
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- Symptoms occur gradually
- Symptoms vary from person to person
- Symptoms include
o Steadily worsening fatigue
o Patches of dark skin, especially around scars and skin creases and on the gums
o Abdominal pain
o Nausea and vomiting
o Diarrhoea
o Loss of appetite and unintentional weight loss
o Muscle pain, muscle spasms and joint pain
o Dehydration
o Low blood pressure which can lead to light-headedness or dizziness upon standing
o Changes in mood and behaviour
Irritability
Depression
Poor concentration
o Craving for salty foods
o Hypoglycaemia
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Q
ADDISON’S DISEASE - CLINICAL PRESENTATION - FEMALE SPECIFIC
A
- Females may experience
o Abnormal menstruation
o Lose body hair
o Decreased sexual drive
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Q
ADDISON’S DISEASE - ADDISONIAL CRISIS
A
- Sometimes symptoms can come on very quickly and cause a life-threatening event called an addisonial crisis
- This is a medical emergency
- It can lead to shock and death if not treated
- Symptoms include
o Extreme weakness
o Sudden, severe pain in the lower back, belly or legs
o Feeling restless, confused, afraid or other mental changes
o Severe vomiting and diarrhoea, potentially leading to dehydration
o Low blood pressure
o Loss of consciousness
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Q
ADDISON’S DISEASE - DIAGNOSIS
A
- Diagnosis often takes a while because the symptoms develop slowly over time
- It is often “accidently” discovered during a routine blood test
- Tests
o Blood tests
Sodium level
Potassium level
Cortisol level
ACTH
o ACTH stimulation test
o Insulin-induced hypoglycaemia test
o CT scan
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Q
ADDISON’S DISEASE - TREATMENT
A
- Treated by replacing the missing hormones – cortisol and aldosterone
- Cortisol is replaced by the drug hydrocortisone
- Aldosterone is replaced by the drug fludrocortisone
- Chronic condition so it will need the patient to take medication for the rest of their life
- Dosage is different for each person
22
Q
ADDISON’S DISEASE - PREVENTION
A
- Addison’s disease cannot be prevented
23
Q
ADDISON’S DISEASE - PROGNOSIS
A
- Prognosis is generally good
- People with Addison’s disease will have to take medicine for the rest of their lives but they can live happy, healthy lives while on this medication
- Most people with the condition have a normal life span and are able to live an active life with few limitations
- However, many people do experience bouts of fatigue
- People with Addison’s disease are also more at risk of having associated health problems
o Diabetes
o Hypothyroidism - Up to 50% of people with Addison’s disease develop another autoimmune condition
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Q
HYPOTHYROIDISM
A
- Hypothyroidism happens when the thyroid gland doesn’t make enough thyroid hormone
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S&S OF HYPOTHYROIDISM
- Symptoms depend on the severity of the conditions
- Problems tend to develop slowly
- Tiredness
- More sensitivity to cold
- Constipation
- Dry skin
- Weight gain
- Puffy face
- Hoarse voice
- Coarse hair and skin
- Muscle weakness
- Muscle aches, tenderness and stiffness
- Menstrual cycles that are heavier than usual or irregular
- Thinning hair
- Bradycardia
- Depression
- Memory problems
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S&S HYPOTHYROIDISM - CHILDREN AND TEENS
- In general symptoms are similar to adults but they may also have:
- Poor growth that leads to short stature
- Delayed development of permanent teeth
- Delayed puberty
- Poor mental development
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S&S HYPOTHYROIDISM - INFANTS
- Feeding problems
- Poor growth
- Poor weight gain
- Jaundice
- Constipation
- Poor muscle tone
- Dry skin
- Hoarse crying
- Enlarged tounge
- Soft swelling or bulge near the belly button – umbilical hernia
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HYPERTHYROIDISM
- Hyperthyroidism happens when the thyroid gland makes too much thyroid hormone
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S&S OF HYPERTHYROIDISM
- Sometimes looks like other health problems
- Losing weight without trying
- Tachycardia - Fast heartbeat
- Arrhythmia – irregular heartbeat
- Pounding of the heart
- Heart palpitations
- Increased hunger
- Nervousness, anxiety and irritability
- Tremor
- Usually a small trembling in the hands and fingers
- Sweating
- Changes in menstrual cycle
- Increased sensitivity to heat
- Changes in bowel patterns
- Especially more-frequent bowel movements
- Enlarged thyroid gland
- Sometimes called goiter
- May appear as a swelling at the base of the neck
- Tiredness
- Muscle weakness
- Sleep problems
- Warm, moist skin
- Thinning skin
- Fine, brittle hair
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THYROID DISEASE
- The thyroid creates and produces hormones that play a role in many different systems throughout the body
- When the thyroid makes either too much or too little of these important hormones, it is called a thyroid disease
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TYPES OF THYROID DISEASE
- Main 2 are
- Hyperthyroidism
- Hypothyroidism
- Others include
- Thyroiditis
- Hashimoto’s thyroiditis
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CAUSES OF HYPOTHYROIDISM - THYROIDITIS
- **Thyroiditis**
- An inflammation of the thyroid gland
- Can lower the amount of hormones the thyroid produces
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CAUSES OF HYPOTHYROIDISM - HASHIMOTO'S THYROIDITIS
- **Hashimoto’s thyroiditis**
- A painless disease
- An autoimmune condition where the body’s cells attack and damage the thyroid
- An inherited condition
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CAUSES OF HYPOTHYROIDISM - POSTPARTUM THYROIDITIS
- **Postpartum thyroiditis**
- Condition occurs in 5% to 9 % of women after childbirth
- Usually a temporary condition
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CAUSES OF HYPOTHYROIDISM - IODINE DEFICIENCY
- **Iodine deficiency**
- Iodine is used by the thyroid to produce hormones
- Affects several million people around the world
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CAUSES OF HYPOTHYROIDISM - A NON-FUNCTIONING THYROID GLAND
- **A non-functioning thyroid gland**
- Sometimes the thyroid gland doesn’t work properly from birth
- Affects about 1 in 4000 new-borns
- If left untreated the child could have physical and mental issues in the future
- All new-borns are given a screening blood test ti check their thyroid function to prevent this
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CAUSES OF HYPERTHYROIDISM - GRAVE'S DISEASE
- **Graves’ disease**
- The entire thyroid gland may be overactive and produce too much hormone
- This problem is also called diffuse toxic goiter (enlarged thyroid gland)
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CAUSES OF HYPERTHYROIDISM - NODULES
- **Nodules**
- Hyperthyroidism can be caused by nodules that are overactive within the thyroid
- A single nodule is called toxic autonomously functioning thyroid nodule, while a gland with several nodules is called a toxic multi-nodular goiter
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CAUSES OF HYPERTHYROIDISM - THYROIDITIS
- **Thyroiditis**
- This disorder can be either painful or not felt at all
- In thyroiditis, the thyroid releases hormones that were stored there
- This can last a few weeks or months
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CAUSES OF HYPERTHYROIDISM - EXCESSIVE IODINE
- **Excessive iodine**
- When you have too much iodine in your body, the thyroid makes more thyroid hormones than it needs
- Excessive iodine can be found in some medications (amiodarone, a heart medication) and cough syrups
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ACROMEGALY - DEFINITION
- A hormonal disorder that develops when your pituitary gland produced too much growth hormone during adulthood
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ACROMEGALY - CAUSE
- Occurs when the pituitary gland produces too much growth hormone over a long period of time
- Most common causes of too much growth hormone production
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ACROMEGALY - POPULATION AFFECTED
- Adults aged 30 – 50
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ACROMEGALY - RISK FACTORS
- Family hx
- MacCun Albright syndrome
- Lung cancer
- Adrenal tumours
- Early menopause in females
- Young age females at the age of first child birth
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ACROMEGALY - CLINICAL PRESENTATION
- Progresses slowly so early signs may not be obvious for years
- Common sign is enlarged hands and feet
- Gradual changes in face shape
- Protrouding lower jaw
- Protrouding brow bone
- Enlarged nose
- Thickened lips
- Wider spacing between teeth
- Other symptoms vary from person to person but may include
- Enlarged hands and feet
- Enlarged facial features - Facial bones, lips, nose and tounge
- Coarse, oily, thickened skin
- Excessive sweating and body odor
- Small outgrowths of skin tissue (skin tags)
- Fatigue
- Jt or muscle weakness
- Px and limited jt mobility
- Deepened husky voice - Due to enlarged vocal cords and sinuses
- Severe snoring - Due to obstruction of the upper airway
- Vision problems
- Headaches - May be persistent or severe
- Loss of interest in sex
- Erectile dysfunction in men
- Menstrual cycle in women
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SYSTEMIC LUPUS ERYTHAMATOSUS (SLE) - DEFINITION
- Lupus is a disease that occurs when your body’s immune system attacks your own tissues and organs
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SYSTEMIC LUPUS ERYTHAMATOSUS (SLE) - CAUSE
- An auto immune disease
- Occurs when the immune system attacks healthy tissue in the body
- Likely that lupus results from a combination of your genetics and your environment
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SYSTEMIC LUPUS ERYTHAMATOSUS (SLE) - POPULATION AFFECTED
- Females aged 15 to 45 from minority ethnic backgrounds
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SYSTEMIC LUPUS ERYTHAMATOSUS (SLE) - RISK FACTORS
- Sex - More common in women
- Age - Can affect anyone, Most often diagnosed between the ages of 15 and 45
- Race - More common in African Americans, Hispanics and Asian Americans
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SYSTEMIC LUPUS ERYTHAMATOSUS (SLE) - CLINICAL PRESENTATION
- Some people have mild disease episodes, called flares, where S&S get worse for a while the improve or even disappear completely for a time
- Fatigue
- Fever
- Joint pain, stiffness and swelling
- Butterfly shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body
- Skin lesions that appear or worsen with sun exposure
- Fingers and toes that turn white or blue when exposed to cold or during stressful periods
- Shortness of breath
- Chest pain
- Dry eyes
- Headaches
- Confusion
- Memory loss
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SYSTEMIC SCLEROSIS - DEFINITION
- A group of rare diseases that involve the hardening and tightening of the skin
- May also cause problems in the blood vessels, internal organs and digestive tract
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SYSTEMIC SCLEROSIS - CAUSE
- Results from an overproduction and accumulation of collagen in body tissues
- The body’s immune system is thought to play a role
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SYSTEMIC SCLEROSIS - POPULATION AFFECTED
- Women aged 30 – 50
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SYSTEMIC SCLEROSIS - RISK FACTORS
- Genetics
- Environmental triggers
- May be triggered by certain viruses, medications or drugs, High exposure to certain chemicals or harmful substances
- Immune system problems - Believed to be an autoimmune disease
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SYSTEMIC SCLEROSIS - CLINICAL PRESENTATION
- Symptoms vary from person to person, depending on which parts of the body are affected
- Skin-related signs and symptoms
- Hardening and tightening of the skin
- First parts of the body that are affected are the Fingers, Hands, Feet, Face
- Early symptoms include swelling and itching
- Affected skin can become lighter or darker in colour and may look shiny because of the tightness
- Some people also experience small red spots – telangiectasia – on their hands and face
- Calcium deposits can form under the skin - Especially at the fingertips
- Raynaud’s phenomenon
- Digestive problems - Heart burn, Difficulty swallowing, Bloating, Diarrhoea, Constipation, Faecal incontinence
- Heart problems - Irregular heartbeat, Heart failure may also occur in some people
- Lung problems - Shortness of breath, Decreased exercise tolerance, Dizziness, Pulmonary hypertension
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