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Pathophysiology > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

1
Q

What are two basic problems that occur in endocrine disorders?

A

1) hypersecretion (excess hormone production)

2) hyposecretion ( low or no hormone production)

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2
Q

Generally speaking, what seven things can cause hyposecretion?

A

1) dietary deficiency (need iodine for ex. to make T3/T4)
2) problem with metabolism (lacking enzyme)
3) immune disorder targets a gland
4) receptor defects
5) lack of trophic stimulation causing atrophy
6) iatrogenic, usually as a result of trying to treat hypersecretion
7) tumour (if it invades the gland and damages the gland)

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3
Q

Generally speaking, what four things can cause hypersecretion?

A

1) excessive trophic stimulation
2) a defect in negative feedback
3) a secretory tumour
4) an ectopic tumour (tumour in another location that secretes the same hormone as the affected gland)

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4
Q

What is a goiter?

A

A structural (but not necessarily functional) enlargement of the thyroid gland that develops in thyroid problems.

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5
Q

Which causes a goiter: hyperthyroidism or hypothyroidism?

A

Both can cause a goiter.

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6
Q

What are the two types of goiters?

A

1) endemic goiter

2) toxic goiter

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7
Q

What causes an endemic goiter?

A
  • d/t iodine deficiency
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8
Q

What happens when someone has an endemic goiter?

A
  • results in low T3 and T4 levels, which creates an increase in thyroid stimulating hormone (TSH) d/t negative feedback mechanisms
  • the increase in TSH causes hyperplasia and hypertrophy resulting in a visible goiter
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9
Q

What causes a toxic goiter?

A

excessive stimulation of the thyroid - NOT a toxin

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10
Q

Is there a problem with iodine levels with toxic goiters?

A

No, iodine levels are adequate.

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11
Q

What causes hyperthyroidism?

A

Almost always autoimmunity - but cells are not destroyed by the antibodies.

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12
Q

What gland does Grave’s disease affect and is it a form of hyper or hypo secretion?

A

Graves disease affects the thyroid, it is a common form of hyperthyroidism.

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13
Q

Who is most affected by Grave’s disease?

A

Young women, usually around 20 years old.

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14
Q

What are the hallmarks of Grave’s disease?

A

1) goiter
2) hyperthyroidism (elevated thyroid hormones)
3) ex opthalmos (bulging eye balls)

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15
Q

What are the signs and symptoms of Grave’s disease?

A
  • weight loss (d/t increased metabolism, increased protein and lipid catabolism)
  • flushed skin, perspiration (from increased metabolic heat)
  • increased heart rate and cardiac output (to meet increased demand from increase metabolism)
  • hyperventilation to expel CO2
  • excitable, irritable, insomnia, anxiety
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16
Q

What is the pathophysiology of Grave’s disease?

A
  • antibodies target TSH receptors on thyroid cells
  • the antibodies displace TSH
  • the antibodies mimic TSH, cause an increase in thyroid hormone secretion
  • the increased levels of thyroid hormone inhibit TSH secretion
  • the antibody is not regulated, avoids enzymatic degradation and continue to be active longer than the TSH normally would be
  • if untreated, can cause “thyrotoxicosis” or thyroid storm
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17
Q

What are the three treatment options for Grave’s disease?

A

1) antithyroid drugs (ex. tapazole)
2) radioiodine therapy (give radioactive iodine, which binds to the thyroid, emits radiation to destroy cells)
3) surgery to excise large goiters

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18
Q

In hypothyroidism, what are three places a problem can occur?

A

1) thyroid (first degree)
2) pituitary (second degree)
3) hypothalamus (third degree)

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19
Q

What problems (signs & symptoms) occur with hypothyroidism?

A
  • decreased body temperature (d/t decreased metabolic heat)
  • decreased cardiac output
  • decreased CNS function
  • weak muscle action (from decreased ATP)
  • increased weight (normal food intake with decreased metabolism)
20
Q

What do T3 and T4 stand for?

A

triiodothyronine and thyroxine

21
Q

What is Hashimoto’s thyroiditis?

A

The most common form of hypothyroidism.

22
Q

What causes Hashimoto’s thyroiditis?

A

autoimmune destruction of the thyroid gland

23
Q

What happens in Hashimoto’s thyroiditis?

A
  • thyroid gland is inflamed
  • antibodies block TSH from binding but do not mimic action of TSH
  • lymphocytes infiltrate
24
Q

How do you treat hypothyroidism?

A
  • provide thyroxine daily

- if endemic goiter, provide dietary iodine

25
Q

What hormones are secreted by the adrenal medulla? What stimulates the secretion of these hormones?

A
  • epinephrine
  • norepinephrine
  • stimulated by the sympathetic nervous system
26
Q

What hormones are secreted by the adrenal cortex? What stimulates the secretion of these hormones?

A
  • glucocorticoids (ex. cortisol)
  • mineralocorticoids (ex. aldosterone)
  • gonadocorticoids (ex. testosterone)

stimulated by trophic hormone adrenocorticotropic hormone (ACTH) secreted from the adenohypophysis (anterior pituitary)

27
Q

Which part of the adrenal gland is more commonly disordered?

A

the cortex

28
Q

What are three causes of hypersecretion in the adrenal gland?

A

1) a cortical tumour or hyperplasia causing excessive cortisol and decreased ACTH
2) a tumour or hyperplasia of the adenohypophysis causing excessive ACTH and cortisol
3) an ectopic ACTH secreting tumour causing an increase in ACTH and cortisol

29
Q

What gland and hormone does Cushing’s Syndrome affect and is it hyposecretion or hypersecretion?

A

Cushing’s syndrome affects the adrenal cortex, it causes hypersecretion of glucocorticoids, especially cortisol.

30
Q

What problems arise when there is excessive cortisol?

A
  • weak muscles from excessive protein catabolism
  • characteristic “moon face” and “buffalo hump” from lipolysis and subsequent deposition of lipids in face, neck and abdomen
  • prolonged hyperglycemia leading to insulin resistance and IGT from excessive gluconeogensis
  • hypertension and hypokalemia because at high levels cortisol will mimic aldosterone and cause sodium and water retention and potassium excretion
  • susceptible to infections because cortisol has anti-inflammatory properties
31
Q

How do you treat Cushing’s Syndrome?

A
  • excise the tumour if it is well-defined, encapsulated
  • irradiate the pituitary gland (if problem lies there)
  • if ectopic tumour, there are specific drugs to suppress
  • last resort = adrenalectomy with hormone replacement therapy
32
Q

What gland is involved in Conn Syndrome? Is this a problem of hypo or hyper secretion? What hormone is involved?

A

Conn syndrome affects the adrenal cortex and is a problem of hypersecretion of aldosterone. It is not very common.

33
Q

What causes Conn Syndrome?

A

1) cortical adenoma (usually)
2) idiopathic cortical hyperplasia
3) renin-secreting renal tumour

34
Q

What are signs and symptoms of Conn Syndrome?

A

1) hypertension because aldosterone causes sodium reabsorption and consequent water reabsorption, this increases blood volume
2) hypokalemia and alkalosis because aldosterone causes excretion of potassium and hydrogen ions

35
Q

How is Conn Syndrome treated?

A
  • adrenalectomy for adenoma (unilateral)
  • drugs for hyperplasia (ex. receptor blockers)
  • sodium restriction to manage hypertension
36
Q

What gland and hormone does Addison’s disease affect? Is it an example of hyper or hypo secretion?

A

Addison’s disease is an example of hyposecretion of the adrenal gland, all three groups of hormones (glucocorticoids, mineralocorticoids and gonadococorticoids) are affected. It is not very common.

37
Q

What causes Addison’s disease?

A
  • autoimmunity (most often)
  • tumour
  • infection
  • iatrogenic (long-term use of steroids causes decrease in ACTH b/c negative feedback)
38
Q

What are the signs and symptoms of Addison’s disease?

A
  • fluid loss (can lead to hypovolemia, decrased cardiac output and hypotension) from decreased mineralocorticoids
  • weakness and fatigue from decreased glucocorticoids
  • decrease in general adaptive syndrome (body can’t counter stress because decrease in adrenal gland function)
39
Q

How is Addison’s disease treated?

A
  • if acute: IV fluids and glucocorticoids

- chronic: provide glucocorticoids and mineralocorticoids

40
Q

What would happen if there is an adenoma in the adenohypophysis?

A

An adenoma in the adenohypophysis could cause hyperactivity if the tumour is functional, or hypoactivity if the tumour is non-functional.

Hyperactivity of the adenohypophysis will also cause hyperactivity of the target gland.

41
Q

What hormones are secreted by the adenohypophysis?

A

follicle stimulating hormone, adrenocorticotropic hormone, thyroid stimulating hormone, human growth hormone…

42
Q

What is SIADH?

A

Syndrome of inappropriate antidiuretic hormone. It is hypersecretion of ADH causing the retention of fluid.

43
Q

What causes SIADH?

A

ectopic tumour

44
Q

What are signs and symptoms of SIADH?

A
  • increased water retention leading to dilutional hyponatremia
  • hypertension (leads to suppression of RAAS and decrease in aldosterone, leading to impaired sodium reabsorption)
  • complication = UTI
45
Q

How is SIADH treated?

A
  • restrict fluid intake
  • diuretics
  • ADH antagonists
46
Q

What is the function of cortisol?

A
  • increase blood glucose during stress (increase metabolism of fat, protein & carbs, increase gluconeogenesis)
  • has anti-inflammatory properties

Pathophysiology (38 decks)

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