Endocrine pathologies Flashcards
Acromegaly and Gigantism
Gigantism: Excess growth hormone while the bones are still developing (results in the person growing to massive heights)
Acromegaly: Excess growth hormone post-puberty (after growth plates closed) (patient grows ‘outwards’ as opposed to ‘upwards’)
Causes:
* A pituitary tumour hyper-secreting growth hormone
Signs and symptoms:
* Large, prominent facial features, increased size hands and feet
* Tiredness, deep voice, impotence, joint pain, bone deformities, soft tissue swellings
Allopathic treatment:
* Surgery to remove tumour
* Lifelong medications may be needed
Complications:
* Hypertension, cardiomegaly
* Type 2 diabetes (growth hormone raises blood glucose levels = insulin resistance)
* Osteoarthritis, vertebral collapse (back pain)
* Bowel polyps
Addison’s Disease
Adrenal insufficiency: Hypo-functioning of the adrenal cortex causing a deficiency of mineralocorticoids and glucocorticoids
Pathophysiology: * Adrenal failure leads to lack of adrenal hormone production and a failure of the normal negative feedback mechanism
* The hypothalamus produces an excess of corticotropin releasing hormone (CRH), which causes the pituitary to erroneously produce melanocyte stimulating hormone
* This causes the skin colour to darken, hence hyperpigmentation
Causes:
* Atrophy of adrenal gland (often autoimmune) (85%)
* Secondary to disease or abrupt cessation of steroids
Signs and symptoms:
* Weakness, fatigue & hypotension
* Hyperpigmentation of skin & mucous membranes
* Diarrhoea, weight loss, anorexia, malaise, muscle weakness, depression, increased thirst
* Impotence / amenorrhea, nausea / vomiting
Complications:
* Addisonian crisis; when the individual has no capacity to cope with stress (e.g. psychological, infection etc.): Signs & symptoms of this inc. severe lethargy & low BP (low sodium), hypoglycaemic, syncope, severe pain, renal failure, fever
Cushing’s syndrome / disease
Excessive amounts of glucocorticoids (hypercortisolaemia); a cortisol excess from any cause
Causes:
* Corticosteroid therapy
* Adrenal adenoma
* Pituitary adenoma (Cushing’s disease)
Signs and symptoms:
* Central weight gain, Moon face, Buffalo hump, insulin resistance
* Depression, insomnia, psychosis, poor libido, hirsutism, amenorrhoea (also releases some androgens)
* Easy bruising, thin skin, abdominal stretch marks (due to protein taken from collagen and lowered immunity)
* Reduced immunity
* Muscular weakness, back pain
* Bone fractures, osteoporosis
* Hypertension
Allopathic treatment;
* Drugs inhibit cortisol production
* Surgery (for tumours)
Complications:
* Lowered immunity, fragile skin, bone fractures, diabetes mellitus
Diabetes Insipidus
Deficiency of ADH production or recognition causing the kidneys to over-excrete water
Causes:
* Cranial: Brain trauma, tumour, encephalitis
* Renal (kidney): Chronic kidney disease, hypercalcaemia and hypokalaemia damages kidney
Signs and symptoms:
* Polydipsia (extreme thirst) – large consumption
* Polyuria: Excess urine production (dilute)
* Weight loss
* Low BP, syncope (‘feinting’ due to hypovolaemia)
Diagnostic:
* 24 hour urine collection
* Urine specific gravity – low (=diluted urine)
* Blood chemistry (raised Na)
Allopathic treatment:
* ADH replacement
* Rehydration: water & electrolytes
Diabetes Mellitus; Type 1 and Type 2
A metabolic disorder associated with hyperglycaemia characterized by a deficiency of insulin due to impaired production or insulin resistance
Pathophysiology:
* Causes a disruption of carbohydrate and fat metabolism and elevated blood glucose levels = hyperglycaemia
Causes:
1. Autoimmune
2. Type 2: Insulin resistance
3. Secondary (1-2% of cases): Due to certain medications (cortisone), pancreatitis
4. Gestational: During pregnancy as a result of placental hormones (i.e. human placental lactogen). There is a sevenfold increased risk of developing Type 2 diabetes later in life
Complications:
Chronic hyperglycaemia causes complications: micro and macro-vascular disease:
* Heart disease, hypercholesterolaemia, hypertension
* Retinopathy
* Nephropathy (diabetic kidney disease)
* Peripheral neuropathy
Diabetes Mellitus; Type 1
Type 1 diabetes refers to an absolute deficiency of insulin causing persistent hyperglycaemia (previously called juvenile-onset or insulin-dependent (IDDM)
Causes:
* An autoimmune condition causing destruction of pancreatic B-cells
* Likely due to the environment in genetically susceptible people
* Viruses (e.g. polio, rotavirus)
* Dietary factors – infant exposure to dairy products (cow’s milk and the milk protein in B casein), vitamin D deficiency, omega-3 deficiency, early exposure to gluten
Signs and symptoms:
* Polydipsia (excessive thirst)
* Polyuria (excess urination)
* Polyphagia (excessive appetite)
* Glycosuria (glucose in urine)
* Unexplained weight loss
* Weakness, extreme fatigue and mental status changes
* Blurred vision
* Slow healing of cuts / infections
* Ketoacidosis; fruity smelling breath (exhaled acetone), shortness of breath
Allopathic treatment:
* Insulin (injectable)
Diabetes Mellitus; Type 2
Type 2 diabetes refers to insulin resistance (previously called adult-onset or non-insulin-dependent diabetes
Pathophysiology:
* Cells develop insulin resistance: Glucose cannot enter cells.
* Hyperglycaemia develops when pancreatic beta cells can no longer secrete insulin to compensate for insulin resistance
Causes:
* Genetic; strong hereditary link, higher rates in Native Americans, Hispanics, African-American and Asians
* Lifestyle; Obesity and weight gain, low fibre, high glycaemic index (GI) diet (sugar, white rice, white bread), lack of exercise
* History of gestational diabetes
Signs and symptoms:
* Polydipsia (excessive thirst)
* Polyuria (excess urination)
* Polyphagia (excessive appetite)
* Acanthosis nigricans (darkening of skin esp. in neck area)
* Often asymptomatic because of mild hyperglycaemia (unlike in Type 1 diabetes)
* Initial symptoms are often complications, indicating the disease has been present for some time
* Ketoacidosis is rare, severe cases
Diagnostic:
* Fasting / random blood glucose test
* Oral glucose tolerance test
* Glycated haemoglobin (HbA1c) >48 mmol/mol = diabetes
* Urine test (assists diagnosis only)
Allopathic treatment:
* Diet (low GI and GL), exercise, oral anti-hyperglycaemics (e.g. metformin), insulin or both
* Statins and anti-hypertensives to prevent complications
Other:
* A third of adults over 65 and increasing numbers of children have impaired glucose tolerance
Hyperprolactinemia
Excessive prolactin production
Causes:
* Pituitary tumour, acromegaly
* Pharmacologic (antipsychotics)
Signs and symptoms:
* Galactorrhoea
* Amenorrhoea (absence of menses – prolactin inhibits GnRH)
* Decreased libido / sexual dysfunction
* Subfertility
Hyperparathyroidism
Hyperparathyroidism is characterized by elevated blood levels of parathyroid hormone and improper calcium regulation
Causes:
* Usually a tumour of the parathyroid gland
Signs and symptoms:
* Often no / few symptoms
* Hypercalcaemia = increased risk of kidney stones, osteoporosis (or osteopenia), low energy, depression
* In some cases, nausea, vomiting, constipation, anorexia, muscle paralysis
Hypoparathyroidism
Hypoparathyroidism is characterized by hypo-metabolism and reduced serum levels of parathyroid hormones (PTH)
Causes:
* Usually surgery or radiation (treating thyroid)
Signs and symptoms:
* Hypocalcaemia = muscle cramps and spasms (tetany), tingling lips, fingers and toes, dry hair, brittle nails, dry scaly skin, cataracts, weakened tooth enamel (in children)
Hyperthyroidism
(Grave’s Disease – Overactive thyroid)
Hyperthyroidism is characterized by hyper-metabolism and elevated serum levels of free thyroid hormones (also known as thyrotoxicosis)
Pathophysiology:
* Autoimmune process: Increased IgG antibodies bind to TSH receptor and stimulate production of thyroid hormones
Causes:
* Graves disease (85%) AI.
* Excessive iodine supplementation
* Tumour (hypothalamic, pituitary)
Signs and symptoms:
* Nervousness, irritability, hyperactivity, weight loss
* Insomnia, palpitations, muscle weakness, frequent bowel and bladder movements, diarrhoea, fatigue
* Heat sensitivity, increased sweating
* Goitre, exophthalmos (bulging eyes), tachycardia, tremor, brisk tendon reflexes, lid lag (von grafe’s sign)
Allopathic treatment:
- carbimazole, radioactive iodine, B-blockers, surgery
Hypothyroidism
(Hashimotos - Underactive Thyroid)
Hypothyroidism is a condition of thyroid hormone deficiency
causes:
* Hashimoto’s thyroiditis (autoimmune)
* Iodine deficiency, thyroid dysfunction (radiactive iodine, surgery, medications, tumour), flouride
Signs and symptoms:
* Tiredness, malaise, weight gain, cold intolerance, constipation, depression
* Slow cognition, poor memory, low libido, deep voice, menstrual changes, muscle aches, arthralgia
* Goitre, dry brittle skin, thin hair, loss of eyebrows
* Myxoedema (swelling) often around eyes (deposition of polysaccharides which attract water)
* Slow tendon reflexes, bradycardia (physical exam)
Diagnostic:
* Blood tests: High TSH, Low thyroid hormones
Allopathic treatment:
* levothyroxine - thyroid hormone replacement
