HORMONES (DISEASE & METHODS) Flashcards
Hypermetabolic condition caused by excessive production of thyroid hormones
Primary Hyperthyroidism
Thyrotoxicosis: excess TH
Primary Hyperthyroidism
Primary Hyperthyroidism Common cause
Thyrotoxicosis
Primary Hyperthyroidism Primary cause
Grav’es disease
Plummer’s disease)
Pituitary tumors
Primary Hyperthyroidism Less minor cause
Subacute thyroiditis
Grave’s disease
Grave’s disease Causes:
Thyrotropin Receptor Antibodies (TRABS)
Thyroid Stimulating Immunoglobulins (TSIS)
Grave’s disease Symptoms and manifestation:
Eye disease
Skin disease
Goiter
Secondary causes of hyperthyroidism:
Thyrotoxicosis factitia
Iodide ingestion in excess
Thyroid carcinoma
Drug induced thyrotoxicosis
Over stimulation of the thyroid
Secondary Hyperthyroidism
Over production of thyroid stimulating hormone
Secondary Hyperthyroidism
Secondary Hyperthyroidism Causes:
Carcinoma of the APG
TSH-secreting tumors
TRH-secreting tumors
Increased TSH
Primary Hypothyroidism
Decreased T3T4
Primary Hypothyroidism
Hashimoto’s disease
Primary Hypothyroidism
Unexplained weight loss
Thyrotoxicosis
Inc HR
Thyrotoxicosis
Sweating
Thyrotoxicosis
Heat intolerance
Thyrotoxicosis
Nervousness
Thyrotoxicosis
Fatigue
Primary Hypothyroidism
Weight gain
Primary Hypothyroidism
Decreased mental and Physical output
Primary Hypothyroidism
Cold intolerance
Primary Hypothyroidism
Fatigue and sluggishness
Hashimoto’s disease
Increase sensitivity to cold
Hashimoto’s disease
Constipation
Hashimoto’s disease
Pale dry skin
Hashimoto’s disease
Puffy face
Hashimoto’s disease
Hair loss
Hashimoto’s disease
Enlargement of the tongue: macroglossia
Hashimoto’s disease
Unexplained weight gain
Hashimoto’s disease
Sensitivity to cold
Hashimoto’s disease
Bradycardia
Hashimoto’s disease
Menstrual changes
Hashimoto’s disease
Central thyroid disease
Secondary Hypothyroidism
Serum T4 and T3 is low
Secondary Hypothyroidism
TSH concentration are either low or within reference interval
Secondary Hypothyroidism
Cause: Pituitary or hypothalamic disease
Secondary Hypothyroidism
Impaired speech and memory
Hypothyroidism
Fatigue
Hypothyroidism
Weight gain
Hypothyroidism
personality changes
Hypothyroidism
cold tolerance
Hypothyroidism
Increased serum cholesterol and LDL
Hypothyroidism
Enlarged thyroid gland (goiter)
Hyperthyroidism
Weight loss
Hyperthyroidism
heat intolerance
Hyperthyroidism
nervousness
Hyperthyroidism
exophthalmos
Hyperthyroidism
Normal functioning thyroid gland in the presence of an abnormal concentration of Thyroxine-binding-globulin
Euthyroid
TSH is suppressed
Subclinical hyperthyroidism
Free T4 is normal
Subclinical hypothyroidism
TSH minimally increased
Subclinical hypothyroidism
Most useful test
TSH
[?]= increased TSH
Primary hypothyroidism
TSH Normal range in most laboratories:
0.5 to 5 mIU/L
Measured by radioimmunoassay or chemiluminometric assay
Serum T4 and T3
ELISA
Serum T4 and T3
Current kits still are unable to accurately measure free T4 and T3
Serum T4 and T3
DIRECT TEST FOR BIOLOGICAL ACTIVE FORMS (FT3 AND FT4)
Direct Equilibrium Dialysis
More challenging method
DIRECT TEST FOR BIOLOGICAL ACTIVE FORMS (FT3 AND FT4)
T3 conc:
0.3
T4 conc:
0.03
Undiluted serum specimen are dialyzed for
16 to 18 hours at 37 deg. Celsius
Dialysate is analyzed using
RIA
DIRECT TEST FOR BIOLOGICAL ACTIVE FORMS (FT3 AND FT4) NV:
20-128 ng/ml
Synthesized and secreted exclusively by thyroid follicular cells
Thyroglobulin
Proof of residual thyroid tissue: benign or malignant
Thyroglobulin
Ideal tumor marker for thyroid cancer patients
Thyroglobulin
Should be undetectable after successful treatment
Thyroglobulin
Thyroglobulin Measured by :
radioimmunoassay, enzyme-linked immunoassay
Tests to detect antibodies to the
TSH receptor
Thyroid autoimmunity
TSAb, TSI
Thyroid autoimmunity
Thyroid stimulating antibody
Thyroid autoimmunity
TRAD, TSHR-Ab
Thyroid autoimmunity
TSH receptor antibody
Thyroid autoimmunity
OTHER TOOLS
- Nuclear medicine evaluation
- Thyroid ultrasound
- Fine needle aspiration
Makes use of radioactive iodine
- Nuclear medicine evaluation
Measured via X-ray
- Nuclear medicine evaluation
Determines anatomy of the thyroid gland
- Thyroid ultrasound
Detects small to medium-sized tumors
- Thyroid ultrasound
Most accurate tool for thyroid nodules
- Fine needle aspiration
Ultrasound
- Fine needle aspiration
80% due to parathyroid adenoma (tumor; less common)
Seen in kidney and bone disease
Secondary Hyperparathyroidism
often asymptomatic
Primary Hyperparathyroidism
if symptomatic: hypercalcemia
Primary Hyperparathyroidism
Seen in chronic renal failure
Secondary Hyperparathyroidism
Due to vitamin D deficiency
Secondary Hyperparathyroidism
Due to injury of the PTG
Primary Hypoparathyroidism
Persistent hypocalcemia
Primary Hypoparathyroidism
Tetany and altered neuromuscular activity
Primary Hypoparathyroidism
Deficiency of blood calcium causes neurons and muscle fibers to depolarize and produce action potentials spontaneously
Primary Hypoparathyroidism
Primary Hypoparathyroidism End results:
-Twitches, spasms and tetany of skeletal muscle
Decreased Sodium and chloride
Hyperaldosteronism
Cortisol
Hyperaldosteronism
Urinary steroids
Hyperaldosteronism
Increased ACTH
Hyperaldosteronism
Hypernatremia
Hypoaldosteronism
Hypokalemia
Hypoaldosteronism
Hypertension
Hypoaldosteronism
Metabolic alkalosis
Hypoaldosteronism
Cushing’s syndrome
Hypercortisolism
Pituitary gland tumor
Hypercortisolism
Ectopic ACTH-secreting tumor
Hypercortisolism
Primary adrenal gland disease
Hypercortisolism
Familial Cushings disease
Hypercortisolism
Weight gain and fatty deposits
Hypercortisolism
Pink and purple stretch marks in the skin of the abdomen, thighs, brests and arm
Hypercortisolism
Slow healing cuts
Hypercortisolism
Thinning fragile skin that bruises easily
Hypercortisolism
Addison’s disease
Hypocortisolism
Darkening areas of skin (hyperpigmentation)
Hypocortisolism
Severe fatigue
Hypocortisolism
Unintentional weight loss
Hypocortisolism
Gastrointestinal problems, such as nausea, vomiting and abdominal pain
Hypocortisolism
Lightheadedness or fainting
Hypocortisolism
Salt cravings
Hypocortisolism
Muscle or joint pains
Hypocortisolism
Makes use of fasting plasma, and levels in pregnant patients are
three to four time higher
Aldosterone Assay
Urine sample is to be used must be collected for a 24 hour specimen in 10g boric acid to maintain pH <7.5
Aldosterone Assay
Exogenous steroid to suppress innate cortisol production
Dexamethasone Suppression
Measure cortisol
Dexamethasone Suppression
• Normal :
• Cushing’s syndrome:
decreased cortisol (suppressed)
increased cortisol (not suppressed)
Tumor in adrenal medulla: excess epinephrine
Pheochromocytoma
Hypertension, headache
Pheochromocytoma
Increased heart rate
Pheochromocytoma
Malignant tumor of adrenal medulla seen in children which may lead to abdominal mass
Neuroblastoma
Methods for Cortisol determination
Makes use of
urine or plasma samples
is best for screening test of pheochromocytoma and urinary VMA and HVA
urinary metanephrine
cathecolamine release is intermitent
Methods for Cortisol determination
Appears before age 20
Diabetes Mellitus: Type 1
Autoimmune Disease - immune system destroys beta cells of pancreas
Diabetes Mellitus: Type 1
Treatment: Insulin injections
Diabetes Mellitus: Type 1
[?] of people with diabetes have type 2
85-90%
Develops after age
Diabetes Mellitus: Type 2
More common in overweight
Diabetes Mellitus: Type 2
Milder symptoms
Diabetes Mellitus: Type 2
Treatment: manage diet and exercise
Diabetes Mellitus: Type 2
Precocious puberty in girls
Increased Estrogen
Feminization in males
Increased Estrogen
Pregnancy
Increased Estrogen
Oral contraceptive use
Increased Estrogen
Polycystic ovary disease
Increased Estrogen
Free & bound fractions are measured
PLASMA ESTRADIOL
RIA commercial kits: I-labeled tracer for direct assay of estradiol
PLASMA ESTRADIOL
Principal route of excretion
URINE ESTRADIOL
Provides adequate info about endogenous prod’n
URINE ESTRADIOL
commonly associated Primary Hyperthyroidism
Grav’es disease
: cause of goiter
Autonomous production of multiple thyroid nodules (Plummer’s disease)
: overprod of TSH
Pituitary tumors
: inflammation of TG leading to release of stored TH
Subacute thyroiditis
: Autoimmune disease that leads to generalized over activity of the thyroid gland; commonly assoc disease to hyperthyroidism
Grave’s disease
: binds to and activated TSH receptors
Thyrotropin Receptor Antibodies (TRABS)
: Abs mimics the action of TSH
Thyroid Stimulating Immunoglobulins (TSIS)
Eye disease aka
Grave’s opthalmopathy/thyroid eye disease
Grave’s opthalmopathy/thyroid eye disease; associated w/
bulging of eyes, double vision, inflamed eye tissues
Skin disease aka
Grave’s dermopathy
- reddening patches in the skin
Grave’s dermopathy
: common manifestation; overstimulation due to two Abs; treatment: surgical
Goiter
: iatrogenic; ingestion excessive TH (supplement/injected)
Thyrotoxicosis factitia
: ingestion of iodized salt
Iodide ingestion in excess
: problem in APG/hypothalamus in TSH secretion
Over stimulation of the thyroid
: causes elevation of TSH
Carcinoma of the APG
: Autoimmune disorder in which the immune system creates antibodies that damage the thyroid gland; chronic
Hashimoto’s disease
: accumulation of fluid/edema
Puffy face
Enlargement of the tongue:
macroglossia
Serum T4 and T3 screening tests
Current kits still are unable to accurately measure free T4 and T3
(tumor; less common)
parathyroid adenoma
(absorption of Ca from intestines)
vitamin D deficiency
PTH (produced by the kidneys)
chronic renal failure
(benign tumor; elevated ACTH; overstimulated AG)
Pituitary gland tumor
(low metabolic rate)
Weight gain and fatty deposits
- most widely accepted principle for quantitative colorimetric determination of estrogens
Kober reaction
Kober reaction (+ result:)
pink
