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Collection of glands that secrete hormones directly into the bloodstream. › Adrenal glands, parathyroid glands, pancreas, pineal gland, pituitary gland, ovaries, testes, thymus gland, thyroid gland (Hormone.org, 2012) (Zelman, Tompary, Raymond, Holdaway, Mulvhill, 2010) TSH T3 T4 Disruption of hormones › Hyperthyroidism › Hypothyroidism (NIDDK, 2006) Exophthalmos Profuse perspiration Hand tremors Goiter Weight loss Nervousness/excitability Rapid pulse Polydipsia Diarrhea Insomnia Most common type: Grave’s Disease Most common type of hypothyroidism › Hashimoto’s Disease › The thyroid doesn’t make enough thyroid hormone › Symptoms: Fatigue, mental depression, feeling cold, weight gain, dry skin and hair, constipation, menstrual irregularities Most people have no symptoms 4 types: › Papillary – slow growing – easily treated – rarely fatal › Follicular – again slow growing – rarely fatal › Medullary – less common – more aggressive › Anaplastic – least common – most aggressive Adrenal Insufficiency › Adrenal glands cannot produce enough cortisol OR › Pituitary gland fails to produce enough adrenocorticotropin (ACTH) Symptoms: › Chronic, worsening › › › › › › › › fatigue Muscle weakness Loss of appetite Weight loss Nausea/vomiting Diarrhea Craving for salty foods Low blood glucose Headache Caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. Relatively rare but risk factors: › Obesity › Type 2 diabetes › High blood pressure Signs & Symptoms: › › › › › › › › Rounded face Upper body obesity Increased neck fat Bruise easily / poor healing Weakened bones Fatigue Increased thirst/urination Irritability / anxiety / depression (NIDDK, 2006) Medication Radioactive Iodine Surgery Prevention?? High Blood Glucose (Hyperglycemia) In diabetes, blood glucose builds up for several possible reasons… Too little insulin is made Cells can’t use insulin well American Diabetes Association Liver releases too much glucose Type 1 › Pancreas makes too little or no insulin Pre-diabetes Gestational Diabetes Type 2 › Cells do not use insulin well (insulin resistant) › Ability for pancreas to make insulin decreases over time Number of Americans with Diagnosed Diabetes, 1980-2009 www.cdc.gov Currently affects about 29.1 million Americans of all ages. › About 9.3% of the population (U.S.) › Estimated 8 million undiagnosed › Hispanics/Latinos – about 13% diagnosed › African Americans – about 13% diagnosed › Asian Americans – about 9% diagnosed (CDC, 2014) (Oregon.gov, 2006) Increased thirst Increased urination Blurry vision Fatigue Weight loss Nausea and vomiting More frequent infections A leading cause of blindness Leading cause of non-accident amputations Kidney disease Nerve damage (peripheral neuropathy) Heart attack / stroke Treatment of Diabetes No medication 16% Insulin only 12% Insulin and oral medicatio n 14% Oral medication only 58% National Diabetes Information Clearinghouse. National Diabetes Statistics, 2011. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/ “The best time to plant a tree is 20 years ago. The second best time is now.” Chinese Proverb Good news with diabetes prevention › Small steps matter Cost-Effectiveness of Lifestyle Modification or Metformin: DPP Active interventions (vs placebo) would: Intensive Lifestyle Metformin 11.1 years 3.4 years 20% 8% Increase life expectancy by 0.5 years 0.2 years Cost per QALY $1,124 $31,286 Delay onset of type 2 diabetes by Reduce incidence of type 2 diabetes by QALY = Quality Adjusted Life Years Herman WH, et al for the Diabetes Prevention Program Research Group. Ann Intern Med. 2005:142:323-332.