Download My Endocrine Patho Outline

Endocrine Patho Outline
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Hypothalamus
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Info
 Main link between nerves & hormones
 Produces “releasing factors” into blood supply
 Releasing factors travel to pituitary gland
 Produces ADH & Oxytocin (then sends to posterior pituitary)
o Disorders of Hypothalamus
 Surgical transection
 Head injury
 Tumor affecting stem to pituitary gland (tumor causes pressure and blocks the gland off from the
hypothalamus)
 Infections (like meningitis)
Pituitary Gland
o Info
 Pituitary hormones affect
 Skin
 Kidneys
 Bones
 Adrenals
 Thyroid
 Mammary glands
 Sex glands
o Pituitary Gland Hormones
 Anterior
 GH (Growth Hormone)
 ACTH (goes to the adrenal glands)
 TSH (Thyroid stimulating Hormone)
 PRL
 FSH
 LH
 MSH (melanocyte stimulating hormone, affects the skin, the higher the level the darker the
complection)
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Posterior (both made and stored in pituitary)
 ADH
 OT
Diseases of Pituitary Gland
o Hypopituitarism
 Patho
 Ranges from absence of certain hormones to complete failure of hormone functions
o Depends on the area being affected. For example growth hormone is only made in one
particular area. If that area is damaged or whatever the pt is going to have less growth
hormone than he should)
 Pituitary extremely vascular
 Vulnerable to infarction (cause the vessels are so small)
 During pregnancy—pituitary gland enlarges (thus more vascular). Affects hormone levels, usually
increasing them. But the swelling of the gland can cut off parts of it
 S/S
 Dwarfism (in children, not in adults)
o Not enough growth hormone
 ↓ lactation or absent lactation
o Oxytocin slows down
 Loss of body hair; ↓ libido
 Hypothyroidism
o Thyroid stimulating hormone
 Causes
 Diabetes Mellitus
o Drop in hormones because of hardening of the arteries and circulation gets worse and
worse. The capillaries are affected and less O2 gets there. From this point there isn’t much of
a chance of reversing it at all.
 Sickle cell disease
o Sickle cells are blood cells that aren’t shaped like they’re supposed to. They have a tendancy
to clump in capillaries
 Shock
o Low fluid volume
 Head trauma
o Squishing off a part or damaging a part of the gland
 Infections (Meningitis, TB, syphilis)
 Ablation due to tumor removal
o It’s hard to cut out a tumor and leave all the healthy tissue. Some good stuff gets cut out
o Hyperpituitarims
 Patho
 Pituitary adenomas—slow-growing tumors from anterior pituitary
o One of the predominant things that cause this. Carcinomas are rare, adenomas are usually
limited. As they grow they cause pressure. Once the cells become cancerous (whether
benign or cancerous) they no longer abide by the rules. If the tumor is near where Growth
Hormone is made, the tumor cells will make growth hormone like crazy
 May put pressure on optic nerves
o Cause of the close proximity of the pituitary gland to the optic nerves.
 May grow/metastasize (remember it’s carcinoma, which is rare) to hypothalamus
 Secrete hormone(s) regardless of what body needs
o More often see this
 S/S
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Related to tumor growth (almost always!) Think about tumor growth and pressure leading to the
following s/s:
 Headache
 Fatigue
 Neck pain / stiffness (pressure on nerves, pain center, etc.)
 Seizures (pressure on nerves)
 Temporary blindness (pressure on optic nerves)
o GH(Growth Hormone) Hypersecretion
 Patho
 Acromegaly (“Giantism”) (if it happens at an early age it will lead to this)
 Rare, caused by GH-secreting tumor (adenoma)
 In adults, leads to characteristic appearance (Note pictures on p.479)
 Leads to HTN, IDDM, CHF
 Associated with ↓ life expectancy (if it’s congenital, kid probably won’t live much longer past the late
20’s)
o Prolactinoma
 Patho
 Most common Pituitary tumor
 ↑ Secretion of prolactin (tumor causes increase in this because of the location)
 S/S
 Women
o ↑ milk production
o Menstrual disturbances (amenorrhea)
o ↑ hair growth (hirsutism)
 Men
o Loss of libido
o Erectile dysfunction
Thyroid Gland
o Info
 Thyroid hormone (T3, T4, Calcitonin) affect
 Metabolism of all cells
 Body heat production
 Muscle tone
 Serum calcium levels (in the blood)
 Secretions in GI tract
 Cardiac rate & force
 Randoms
 They draw blood looking for thyroid stimulating hormone. If you’ve got tiny amounts of TSH, you
will probably have a small hormone aka hypothyroidism
Diseases of the Thyroid
o Hyperthyroidism (aka Graves Disease)
 Info
 Most common cause of ↑ thyroid (is Graves Disease)
 Autoimmune disease (the body makes antibodies that stimulate the production/secretion of thyroid
hormone)
 Antibodies stimulate cells to overproduce TH (Thyroid grows bigger)
 Thyroid gland usually grows (Goiter)
 S/S of Graves Disease
 Weight loss (metabolism is going faster)
 Restlessness
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Hypothyroidism
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Patho
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S/S
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Heat intolerance (people get very irritated in the heat)
Sweating (r/t increased metabolism and all that)
Oily skin
Tachycardia (affects heart muscles)
Agitation
Tremors (also affects all muscles)
Exopthalmos
Fine Hair
Muscle weakness
Muscle wasting
Most common disorder of thyroid function
More common in women than men (Why? Don’t know)
Primary—Congenital defect; post hyperthyroid treatment (if they had hyper and they removed some
of the gland, now they have hypo); iodine deficiency (more common in 3rd world countries)
Secondary—?hypothalamus; ?pituitary (could be something going on elsewhere, they try to figure
out)
Loss of thyroid tissue
Thus, ↓ production of TH
Thus, ↑ production of TSH
Thus, growth of thyroid tissue → Goiter
Lower metabolic rate (weight gain)
Cold intolerance
Lethargy / fatigue
Myxedema (diffuse edema that develops in the interstitial space, everywhere in the body. Shows up
in the face. Good description in the book. He’ll let us look it up. Hooray.)
Constipation
Coarse hair
Dry skin
Possibly goiter
Parathyroid Glands
o Info
 Increases calcium levels in blood
 Acts on bones to release stored calcium
 Acts on intestines to ↑ calcium absorption
 Acts on kidneys to ↓ calcium loss
 There are four of them on the thyroid. If they operate and take out some of the thyroid gland, chances are
they might remove some of the parathyroid glands in the process.
Diseases of the Parathyroid Gland
o Hyperparathyroidism
 Patho
 Primary— ↑ secretion of PTH; usually results from chief cell adenoma (chief cells are in the stomach,
they kick off something for the PTH to increase)
o Thus, GI aborption of calcium ↑
o Thus, kidneys generate ↑ vitamin D
 Secondary—Response to chronic hypocalcemia (if calcium is too low in the blood the PTH is going to
be pumped out in excess)
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Hypoparathyroid
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Resulting from malabsorption in GI tract, or ↓ activation of vitamin D (renal failure, vit D is
down and we start spilling calcium, calcium declines in the blood)
Pathologic fractures (r/t loss of calcium in bones, bones get weak)
Kyphosis of dorsal spine
Compression fractures in vertebrae
Calcium “spilling” into urine (Hypercalciuria)
Can lead to metabolic acidosis
o Calcium has a strong positive charge. You get rid of too many, may get acidic. The
following s/s are below
Fatigue, N/V, anorexia, depression, headache
The calcium spilling is the primary s/s of this cause so many of the other ones are non specific. They
make you think of other diseases first.
Damage post thyroid surgery (lose some tissue containing a parathyroid gland)
Thus, ↓ circulating PTH
Thus, reabsorption of calcium is impaired (cause the gut isn’t being signaled to hang onto it)
Thus, phosphate ↑ in blood (there aren’t many things that cause this in the blood. In this disease the
low levels of calcium lead to the increased phosphate)
S/S
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Hypocalcemia
Leads to ↑ muscle spasms, hyperreflexia, laryngeal spasms
Dry skin
Loss of body/scalp hair