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11 Lecture Notes Endocrine System Diseases and Disorders Classroom Activity to Accompany Diseases of the Human Body Fifth Edition Carol D. Tamparo Marcia A. Lewis Copyright © 2011 by F.A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise— without written permission from the publisher. To keep a lamp burning, we have to keep putting oil in it. —Mother Teresa 3 Common Signs and Symptoms of Endocrine System Diseases and Disorders • • • • • • • • • • • Mental abnormalities Unusual change in energy level Changes in skin, nails, or hair Muscle atrophy Growth abnormalities Polyuria or polydipsia Cold/heat intolerance Unusual weight gain or loss Nausea and vomiting Irregular menstruation Erectile dysfunction 4 Hyperpituitarism • Description • Hypersecretion of human growth hormone (hGH) by the anterior pituitary gland • Giantism results from hypersecretion of hGH during the growing years • Acromegaly results from hypersecretion of hGH in adulthood 5 Hyperpituitarism • Etiology • Benign slowing growing adenoma in the pituitary gland • Adenoma releases high levels of hGH • May also be genetic 6 Hyperpituitarism • Signs and symptoms • Excessive growth of the long bones in giantism • Abrupt increases in height • Gradual deformation of facial features in acromegaly • Enlargement of hands, feet, head, and tongue • Sweating, chronic sinus congestion, weakness, joint pain, numbness or tingling 7 Hyperpituitarism • Diagnostic procedures • Clinical picture • Glucose tolerance test • MRI and CT scans • Bone x-rays MRI=magnetic resonance imaging; CT=computed tomography. 8 Hyperpituitarism • Treatment • Surgical management of pituitary tumors • Radiation to reduce or destroy tumor • Medication to stop hGH production 9 Hyperpituitarism Complementary therapy • None indicated Client communication • Explain nature of hormone hypersecretion • Monitor replacement therapy 10 Hyperpituitarism • Prognosis • Dependent on how the condition has advanced • For giantism prognosis is good • Advanced acromegaly causes serious complications • Prevention • None known 11 Hyperpituitarism • What gland produces hGH? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal 12 Hypopituitarism • Description • Commonly, gonadotropin and hGH are deficient in anterior pituitary • Complex disorder causes metabolic dysfunction, sexual immaturity, growth retardation in childhood • Can result in hyposecretion of essential “target gland” hormones 13 Hypopituitarism • Etiology • Pituitary or hypothalamus tumors • Congenital defect • Pituitary vascular diseases • Iatrogenic 14 Hypopituitarism • Signs and symptoms • Depend upon age of client, deficient hormones • May be dwarfism in children • Slow emergence of secondary sexual characteristics • Amenorrhea • Infertility • Decreased libido • Loss of body hair in adults • Fatigue, weakness, anorexia 15 Hypopituitarism • Diagnostic procedures • Clinical history • Laboratory tests to measure pituitary and “target” gland hormone levels will confirm diagnosis • CT scan, MRI to pinpoint tumors or lesions 16 Hypopituitarism • Treatment • Hormone replacement therapy with constant monitoring of levels • Surgical management of pituitary tumors 17 Hypopituitarism Complementary therapy • Manage stress, maintain appropriate weight, eat healthy food, limit fat intake Client communication • Explain nature of hormone deficits • Monitor replacement therapy 18 Hypopituitarism • Prognosis • Good with hormone replacement • Total loss of all hormonal secretions from anterior pituitary can be fatal • Prevention • None known 19 Diabetes Insipidus • Description • Kidneys are unable to conserve water • Insufficient secretion of vasopressin by the posterior pituitary gland • Failure of the kidney to respond to vasopressin • Affects men more than women; usually starts in childhood 20 Diabetes Insipidus • Etiology • Tumors • Hypophysectomy • Skull fracture • Infection • Idiopathic 21 Diabetes Insipidus • Signs and symptoms • Polyuria (4 to 16 liters of urine in 24 hours) • Polydipsia • Dehydration, weakness, mental confusion • Diagnostic procedures • UA • Dehydration test to rule out other diseases UA=urine analysis. 22 Diabetes Insipidus • Treatment • Increased fluid intake • Hormone replacement therapy 23 Diabetes Insipidus Complementary therapy • None Client communication • Monitor proper fluid balance, weight gain, and recurrence of polyuria 24 Diabetes Insipidus • Prognosis • Depends upon underlying cause, success of treatment • Normal life with vasopressin replacement therapy • Prevention • None known 25 Diabetes Insipidus • Which hormone is deficient in diabetes insipidus? 1. hGH 2. Thyroxine 3. Prolactin 4. Vasopressin 26 Simple Goiter • Description • Enlarged thyroid not caused by infection or neoplasm • Endemic or sporadic • More common in women • Thyroid enlarges when it cannot secrete enough of thyroid hormones T3, T4 27 Simple Goiter • Etiology • Endemic goiter result of insufficient intake of iodine • Sporadic goiter follows ingestion of certain drugs or foods • Usually occurs in females over age 40 with a family history • May be idiopathic 28 Simple Goiter • Signs and symptoms • May appear as small nodule or large, swollen mass at front of neck • Diagnostic procedures • Rule out other diseases • Enlarged thyroid gland with T3, T4 levels normal by radioimmunoassay test • Biopsy of the nodule 29 Simple Goiter • Treatment • Reduce goiter size • Dietary supplements of iodine • Hormone replacement therapy • Excision, if quite large, followed by lifelong hormone replacement 30 Simple Goiter Complementary therapy • Nutritional supplements • Avoid such goitrogenic foods as cabbage, spinach, peanuts, soybeans, peaches Client communication • Use iodized salt • Teach clients how to monitor progressive thyroid enlargement 31 Simple Goiter • Prognosis • Good with successful treatment • Hormone replacement therapy may be necessary • Prevention • Adequate dietary intake of iodine 32 Hyperthyroidism (Graves Disease) • Description • Oversecretion of thyroid hormones causes goiter, ophthalmopathy, dermopathy, thyrotoxicosis • Affects women more than men 33 Hyperthyroidism (Graves Disease) • Etiology • Oversecretion of thyroid hormones influences metabolism of cells throughout body • Graves may be genetic but more likely autoimmune 34 Hyperthyroidism (Graves Disease) • Signs and symptoms • • • • • • • • Goiter Exophthalmos that may interfere with eye blinking Thickened patches of skin on feet or legs Nervousness, anxiety Loss of sleep Excessive perspiration, heat intolerance Muscle wasting, bone decalcification Cardiac problems 35 Hyperthyroidism (Graves Disease) • Diagnostic procedures • Physical manifestation of disease • Radioimmunoassay to confirm increased levels of T3 and T4; nuclear thyroid scan • Blood tests showing high levels of antithyroid immunoglobulins 36 Hyperthyroidism (Graves Disease) • Treatment • Dependent upon client’s age, sex, severity of disease • Goal: to block thyroid hormone production with surgery or radioactive iodine therapy • Short-term use of iodide compounds 37 Hyperthyroidism (Graves Disease) Complementary therapy • Same as for goiter • Cool compresses and eye drops for exophthalmos • Hydrocortisone creams for dermopathy Client communication • Teach clients to recognize symptoms of hypothyroidism that may result from drug therapy • Drug and iodide compound therapy require monitoring 38 Hyperthyroidism (Graves Disease) • Prognosis • Varies; if treatment results in disease remission, prognosis is good • Potentially fatal complication thyroid storm (medical emergency) that results from severe thyrotoxicosis • Prevention • None known 39 Hypothyroidism (Cretinism, Myxedema) • Description • Undersecretion of thyroid hormones • Cretinism result of congenital deficiency of hormones • Myxedema result of deficiency of hormones in childhood or adulthood • Affects women more than men 40 Hypothyroidism (Cretinism, Myxedema) • Etiology • Insufficiency or loss of thyroid tissue • Iatrogenic due to surgery, radioactive iodine therapy or congenital abnormality • Common causes are inflammation and chronic autoimmune and Hashimoto thyroiditis • Dietary or metabolic iodine deficiencies 41 Hypothyroidism (Cretinism, Myxedema) • Signs and symptoms • In neonate constipation and feeding problems • Brain and skeleton fail to develop • Retarded growth, impaired intelligence, delayed secondary sexual characteristics 42 Hypothyroidism (Cretinism, Myxedema) • Signs and symptoms (cont.) • In children, there may be a hoarse cry, sleeping too much, feeding problems; in adults, symptoms insidious • Fatigue, constipation, intolerance to cold, muscle cramps • Later symptoms include mental clouding, diminished appetite and weight gain, dry skin, brittle hair and nails 43 Hypothyroidism (Cretinism, Myxedema) • Diagnostic procedures • Radioimmunoassay reveals decreased levels of T3, T4, and elevated TSH • Thyroid scan shows diminished iodine uptake • High cholesterol, alkaline phosphates, triglycerides 44 Hypothyroidism (Cretinism, Myxedema) • Treatment • Lifelong hormone replacement therapy • Infants should begin as soon as possible 45 Hypothyroidism (Cretinism, Myxedema) Complementary Therapy • None Client Communication • Hormone replacement therapy needs continued monitoring throughout client’s life 46 Hypothyroidism (Cretinism, Myxedema) • Prognosis • Good with successful replacement therapy • Myxedema coma is a life-threatening complication • Prevention • Only hypothyroidism due to dietary deficiency, radiation, or surgical removal of the thyroid, and drug-induced forms are preventable 47 Hypothyroidism (Cretinism, Myxedema) • Cretinism is the result of ____ deficiency of thyroid hormones? 1. congenital 2. adult 3. iatrogenic 4. secondary 48 Hyperparathyroidism (Hypercalcemia) • Description • General disorder of calcium, phosphorus metabolism • High levels of PTH cause hypophosphatemia, hypercalcemia • Affects women twice as much as men PTH = parathyroid hormone. 49 Hyperparathyroidism (Hypercalcemia) • Etiology • Excessive secretion of PTH • Primary cause is adenoma of a parathyroid gland • Secondary causes include chronic renal failure, dietary insufficiency of calcium or Vitamin D, tuberculosis, and sarcoidosis 50 Hyperparathyroidism (Hypercalcemia) • Signs and symptoms • • • • • • • • Gradual onset Clients may remain asymptomatic Weak, brittle bones Joint pain Kidney stones Polyuria CNS disturbances CNS = central nervous system. Chronic fatigue 51 Hyperparathyroidism (Hypercalcemia) • Diagnostic procedures • Radioimmunoassay reveals increased serum PTH • 24-hour urine shows calcium excretion • Bone mineral density test • CT scan of bone 52 Hyperparathyroidism (Hypercalcemia) • Treatment • Varies with etiology • Goal is to reduce levels of circulating calcium • Surgery and/or drug therapy 53 Hyperparathyroidism (Hypercalcemia) Complementary therapy • Monitor calcium and vitamin D supplements • Avoid smoking Client communication • Teach client about disease and its treatment • Stress importance of follow-up care 54 Hyperparathyroidism (Hypercalcemia) • Prognosis • Good with successful treatment • Complications include organ damage, coma, cardiac arrest from severe hypercalcemia • Prevention • None known 55 Cushing Disease • Description • Hypersecretion of the adrenal cortex of the adrenal glands resulting in production of excess cortisol • More common in females 56 Diabetes Mellitus • Description • Chronic disorder of carbohydrate metabolism, the result of insufficient or inadequate use of insulin • Causes hyperglycemia, diabetic ketoacidosis 57 Diabetes Mellitus • Description • Four types • Immune-mediated type 1 diabetes: abrupt onset; occurs prior to age 30; complete absence of insulin secretion • Type 2 diabetes: gradual onset; most common form; occurs after age of 40; pancreas has some insulin-secreting ability 58 Diabetes Mellitus • Description (cont.) • Gestational diabetes (GDM): develops during pregnancy; resolves after delivery; increased risk to type 2 diabetes later • Other types of diabetes: caused by pancreatic dysfunction as the result of drugs, chemicals, infections 59 Diabetes Mellitus • Etiology • Cause of types 1 and 2 diabetes are unknown • Type 1 may be autoimmune disorder; type 2 may be genetic • Type 2 risk factors are obesity, sedentary lifestyle, family member with diabetes • Other types of diabetes are related to specific conditions 60 Diabetes Mellitus • Signs and symptoms • Polyuria • Glycosuria • Polydipsia • Weight loss; polyphagia 61 Diabetes Mellitus • Signs and symptoms (cont.) • Type 1 • Ketoacidosis • Type 2 • May have hard-to-heal infections, blurred vision • Muscle weakness, fatigue • Often asymptomatic 62 Diabetes Mellitus • Diagnostic procedures • Presenting symptoms • Hemoglobin A1C • Random blood glucose test • Fasting blood glucose test 63 Diabetes Mellitus • Treatment • Diet and exercise helpful for most forms • Type 1 = glucose monitoring and insulin management • Type 2 = diet; may require insulin therapy • Self-management of disease important 64 Diabetes Mellitus Complementary therapy • Diet high in complex carbohydrates, fiber, and whole grains • Exercise Client communication • Teach clients how to monitor blood sugar levels • Advise clients to pay special attention to their teeth and feet 65 Diabetes Mellitus • Prognosis • With early diagnosis, successful treatment, few complications, prognosis is good • Complications can be acute, resulting in diabetic coma or insulin shock; both are life threatening • Complications may come late in disease process, affecting nearly every body organ 66 Diabetes Mellitus • Prevention • None known • Persons at risk should carefully manage their weight, diet; get plenty of exercise 67 Diabetes Mellitus • Type 1 diabetes is the result of ____ not being produced by the pancreas. 1. calcium 2. glucagon 3. hGH 4. insulin 68 Credits Publisher: Margaret Biblis Acquisitions Editor: Andy McPhee Developmental Editors: Yvonne Gillam, Julie Munden Backgrounds: Joseph John Clark, Jr. Production Manager: Sam Rondinelli Senior Developmental Editor, Electronic Publishing: Kirk Pedrick Electronic Publishing: Frank Musick The publisher is not responsible for errors of omission or for consequences from application of information in this presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should be applied by the reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each situation. 69