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Chapter 25 Endocrine Disorders Endocrine System Endocrine system deals with transmission of “messages” via hormones Compared to nervous system which uses electrical conduction of neurons. Hormones are transmitted by two methods: Endocrine: hormone released directly into the blood stream Exocrine: hormone released via a duct or tube into the blood stream. Hormones Most hormones work on a negative feedback mechanism e.g. when glucose gets too high, the pancreas releases insulin to raise the blood glucose level When glucose gets too low, the pancreas releases glucagon to increase the blood glucose level. Important Glands and Hormones Pituitary gland The master gland of the body Controlled by the hypothalamus of the diencephalon of the brain. Located beneath the hypothalamus, protected by the sella turcica “turkish saddle” of the Sphenoid bone. Pituitary Gland is divided into two parts. Adeno-hypophysis Secretes “sex” hormones Growth Hormone (GH)-stimulates growth plates Follicle-Stimulating Hormone (FSH)stimulates sperm and ovary production at puberty. Regulates secretion of estrogen by ovaries. Luteinizing Hormone (LH)-stimulates testosterone and maturation of eggs Prolactin-stimulates breast milk production Adenocorticotropic (ACTH)-stimulates adrenal gland to secrete Cortisol. Thyroid-stimulating (TSH)-stimulates thyroid gland. Neuro-hypophysis Oxytocin Stimulates contraction during labor and expulsion of placenta. Stimulates “love” sensation Important Glands and Hormones Adrenal gland- sits atop the kidneys Two sections Adrenal cortex (outer layer) Cortisol- hormone released to lower stress and inflammation Also releases stored glucose when energy levels run low Excessive use of Prednisone leads to adrenal shutdown. Adrenal medulla (inner layer) Epinephrine (adrenaline) and Norepinephrine Stimulates increased heart rate, breathing rate, and vasodilation to skeletal muscles. “Fight or Flight” response. Signal sent from pituitary to release these hormones Thyroid gland and parathyroid glands Thyroid gland is wrapped around your trachea just beneath your larynx Secretes thyroxine hormone (T4)which stimulates cell metabolism. Too much-hyperthyroidism Too little- hypothyroidism The parathyroid glands are 4 tiny dots enmeshed in your thryroid gland Releases Parathyroid hormone- used to regulate the amount of calcium in your blood and bones. Important Glands and Hormones (cont) Pancreas Largest gland in the body located beneath liver Its exocrine function is to release trypsin and other digestive juices. Its cells secrete into the long Pancreatic duct when funnels into the Sphincter of Odi of the duodenum. Its endocrine function is primarily the release of two important hormones by special “nodes” in the pancreas called the Islets of Langerhans. Insulin Produced by Beta Cells in the Islets of Langerhans Secreted when blood sugar level is too high. Insulin helps cells accept glucose. If insulin is low/non-existent, too much glucose runs amok in the body. Glucagon Produced by Alpha Cells in the Islets of Langerhans Secreted when blood sugar level is too low Causes liver to release glycogen (stored glucose) into the blood stream. Cortisol and Glucagon serve similar purposes. Other glands and hormones Gonadal Hormones Follicle Stimulating hormone (FSH) of pituitary gland regulates gonadal hormones. Testosterone Estrogen and Progesterone Produced by gonads Makes women “women” and regulates cycle. Human Chorionic Gonadotropin Hormone (hCG) Produced by gonads (ovaries and testicles) Makes men “men” and women horny Produced by placenta once zygote attaches to uterine wall Pregnancy tests detect hCG Pineal gland Located in brain posterior to pituitary gland Releases melatonin hormone, which regulates sleep Diagnostic Tests/Treatment Diagnostic Blood tests Urine analysis (UA) tests Scans, ultrasounds, magnetic resonance imaging (MRI) Biopsy Treatment Hormone replacement medications Radiation Surgery Medications Insulin and Diabetes Mellitus Diabetes Mellitus (DM) manifests in 2 predominant ways. Insufficient amount of insulin secretion by pancreas, or Production of insulin antagonists that disallow insulin being absorbed by cells. Either way, insulin is required for glucose to pass through cell membranes to be metabolized by cells for energy. In DM, blood glucose levels rise too high leading to complications. Type 1 DM Autoimmune destruction of beta cells in pancreas Insulin replacement required Acute onset in children and adolescents Not linked to obesity Genetic factors may play a role. Type 2 DM Non–insulin-dependent Oral hypoglycemic medications may be used. Caused by decreased production of insulin and/or increased resistance by body cells to insulin Onset is slow and insidious and usually in 50+ age Associated with obesity Caused largely by lifestyle choices (poor diet, lack of exercise) Symptoms of DM The high level of glucose circulating in the body leads to the following symptoms. Polyuria The kidneys produce more glucose-filled urine to rid the body of the excess glucose. Glucosuria in a urine analysis is an easy indicator of DM. Polydipsia (Excess thirst) The release of higher than normal urine dehydrates the body, thus leading to perpetual thirst. Polyphagia Since the organs are not receiving glucose, the brain overcompensates by increasing hunger pangs. Fatigue Cells cannot be metabolize glucose for energy so energy levels drop. Weight Loss Organs are “starving” for lack of energy; kidneys expelling sugar so quickly weight loss ensures. Diabetes – Treatment Principles 1. Diet and exercise Exercise reduces blood glucose as skeletal muscle uses glucose. Reduce simple carbohydrates 2.Oral medication Increase insulin secretion Reduce blood glucose levels Chronic Complications of Diabetes Macroangiopathy: -plaque accumulation of greater arteries. Result of abnormal lipid levels High incidence of heart attacks, strokes, peripheral vascular disease May result in ulcers on feet and legs – slow healing Frequent infections and gangrenous ulcers Amputation may be necessary. Peripheral neuropathy Common complication due to ischemia in microcirculation to peripheral nerves Impaired sensation, numbness, tingling, weakness, muscle wasting Neuropathic Diabetic Foot Ulcer Chronic Complications of Diabetes (Cont’d) Infections Common and often more severe in diabetics Infections in feet and legs due to vascular and neurologic impairment Fungal infections common Candida Vagina and/or oral cavity Urinary tract infections Dental caries Gingivitis and perodontitis Retinopathy in Eye Causes blindness Pregnancy Complications to both mother and fetus may occur. Increased incidence of spontaneous abortions Increased birth size; predisposition to obesity for child. Periodontal Disease in Diabetics Potential Complications of Diabetes Mellitus Pituitary Problems. Adenomas are the most common cause of pituitary disorders. May cause pressure in the skull Headaches, seizures, drowsiness, visual deficits Its Effect on hormone secretion is dependent on cells and location involved May cause excessive or decreased release of hormones Pituitary Problems. Dwarfism Deficit in growth hormone production/release Gigantism Excess GH prior to puberty and fusion of growth plates Agromegaly Excess GH secretion in adults Often associated with pituitary adenoma Bones become broader and heavier Soft tissue grows Enlarged hands and feet; change in facial features Effects of Growth Hormone Parathyroid Abnormalities Hypoparathyroidism Too little secretion of parathyroid pTH hormone Leads to Hypocalcemia Causes Tumor Congenital lack of parathyroid Surgery or radiation in neck region Eating Disorders; too little Vitamin D Results in: Seizures Arrhythmia and Numbness/Tingling Hyperparathyroidism Too much secretion of pTH hormone Results in hypercalcemia, results in: Arrthymia Osteoporosis Predisposition to kidney stones and peptic ulcers Causes Tumor Renal Failure Too much Vitamin D Common Effects of Parathyroid Hormone Imbalance Quiz-ito Cortisol and Epinephrine are created by this endocrine organ? In what intercostal space is V4 placed? Name one of the classic symptoms of diabetes. What is the condition in which too little growth hormone is produced during puberty? Hypothalamus-PituitaryThyroid Gland Feedback Thyroid Disorders Goiter Enlargement of thyroid gland It is a symptom not a disease, similar to jaundice. Normally due to deficiency in Iodine in diet. Hyper or hypothyroidism is indicator Treatment: based on cause: Iodine given If hypo, then oral supplements of thyroxin given If hyper, radiation to suppress the overproduction of thyroxin. Hyperthyroidism Hyperthyroidism (Graves disease) Autoimmune disease that causes goiter Hypermetabolism and increased stimulation of SNS Increased body temperature Sweating Soft silky hair and skin Reduced BMI Insomnia Hyperactivity Exophthalmos is most pronounced symptom. Presence of protruding, staring eyes, decreased blink and eye movement Result of increased tissue mass in the orbit May result in visual impairment Hypothyroidism Hypothyroidism Normally an Iodine deficiency 2 Other causes Hashimoto Thyroiditis Autoimmune disorder; body attacks the thyroid Causes mania, depression, weight gain, parasthesia Cretinism Untreated congenital hypothyroidism Results in short stature and severe cognitive deficits May be related to iodine deficiency during pregnancy Comparison of Hypothyroidism and Hyperthyroidism Adrenal Glands Abnormalities Adrenal Cortex Cushing syndrome Caused by an excessive level of cortisol – possible result of Adrenal adenoma Pituitary adenoma Substance abuse Changes associated with Cushing syndrome Change in person’s appearance Round face with ruddy color Truncal obesity with fat pad between scapulae Thin limbs Thin hair Fragile skin Addison Disease Caused by the deficiency of cortisol hormone Opposite of Cushings Autoimmune reaction is a common cause. Gland may be destroyed by hemorrhage or infection. Symptoms Decreased blood glucose levels Inadequate stress response Fatigue Weight loss; frequent infections Comparison of Addison Disease with Cushing Syndrome Antidiuretic Hormone (ADH) Diabetes insipidus: deficit of ADH Adenoma May originate in the neurohypophysis Head injury or surgery Possible genetic problem Replacement treatment required Inappropriate ADH syndrome Excess ADH May be temporary, triggered by stress, may be secreted by an ectopic source such as a tumor Treatment: diuretics and sodium supplements