ENDOCRINE & ENDOCRINE & METABOLIC DISORDERSMETABOLIC DISORDERS

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PARATHROID GLANDS

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Primary Primary hyperparathyroidismhyperparathyroidismEtiology:Etiology:

1. Parathyroid adenoma (80%)2. Parathyroid hyperplasia (15%)3. Parathyroid carcinoma is very

rare4. Para-neoplastic syndrome: lungs

and renal carcinomas can secrete parathyroid-like substances and give a picture of hyperparathyroidism

Pathogenesis:Pathogenesis: Excess production of parathyroid hormone

(PTH) leads to hypercalcaemia

Clinically:Clinically:1. Laboratory: elevated serum calcium and

PTH2. Kidney stones3. Osteoporosis (calcium moves out of

Bones)4. Metastatic calcification (abnormal

deposition of calcium in tissues)5. Neurological changes

Secondary Secondary HyperparathyroidismHyperparathyroidism

Etiology:Etiology:1. Chronic renal failure2. Vitamin D deficiency3. Malabsorption

Pathogenesis:Pathogenesis: -Caused by any disease that results in

hypocalcaemia, leading to increased secretion of PTH by the parathyroid glands

Hypo-parathyroidismHypo-parathyroidism

Etiology:Etiology:

Surgical removal of gland during thyroidectomy

Digeorge syndrome (congenital absence of parathyroid glands)

Clinical picture of Clinical picture of hypoparathyroidismhypoparathyroidism1-1-Lab: hypocalcaemia

2-Neuromuscular excitability and tetany:

-Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)

-Chvostek's sign (tapping of the inferior portion of the zygoma will produce facial spasms)

3-Psychiatric disturbances

4-Cardiac conduction defects

Normal pituitary glandNormal pituitary gland

PITUITARY GLAND

Gigantism:Gigantism:

Children & adolescents Before fusion of growth

plates Tall stature & long

extremities

Acromegaly:Acromegaly:

Adults After fusion Prominent jaw Flat, broad forehead Enlarged hands and

feet Visceral

abnormalties

Growth hormone producing Growth hormone producing adenomaadenoma Elevated growth hormone

GigantismGigantism

AcromegalyAcromegaly

Pituitary DwarfismPituitary Dwarfism

Definition

Dwarfism is a condition in which the growth of the individual is very slow or delayed, resulting in less than normal adult stature.

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Pituitary Pituitary DwarfismDwarfism

Therefore, pituitary dwarfism is decreased bodily growth due primarily to hormonal problems (decreased growth hormone).

The end result is a proportionate little person, because the height and the growth of all other structures of the individual are decreased.

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Cushing syndromeCushing syndrome

Definition:Definition:Disease characterized by increased

levels of glucocorticoids

Causes of Cushing’s Causes of Cushing’s Syndrome:Syndrome:1. Adenoma of adrenal cortex2. Excessive secretion of adreno-

corticotrophic hormone (ACTH)3. Prolonged administration of

glucocorticoids

Clinical features of Cushing Clinical features of Cushing disease:disease:1. Trunkal obesity2. Hypertension3. Glucosuria 4. Menstrual and sexual dysfunction5. Hirsutism and acne6. Muscle weakness7. Osteoporosis8. Poor wound healing 9. Edema10.More susceptible to infections

Clinical features of Cushing’s diseaseClinical features of Cushing’s disease

Addison’s diseaseAddison’s disease (chronic adrenocortical insufficiency)

Definition:Definition: Destruction of the adrenal cortex,

leading to a deficiency of glucocorticoids and androgens

Etiology:Etiology: Autoimmune adrenalitis Tuberculosis Metastatic cancer

Clinical presentation:Clinical presentation:1. Gradual onset of weakness2. Skin pigmentation3. Hypotension4. Hypoglycemia5. Poor response to stress

Addison’s diseaseAddison’s disease

METABOLIC METABOLIC DISORDERSDISORDERS

CALCIUM METABOLISM

Definition:

Calcium metabolism is the mechanism by which the body maintains adequate calcium levels.

Sources of calcium:Sources of calcium:

Calcium enters the body in a normal diet.

Vitamin D is an important co-factor in the intestinal absorption of calcium.

Calcium location in the body:Calcium location in the body:

99% in the skeleton in the form of calcium phosphate salts.

The extracellular fluid (ECF) and the serum.

DISORDERS OF CALCIUM DISORDERS OF CALCIUM METABOLISMMETABOLISM

Calcium

Regulated by three hormones1. Parathyroid hormone (PTH)

Increases plasma calcium levels2. Vitamin D

Fat-soluble steroid; increases calcium absorption from the gatrointectinal tract

3. Calcitonin Decreases plasma calcium levels

HYPERCALCAEMIAHYPERCALCAEMIA

Definition:

Hypercalcaemia is an elevated calcium level in the blood. It can be due to 1-excessive skeletal calcium release, 2-increased intestinal calcium absorption, or 3-decreased renal calcium excretion

Causes of hypercalcaemiaCauses of hypercalcaemia

1.Hyperparathyroidism and malignancy account for ~90% of cases

2.Vitamin D metabolic disorders3.Renal failure

Signs and symptoms:Signs and symptoms:

1.Hypercalcaemia can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, pancreatitis, renal stones and bladder stones.

2.Abnormal heart rhythms.

3.Severe hypercalcaemia is considered a medical emergency: at these levels as coma and cardiac arrest can result.

HypocalcaemiaHypocalcaemia

Definition:

Hypocalcaemia is the presence of low serum calcium levels in the blood.

Cause:Cause:

1.Eating disorders 2.Magnesium over supplementation 3.Prolonged use of medications/laxatives containing magnesium

4.Absent parathyroid hormone 5.Absent active vitamin D6.Decreased sun exposure 7.Intestinal malabsorption

Symptoms:Symptoms:

1.Peri-oral tingling and decreased sensations.

2.Tetany, carpo-pedal spasm are seen. 3.Latent tetany 4.Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)

5.Chvostek's sign (tapping of the inferior portion of the zygoma will produce facial spasms)

6.Tendon reflexes are hyperactive

Life threatening complications:Life threatening complications:

1.Laryngospasm2.Cardiac arrhythmias

Hypocalcemia and Hypercalcemia Hypocalcemia

Increased neuromuscular excitability

Muscle cramps

Hypercalcemia Decreased

neuromuscular excitability

Muscle weakness Increased bone

fractures Kidney stones Constipation

Vitamin D deficiency:

SIGNS OF VITAMIN D DEFICIENCY:

1. Rickets (children)

2.Osteomalacia (adults)

Vitamin D excess: → hypercalcaemia and kidney stones.

Rickets

A disease that is characterized by deficient mineralization of bone in children (before epiphyseal closure) leading to softening of the bones and potentially leading to fractures and deformity.

It is caused by Vitamin D deficiency which leads to decreased absorption of calcium

Vit. D deficiency may be due Vit. D deficiency may be due to:to:

1-Malnutrition associated with decreased exposure to sunlight

2-Secondary to intestinal malabsorption

Pathological features

There is abnormal bony trabeculae with big amounts of uncalcified osteoid leading to soft weak bones

Rickets :

Signs and symptoms of rickets include:

1. Bone pain or tenderness 2. dental problems (delayed teeth erruption) 3. muscle weakness (rickety myopathy or "floppy

baby syndrome") 4. increased tendency for fractures (easily broken

bones), especially greenstick fractures 5. Skeletal deformity: Bowed legs, cranial, spinal

and pelvic deformities 6. Growth disturbances7. Thoracic changes – pigeon breast deformity,

ricketic rosary.8. Head – cranio-tabes and frontal bossing.9. Vertebrae – lumbar lordosis.

Diagnosis:

1.Blood tests: Serum calcium may show low levels of calcium and serum alkaline phosphatase may be high.

2.X-rays of affected bones may show loss of calcium from bones or changes in the shape or structure of the bones.

3.Bone biopsy is rarely performed but will confirm rickets.

OSTEOMALACIAOSTEOMALACIA

Osteomalacia is the term used to

describe a similar condition occurring in adults, generally due to a deficiency of vitamin D.

It is characterized by inadequate mineralization of newly formed bone matrix.

OsteomalaciaOsteomalacia

Introduction 3% of world population, 100 million

people Incidence is increasing alarmingly Most Common non communicable

disease High Morbidity & mortality. Leading cause of blindness and Kidney

diseases

DIABETES MELLITUS

Definition:

Diabetes mellitus (DM) is a systemic disease resulting from deficient insulin secretion or development of resistance to insulin.

This leads to disturbance of carbohydrate metabolism and fat metabolism that is reflected on all body systems

Symptoms and signs of uncontrolled hyperglycaemia in Diabetes Mellitus

Infections in Diabetes: Diabetes Diabetes State of State of

immunosuppressionimmunosuppression

Causes of decreased immunity in DM:: Decreased metabolism low immunity Decreased function of lymphocytes &

neutrophils Ischemia & infarctions Increased glucose

Types of DM

Primary DM – (primary - no other disease) Type I – IDDM / Juvenile . Type II – NIDDM /Adult onset Gestational Diabetes

Secondary DM – (secondary to other dis.) Pancreatitis/ tumors/ Haemochromatosis. Infectious – congenital rubella. Endocrine diseases, Down Syndrome. Drugs – Corticosteroids.

Laboratory Diagnosis:

Urine glucose – (dip-stick) –Screening Fasting blood glucose Random blood glucose Post-prandial blood glucose

EFFECTS EFFECTS AND AND

COMPLICATIONS OF COMPLICATIONS OF DIABETESDIABETES

Complications:

Short term Complications: Hyperglycaemia Hypoglycaemia Diabetic Ketoacidosis Non Ketotic hyperosmolar diabetic coma Lactic acidosis

Long term Complications Microngiopathy - Retinopathy, Nephropathy,

Neuropathy, dermatopathy. Macroangiopathy – Atherosclerosis.

Microangiopathy Pathogenesis:

Hyperglycemia chronic. Glycosylation of basement membrane

proteins Leaky blood vessels. Excess deposition of proteins Thick and Leaky blood vessels. Narrow lumen Ischemic Organ damage...

Diabetic MicroangiopathyNormal

Diabetic

Diabetic Neuropathy

Peripheral Neuropathy Bilateral, symmetric Progressive, irreversible Leads to decreased sensation, pain,

muscle atrophy

Visceral neuropathy Cranial nerve diplopia GIT constipation, diarrhoea CVS orthostatic hypotension

Diabetic Neuropathic ulcer

Use of a monofilament in testing for impaired sensation in the foot of a person with diabetes

Neuropathic ulcer

Etiology: peripheral sensory

neuropathy, trauma & deformity.

Factors: Ischemia, callus

formation, and edema.

Neuropathic ulcers

FEATURES:Painless, surrounded by callus At pressure points. associated with good foot pulsesMay or may not be associated with gangrene

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