2/6/2009

-Notes by: Islamiat Olaribigbe-olaribs14@hotmail.com

-A lot of the endocrine disorders do not have specific symptoms! Just a warning.

1

2/6/2009

-Read Slide-Endocrine disorders affect a lot of organ systems.

2

2/6/2009

-This is a form of hyperthyroidism. -It affects the eyes Exophthalmus; the neck Goiter; the skin pretibial myxedema; heart Tachycardia; GI diarrhea; muscles weakness.-You can see that all endocrine disorders affect a lot of organs systems-Diagnosis is made by putting all of these signs and symptoms together.

3

2/6/2009

- Read Slide.

4

2/6/2009

-This is just a review of the endocrine system. -For example: Let us take Corticotropin – Releasing Hormone (CRH).

-Stimulates the anterior pituitary (AP) to produce and release ACTH-ACTH acts on the Adrenal gland to produce Cortisol.-There are a lot of negative feedback loops in the endocrine system. Increase in cortisol will negative feedback to decrease ACTH (in the AP) and CRH (in the hypothalamus.)-GHRF stimulates the AP to release GH, which then goes to the target organs.-TRH TSH Thyroid Hormones (T3 and T4)-The posterior pituitary hormones are: ADH and Oxytocin (involved in milk ejection)-A special hormone is Prolactin (it is involved in lactation). It can give you a clue of a CNS dysfunction.

-Not part of the hypothalamic-pituitary pathway is the: Parathyroid gland; Insulin from the pancreas.

-Gonadal Hormones: They are part of the hypothalamic-pituitary axis; Important for secondary characteristics in males and females.

5

2/6/2009

-Read Slide.-E.g. Hypothyroidism due to a thyroid problem negative feedback to the AP to release TSH try to correct the pathology.

6

2/6/2009

-A pituitary tumor may enlarge and compress the optic chiasm visual defects (Bitemporal Hemianopsia).-Read Slide.-If the thyroid is affected, it may compress the esophagus dysphagia-Depending on the hormone secreted by the mass, you can get feminization in the males and virilization in the females.

7

2/6/2009

-Read Slide.-Hyperthyroidism/Hypothyroidism Problems with Basal Metabolic Rate-Insulin is necessary to maintain glucose. If there isn’t enough insulin, you may start to break protein and fats to compensate.-ADH affects your water and electolytes (indirectly)-Calcium metabolism can be affected by PTH, Vit D and other misc. causes

8

2/6/2009

-Heat/Cold Intolerance thyroid problem-Polyphagia (eating a lot) and Polydipsia Diabetes-Puffiness thyroid problem-Salt Craving due to loss of salt in the urine.

9

2/6/2009

-Gain weight rapidly clue to Hypercortisolism (Cushing’s) or Hypothyroidism-Decrease in weight Hyperthyroidism or Adrenal Insufficiency.-Increase in height Excess GH-Decrease in height may be due to vertebral fractures from osteoporosis (Vit D probs.)Neck Swelling Thyroid Condition-Neck Swelling Thyroid Condition

10

2/6/2009

-Hair growth in females on the face or on the back sign of virilization (inc. testosterone)-Inc Sweating GH excess or hyperthyroidism-Dec Sweating Hypothyroidism-Pigmentation (especially on the palms of hands or oral mucosa) Adrenal Insufficiency

Low cortisol increase ACTH via the negative feedback loop-Low cortisol increase ACTH via the negative feedback loop-Increased ACTH Increase melanocyte-stimulating hormone (MSH)-Leads to hyperpigmentation.

11

2/6/2009

-Bone pains and tenderness Calcium metabolism disorders (can be Vit D or PTH)-Muscle pain Thyroid problem (may be either hyper- or hypo-)-Periodic Paralysis – generally associated with thyroid dysfunction.

12

2/6/2009

-Loss of Libido Low sex hormones-Amenorrhea can be primary (never had menses) or secondary (cessation of menses) Gonadal dysfunction-Lack of secondary characteristics Hypothalamic-Pituitary Dysfunction or Primary gonadal problems where the gonads never developed e.g. Turner’s, etc-Galactorrhea (outside of childbirth) Sign of increased prolactinGalactorrhea (outside of childbirth) Sign of increased prolactin-Failure of Lactation (after childbirth) Hypopituitarism-Gynecomastia too much female hormones in a male.

13

2/6/2009

- Protrusion of Eyes Exophthalmos Graves disease

14

2/6/2009

-Past history is important especially in children. -Read Slide.-Watch to see if children have fallen out of their growth curves.-Failure to enter puberty Endocrinal or Genetic (e.g. Kallmann Syndrome – Hypogonadism/lack of secondary sex characteristics and Anosmia)

15

2/6/2009

-Read Slide.-There are some genetic causes of hormonal problems (very rare)-Hirsutism – Polycystic Ovary Syndrome (usually overweight with secondary amenorrhea)

16

2/6/2009

-Read Slide.-Medications can mimic endocrine dysfunction.-Cocaine – can mimic hyperthryroidism (e.g. palpitations)-Lithium – may cause endocrine problem Hypothyroidism becauses it interferes with iodine trapping in the thyroid.-Hormonal Replacement Therapy can present as endocrine disorders (may be too much or too little)be too much or too little)

17

2/6/2009

-Read Slide.-Diet Pills – Tachycardia-Exogenous Steroids Cushing-like Syndrome-Estrogen May increase TBG-Iodide May cause either hyper- or hypothyroidism

18

2/6/2009

- Endocrine disorders covers all of the organ systems.

19

2/6/2009

Lassitude – Fatigue or Lethargy-Combination of these signs and symptoms will help with diagnosis-Growth Rate especially in kids. The main culprits in kids that interfere with growth are: GH deficiency, Thyroid Hormone deficiency and Cortisol excess.-Temperature Intolerance – Thyroid problemsCause of the most significant weight gain Hypercortisolism-Cause of the most significant weight gain Hypercortisolism.

20

2/6/2009

-Read Slide.-She repeated what she had said before.-Poor Healing and Bruising – Hypercortisolism-Flushing – secondary to Carcinoid or may be due to Pheochromocytoma.-Look at next slide.

21

2/6/2009

- Read Slide

22

2/6/2009

Read Slide.

23

2/6/2009

-Headaches – Pituitary dysfunction-Coarsening of appearance – may be due to excess GH-Voice change – hypothyroidism-Pain, Swelling or Pressure on neck Thyroid problems

24

2/6/2009

-Palpitations can be severe enough to cause High output cardiac failure esp. Hyperthyroidism-Hypertension – Hyperaldosteronism (with an associated hypokalemia), Pheochromocytoma (associated with episodic headaches and palpitations)

25

2/6/2009

-Read Slide.-Addison’s Disease also presents with low BP.-Hyperthyroidism doesn’t cause true diarrhea (i.e. loose stools) but may be more of hyper-defecation (frequent small stool, not necessarily loose).

26

2/6/2009

- Read Slide

27

2/6/2009

-Read Slide-DI usually want COLD ICE WATER, compared to DM. DM patients do not have a special need for ice water (they will drink anything).-Hypercalcemia may be cause by hyperparathroidism or Vit D toxicity.-Hypokalemia – Hyperaldosteronism with resistant HTN.

28

2/6/2009

-Hypogonadism will have no interest in sex.-Obstretrical Hx Blood loss during delivery may cause Sheehan’s Syndrome-Menstrual Hx early menopause, amenorrhea, etc-Fertility has to do with H-P axis

29

2/6/2009

- Read Slide.

30

2/6/2009

- Read Slide.

31

2/6/2009

- Endocrine disorder usually has to do with “too” something.

32

2/6/2009

-Read slide.-Increased RR DKA (Kussmaul’s Breathing)

33

2/6/2009

- Eunuchoidism – sign of hypogonadism. Long extremities with small trunk.

34

2/6/2009

-They may complain that the shoe or glove size does not fit.-Acromegaly.

35

2/6/2009

-This is Truncal Obesity. Characteristic of Cushing’s.-If you were to examine the abdomen carefully, you might see purple striae.

36

2/6/2009

-Read Slide.-Thyroid Achropachy – Clubbing-like effect.-Hypoparathyroidism Mucocutaneous Candidiasis

37

2/6/2009

-These are identical twins. Which one has Addison’s Disease?-The one on the R (Hyperpigmentation, thinner)

38

2/6/2009

- Read Slide

39

2/6/2009

40

2/6/2009

- When looking @ signs and symptoms of Goiter.

41

2/6/2009

- Read Slide.

42

2/6/2009

43

2/6/2009

- Hypogonadism – check the hypothalamic-pituitary axis.

44

2/6/2009

45