Endocrine System

Thyroid disorders

• Hypothyroidism

• Hyperthyroidism

• Thyroiditis

• Goiter

Hypothyroidism

Low blood levels of thyroid hormone

Hypothyroidism - Symptoms

• Weight gain

• Cold intolerance

• Fatigue

• Weakness

• Bradycardia

• Hypoventilation

• Constipation

• Myalgias

• Arthralgia

• Anemia

• Goiter

Hypothyroidism - Primary causes

• Congenital thyroid problems

• Hashimoto’s thyroiditis

• Side effects of a drug

• Iodine deficient

• Post-surgical damage/removal

• Radiotherapy with Iodine 131

Hypothyroidism - Second guesses

Result of pituitary pathology

• Infection

• Inflammation

• Infiltration

• Hemorrhage

• Tumor

Hypothyroidism Medications

• Levothyroxine

• Thyroglobulin

• Liothyronine/liotrix

• Desiccated thyroid

Levothyroxine - I

Hypothyroidism

Levothyroxine - MOA

Synthetic T4 hormone

Levothyroxine - SE

• Nervousness

• Palpitations

• Tachycardia

• Heat intolerance

• Unexplained weight loss

Thyroglobulin - I

Hypothyroidism

Thyroglobulin - MOA

Synthetic T3 and T4 hormone

Thyroglobulin - SE

• Neevousness

• Palpitations

• Tachycardia

• Heat intolerance

• Unexplained weight loss

Liothyronine - I

Hypothyroidism

Liothyronine - MOA

Synthetic T3 and T4 hormone

Liothyronine - SE

• Nervousness

• Palpitations

• Tachycardia

• Heat intolerance

• Unexplained weight loss

Desiccated thyroid - I

Hypothyroidism

Desiccated thyroid - MOA

Natural T3 and T4 hormone

Desiccated thyroid - SE

• Nervousness

Hyperthyroidism

Elevated levels of thyroid hormone in the blood

Hyperthyroidism - Symptoms

• Unexplained weight loss

• Tachycardia

• Dyspnea

• Heat intolerance

• Hot skin

• Increased appetite

• Tremor

• Nervousness

Hyperthyroidism - Causes

• Toxic nodule

• Graves’ disease

• Pituitary humor

• Amiodarone toxicity

• Struma ovarii

• Thyroiditis (early stages)

Hyperthyroidism - Medications

• Removal of part or all of the thyroid gland

• Thioamides

• Propylthiouracil

• Methimazole

• Iodine 131 Radiation

Thionamide and Propylthiouravil - I

Hyperthyroidism

Thionamide and Propylthiouravil - MOA

Competitive inhibitors of TPO = stops the incorporation of iodine to tyrosine = decreased thyroglobulin production

Thionamide and Propylthiouravil - SE

• Rashes

• Nausea

• Vomiting

• Stomach pain

• Fever

• Increased bleeding

Methimazole - I

Hyperthyroidism

Methimazole - MOA

Inhibits TPO enzyme = stops the incorporation of iodine to tyrosine = decreased thyroglobulin production

Methimazole - SE

• Rashes

• Nausea

• Vomiting

• Stomach pain

• Fever

• Increased bleeding

Iodine 131 Radiation - I

Hyperthyroidism

Iodine 131 Radiation - MOA

Uses radiation to kill thyroid cells

Iodine 131 Radiation - SE

• Rashes

• Nausea

• Vomiting

• Stomach pain

• Fever

• Increased bleeding

Thyroiditis

Inflammation of the thyroid gland

Thyroiditis - Symptoms

• Early: hyperthyroid symptoms

• Late: hypothyroid symptoms

• Enlargement of the thyroid gland

Thyroiditis - Causes

• Viral infections (deQuervain’s thyroiditis, Epstein Barr)

• Radiation

• Autoimmunity

• Delivery of a baby

Thyroiditis - Treatment

Treat underlying cause and symptoms

Goiter

Enlargement of the thyroid gland

Goiter - Causes

• Iodine deficiency

• Thyroiditis

• Autoimmune diseases (Grave’s and Hoshimoto’s)

• Thyroid cancer

• Pregnancy

Goiter - Treatment

• Treat underlying cause and symptoms

• Surgical removal if severe

Calcitonin - I

Osteoporosis

Calcitonin - MOA

• Inhibits osteoclast activity

• Decreases calcium absorption in the small intestine

• N creases calcium loss in the urine

Calcitonin - SE

• Hypersensitivity

• Reactions of the tongue and throat

• Hypocalcemia

• Nasal mucosa adverse event

• Malignancy

Adrenal Disorders

• Hyperaldosteronism

• Hypoaldosteronism

• Cushing’s syndrome

• Adrenal insufficiency

Hyperaldosteronism

Elevated blood levels of aldosterone

Hyperaldosteronism - Symptoms

• Hypernatremia

• Hypokalemia

• Hypertension

Hyperaldosteronism - Causes

• Hyperactive adrenal glands due to adenoma or adrenal carcinoma

• Over stimulation to secrete

Hyperaldosteronism - Treatment

• Treatment underlying cause

• Hypertensive medications

Hypoaldosteronism

Low blood levels of aldosterone

Hypoaldosteronism - Symptoms

• Fatigue

• Low blood pressure

• Hyperkalemia

• Muscle weakness

• Nausea

• Dehydration

Hypoaldosteronism - Causes

• Decreased renin secretion from the kidneys due to diabetes and chronic kidney diseases

• ACE inhibitors

• Adrenal insufficiency

Hypoaldosteronism - Treatment

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Cushing’s Syndrome

Pathological elevation of cortisol

Cushing’s Syndrome - Symptoms

• Obesity

• Moon face

• Buffalo hump

• Easy bruising

• Purple striae

• Hypertension

• Edema

• Weakness

• Osteoporosis

• Diabetes (type II)

Cushing’s Syndrome - Causes

• Iatrogenic

• Over secretion

• Over stimulation of adrenal glands due to a pituitary tumor

Cushing’s Syndrome - Treatment

Treat underlying causes

Adrenal medications

• Glucocorticoids

• Hydrocortisone

• Fludrocortisone

Glucocorticoids - I

Inflammation or immunosuppression

Glucocorticoids - MOA

Varied metabolic effects

• Gluconeogenesis

• Stimulate protein catabolism and lipolysis

Glucocorticoids - SE

• Fluid and electrolyte imbalances

• Increase in blood glucose

• Muscle weakness

• Peptic ulcers

• Thin, fragile skin that bruises easily

• Poor wound healing

• Development of Cushing’s syndrome

• May mask some signs of infection

• Psychic derangements may appear when corticosteroids are used ranging from euphoria, insomnia, mood swings, and personality changes to severe depression

Hydrocortisone - I

Topical relief of itching, redness, and swelling

Hydrocortisone - MOA

Binds to glucocorticoid receptors that lead to anti-inflammatory effects

Hydrocortisone - SE

• Fluid retention

• Increased blood sugar

• Mood changes

• Skin reactions

Fludrocortisone - I

Aldosterone replacement in Addison’s disease

Fludrocortisone - MOA

Acts as a mineralocorticoid leading to increased reabsorption of sodium and potassium from the nephron

Fludrocortisone - SE

Potential adverse effects from retention of sodium and water:

• Hypertension

• Edema

• Cardiac enlargement

• Congestive heart failure

• Potassium loss

• Hypokalemic alkalosis

Diabetes Mellitus

Decreased insulin secretion or insensitivity to insulin occurs resulting in high levels of blood glucose (>100 fasting/120 nonfasting

• Type 1 (Juvenile): loss of insulin production

• Type 2 (Adult onset): insulin resistance

Diabetes Mellitus - Symptoms

• Hyperglycemia

• Weight loss

• Excessive appetite

• Dental caries

• Increased infections and delayed healing

• Vaginitis

• Increased thirst

• Increased urinary frequency

• Hypo/hypertension (more hyper than hypo)

• Ketoacidosis

• Kidney failure

• Breath that smells like rotten fruit

Diabetes Mellitus - Treatment

• Diet

• Lifestyle changes (decrease amount of sugar in diet)

• Medications

Diabetes Mellitus - Medications

• Sulfonylureas

• Glinides

• Bigunanides

• Thiazolidinediones

• Alpha-glucosidease inhibitors

• Dipeptidyl peptidease-4 inhibitors

• Sodium-glucose cotransporter 2 inhibitors

• Insulin injections

Sulfonylureas - I

Type II

Sulfonylureas - MOA

Stimulation of insulin release by blocking ATP-are potassium channels, resulting in depolarization = exocytosis of insulin

Sulfonylureas - SE

• Weight gain

• Hyperinsulinemia

• Hypoglycemia

• Renal impairment

Glinides - I

Type II

Glinides - MOA

Stimulation of insulin release by closing ATP-ass potassium channels, resulting in depolarization = Exocytosis of insulin

Glinides - SE

• Hypoglycemia

• Weight gain

Biguanides (Metformin) - I

Type II

Biguanides (Metformin) - MOA

Reduction hepatic gluconeogenesis, slows intestinal, absorption of glcuose

Biguanides (Metformin) - SE

• Hypoglycemia

• Weight loss

• Lactic acidosis

• Acute renal failure

• Decreases B vitamin absorption

Thiazolidinediones - I

Type II

Thiazolidinediones - MOA

Lower insulin resistance by increasing insulin sensitivity of adipose, liver, and skeletal tissue

Thiazolidinediones - SE

• Liver toxicity

• Weight gain

• Osteopenia

• Increased fracture risk

• MI

Alpha-Glucosidase inhibitors - I

Type II

Alpha-Glucosidase inhibitors - MOA

Blocks the enzyme that breaks down carbs into their monomer

Alpha-Glucosidase inhibitors - SE

• Flatulence

• Diarrhea

• Abdominal cramping

Dipeptidyl peptidase-4 inhibitors - I

Type II

Dipeptidyl peptidase-4 inhibitors - MOA

Inhibit the enzyme that is responsible for the inactivation of GLP-1, resulting in increased insulin secretion

Dipeptidyl peptidase-4 inhibitors - SE

• Nasopharyngitis

• Headache

• Pancreatitis

Sodium-glucose cotransporter 2 inhibitors - I

Type II

Sodium-glucose cotransporter 2 inhibitors - MOA

Inhibits the SLGT in the nephron = decreased absorption of glucose

Sodium-glucose cotransporter 2 inhibitors - SE

• Genital mycotic infections

• UTI’s

• Urinary frequency

Insulin - I

Type I

Insulin - MOA

Replaces insulin that is not secreted by the pancreas

Insulin - SE

• Hypoglycemia

• Weight gain

• Injection site reactions

• Lipodystrophy