Endocrine Disorders - Pathophysiology and Management

Endocrine Disorders Overview

• The endocrine system regulates internal body functions such as growth, metabolism, and reproduction.

• Major endocrine organs include the thyroid gland, pituitary gland, pancreas, adrenal glands, and gonads.

Learning Outcomes

• Understand the etiology, diagnosis, and treatment strategies for:

  • Hyperthyroidism

  • Hypothyroidism

  • Diabetes Mellitus Type 2

Thyroid Gland Functions

• Butterfly-shaped gland located in front of the trachea; secretes thyroid hormones.

• Functions:

  1. Increases basal metabolic rate.

  2. Affects protein synthesis.

  3. Essential for growth and development.

  4. Regulates body heat production.

Hyperthyroidism

• Definition: Increased production of thyroid hormones.

• Causes:

  • Graves’ disease

  • Toxic multinodular goiter

  • Thyroid carcinoma

  • TSH-secreting pituitary adenomas

  • Thyroiditis

  • Excessive intake of thyroid medication.

• Graves' Disease: Most common cause; an autoimmune disorder leading to excessive thyroid hormone production.

Diagnosis of Hyperthyroidism

• Thyroid Function Tests (TFT): Low TSH, high T3 and T4.

• Thyroid Antibodies: Testing for TSI.

• Ultrasound & Biopsy: Check for lesions or tumors.

• Radioactive Iodine Uptake Test: Increased uptake indicates Graves’ disease.

Symptoms of Hyperthyroidism

• Fever

• tachycardia

• agitation

• delirium

• nausea and vomiting

Treatments for Hyperthyroidism

• Drug Therapy: Carbimazole and Propylthiouracil to reduce hormone production; Beta-blockers for symptoms.

• Radioactive Iodine Therapy: Destroys thyroid cells.

• Surgery: Thyroidectomy, either partial or total.

Thyroid Storm

• A life-threatening condition caused by untreated hyperthyroidism; symptoms include fever, tachycardia, and agitation.

Hypothyroidism

• Definition: Deficiency in thyroid hormone production.

• Primary Causes: Autoimmune thyroiditis, iodine deficiency, congenital defects.

• Secondary Causes: Pituitary or hypothalamic failure.

Diagnosis of Hypothyroidism

• Thyroid Function Tests (TFT): Elevated TSH, low T3 and T4.

Symptoms of Hypothyroidism

• Loss of consciousness

• Hypothermia 低體溫

• Hypoventilation

• Hypotension

Treatments for Hypothyroidism

• Drug Therapy: Levothyroxine replacement; iodine supplements where needed.

Complications of Hypothyroidism

• Myxedema Coma: Severe, life-threatening state characterized by hypothermia, hypotension, and loss of consciousness.

Diabetes Mellitus Overview

• Characterized by chronic hyperglycemia; arises from defects in insulin secretion or action.

• Types:

  • Type 1 (IDDM): Autoimmune destruction of insulin-secreting beta cells.

  • Type 2 (NIDDM): Insulin resistance.

  • Gestational diabetes.

Pathophysiology of Diabetes Mellitus

• Type 2 DM: Cells become resistant to insulin leading to hyperglycemia; beta-cell function declines over time.

Diagnosis of Diabetes Mellitus

• Blood Tests: A1c greater than 6.5% or fasting glucose of 7.0mmol/L or greater.

• Oral Glucose Tolerance Test: Measures body's response to glucose.

Treatment for Diabetes Mellitus

• Lifestyle Modification: Diet control and regular exercise.

• Hypoglycemic Agents: Various classes available to lower blood sugar levels.

• Insulin Therapy: Essential for Type 1 and in some cases of Type 2.

Complications of Diabetes Mellitus

• Acute Complications: Hypoglycemia, diabetic ketoacidosis (DKA).

• Chronic Complications: Microvascular (neuropathy, retinopathy, nephropathy) and macrovascular diseases (CAD, stroke).

Living with Diabetes

• Importance of regular monitoring and managing lifestyle choices to prevent complications.

• Periodic Screening: Regular blood tests and physical check-ups to manage diabetes effectively and prevent complications.

Prevention of Diabetes

• Healthy lifestyle, dietary control, physical activity, and avoiding sedentary behavior.