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.