3/26 endocrine disorders (Chadbourne)

• Hormones

  • Secrete Chemical messengers into bloodstream

• Tissues

  • Hypothalamus

    • Sends signals

    • Masterswitch board

    • Controls endrocirne

  • anterior pituitary and posterior pituitary

    • Receives from hypothalamus

    • Master gland

    • Releases homrones

• Function is to maintain homeostasis

Link between hypothalamus and end organs

• Ex

  • Estrogen is low

  • hypothalamus> pituitary >ovaries >makes estrogen>into blood stream

hypothalamus-pituitary hormonal axis

• Link between hypothalamus and pituitary end organ

• Pituitary (hypophysis)

  • Anterior pituitary (adenohypophysis)

    • Blood vessel connection with hypothalamus (hypothalamus- hypophyseal portal system)

    •  Releases tropic hormones

  • Posterior pituitary (neurohypophysis)

    • Neural connection with hypothalamus

    •  Hormones made by hypothalamus, stored and released by posterior pituitary

Pitutary Hormones

• anterior pituitary hormones

  • Growth hormone

  • Prolactin

  • Adrenocorticotropic hormone ( )

  • Thyroid-stimulating hormone (TSH

  • Follicle-stimulating hormone (FSH)

  • Luteinizing hormone (LH)

• Posterior pitaurary hormones 

  • Antidiuretic hormone

    • AKA: arginine vasopressin

  • Oxytocin

Posterior pituitary releases what hormones?

Anterior pituitary releases what hormones?

Endocrine regulation

• negative feedback system

  • End-product hormone negatively feeds back to prevent further stimulations

    •  Example: thyroid hormones suppress thyroid that stimulates hormone production

“What feedback system does the endocrine system use?”

“What is the negative feedback system in the endocrine system?”

Receptor activity

• Upregulation

  • Increased receptor sensitivity and number

• Downregulation

  • Decreased receptor sensitivity and number

Endocrine Conditions

 3 Major types of endocrine conditions

• Hormone deficiency

  • Gland destruction

    •  Autoimmune, infection, tumor

• Hormone excess

  • Tumor, autoimmune, genetic mutation

• Hormone resistance

  • Usually genetic (lack hormone receptor or ability to respond)

Dysfunctions of endocrine glands

• Hypofunction

  • Not enough hormone

• Hyperfunction

  • Excessive

Levels of dysfunction

• Primary

  • Endocrine Gland dysfunction

• Secondary

  • pituitary gland dysfunction

• Tertiary

  • Hypothalamus dysfunction

Causes of endocrine dysfunction

• Autoimmune

  • Within self

• Neoplasia

  • Cancers

• EDC endocrine disrupting compounds

  • Drugs

  • Enrvioromental 

Assessment

• Medical history

• Often multisystem

  • Affects mood and behavior

Diagnosis

• Immunoassays and blood levels of hormone!!

• Urinary hormone levels

• 24 hr urine collection

• Supression and stimulation tests

• ct/mri/ultrasound

Treatment

• Hormone replacement therapy

  • Dosages scheduling mimic physiological effects

  • Common hormonal replacements

    • Glucorticoid, thyroid hormones, sex steroids, adh 

• Supression of hormone overproduction

  • Meds, surgery, raidiation

Hypopituitarism

• Affecting One or more pituary hormones

• Types

  • Panhypopitaruarism

    • Complete loss of all pituitary hormones

• Causes

  • Pituitary tumor, brain surgery, brain radiation, congential

  • Trauma, ischemia, infaraction can cause sudden loss

    • Sheehans syndrome

      • Developes after childbirth with severe hermorrhage

  • Primary adenoma

    • Most common cause 

    • Benign neoplasm

    • Growth Compresses gland itself in sella turcia

      • Interferes with function of pituitary gland

  • Craniopharyngioma

    • Bengin neoplasm close to pituary gland

  • Pitutary apolexy

    • Sudden destruction of pituitary tissue due to infarction

    • TBI

  • Sheehans syndrome

    • Ischemia and infarction of pituitary after childbirth

    • Severve hemorhage

    • Develop deficiency of ACTH, TSH, FSH, LH, ADH, and PRL

    • baby

  • Empty Sella

    • Herniation of minigenal membrane compress pituaries

  • TBI

  • Hypothalamus dysfunction

    • Causes pituitary dysfunction

Signs and symptoms of hypopituatarism

• Dependent on hormones supressed

  • Serious

    • Adrenal insuffients

    • Hypothyroidism

    • Diabetes insidious

• Age of onset

  • Child vs adult have different sysmptoms of hypopitaruatsm 

  • Infant hypoutuarism

    • Dwarfism

    • Develeopment delay

    • Seizures

    • Neuro and visual symptoms

  • Adults

    • Weakness

    • Sluggish

    • Depression

    • Weight loss aand gain

    • Thirst

    • hypotension

• Acute hypopituary

  • Rapid deterioaration

Daignosis

• Blood tests

  • Pituitary, hypothyalmic and end organ levels

• Corictropin stimulation test

  • Gibing ACTH

    • Cortisol levels SHOULD RISE

      • If cortisol levels rise with ACTH administration= pituitary problem

      • If cortisol levels do not rise with ACTH administration= adrenal gland problem

• MRI and CT

If cortisol levels rise with ACTH administration= pituitary problem

If cortisol levels do not rise with ACTH administration= adrenal gland problem

Diabetes Insipidus (DI)

• Posterior pituitary hypopituitarism

  •  Lack of ADH or response to ADH

• Dilute, large volume urine is main symptom

• Plasma concentration increases

• Categories of disease

  • Central DI

    • Lack ADH from the posterior pituitary

  • Nephrogenic DI

    • Kidney fails to respond to ADH

    • Distinguish by administering ADH to see if kidneys can respond, if so, central DI

Signs and symptoms of DI

• Freuqent urination, thrirst, dehyrdation, disorentation > sezuires

• Blood test with high osmolarity and hypernatremia

• urine  Osmoity and specific gravity is LOW

DI does not affect glyemia! Only water

Treatment

• Adh administration if central DI

• Desmopression

Desmopression

• Actions

  • Pressor and antidiareteic effects

  • REPLACES VASOPRESSIN

  • Reduces urine output 

• Indication

  • Treatment of DI (hypernatremia)

• Controindations

  • Kidney issues 

  • HF (fluid retention)

  • HTN (clotting factors is bad)

• Catuions

• Adverse effects

  • CNS depression

  • Headache

  • Hyponaturmeia

  • Nausea 

  • Water intoxication

  • HTN

• Drug interactions

  • Caffeine

• Assess

  • Monitor serum sodium levels

    • Very sensititive

  • Assess fluid 

    • Monitor edema and fluid outload

• Teach

  • Limit fluid intake

  • Same time everyday

  • Report CNS symptoms 

  • Avoid caffeiene 

Hyperpituatarism

• Pituary ademona

  • Common cause

  • Produces ACTH, FSH, GH

    • Prolactinoma is most common form

      • Secretes PRL

      • High PRL has antiestrogen and antiandrogenic

• Large tumors

  • Headaches

• Children

  • Acth ademona

  • Corticostinomas before puberty

  • Cushingssympotms

• GH secreteiona adeoma

  • Giantism

  • Acromegaly

• Diagnosis

  • Serum hormone

• Treatment

  • Depends on elevated hormone

  • Surgery, drugs

Syndrome of Inapproriate ADH (SIADH)

• Excessive adh

  • Causes

    • Brain injury, neruvosuergy

• Causes FLUID RETINTION

  • Concentrated urine, dilute plasma,

  • HYPERVOLEMIA + hyponatrema

    • Causes HIGH blood pressor HTN

• Symtpoms

  • Naseuea

  • CNS depression

  • Edema

  • Fatigue

  • Muscle cramps

  • sezuires

• Treatment

  • Fluid restriction

  • Slow correction of hyponatrmia

  • Adh recptor antagonists

Comparison of DI vs SIADH

• di=little ADH, hypernatremia, diluted urine

• siadh= lots of ADH, fluid retention and hyponatremia, concentrated urine