2/6/2009

-Notes by: Islamiat Olaribigbe

-olaribs14@hotmail.com
-A lot of the endocrine disorders do not have specific symptoms! J ust a
warning.
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-Read Slide
-Endocrine disorders affect a lot of organ systems.
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-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.
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- Read Slide.
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-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.
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-Read Slide.
-E.g. Hypothyroidism due to a thyroid problem negative feedback to the
AP to release TSH try to correct the pathology.
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-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.
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-Read Slide.
-Hyperthyroidism/Hypothyroidism Problems with Basal Metabolic Rate
-Insulin is necessary to maintain glucose. If there isnt 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
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-Heat/Cold Intolerance thyroid problem
-Polyphagia (eating a lot) and PolydipsiaDiabetes
-Puffiness thyroid problem
-Salt Craving due to loss of salt in the urine.
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-Gain weight rapidly clue to Hypercortisolism (Cushings) 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 SwellingThyroid Condition -Neck Swelling Thyroid Condition
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-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
Lowcortisol increaseACTH via the negative feedback loop -Low cortisol increase ACTH via the negative feedback loop
-Increased ACTH Increase melanocyte-stimulating hormone (MSH)
-Leads to hyperpigmentation.
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-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.
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-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. Turners,
etc
-Galactorrhea (outside of childbirth) Sign of increasedprolactin Galactorrhea (outside of childbirth) Sign of increased prolactin
-Failure of Lactation (after childbirth) Hypopituitarism
-Gynecomastia too much female hormones in a male.
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- Protrusion of Eyes Exophthalmos Graves disease
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-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)
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-Read Slide.
-There are some genetic causes of hormonal problems (very rare)
-Hirsutism Polycystic Ovary Syndrome (usually overweight with secondary
amenorrhea)
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-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)
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-Read Slide.
-Diet Pills Tachycardia
-Exogenous Steroids Cushing-like Syndrome
-Estrogen May increase TBG
-Iodide May cause either hyper- or hypothyroidism
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- Endocrine disorders covers all of the organ systems.
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Lassitude Fatigue or Lethargy
-Combination of these signs and symptoms will help with diagnosis
-Growth Rateespecially in kids. The main culprits in kids that interfere
with growth are: GH deficiency, Thyroid Hormone deficiency and Cortisol
excess.
-Temperature Intolerance Thyroid problems
Cause of the most significant weight gain Hypercortisolism -Cause of the most significant weight gain Hypercortisolism.
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-Read Slide.
-She repeated what she had said before.
-Poor Healing and Bruising Hypercortisolism
-Flushing secondary to Carcinoidor may be due to Pheochromocytoma.
-Look at next slide.
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- ReadSlide
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Read Slide.
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-Headaches Pituitary dysfunction
-Coarsening of appearance may be due to excess GH
-Voice change hypothyroidism
-Pain, Swelling or Pressure on neck Thyroid problems
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-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)
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-Read Slide.
-Addisons Disease also presents with low BP.
-Hyperthyroidism doesnt cause true diarrhea (i.e. loose stools) but may be
more of hyper-defecation (frequent small stool, not necessarily loose).
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- Read Slide
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-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 hyperparathroidismor Vit D toxicity.
-Hypokalemia Hyperaldosteronismwith resistant HTN.
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-Hypogonadismwill have no interest in sex.
-Obstretrical Hx Blood loss during delivery may cause Sheehans
Syndrome
-Menstrual Hx early menopause, amenorrhea, etc
-Fertility has to do with H-P axis
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- Read Slide.
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- ReadSlide.
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- Endocrine disorder usually has to do with too something.
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-Read slide.
-IncreasedRR DKA (Kussmauls Breathing)
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- Eunuchoidism sign of hypogonadism. Long extremities with small trunk.
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-They may complain that the shoe or glove size does not fit.
-Acromegaly.
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-This is Truncal Obesity. Characteristic of Cushings.
-If you were to examine the abdomen carefully, you might see purple striae.
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-ReadSlide.
-Thyroid Achropachy Clubbing-like effect.
-HypoparathyroidismMucocutaneous Candidiasis
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-These are identical twins. Which one has Addisons Disease?
-The one on the R (Hyperpigmentation, thinner)
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- ReadSlide
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- When looking @ signs and symptoms of Goiter.
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- Read Slide.
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- Hypogonadism check the hypothalamic-pituitary axis.
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