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Type of Disease
Hyperpituitarism
Pathology
Overproduction of ACTH from Over production of Overproduction of GH
pituitary GH in a child in an adult
Cause
Pituitary: Tumor or Functioning adenoma of anterior pituitary
hyperplasia
Diagnosis
Hypokalemia, alkalosis, CRH
assay (differentiate Cushing GH Level GH level
Ds from ectopic ACTH)
↑ cortisol
Treatment
Surgical removal of producing
tumor
**Octreotide
High doses of hydrocortisone (Sandostatin)
1 day prior to surgery and Bromocriptine
300mg continuous IV on the (Parlodel)
day of surgery
Disease
Prolactinoma
(Amenorrhea-Galactorrhea Syndrome) Simmond’s Disease Craniopharyngioma
(Pituitary Cachexia)
**most common functional pituitary
tumor**
Type of
Disease Hyperpituitarism Hypopituitarism
Pathology
Overproduction of prolactin Underproduction of pituitary Pressure on pituitary thus
tropic hormones decreasing output of
tropic hormones
Cause
Lesions of Hypothalamus
from:
Craniopharyngioma,
Glioma
Germinoma
Signs &
Symptoms Women Males Pressure on pituitary – erosion
Galactorrhea Visual defects of surrounding bones,
Amenorrhea Impotence hypothalamus –
Oligomenorrhea Headaches hydrocephalus, optic nerves –
Infertility EOM paralysis bitemporal hemianopia
Early Late
manifestations manifestations
Diagnosis
↑ prolactin level ↓ tropic hormones ↓ tropic hormones
Treatment
Bromocriptine (Parlodel)
Pathology
Enlargement of Underproduction of ADH Overproduction of ADH
pituitary during
pregnancy followed by
sudden hypotension
precipitates necrosis
leading to decreased
pituitary secretion
OR
DIC, cavernous sinus
thrombosis, DM
Cause
Sudden infarction of Acquired: **Cranial: Intracranial trauma
anterior lobe due to Compression familial (hemorrhage), infection
hemorrhage or shock or (meningitis), cytotoxic
during delivery or destruction drugs
traumatic abortion of OR
hypothalamu Ectopic ADH secretion
s OR
posterior
pituitary by
inflammatory
and
infiltrative
lesions,
tumors,
radiation,
trauma or
surgery
Diagnosis
Water Depravation Test
Treatment
Vasopressin
Lypressin (Diapid)
Desmopressin Acetate
(DDAVP, concentraid)
Pathology
Underproduction of Underproduction of Circulating
thyroid hormones during thyroid hormones in autoantibodies to
infancy older children or adults thyroglobulin, follicular
cell membranes and
Usually due to iodine surface receptors.
deficiency
Cause
Diagnosis
↓ fT3 and fT4, ↑ sTSH >5 (except hypothalamic Test for Ab
lesions and hypopituitarism) TSH, T4
ESR
Treatment
Hypothyroidism
Pathology
Granulomas develop in
thyroid gland resulting
in enlargement
Cause
Treatment
Type of Disease
Hyperthyroidism
Pathology
Cause
Transformation from Uncertain, probably Iodine deficiency due to:
long-standing Simple caused by immunologic 1. Deficiency in food
Goiter mechanism and defect and water
in Ag-specific 2. Goitrogens
suppressor T-cells 3. Physiologic demand
Associated w/ HLA-DR3
and autoimmune Ds
(SLE, Hashimoto’s
Disease)
Thyroid Storm
Diagnosis
↑ fT3 & fT4, ↓ sTSH
↑T3RIA, Thyroid Ab ↑ fT3 & fT4, ↓ TSH
Treatment
Propylthiouracil
Propylthiouracil Methimazole
Methimazole *Radioactive iodide
*Radioactive iodide Surgery: Subtotal
Thyroidectomy
Subclinical Primary
Hyperthyroidism Hyperparathyroidism Secondary
Hyperparathyroidism
**most common cause of
hypercalcemia
Type of Disease
Hyperthyroidism Hyperparathyroidism
Pathology
Compensatory
hyperplasia in response
to hypocalemic state
Cause
Euthyroid Graves, Parathyroid adenoma
autonomous Carcinoma **Chronic renal failure
adenoma, Excessive hyperplasia Malabsorption Sx
THR Tx, Thyroid Vit D deficiency
Hormone
suppressive therapy
Diagnosis
Nl fT4, FTI, T3RIA ↑serum Ca (3 consec. ↓ serum Ca
↓ TSH Tests;unless >12) ↑ serum phosphate
↓ serum phosphate ↑PTH
↑PTH ↑ALP
↑urinary Ca in 24hr urine
↑ALP
↑cAMP in serum or urine
radiograph (find brown
turmors)
Treatment
If on suppression CA or adenoma: surgery
therapy: ↓ Rx Acute Ds: ↑ excretion w/ saline & furosemide,
Asx: repeat TSH 3- Mithramycin, Calcitonin, Diphosphates, Hydrocortisone,
6mo, Gallium Nitrate
24hr RAIU – if ↑ use Moderate Ds : hydration, diuresis, phosphates,
beta blocker or calcitonin, indocin, ASA, Disodium Etdronate
antithyroid rx Crisis: hopitlization, hydration Mithramycin, Disodium
Etidronate
Hypoparathyroidism Thyroid Cancer
**VERY RARE***
Type of Disease
Hypoparathyroidism Papillary (most commom), Follicular,
mixed, anaplastic, medullary (can be
assoc w/ MEN)
Pathology
Inadequate secretion of PTH or end-
organ resistance
Cause
Diagnosis
Treatment
Type of Disease
Hyperadrenalism
Pathology
Iatrogenic
Cause
Overproduction of ACTH from pituitary(Cushing Ds) **Adrenocortical
OR overproduction of CRF from hypothalamus OR adenoma
ectopic ACTH production OR Adrenal tumor Hyperplasia
producing cortisol Carcinoma (rarely)
Diagnosis
Treatment
Spironolactone
Surgical removal of producing tumor, irradiation or (Aldactone)
resection of hyperplastic adrenals Or Diuretics
High doses of hydrocortisone 1 day prior to surgery
and 300mg continuous IV on the day of surgery
Type of Disease
Hyperadrenalism Hypoadrenalism
Pathology
Hypersecretion of Congenital Adrenal Decreased
aldosterone/glucocorticoid Adrenal Virilization: production of
suppression Hyperplasia Tumor or ACTH
(CAH): inborn hyperplasia
enzyme defect resulting in an
which inhibits overproductio
cortisol thus ↑ n of androgens
ACTH causing
adrenal
hyperplasia and
overproduction
of androgens
Cause
Abnl hybrid gene results Congenital Adrenocortical, Destructive
in stimulation of hyperplasia, pituitary or
aldosterone by ACTH adenoma or lesions of the
carcinoma hypothalamus
Salt wasting
Diagnosis
↑ aldosterone level ↑ ACTH ↓ ACTH
↓ cortisol level ↓ cortisol level ↓ cortisol level
↑androgens nl aldosterone
Treatment
Dexamethasone given to Corticotropin
predisposed mother to prevent (only parenteral)
fetus from genital deformation Hydrocortisone
(oral)
IV Hydrocortisone
Mineralcorticoids
Disease
Addison’s Disease Pheochromocytoma
(Primary Adrenocortical Insufficiency)
Type of Disease
Hypoadrenalism Ds of Hypersecretion of the
Adrenal Medulla
Pathology
Destruction of adrenal cortex resulting in ↓ Tumor arising from chromaffin
cortisol production and aldosterone cells of adrenal medulla secreting
catecholamines
(outside the adrenals:
paragangliomas)
Cause
***Idiopathic adrenalitis (autoimmune) Sporatic
*TB Familial
*Histoplasmosis
Amyloidosis, metastatic carcinoma, Some associated w/ MEN II, MEN
hemochromatosis III
Treatment
Acute: Chronic: Alpha adrenergic blockers w/ Beta
Cortisol 100mg IV Q Hydrocortisone 20- Blockers
6-8° until stable 30mg QD
Reduce over 5d to 2/3 given in am Surgery
maintenance dose of 1/3 given in
50mg/d afternoon
IV saline
Glucose Fludrocortisone
Disease
Ganglioneuroma/ Neuroblastoma Type I Diabetes Mellitus Type II Diabetes
Mellitus
Type of
Disease Ds of Hypersecretion of the Adrenal Metabolic Disorder of the Pancreas
Medulla
Pathology
Ganglioneuroma Neuroblastom Ab against beta cells Target tissue develops
Benign tumor of a destroy islet cells insulin resistance
ganglion cells Highly resulting in a decreased
malignant production of insulin
tumor from
neural crest
Cause
Tumor Immune Overeating, Obesity,
Viral (Cacksackie Virus – Genetics (large
molecular mimecry) predisposition)
Genetic (linked to HLA Risk factors: aging,
DR3&4 on sedentary lifestyle
Chromosome 6)
Signs &
Symptoms Onset early in life, but can Onset usually >30, but
Neuroblastoma: common in occur at any time, Wt is becoming more
childhood, abdominal mass, anemia, loss, dry skin, weakness, common in younger,
fever, wt loss Insulitis, DKA, upper segment
Hyperglycemia resulting obesity, polyuria, abnl
Commonly metastasizes to bone of in AGES & sorbitol insulin secretion,
skull and orbit (Hutchison-type) depositions, eventually insulin resistance, ↑
To liver (Pepper Syndrome) coma if untx, glucose production
insulinopenia, infections, from liver, ↑
polyuria, polyphagia, triglycerides d/t
polydipsia inability to activate
lipoprotein lipase,
Chronic Complications: hyperlipidemia
CAD, MI, stroke, indicates poor control
gangrene, cataracts,
artherosclerosis, Chronic Complications:
retinopathy, nephropathy, CAD, MI, stroke,
neuropathy, vascular gangrene, cataracts,
disease artherosclerosis,
retinopathy,
nephropathy,
neuropathy, vascular
Ds
Diagnosis
↓ insulin ↓ insulin
↑ HbA1c ↑ HbA1c
Ab to islet cells or insulin Fasting glucose
Fasting glucose >126mg/dL
>126mg/dL Random glucose
Random glucose >200mg/dL
>200mg/dL
Insulinoma Gastrinoma
(Zollinger-Ellison
Syndrome)
Type of Disease
Pancreatic Tumor Pancreatic Tumor
Pathology
Insulin producing Gastrin Producing
tumor of the islet tumor of islet cells
cells
Cause
Tumor Tumor
60% malignant
Assoc w/ MEN I
Diagnosis
↑ insulin
↓ glucose
Treatment