Chapter 18

Failure of feedback systems

Dysfunction of an endocrine gland
Secretory cells are unable to produce,
obtain, or convert hormone precursors
The endocrine gland synthesizes or
releases excessive amounts of hormone
Increased hormone degradation or
inactivation
Ectopic hormone release
Cell surface receptor-associated
disorders
Decrease in number of receptors
Impaired receptor function
Presence of antibodies against specific
receptors
Antibodies that mimic hormone action
Unusual expression of receptor function
Intracellular disorders
Circulating inhibitors
Syndrome of inappropriate antidiuretic
hormone secretion (SIADH)
Hypersecretion of ADH
For diagnosis, normal adrenal and thyroid
function must exist
Clinical manifestations are related to
enhanced renal water retention,
hyponatremia, and hypo-osmolality
Diabetes insipidus
Insufficiency of ADH
Polyuria and polydipsia
Partial or total inability to concentrate the urine
Neurogenic
Insufficient amounts of ADH
Nephrogenic
Inadequate response to ADH
Psychogenic
Hypopituitarism
Pituitary infarction
Sheehan syndrome
Hemorrhage
Shock
Others: head trauma, infections, and tumors
Hypopituitarism
Panhypopituitarism
ACTH deficiency
TSH deficiency
FSH and LH deficiency
GH deficiency
Hyperpituitarism
Commonly caused by a benign slow-growing
pituitary adenoma
Manifestations
Headache and fatigue
Visual changes
Hyposecretion of neighboring anterior pituitary
hormones
Hypersecretion of growth hormone (GH)
Acromegaly
Hypersecretion of GH during adulthood
Gigantism
Hypersecretion of GH in children and adolescents
Hypersecretion of prolactin
Caused by prolactinomas
In females, increased levels of prolactin cause
amenorrhea, galactorrhea, hirsutism, and
osteopenia
In males, increased levels of prolactin cause
hypogonadism, erectile dysfunction, impaired
libido, oligospermia, and diminished ejaculate
volume
Hyperthyroidism
Thyrotoxicosis
Graves disease
Pretibial myxedema
Hyperthyroidism resulting from nodular thyroid
disease
Goiter
Thyrotoxic crisis
Hyperthyroidism
Hypothyroidism
Primary hypothyroidism
Subacute thyroiditis
Autoimmune thyroiditis (Hashimoto disease)
Painless thyroiditis
Postpartum thyroiditis
Myxedema coma
Congenital hypothyroidism
Thyroid carcinoma
Hyperparathyroidism
Primary hyperparathyroidism
Excess secretion of PTH from one or more
parathyroid glands
Secondary hyperparathyroidism
Increase in PTH secondary to a chronic disease
Hypoparathyroidism
Abnormally low PTH levels
Usually caused by parathyroid damage in
thyroid surgery
Demonstrates pancreatic atrophy and
specific loss of beta cells
Macrophages, T- and B-lymphocytes,
and natural killer cells are present
Two types
Immune
Nonimmune
Genetic susceptibility
Environmental factors
Immunologically mediated destruction
of beta cells
Manifestations
Hyperglycemia, polydipsia, polyuria,
polyphagia, weight loss, and fatigue
Type 2 diabetes mellitus
Maturity-onset diabetes of youth (MODY)
Gestational diabetes mellitus (GDM)
Common form of diabetes mellitus type 2
Insulin resistance
Hypoglycemia
Diabetic ketoacidosis
Hyperosmolar hyperglycemic nonketotic
syndrome (HHNKS)
Somogyi effect
Dawn phenomenon
Hyperglycemia and nonenzymatic
glycosylation
Hyperglycemia and the polyol pathway
Protein kinase C
Microvascular disease
Retinopathy
Diabetic nephropathy
Macrovascular disease
Coronary artery disease
Stroke
Peripheral arterial disease
Diabetic neuropathies
Infection
Disorders of the adrenal cortex
Cushing disease
Excessive anterior pituitary secretion of ACTH
Cushing syndrome
Excessive level of cortisol, regardless of cause
Disorders of the adrenal cortex
Hyperaldosteronism
Primary hyperaldosteronism (Conn disease)
Secondary hyperaldosteronism
Disorders of the adrenal cortex
Adrenocortical hypofunction
Primary adrenal insufficiency (Addison disease)
Idiopathic Addison disease
Secondary hypocortisolism
Disorders of the adrenal cortex
Hypersecretion of adrenal androgens and
estrogens
Feminization
Virilization
Disorders of the adrenal medulla
Adrenal medulla hyperfunction
Caused by tumors derived from the chromaffin
cells of the adrenal medulla
Pheochromocytomas
Secrete catecholamines on a continuous or
episodic basis