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Endocrine Pathology

Endocrine Pathology. Susan Nordin MD 11/3/11. Overview – Pathologies. Diabetes Mellitus – Separate Lecture Disorders of the Pituitary Gland Disorders of the Thyroid & Parathyroid Disorders of the Adrenals Disorders of the ovaries or testes Thermoregulation and Environmental Conditions

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Endocrine Pathology

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  1. Endocrine Pathology Susan Nordin MD 11/3/11

  2. Overview – Pathologies • Diabetes Mellitus – Separate Lecture • Disorders of the Pituitary Gland • Disorders of the Thyroid & Parathyroid • Disorders of the Adrenals • Disorders of the ovaries or testes • Thermoregulation and Environmental Conditions • Metabolic Disorders

  3. Introduction – Endocrine System • Maintain equilibrium • Regulate functions of organ systems, through hormones • Reproductive • Growth & Development • Defense against stressors • Blood Glucose levels • Core body Temp • Blood pressure and heart rate • Water & electrolyte balance • Metabolism

  4. Anatomy

  5. Glands • Hypothalamus- • Releasing hormones which stimulate the pituitary • Dopamine which inhibits the pituitary production of prolactin • Pituitary Gland- Anterior and Posterior • Anterior: 6 hormones: ACTH, TSH, LH, FSH, PRL, GH • Posterior: 2 hormones: Oxytocin and ADH • Thyroid: Thyroxine • Parathyroid: Parathyroid hormone (PTH) and Calcitonin • Adrenal Glands: Cortisol, aldosterone, epinephrine • Pancreas and Gut: Insulin and glucagon and gut hormones • Ovaries/Testes: Estrogen, Progesterone and testosterone

  6. Anatomy

  7. Feedback loops

  8. Body Function Regulation • Body Energy • Body Temperature • Body Fluid • Hormone response to Exercise

  9. Common Signs & Symptoms • Fatigue/lethargy • Skin changes (dryness) • Orthostatic hypotension • Hypertension • Flushing/Sweating • Weight changes • Confusion/Mental Status Changes • Tremor • Lactation • Tachycardia/bradycardia • Diarrhea/Constipation • Heat or Cold intolerance • Muscle Weakness/Atrophy/Pain • Gynecomastia • Irregular menstrual cycles/Impotence • Abnormal hair growth • Polyphagia/polydipsia/polyuria • Weight changes

  10. Disorders of the Pituitary Gland • Anterior Pituitary Disorders can cause: • Adrenal, Thyroid, Gonad, Lactation, Growth problems • Posterior Pituitary Disorders can cause: • Diabetes Insipidus (can’t concentrate urine)

  11. Thyroid and Parathyroid Gland Disorders • Hyperthyroidism • Grave’s Disease • Hypothyroidism • Hyperparathyroidism The Parathyroids regulate Calcium

  12. Disorders of the Adrenals • Addison’s Disease: Decreased production of adrenal hormones (Cortisol/Aldosterone) • Cushing’s Syndrome: Increased production of adrenal hormones (cCortisol/Aldosterone) • Pheochromocytoma: Produces epinephrine

  13. Thermoregulation/Environmental • Heat Cramps • Heat Syncope • Heat Exhaustion • Heat Stroke • Exertional Hyponatremia • Frostbite • Hypothermia • Altitude Sickness

  14. Metabolic Disorders • Gout • Metabolic Bone Disease • Osteoporosis • Paget Disease

  15. The Tired Athlete • Psychological Profile of Athletes – Separate Lecture • Depression (SIGECAPS) • Endocrine Disorders • Infections • Anemia

  16. I’m Still TiredInfections • Skin/Wound Infections • Blisters, puncture wounds, lacerations • Worsening of an underlying process due to continued training during viral illness: • Pneumonia, Pericarditis, Myocarditis, Sepsis • STI’s • Foodborne illness causing diarrhea • Viral infections like MONO, parvovirus • Tickborne illnesses (LYME, Anaplasmosis)

  17. Still TiredAnemia • Fatigue usually with exertion • Pallor • Headache • Elevated heart rate • Glossitis • Poor immunity/frequent illness • Pica

  18. Classification of AnemiaPathologic/Cause • Blood Loss • Acute or Chronic • Impaired Production • Aplastic anemia, or anemia associated with disease • Impaired DNA synthesis (B12/Folate) • Impaired hemoglobin synthesis (Iron, and thalassemia) • Increased Destruction • Hemolysis: Can be related to intrinsic defects, medications, infections, immune mediated

  19. Classification of AnemiaMorphologic/Shape • Microcytic (MCV is <80) • Hypochromic • Most commonly iron deficiency • Normocytic (MCV is 80-100) • Normochromic • Can be from chronic disease, dilution, destruction, acute loss • Macrocytic (MCV is >100) • Usually B12 or Folate deficiency

  20. AnemiaBlood Loss • Chronic Causes • Menses • GI blood loss (Crohn’s, ulcers, ischemia) • Microtrauma on the soles of the feet (marathon runners)

  21. Impaired ProductionIneffective Erythropoiesis • Iron deficiency • Defective hemoglobin synthesis • Vitamin B12 deficiency • Defective DNA synthesis • Nuclear maturation defect • Nutritional deficiency in strict vegans possible • Acid suppression with medications can cause poor absorption • Folic acid deficiency • Usually from poor nutrition, similar effects to B12 deficiency

  22. Anemia • Think about elevation • S/S: • At Risk Population: Nutrition!

  23. Laboratory Finding • Hct (Hematocrit) (%) • women 36-48 men 40-52 • Hb (Hemoglobin) (g/dl) Normal is 12-16 • Anemic when < 12 g/dl • MCV (Mean Corpuscular Volume) • Normal is 80-100 • 60-70 = Microcytic 100+ = Macrocytic • RBC (Red blood cell) count • women 4.0-5.4 men 4.5-6.0 • Anemia = low hemoglobin

  24. Iron Deficiency Anemia - Treatment • 3-6 mg per kg of body weight of elemental iron • http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html • Better with vitamin C on an empty stomach • Frequent monitoring

  25. Sports Anemia • Dilutional pseudoanemia • Will not respond to tx with iron • Normal MCV & ferritin • No affect of performance • Would not expect it to cause symptoms

  26. How to Assess Patients • HISTORY, HISTORY, HISTORY • Cover all organ systems (ROS) • Physical Exam – General Affect, Appearance • Labs

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