Powerpoint + Slides + etc etc o Secondary to destruction of pituitary
o 75% of the parenchyma is lost; hypopituitarism is Endocrine diseases are of three (3) types: already indicated Overproduction of hormone o May be secondary to trauma, brain surgery or pituitary Underproduction of hormone adenoma treated by laser surgery with over-removal of Mass occupying lesions (malignant or benign) (rare) pituitary gland Pituitary gland o Growth hormone deficiency Has posterior lobe (80%) and anterior lobe (20%) Dwarfism Composed of numerous cells secreting numerous trophic o Gonadotropin deficiency hormones No LH & FSH Posterior lobe has direct connection with hypothalamus Lack of secondary sex characteristics Hypothalamus orchestrates the pituitary o TSH deficiency Posterior pituitary gland hormones (2): Causes hypothyroidism o Anti-diuretic hormone tries to maintain the body fluids o Prolactin deficiency by fluid retention when blood pressure goes down More prominent in women o Oxytocin assists and facilitates labor; dilates the cervix No release of breast milk even when pregnant and assists in contraction o MSH deficiency Only ADH is related to disease; oxytocin does not have Melanin any disease related to it Causes pallor due to lack of pigment Hyperpituitarism ADH diseases o Most commonly caused by adenomas o Diabetes insipidus Benign lesions Same manifestations as diabetes mellitus (polyuria, Can be microadenomas or macroadenoma (by size) polyphagia, polydipsia) Can be functional or non-functional More extensive polyuria Can be hormone-negative (no secretion) Inability of the kidney to retain water from urine Can be a genetic mutation or sporatic (spontaneous) May be caused by central (ADH problem) or o Pituitary adenoma nephrogenic (unresponsive kidneys) Pituitary is in the sella turcica under the brain; very Loss of water causes high serum sodium invasive procedure to operate on concentrations Overgrowth of tumor can infringe surrounding blood o SIADH (Syndrome of inappropriate ADH secretion) vessels & nerves: Causes dilution of sodium (hyponatremia) Optic nerve Visual acuity Causes cerebral edema without peripheral edema Blood vessels Deprivation of different parts of Thyroid gland the brain Composed of two (2) lobes found in the middle of the neck Biopsy hallmark: Monomorphic cells look the same During development, it is located at the back of the tongue as each other o Descend during development Can increase the intracranial pressure Lingual thyroid Can create visual field abnormalities o Poor descent of the thyroid gland Can suddenly blead (apoplexy) o Behind the tongue Can cause hypopituitarism Ectopic thyroid Prolactinoma o Excessive descent of the thyroid gland Most common dominant hormone secreted by o At the level of the chest wall pituitary adenomas are prolactin Secretes T3 and T4 stimulated by TSH and acts in through Important in lactation negative feedback inhibition Can develop in men; causes breast secretion Increases basal metabolic rate and loss of libido Important in brain development in developing children Can develop in women; causes amenorrhea and o Reason why thyroid hormones are checked during causes infertility pregnancy May be seen in pregnancy, drugs blocking Goitrogens dopamine receptors o Food with not much nutrition (salads & leaves) Treatment is laser-surgery because an open- o Inhibit the function of thyroid glands surgery is very invasive (stereotactic surgery) o Suppresses T3 and T4 synthesis Growth-hormone adenoma Causes overstimulation of TSH which causes Second most common type of pituitary adenoma hyperplastic thyroid without hyperthyroidism If adenoma develops before closure of long Iodine bones causes gigantism o Helps in the synthesis of T3 and T4 If adenoma develops after closure of long bones Hyperthyroidism causes acromegaly can cause dramatic o Most commonly caused by hyperplasia change in their face due to growth of face bones o Type of thyrotoxicosis in which there is a o Can cause psychological effect hypermetabolic state (Increased T3 and T4) Diagnosis is through reconigition of increased o Primary hyperthyroidism growth hormones which stimulates Most common cause is hyperplasia somatomedin C induces increase in height Problem coming from the thyroid Corticotroph cell adenoma o Secondary hyperthyroidism Secretion of ACTHcortisol causing Problem coming from other organs affecting the hypercortisolism thyroid gland Increase in body size concentrated creating o Over-activity of the sympathetic system what is called a buffalo hump or truncal- Sweating profusely obesity Tachycardia Others cause LH, FSH, TSH adenomas Anxious & panicking Not as common Irregular menstrual periods Pituitary carcinoma o Presence of exophthalmos protrusion of the eye Rare Common sign of hyperthyroidism o Diagnosis is by a depressed TSH or increased T3 and T4 (usually T3 and T4 both elevated) o Graves disease o Sporadic simple goiter Triad of: May happen following a diet that is rich in goitrogens Myxedema (in the leg) (has excessive calcium & acts against thyroid Hyperthyroidism hormones) Exophthalmos o Multinodular goiter Autoimmune disease Continuous involution (small big) which creates Antibodies directed against TSH receptors (may nodulation also be for the T3 and T4 hormones & thyroglobulin) Causes scarring & calcification producing nodules Stimulates hyperplasia of the gland Can infringe on the neck causing difficulty in Biopsy hallmark: Overcrowded cells & scalloped breathing, swallowing, talking and blood vessels colloid causing ischemia Hypothyroidism (Cretinism) Can cause compression of the lungs o Has primary & secondary hypothyroidism Long-standing multinodular goiter gives rise to risk o Congenital hypothyroidism of malignancy Part of newborn-screening Malignancy is diagnosed by radionuclide scanning Must be found early to prevent mental retardation Hot nodule (functioning) usually benign o Myxedema (Gull disease) Cold nodule (non-functioning) usually Hypothyroidism in adults malignant; but can be benign upon biopsy Mental sluggishness & obesity o If biopsy and radionuclide scanning oppose Poor retention (poor in class) each other, follow the biopsy results Some form of edema because of accumulation of o May probably be a benign tumor that glycosaminoglycan & hyaluronic acid in produces a cold nodule effect on the scan subcutaneous area Thyroid adenoma Increased TSH and decreased T3 and T4 (T3 may be o Benign as with all adenomas decreased at times but T4 is always decreased after o Unilateral painless mass treatment) o Perceived as cold nodule; capsule that encloses the Treatment is to supply thyroid hormones tumor must be evaluated for differentiation from o Hashimoto thyroiditis malignancy Iodine is very important in hormone synthesis Thyroid carcinoma Autoimmune disease o Mostly developing in adults Breakdown of self-tolerance to thyroid antigens o Major causing factor is ionizing radiation particularly in Antibodies directed against thyroid tissue itself the first two (2) decades of life Infiltrates of lymphocytes replace thyroid tissue o May also be due to long-standing multinodular goiter or Biopsy hallmark: Lymphoid follicles with prominent Hashimoto thyroiditis developing into lymphomas germinal centers o Papillary carcinoma (85%+) Usually found in lymphoid organs (tonsils, spleen, Most common thyroid carcinoma Peyers patches in ileum) Papillary because arrangement of malignant cells Lymphoma can grow in places wherein lymphocytes is leaf-life or papillae should not be normally seen Orphan-Anne eye (right) Prone to development of lymphoma in thyroid Characterized by a blank-staring eye ~(O_O~) Malignant lymphocytes Presence of Psammona bodies (left) Prone to develop Hodgkins lymphoma and Common but not characteristic finding susceptibility to other autoimmune disease o Main risk factor of Hashimoto thyroiditis Predominantly a hypothyroidism state Stages of high-levels of thyroid hormones may occur called hashotoxicosis but this subsides and reverts to hypothyroidism state o De Quervain thyroiditis Development of viral infection causing inflammation of thyroid afterwards Stimulated by virus-induced host tissue damage which stimulates T-lymphocytes causing damage to the thyroid gland Usually painful but heals in 6 8 weeks Subacute lymphocytic thyroiditis o Mild hyperthyroidism Riedels thyroiditis o Hardened and fixed that stimulates a carcinoma o Benign May start as a asymptomatic simple nodule Goiter Perceived as a cold nodule o Enlarged thyroid gland Most common & indolent carcinoma o Doesnt indicate malignant or benign conditions Painless and slow-growing o Maybe proportional to thyroid hormone deficiency Chance-to-live more than 10 years is 95% if no Paired synthesis of hormone caused by iodine complications deficiency Recurrence or relapse reduces 10-year survival rate TSH tries to stimulate synthesis of T3 and T4 to 5 20% lack of iodine causes failure of synthesis Distant metastasis reduces 10-year survival rate to euthyroid goiter 10 15% o Simple goiter Prognosis depends on the age, extension, stage Simple nodule o Follicular carcinoma (5 15%) May be endemic due to the lack of iodine in the Common in areas with iodine deficiency community (mountainous regions) Spreads faster in the blood vessels than in the lymphatics (unlike most carcinomas which spread through the blood vessels) o Medullary carcimoma (5%) o Impaired glucose tolerance (IGT) FBS in 100 125 Neuroendocrine tumors derived from C-cells mg/dL range or OGTT values of 140 200 mg/dL Secrete calcitonin Considered as pre-diabetics Which is measured for its diagnosis o Delay in development can be modulated by strict diet, Typical description: Grow in nests & trabeculae; lifestyle change, etc. amyloid-deposits in the stroma (characteristic) o Glucose homeostasis is normally maintained by: No hypocalcemia even if calcitonin levels are high Glucose production in the liver o Anaplastic carcinoma (<5%) Uptake & utilization 100% mortality in less than a year of diagnosis Insulin & other regulating hormones Can spread to the lungs and the brain o Insulin Fast-spreading cancer and very fatal Increases rate of glucose transfer into the muscle Parathyroid gland (skeletal muscle: major insulin-responsive site) Located at the back of the thyroid reason for intramuscular nature of injection Four (4) in total; two (2) superior, two (2) inferior o Type I - diabetes mellitus (usually in children) Controlled by the level of calcium in the body Lacks insulin production due to an autoimmune Decreased levels of calcium cause the increase of disorder against the beta-cells of the pancreas secretion of PTH regulate calcium homeostasis Insulitis autoantibodies against pancreatic cells Hyperparathyroidism Hyperglycemia due to lack of insulin o Excessive secretion of PTH Inheritances of class-II-MHC, HLA-B, R3, ER4 o Primary hyperparathyroidism: 90 95% will develop diabetes Most commonly caused by an adenoma Risk factors include previous infections MEN (multiple endocrine neoplastic syndrome) coxsackievirus, mumps virus etc. Carcinoma of multiple endocrine organs such as Requires islet-cell transplantation parathyroid, thyroid, pituitary etc Biopsy hallmarks: Reduced number & size of islets, Manifestations in patients are skeletal and renal insulitis, beta-cell degranulation changes because of calcium o Type II diabetes mellitus (usually in adults) If caused adenoma; it can be removed surgically Insulin-resistance on glucose uptake If hyperplasia; it can be treated medically More dependent on genetic factors than type I Carcinoma is quite rare Qualitative & quantitative defects Overproduction of PTH Hallmark: Amyloid-deposits (like medullary Biopsy hallmark: Monomorphic cells look alike carcinoma) Can be asymptomatic or symptomatic Fat content is inversely proportional to insulin Can cause osteoporosis sensitivity Can caused development of stones (renal & gall) Antihyperglycemics (adipokines) improve insulin Can cause neurological disturbances due to sensitivity; reduce obesity problems with calcium Inflammation can induce cytokines to promote o Secondary & tertiary parathyroidism insulin resistance Commonly due to renal failure Complications can be: Mechanism is not quite clear Macrovascular aorta Joined with chronic end-stage renal disease Microvascular kidney, eye vessels Due to loss of renal substance Can cause formation of AGEs which cause free- Decrease in intestinal absorption of calcium radical formation Treatment is parathyroidectomy Can cause neovascularization in the blood vessels Hypoparathyroidism which increases vascular premability o Commonly caused by surgery Vasoconstriction Usually happens when there is surgical removal of Biopsy hallmark: Subtle reduction of islet cell mass; thyroid glands and parathyroid is accidentally amyloid replacement removed along with it (complication) Atheroma can cause thrombosis embolus o May cause tetany (unwanted muscular movements), may cause gangrene in foot infection depression, emotional disturbance, ocular Poor wound-healing & resistance to infection manifestations, dental abnormalities Life-style alteration & glycemic control o Can be treated with supplements Insulinoma Pseudo-hypoparathyroidism o Secretes insulin constant hypoglycemia o Resistance to the action of PTH Gastrinoma o Organ is non-reactive to parathyroid hormone o Secretes gastrin frequent peptic ulcer Pancreas Adrenal glands (suprarenal glands) Contains one-million (1,000,000) islets of Langerhans Three (3) zones of cortex: Four major cell types: o Glomerulosa mineralocorticoid, aldosterone o Beta cells (68%) insulin hypoglycemia o Fasciculata glucocorticoids; cortisol o Alpha cells (20%) glucagon hyperglycemia o Reticularis androgen & estrogen (sex hormones) o Delta cells (10%) somatostatin suppresses both Medulla insulin & glucagon o Cathecolamines epinephrine o PP cells (2%) pancreatic polypeptide stimulation of Cushing syndrome gastric & intestinal enzymes o Increased cortisol Two minor cell types: o Central obesity; buffalo hump o DI cells o Diagnosis is by finding increased levels of cortisol o Enterochromaffin cells Hyperaldosteronism Diabetes Mellitus o Primary hyperaldosteronism o Group of metabolic disorders Most common cause is an adenoma (Conn o May be due to defective insulin section, action or both syndrome) o Diagnosis (3): Sodium retention & potassium excretion FBS 126+ mg/dL on more than one occassion Normally-used to maintain blood pressure RBS 200+ mg/dL (with classical symptoms) Hypernatremia and hypokalemia Abnormal OGTT wherein glucose is 200+ mg/dL two Suppresses the RAAS system (negative feedback) (2) hours after a standard carbohydrate load Need potassium (give banana lolwtf) Secondary to adenoma; surgical removal Secondary to hyperplasia; treat medically o Secondary hyperaldosteronism Response to activation of RAAS Adrenal insufficiency o Primary hypoadrenalism Due to primary adrenal disease which can be acute or chronic o Secondary hypoadrenalism Decreased stimulation of adrenals due to deficiency of ACTH o Waterhouse-Friderichsen syndrome Overwhelming bacterial (N. meningitidis) infection Develops adrenocortical insufficiency associated with massive bilateral adrenal hemorrhage due to bacterial seeding of the small blood-vessels (DIC) o Primary chronic adrenocortical insufficiency (Addison disease) Uncommon disorder (commonly caused by TB) Due to progressive destruction of 90% of the adrenal cortex Adrenocortical neoplasm o May be functional or nonfunctional Pheochromocytoma o Composed to chromaffin cells which synthesize catecholamines o Rule of 10 10% associated with familial syndromes 10% extra adrenal 10% bilateral 10% malignant 10% arise in childhood o Hypertension o Tachycardia, palpitations secondary to sympathetic stimulation o Congestive heart failure & ventricular fibrillation o Diagnosis: Urinary excretion of catecholamines & metabolites; o Tests VMA & metanephrines pheochromocytoma Multiple Endocrine Tumor MEN, type 1 o Wermer syndrome o 3 Ps Pituitary glands Parathyroid Pancreas MEN, type 2A o Sipple syndrome o Pheochromocytoma o Medullary carcinoma o Parathyroid hyperplasia MEN, type 2B o All of MEN-2A plus: Neuromas Ganglioneuromas Marfanoid habitus o 2B is 2A with added brain involvement Familial medullary thyroid cancer o Variant of MEN-2A o Same clinical manifestations o Genetic testing must be done to screen for mutation & possible treatment prophylactic thyroidectomy Pineal gland Composed of loose, neuroglial stroma enclosing nests of pineocytes (cells with photosensory & neuroendocrine function) 3rd eye Lesion in pineocytoma can cause sightings AngeloBautista