DISORDERS OF THE

ENDOCRINE SYSTEM
BY
Mr. Jonathan Adeoye
Excelsior Community College
The Endocrine System
The Endocrine System
 The endocrine system involves the release of chemical
substances known as hormones to regulate and
integrate body functions.
 Generally, these hormones are produced by the
endocrine glands
 The endocrine system is composed of several glands:
 the pituitary,
 the thyroid gland,
 parathyroid glands,
The Endocrine System
 adrenal glands,
 pancreatic islets,
 ovaries, and
 testes
 Unlike the exocrine glands, most hormones secreted
from endocrine glands are released directly into the
bloodstream
 Disorders of endocrine system are common and are
manifested by hyperfunction and hypofunction
THE PITUITARY GLAND
 The pituitary gland, or hypophysis, is commonly
referred to as the master gland because of the
influence it has on secretion of hormones by other
endocrine glands
 The pituitary gland is divided into anterior and
posterior lobes.
 It is controlled by the hypothalamus
Pituitary Gland
Pathophysiology
 Abnormalities of pituitary function are caused by
oversecretion or undersecretion of any of the
hormones produced or released by the gland.
 Abnormalities of the anterior and posterior portions
of the gland may occur independently
 Pathophysiology
 Hypofunction of the pituitary gland (hypopituitarism)
can result from:
 disease of the pituitary gland itself or disease of the
hypothalamus;
 radiation therapy to the head and neck area.
 The total destruction of the pituitary gland by
 trauma,
 tumor, or
 vascular lesion removes all stimuli that are normally
received by the thyroid, the gonads, and the adrenal
glands
Pathophysiology
 The result is extreme weight loss,
 Emaciation-the state of being ab
 atrophy of all endocrine glands and organs,
 hair loss,
 impotence,
 amenorrhea,
 hypometabolism, and
 hypoglycemia.
 Coma and death occur if the missing hormones are not
replaced.
Anterior Pituitary
 The major hormones of the anterior pituitary gland
are:
 follicle-stimulating hormone (FSH),
 luteinizing hormone (LH),
 prolactin,
 adrenocorticotropic hormone (ACTH),
 thyroid-stimulating hormone (TSH), and
 growth hormone (GH) (also referred to as
somatotropin).
 The secretion of these major hormones is controlled
by releasing factors secreted by the hypothalamus
Anterior Pituitary
 The main function of TSH, ACTH, FSH, and LH is the
release of hormones from other endocrine glands
 Oversecretion (hypersecretion) of the anterior
pituitary gland most commonly involves ACTH or GH
and results in Cushing’s syndrome or acromegaly,
respectively.
 Acromegaly, an excess of GH in adults, results in
bone and soft tissue deformities and enlargement
of the viscera without an increase in height
Anterior Pituitary
 It occurs in approximately 3 cases per 1 million
people per year.
 Oversecretion of GH results in gigantism in children;
a person may be 7 or even 8 feet tall.
 Insufficient secretion of GH during childhood results
in generalized limited growth and dwarfism(Porth &
Matfin, 2009).
 Undersecretion (hyposecretion) commonly involves
all of the anterior pituitary hormones and is termed
panhypopituitarism
Anterior Pituitary
 Hypopituitarism may result from destruction of the
anterior lobe of the pituitary gland.
 Postpartum pituitary necrosis (Sheehan’s syndrome)
is another uncommon cause of failure of the anterior
pituitary.
 It is more likely to occur in women with severe blood
loss,
 hypovolemia, and
 hypotension at the time of delivery.
Posterior Pituitary
 The important hormones secreted by the posterior
lobe of the pituitary gland are
 vasopressin, also called antidiuretic hormone (ADH),
and
 oxytocin.
 These hormones are synthesized in the
hypothalamus and travel from the hypothalamus to
the posterior pituitary gland for storage.
Posterior Pituitary
 Vasopressin controls the excretion of water by the
kidney;
 its secretion is stimulated by
 an increase in the osmolality of the blood or
 by a decrease in blood pressure.

 Oxytocin secretion is stimulated during pregnancy and

at childbirth.
 It facilitates milk ejection during lactation and increases
the force of uterine contractions during labor and
delivery.
Posterior Pituitary
 The most common disorder related to posterior lobe
dysfunction is diabetes insipidus, a condition in
which abnormally large volumes of dilute urine are
excreted as a result of deficient production of
vasopressin.
DIABETES INSIPIDUS
 Diabetes insipidus (DI) is a disorder of the posterior
lobe of the pituitary gland that is characterized by
a deficiency of ADH (vasopressin).
 Excessive thirst (polydipsia) and large volumes of
dilute urine characterize the disorder
Causes of DI
 It may occur secondary to head trauma,
 brain tumor,
 Surgical ablation or irradiation of the pituitary
gland.
 Infections of the central nervous system (meningitis,
encephalitis, tuberculosis) or with tumors (eg,
metastatic disease, lymphoma of the breast or lung).
 Failure of the renal tubules to respond to ADH;
 This may be related to hypokalemia, hypercalcemia,
and a variety of medications (eg, lithium,
demeclocycline [Declomycin]).
Clinical Manifestations
 large daily output of very dilute, waterlike urine
with a specific gravity of 1.001 to 1.005 occurs.
 Consumption of 2 to 20 L of fluid daily and craves
cold water due to excessive thirst
Medical Management
 Replace ADH (which is usually a long-term
therapeutic program),
 Ensure adequate fluid replacement,
 Identify and correct the underlying intracranial
pathology. Nephrogenic causes require different
management approaches.
 Desmopressin (DDAVP), a synthetic vasopressin is
administered intranasally
 Intramuscular administration of ADH, vasopressin
The Thyroid Gland
Thyroid Hormone
 Thyroid Hormones are T4 and T3
 T4 contains four iodine atoms in each molecule, and
T3 contains three.
 These hormones are synthesized and stored bound
to proteins in the cells of the thyroid gland until
needed for release into the bloodstream
 Calcitonin, or thyrocalcitonin, is another important
hormone secreted by the thyroid gland
Pathophysiology
 Inadequate secretion of thyroid hormone during fetal
and neonatal development results in stunted physical
and mental growth (cretinism) because of general
depression of metabolic activity.
 In adults, hypothyroidism manifests as lethargy, slow
mentation, and generalized slowing of body functions.
 Oversecretion of thyroid hormones (hyperthyroidism) is
manifested by a greatly increased metabolic rate.
 Oversecretion of thyroid hormones is usually associated
with an enlarged thyroid gland known as a goiter.
Pathophysiology
 Goiter also commonly occurs with iodine deficiency.
 In this condition, lack of iodine results in low levels
of circulating thyroid hormones, which causes
increased release of TSH;
 The elevated TSH causes overproduction of
thyroglobulin (a precursor of T3 and T4) and
hypertrophy of the thyroid gland.
Disorders of Thyroid Gland
HYPOTHYROIDISM
 Hypothyroidism results from suboptimal levels of
thyroid hormone.
 Thyroid deficiency can affect all body functions and
can range from mild, subclinical forms to
myxedema, an advanced form.
 More than 95% of patients with hypothyroidism
have primary or thyroidal hypothyroidism, which
refers to dysfunction of the thyroid gland itself.
HYPOTHYROIDISM
 If the cause of the thyroid dysfunction is failure of
the pituitary gland, the hypothalamus, or both, the
hypothyroidism is known as central hypothyroidism.
 If the cause is entirely a pituitary disorder, it may
be referred to as pituitary or secondary
hypothyroidism. If the cause is a disorder of the
hypothalamus resulting in inadequate secretion of
TSH it is referred to as hypothalamic or tertiary
hypothyroidism.
HYPOTHYROIDISM
 If thyroid deficiency is present at birth, it is referred
to as cretinism.
 In such instances, the mother may also have thyroid
deficiency.
 Hypothyroidism affects women five times more
frequently than men
 Occurs most often between 40 and 70 years of
age.
 The prevalence of the disease increases with
increasing age.
Myxedema
 The term myxedema refers to the accumulation of
mucopolysaccharides in subcutaneous and other
interstitial tissues.
 Causing swelling of the skin and underlying tissues
giving a waxy consistency, typical of patients with
underactive thyroid glands.
 Although myxedema occurs in long-standing
hypothyroidism, the term is used appropriately only
to describe the extreme symptoms of severe
hypothyroidism.
Causes
 The most common cause of hypothyroidism in adults
is autoimmune thyroiditis (Hashimoto’s disease), in
which the immune system attacks the thyroid gland.
 Hypothyroidism also commonly occurs in patients
with previous hyperthyroidism that has been treated
with radioiodine or antithyroid medications or
thyroidectomy.
 The condition occurs most frequently in older
women.
Summary of causes
 Autoimmune disease
(Hashimoto’s thyroiditis, post-
Graves’ disease)
 Atrophy of thyroid gland
with aging
 Therapy for hyperthyroidism
Radioactive iodine (131I)
 Thyroidectomy
 Medications-
 Lithium
 Iodine compounds
 Antithyroid medications
 Radiation to head and
neck for treatment of
head and neck cancers,
 lymphoma Infiltrative
diseases of the thyroid
(amyloidosis, scleroderma,
lymphoma)
 Iodine deficiency and
iodine excess
Clinical Manifestations
 Extreme fatigue which makes it difficult for the
person to complete a full day’s work or participate
in usual activities.
 Reports of hair loss,
 brittle nails, and
 dry skin are common, and
 numbness and tingling of the fingers may occur
Clinical Manifestations
 Patient may complain of hoarseness.
 Menstrual disturbances such as menorrhagia or
amenorrhea may occur,
 Loss of libido.
 Subnormal body temperature and pulse rate.
 Weight gain without an increase in food intake,
although he or she may be cachectic.
 The skin becomes thickened because of an
accumulation of mucopolysaccharides in the
subcutaneous tissues.
Clinical Manifestations
 The hair thins and falls out
 Face becomes expressionless and masklike.
 The patient often complains of being cold even in a
warm environment.
 patient may be irritable and may complain of
fatigue,
 The mental processes become dulled, and the
patient appears apathetic.
Clinical Manifestations
 Speech is slow,
 the tongue enlarges,
 the hands and feet increase in size,
 deafness may occur.
 Patient frequently complains of constipation.
 Advanced hypothyroidism may produce personality
and cognitive changes characteristic of dementia
 Medical Management
 The primary objective in the management of
hypothyroidism is to restore a normal metabolic state
by replacing the missing hormone.
 Synthetic levothyroxine (Synthroid or Levothroid) is the
drug of choice for treating hypothyroidism and
suppressing nontoxic goiters.
 Its dosage is based on the patient’s serum TSH
concentration.
 If replacement therapy is adequate, the symptoms of
myxedema disappear and normal metabolic activity is
resumed.
HYPERTHYROIDISM

 Hyperthyroidism is the second most prevalent

endocrine disorder, after diabetes mellitus.
 Graves’ disease, the most common type of
hyperthyroidism, results from an excessive output of
thyroid hormones caused by abnormal stimulation of
the thyroid gland by circulating immunoglobulins
 It affects women eight times more frequently than
men, with onset usually between the second and
fourth decades.
HYPERTHYROIDISM
 The disorder may appear after an emotional shock,
stress, or an infection, but the exact significance of
these relationships is not understood.
 Other common causes of hyperthyroidism include
thyroiditis and excessive ingestion of thyroid
hormone.
Clinical Manifestations
 Patients with well-developed hyperthyroidism exhibit a
characteristic group of signs and symptoms (sometimes
referred to as thyrotoxicosis).
 The presenting symptom is often nervousness.
 These patients are often emotionally hyperexcitable,
irritable, and apprehensive
 They are unable to sit quietly
 They suffer from palpitations
 Their pulse is abnormally rapid at rest as well as on
exertion.
 They tolerate heat poorly and perspire unusually freely.
Clinical Manifestations
 The skin is flushed continuously, with a characteristic
salmon color, and is likely to be warm, soft, and
moist.
 Patients may report dry skin and diffuse pruritus.
 A fine tremor of the hands may be observed.
 Patients may exhibit ophthalmopathy, such as
exophthalmos(bulging eyes), which produces a
startled facial expression.
Clinical Manifestations
 Other manifestations include:
 Increased appetite and dietary intake,
 Progressive weight loss,
 Abnormal muscular fatigability and weakness
(difficulty in climbing stairs and rising from a chair),
 Amenorrhea
 Changes in bowel function.
 The pulse rate ranges constantly between 90 and
160 bpm; the systolic blood pressure is elevated
Medical Management
 Appropriate treatment of hyperthyroidism depends
on the underlying cause and often consists of a
combination of therapies, including
 antithyroid agents,
 radioactive iodine, and
 surgery.
 Treatment of hyperthyroidism is directed toward
reducing thyroid hyperactivity to relieve symptoms
and preventing complications.
Medical Management
 Use of radioactive iodine is the most common form
of treatment for Graves’ disease.
 Beta-adrenergic blocking agents (eg, propranolol
[Inderal]) are used as adjunctive therapy for
symptomatic relief, particularly in transient
thyroiditis .
 Surgical removal of most of the thyroid gland is a
nonpharmacologic alternative.
Medical Management
 All treatment for thyrotoxicosis have side effects,
and
 All three treatments (radioactive iodine therapy,
antithyroid medications, and surgery) share the
same complications; i.e relapse or recurrent
hyperthyroidism and permanent hypothyroidism.
Medical Management
 Pharmacologic Therapy includes:
 (1) use of irradiation by administration of the
radioisotope iodine 131 (131I) for destructive
effects on the thyroid gland and
 (2) antithyroid medications that interfere with the
synthesis of thyroid hormones and other agents that
control manifestations of hyperthyroidism.
Medical Management
 Radioactive Iodine Therapy
 The goal of radioactive iodine therapy (131I) is to
destroy the overactive thyroid cells.
 Over a period of several weeks, thyroid cells
exposed to the radioactive iodine are destroyed,
resulting in reduction of the hyperthyroid state and
inevitably hypothyroidism
Thyroid Gland cont’d
 Other conditions of the thyroid gland are:
 Thyroiditis
 Thyroid Tumors
 Thyroid Storm (Thyrotoxic Crisis, Thyrotoxicosis)
 Endemic (Iodine deficient) goitre
 Thyroid cancer
PARATHYROID GLANDS
DISORDERS
Parathyroid Glands
Parathyroid Glands
 The parathyroid glands (normally four) are situated
in the neck
 The parathyroid glands are located behind the
thyroid gland
 The parathyroid may be embedded in the thyroid
tissue
Pathophysiology
 Parathormone (parathyroid hormone), produced by the
parathyroid glands, regulates calcium and phosphorus
metabolism.
 Increased secretion of parathormone results in
increased calcium absorption from the kidney, intestine,
and bones, which raises the blood calcium level.
 When the product of serum calcium and serum
phosphorus (calcium phosphorus) rises, calcium
phosphate may precipitate in various organs of the
body (eg, the kidneys) and cause tissue calcification.
HYPERPARATHYROIDISM
 Hyperparathyroidism, which is caused by
overproduction of parathormone by the
parathyroid glands, is characterized by bone
decalcification and the development of renal calculi
(kidney stones) containing calcium.
Types - Primary hyperparathyroidism

 occurs two to four times more often in women than in

men and is most common in people between 60 and
70 years of age.
 Its incidence is approximately 25 cases per
100,000
 The disorder is rare in children younger than 15
years of age, but its incidence increases 10-fold
between the ages of 15 and 65 years.
 Half of the people diagnosed with
hyperparathyroidism do not have symptoms.
Types- Secondary hyperparathyroidism

 Manifestations are similar to those of primary

hyperparathyroidism,
 Occurs in patients who have chronic renal failure
 Occurs as a result of phosphorus retention,
increased stimulation of the parathyroid glands,
and increased parathormone secretion.
Clinical Manifestations
 The patient may have no symptoms or
 May experience signs and symptoms resulting from
involvement of several body systems.
 There is Apathy, fatigue, muscle weakness, nausea,
vomiting, constipation, hypertension, and cardiac
dysrhythmias may occur.
 All these signs and symptoms are attributable to the
increased concentration of calcium in the blood
Clinical Manifestations
 Psychological effects may include:
 Irritability
 Neurosis to psychoses
 Caused by the direct action of calcium on the brain
and nervous system.
 An increase in calcium produces a decrease in the
excitation potential of nerve and muscle tissue.
Complications
 Renal damage results from the precipitation of
calcium phosphate in the renal pelvis and
parenchyma,
 This causes renal calculi (kidney stones), obstruction,
pyelonephritis, and renal failure.
 Musculoskeletal symptoms may be caused by
demineralization of the bones or by bone tumors
Complications
 The patient may develop:-
 skeletal pain and tenderness, especially of the back
and joints;
 pain on weight bearing;

 pathologic fractures;

 deformities; and

 shortening of body stature.

 Bone loss attributable to hyperparathyroidism

increases the risk of fracture.
Complications
 The incidence of peptic ulcer and pancreatitis is
increased with hyperparathyroidism and may be
responsible for many of the GI symptoms that occur.
 Medical Management
Surgical Management
 The recommended treatment for primary
hyperparathyroidism is the surgical removal of
abnormal parathyroid tissue (parathyroidectomy)
Medical Management
Hydration Therapy
 Because kidney involvement is possible, patients with
hyperparathyroidism are at risk for renal calculi.
 Therefore, a daily fluid intake of 2000 mL or more
is encouraged to help prevent calculus formation.
 Cranberry juice is suggested, because it may lower
the urinary pH
Medical Management
Mobility
 Mobility of the patient, with walking or use of a
rocking chair for those with limited mobility, is
encouraged as much as possible,
 This is because bones that are subjected to normal
stress give up less calcium
Medical Management
Diet and Medications
 patient is advised to avoid a diet with restricted or
excess calcium.
 If the patient has a coexisting peptic ulcer, prescribed
antacids and protein feedings are necessary.
 Because anorexia is common, efforts are made to
improve the appetite.
 Prune juice, stool softeners, and physical activity, along
with increased fluid intake, help offset constipation,
which is common postoperatively.
 HYPOPARATHYROIDISM
 The most common cause of hypoparathyroidism is
inadequate secretion of parathormone
 May result from interruption of the blood supply or
surgical removal of parathyroid gland tissue during
thyroidectomy, parathyroidectomy, or radical neck
dissection.
HYPOPARATHYROIDISM
 Deficiency of parathormone results in -
 increased blood phosphate (hyperphosphatemia)
 decreased blood calcium (hypocalcemia) levels.
 In the absence of parathormone,
 there is decreased intestinal absorption of dietary
calcium and
 decreased resorption of calcium from bone and through
the renal tubules.
 Decreased renal excretion of phosphate causes
hypophosphaturia, and
 low serum calcium levels result in hypocalciuria.
 Clinical Manifestations
 Hypocalcemia causes
 irritability of the neuromuscular system - tetany.
 Tetany is
 a general muscle hypertonia, with tremor and
spasmodic or uncoordinated contractions occurring with
or without efforts to make voluntary movements.
 Symptoms of latent tetany are numbness, tingling, and
cramps in the extremities, and stiffness in the hands and
feet.
Clinical Manifestations
 In overt tetany, the signs include
 bronchospasm,
 laryngeal spasm,
 carpopedal spasm (flexion of the elbows and wrists
and extension of the carpophalangeal joints and
dorsiflexion of the feet),
 dysphagia,
 photophobia,
 cardiac dysrhythmias, and
 seizures.
Clinical Manifestations
 Other symptoms include
 anxiety,
 irritability,
 depression,
 delirium.
 ECG changes and hypotension also may occur
Medical Management
 The goal of therapy is to increase the serum calcium level
to between 9 & 10 mg/dL (2.2 to 2.5 mmol/L) and
 to eliminate the symptoms of hypopara-thyroidism and
hypocalcemia.
 When hypocalcemia and tetany occur after a
thyroidectomy, the immediate treatment is administration
of IV calcium gluconate.
 Sedative agents such as pentobarbital may be
administered if irritability and seizure persist.
 Parenteral parathormone can also be administered to
treat acute hypoparathyroidism with tetany.
THE ADRENAL GLANDS
DISORDERS
Adrenal Gland
Adrenal Gland
 The adrenal glands sit on top of the kidneys.
 Each gland is composed of an outer cortex and an inner
medulla.
 Each area secretes specific hormones.
 The adrenal medulla secretes :-
 catecholamines—epinephrine (adrenaline) and
norepinephrine;
 the adrenal cortex secretes :-
 glucocorticoids,
 mineralocorticoids, and
 sex hormones (androgens)
Adrenal Gland
 Catecholamines regulate metabolic pathways to
promote catabolism of stored fuels to meet caloric
needs from endogenous sources.
 The major effects of epinephrine release are to prepare
to meet a challenge (fight-or-flight response).
 Secretion of epinephrine causes decreased blood flow
to tissues that are not needed in emergency situations,
such as the GI tract, and
 increased blood flow to tissues that are important for
effective fight or flight, such as cardiac and skeletal
muscles.
ADRENOCORTICAL INSUFFICIENCY
CUSHING’S SYNDROME
 Is a metabolic disorder caused by overproduction of
corticosteroid hormones by the adrenal cortex and
often involving obesity and high blood pressure
 Cushing’s syndrome results from excessive,
adrenocortical activity
 Cushing’s syndrome is commonly caused by use of
corticosteroid medications and is infrequently the
result of excessive corticosteroid production
secondary to hyperplasia of the adrenal cortex.
Signs and Symptoms
Moon face
Medical Management
 If Cushing’s syndrome is caused by pituitary tumors
rather than tumors of the adrenal cortex, treatment
is directed at the pituitary gland.
 Surgical removal of the tumor by transsphenoidal
hypophysectomy is the treatment of choice and has
an 80% success rate.
 Radiation of the pituitary gland also has been
successful, although it may take several months for
control of symptoms.
 Adrenalectomy is the treatment of choice in patients
with primary adrenal hypertrophy.
 Medical Management
 Adrenal enzyme inhibitors (eg, metyrapone [Metopirone],
aminoglutethimide [Cytadren], mitotane [Lysodren], and
ketoconazole [Nizoral]) may be used to reduce
hyperadrenalism if the syndrome is caused by ectopic
ACTH secretion by a tumor that cannot be eradicated
 If Cushing’s syndrome is a result of the administration of
corticosteroids, an attempt is made to reduce or taper the
medication to the minimum dosage needed to treat the
underlying disease process (eg, autoimmune or allergic
disease, rejection of a transplanted organ).