Endocrine Diseases Endocrine Sys:

Hypercorticism (Cushings Disease) Type of Disease Pathology O erproduction of !CTH from pituitary

Gigantism

Acromegaly

Hyperpituitarism

O er production of "H in a child

O erproduction of "H in an adult

Cause Pituitary: Tumor or hyperplasia #unctioning adenoma (Tumor) of anterior pituitary

Signs $ Symptoms

Hirtuism% masculini&ation' irili&ation (indicati e of adrenal tumor due to androgens)% striae% central o(esity% round face% hyperpigmentation (indicati e of pit or ectopic production of !CTH)% se ere pro)imal myopathy% psychological distur(ances% osteoporosis% (uffalo hump% D*% HT+% facial plethora% acne% menstrual disorders

Eunuchoid ha(itus% elongated arms and legs% deficient genital and secondary se) characteristics

Course facial features% prominent eye(ro,% massi e scalloped tongue% myopathy% ner e entrapment% prognathism% spade-shaped hands and feet% osteoporosis% HT+% hypertrophied iscera

Diagnosis Hypo.alemia% al.alosis% C/H assay (differentiate Cushing Ds from ectopic !CTH) cortisol Treatment Surgical remo al of producing tumor High doses of hydrocortisone 1 day prior to surgery and 233mg continuous 45 on the day of surgery 4atrogenic Cushings Disease: Hydrocortisone 133mg 6D% metyrapone (*etopirone)% !minogluthemide (Cytadren) in com(ination ,' 7etocona&ole 88Octreotide (Sandostatin) 9romocriptine (Parlodel) "H 0e el "H le el

Disease Prolactinoma (!menorrhea-"alactorrhea Syndrome) 88most common functional pituitary tumor88 Simmonds Disease (Pituitary Cache)ia) Panhypopituitarism Craniopharyngioma

Type of Disease Pathology

Hyperpituitarism O erproduction of prolactin

Hypopituitarism :nderproduction of pituitary tropic hormones Pressure on pituitary thus decreasing output of tropic hormones

Cause #unctioning adenoma of anterior pituitary Destruction of pituitary gland from: Causes: postpartum em(oli% surgery% tumor or T9 +on-secretory adenoma *etastases to pituitary !d;acent tumor placing pressure on pituitary 4nfarction after deli ery 4nflammatory "ranulomatous Ds !utoimmune pituitary destruction 4rradiation Empty Sella Tursica S) 4nfiltration: sarcoidosis% histocytosis% hemachromatosis Lesions of Hypothalamus from: Craniopharyngioma% "lioma "erminoma Signs $ Symptoms <omen "alactorrhea !menorrhea Oligomenorrhea 4nfertility Early manifestations *ales 5isual defects 4mpotence Headaches EO* paralysis 0ate manifestations Pressure on pituitary = erosion of surrounding (ones% hypothalamus = hydrocephalus% optic ner es = (itemporal hemianopia 5estigial remnants of /ath.es pouch form slo, gro,ing cystic tumors along craniopharyngeal canal

Diagnosis prolactin le el tropic hormones tropic hormones

Treatment 9romocriptine (Parlodel)

Sheehans Syndrome (Post-partum Pituitary +ecrosis) Type of Disease Hypopituitarism

Dia(etes 4nsipidus Hypopituitarism of posterior pituitary

4nappropriate !DH Secretion (S4!DH) Hyperpituitarism of posterior pituitary

Pathology Enlargement of pituitary during pregnancy follo,ed (y sudden hypotension precipitates necrosis leading to decreased pituitary secretion OR D4C% ca ernous sinus throm(osis% D* Cause Sudden infarction of anterior lo(e due to hemorrhage or shoc. during deli ery or traumatic a(ortion !c>uired: Compression or destruction of hypothalamus O/ posterior pituitary (y inflammatory and infiltrati e lesions% tumors% radiation% trauma or surgery 88Cranial: familial 4ntracranial trauma (hemorrhage)% infection (meningitis)% cytoto)ic drugs OR Ectopic !DH secretion :nderproduction of !DH O erproduction of !DH

Signs $ Symptoms

#ailure of lactation% gonadotropic deficiency% !CTH% TSH% *SH deficiency Empty sella turcica

0arge olumes of dilute urine (polyuria)% e)cessi e thirst (polydipsia)% and hypernaturemia% prefer ice cold ,ater

Diagnosis <ater Depra ation Test

Treatment 5asopressin 0ypressin (Diapid) Desmopressin !cetate (DD!5P% concentraid)

Cretinism Type of Disease Pathology :nderproduction of thyroid hormones during infancy :sually due to iodine deficiency

*y)edema

Hashimotos Thyroiditis (!utoimmune Thyroiditis)

Hypothyroidism :nderproduction of thyroid hormones in older children or adults Circulating autoanti(odies to thyroglo(ulin% follicular cell mem(ranes and surface receptors?

Cause 1? @? 2? A? Deficiency of thyroid tissue: agenesis or hypoplasia% surgery% radiation "oiter: iodine deficiency% goitrogenic agents% Hashimotos Thyroiditis Hypothalamic lesions and hypopituitarism Peripheral resistance to thyroid hormones 1? @? 2? !utoimmune disease of humoral and C*4 #amilial H0! D/B

**Most common form of hypothyroidism** Signs $ Symptoms #ailure of normal mental and (odily de elopment% short stature% ,ide-set eyes% protuberant tongue% dry s.in% coarse facial features +eurologic: spasticity deafness% se ere mental retardation Cold% lethargic% mentally dull% coarse features% puffy s.in% hair loss% accumulation of mucinous ground su(stance ,ithin dermis (my)edema) C5S: cardiomegaly% (radycardia C+S: mental slo,ing% stupor% coma Diagnosis fT2 and fTA% sTSH CB (e)cept hypothalamic lesions and hypopituitarism) Test for !( TSH% TA ES/ #eatures of hypothyroidism% progressi e painless moderate enlargement of thyroid 4ncreased incidence of lymphoma Often associated ,ith other autoimmune disorders (S0E% /!% "ra es Ds)

Treatment 0e othyro)ine (TA) (Synthroid) T) must start ,'in @-2mo to re erse s) 0e othyro)ine (TA) (Synthroid) 4nfants (1-Dmo) 1-1?Bmg !dult ?31Emg /echec. after D-F ,ee.s

Su(acute "ranulomatous Thyroiditis (De6uer ains Thyroiditis)

Post Partum Thyroiditis (PPT) (Silent Thyroiditis)

Su(clinical Hypothyroidism

Type of Disease Hypothyroidism Pathology "ranulomas de elop in thyroid gland resulting in enlargement Cause :ncertain% iral infection suggested :ncertain% response to pregnancy Hashimotos% T) "ra es Ds% 0ithium% inade>uate thyroid replacement% 4odinecontaining r)% pulsatile TSH% !drenal insufficiency% drugs% TSH producing tumor

Signs $ Symptoms Painful enlargement of thyroid% self limited ds% NONPainful enlargement some asymptomatic% Some symptomatic:

reco ery in a(out 2-D months Phase 4: hyperthyroid% to nl TSH% fT2$TA% /!4: Phase 44: T2$TA% TSH% /!4: Phase 444 : TSH% T2% TA ,nl

of thyroid% self limited ds Phase 4: hyperthyroid% to nl TSH% fT2$TA% /!4: Phase 44: T2$TA% TSH% /!4: Phase 444 : TSH% T2% TA ,nl Can mimic pp depression

cardiac% lipid% neuro(eha ior (esp? depression)

Diagnosis TSH TA /!4: Treatment Hyperthyroid state: s):(eta-(loc.ers !s): monitor Hypothyroid state: S): 0e othyro)ine for D = 1@ mo? !s): monitor T) symptomatic as ,ell as asymptomatic ,' 0e othyro)ine /echec. D ,ee.s TSH% nl TA% fTA

*ultinodular "oiter (Plummers Ds)

"ra es Disease (To)ic Diffuse "oiter) **Most common form of hyperthyroidism**

Diffuse +onto)ic "oiter (Simple "oiter)

Type of Disease Hyperthyroidism Pathology 4rregular nodular enlargement of thyroid due to distended follicles ,ith mar.ed colloid accumulation% fi(rosis% hemorrhage E)cessi e stimulation (y thyroid stimulating immunoglo(ulins Diffuse enlargement of thyroid

Cause Transformation from long-standing Simple "oiter :ncertain% pro(a(ly caused (y immunologic mechanism and defect in !g-specific suppressor T-cells !ssociated ,' H0!-D/2 and autoimmune Ds (S0E% Hashimotos Disease) Signs $ Symptoms *ight (e s)-free Complication include: pressure on trachea% esophagus occasional O(struction of S5C ,' retrosternal e)tension of goiter? #eatures of hyperthyroidism: ner ousness% restlessness% emotional la(ility% tachycardia% palpitations% arrythmias% dyspnea% heat intolerance% s,eating% fatigue% tremor% hair loss% lid lag and stare% atrial fi(rillation% thyromegaly% e ophthalmos Thyroid Storm Self limited in 23G Diagnosis fT2 $ fTA% sTSH T2/4!% Thyroid !( Treatment Propylthiouracil *ethima&ole 8/adioacti e iodide Propylthiouracil *ethima&ole 8/adioacti e iodide Surgery: Su(total Thyroidectomy fT2 $ fTA% TSH Diffuse enlarged thyroid 4odine deficiency due to: 1? Deficiency in food and ,ater @? "oitrogens 2? Physiologic demand

Su(clinical Hyperthyroidism

Primary Hyperparathyroidism Secondary Hyperparathyroidism **most common cause of hypercalcemia

Type of Disease Hyperthyroidism Pathology Compensatory hyperplasia in response to hypocalemic state Hyperparathyroidism

Cause Euthyroid "ra es% autonomous adenoma% E)cessi e TH/ T)% Thyroid Hormone suppressi e therapy Parathyroid adenoma Carcinoma hyperplasia 88Chronic renal failure *ala(sorption S) 5it D deficiency

Signs $ Symptoms !symptomatic or symptomatic: atrial fi(rillation% osteoporosis Osteitis #i(rosa Cystica (cysts formed from resorption of Ca = leads to pathologic f) and H9ro,n tumorsI) 9O+ES +ephrolithiasis% gallstones = STO+ES Pancreatitis = "/O+ES Peptic :lcers = *O+ES !ssoc? ,' *E+ serum Ca (2 consec? TestsJunless C1@) serum phosphate PTH urinary Ca in @Ahr urine !0P c!*P in serum or urine radiograph (find (ro,n turmors) serum Ca serum phosphate PTH !0P

Diagnosis +l fTA% #T4% T2/4! TSH

Treatment 4f on suppression therapy: /) !s): repeat TSH 2-Dmo% @Ahr /!4: = if use (eta (loc.er or antithyroid r) C! or adenoma: surgery !cute Ds: e)cretion ,' saline $ furosemide% *ithramycin% Calcitonin% Diphosphates% Hydrocortisone% "allium +itrate *oderate Ds : hydration% diuresis% phosphates% calcitonin% indocin% !S!% Disodium Etdronate Crisis: hopitli&ation% hydration *ithramycin% Disodium Etidronate

Hypoparathyroidism 885E/K /!/E888 Type of Disease Pathology 4nade>uate secretion of PTH or end-organ resistance Cause 4diopathic% post surgical% radiation therapy% autoimmune ds% parathyroid aplasia associated ,' Di"eorges Hypoparathyroidism

Thyroid Cancer

Papillary (most commom)% #ollicular% mi)ed% anaplastic% medullary (can (e assoc ,' *E+)

/ecurrent thyroid C!% h) of radiation e)posure

Signs $ Symptoms Se ere cases: cardiac arrhythmias% tetany% intracranial pressure ,' papilledema% cataracts% diarrhea% epilepsy% Trousseaus Sign% num(ness% tingling% Ch este. sign 5ary Dysphagia% hoarseness% firm and immo(ile nodules% cer ical lymphadenopathy Suspect nodules in males CA3 and females CB3 and !00 nodules in children

Diagnosis Serum Ca phosphate le els PTH sTSH% !(% Tg (L in malignancy) Thyroid scan (cold nodules)% Calcitonin le el :'S #+! (iopsy

Treatment Thyroidectomy (suspect !!% compression% cosmetic) /4!(inopera(le% residual ds in nec.% in asion% metastasis) Chemotherapy TA suppressi e therapy of TSH

Disease Cushing Syndrome Conns Syndrome (Primary Hyperaldosteronism)

Type of Disease Hyperadrenalism Pathology 88Pituitary: Tumor or hyperplasia (Cushing Disease) !drenal: Tumor Ectopic production of !CTH or C/H (usually carcinoid tumor of lung or pancreas) 4atrogenic 4ncreased le els of cortisol and aldosterone may result in hypertension% so fre>uent monitoring of 9P is a nursing priority? Cause O erproduction of !CTH from pituitary(Cushing Ds) OR o erproduction of C/# from hypothalamus OR ectopic !CTH production OR !drenal tumor producing cortisol Signs $ Symptoms Hirtuism% masculini&ation' irili&ation (indicati e of adrenal tumor due to androgens)% striae% central o(esity% round face% hyperpigmentation (indicati e of pit or ectopic production of !CTH)% se ere pro)imal myopathy% psychological distur(ances% osteoporosis% (uffalo hump% D*% HT+% facial plethora% acne% menstrual disorders% (ruising% CH#% edema% polyuria% polydipsia Diagnosis Hypo.alemia% al.alosis% C/H assay (differentiate Cushing Ds from ectopic !CTH) (pituitary or ectopic) or (adrenal adenoma) !CTH depending on cause% or *SH depending on cause% serum and @A urine cortisol% serum glucose De)amethasone Suppression Test Pituitary */4 to confirm Treatment Surgical remo al of producing tumor% irradiation or resection of hyperplastic adrenals High doses of hydrocortisone 1 day prior to surgery and 233mg continuous 45 on the day of surgery 4atrogenic Cushings Disease: Hydrocortisone 133mg 6D% metyrapone (*etopirone)% !minogluthemide (Cytadren) in com(ination ,' 7etocona&ole Spironolactone (!ldactone) Or Diuretics !ldosterone le el /enin 0e el *eta(olic al.alosis E)essi e 7 in urine serum 7 Saline Suppression Test CT % then 5enous'!rterial sampling Polyuria% polydypsia% muscle ,ea.ness% renal 7 loss H"N but hyporeninemia (due to feed(ac. from aldosterone) 88!drenocortical adenoma Hyperplasia Carcinoma (rarely) Hypersecretion of aldosterone

Disease "lucocorticoid /emedia(le !ldosteronism ("/!) Type of Disease Hyperadrenalism Hypoadrenalism !drenogenital Syndrome Secondary !drenal 4nsufficiency

Pathology Hypersecretion of aldosterone'glucocorticoid suppression !ongenital Adrenal Hyperplasia (C!H): in(orn en&yme defect ,hich inhi(its cortisol thus !CTH causing adrenal hyperplasia and o erproduction of androgens Congenital Adrenal #irili$ation: Tumor or hyperplasia resulting in an o erproduction of androgens Decreased production of !CTH

Cause !(nl hy(rid gene results in stimulation of aldosterone (y !CTH !drenocortical% hyperplasia% adenoma or carcinoma Destructi e pituitary or lesions of the hypothalamus

Signs $ Symptoms

HT+

Present M (rith ,' irili&ation of female Salt ,asting

5irili&ation of female

Diagnosis aldosterone le el cortisol le el !CTH cortisol le el androgens !CTH cortisol le el nl aldosterone

Treatment De)amethasone gi en to predisposed mother to pre ent fetus from genital deformation 45 Hydrocortisone *ineralcorticoids Corticotropin (only parenteral) Hydrocortisone (oral)

Disease !ddisons Disease (Primary !drenocortical 4nsufficiency) Type of Disease Hypoadrenalism Pathology Destruction of adrenal corte) resulting in cortisol production and aldosterone Tumor arising from chromaffin cells of adrenal medulla secreting catecholamines (outside the adrenals: paragangliomas) Ds of Hypersecretion of the !drenal *edulla Pheochromocytoma

Cause 8884diopathic adrenalitis (autoimmune) 8T9 8Histoplasmosis !myloidosis% metastatic carcinoma% hemochromatosis (all resulting in damage to the pituitary or hypothalamus) Signs $ Symptoms !cute: rapid progression% shoc.% septicemia% %aterhouse&'riderichsen% D4C ,' ,idespread hemorrhage in s.in and organs% dehydration% hypotension% ,ea.ness% hypothermia% a(d pain% +'5 Chronic: insidious onset% malaise% ,eight loss% hypotension% loss of (ody hair% menstrual irregularities% s.in hyperpigmentation% ,ea.ness% fatigue% anore)ia% "4 s)% saltcra ings% postural hypotension 4diopathic often assoc? ,' other autoimmune diseases Paro)ysmal or sustained HT+% angina% cardiac arrhythmias leading to CH#% flushing% diaphoresis% palpitations% +'5 tachycardia% Episodic H!% s,eating% an)iety% tremor% isual distur(ances% ringing in ears% papilledema% heart murmurs% cardiomegaly Sporatic #amilial Some associated ,' *E+ 44% *E+ 444

Diagnosis cortisol +aL glucose 7L !CTH catecholamines in serum and urine Presence of 5*! (5anillylmandelic acid)in @A urine 88pathnomonic */4 to confirm

Treatment Acute: !ortisol 133mg 45 6 D-F until sta(le /educe o er Bd to maintenance dose of B3mg'd (# saline Glucose !hronic: Hydrocortisone @323mg 6D @'2 gi en in am 1'2 gi en in afternoon #ludrocortisone !lpha adrenergic (loc.ers ,' 9eta 9loc.ers Surgery

Disease "anglioneuroma' +euro(lastoma Type of Disease Ds of Hypersecretion of the !drenal *edulla Pathology "anglioneuroma 9enign tumor of ganglion cells +euro(lastoma Highly malignant tumor from neural crest !( against (eta cells destroy islet cells resulting in a decreased production of insulin 4mmune 5iral (Cac.sac.ie 5irus = molecular mimecry) "enetic (lin.ed to H0! D/2$A on Chromosome D) Onset early in life% (ut can occur at any time% <t loss% dry s.in% ,ea.ness% 4nsulitis% D7!% Hyperglycemia resulting in !"ES $ sor(itol depositions% e entually coma if unt)% insulinopenia% infections% polyuria% polyphagia% polydipsia Chronic Complications: C!D% *4% stro.e% gangrene% cataracts% artherosclerosis% retinopathy% nephropathy% neuropathy% ascular disease Diagnosis insulin H(!1c !( to islet cells or insulin #asting glucose C1@Dmg'd0 /andom glucose C@33mg'd0 Treatment 1? +PH 94D ,' premeal 0ispro @? "largine 6 HS ,' premeal 0ispro Pt education "oal: H(!1C EG or lo,er D7! t): hydration% insulin insulin H(!1c #asting glucose C1@Dmg'd0 /andom glucose C@33mg'd0 Target tissue de elops insulin resistance *eta(olic Disorder of the Pancreas Type 4 Dia(etes *ellitus Type 44 Dia(etes *ellitus

Cause Tumor O ereating% O(esity% "enetics (large predisposition) /is. factors: aging% sedentary lifestyle

Signs $ Symptoms +euro(lastoma: common in childhood% a(dominal mass% anemia% fe er% ,t loss Commonly metastasi&es to (one of s.ull and or(it (Hutchison-type) To li er (Pepper Syndrome)

Onset usually C23% (ut is (ecoming more common in younger% upper segment o(esity% polyuria% a(nl insulin secretion% insulin resistance% glucose production from li er% triglycerides d't ina(ility to acti ate lipoprotein lipase% hyperlipidemia indicates poor control Chronic Complications: C!D% *4% stro.e% gangrene% cataracts% artherosclerosis% retinopathy% nephropathy% neuropathy% ascular Ds

Diet% e)ercise% ,t loss Sulfonylureas "lucophage 4nsulin (occas?) T) hyperlipidemia Pt education

Disease

Type of Disease

Pathology

Cause

Signs $ Symptoms

Diagnosis

Treatment

Risk for fluid deficit----Addisions Disease & sweating profusely Dehydratuionrestlessness Fluid loss during severe diarrhea---reduced urine output vloume r/t AD secretion which is stimulated!