1. Endocrine System Diseases
Introduction to Human Diseases:
Chapter 14

2. Endocrine System Terminology
• Endocrine
• Exocrine
• Hormone
• Target organ
• Hypersecretion
• Hyposecretion

3. Pituitary Gland Diseases
• Hyperpituitarism
– Hypersecretion of growth hormone (GH) by the
pituitary
• Gigantism
– GH hypersecretion during puberty and growth years
• Person is very tall, proportioned normally
• Acromegaly
– GH hypersecretion during adulthood
– Disfiguring overgrowth of bones & soft tissues

4. Hyperpituitarism
• Other aspects:
– Gigantism:
• Fairly abrupt onset
• Non-life threatening
• Growth up to 6 inches/yr
– Agromegaly:
• Gradual onset
• Decreases life expectancy
• Headache, sinus problems, skin changes, paresthesias, joint
pain, visual disorders

5. Hypopituitarism
• Deficiency of any or all of the pituitary
hormones
• Usually involve GH and gonadotropin
– LH, FSH, Prolactin, Oxytocin
• Less commonly involved:
– ACTH and TSH
• Panhypopituitarism:
– All hormones are deficient

6. Hypopituitarism
• S/S: varies with hormone deficiency and
age of disease onset
– In childhood: S/S are dwarfism and delayed
development of 2ndary sexual characteristics
– In adults: S/S are amenorrhea, infertility,
lowering of testosterone levels, libidy, hair
loss.
– ACTH & TSH deficiency: general S/S:
fatigue, pallor, anorexia, poor stress response

7. Hypopituitarism:
• Treatment: hormone replacement

8. Diabetes Insipidus
• Hyposecretion of vasopressin
– ADH (antidiuretic hormone)
• S/S: extreme polyuria, thirst, very dilute
urine produced, leads to dehydration
• Etiology: anything that destroys the
pituitary or idiopathic
• Treatment: fluid replacement, hormone
replacement (tablet, nasal spray)

9. Thyroid Gland Diseases
• Goiter
– Enlargement or hyperplasia of thyroid gland
• Simple goiter
– Goiter not caused by infection, tumor, other
hypo- or hyperthyroid condition
– More common in females
– Sporadic and endemic types

10. Goiter
• Sporadic type
– Ingestion of certain foods, drugs (goitrogens)
• Endemic type
– Diet deficiency of iodine
• Etiology: hyperplasia due to inability to
make sufficient T3 and T4, compensation
• Treatment: T3 or T4 or iodine
replacements, surgery, dietary changes

11. Thyroiditis
• Inflammation of thyroid gland
• Females more than males
• Etiology & types:
– Autoimmune
• Antibodies to thyroid hormones
• Myxedema, Grave’s disease
• Hashimoto’s thyroiditis (lymphocytes infiltrate)
– Subacute granulomatous
• Follows an infection (mumps, influence, adenovirus)
– Miscellaneous
• Bacterial infections (TB, syphilis, suppurative)

12. Thyroiditis
• S/S: may have no symptoms or thyroid
enlargement, pain and dysphagia
• Autoimmune thyroiditis = most common
type, common in females
• Treatment varies with type:
– Hormone replacement, steroid, antibiotics,
anti-inflammatories, pain meds

13. Grave’s Disease
• Hyperthyroidism
– Grave’s disease is most common hyperthyroid disease
• Hypersecretion of T3 and T4
• May cause thyrotoxicosis
– Diffuse effect, multiple symptoms
• Females mostly, 30-40 YOA
• Etiology:
– Genetic or immunologic

14. Grave’s Disease
• S/S:
• Thyrotoxicosis
– Anxiety, insomnia, heat intolerance, sweating, muscle
wasting, weight loss, tachycardia, hypertension
– Thyroid storm: critical episode of thyrotoxicosis
• Ophthalmopathy: exophthalmos (protrusion of
eyeballs, “frightened” appearance)
• Dermopathy: thickened skin on legs/feet
(“orange skin”
• Exacerbations & remissions

15. Grave’s Disease
• Treatment:
– Varies with disease severity & patient age
– Antithyroid drugs, surgery, radioactive iodine
therapy

16. Hypothyroidism
• Hyposecretion of thyroid hormones
• More common in women, esp. over 40
YOA
• Two versions:
– Cretinism
• Congenital form
– Myxedema
• Starts in childhood or adulthood

17. Hypothyroidism
• Etiology:
– Dietary, metabolic, iatrogenic, congenital,
inflammatory, chronic autoimmune
• S/S:
– Children: growth retardation, delayed sexual
development, impaired intelligence
– Adults: cold intolerance, fatigue, constipation, weight
gain, anorexia, dry skin, brittle hair &nails,
cardiomegaly, myxedema coma
• Treatment: Hormone replacement meds

18. Parathyroid Diseases
• Hyperparathyroidism
• Affects women more than men (2:1)
• Excessive secretion of PTH by gland
causes abnormalities of calcium (Ca++)
and phosphates (PO4--)
• Effects:
– Hypercalcemia (most important effect)
– hypophosphatemia

19. Hyperparathyroidism/
Hypercalcemia
• Primary disease: parathyroid adenoma
• Secondary disease: chronic RF, calcium deficient
diet, calcium malabsorption
– Any condition that tends to reduce circulating levels
of calcium
• S/S: many patients are asymptomatic
– Brittle bones, arthralgias, calcium renal stones,
polyuria, nausea, vomiting, fatigue, muscle weakness
or atrophy, cardiac arrythmias

20. Hyperparathyroidism
• Treatment:
– Surgical removal of gland(s)
– Increasing fluid & sodium intake
– Meds that increase calcium excretion
– Treatment varies with the etiology, primary or
secondary

21. Hypoparathyroidism
• Undersecretion of PTH by gland
– Hypocalcemia
– Excessive calcium deposition into bones
• Etiology: iatrogenic (surgical) or inherited
• S/S: paresthesias of extremities, muscle
cramps (tetany), depresion, irritability,
laryngospasm, seizures, brittle nails, hair
loss

22. Hypoparathyroidism
• Treatment:
– Vitamin D and calcium supplements
– Periodic lab tests to determine serum levels
– High calcium, low phosphorus diet

23. Adrenal Disease
• Cushing’s Syndrome:
– Hypersecretion of hormones by the adrenal
cortex
– Cortisol excess
– More common in women
– May be due to:
• Oversecretion of ACTH
• Benign or malignant neoplasm of adrenal cortex
• Iatrogenic (prolonged steriod treatment)

24. Cushing’s Disease
• S/S:
– “moon facies”, truncal obesity with thin limbs,
“buffalo hump”, decreased glucose tolerance,
muscle weakness, hypertension, anxiety,
depression
• Treatment:
– Surgery for tumor removal, drug or radiation
to decrease ACTH secretion

25. Other Adrenal Diseases
• Addison’s Disease
– Hyposecretion of adrenal cortex hormones
– Decreased ability to handle physiological stress
– Low BP, increased temperature
• Pheochromocytoma
– Tumor of adrenal medulla
– Secretes catecholamines
• Epinephrine
• Norepinephrine
• Like SNS, increases blood pressure, heart rate, skin flushing

26. Diabetes Mellitus
• Chronic carbohydrate metabolism disorder
due to insulin deficiency or inadequate
insulin utilization by cells
• Insulin
– Pancreatic endocrine secretion (hormone)
– Made by islet of Langerhans
– Lowers serum glucose level
– Allows cellular uptake and use of glucose

27. Diabetes Mellitus (DM)
• Disorder characterized by:
– Hyperglycemia
– Ketosis (ketones in the blood)
– Acidosis (excess hydrogen ions in the blood)
– Ketoacidosis

28. Diabetes Mellitus
• Types of DM:
– Type 1 (juvenile onset)
• Immune-mediated absence of insulin
• Often seems to appear abruptly & emergently
– Type 2 (adult onset)
• Able to make insulin
• Often obesity related
– Gestational (GDM)
• Occurs during pregnancy & resolves after delivery
• 25% risk of DM development later in life
• Tend to have large babies (over 9 lbs)

29. Diabetes:
• Etiology:
– Autoimmune, genetic, pancreatic disorders,
drugs, tumors, Cushing’s, cells become
insensitive to insulin in some
• S/S:
– Three P’s: polyuria, polydipsia, polyphagia
– Increased susceptibility to infections &
vascular diseases, retinopathy, renal failure

30. Diabetes:
• Treatment:
– Type 1: insulin administration
– Type 2: diet & exercise
• Oral hypoglycemics
• insulin

31. Diabetic Emergencies:
• Insulin shock (severe hypoglycemia)
• Diabetic Ketoacidosis
– Severe hyperglycemia & ketoacidosis
– Altered mental status, possible coma
– Severe dehydration