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Endocrine Patho OutlineHypothalamuscenter409575InfoMain link between nerves & hormonesProduces “releasing factors” into blood supplyReleasing factors travel to pituitary glandProduces ADH & Oxytocin (then sends to posterior pituitary)Disorders of HypothalamusSurgical transection Head injuryTumor affecting stem to pituitary gland (tumor causes pressure and blocks the gland off from the hypothalamus)Infections (like meningitis)Pituitary GlandInfoPituitary hormones affectSkinKidneysBonesAdrenalsThyroidMammary glandsSex glandsPituitary Gland HormonesAnteriorGH (Growth Hormone)ACTH (goes to the adrenal glands)TSH (Thyroid stimulating Hormone)PRLFSH LHMSH (melanocyte stimulating hormone, affects the skin, the higher the level the darker the complection)Posterior (both made and stored in pituitary)ADHOTDiseases of Pituitary GlandHypopituitarismPathoRanges from absence of certain hormones to complete failure of hormone functionsDepends on the area being affected. For example growth hormone is only made in one particular area. If that area is damaged or whatever the pt is going to have less growth hormone than he should)Pituitary extremely vascularVulnerable to infarction (cause the vessels are so small)During pregnancy—pituitary gland enlarges (thus more vascular). Affects hormone levels, usually increasing them. But the swelling of the gland can cut off parts of itS/SDwarfism (in children, not in adults)Not enough growth hormone↓ lactation or absent lactationOxytocin slows downLoss of body hair; ↓ libidoHypothyroidismThyroid stimulating hormoneCausesDiabetes MellitusDrop in hormones because of hardening of the arteries and circulation gets worse and worse. The capillaries are affected and less O2 gets there. From this point there isn’t much of a chance of reversing it at all. Sickle cell diseaseSickle cells are blood cells that aren’t shaped like they’re supposed to. They have a tendancy to clump in capillariesShockLow fluid volumeHead traumaSquishing off a part or damaging a part of the glandInfections (Meningitis, TB, syphilis)Ablation due to tumor removalIt’s hard to cut out a tumor and leave all the healthy tissue. Some good stuff gets cut outHyperpituitarimsPathoPituitary adenomas—slow-growing tumors from anterior pituitaryOne of the predominant things that cause this. Carcinomas are rare, adenomas are usually limited. As they grow they cause pressure. Once the cells become cancerous (whether benign or cancerous) they no longer abide by the rules. If the tumor is near where Growth Hormone is made, the tumor cells will make growth hormone like crazyMay put pressure on optic nervesCause of the close proximity of the pituitary gland to the optic nerves. May grow/metastasize (remember it’s carcinoma, which is rare) to hypothalamusSecrete hormone(s) regardless of what body needsMore often see thisS/SRelated to tumor growth (almost always!) Think about tumor growth and pressure leading to the following s/s:HeadacheFatigueNeck pain / stiffness (pressure on nerves, pain center, etc.)Seizures (pressure on nerves)Temporary blindness (pressure on optic nerves)GH(Growth Hormone) HypersecretionPathoAcromegaly (“Giantism”) (if it happens at an early age it will lead to this)Rare, caused by GH-secreting tumor (adenoma)In adults, leads to characteristic appearance (Note pictures on p.479)Leads to HTN, IDDM, CHFAssociated with ↓ life expectancy (if it’s congenital, kid probably won’t live much longer past the late 20’s)ProlactinomaPathoMost common Pituitary tumor↑ Secretion of prolactin (tumor causes increase in this because of the location)S/SWomen↑ milk productionMenstrual disturbances (amenorrhea)↑ hair growth (hirsutism)MenLoss of libidoErectile dysfunctionThyroid GlandInfoThyroid hormone (T3, T4, Calcitonin) affectMetabolism of all cellsBody heat productionMuscle toneSerum calcium levels (in the blood)Secretions in GI tractCardiac rate & forceRandomsThey draw blood looking for thyroid stimulating hormone. If you’ve got tiny amounts of TSH, you will probably have a small hormone aka hypothyroidismDiseases of the ThyroidHyperthyroidism (aka Graves Disease)InfoMost common cause of ↑ thyroid (is Graves Disease)Autoimmune disease (the body makes antibodies that stimulate the production/secretion of thyroid hormone)Antibodies stimulate cells to overproduce TH (Thyroid grows bigger)Thyroid gland usually grows (Goiter)S/S of Graves DiseaseWeight loss (metabolism is going faster)Restlessness Heat intolerance (people get very irritated in the heat)Sweating (r/t increased metabolism and all that)Oily skinTachycardia (affects heart muscles)AgitationTremors (also affects all muscles)ExopthalmosFine HairMuscle weaknessMuscle wastingHypothyroidismInfoMost common disorder of thyroid function More common in women than men (Why? Don’t know)Primary—Congenital defect; post hyperthyroid treatment (if they had hyper and they removed some of the gland, now they have hypo); iodine deficiency (more common in 3rd world countries)Secondary—?hypothalamus; ?pituitary (could be something going on elsewhere, they try to figure out)PathoLoss of thyroid tissueThus, ↓ production of THThus, ↑ production of TSHThus, growth of thyroid tissue → GoiterS/SLower metabolic rate (weight gain)Cold intoleranceLethargy / fatigueMyxedema (diffuse edema that develops in the interstitial space, everywhere in the body. Shows up in the face. Good description in the book. He’ll let us look it up. Hooray.)ConstipationCoarse hairDry skinPossibly goiterParathyroid GlandsInfoIncreases calcium levels in blood Acts on bones to release stored calciumActs on intestines to ↑ calcium absorptionActs on kidneys to ↓ calcium lossThere are four of them on the thyroid. If they operate and take out some of the thyroid gland, chances are they might remove some of the parathyroid glands in the process. Diseases of the Parathyroid GlandHyperparathyroidismPathoPrimary— ↑ secretion of PTH; usually results from chief cell adenoma (chief cells are in the stomach, they kick off something for the PTH to increase)Thus, GI aborption of calcium ↑Thus, kidneys generate ↑ vitamin DSecondary—Response to chronic hypocalcemia (if calcium is too low in the blood the PTH is going to be pumped out in excess)Resulting from malabsorption in GI tract, or ↓ activation of vitamin D (renal failure, vit D is down and we start spilling calcium, calcium declines in the blood)S/SPathologic fractures (r/t loss of calcium in bones, bones get weak)Kyphosis of dorsal spineCompression fractures in vertebraeCalcium “spilling” into urine (Hypercalciuria)Can lead to metabolic acidosisCalcium has a strong positive charge. You get rid of too many, may get acidic. The following s/s are belowFatigue, N/V, anorexia, depression, headacheThe calcium spilling is the primary s/s of this cause so many of the other ones are non specific. They make you think of other diseases first. HypoparathyroidPathoDamage post thyroid surgery (lose some tissue containing a parathyroid gland)Thus, ↓ circulating PTHThus, reabsorption of calcium is impaired (cause the gut isn’t being signaled to hang onto it)Thus, phosphate ↑ in blood (there aren’t many things that cause this in the blood. In this disease the low levels of calcium lead to the increased phosphate)S/SHypocalcemia Leads to ↑ muscle spasms, hyperreflexia, laryngeal spasmsDry skinLoss of body/scalp hair ................
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