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Alterations of Hormonal RegulationChapter 21
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Elevated or Depressed Hormone Levels Failure of feedback systems Dysfunction of an endocrine gland Secretory cells are unable to produce, obtain, or
convert hormone precursors The endocrine gland synthesizes or releases
excessive amounts of hormone Increased hormone degradation or inactivation Ectopic hormone release
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Target Cell Failure Receptor-associated disorders
Decrease in number of receptors Impaired receptor function Presence of antibodies against specific receptors Antibodies that mimic hormone action Unusual expression of receptor function
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Hormone Delivery
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Alterations of the Hypothalamic-Pituitary System
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Diseases of the Posterior Pituitary Syndrome of inappropriate antidiuretic
hormone secretion (SIADH) Hypersecretion of ADH For diagnosis, normal adrenal and thyroid
function must exist Clinical manifestations are related to enhanced
renal water retention, hyponatremia, and hypoosmolarity
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Diseases of the Posterior Pituitary Diabetes insipidus
Insufficiency of ADH Polyuria and polydipsia Partial or total inability to concentrate the urine Neurogenic
Insufficient amounts of ADH
Nephrogenic Inadequate response to ADH
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Diseases of the Anterior Pituitary Hypopituitarism
Pituitary infarction Sheehan syndrome Hemorrhage Shock
Others: head trauma, infections, and tumors
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Diseases of the Anterior Pituitary Hypopituitarism
Panhypopituitarism ACTH deficiency TSH deficiency FSH and LH deficiency GH deficiency
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Diseases of the Anterior Pituitary Hyperpituitarism
Commonly due to a benign, slow-growing pituitary adenoma
Manifestations Headache and fatigue Visual changes Hyposecretion of neighboring anterior pituitary
hormones
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Diseases of the Anterior Pituitary Hypersecretion of growth hormone (GH)
Acromegaly Hypersecretion of GH during adulthood
Gigantism Hypersecretion of GH in children and adolescents
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Hypersecretion of Growth Hormone (GH)
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Diseases of the Anterior Pituitary Hypersecretion of prolactin
Caused by prolactinomas In females, increased levels of prolactin cause
amenorrhea, galactorrhea, hirsutism, and osteopenia In males, increased levels of prolactin cause
hypogonadism, erectile dysfunction, impaired libido, oligospermia, and diminished ejaculate volume
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Alterations of Thyroid Function Hyperthyroidism
Thyrotoxicosis Graves disease
Pretibial myxedema
Hyperthyroidism resulting from nodular thyroid disease Goiter
Thyrotoxic crisis
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Thyrotoxicosis (Graves’ Disease)
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Alterations of Thyroid Function Hypothyroidism
Primary hypothyroidism Subacute thyroiditis Autoimmune thyroiditis (Hashimoto disease) Painless thyroiditis Postpartum thyroiditis Myxedema coma
Congenital hypothyroidism Thyroid carcinoma
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Hypothyroidism
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Alterations of Parathyroid Function Hyperparathyroidism
Primary hyperparathyroidism Excess secretion of PTH from one or more
parathyroid glands Secondary hyperparathyroidism
Increase in PTH secondary to a chronic disease Hypoparathyroidism
Abnormally low PTH levels Usually caused by parathyroid damage in thyroid
surgery
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Type 1 Diabetes Mellitus Demonstrates pancreatic atrophy and specific
loss of beta cells Macrophages, T and B lymphocytes, and
natural killer cells are present Two types
Immune Nonimmune
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Type 1 Diabetes Mellitus Genetic susceptibility Environmental factors Immunologically mediated destruction of beta
cells Manifestations
Hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, and fatigue
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Type 1 Diabetes Mellitus
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Type 1 Diabetes Mellitus
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Dysfunction of the Pancreas Type 2 diabetes mellitus
Maturity-onset diabetes of youth (MODY) Gestational diabetes mellitus (GDM) Common form of diabetes mellitus type 2
Insulin resistance
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Type 2 Diabetes Mellitus
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Acute Complications of Diabetes Mellitus Hypoglycemia Diabetic ketoacidosis Hyperosmolar hyperglycemic nonketotic
syndrome (HHNKS) Somogyi effect Dawn phenomenon
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Diabetic Ketoacidosis
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Chronic Complications of Diabetes Mellitus Hyperglycemia and nonenzymatic
glycosylation Hyperglycemia and the polyol pathway
Protein kinase C Microvascular disease
Retinopathy Diabetic nephropathy
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Diabetic Nephropathy
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Chronic Complications of Diabetes Mellitus Macrovascular disease
Coronary artery disease Stroke Peripheral arterial disease
Diabetic neuropathies Infection
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Diabetic Amputation
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Diabetic Neuropathy
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Alterations of Adrenal Function Disorders of the adrenal cortex
Cushing disease Excessive anterior pituitary secretion of ACTH
Cushing syndrome Excessive level of cortisol, regardless of cause
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Cushing Disease
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Alterations of Adrenal Function Disorders of the adrenal cortex
Hyperaldosteronism Primary hyperaldosteronism (Conn disease) Secondary hyperaldosteronism
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Primary Hyperaldosteronism
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Alterations of Adrenal Function Disorders of the adrenal cortex
Adrenocortical hypofunction Primary adrenal insufficiency (Addison disease)
Idiopathic Addison disease
Secondary hypocortisolism
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Alterations of Adrenal Function Disorders of the adrenal cortex
Hypersecretion of adrenal androgens and estrogens Feminization Virilization
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Virilization
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Alterations of Adrenal Function Disorders of the adrenal medulla
Adrenal medulla hyperfunction Caused by tumors derived from the chromaffin cells
of the adrenal medulla Pheochromocytomas
Secrete catecholamines on a continuous or episodic basis
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Pheochromocytoma