endocrine & metabolic disorders ii 1. parathroid glands
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ENDOCRINE & ENDOCRINE & METABOLIC DISORDERSMETABOLIC DISORDERS
II II
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PARATHROID GLANDS
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Primary Primary hyperparathyroidismhyperparathyroidismEtiology:Etiology:
1. Parathyroid adenoma (80%)2. Parathyroid hyperplasia (15%)3. Parathyroid carcinoma is very
rare4. Para-neoplastic syndrome: lungs
and renal carcinomas can secrete parathyroid-like substances and give a picture of hyperparathyroidism
Pathogenesis:Pathogenesis: Excess production of parathyroid hormone
(PTH) leads to hypercalcaemia
Clinically:Clinically:1. Laboratory: elevated serum calcium and
PTH2. Kidney stones3. Osteoporosis (calcium moves out of
Bones)4. Metastatic calcification (abnormal
deposition of calcium in tissues)5. Neurological changes
Secondary Secondary HyperparathyroidismHyperparathyroidism
Etiology:Etiology:1. Chronic renal failure2. Vitamin D deficiency3. Malabsorption
Pathogenesis:Pathogenesis: -Caused by any disease that results in
hypocalcaemia, leading to increased secretion of PTH by the parathyroid glands
Hypo-parathyroidismHypo-parathyroidism
Etiology:Etiology:
Surgical removal of gland during thyroidectomy
Digeorge syndrome (congenital absence of parathyroid glands)
Clinical picture of Clinical picture of hypoparathyroidismhypoparathyroidism1-1-Lab: hypocalcaemia
2-Neuromuscular excitability and tetany:
-Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)
-Chvostek's sign (tapping of the inferior portion of the zygoma will produce facial spasms)
3-Psychiatric disturbances
4-Cardiac conduction defects
Normal pituitary glandNormal pituitary gland
PITUITARY GLAND
Gigantism:Gigantism:
Children & adolescents Before fusion of growth
plates Tall stature & long
extremities
Acromegaly:Acromegaly:
Adults After fusion Prominent jaw Flat, broad forehead Enlarged hands and
feet Visceral
abnormalties
Growth hormone producing Growth hormone producing adenomaadenoma Elevated growth hormone
GigantismGigantism
AcromegalyAcromegaly
Pituitary DwarfismPituitary Dwarfism
Definition
Dwarfism is a condition in which the growth of the individual is very slow or delayed, resulting in less than normal adult stature.
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Pituitary Pituitary DwarfismDwarfism
Therefore, pituitary dwarfism is decreased bodily growth due primarily to hormonal problems (decreased growth hormone).
The end result is a proportionate little person, because the height and the growth of all other structures of the individual are decreased.
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Cushing syndromeCushing syndrome
Definition:Definition:Disease characterized by increased
levels of glucocorticoids
Causes of Cushing’s Causes of Cushing’s Syndrome:Syndrome:1. Adenoma of adrenal cortex2. Excessive secretion of adreno-
corticotrophic hormone (ACTH)3. Prolonged administration of
glucocorticoids
Clinical features of Cushing Clinical features of Cushing disease:disease:1. Trunkal obesity2. Hypertension3. Glucosuria 4. Menstrual and sexual dysfunction5. Hirsutism and acne6. Muscle weakness7. Osteoporosis8. Poor wound healing 9. Edema10.More susceptible to infections
Clinical features of Cushing’s diseaseClinical features of Cushing’s disease
Addison’s diseaseAddison’s disease (chronic adrenocortical insufficiency)
Definition:Definition: Destruction of the adrenal cortex,
leading to a deficiency of glucocorticoids and androgens
Etiology:Etiology: Autoimmune adrenalitis Tuberculosis Metastatic cancer
Clinical presentation:Clinical presentation:1. Gradual onset of weakness2. Skin pigmentation3. Hypotension4. Hypoglycemia5. Poor response to stress
Addison’s diseaseAddison’s disease
METABOLIC METABOLIC DISORDERSDISORDERS
CALCIUM METABOLISM
Definition:
Calcium metabolism is the mechanism by which the body maintains adequate calcium levels.
Sources of calcium:Sources of calcium:
Calcium enters the body in a normal diet.
Vitamin D is an important co-factor in the intestinal absorption of calcium.
Calcium location in the body:Calcium location in the body:
99% in the skeleton in the form of calcium phosphate salts.
The extracellular fluid (ECF) and the serum.
DISORDERS OF CALCIUM DISORDERS OF CALCIUM METABOLISMMETABOLISM
Calcium
Regulated by three hormones1. Parathyroid hormone (PTH)
Increases plasma calcium levels2. Vitamin D
Fat-soluble steroid; increases calcium absorption from the gatrointectinal tract
3. Calcitonin Decreases plasma calcium levels
HYPERCALCAEMIAHYPERCALCAEMIA
Definition:
Hypercalcaemia is an elevated calcium level in the blood. It can be due to 1-excessive skeletal calcium release, 2-increased intestinal calcium absorption, or 3-decreased renal calcium excretion
Causes of hypercalcaemiaCauses of hypercalcaemia
1.Hyperparathyroidism and malignancy account for ~90% of cases
2.Vitamin D metabolic disorders3.Renal failure
Signs and symptoms:Signs and symptoms:
1.Hypercalcaemia can result in fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, pancreatitis, renal stones and bladder stones.
2.Abnormal heart rhythms.
3.Severe hypercalcaemia is considered a medical emergency: at these levels as coma and cardiac arrest can result.
HypocalcaemiaHypocalcaemia
Definition:
Hypocalcaemia is the presence of low serum calcium levels in the blood.
Cause:Cause:
1.Eating disorders 2.Magnesium over supplementation 3.Prolonged use of medications/laxatives containing magnesium
4.Absent parathyroid hormone 5.Absent active vitamin D6.Decreased sun exposure 7.Intestinal malabsorption
Symptoms:Symptoms:
1.Peri-oral tingling and decreased sensations.
2.Tetany, carpo-pedal spasm are seen. 3.Latent tetany 4.Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)
5.Chvostek's sign (tapping of the inferior portion of the zygoma will produce facial spasms)
6.Tendon reflexes are hyperactive
Life threatening complications:Life threatening complications:
1.Laryngospasm2.Cardiac arrhythmias
Hypocalcemia and Hypercalcemia Hypocalcemia
Increased neuromuscular excitability
Muscle cramps
Hypercalcemia Decreased
neuromuscular excitability
Muscle weakness Increased bone
fractures Kidney stones Constipation
Vitamin D deficiency:
SIGNS OF VITAMIN D DEFICIENCY:
1. Rickets (children)
2.Osteomalacia (adults)
Vitamin D excess: → hypercalcaemia and kidney stones.
Rickets
A disease that is characterized by deficient mineralization of bone in children (before epiphyseal closure) leading to softening of the bones and potentially leading to fractures and deformity.
It is caused by Vitamin D deficiency which leads to decreased absorption of calcium
Vit. D deficiency may be due Vit. D deficiency may be due to:to:
1-Malnutrition associated with decreased exposure to sunlight
2-Secondary to intestinal malabsorption
Pathological features
There is abnormal bony trabeculae with big amounts of uncalcified osteoid leading to soft weak bones
Rickets :
Signs and symptoms of rickets include:
1. Bone pain or tenderness 2. dental problems (delayed teeth erruption) 3. muscle weakness (rickety myopathy or "floppy
baby syndrome") 4. increased tendency for fractures (easily broken
bones), especially greenstick fractures 5. Skeletal deformity: Bowed legs, cranial, spinal
and pelvic deformities 6. Growth disturbances7. Thoracic changes – pigeon breast deformity,
ricketic rosary.8. Head – cranio-tabes and frontal bossing.9. Vertebrae – lumbar lordosis.
Diagnosis:
1.Blood tests: Serum calcium may show low levels of calcium and serum alkaline phosphatase may be high.
2.X-rays of affected bones may show loss of calcium from bones or changes in the shape or structure of the bones.
3.Bone biopsy is rarely performed but will confirm rickets.
OSTEOMALACIAOSTEOMALACIA
Osteomalacia is the term used to
describe a similar condition occurring in adults, generally due to a deficiency of vitamin D.
It is characterized by inadequate mineralization of newly formed bone matrix.
OsteomalaciaOsteomalacia
Introduction 3% of world population, 100 million
people Incidence is increasing alarmingly Most Common non communicable
disease High Morbidity & mortality. Leading cause of blindness and Kidney
diseases
DIABETES MELLITUS
Definition:
Diabetes mellitus (DM) is a systemic disease resulting from deficient insulin secretion or development of resistance to insulin.
This leads to disturbance of carbohydrate metabolism and fat metabolism that is reflected on all body systems
Symptoms and signs of uncontrolled hyperglycaemia in Diabetes Mellitus
Infections in Diabetes: Diabetes Diabetes State of State of
immunosuppressionimmunosuppression
Causes of decreased immunity in DM:: Decreased metabolism low immunity Decreased function of lymphocytes &
neutrophils Ischemia & infarctions Increased glucose
Types of DM
Primary DM – (primary - no other disease) Type I – IDDM / Juvenile . Type II – NIDDM /Adult onset Gestational Diabetes
Secondary DM – (secondary to other dis.) Pancreatitis/ tumors/ Haemochromatosis. Infectious – congenital rubella. Endocrine diseases, Down Syndrome. Drugs – Corticosteroids.
Laboratory Diagnosis:
Urine glucose – (dip-stick) –Screening Fasting blood glucose Random blood glucose Post-prandial blood glucose
EFFECTS EFFECTS AND AND
COMPLICATIONS OF COMPLICATIONS OF DIABETESDIABETES
Complications:
Short term Complications: Hyperglycaemia Hypoglycaemia Diabetic Ketoacidosis Non Ketotic hyperosmolar diabetic coma Lactic acidosis
Long term Complications Microngiopathy - Retinopathy, Nephropathy,
Neuropathy, dermatopathy. Macroangiopathy – Atherosclerosis.
Microangiopathy Pathogenesis:
Hyperglycemia chronic. Glycosylation of basement membrane
proteins Leaky blood vessels. Excess deposition of proteins Thick and Leaky blood vessels. Narrow lumen Ischemic Organ damage...
Diabetic MicroangiopathyNormal
Diabetic
Diabetic Neuropathy
Peripheral Neuropathy Bilateral, symmetric Progressive, irreversible Leads to decreased sensation, pain,
muscle atrophy
Visceral neuropathy Cranial nerve diplopia GIT constipation, diarrhoea CVS orthostatic hypotension
Diabetic Neuropathic ulcer
Use of a monofilament in testing for impaired sensation in the foot of a person with diabetes
Neuropathic ulcer
Etiology: peripheral sensory
neuropathy, trauma & deformity.
Factors: Ischemia, callus
formation, and edema.
Neuropathic ulcers
FEATURES:Painless, surrounded by callus At pressure points. associated with good foot pulsesMay or may not be associated with gangrene
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