Endocrine

Primary Adenoma of the Pituitary Gland

• Benign tumors of the pituitary gland are located at the brain's base.
• Arises from pituitary cells and affects hormone secretion.
• Pituitary adenomas result from abnormal pituitary cell growth and cause excessive hormone secretion or hyposecretion due to tumor mass effects.
• Adenomas can be functioning (hormone-secreting) or non-functioning.
• Functioning adenomas produce hormones like prolactin, growth hormone (GH), ACTH, or TSH.
• Non-functioning adenomas do not produce hormones but may cause symptoms by compressing structures like the optic chiasm, leading to visual disturbances.

Functioning Adenomas

• Prolactin-secreting adenomas can cause galactorrhea, infertility, amenorrhea, and decreased libido.
• Growth hormone-secreting adenomas can lead to acromegaly (in adults) or gigantism (in children), characterized by abnormal growth of bones and soft tissues.
• ACTH-secreting adenomas can lead to Cushing's disease, causing hypercortisolism and central obesity.
• TSH-secreting adenomas are rare but can lead to hyperthyroidism.

Non-Functioning Adenomas

• Can present with mass effect symptoms, including headaches.
• Visual disturbances, particularly bitemporal hemianopia (loss of vision in the outer field of both eyes due to optic chiasm compression) can occur.
• Hypopituitarism results from compression of normal pituitary tissue, causing deficiencies in hormones like gonadotropins, TSH, and ACTH.

Acromegaly

• It is characterized by excessive growth hormone (GH) secretion, commonly caused by a growth hormone-secreting pituitary adenoma.
• Pituitary adenomas secrete excess GH, leading to overproduction of insulin-like growth factor 1 (IGF-1) in the liver.
• Elevated IGF-1 causes abnormal growth of bones and soft tissues.
• In children, this results in gigantism, excessive linear growth.
• In adults, after the closure of epiphyseal plates, acromegaly occurs, causing acral enlargement.

Clinical Manifestations of Acromegaly

• Enlarged hands and feet (spade-like hands, widened shoes and rings) can manifest.
• Coarsened facial features, including a prominent jaw, enlarged nose, and thicker lips can be observed.
• Soft tissue hypertrophy can be noted, leading to thickened skin, tongue enlargement, and possible sleep apnea.
• Joint pain results from the enlargement of joints.
• Hyperhidrosis (excessive sweating) and oily skin can be observed.
• Patients have an increased risk of cardiovascular disease, including hypertension and cardiomegaly.
• Some individuals experience glucose intolerance or diabetes mellitus due to GH's insulin-antagonistic effects.

Diabetes Insipidus (DI)

• Is characterized by excessive urination (polyuria) and thirst (polydipsia) due to an inability to concentrate urine.

Central Diabetes Insipidus (CDI)

• It is caused by insufficient secretion of antidiuretic hormone (ADH), also called vasopressin, from the posterior pituitary.
• This can result from damage to the hypothalamus or pituitary gland.
• Kidneys cannot reabsorb water properly without ADH, leading to the excretion of large volumes of dilute urine.

Nephrogenic Diabetes Insipidus (NDI)

• Kidneys are resistant to ADH despite normal or high hormone levels.
• Resistance may be due to genetic mutations, medications such as lithium, or kidney disease.

Clinical Manifestations of Diabetes Insipidus

• Polyuria (frequent urination) with large volumes of dilute urine is common.
• Polydipsia (excessive thirst) is a symptom due to dehydration.
• Nocturia (frequent nighttime urination) impacts sleep.
• Severe cases cause hypernatremia and dehydration if water intake is inadequate.
• Dry skin and fatigue occur as a result of fluid loss.

Syndrome of Inappropriate ADH Secretion (SIADH)

• It is the excessive release of ADH, leading to water retention and hyponatremia.
• Any surgery can result in increased ADH secretion for as long as 5 to 7 days after surgery.
• SIADH is characterized by excessive secretion of ADH from the posterior pituitary or ectopic sources.
• ADH causes the kidneys to retain water, leading to water intoxication and dilutional hyponatremia.
• Excessive water retention dilutes the sodium in the blood, often leading to hyponatremia and possibly cerebral edema.

Clinical Manifestations of SIADH

• Hyponatremia can occur, with its range of symptoms from mild to severe.
• Nausea, vomiting, and anorexia can be experienced.
• Confusion and lethargy may be experienced, and in severe cases, seizures or coma due to cerebral edema can occur.
• Patients can have decreased urine output despite normal fluid intake.
• Weight gain can occur due to fluid retention.
• The absence of edema can be noted due to the condition relating to the dilution of sodium rather than actual fluid overload.
• Rapidly correcting hyponatremia can cause central pontine myelinolysis.

Graves' Disease

• The most common cause of hyperthyroidism is an autoimmune disorder.
• Often occurs more frequently in women, particularly during early adulthood or middle age, and is associated with other autoimmune conditions.

Pathophysiology of Graves' Disease

• Thyroid-stimulating immunoglobulins or TSI are autoantibodies produced.
• TSI antibodies bind to the TSH receptor on thyroid follicular cells, leading to the excessive stimulation of the thyroid gland, which generates increased T3 and T4 production.
• These antibodies are not regulated by negative feedback, unlike normal TSH.
• The thyroid becomes enlarged (goiter) because of overstimulation.

Graves' Disease Manifestations

• It can lead to increased metabolic rate because of excessive thyroid hormones.
• Resulting in weight loss, despite increased appetite.
• Possible symptoms are tachycardia (rapid heart rate) often with palpitations, heat intolerance and sweating.
• Tremors (fine hand tremors), and fatigue or muscle weakness in the arms and thighs may be experienced.
• Can include goiter (enlarged thyroid gland).
• Exophthalmos (bulging eyes) and periorbital edema occurs in 25–50% of cases may cause dry eyes, diplopia, and impaired vision.
• Skin changes, such as pretibial myxedema, occur with orange-peel-like skin on the shins.
• Increased rate due excess thyroid hormones include nervousness, irritability, and insomnia.
• Increased gut motility can cause diarrhea or more bowel movements.
• Menstrual irregularities occur, particularly oligomenorrhea or amenorrhea.

Thyrotoxic Crisis

• A life-threatening complication of severe hyperthyroidism can be precipitated by infection, surgery, trauma, or discontinuing anti-thyroid medications.
• It requires medical intervention.

Pathophysiology of Thyrotoxic Crisis

• Levels of thyroid hormones elevates at a rapid and extreme rate which affects virtually every organ system.
• Is a sudden surge in T3 and T4 levels often due to acute exacerbation of underlying hyperthyroidism
• The increase in thyroid hormones can dramatically affects the sympathetic nervous system, cardiovascular function, and metabolism.
• This leads to severe cardiac arrhythmias, tachycardia, hyperthermia, and multi-organ dysfunction.

Clinical Manifestations of Thyrotoxic Crisis

• Severe tachycardia and arrhythmias can lead to heart failure.
• Body temperature often exceeds 40°C (104°F), this condition is known as, Hyperpyrexia (fever).
• Agitation, confusion, and delirium can advance to possible severe cases that leads to coma.
• Metabolic activity increases which leads to Profuse sweating.
• Hypertension caused by increased cardiac output is also a clinical manifestation.
• Liver dysfunction can leads to jaundice.
• Muscle weakening leads to muscle wasting.
• Dehydration and electrolyte imbalances can occur.
• Underlying Grave's disease symptoms are exacerbated, these symptoms include goiter, tremors, and exophthalmos.

Key Differences Between Graves' Disease and Thyroid Storm

• Graves' disease involves a more subtly symptoms and gradually leads a onset of hyperthyroidism.
• Extreme symptoms require acute intervention and shows that the thyroid storm can be life-threatening.

Hyperthyroidism Diagnosis

• Low TSH resulted from elevated levels of T3/T4 due to negative feedback.
• Elevated T3 and T4 levels have an increased ratio often during Graves' disease.
• TSI can be elevated and help diagnose Grave's Disease, during testing.

Radioactive Iodine Uptake (RAIU)

• Shows a diffusely increased uptake in the thyroid gland of someone who has Graves' disease.
• Toxic adenoma or a toxic multinodular goiter has a more specific uptake located to affected areas.

Hyperthyroidism Management

• Thionamides drugs help inhibit the thyroid hormone produced such as, methimazole or propylthiouracil.
• Propranolol can also control symptoms such as, tremors, anxiety and tachycardia.
• Radioiodine to eradicate thyroid with surgical thyroidectomy after.
• Includes supportive care Beta-blockers, Iodine therapy, Anti-thyroid drugs.
• Reduce thyroid hormone conversion from Adrenal insufficiency by administering Corticosteriods.

Thyroid Hormones

• Thyroxine (T4) contains four iodine atoms
• Triiodothyronine (T3) contains three iodine atoms.

Iodine Deficiency

• The thyroid can not produce T4 and T3 at healthy levels causing a goiter.
• Lack of iodine can result in slowed metabolisms and an inability to produce adequate hormones.

Goiter From Inadequate Iodine

• Thyroid Enlarges causing iodine dificiency (goiter) resulting in slowed metabolisms.

Clinical Manifestations of Congenital Hypothyroidism From Deficiency

• Cold Intolerance
• Thinning hair
• Weight Change
• Fatigue
• Constipation
• Slow Heart Rate
• Could show a goiter
• Muscles Stiffness
• Mental Sluggishness including depression

In Children:

• There can be a development delays, intellectual disability, and stunted growth.

Goiter Symptoms and Development

• The thyroid increases to have a healthy production of hormones
• In large regions where iodine-rich foods aren't eaten more people have goiter

Cretinism

• Mental retardation resulting in pregnancy for infants.

Iodine Deficiency Role

• The hypothalamus compensates with high TSH causing high TRH as a result.
• If levels of TSH are high then levels of T4 + T3 will be lowered leading to primary hypothyroidism. To diagnose it can be helpful to detect elevated TSH.

Iodine Dificiency Public Health

• Iodized salt, can majorly combat deficiency by iodine and has dropped deficiencies significantly.
• Supplements are good at preventing abnormality.

Diagnosing Defiency

• Testing thyroid function, testing iodine levels, with ultra sounds or detection of possible antibodies can help.
• Thyroid replacement can be helpful

Thyroid and Hashimoto's

• Hashimoto's can make it more difficult and damaging to the thyroid leading to over or under producing.
• High TSH in this case can indicate to doctors or physicians that hormone levels are not being produced healthily/ well.

Diagnostics of Hashimoto's include:

• Blood Test's which high elevated TSH is prevalent.
• Ultrasounds for the thyroid checking the size of the texture
• And Needle testing (FNA) with possible concern's to cancerous tissues for peace of mind.

Treatment + Managment

• Synthetic forms of T4 through daily use along with 6-8 week check up can control the health of someone inflicted with Hashimoto's
• Hashimoto's complications can lead to many problems, such as heart trouble or organ failure due to harsh circumstances.

Calcium and Phosphate

• Calcium and phosphate imbalance (typically hypercalcimia and hypophosphatemia for high and hypocalcemia and hyperphosphatemia w Low)

Diagnosing Hyperparathyroidism and Hypoparathyroidism

• It's can be diagnosed due to an enlargement of Calcium excretion or levels, and some can show neurological symptoms and can be surgically treated for best results as possible.
• And PTH is the best determiner high or low in the body

Type II Diabetes

• Visceral Fat is a significant Risk Factor, and high glucose can causes tiredness and fatigue
• Acanthosis and increase infections and high urination is also common.

Gestational Diabetes

• Asymptomatic
• Macrosomia can arise and GDM

Managing T2 Diabetes.

• Modified Lifestyle Changes
• Metformin
• Glucose Checks

Gestational Diabetes

• The same can be said as T2 but the sugar is for pregnancy.

Metabolic Syndrome

• Insulin resistance is the main factor associated with this but high CRP Is a good sign as well.
• Genetics and visceral fat contribute to an uncomfy feeling.

Complications include

• Stroke and or heart disease problems

In regards to Type 2 Diabetes

• High T2 is linked with the high risk of strokes and other problems related to the heart and metabolic problems that stem from it.

Main components are

• High Blood Pressure and High Insulin
• Forcing a diet that will combat high levels and better cardio health with glucose checks can help control or even fully deter type II.

Hyperglycemia

• Glucose is known commonly as sugar.

DKA

• Commonly for DM2

Causes are:

• Infections from other health concerns. As is Pnemonia.
• Symptoms are a lack of breath or fruity like in the area.

HHNKS

• Commonly from DM2 as well, though no ketoacidosis.

Common signs are

• Hyperglycemia, and polydipsia and can get to the point of seizures.

How-to Control?

• Insulin checks and electrolyte replacement.

Vasculature

• Can causes vision difficulty is some cases.

Diabetes is chronic and must take precautions to reduce heart troubles as one develops

• Can result in high lipids and other cardiovascular problems, also including nephropathy from kidney complications

Diabetic neuropathies

• Peripheral that affect feet
• Autonomic affecting heart rate etc.

Retinopathy

• Non-Pro= microaneurysms
• Pro= Retinal detachment
• Can cause poor vison and possible blindness if more common, needs management in the form of blood testing and laser- retina care.

Risk of Infections

• With infections coming about because of the lack of immune regulation common signs are UTIs, Pneumonia or even Skin Infections/Wounds. Be sure to test feet.

Complications and more

• Oxidative Stress and glycation can be common for problems with the heart.
• Cataracts develop.

Oxidative Stress:

• Damages Cell and function
• Damages kidney and nerves and promotes cardiovascular risk.

Polyol Pathway

• Damages the nerves of an individual causing numbness and more.

Glaction

• Contributes to Atherosclerosis.

Cushing / Addison's Syndrome (Disease):

• Elevated Cortisol/ACTH Causes the face to be come much rounder due to inflammation.
• Also with osteoporosis as a high influence
• But these syndromes are treatable

Cushing Syndrome

• The pituitary may be out of check during testing.
• High or Very depending if you’re testing
• While with Addison's you can test kidney abnormalities for better peace of mind.

Addison’s:

• Weakness and Hypotension are very relevant!

Important Note

• Diet and lifestyle and reducing all above points can help reduce diabetes

Adrenal and Hormones

• Cortisol plays and important role
• The zones of the Adrenal important functions, like the regulation of the body's function.
• Polypathways can lead to damage.
• Graves are a form of hypertention