Lecture 10 Endocrine Alterations in Body Systems PDF

NURS 115 Pathophysiology Lecture 9 Alterations in Body Systems Endocrine Structure and function Mechanism of Hormonal...

NURS 115 Pathophysiology Lecture 9 Alterations in Body Systems Endocrine Structure and function Mechanism of Hormonal regulation Alterations of Hormonal regulation Week 11 02/11/2022 Dr. Manfred Mortell Assistant Professor Department of Nursing and Allied Health University of the Bahamas  Learning Outcomes The student will comprehend Endocrine system Structure and function Mechanism of Hormonal regulation Alterations of Hormonal regulation In addition to further review of the recommended Chapters 8/21/2022 NURS 115 Pathophysiology 2  Terminology Acromegaly a hormonal disorder where the pituitary gland produces excess amounts of growth hormone. Adrenal Cortex outer portion of the adrenal gland, produces steroid hormones Adrenal Glands are triangle-shaped glands located on top of the kidneys and synthesis of cortisol and adrenaline Adrenaline a hormone that triggers the fight-or-flight response, Adrenocorticotropin (ACTH) a hormone produced by the anterior pituitary gland and stimulates the adrenal cortex Calcitonin is a protein hormone secreted by the thyroid gland, it helps to regulate calcium and phosphate levels in the blood Cushing Syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol Diabetes Mellitus is a disease in which blood glucose levels are above normal, because the pancreas do not synthesize insulin or can't use the insulin generated Erythropoietin is a hormone directly connected to red blood cell production, ,low levels occur with renal disease Glucagon is a hormone that controls glucose levels in the blood, from alpha cells found in the pancreas Graves Disease is the most common form of hyperthyroidism, an autoimmune disorder that causes overproduction of Thyroxine. Growth Hormone controls the body’s growth, increases muscle mass, and decreases body fat Parathyroid gland helps control both calcium and phosphorous levels and are four small glands located behind the thyroid gland Parathyroid Hormone regulates blood calcium levels, 8/21/2022 NURS 115 Pathophysiology 3  Structure and Function Endocrine Glands The endocrine system consists of ductless glands that secrete hormones into the blood stream These hormones drive the homeostatic feedback loops that keep the body healthy and in equilibrium The endocrine system provides an essential mechanism called homeostasis In addition to their homeostatic functions, hormones coordinate growth, reproduction and many other processes 8/21/2022 NURS 115 Pathophysiology 4  Endocrine glands Major 8/21/2022 NURS 115 Pathophysiology 5  Structure and Function Endocrine System Hypothalamus controls many processes, mood, hunger, thirst, sleep patterns and sexual function Pineal gland Manages the sleep cycle by releasing melatonin Pituitary gland Makes hormones that control the thyroid gland, adrenal glands, ovaries and testicles. Thyroid gland Is responsible for metabolism, how the body uses energy Parathyroid glands : Are four glands that control the level of calcium in your body Adrenal glands control metabolism, blood pressure, sexual development and response to stress. Pancreas : Makes insulin and glucagon that controls the blood sugar levels Ovaries : Release sex hormones estrogen, progesterone and testosterone Testes : Makes sperm, releases testosterone which affects sperm production, muscle strength and libido 8/21/2022 NURS 115 Pathophysiology 6  Endocrine System Hypothalamus The hypothalamus is located just above the brain stem and below the thalamus This gland activates and controls involuntary body functions, including respiration, heart rate, appetite, sleep, temperature, and the circadian cycles, or daily rhythms The hypothalamus links the nervous system to the endocrine system via the pituitary gland 8/21/2022 NURS 115 Pathophysiology 7  Structure and Function Hypothalamic-Pituitary System The hypothalamic- pituitary axis (HPA) forms the structural and functional basis for central integration of the neurologic and endocrine systems, creating what is called the neuro-endocrine system The HPA produces several hormones that affect diverse body functions including thyroid, adrenal, and reproductive functions 8/21/2022 NURS 115 Pathophysiology 8  Structure and Function Hypothalamus / Pituitary Gland The hypothalamus is a structure of the diencephalon of the brain located anterior and inferior to the thalamus The pituitary gland AKA hypophysis, a bean-sized organ suspended from it by a stem called the infundibulum AKA the pituitary stalk The pituitary gland has two lobes the posterior pituitary AKA the neurohypophysis and is is neural tissue, whereas the anterior pituitary AKA the adenohypophysis, is glandular tissue 8/21/2022 NURS 115 Pathophysiology 9  Structure and Function Pituitary Gland The “Master gland” The pituitary gland is attached to the bottom of the hypothalamus The hypothalamus signals the pituitary gland to release hormones The pituitary gland is about the size of a pea Located at the base of the brain, behind the bridge of your nose Called the “master gland” because it produces 9 hormones and controls other glands It has two parts, which release different hormones, the anterior lobe and a posterior lobe The pituitary gland is also part of the endocrine system 8/21/2022 NURS 115 Pathophysiology 10  Structure and Function Pituitary Gland Attached to the Hypothalamus at the base of the brain AKA the master endocrine gland because it secretes hormones that regulate the functions of other glands, as well as growth and several other bodily functions Anterior pituitary gland secretes 7 hormones Adrenocorticotrophic hormone Follicle-stimulating hormone Luteinizing hormone Growth hormone Prolactin Thyroid-stimulating hormone Melanocyte stimulating Hormone Posterior pituitary gland secretes 2 hormones oxytocin, a hormone that increases contractions of the uterus and antidiuretic hormone which encourages the kidneys to reabsorb water. 8/21/2022 NURS 115 Pathophysiology 11  Structure and Function Pituitary Gland Hormones Growth hormone Prolactin Thyroid-stimulating hormone Adrenocorticotrophic hormone Follicle-stimulating hormone Luteinizing hormone Antidiuretic Hormone Oxytocin Melanocyte stimulating Hormone 8/21/2022 NURS 115 Pathophysiology 12  Structure and Function Pituitary gland hormones Follicle ADH stimulating hormone Luteinizing Oxytocin hormone Growth Oxytocin hormone Melanocyte Adreno Stimulating Prolactin Corticotropic Thyroid Hormone hormone Stimulating Hormone 8/21/2022 NURS 115 Pathophysiology 13  Anterior Pituitary Gland Growth Hormone [GH] GH AKA Somatotropin, is produced and secreted by the anterior pituitary gland Its primary function is anabolic; promotes protein synthesis and tissue building GH accelerates the rate of protein synthesis in skeletal muscle and bones / supports the formation of new proteins in muscle cells and bone GH levels are controlled by the release of GHRH and GHIH AKA somatostatin from the Hypothalamus 8/21/2022 NURS 115 Pathophysiology 14  Anterior Pituitary Gland Thyroid Stimulating Hormone [TSH] The Thyroid gland is regulated by TSH, AKA Thyrotropin TSH is released from the anterior pituitary in response to thyrotropin-releasing hormone (TRH) from the hypothalamus TRH triggers the secretion of thyroid hormones by the Thyroid gland In a negative feedback loop, elevated levels of thyroid hormones in the bloodstream, then trigger a decrease in production of TRH and subsequently TSH 8/21/2022 NURS 115 Pathophysiology 15  Thyroid Hormones T3 - Triiodothyronine / T4 - Thyroxine Triiodothyronine - T3 Thyroxine - T4 Regulate the body Temperature Metabolism Heart rate 8/21/2022 NURS 115 Pathophysiology 16  Anterior Pituitary Gland Adrenocorticotropic Hormone [ACTH] AKA Corticotropin, stimulates the adrenal cortex to secrete cortisol The release of ACTH is regulated by the corticotropin-releasing hormone [CRH] from the hypothalamus in response to normal physiologic rhythms Stressors can also influence ACTH release to stimulate the Adrenal gland Cortisol, Epinephrine, Norepinephrine are 3 Adrenal gland hormones 8/21/2022 NURS 115 Pathophysiology 17  Posterior Pituitary Gland Oxytocin [Tocia “Childbirth”] Oxytocin is continually released throughout childbirth via a positive feedback mechanism that prompts uterine contractions that push the fetal head toward the cervix In response, cervical stretching stimulates more oxytocin to be synthesized by the hypothalamus and released from the posterior pituitary The feedback loop continues until birth Oxytocin is also necessary for the milk ejection reflex AKA “let-down” in breastfeeding women As the newborn begins suckling, sensory receptors in the nipples transmit signals to the hypothalamus, the mother’s milk ducts contract, ejecting milk into the infant’s mouth 8/21/2022 NURS 115 Pathophysiology 18  Posterior Pituitary Gland Antidiuretic Hormone [ADH] Blood osmolarity is constantly monitored by osmoreceptors within the hypothalamus that are sensitive to the concentration of sodium ions In response to high blood osmolarity, osmoreceptors signal the posterior pituitary to release ADH The target cells of ADH are in the renal tubular cells and increases permeability to water, and increased water reabsorption from the filtrate, and less water is excreted in the urine ADH AKA Vasopressin causes constriction of blood vessels, which increases blood pressure The release of ADH is controlled by a negative feedback loop, as blood osmolarity decreases, the hypothalamic osmoreceptors sense the change and decrease secretion of ADH. As a result, less water is reabsorbed from the urine filtrate 8/21/2022 NURS 115 Pathophysiology 19  The Anterior Pituitary The Anterior pituitary (adenohypophysis) is composed of 3 regions 1. Pars distalis is the major component of the anterior pituitary and is the source of the anterior pituitary hormones. 2. Pars tuberalis is a thin layer of cells on the anterior and the pituitary stalk 3. Pars intermedia lies in-between and secretes melanocyte-stimulating hormone in the fetus In the adult, Pars intermedia, recedes and cells are distributed diffusely throughout the pars distalis and pars nervosa (neurohypophysis) of the posterior pituitary 8/21/2022 NURS 115 Pathophysiology 20  Anterior Pituitary Hormones Functions 8/21/2022 NURS 115 Pathophysiology 21  The Posterior Pituitary The posterior pituitary is nervous tissue, hence the name neurohypophysis Embryonically, it originates as an outgrowth from the diencephalic region that will become the hypothalamus The neurohypophysis consists of the terminals of axons extending down through the stalk from cell bodies in the hypothalamus, and hormones are released directly from the axonal endings of their source neurons into the circulation The posterior pituitary secretes two polypeptide hormones: (1) Antidiuretic hormone (ADH), also called arginine vasopressin, and (2) Oxytocin 8/21/2022 NURS 115 Pathophysiology 22  Antidiuretic hormone Normal plasma osmolality 275 - 295 mOsm/kg A decrease in blood volume, increases blood osmolality, > 300 mOsm/kg which occurs during loss of circulation blood volume as with dehydration or hemorrhage The secretion of ADH is regulated primarily by the osmoreceptors of the hypothalamus. ADH decreases permeability of the renal collecting ducts This decreased permeability leads to increased water reabsorption into the blood, thus decreasing serum osmolality. As the plasma osmolality increases, back to normal osmolality, the osmoreceptors decrease the rate of ADH secretion, less water is reabsorbed by the kidney, as the plasma is diluted back to normal osmolality 8/21/2022 NURS 115 Pathophysiology 23  Oxytocin Oxytocin is responsible for contraction of the uterus and milk ejection in lactating women Oxytocin is secreted in response to suckling and mechanical distention of the female reproductive tract Oxytocin binds to receptors in the mammary tissues and causes contraction of those cells, which increases milk expression (“let- down” reflex) Oxytocin acts on the uterus to stimulate contractions Oxytocin functions near the end of labor to enhance the effectiveness of contractions, promote delivery of the placenta, and stimulate postpartum uterine contractions, thereby preventing excessive bleeding. 8/21/2022 NURS 115 Pathophysiology 24  Thyroid and Parathyroid Glands The thyroid gland, located in the neck just below the larynx, produces hormones that control the metabolism in the body The four parathyroid glands are near the posterior side of the thyroid and function to control serum calcium levels 8/21/2022 NURS 115 Pathophysiology 25  Thyroid Gland The Thyroid gland is a butterfly-shaped gland located just below the Thyroid cartilage “Adam’s apple” in the neck It uses iodine from food to produce two hormones Thyroxine (T4) and Triiodothyronine (T3) which regulate blood pressure, body temperature, heart rate, metabolism Calcitonin, is also synthesized which helps strengthen bones and regulates the metabolism of calcium The Thyroid gland stores T3 and T4 and releases them as they are needed The hypothalamus releases Thyrotropin-releasing hormone [TRH], which stimulates the pituitary gland to release Thyroid-stimulating hormone [TSH] 8/21/2022 NURS 115 Pathophysiology 26  Thyroid Hormones Triiodothyronine - T3 Thyroxine - T4 Regulate the body Temperature Metabolism Heart rate 8/21/2022 NURS 115 Pathophysiology 27  Thyroid Gland Hormones Regulation and Functions 8/21/2022 NURS 115 Pathophysiology 28  Parathyroid Glands Normally two pairs of parathyroid glands are present behind the upper and lower poles of the thyroid gland. However, their number may range from two to six The parathyroid glands produce parathyroid hormone (PTH), which is the single most important factor in the regulation of serum calcium concentration. PTH secretion is to increase serum calcium concentration and decrease the serum phosphate 8/21/2022 NURS 115 Pathophysiology 29  Endocrine Pancreas The pancreas is both an endocrine gland that produces hormones and an exocrine gland that produces digestive enzymes. The pancreas is located behind the stomach, between the spleen and the duodenum, and contains the islets of Langerhans The islets of Langerhans have four types of hormone-secreting cells: alpha cells, secrete glucagon; beta cells, insulin and amylin; delta cells, secrete gastrin and somatostatin; and PP cells, which secrete pancreatic polypeptide 8/21/2022 NURS 115 Pathophysiology 30  Insulin Actions 8/21/2022 NURS 115 Pathophysiology 31  Insulin Action on Cells Insulin is an anabolic hormone that functions mainly in the liver, muscle, and adipose tissue. It promotes glucose uptake and increases the synthesis of proteins, carbohydrates, lipids, and nucleic acids. The brain, red blood cells, and kidney, do not require insulin for glucose transport 8/21/2022 NURS 115 Pathophysiology 32  Amylin β cells - Glucagon α cells Amylin is a hormone co-secreted with insulin by β cells in the islets of Langerhans and has an antihyperglycemic effect. Amylin has a satiety effect, which reduces food intake and regulates blood glucose concentration by delaying gastric emptying and suppressing glucagon secretion after meals Glucagon is produced by the α cells in the islets of Langerhans. Glucagon acts primarily in the liver and increases blood glucose concentration by stimulating glycogenolysis and gluconeogenesis in muscle and lipolysis in adipose tissue. Glucagon release is stimulated by low glucose levels. It is the antagonistic to insulin 8/21/2022 NURS 115 Pathophysiology 33  Adrenal Glands Adrenal glands, are triangular-shaped glands located on each kidney Have 2 parts that produce hormones which regulate metabolism, immune system, blood pressure, and response to stress The cortex [outer region] and is divided into 3 zones Zona Glomerulosa Aldosterone is a mineral corticoids important for fluid homeostasis Zona Fasciculate Cortisol is a glucocorticoid hormone produced to control the suppresses inflammation; regulate blood pressure; increase blood sugar; and decrease bone formation Zona Reticularis Secretes sex hormones, Androgens The medulla [Inner region] produces “stress hormones, Adrenaline and Noradrenaline. 8/21/2022 NURS 115 Pathophysiology 34  Glucocorticoid effects Glucocorticoids are steroid hormones that have metabolic, neurologic, anti-inflammatory, and growth-suppressing effects The glucocorticoids act at several sites to suppress immune and inflammatory reactions. Potentiate the effects of catecholamines, Thyroid and growth hormone. Also affects mood, such as anxiety and depression The most potent naturally occurring glucocorticoid is cortisol, and is needed to maintain life and protect the body from stress 8/21/2022 NURS 115 Pathophysiology 35  Adrenal Glands Adrenal Cortex 1. Zona glomerulosa, the outer layer, constitutes about 15% of the cortex and primarily produces the mineralocorticoid aldosterone. 2. Zona fasciculata, the middle layer, constitutes 78% of the cortex and secretes the glucocorticoids cortisol, cortisone, and corticosterone. 3. Zona reticularis, the inner layer, constitutes 7% of the cortex and secretes mineralocorticoids, aldosterone, adrenal androgens and estrogens, and glucocorticoids Adrenal Medulla The pheochromocytes of the adrenal medulla secrete and store the catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline). Only 30% of circulating epinephrine comes from the adrenal medulla; the other 70% is released from nerve terminals 8/21/2022 NURS 115 Pathophysiology 36  The Stress Response 8/21/2022 NURS 115 Pathophysiology 37 Alterations of Hormonal Regulation 8/21/2022 NURS 115 Pathophysiology 38  Diseases of the Posterior Pituitary Gland Diabetes Insipidus 8/21/2022 NURS 115 Pathophysiology 39  Diseases of the Posterior Pituitary Gland Diabetes Insipidus Defined/Etiology Diabetes insipidus [DI] causes an imbalance of fluids in the body, producing large amounts of urine [polyuria] and makes the person very thirsty [polydipsia] The hormone anti-diuretic hormone [ADH], or arginine vasopressin [AVP], helps regulate the amount of water the kidneys reabsorb as they filter out waste from the blood ADH is made in the hypothalamus and stored in the posterior pituitary gland Conditions that cause a deficiency of ADH or block the effect of ADH result in polyuria 8/21/2022 NURS 115 Pathophysiology 40  Diabetes Insipidus Types Central diabetes insipidus Genetics or damage to the pituitary gland or hypothalamus, affects production, storage and release of ADH Nephrogenic diabetes insipidus Is due to a genetic defect in the Nephron, Chronic Renal Failure, antiviral drugs that makes the kidneys unable to respond effectively to ADH Gestational diabetes insipidus Is rare and only occurs during pregnancy when an enzyme made by the placenta destroys the maternal ADH Primary polydipsia AKA dipsogenic diabetes insipidus, due to polydipsia caused by damage to the thirst-regulating mechanism in the hypothalamus 8/21/2022 NURS 115 Pathophysiology 41  Diabetes Insipidus Clinical manifestations Being extremely thirsty Producing large amounts of pale urine Frequently needing to get up to urinate during the night Preferring cold drinks NB: If the DI is severe, patients can produce > 20 liters of urine / day. A healthy adult typically produces 1 to 2 liters / day. Complications Dehydration Electrolyte imbalance Weakness Nausea Vomiting Loss of appetite Muscle cramps Confusion 8/21/2022 NURS 115 Pathophysiology 42  Clinical manifestations Diabetes Insipidus 8/21/2022 NURS 115 Pathophysiology 43  Diseases of the Posterior Pituitary Gland Diabetes Insipidus Diagnostics Water deprivation test Stop drinking fluids for several hours and monitor Weight The output of urine pH of urine [Specific gravity] and blood Assess the serum levels of ADH Perform synthetic ADH test Magnetic resonance imaging (MRI) Determine if pituitary gland has anomalies Genetic screening 8/21/2022 NURS 115 Pathophysiology 44  Diseases of the Posterior Pituitary Gland Management Diabetes Insipidus Central diabetes insipidus. Mild DI may require to increase daily water intake Pituitary gland or Hypothalamus, anomaly, surgical / oncology +-, Typically, treated with a synthetic ADH, Desmopressin [DDAVP] Nephrogenic diabetes insipidus Low-salt diet to reduce the amount of urine your kidneys make Drink enough water to avoid dehydration. Diuretic Hydro-chlorothiazide may be effective Gestational diabetes insipidus Synthetic ADH Desmopressin [DDAVP] Primary polydipsia No specific treatment, other than decreasing fluid intake, and mental health consultation 8/21/2022 NURS 115 Pathophysiology 45 Syndrome of Inappropriate Anti-Diuretic Hormone secretion 8/21/2022 NURS 115 Pathophysiology 46 Syndrome of Inappropriate Anti Diuretic Hormone Overview / Defined SIADH AKA “ectopic ADH secretion” occurs when ADH AKA Vasopressin, is produced in excess, which makes it difficult for the kidney to excrete excess water SIADH causes a relative hyponatremia due to excess water retention Hyponatremia is a major complication of SIADH and is responsible for many of the manifestations of SIADH Early symptoms include cramping, nausea, and vomiting, in severe cases, cause confusion, seizures, and coma Treatment begins with fluid restrictions to prevent further overloading of the circulation Additional treatment will depend on the cause 8/21/2022 NURS 115 Pathophysiology 47 Syndrome of Inappropriate Anti Diuretic Hormone Etiology / Numerous triggers Brain infections Cerebral hemorrhage Head trauma Hydrocephalus Guillian-barre syndrome Multiple sclerosis HIV Cancers * Lung infections * Asthma Cystic fibrosis Medications * Hereditary factors Sarcoidosis 8/21/2022 NURS 115 Pathophysiology 48 Syndrome of Inappropriate Anti Diuretic Hormone Clinical manifestations Nausea or vomiting Cramps or tremors Depressed mood Memory impairment Irritability Personality changes Combativeness Confusion Hallucinations Seizures Stupor Coma 8/21/2022 NURS 115 Pathophysiology 49  Clinical manifestations SIADH 8/21/2022 NURS 115 Pathophysiology 50 Syndrome of Inappropriate Anti Diuretic Hormone Assessments/Diagnostics Complete Medical history and Physical examination, to confirm diagnosis of SIADH Blood Sodium Potassium Osmolality ADH Test Urine tests Sodium Potassium Osmolality 8/21/2022 NURS 115 Pathophysiology 51  Syndrome of Inappropriate Anti Diuretic Hormone Management / Treatment Most common prescribed treatment Fluid and water restriction If chronic, fluid restriction may need to be permanent Surgical removal of a tumor that is producing ADH Diuretics [Furosemide / Lasix] Demeclocycline acts on renal collecting tubule to diminish their responsiveness to ADH 8/21/2022 NURS 115 Pathophysiology 52  Diseases of the Anterior Pituitary 8/21/2022 NURS 115 Pathophysiology 53  Hypersecretion of Growth Hormone Acromegaly Acromegaly is a disorder that occurs when your body makes excessive amounts of growth hormone [GH] Produced in the anterior pituitary gland GH controls the physical growth of the body Secretion of excessive amounts of growth hormone causes bones, cartilage, body organs, Tanya Angus before the disease began and other tissues to 21 years old 5 feet 8 inches tall, weighed 135 pounds Pituitary tumor at 22 years onwards increase in size Grew > 7 feet tall, weighed 400 pounds Died aged 34 years CV Disease 8/21/2022 NURS 115 Pathophysiology 54  Acromegaly Hyper-Cortisolism Clinical manifestations Big nose, tongue, lips, hands, and feet Facial structure changes, protruding jaw, brow Skin thick, coarse, and oily Irregular periods in women Erectile dysfunction in men Increased risk for high blood pressure, diabetes mellitus, ACS, and certain types of cancer In children and adolescents, excessive levels of growth hormone can result in a condition called GIGANTISM Children with this condition may have unusually long arms and legs and may grow to heights of > 7 to 8 feet 8/21/2022 NURS 115 Pathophysiology 55  Acromegaly Assessment and Diagnosis History / Physical assessment * Investigations IGF-1 measurement Insulin-like growth factor 1, is a hormone which is important in childhood growth, and has anabolic effects in adults An elevated IGF-1 level suggests acromegaly Growth hormone suppression test Diagnostic for confirming an acromegaly, in people who don't have acromegaly, a glucose drink typically causes the GH level to fall, with acromegaly, the GH level stays elevated Imaging CT Scan or Magnetic resonance imaging identifies the location and size of a pituitary gland tumor, if no pituitary tumors are located other imaging tests may be required to scan for non-pituitary tumors 8/21/2022 NURS 115 Pathophysiology 56  Acromegaly Medical / Surgical Management Drugs that reduce growth hormone production (Somatostatin analogues) These drugs signals the pituitary gland to produce less GH, may also decrease tumor size Drugs to lower hormone levels (Dopamine agonists) May reduce levels of GH and IGF-1, may also decrease tumor size Drugs block the action of GH (GH antagonist) Blocks the effect of GH on the body's tissues, and can help lower IGF-1 levels, doesn't lower GH levels or reduce tumor size Conventional radiation therapy May not see the effect for > 10 years after treatment Stereotactic radiosurgery Delivers high dose radiation to the tumor cells, limits to normal tissues, may return GH to normal < 5 to 10 years Surgery Endoscopic Trans-nasal Trans-sphenoidal surgery If the tumor is small, removal of the tumor returns your GH levels to normal and helps relieve headaches and vision changes 8/21/2022 NURS 115 Pathophysiology 57  Alterations of Thyroid Function Hyperthyroidism Thyrotoxicosis 8/21/2022 NURS 115 Pathophysiology 58  Alterations of Thyroid Function Hyperthyroidism Hyperthyroidism occurs when the thyroid gland produces too much of the hormone Thyroxine [T4] Is often caused by an autoimmune disease called Grave’s disease or by a metabolically active thyroid nodule that is making too much hormone Although numerous disorders may result in hyperthyroidism, Grave’s disease is a common cause 8/21/2022 NURS 115 Pathophysiology 59  Alterations of Thyroid Function Hyperthyroidism Graves' disease Is the most common cause of hyperthyroidism, an autoimmune disorder in which antibodies stimulate the Thyroid gland to produce excessive T4 Plummer's disease AKA Hyperfunctioning thyroid nodules, toxic adenoma, toxic multinodular goiter This form of hyperthyroidism occurs when a Thyroid adenoma, a benign tumor may cause a goiter and produce excess T4 Thyroiditis Post partum [Pregnancy], due to an idiopathic autoimmune condition, inflammation can cause T4 to leak into the bloodstream 8/21/2022 NURS 115 Pathophysiology 60  Hyperthyroidism Clinical manifestations Unintentional weight loss Tachycardia Arrhythmia – Atrial fibrillation Palpitations Increased appetite Nervousness, anxiety Fine tremor Sweating Changes menstrual patterns Heat intolerance Frequent bowel movements Goiter Easily fatigued, weakness Difficulty sleeping Skin thinning Fine, brittle hair 8/21/2022 NURS 115 Pathophysiology 61  Hyperthyroidism Complications Cardiac problems Atrial fibrillation that increases your risk of stroke Congestive heart failure Eye problems Grave’s ophthalmopathy: bulging, red or swollen eyes, sensitivity to light, blurred or double vision. Untreated, blindness Red, swollen skin Grave’s dermopathy, causes skin redness, swelling Thyrotoxic crisis AKA Thyroid storm An acute, life-threatening, hypermetabolic state induced by excessive thyroid hormones Manifestations are fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular pulse, jaundice, hypotension and coma 8/21/2022 NURS 115 Pathophysiology 62  Hyperthyroidism Assessment / Diagnostics Medical history and physical examination Observe if a slight tremor in fingers when extended, overactive reflexes, eye changes and warm, moist skin Examine Thyroid gland if enlarged, bumpy or tender Check pulse if rapid or irregular Blood tests. High levels of T4 and low TSH indicate an overactive thyroid High T4 and low or no TSH confirm hyperthyroidism Radioiodine uptake test Oral radioactive iodine collects in the thyroid gland A high uptake of radioiodine confirms hyperthyroidism Thyroid scan Radioactive iodine uptake in the Thyroid gland Cold poor uptake/ / Hot good uptake normal Thyroid ultrasound Uses high-frequency sound waves to detect nodules 8/21/2022 NURS 115 Pathophysiology 63  Hyperthyroidism Medical management Radioactive iodine Taken orally, causes the thyroid gland to shrink Sometimes too much and may need Thyroxine supplements Anti-thyroid medications Prevent Thyroid gland producing excess amounts of T3 T4 Medications include Methimazole and Propylithiouracil Symptoms improve within several weeks to months Treatment with anti-thyroid medications for > 1 year Beta blockers Can ease symptoms, tremor, rapid heart rate and palpitations Thyroidectomy Contraindicated anti-thyroid drugs and radioactive iodine therapy Risks include damage to the vocal cords and parathyroid glands Require lifelong treatment with synthetic thyroid hormone Parathyroid glands are removed, life-long Calcium and Vitamin D 8/21/2022 NURS 115 Pathophysiology 64  Alterations of Thyroid Function Hypothyroidism Hypothyroidism is an underactive thyroid gland and a condition in which your thyroid gland doesn't produce enough T3 and T4 Hypothyroidism may not cause noticeable symptoms in the early stages Untreated hypothyroidism can cause health problems, such as obesity, joint pain, infertility and heart disease 8/21/2022 NURS 115 Pathophysiology 65  Hypothyroidism Autoimmune disease Etiology Most common cause is Hashimoto's thyroiditis Genetics / family history Iatrogenic: permanent hypothyroidism +- Radioactive iodine/anti-thyroid medications Thyroid surgery Radiation therapy. Medications for example Lithium Pituitary TSH disorder Benign tumor of the pituitary gland Pregnancy During or postpartum hypothyroidism, antibodies attack the mother’s thyroid gland Left untreated, risk of miscarriage, premature delivery and preeclampsia Iodine deficiency Iodine is essential for production T3 T4. 8/21/2022 NURS 115 Pathophysiology 66  Hypothyroidism Clinical manifestations Fatigue and muscle weakness Cold sensitivity Constipation Dry skin Weight gain Puffy face Hoarse voice Hypercholesterolemia Muscle aches Joint pain, stiffness or swelling Irregular menstrual periods Thinning hair Bradycardia Depression Impaired memory Goiter 8/21/2022 NURS 115 Pathophysiology 67  Hypothyroidism Goiter Complications Constant stimulation of the thyroid may cause the gland to become larger, affect appearance and may interfere with swallowing or breathing Heart problems Heart disease/failure, due to high levels of LDL-C Mental health issues Depression and impaired mentation Peripheral neuropathy Pain, numbness and tingling in affected areas Infertility Interfere with ovulation, impairs fertility Birth defects Infants with untreated hypothyroidism at birth are at risk of developmental issues Myxedema crisis +- Coma A life-threatening condition, signs and symptoms include intense cold intolerance, drowsiness, profound lethargy and unconsciousness 8/21/2022 NURS 115 Pathophysiology 68  Hypothyroidism Diagnosis / Medical management History and physical assessment Clinical manifestations Blood tests - TSH A low level of thyroxine and high level of TSH indicate an underactive thyroid, because the pituitary gland produces more TSH to stimulate the thyroid gland to produce more thyroid hormones Management Standard treatment involves daily use of the synthetic thyroid hormone Levothyroxine [Levo-T, Synthroid], others) This oral medication restores adequate hormone levels, reversing the signs and symptoms of Hypothyroidism 8/21/2022 NURS 115 Pathophysiology 69  Alterations of Thyroid Function Hyperparathyroidism When the Parathyroid glands create too much parathyroid hormone Two types of hyperparathyroidism Primary hyperparathyroidism An enlargement of one or more of the parathyroid glands causing overproduction of the hormone Causes high calcium levels in the blood Secondary hyperparathyroidism Occurs due to another disease that first causes low calcium levels in the body Over time, increased parathyroid hormone levels occur. 8/21/2022 NURS 115 Pathophysiology 70  Hyperparathyroidism Etiology Primary hyperparathyroidism 1 - 4 parathyroid glands involved A non-cancerous adenoma on a gland is the most common cause Enlargement, hyperplasia of two or more parathyroid glands A cancerous growth/tumor is a very rare cause Rarely an inherit a gene that causes the disorder Secondary hyperparathyroidism Another condition lowers calcium levels, which causes the parathyroid glands to compensate for calcium loss Severe calcium deficiency Severe vitamin D deficiency Vitamin D maintains calcium levels in the blood Chronic kidney failure most common cause of secondary hyperparathyroidism 8/21/2022 NURS 115 Pathophysiology 71  Hyperparathyroidism Clinical manifestations May be slight and nonspecific or severe Osteoporosis Renal stones Polyuria Abdominal pain Fatigue or weakness Depression Forgetfulness Bone and joint pain Malaise Nausea Vomiting Anorexia 8/21/2022 NURS 115 Pathophysiology 72  Hyperparathyroidism Complications Relate to the chronic effects of Osteopenia and Hypercalcemia Osteoporosis Loss of calcium often results in weak, brittle bones that fracture easily Kidney stones AKA Renal calculi, Nephrolithiasis Hypercalcemia, may cause Calciuria, which can cause Nephrolithiasis and Renal colic Cardiovascular disease The link is idiopathic, but hypercalcemia is associated with hypertension, heart conditions, such as prolonged PR interval, short QT interval, widened QRS complex, and bradycardia Neonatal hypoparathyroidism Untreated hyperparathyroidism in pregnant women may cause Hypocalcemia in newborns 8/21/2022 NURS 115 Pathophysiology 73  Alterations of Thyroid Function Hypoparathyroidism Hypoparathyroidism is an uncommon condition in which produces abnormally low levels of parathyroid hormone [PTH] PTH is key to regulating and maintaining a balance the Calcium and Phosphorus Low production of PTH in hypoparathyroidism leads to Hypocalcemia and Hyperphosphatemia Supplements to normalize serum Calcium and Phosphorus levels to treat the condition, and depending on the cause of the Hypoparathyroidism, will usually be life long 8/21/2022 NURS 115 Pathophysiology 74  Hypoparathyroidism Neck surgery Etiology This most common cause of hypoparathyroidism after accidental damage or removal of the parathyroid glands for thyroid gland, throat or neck cancer surgery Autoimmune disease Hereditary hypoparathyroidism Born either without parathyroid glands or they don't work properly Hypomagnesemia Normal magnesium levels are required for production of PTH Extensive radiotherapy to face or neck Radiation can damage parathyroid glands, even radioactive iodine treatment for hyperthyroidism may lead to hypoparathyroidism 8/21/2022 NURS 115 Pathophysiology 75  Hypoparathyroidism Clinical manifestations Tingling or burning fingertips, toes and lips Muscle aches or cramps in legs, feet, abdomen or face Twitching or muscle spasms mouth, hands, arms and throat Fatigue or weakness Dysmenorrhea Patchy hair loss Dry, coarse skin Brittle nails Depression Anxiety 8/21/2022 NURS 115 Pathophysiology 76  Hypoparathyroidism Assessment / Diagnostics History and Physical assessment Chvostek sign for hypocalcemia [latent tetany] refers to a twitch of the facial muscles when gently tapping an individual's cheek, in front of the ear Chvostek sign Trousseau sign for hypocalcemia [latent tetany] when the hand adopts a characteristic posture when the sphygmomanometer cuff is inflated above the systolic blood pressure Blood tests diagnostic Low serum calcium levels and low levels of parathyroid hormone Trousseau sign 8/21/2022 NURS 115 Pathophysiology 77  Dysfunction of the Endocrine Pancreas Diabetes Mellitus Diabetes mellitus refers to a group of diseases that affect how the body uses glucose in the blood. Glucose is vital for health because it's an important source of energy for the cells, tissues, organs and is the brain's main source of fuel Diabetes mellitus is taken from the Greek word Diabetes, meaning siphon to pass through and the Latin word Mellitus meaning sweet Chronic Diabetes Mellitus Conditions include Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Reversible Diabetes Conditions include Prediabetes Gestational diabetes 8/21/2022 NURS 115 Pathophysiology 78  Diabetes Mellitus Type 1 Defined Type 1 Diabetes mellitus, once known as Juvenile diabetes or Insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin Is an autoimmune disorder that destroys the beta cells in the pancreas that make insulin. Different factors, including genetics and some viruses, may contribute to Type 1 Diabetes Mellitus This process can go on for months or years before any symptoms appear and can develop at any age, though it often appears during childhood or adolescence Despite active research, Type 1 Diabetes has no cure and treatment focuses on managing blood sugar levels with insulin, diet and lifestyle to prevent complications 8/21/2022 NURS 115 Pathophysiology 79  Diabetes Mellitus Type 1 Etiology Genetic markers Chromosome 6, and it’s an HLA [Human Leukocyte Antigen] complex: Autoimmune disease/s Viral infections: Viruses that are believed to trigger type 1 include, German measles, Coxsackie, and Mumps Race/Ethnicity: Caucasians higher risk than African-Americans, Hispanic-Americans, Chinese and South Americans Geography Northern climates are at a higher risk than Southern climates Family history: Genetics Early diet: Cow’s milk to early if infant development Other autoimmune conditions: Graves' disease, multiple sclerosis, and pernicious anemia 8/21/2022 NURS 115 Pathophysiology 80  Diabetes Mellitus Type 2 Defined Type 2 Diabetes mellitus is an impairment in the way the body regulates and uses glucose and there are two interrelated problems 1. The pancreas do not produce enough insulin 2. Tissue cells are insulin resistant Type 2 Diabetes mellitus was known as adult-onset diabetes, but Type 2 Diabetes mellitus affects children Type 2 Diabetes mellitus is more common in older adults, but childhood obesity has increased the incidence of Type 2 Diabetes Mellitus in younger people There is no cure for Type 2 Diabetes mellitus, but losing weight, a healthy diet, and exercising can help you manage the disease If life-style modification are ineffective, then oral hypoglycemic medications or insulin therapy may be required 8/21/2022 NURS 115 Pathophysiology 81  Diabetes Mellitus Type 2 Family history Etiology Race and ethnicity: Black, Hispanic, American Indian and Asian American people are at higher risk High blood pressure: > 140/90 mm Hg High Cholesterol LDL-C and Triglyceride levels and low levels of high-density lipoprotein (HDL-C) Smoking Overweight: Fatty tissue, promotes cell resistance to insulin Physical inactivity: Promotes increase in blood glucose, fat accumulation and cell resistance to insulin Ageing: Lack of exercise and weight gain 8/21/2022 NURS 115 Pathophysiology 82  Pathophysiology Type 2 Diabetes Mellitus 8/21/2022 NURS 115 Pathophysiology 83  Pre-Diabetes Prediabetes means that a person is at risk of developing Diabetes mellitus Type 2 have a higher than normal blood sugar level It's not high enough to be considered Type 2 Diabetes Mellitus, but without lifestyle modification, adults and children with prediabetes are more likely to develop Type 2 Diabetes Mellitus Prediabetes, initiates damage of to the heart, blood vessels and kidneys, therefore, cardiovascular disease NB Normal HbA1c is 4 – 5.6% (20 – 38 mmol / mol) Prediabetes 5.7% - 6.4% (39 – 46 mmol / mol) point to HbA1c Probable Diabetes mellitus > 6.5% (47 mmol / mol) 8/21/2022 NURS 115 Pathophysiology 84  Gestational Diabetes Gestational diabetes is diagnosed for the first-time during pregnancy Like other types of diabetes, gestational diabetes affects how the tissues/cells utilize glucose Gestational diabetes causes high blood sugar that can affect the pregnancy and the baby's health Expectant mothers can help control gestational diabetes by eating healthy foods, exercising and, if necessary, take prescribed medication In women with gestational diabetes, blood sugar usually returns to normal soon after delivery However, developing gestational diabetes, increases the risk of getting Type 2 Diabetes Therefore, follow up with a medical practitioner is required 8/21/2022 NURS 115 Pathophysiology 85  Diabetes Mellitus Clinical manifestations - Generic Diabetes symptoms vary depending on the degree of blood sugar Type 1 Diabetes mellitus, symptoms are acute and more severe Type 2 Diabetes mellitus, especially with prediabetes, may not experience symptoms Hyperglycemia/Hypoglycemia Polyphagia Polydipsia Polyuria Weight loss Glycosuria Ketonuria/ Ketoacidosis Fatigue Irritability Blurred vision Slow-healing sores Frequent infections Gums Skin infections Vaginal infections 8/21/2022 NURS 115 Pathophysiology 86  Clinical Manifestations and Mechanisms Type 1 Diabetes Mellitus 8/21/2022 NURS 115 Pathophysiology 87  Diabetes Mellitus Diagnostics criteria Glycated hemoglobin (HbA1C) 4 - 5.6% Random blood sugar < 140mg/dL 7.8 mmol/L Fasting blood sugar < 100mg/dL < 5 mmol/L Oral glucose tolerance test