Endocrine System Disorders Past Paper (HIM-2113) - 2020/2022

HIM-2113 Disorders of the Endocrine System CLO6 Dr. Riaz Akseer 2  PITUITAR Y GROSS ANATOMY 3  HYPOTHALAMIC CONTROL 4  GENERAL PITUITAR Y STRUCTURE & ACTIONS 5  PITUITAR Y HYPOPHYSEAL PORTAL SYSTEM 6 7 8  Endocrine System Endo means insi...

HIM-2113 Disorders of the Endocrine System CLO6 Dr. Riaz Akseer 2  PITUITAR Y GROSS ANATOMY 3  HYPOTHALAMIC CONTROL 4  GENERAL PITUITAR Y STRUCTURE & ACTIONS 5  PITUITAR Y HYPOPHYSEAL PORTAL SYSTEM 6 7 8  Endocrine System Endo means inside.... Krinein means to secrete Is made up of several glands Pituitary Thyroid Parathyroid Adrenal Primary function of endocrine cells is to produce hormones These are chemical substances that regulate the function of other cells, tissues or organs 9  Diabetes Diabetes is a disease in which blood glucose, or blood sugar, levels are too high. Glucose comes from the foods. Insulin is a hormone that helps the glucose get into the cells to give them energy. What is the meaning of: Diabetes mellitus Diabetes insipidus 10  Diabetes in United Arab Emirates - 2015 Total adult 7,442 Number of 1,384 population deaths in adults (1000s) due to diabetes (20-79 years) Prevalence of 14.6 Cost per perso 2,155.9 diabetes in n with diabetes adults (USD) (20-79 years) (%) Total cases of 1,086.3 Number of adults (20-79 cases of years) with diabetes in diabetes adults that are (1000s) undiagnosed (1000s) 11 12  Diabetes Mellitus Type 1 diabetes – Juvenile Onset DM, Insulin-dependent DM (IDDM) The body does not make insulin. Type 2 diabetes – Maturity Onset DM, Non-insulin-dependent DM (NIDDM) The most common type of diabetes. The body does not make or use insulin well, insulin resistance Pregnant women can also get diabetes, called gestational diabetes. 13  Diabetes Mellitus Signs & Symptoms Without enough insulin activity, the glucose stays in your blood leading to hyperglycemia = elevated blood glucose level. Polyuria = increase urine production Polydipsia = increased thirst Polyphagia = increased hunger and eating 14  Type I Diabetes Mellitus A life-threatening complication of type I diabetes mellitus: Diabetic Ketoacidosis (DKA) Without insulin, glucose cannot enter cells to make energy. Cells start to break down fats for energy. Breaking of fats produces ketones, an acid end product. The person is now is ketosis. As ketones build up in the blood, acidosis results. SYMPTOMS: polyuria, polydipsia, ketonuria (ketones in urine), low serum potassium (hypokalemia), tachypnea, dizziness. If not treated quickly, DKA can lead to coma and death. 15  Complications Over time, having too much glucose in your blood can cause Over time, having too much glucose in your blood can cause serious problems= long-term complications: Cardiovascular disease = atherosclerosis, coronary artery disease, myocardial infarction, heart failure, aortic aneurysm, stroke and even gangrene of the toes or feet leading to the need to remove a limb = amputation. Damage to the eyes = retinopathy, cataracts, glaucoma, blindness. Damage to the kidneys = nephropathy, glomerulosclerosis, renal failure Damage to the nerves = neuropathy Increased susceptibility to infections 16  Investigations A blood test can show if you have diabetes. Treatment Exercise, weight control and sticking to a healthy meal plan can help control diabetes. Patients should also monitor glucose level and Patients may need to take medicine if prescribed. 17  What are some commonly prescribed medications for: Type 1 diabetes Type 2 diabetes Familiarize yourself with common types of medication used to treat both conditions It is important to know how each medication is administered 18  Gestational Diabetes Pre-disposing factors Previous pregnancy with gestational diabetes or large baby (macrosomia), obesity, glucose intolerance or glycosuria, family history of diabetes 19  Pathophysiology Glucose intolerance (insulin resistance) begins or is first recognized during pregnancy. 20  Gestational Diabetes Cont.. Diagnostic tests Universal (all pregnancies) screening with 50-gram one-hour glucose challenge test If positive screen, follow by diagnostic 100-gram three- hour glucose tolerance test Treatment strategies Glucose monitoring, dietary changes, exercise, insulin injections may be needed 21  Complications Fetal malformation or death Large baby with difficult delivery (shoulder dystocia, nerve palsy) Neonatal hypoglycemia, mother at higher risk later for Type II DM 22  Thyroid Disease The thyroid is a butterfly-shaped gland in the neck, just above the collarbone. It is one of the endocrine glands which make hormones. Thyroid hormones control the rate of many activities in the body. How fast we burn calories How fast our heart beats. metabolism An estimated 5% of patients in the Middle East have Thyroid Disease (Annual Middle East Update in Otolaryngology surgery, 2016) 23  Thyroid Gland 24  Thyroid Follicle Function THYROGLOBULINS [T4 & T3] ▪Regulation of O2 utilization & metabolism. ▪Depends on energy need, caloric supply & thermal environment. ▪Essential for healthy growth & maturation of fetus and children CALCITONIN ▪Decreases [Ca++] in body fluids inhibit osteoclast activity increase renal {Ca++] ▪During growth & stress 25 especially  Thyroid Disease 26  Diagnosing Thyroid Disease Investigations done to diagnose thyroid disease are: Thyroid Function Tests (TSH, T3, T4) T3 (Triiodothyronine) Test T4 (Thyroxine) Test Thyroid Scan and uptake Ultrasound of the Thyroid Gland Needle Biopsy of the thyroid 27  Treatment Medicines for Hypothyroidism Thyroid Hormone Treatment Radioactive Iodine Treatment for Hyperth yroidism Thyroidectomy 28  PARATHYROID GLANDS 29  PARATHYROID GLANDS PARATHYROID / CHIEF CELLS MONITOR CIRCULATING [Ca++] PRODUCE PARATHYOID HORMONE [PTH] PARATHYROID HORMONE [PTH] [PARATHYROID / CHIEF CELLS]] INCREASES OSTEOCLAST ACTIVITY DECREASES RENAL [Ca++] EXCRETION INCREASES CIRCULATING [Ca++] Fig. 19- 6 NOTE THE COOPERATIVE ROLES OF CALCITONIN & PTH IN REGULATING HEALTHY [Ca++] LEVELS 30  THE SUPRARENAL [ADRENAL] GLANDS Fig. 19- 7 31  ADRENAL HORMONES Fig. 19- 7 MEDULLA EPINEPHRINE & NOREPINEPHRINE [Remember direct hypothalamic preganglionic sympathetic fiber innervation to Chromaffin cells!] Inceased BP, cardiac output and blood glucose CORTEX RETICULARIS ANDROGENS Under research FASCICULATA GLUCOCORTICOIDS Increase protein, fat and carbohydrate metabolism & release GLOMERULOSA MINERALOCORTICOIDS [ALDOSTERONE] Increases reabsorption of renal sodium & water 32  THE ENDOCRINE PANCREAS Fig. 19- 8 33  PANCREATIC ISLETS [of Langerhans] Fig. 19- 8 34  PANREATIC HORMONES ALPHA CELLS GLUCAGON Mobilize lipid reserves; glucose synthesis & glycogen breakdown (liver); INCREASE [BLOOD GLUCOSE] BETA CELLS INSULIN facilitate uptake of glucose; stimulate lipid / glycogen formation & storage; DECREASE IN [BLOOD GLUCOSE] DELTA CELLS F CELLS 35  BLOOD GLUCOSE REGULATION 36  A GENERAL REVIEW [NOT ALL OF IT – YET] Fig. 19- 1 37  References Damjanov, Ivan (2011). Pathology for the Health Professions 4th edition. Elsevier Health Sciences Damjanov, Ivan (2005). Pathology for the health related professions. (3rd ed.) Elsevier Health Sciences. ISBN: 9781416000310 Martini, F., & Nath, J. L. (2015). Fundamentals of anatomy & physiology. San Francisco: Pearson/Benjamin Cummings. Richards, A. (12/2014). Essential Pathophysiology for Nursing and Healthcare Students, 1st Edition 38