Endocrine Pathophysiology Intro PDF

**Endocrine Pathophysiology Intro** ### **Focus of this Talk** - - - - - - - - - - - - - - - - ### **Brief Review** - - - - - - - - - - - - - - - - - ### **A Delicate (and Constant) Balance** - 1....

**Endocrine Pathophysiology Intro** ### **Focus of this Talk** - - - - - - - - - - - - - - - - ### **Brief Review** - - - - - - - - - - - - - - - - - ### **A Delicate (and Constant) Balance** - 1. - - - - - 2. - ### **Hormone Receptors** - 1. - 2. - 3. - 4. ### **Hypothalamic Disruptions** - - - - - - - - - - - - **Posterior Lobe DI\ Diabetes Insipidus** - - - ### **ADH: Vasopressin** - 1. 2. - 3. 4. 5. ### **Neurogenic (Central) DI** - - - - - - - - - - ### **Nephrogenic DI** - - - - - - - - ### **Pseudo DI** - - - - ### **Pathophysiology of DI** - - - - - - - - ### **Clinical Manifestations** - - - - - 1. 2. 3. ### **Evaluation** - - - - - - - - - - ### **Treatment** - - - - - - - - **Posterior Lobe SIADH\ Syndrome of Inappropriate Antidiuretic Hormone** - ### **Causes of SIADH** - - - - - - - - - - - - - - ### **Pathophysiology** - - - - ### **Clinical Manifestations** - - - - - ### **Diagnosis** - - - - - - ### **Treatment** - - - - - - - - **Anterior Pituitary Hypopituitarism** - ### **Pituitary Failure** - - 1. - - 2. 3. 4. - 5. - 6. - 7. 8. - 9. 10. ### **Pathophysiology** - - - - - ### **Clinical Manifestations** - - - - - - - ### **Evaluation & Treatment** - - - - - - - - - - **Anterior Lobe Growth Hormone** - ### **GH Secretion** - - - - - - - - - ### **GH Actions** - - - - - - - - ### **Acromegaly** - - ### **Excess GH (IGF-1) Production** - - - - - - - - - - - ### **Pathophysiology** - - - - - ### **Clinical Manifestations (Adults)** - - - - - - - - - - - - - - ### **Evaluation** - - - - - - - - - - ### **Treatment** - - - - - - **Anterior Lobe Prolactin Excess** - ### **Prolactin Regulation** - - - - - - 1. 2. 3. ### **Prolactin Excess** - - - - - - - - - - - - - ### **Pathophysiology** - - - - - - ### **Clinical Manifestations** - - - - - - - - - ### **Evaluation & Treatment** - - - - - - - - - - - - **Parathyroid Dysfunction** - - - ### **PTH Secretion** - - - - - ### **Function** - - - - - ### **Hypoparathyroid** - ### **Causes of Hypoparathyroid** - - - - - - - - ### **Pathophysiology** - - - ### **Clinical Manifestations of Hypoparathyroid** - - - - - - ### **Evaluation of Hypoparathyroid** - - - - - - ### **Treatment of Hypoparathyroid** - - - - - - ### **Hyperparathyroid** - - ### **Primary Hyperparathyroidism** - - - - - - - - ### **Secondary Hyperparathyroidism** - - - - - ### **Tertiary/Pseudo Hyperparathyroidism** - - - - - - - ### **Clinical Manifestations of Primary Hyperparathyroidism** +-----------------------------------+-----------------------------------+ | **Symptoms (by system)** | **Cause** | +===================================+===================================+ | **GU**: renal colic, | Ca+/phosphate & CA+ oxalate salts | | nephrolithiasis, recurrent UTI, | precipitate in alkaline urine | | renal failure | àstones | +-----------------------------------+-----------------------------------+ | **GI**: Abd pain, PUD, | ­ HCL secretion | | | | | Pancreatitis | ? Cause | | | | | Constipation | ¯ peristalsis | | | | | Anorexia, N/V | Stimulation of vomiting center | +-----------------------------------+-----------------------------------+ | **M/S**: osteoporosis, kyphosis, | PTH stimulates bone resorption | | fractures | | | | Diagnostic for | | \* osteitis fibrosa & cystica, | hyperparathyroidism | | | | | \* Muscle weakness/myalgia | Neuropathy of Type I/II muscle | | | fibers | | \* Arthralgia/arthritis | | | | Hyperuricemia & renal failure | +-----------------------------------+-----------------------------------+ | **CNS**: Memory loss, confusion, | Neuropathy; EEG changes | | stupor, coma | | +-----------------------------------+-----------------------------------+ | **Polyuria/polydipsia** | Direct effect on renal tubule to | | | decrease responsiveness to ADH | +-----------------------------------+-----------------------------------+ | **HTN** | Plasma renin activity often ­ | +-----------------------------------+-----------------------------------+ ### **Evaluation & Treatment of Hyperparathyroidism** - - - - - - - - - - - - - - - - **Anterior Lobe Adrenal Axis** - - ### **Background** - - - - - - ### **ACTH** - - - - - - - - - ### **ACTH Effects** - 1. - - 2. - 3. - ### **ACTH Secretion** - - - - - - ### **ACTH Negative Feedback** - 1. 2. 3. - - ### **Dexamethasone Challenge** - - - - - - - - - **Hypofunction\ Anterior Lobe Adrenal Axis - Addison's** ### **Hypocortisolism** - - - ### **Addison's Disease** - - - - - - - - - - - ### **Primary Addison\'s Disease Pathophysiology** - - - - - - - - ### **Secondary Addison\'s Disease Pathophysiology** - - - - - ### **Clinical Manifestations of Addison\'s Disease** - - - - - - - - - ### **Evaluation (Labs)** - - - - - - - - - - - ### **Treatment** - - - **Hyperfunction\ Anterior Lobe Adrenal Axis - Cushing Disease** ### **Excess Cortisol** - - - - - - - - ### **Autonomous Adrenal Tumors** - - ### **Corticotropin Dependent** - - - - - - ### **Corticotropin Independent** - - - - - ### **Clinical Symptoms of Hypercortisolism** - - - - - - - - - - - - - - - - - - - - - - - - - - ### **Clinical Symptoms of Hypercortisolism (Continued)** - - - - - - - ### **Evaluation** - - - - - - - - ### **Treatment (Depends on Cause)** - - - - - - - - **Hyperfunction\ Anterior Lobe Adrenal Axis - Pheochromocytoma** ### **Pheochromocytoma** - - - - - - - - ### **Pathophysiology** - - - - - - - - ### **Clinical Manifestations** - - - - - - - - - - - - - - - - ### **Evaluation** - - - - - - - - - ### **Treatment** - - - - - - - **Hyperfunction\ Anterior Lobe Adrenal Axis - Hyperaldosteronism** ### **Aldosterone Regulation** - - - - - - - - - ### **Renal Sensitivity to Hormones** - - - - ### **Excess Aldosterone** - - - - ### **Primary Hyperaldosteronism (Conn Disease)** - - - - - ### **Primary Hyperaldosteronism Pathophysiology** - - - - - - ### **Secondary Hyperaldosteronism** - - - - - - - - - ### **Secondary Hyperaldosteronism Pathophysiology** - - - - - ### **Clinical Manifestations** - - - - - - - ### **Evaluation & Treatment** - - - - - - - - - - **Thyroid Dysfunction** ### **Largest Endocrine Gland** - - - - - - - ### **Some Facts** - - - - - ### **What Thyroid Hormones Do** - - - - - - ### **Why We Need It** - - - - - - - - - - ### **Regulation** - - - - - - - - ### **Thyroid Follicle** - - - ### **Types of Thyroid Hormone** - - - - - - - - - - ### **Highly Bound** - - - - - - - - - ### **Feedback & Autoregulation** - - - - - - - - ### **Estrogen** - - - - - - - - ### **Fetal Thyroid** - - - - - - - - ### **Serum TSH: Single best test** - - - - - - - - - ### **Total T4, Free T4, and T3** - - - - - - ### **Thyroid Antibodies** - - - ### **Goiter** - - - - - - - - - - - - - ### **Graves\' Disease** - - - - - **Hypothyroid:** - - - **Undersecretion of T4** - - - - - - - - - - - **Hashimoto's Thyroiditis** - - - - **Hyperthyroid** - - - - - - - **Graves Disease** - - - - - - - - - - - - - - ### **Non-Graves Hyperthyroid Conditions** - - - - - - ### **Thyroid Storm (thyrotoxicosis)** - -  ### **Subacute Thyroiditis** - - - - - - - ### **Postpartum (silent) Thyroiditis** - - - - - - - - - - - ### **Acute Thyroiditis** - - - - - - ### **Toxic Multinodular Goiter** - - ### **Invasive Fibrous Thyroiditis** - - - - - Thyroiditis Algorithm ### **Thyroid Nodules** - - - - - ### **Risk Factors for Thyroid Cancer** - - - - ### **Differential Diagnosis** - - - - ### **Subclinical Disease** - - - - - - - - ### ### ### ### ### ### **TSH Algorithm**  ### **Screening Summary** +-----------------+-----------------+-----------------+-----------------+ | Type | TSH | T4 Level | Complications | +=================+=================+=================+=================+ | Overt | Undetectable | Elevated | Sx's, atrial | | | | | fib, bone | | **Hyper** | | | density | +-----------------+-----------------+-----------------+-----------------+ | Overt | Elevated | Decreased | Sx's, Elevated | | | | | cholesterol | | **Hypo** | | | | +-----------------+-----------------+-----------------+-----------------+ | Subclinical | Undetectable to | Normal | Progression to | | | very low | | overt HyperT, | | **Hyper** | | | osteoporosis, | | | | | a-fib | +-----------------+-----------------+-----------------+-----------------+ | Subclinical | Mildly Elevated | Normal | May not have | | | | | sx's, | | **Hypo** | | | progression to | | | | | overt HypoT, | | | | | elevated | | | | | cholesterol | +-----------------+-----------------+-----------------+-----------------+