endocrine pathology susan nordin md 11/3/11. overview – pathologies diabetes mellitus –...
TRANSCRIPT
Overview – Pathologies
Diabetes Mellitus – Separate Lecture
Disorders of the Pituitary Gland
Disorders of the Thyroid & Parathyroid
Disorders of the Adrenals
Disorders of the ovaries or testes
Thermoregulation and Environmental Conditions
Metabolic Disorders
Introduction – Endocrine System
Maintain equilibrium
Regulate functions of organ systems, through hormones Reproductive Growth & Development Defense against stressors Blood Glucose levels Core body Temp Blood pressure and heart rate Water & electrolyte balance Metabolism
Glands
Hypothalamus- Releasing hormones which stimulate the pituitary Dopamine which inhibits the pituitary production of prolactin
Pituitary Gland- Anterior and Posterior Anterior: 6 hormones: ACTH, TSH, LH, FSH, PRL, GH Posterior: 2 hormones: Oxytocin and ADH
Thyroid: Thyroxine
Parathyroid: Parathyroid hormone (PTH) and Calcitonin
Adrenal Glands: Cortisol, aldosterone, epinephrine
Pancreas and Gut: Insulin and glucagon and gut hormones
Ovaries/Testes: Estrogen, Progesterone and testosterone
Common Signs & Symptoms
Fatigue/lethargy
Skin changes (dryness)
Orthostatic hypotension
Hypertension
Flushing/Sweating
Weight changes
Confusion/Mental Status Changes
Tremor
Lactation
Tachycardia/bradycardia
Diarrhea/Constipation
Heat or Cold intolerance
Muscle Weakness/Atrophy/Pain
Gynecomastia
Irregular menstrual cycles/Impotence
Abnormal hair growth
Polyphagia/polydipsia/polyuria
Weight changes
Disorders of the Pituitary Gland
Anterior Pituitary Disorders can cause: Adrenal, Thyroid, Gonad, Lactation, Growth problems
Posterior Pituitary Disorders can cause: Diabetes Insipidus (can’t concentrate urine)
Thyroid and Parathyroid Gland Disorders
Hyperthyroidism
Grave’s Disease
Hypothyroidism
Hyperparathyroidism
The Parathyroids regulate Calcium
Disorders of the Adrenals
Addison’s Disease: Decreased production of adrenal hormones (Cortisol/Aldosterone)
Cushing’s Syndrome: Increased production of adrenal hormones (cCortisol/Aldosterone)
Pheochromocytoma: Produces epinephrine
Thermoregulation/Environmental
Heat Cramps
Heat Syncope
Heat Exhaustion
Heat Stroke
Exertional Hyponatremia
Frostbite
Hypothermia
Altitude Sickness
The Tired Athlete
Psychological Profile of Athletes – Separate Lecture
Depression (SIGECAPS)
Endocrine Disorders
Infections
Anemia
I’m Still TiredInfections
Skin/Wound Infections Blisters, puncture wounds, lacerations
Worsening of an underlying process due to continued training during viral illness: Pneumonia, Pericarditis, Myocarditis, Sepsis
STI’s
Foodborne illness causing diarrhea
Viral infections like MONO, parvovirus
Tickborne illnesses (LYME, Anaplasmosis)
Still TiredAnemia
Fatigue usually with exertion Pallor Headache Elevated heart rate Glossitis Poor immunity/frequent illness Pica
Classification of AnemiaPathologic/Cause
Blood Loss Acute or Chronic
Impaired Production Aplastic anemia, or anemia associated with disease Impaired DNA synthesis (B12/Folate) Impaired hemoglobin synthesis (Iron, and thalassemia)
Increased Destruction Hemolysis: Can be related to intrinsic defects,
medications, infections, immune mediated
Classification of AnemiaMorphologic/Shape
Microcytic (MCV is <80) Hypochromic Most commonly iron deficiency
Normocytic (MCV is 80-100) Normochromic Can be from chronic disease, dilution, destruction, acute
loss
Macrocytic (MCV is >100) Usually B12 or Folate deficiency
Chronic Causes Menses GI blood loss (Crohn’s, ulcers, ischemia) Microtrauma on the soles of the feet (marathon
runners)
AnemiaBlood Loss
Impaired ProductionIneffective Erythropoiesis
Iron deficiency Defective hemoglobin synthesis
Vitamin B12 deficiency Defective DNA synthesis Nuclear maturation defect Nutritional deficiency in strict vegans possible Acid suppression with medications can cause poor
absorption
Folic acid deficiency Usually from poor nutrition, similar effects to B12
deficiency
Laboratory Finding
Hct (Hematocrit) (%) women 36-48 men 40-52
Hb (Hemoglobin) (g/dl) Normal is 12-16 Anemic when < 12 g/dl
MCV (Mean Corpuscular Volume) Normal is 80-100
60-70 = Microcytic 100+ = Macrocytic
RBC (Red blood cell) count women 4.0-5.4 men 4.5-6.0
Anemia = low hemoglobin
Iron Deficiency Anemia - Treatment
3-6 mg per kg of body weight of elemental iron
http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html
Better with vitamin C on an empty stomach
Frequent monitoring
Sports Anemia
Dilutional pseudoanemia
Will not respond to tx with iron
Normal MCV & ferritin
No affect of performance
Would not expect it to cause symptoms