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Alterations of Hormonal RegulationChapter 21

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Elevated or Depressed Hormone Levels Failure of feedback systems Dysfunction of an endocrine gland Secretory cells are unable to produce, obtain, or

convert hormone precursors The endocrine gland synthesizes or releases

excessive amounts of hormone Increased hormone degradation or inactivation Ectopic hormone release

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Target Cell Failure Receptor-associated disorders

Decrease in number of receptors Impaired receptor function Presence of antibodies against specific receptors Antibodies that mimic hormone action Unusual expression of receptor function

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Hormone Delivery

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Alterations of the Hypothalamic-Pituitary System

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Diseases of the Posterior Pituitary Syndrome of inappropriate antidiuretic

hormone secretion (SIADH) Hypersecretion of ADH For diagnosis, normal adrenal and thyroid

function must exist Clinical manifestations are related to enhanced

renal water retention, hyponatremia, and hypoosmolarity

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Diseases of the Posterior Pituitary Diabetes insipidus

Insufficiency of ADH Polyuria and polydipsia Partial or total inability to concentrate the urine Neurogenic

Insufficient amounts of ADH

Nephrogenic Inadequate response to ADH

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Diseases of the Anterior Pituitary Hypopituitarism

Pituitary infarction Sheehan syndrome Hemorrhage Shock

Others: head trauma, infections, and tumors

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Diseases of the Anterior Pituitary Hypopituitarism

Panhypopituitarism ACTH deficiency TSH deficiency FSH and LH deficiency GH deficiency

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Diseases of the Anterior Pituitary Hyperpituitarism

Commonly due to a benign, slow-growing pituitary adenoma

Manifestations Headache and fatigue Visual changes Hyposecretion of neighboring anterior pituitary

hormones

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Diseases of the Anterior Pituitary Hypersecretion of growth hormone (GH)

Acromegaly Hypersecretion of GH during adulthood

Gigantism Hypersecretion of GH in children and adolescents

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Hypersecretion of Growth Hormone (GH)

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Diseases of the Anterior Pituitary Hypersecretion of prolactin

Caused by prolactinomas In females, increased levels of prolactin cause

amenorrhea, galactorrhea, hirsutism, and osteopenia In males, increased levels of prolactin cause

hypogonadism, erectile dysfunction, impaired libido, oligospermia, and diminished ejaculate volume

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Alterations of Thyroid Function Hyperthyroidism

Thyrotoxicosis Graves disease

Pretibial myxedema

Hyperthyroidism resulting from nodular thyroid disease Goiter

Thyrotoxic crisis

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Thyrotoxicosis (Graves’ Disease)

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Alterations of Thyroid Function Hypothyroidism

Primary hypothyroidism Subacute thyroiditis Autoimmune thyroiditis (Hashimoto disease) Painless thyroiditis Postpartum thyroiditis Myxedema coma

Congenital hypothyroidism Thyroid carcinoma

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Hypothyroidism

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Alterations of Parathyroid Function Hyperparathyroidism

Primary hyperparathyroidism Excess secretion of PTH from one or more

parathyroid glands Secondary hyperparathyroidism

Increase in PTH secondary to a chronic disease Hypoparathyroidism

Abnormally low PTH levels Usually caused by parathyroid damage in thyroid

surgery

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Type 1 Diabetes Mellitus Demonstrates pancreatic atrophy and specific

loss of beta cells Macrophages, T and B lymphocytes, and

natural killer cells are present Two types

Immune Nonimmune

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Type 1 Diabetes Mellitus Genetic susceptibility Environmental factors Immunologically mediated destruction of beta

cells Manifestations

Hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, and fatigue

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Type 1 Diabetes Mellitus

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Type 1 Diabetes Mellitus

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Dysfunction of the Pancreas Type 2 diabetes mellitus

Maturity-onset diabetes of youth (MODY) Gestational diabetes mellitus (GDM) Common form of diabetes mellitus type 2

Insulin resistance

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Type 2 Diabetes Mellitus

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Acute Complications of Diabetes Mellitus Hypoglycemia Diabetic ketoacidosis Hyperosmolar hyperglycemic nonketotic

syndrome (HHNKS) Somogyi effect Dawn phenomenon

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Diabetic Ketoacidosis

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Chronic Complications of Diabetes Mellitus Hyperglycemia and nonenzymatic

glycosylation Hyperglycemia and the polyol pathway

Protein kinase C Microvascular disease

Retinopathy Diabetic nephropathy

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Diabetic Nephropathy

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Chronic Complications of Diabetes Mellitus Macrovascular disease

Coronary artery disease Stroke Peripheral arterial disease

Diabetic neuropathies Infection

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Diabetic Amputation

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Diabetic Neuropathy

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Alterations of Adrenal Function Disorders of the adrenal cortex

Cushing disease Excessive anterior pituitary secretion of ACTH

Cushing syndrome Excessive level of cortisol, regardless of cause

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Cushing Disease

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Alterations of Adrenal Function Disorders of the adrenal cortex

Hyperaldosteronism Primary hyperaldosteronism (Conn disease) Secondary hyperaldosteronism

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Primary Hyperaldosteronism

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Alterations of Adrenal Function Disorders of the adrenal cortex

Adrenocortical hypofunction Primary adrenal insufficiency (Addison disease)

Idiopathic Addison disease

Secondary hypocortisolism

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Alterations of Adrenal Function Disorders of the adrenal cortex

Hypersecretion of adrenal androgens and estrogens Feminization Virilization

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Virilization

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Alterations of Adrenal Function Disorders of the adrenal medulla

Adrenal medulla hyperfunction Caused by tumors derived from the chromaffin cells

of the adrenal medulla Pheochromocytomas

Secrete catecholamines on a continuous or episodic basis

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Pheochromocytoma