symptomatology of endocrinology2012
TRANSCRIPT
Symptomatology of Endocrinology
Dr. Pınar Kadıoğlu
Disorders of Endocrine System
• Hypofunction
• Hyperfunction
• Defects in sensitivity to hormones
• Syndromes of hormone excess due to administration of exogenous hormone or medication
Hypofunction
• Destruction of the gland
• Extraglandular disorders
• Specific defects in hormone biosynthesis
Hypofunction• Destruction of the gland
• Extraglandular disorders
• Specific defects in hormone biosynthesis
HypofunctionExtraglandular Disorders
• Renal disease– 25 (OH)D3 1,25 (OH)2D3
• Damage of the renin-producing juxtaglomerular cells– Hyporeninemic hypoaldosteronism
• Damage to erythropoietin-producing cells– Anemia
HypofunctionExtraglandular Disorders
• Congenital 5 -reductase deficiency– Partial androgen deficiency
• Factors that influnce hormone degradation and sensitivity– Glucocorticoid Insulin– Thyroid hormones Glucocorticoids
HypofunctionSpecific Defects in Hormone
Biosynthesis• Congenital defect in hormone synthesis
– Congenital adrenal hyperplasia– Congenital defects of thyroid
• Mutations of genes encoding polypeptide hormones– GH– GH receptor– Pit-1– MODY
Disorders of Endocrine System
• Hypofunction
• Hyperfunction
• Defects in sensitivity to hormones
• Syndromes of hormone excess due to administration of exogenous hormone or medication
Hyperfunction
Gland Prohormone
Hormone
Receptor
Effector
Response
TumorHyperplasia
Degraded
*Ectopic production*Iatrogenic
Block
Stimulation
Tissue damage
Hyperfunction• Tumors
• Hyperplasia
• Autoimmune stimulation
Disorders of Endocrine System
• Hypofunction
• Hyperfunction
• Defects in sensitivity to hormones
• Syndromes of hormone excess due to administration of exogenous hormone or medication
Defects in Sensitivity to Hormones
• Resistance to the hormone– In the receptors– Functions distal to the receptor– Influnces extrinsic to the receptor-response
pathway
Resistance Due to Postreceptor Defects
• Pseudohyperparathyroidism• Metabolic syndrome • NIDDM
History Taking in Endocrine Diseases
• Tecniques of Examination– General endocrine assesement– Thyroid– Gonads– Pituitary, adrenal, pancreatic islets,
parathyroid glands
General Endocrine Assessment• Overall appearance• General techiques• Habitus• Skeletal proportions• Body weight• Special consideration
Overall Appearance
• Appropiateness of appearance for age and sex
• Growth and maturation
• Vital signs: blood pressure, pulse, respiration, temperature
General techniques• Inspection
– Note size and configuration of the following:• Skull, facial and jaw bones, facies, prearicular and
supraclavicular areas, scalp, ears, nose, lips, tongue, teeth
– Skin:• Color• Pigmentation• Texture and thickness• Hair• Distribution of subcutaneous fat• Secondary sex characteristics
– Eyes– Genitalia and breasts
General techniques
• Palpation– Thickening or thinning of the skin.– Muscle size– Thyroid
Skeletal Proportions• Span of fingertip to
fingertip• Lower skeletal
segment- floor to top of symphysis pubis
• Upper skeletal segment- height minus lower sgment
• Body ratio- upper/ lower skeletal segment
• Normal: Span= height• Body ratio is 1.0 after
age 10
Body weight
• Body mass index: weight (kg)/ height2 (m2)
• Waist/hip ratio
Physical examination
• Thyroid
• Gonads
• Pituitary, adrenal, pancreas, parathyroid
Gonads
• Male:– External genitalia– Secondary sex characterisics
• Female– External genitalia– Adult breast development – Habitus
Assessment of adrenal function
• Blood pressure, pulse• Skin pigmentation and color• Weight• Presence of body hair• Distribution of body fat
Assessment of pituitary function
• Assessed by addressing individual target gland function– Adrenal cortex– Thyroid– Gonad
• Assesment of growth parameters• Visual field assessment
Assessment of parathyroid function
• Musculoskeletal irritability (Chvosteck/ Trousseau’s sign)
• Mental status• Hydration