EMRGI - ENDOCRINE DSE

• Anterior Lobe Disorders

  • Most common cause: Tumors, pituitary infarction, genetic disorders, and trauma
• Hyperpituitarism


  Over secretion of growth hormone resulting in acromegaly or gigantism
• Acromegaly


  • Increased bone thickness, hypertrophy of soft tissues, abnormal enlargement of the extremities, disease of adults
• Central DI is the most common type of Diabetes Insipidus
• Medical Management of Pituitary Tumors

  Treated by surgical removal, drug therapy, & external beam radiation therapy
• Clinical Manifestations of Hypopituitarism

  • Growth Hormone Deficiency
  • Adrenocortical Insufficiency
  • Hypothyroidism
  • Gonadal Failure
  • Neurologic signs (due to tumor)
• Manifestations of Acromegaly


  • Degenerative arthropathy in peripheral joints
  • Widening of joint space
  • Stiffness of the hand
  • Broad enlargement of the fingers
  • Pain and stiffness due to premature osteoarthritis
  • Carpal Tunnel Syndrome
  • Myopathy
  • Muscle weakness and poor exercise
  • Back pain
  • Hypertension
  • Diabetes Mellitus
• Hypopituitarism


  • “Dwarfism” & “Panhypopituitarism”
• Gigantism


  • An overgrowth of the long bones that develops in children before the epiphyses of the bones close
• Pathological consequences of Pituitary Gland Disorders

  • Hyperpituitarism
  • Hypopituitarism
  • Expanding tumor masses
• Nephrogenic DI is due to diseases affecting the renal system
• Diabetes Insipidus is a physiologic imbalance of water secondary to ADH deficiency
• Diabetes Insipidus

  1. Excessive thirst

  2. Excessive urination at night

  3. Dehydration

  4. Fatigue, irritability secondary to sleep disturbances
• Types of Diabetes Insipidus

  • Central DI
  • Nephrogenic DI
• Nephrogenic DI

  • Diseases affecting the Renal system
• If the person is unconscious or confused & unable to take necessary fluids to compensate for fluid loss

  Dehydration, shock, and death can occur
• Thyroiditis is the inflammation of the thyroid gland
• Thyroid Gland Disorders include Thyroiditis, Hyperthyroidism, Hypothyroidism
• Thyroid Storm is characterized by signs and symptoms of hypermetabolism
• Central DI


  • Most common type; idiopathic or due to secondary causes
• If a person is conscious & able to respond appropriately to the thirst mechanism

  Hydration is maintained
• Urine in Diabetes Mellitus results in many glucose, while in Diabetes Insipidus the urine is diluted and no glucose
• Syndrome of Inappropriate ADH (SIADH)
• Hyperthyroidism is the excessive secretion of thyroid hormone
• Goiter is the enlargement of the thyroid gland
• Hypothyroidism is the insufficient thyroid hormone; creates a generalized depress
• Thyroid storm is characterized by signs and symptoms of hypermetabolism including severe tachycardia with heart failure, shock, and hyperthermia (up to 105.3 F or 40.7 C)
• Hypothyroidism is characterized by insufficient thyroid hormone, creating a generalized depression of body metabolism
• Primary symptoms of hypothyroidism

  • Intolerance to cold
  • Excessive fatigue and drowsiness
  • Headaches and weight gain
• Classification of Hypothyroidism

  1. Primary Hypothyroidism: reduced functional thyroid tissue mass or impaired hormonal synthesis

  2. Secondary Hypothyroidism: result of inadequate stimulation of the gland because of anterior pituitary gland dysfunction
• Hyperparathyroidism is characterized by excessive secretion of parathyroid hormone leading to demineralization of bone and subsequent loss of bone strength and density, most common in postmenopausal women
• Hypoparathyroidism is characterized by insufficient secretion of PTH, often due to removal or injury of the gland during thyroid or anterior neck surgery
• Neuromuscular symptoms of myxedema include median nerve compression leading to carpal tunnel syndrome, proximal muscle weakness with pain, development of involved muscles with persistent muscle trigger points, and association with fibromyalgia syndrome
• Clinical manifestations of hyperparathyroidism include proximal muscle weakness and fatigability, myopathy of respiratory muscles, muscle weakness, loss of appetite, weight loss, nausea and vomiting, and increased thirst
• Risk factors for hypothyroidism

  • Women, Men over 65 years old
  • Surgical removal of the thyroid gland, external irradiation, some medications
• In fetus and infants, absent thyroid tissue and hereditary defects in thyroid hormone synthesis can lead to untreated congenital hypothyroidism resulting in cretinism
• Immediate medical referral is required for thyroid storm
• Myxedema is a characteristic sign of hypothyroidism resulting in alteration in the composition of the dermis and other tissues
• Risk factors for thyroid neoplasm include being a woman, over 40 years of age, Caucasian, iodine deficiency, history of thyroid cancer, and exposure to radioactive iodine
• Clinical manifestations of hyperparathyroidism also include osteitis fibrosa cystica, brown tumors, bone pain secondary to osteopenia, and osteogenic synovitis associated with chondrocalcinosis and CPPD deposits in the synovial fluid