Endocrine

• Clinical findings of Hypercalcemia include:

  • Cognitive dysfunction
  • Fatigue
  • Muscle weakness
  • Constipation
  • Decreased appetite
  • Polyuria
  • Polydipsia
• Complication of Hypercalcemia


  Urolithiasis, of which flank pain may be a clinical manifestation
• Pathophysiology of Hypercalcemia - Changes in calcium concentration in the blood

  Cause alterations in the balance of electrical charges of cell membranes leading to sluggish neuronal activity
• Pathophysiology of Hypercalcemia - Low calcium


  Causes a decrease in the permeability of collecting duct membrane in the nephrons

  
  

  Leads to increase in Na/Cl into tubule lumen (nephrons) with osmotic effects. This leads to less water reabsorption into the blood; and more water eliminated in the urine.
• Causes of Hypercalcemia


  • Primary Hyperparathyroidism = most relevant
  • Malignancy = most relevant
  • Granulomatous Disease
  • Increased vitamin D intake
  • Thiazide diuretics
  • Immobilization
  • Paget’s Disease
  • Hyperthyroidism
  • Milk Alkali Syndrome
• Clinical manifestation of Hypocalcemia


  • Paraesthesia
  • Numbness
  • Chvostek's sign - twitching of facial muscles in response to tapping over the facial nerve
  • Trousseau's sign - carpopedal spasm induced by pressure applied to the arm by sphygmomanometer cuff
• Hypocalcaemia Pathophysiology 


  Calcium changes lead to a change in cell membrane polarisation, decrease in the threshold for cell depolarisation causing an increase in neuronal excitability
• Causes of Hypocalcemia


  • Hypoparathyroidism
  • Vitamin D inadequacy or resistance
  • Renal disease
  • Terminal liver disease with Vitamin D inadequacy
• Osteoporosis clinical manifestations

  • Pain (from fractures and other conditions)
  • Postural changes
  • Fractures
  • Loss of height
• Osteoporosis


  Imbalance in bone reabsorption vs bone formation leading to a decrease in bone density and bone mass. Low serum concentrations of Vitamin D lead to a decrease in Calcium available for the mineralisation of bone
• Diabetes mellitus

  • Frequent urination
  • Excessive thirst
  • Unexplained weight loss
  • Extreme hunger
  • Sudden vision changes
  • Tingling or numbness in the hands or feet
  • Feeling very tired much of the time
  • Very dry skin
• Diabetes Mellitus

  Core pathophysiology is manifested by a state of Resistance to the effects of Insulin. Consequently, various organs are less able to use glucose as a source of energy, there is Hyperglycaemia leading to Glucotoxicity, ie, damage to Pancreatic cell that produce Insulin, Deficient insulin causes Diabetes
• Hyperthyroidism


  • Abnormally increased production and release of thyroid hormone.
  • Signs and symptoms occur in:
  • Eyes
  • Systemic signs
  • Heart
  • Nervous system
  • Gastrointestinal system
  • Nutritional state
  • Thermoregulation
• Pathophysiology of Hyperthyroidism


  Abnormally increased production and release of Thyroid hormone. The endocrine effects over various organs and systems include an increase in cardiac output, gut hypermotility, CNS overstimulation, increased thermogenesis, increase in osmotic pressure behind the eyes and changes in the dermis and subcutaneous tissues
• Hypothyroidism


  • Abnormally increased production and release of thyroid hormone
  • Clinical signs occur in:
  • Heart
  • Nervous system
  • Hair and skin
  • Musculoskeletal system
  • Reproductive system
  • Systemic signs
  • Metabolic functions
  • Nutrition
  • Thermogenesis
  • Gastrointestinal functions
• Hypothyroidism Pathophysiology 


  Impaired function of the gland and a decrease in the secretion of thyroid hormones T3 and T4. This abnormal function of body systems engages a number of mechanisms which explain the symptoms, signs and complications
• Hypercortisolemia


  Abnormal increase of cortisol in the blood, leading to an increase in the effects of cortisol in various systems of the body
• Signs and Symptoms of Hypercortisolemia

  • Supraclavicular & dorsal fat pads
  • Hyperglycermia
  • Central obesity
  • Easy bruising
  • Round face
  • Proximal muscle weakness
  • Purple striae
  • Hypertension
  • Hypokalemia
  • Arrhymias, paralysis, cramps
  • acne
• Hypercortisolaemia Pathophysiology 


  Increase in circulating cortisol which leads to a generalised catabolic state, i.e., the body breaks down/burns tissues and reserves in order to release energy. Most systems are effected. The involvement of multiple body systems triggers disease mechanisms which explain the clinical manifestations. This is a serious disease with several complications
• Symptoms of hypothyroidism

  Thinning hair

  Hair loss

  Dry and coarse skin

  Constipation

  Cool extremities and swelling of the limbs

  Loss of eyebrow

  Enlarged thyroid

  Slow Heart rate

  Poor appetite

  Infertility, heavy menstruation

  Carpal tunnel syndrome

  weight gain

  poor memory

  intolerance to cold

  feeling of tiredness