Patho-endocrine system

• Endocrine Disorders

  • Excess hormone levels
  • Deficit of hormone or reduced effects
• Types of Diabetes

  • Type 1
  • Type 2
• Type 1 Diabetes


  • Autoimmune destruction of beta cells in pancreas
  • Insulin replacement required
  • Acute onset in children and adolescents
  • Not linked to obesity
  • Genetic factors may play a role
• Metabolic changes in Type 1 Diabetes

  • Catabolism of fats and proteins
  • Excessive amounts of fatty acids and metabolites
  • Ketones in the blood
• Ketonuria


  • Decreased serum bicarbonate
  • Decrease in pH of body fluids
  • Ketoacids excreted in urine
  • Decompensated metabolic acidosis
  • Low bicarbonate levels in the blood are a sign of metabolic acidosis
• Type 2 Diabetes


  • Noninsulin-dependent
  • Oral hypoglycemic medications may be used
  • Caused by decreased production of insulin and/or increased resistance by body cells to insulin
  • Onset is slow and insidious, usually in those older than 50 years
  • Associated with obesity
  • Component of metabolic syndrome
  • Increasing incidence in teens and young adults
• Control of Type 2 Diabetes

  • Adjusting dietary intake
  • Increase body's use of glucose through exercise
  • Reducing insulin resistance
  • Stimulating the beta cells of the pancreas to produce more insulin
  • Monitoring blood glucose levels as ordered
  • Medication to stimulate the beta cells of the pancreas to produce more insulin
  • If insulin-dependent, proper administration of insulin to maintain glucose levels in normal range
  • Routine follow-up and blood testing
• Initial Stage of Diabetes

  • Insulin deficit results in decreased transportation and use of glucose in many cells
  • Blood glucose levels rise (hyperglycemia)
  • Excess glucose found in urine
  • Large urine volume
  • Fluid loss through urine, resulting in dehydration
  • Dehydration causes thirst (polydipsia)
• General Manifestations of Diabetes

  • Polyphagia
  • Fatigue
  • Hyperglycemia
  • Glucosuria
  • Dehydration results from hyperosmolar filtrate
  • Polyuria
  • Polydipsia
• Diagnostic Tests for Diabetes

  • Fasting blood glucose level
  • Glucose tolerance test (OGTT)
  • Glycosylated hemoglobin test (HbA1c)
  • Clinical and subclinical diabetes
  • Monitor glucose levels over several months
• Treatment Principles for Diabetes

  • Maintenance of blood glucose levels in normal range
  • Diet and exercise
  • Exercise reduces blood glucose level as skeletal muscle uses glucose
  • Oral medication to increase insulin secretion and reduce blood glucose levels
  • Insulin replacement
• Complications of Diabetes

  • Complications are directly related to duration and extent of abnormal blood glucose levels
  • Many factors lead to fluctuations in serum glucose levels
  • Variations in diet and alcohol use
  • Change in physical activity
  • Infection
  • Vomiting
  • Complications may be acute or chronic
• Acute Complications of Diabetes

  • Hypoglycemia (insulin shock)
  • Diabetic ketoacidosis (diabetic coma or hyperglycemia, DKA)
• Hypoglycemic Shock


  • Disorientation and change in behavior
  • Anxiety or decreased responsiveness
  • Decreased blood glucose level
  • Decreased BP, increased heart rate
  • Decreasing level of consciousness
  • Immediate administration of glucose is required to prevent brain damage
• Emergency Treatment for Hypoglycemic Shock


  • If conscious, immediately give sweet fruit juice, honey, candy, or sugar
  • If unconscious, give nothing by mouth, intravenous glucose 50% is required
  • Diabetic ketoacidosis (DKA) also causes loss of consciousness, the emergency treatment is insulin, fluid, and sodium bicarbonate
• Diabetic Ketoacidosis (DKA)


  • Occurs in insulin-dependent clients
  • More commonly seen in type 1 diabetes
  • Result of insufficient insulin in blood
  • High blood glucose levels
  • Mobilization and use of lipids to meet cellular needs result in production of ketoacids
  • May be initiated by infection or stress
  • May result from error in dosage, infection, change in diet, alcohol intake, or exercise
• Signs and Symptoms of Diabetic Ketoacidosis


  • Thirst
  • Dry, rough oral mucosa
  • Warm, dry skin
  • Rapid pulse, but weak
  • Blood pressure is low as the vascular volume decreases
  • Oliguria (decreased urine output) indicates that compensation mechanisms to conserve fluid in the body are taking place
  • Rapid, deep respirations (Kussmaul respirations)
  • Acetone breath (a sweet, fruity smell)
  • Lethargy and decreased responsiveness indicate depression of the central nervous system owing to acidosis and decreased blood flow
  • Hyperpnea: abnormally rapid or deep breathing
• Metabolic Acidosis in Diabetic Ketoacidosis

  • Decreased serum bicarbonate levels and decreased serum pH
  • Dehydration progresses, renal compensation is reduced
  • Serum pH falls
  • Loss of consciousness
• Electrolyte Imbalances in Diabetic Ketoacidosis

  • Primarily abdominal cramps
  • Nausea, and vomiting
  • Lethargy and weakness
• Treatment for Diabetic Ketoacidosis

  • Insulin administration
  • Replacement of fluid and electrolytes
• Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)

  • Occurs in type 2 diabetes
  • Insidious in onset and diagnosis may be missed
  • Often occurs in older clients and assumed to be cognitive impairment
  • Results in severe dehydration and electrolyte imbalances
• HHNK Manifestations


  • Hyperglycemia
  • Severe dehydration
  • Increased hematocrit
  • Loss of turgor (dehydration)
  • Increased heart rate and respirations
  • Electrolyte imbalances result in neurologic deficits, muscle weakness, difficulties with speech, abnormal reflexes
• Chronic Complications of Diabetes

  • Vascular problems
  • Infections
• Vascular Problems with Diabetes

  • Increased incidence of atherosclerosis
  • Changes may occur in small and large arteries
  • Microangiopathy - changes in microcirculation, obstruction or rupture of small capillaries and arteries, tissue necrosis and loss of function, neuropathy and loss of sensation, retinopathy - leading cause of blindness, chronic renal failure - degeneration in glomeruli of kidney
  • Macroangiopathy - affects large arteries, result of abnormal lipid levels, high incidence of heart attacks, strokes, peripheral vascular disease, may result in ulcers on feet and legs - slow-healing, frequent infections and gangrenous ulcers, amputation may be necessary
  • Peripheral neuropathy - common complication caused by ischemia in microcirculation to peripheral nerves, impaired sensation, numbness, tingling, weakness, muscle wasting
• Infections Common in Diabetes

  • Fungal infections common, caused by Candida in vagina and/or oral cavity
  • Urinary tract infections
  • Dental caries
  • Gingivitis (gum inflammation) and periodontitis (serious gum infection)
• Chronic Complications of Diabetes (Cont.)

  • Cataracts - opacity of lens in eye, related to abnormal metabolism of glucose
  • Pregnancy - complications in both mother and fetus may occur
• Chronic Complications of Diabetes (Cont.)

  • Infections
  • Fungal infections
  • Urinary tract infections
  • Dental caries
  • Gingivitis
  • Periodontitis
• Gingivitis


  A common and mild form of gum disease (periodontal disease)
• Chronic Complications of Diabetes (Cont.)

  • Cataracts
  • Pregnancy complications
• Cataracts


  Opacity of lens in eye, related to abnormal metabolism of glucose
• Pregnancy complications in diabetics

  • Increased incidence of spontaneous abortions
  • Infants born to diabetic mothers increased size and weight for date (fetal macrosomia)
  • Infants may experience hypoglycemia in first hours postnatally
• Parathyroid hormone


  4 parathyroid glands release PTH in response to drop in serum calcium, magnesium needed to activate PTH release, effects on bone, kidney and indirectly on intestines
• Action of PTH on bone

  PTH causes resorption of bone (osteoclastic activity), this causes mobilization of Ca++ from the bone or demineralization, hence it increases serum Ca++ levels
• Hypoparathyroidism


  Leads to hypocalcemia, weak cardiac muscle contractions, increased excitability of nerves—spontaneous contractions of skeletal muscle, causes include tumor, congenital lack of parathyroid, surgery or radiation in neck region, autoimmune disease
• Hyperparathyroidism


  Results in hypercalcemia, forceful cardiac contractions, osteoporosis, predisposition to kidney stones, causes include tumor, secondary to renal failure, paraneoplastic syndrome (ectopic PTH production which increases bone resorption)
• Pituitary Adenomas


  Most common cause of pituitary disorders, may cause pressure in the skull (headaches, seizures, drowsiness, visual deficits), may cause excessive or decreased release of hormones
• Dwarfism


  Deficit in growth hormone production and release
• Gigantism


  Excess GH prior to puberty and fusion of epiphysis
• Acromegaly


  Excess GH secretion in adults, often associated with adenoma, bones become broader and heavier, soft tissue grows, enlarged hands and feet, change in facial features
• Pygmies of Africa


  Unable to synthesize significant amount of somatomedin C despite GH levels being normal, Lorain-Levi dwarfism is caused by mutations in the gene for the GH receptor