PATHO QUIZ2

• Endocrine Disorders

  All disorders reflect impaired control or feedback.

  Excess hormone levels

  • Tumor produces high levels
  • Excretion by liver or kidney is impaired.
  • Congenital condition produces excess hormone.

  Deficit of hormone or reduced effects

  • Tumor produces too little hormone.
  • Inadequate tissue receptors present
  • Antagonistic hormone production is increased.
  • Malnutrition
  • Atrophy, surgical removal of gland
  • Congenital deficit
• Diagnostic Tests

  • Blood tests
  • Check serum hormone levels
  • Radioimmunoassay
  • Immunochemical methods
  • Urine tests
  • Stimulation or suppression tests
  • Scanning, ultrasound, magnetic resonance imaging (MRI)
  • Biopsy 

  Treatment

  Deficit may be treated with replacement therapy.

  Excessive secretion may be treated with 

  • medications.
  • surgery. 
  • radiation.
• Insulin and Diabetes Mellitus

  Diabetes mellitus 

  • basic problem is inadequate insulin effects in receptor tissues
  • Deficit of insulin secretion
  • Production of insulin antagonists

  Diabetes results in abnormal carbohydrate, protein, and fat metabolism.

  Some tissues can transport glucose in the absence of insulin:

  • CNS, kidney, myocardium, gut, skeletal muscle
  • Skeletal muscle can partially meet tissue needs without insulin.
• A - Type 1 Diabetes

  Type 1

  • 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

  • Catabolism of fats and proteins
  • Excessive amounts of fatty acids and metabolites
  • Ketones in the blood
• Ketones, or ketone bodies, are acidic molecules made in your liver.

  When the liver breaks down cells, fat, or protein to give you energy, it makes ketones as by-products. 

  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.
• B - Type 2 Diabetes

  Type 2

  • Non Insulin-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

  May be controlled by adjusting:

  • Dietary intake
  • Increase body’s use of glucose
  • That is, with exercise
  • Reducing insulin resistance
  • Stimulating the beta cells of the pancreas to produce more insulin
• B - Initial Stage

  • 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).
• B-General Manifestations

  Insulin deficit results in decreased transport and use of glucose in many cells.

  • Polyphagia
  • Fatigue

  Blood glucose levels rise — hyperglycemia

  Excess glucose in urine — glucosuria

  • Dehydration results from hyperosmolar filtrate.
  • Polyuria
  • Polydipsia
• B-Diagnostic Tests

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

  Maintenance of blood glucose levels in normal range

  • Helps reduce complications

  Diet and exercise

  • Exercise reduces blood glucose level as skeletal muscle uses glucose. 

  Oral medication

  • Increase insulin secretion.
  • Reduce blood glucose levels.

  Insulin replacement
• B-Complications

  • 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.
• B-Acute Complications

  Hypoglycemia (insulin shock)

  • More common with insulin replacement treatment
  • Can occur because of excess oral hypoglycemic drugs
  • Excess insulin in circulation
  • Glucose deficit in blood
  • Can be life-threatening or cause brain damage if untreated
  • Often follows strenuous exercise
  • Dosage error
  • Vomiting
  • Skipping meal after taking insulin 
• B-Hypoglycemic Shock: Signs and Symptoms

  • Disorientation and change in behavior
  • Anxiety or decreased responsiveness
  • Decreased blood glucose level
  • Decreased BP, increased heart rate
  • Decreasing level of consciousness
  • Note: Immediate administration of glucose is required to prevent brain damage.
• B-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.
  • Note: Diabetic ketoacidosis (diabetic coma or hyperglycemia, DKA) also causes loss of consciousness. The emergency treatment is insulin, fluid, and sodium bicarbonate.
• C-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
• C-Signs and Symptoms of DKA

  • 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.
• C-Ketoacidosis

  • 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.
• C-Metabolic Acidosis

  • Decreased serum bicarbonate levels and decreased serum pH 
  • Dehydration progresses, renal compensation is reduced.
  • Serum pH falls.
  • Loss of consciousness
• C-Treatment for DKA

  • Insulin administration
  • Replacement of fluid and electrolytes
• D-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
• D-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

  1. 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
• Chronic Complications of Diabetes

  2- 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. 
• Chronic Complications of Diabetes

  3- Peripheral neuropathy

  • Common complication caused by ischemia in microcirculation to peripheral nerves
  • Impaired sensation, numbness, tingling, weakness, muscle wasting 
• Chronic Complications of Diabetes

  Infections

  • Common and often more severe in diabetics
  • Infections in feet and legs caused by vascular and neurologic impairment
  • 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)

  Gingivitis is a common and mild form of gum disease (periodontal disease)
• Chronic Complications of Diabetes

  Cataracts

  • Opacity of lens in eye
  • Related to abnormal metabolism of glucose

  Pregnancy

  • Complications in both mother and fetus may occur.
  • Increased incidence of spontaneous abortions
  • Infants born to diabetic mothers
  • increased size and weight for date (fetal macrosomia).
  • may experience hypoglycemia in first hours postnatally.
• 2-Parathyroid Hormone and Calcium

  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.
• 2-Parathyroid Hormone and Calcium

  Hypoparathyroidism

  • Leads to hypocalcemia
  • Weak cardiac muscle contractions
  • Increased excitability of nerves— spontaneous contractions of skeletal muscle
  • Causes
  • Tumor
  • Congenital lack of parathyroid
  • Surgery or radiation in neck region
  • Autoimmune disease
• 2-Parathyroid Hormone and Calcium

  Hyperparathyroidism

  • Results in hypercalcemia
  • Forceful cardiac contractions
  • Osteoporosis
  • Predisposition to kidney stones
  • Causes
  • Tumor
  • Secondary to renal failure 
  • Paraneoplastic syndrome (ectopic PTH 
  • production which increases bone resorption)
• 3-Pituitary Hormones

  Pituitary Hormones:

  • Adenomas are the most common cause of pituitary disorders.
  • Effect of mass
  • May cause pressure in the skull
  • Headaches, seizures, drowsiness (sleepy), visual deficits
  • Effect on hormone secretion
  • Dependent on cells and location involved
  • May cause excessive or decreased release of hormones
• 3-Pituitary Hormones

  Growth Hormone

  Dwarfism

  • Deficit in growth hormone production and release

  Gigantism (before puberty)

  • Excess GH prior to puberty and fusion of epiphysis

  Acromegaly (after puberty)

  • 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>>>inability to synthesize significant amount of somatomedin C
  • Lorain-Levi dwarfism (mutations in the gene for the GH receptor
• 3-Pituitary Hormones

  Antidiuretic Hormone (ADH)

  Diabetes insipidus — deficit of ADH 

  • Adenoma
  • May originate in the neurohypophysis
  • Head injury or surgery
  • Possible genetic problem
  • Replacement treatment required

  Diabetes insipidus is a rare condition that causes your body to make a lot of urine that is "insipid," or colorless and odorless.
• 3-Pituitary Hormones

  Inappropriate ADH Syndrome (SIADH)

  • Excess ADH
  • May be temporary, triggered by stress; may be secreted by an ectopic source, such as a tumor
  • Treatment 
  • Diuretics 
  • Sodium supplements
• 4-Thyroid Disorders

  Goiter

  is used to describe any enlarged thyroid gland. The thyroid is a butterfly-shaped gland located in your neck.

  Endemic goiter (iodine deficiency)

  • Hypothyroid condition in regions with low iodine levels in soil and food

  Goitrogens

  • Foods that contain elements to block synthesis of triiodothyronine (T3) and thyroxine (T4)

  Toxic goiter

  • Results from hyperactivity of thyroid gland
• 4-Thyroid Disorders

  Hyperthyroidism

  • Related to autoimmune factor
  • Hypermetabolism and increased stimulation of SNS
  • Increased body temperature
  • Sweating
  • Soft silky hair and skin
  • Reduced BMI
  • Insomnia
  • Hyperactivity
  • Toxic goiter

  Exophthalmos

  • Presence of protruding, staring eyes, decreased blink and eye movement
  • Result of increased tissue mass in the orbit
  • May result in visual impairment
• 4-Thyroid Disorders

  Hypothyroidism

  • Iodine deficit
  • Hashimoto thyroiditis
  • Autoimmune disorder
  • Tumor
  • Surgical removal or treatment of gland
  • Cretinism
  • Results in short stature and severe cognitive deficits
  • Untreated congenital hypothyroidism 
  • May be related to iodine deficiency during pregnancy
• 4-Thyroid Disorders

  Hashimoto’s Disease

  • Most common cause of hypothyroidism 
  • Autoimmune lymphocytic thyroiditis
  • Antithyroid antibodies:
  • Females > Males
  • Runs in Families!
• 4-Thyroid Disorders

  Hypothyroidism Manifestations

  • Goiter if cause is endemic iodine deficiency
  • Intolerance to cold
  • Increased BMI
  • Lethargy and fatigue
  • Decreased appetite
  • Myxedema in severe, untreated hypothyroidism
• 5-Adrenal Glands

  Adrenal medulla

  • Pheochromocytoma (is a type of neuroendocrine tumor that grows from cells called chromaffin cells)

  Adrenal cortex

  • Cushing syndrome
  • Addison disease
• 5-Adrenal Glands

  A-Adrenal Medulla

  • Pheochromocytoma
  • Benign tumor of the adrenal medulla — secretes epinephrine, norepinephrine, and possibly other substances
  • Occasionally, multiple tumors
  • Headache, heart palpitations, sweating, intermittent or constant anxiety