Endocrine Pathology

Susan Nordin MD 11/3/11

Overview – Pathologies

Diabetes Mellitus – Separate Lecture

Disorders of the Pituitary Gland

Disorders of the Thyroid & Parathyroid

Disorders of the Adrenals

Disorders of the ovaries or testes

Thermoregulation and Environmental Conditions

Metabolic Disorders

Introduction – Endocrine System

Maintain equilibrium

Regulate functions of organ systems, through hormones Reproductive Growth & Development Defense against stressors Blood Glucose levels Core body Temp Blood pressure and heart rate Water & electrolyte balance Metabolism

Anatomy

Glands

Hypothalamus- Releasing hormones which stimulate the pituitary Dopamine which inhibits the pituitary production of prolactin

Pituitary Gland- Anterior and Posterior Anterior: 6 hormones: ACTH, TSH, LH, FSH, PRL, GH Posterior: 2 hormones: Oxytocin and ADH

Thyroid: Thyroxine

Parathyroid: Parathyroid hormone (PTH) and Calcitonin

Adrenal Glands: Cortisol, aldosterone, epinephrine

Pancreas and Gut: Insulin and glucagon and gut hormones

Ovaries/Testes: Estrogen, Progesterone and testosterone

Anatomy

Feedback loops

Body Function Regulation Body Energy

Body Temperature

Body Fluid

Hormone response to Exercise

Common Signs & Symptoms

Fatigue/lethargy

Skin changes (dryness)

Orthostatic hypotension

Hypertension

Flushing/Sweating

Weight changes

Confusion/Mental Status Changes

Tremor

Lactation

Tachycardia/bradycardia

Diarrhea/Constipation

Heat or Cold intolerance

Muscle Weakness/Atrophy/Pain

Gynecomastia

Irregular menstrual cycles/Impotence

Abnormal hair growth

Polyphagia/polydipsia/polyuria

Weight changes

Disorders of the Pituitary Gland

Anterior Pituitary Disorders can cause: Adrenal, Thyroid, Gonad, Lactation, Growth problems

Posterior Pituitary Disorders can cause: Diabetes Insipidus (can’t concentrate urine)

Thyroid and Parathyroid Gland Disorders

Hyperthyroidism

Grave’s Disease

Hypothyroidism

Hyperparathyroidism

The Parathyroids regulate Calcium

Disorders of the Adrenals

Addison’s Disease: Decreased production of adrenal hormones (Cortisol/Aldosterone)

Cushing’s Syndrome: Increased production of adrenal hormones (cCortisol/Aldosterone)

Pheochromocytoma: Produces epinephrine

Thermoregulation/Environmental

Heat Cramps

Heat Syncope

Heat Exhaustion

Heat Stroke

Exertional Hyponatremia

Frostbite

Hypothermia

Altitude Sickness

Metabolic Disorders

Gout

Metabolic Bone Disease Osteoporosis Paget Disease

The Tired Athlete

Psychological Profile of Athletes – Separate Lecture

Depression (SIGECAPS)

Endocrine Disorders

Infections

Anemia

I’m Still TiredInfections

Skin/Wound Infections Blisters, puncture wounds, lacerations

Worsening of an underlying process due to continued training during viral illness: Pneumonia, Pericarditis, Myocarditis, Sepsis

STI’s

Foodborne illness causing diarrhea

Viral infections like MONO, parvovirus

Tickborne illnesses (LYME, Anaplasmosis)

Still TiredAnemia

Fatigue usually with exertion Pallor Headache Elevated heart rate Glossitis Poor immunity/frequent illness Pica

Classification of AnemiaPathologic/Cause

Blood Loss Acute or Chronic

Impaired Production Aplastic anemia, or anemia associated with disease Impaired DNA synthesis (B12/Folate) Impaired hemoglobin synthesis (Iron, and thalassemia)

Increased Destruction Hemolysis: Can be related to intrinsic defects,

medications, infections, immune mediated

Classification of AnemiaMorphologic/Shape

Microcytic (MCV is <80) Hypochromic Most commonly iron deficiency

Normocytic (MCV is 80-100) Normochromic Can be from chronic disease, dilution, destruction, acute

loss

Macrocytic (MCV is >100) Usually B12 or Folate deficiency

Chronic Causes Menses GI blood loss (Crohn’s, ulcers, ischemia) Microtrauma on the soles of the feet (marathon

runners)

AnemiaBlood Loss

Impaired ProductionIneffective Erythropoiesis

Iron deficiency Defective hemoglobin synthesis

Vitamin B12 deficiency Defective DNA synthesis Nuclear maturation defect Nutritional deficiency in strict vegans possible Acid suppression with medications can cause poor

absorption

Folic acid deficiency Usually from poor nutrition, similar effects to B12

deficiency

Anemia

Think about elevation

S/S:

At Risk Population: Nutrition!

Laboratory Finding

Hct (Hematocrit) (%) women 36-48 men 40-52

Hb (Hemoglobin) (g/dl) Normal is 12-16 Anemic when < 12 g/dl

MCV (Mean Corpuscular Volume) Normal is 80-100

60-70 = Microcytic 100+ = Macrocytic

RBC (Red blood cell) count women 4.0-5.4 men 4.5-6.0

Anemia = low hemoglobin

Iron Deficiency Anemia - Treatment

3-6 mg per kg of body weight of elemental iron

http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html

Better with vitamin C on an empty stomach

Frequent monitoring

Sports Anemia

Dilutional pseudoanemia

Will not respond to tx with iron

Normal MCV & ferritin

No affect of performance

Would not expect it to cause symptoms

How to Assess Patients

HISTORY, HISTORY, HISTORY

Cover all organ systems (ROS)

Physical Exam – General Affect, Appearance

Labs