Essentials of Human Diseases
and Conditions
4th edition
Margaret Schell Frazier
Jeanette Wist Drzymkowski
Chapter 4
Diseases and Conditions of the Endocrine
System
Learning Objectives
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List the major glands of the endocrine
system.
Describe the importance of hormones and
explain some of the critical body functions
that they control.
Explain the importance of normal pituitary
function.
Compare gigantism to acromegaly.
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Learning Objectives (cont’d.)
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Describe the condition of dwarfism and its
etiology.
Explain the cause of diabetes insipidus.
Explain the treatment of a simple goiter.
List the signs and symptoms of Graves’
disease.
Distinguish between cretinism and
myxedema.
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Learning Objectives (cont’d.)
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Explain the pathogenesis of diabetes mellitus.
Identify the two major types of diabetes
mellitus.
Distinguish between diabetic coma and
insulin shock.
Explain the medical management of all three
types of diabetes mellitus.
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Learning Objectives (cont’d.)
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Explain why hypoglycemia can be a serious
medical condition.
Compare the signs and symptoms of thyroid
hypofunction with those of thyroid
hyperfunction.
Describe the signs and symptoms of thyroid
malignancy. Discuss the most important
prognostic factor.
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Chapter 4
Lesson 4.1
The Endocrine System
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uses powerful chemical messengers called
hormones to:
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maintain homeostasis
respond to stress
regulate essential functions
control metabolic rate
direct growth and development
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Major glands of the endocrine system are:
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pituitary
thyroid
parathyroid
adrenal
pancreas
ovaries/testes
pineal
thymus
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Major Glands of Normal Endocrine
System
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Hormones are chemical messengers that:
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are either amino acids (proteins) or steroids
are secreted into the bloodstream by
specialized glands
target their actions to very specific tissue
receptor sites
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Important hormones include:
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insulin and glucagon
estrogen, progesterone, and testosterone
thyroxine, calcitonin, and thyroid stimulating hormone
(TSH)
vasopressin
cortisol and cortisone
aldosterone
growth hormone (GH)
follicle stimulating hormone (FSH) and luteinizing
hormone (LH)
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Hypothalamus-Pituitary-Thyroid Gland
Feedback Mechanism
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Negative Feedback
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Hormonal secretions typically regulated by
negative feedback; information about the
hormone level or its effect is fed back to the
gland, which then responds accordingly
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The effect of pituitary hormones on target
tissues
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Pituitary Gland Diseases
Hyperpituitarism: Chronic, progressive
disease caused by excessive production and
secretion of pituitary hormones, especially
growth hormone (HGH)
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Types of Hyperpituitarism
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Gigantism: increased growth hormone —
occurs prior to puberty
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Treatment focuses on reducing secreted hGH
through radiation or surgical intervention to reduce
pituitary size
Acromegaly: increased growth hormone —
occurs after puberty is complete
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Treatment focuses on reversing or preventing
tumor mass effects and reducing secreted GH
ideally through surgery with or without radiation to
the pituitary gland.
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Hypopituitarism
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A deficiency or absence of the hormones produced
by the pituitary gland, especially those of the anterior
pituitary.
The cause of hypopituitarism may be a tumor or the
pituitary or hypothalamus. Headache and blindness
may be symptoms of tumor compression of the
adjacent optic nerve.
Cause of panhypopituitarism is sometimes unknown;
it is more common in women.
Treatment, based on patient age, severity and type,
and underlying cause, includes removal of tumor and
hormone replacement therapy.
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Example of Hypopituitarism
Dwarfism: abnormal underdevelopment that
occurs in children due to decreased growth
hormone production
Treatment
 Somatotropin (hGH) administration
 Replacement of thyroid and adrenal
hormones
 Sex hormones as puberty approaches as
necessary
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Diabetes Insipidus
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A deficiency in the release of vasopressin
(ADH) from the posterior pituitary resulting in
excessive (polyuria) urine excretion and thirst
(polydipsia)
Treatment consists of vasopressin injections,
nasal spray or oral desmopressin acetate.
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Thyroid Gland Diseases
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A group of disorders caused by increased or
decreased amounts of thyroid hormones:
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Simple goiter
Hashimoto disease
Hyperthyroidism/Graves’ disease
Hypothyroidism
myxedema
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Thyroid Gland Diseases Symptoms
Hypofunction
 bradycardia
 constipation
 weight gain
 reduced alertness
 fatigue
 edema/bloating
 poor circulation
 cold intolerance
 dry skin and hair
Hyperfunction
 tachycardia/palpitations
 diarrhea
 weight loss
 anxiety/restlessness
 fatigue
 appetite
 sweating
 heat intolerance
 hair loss
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Simple Goiter
Enlargement of the thyroid gland: usually
palpable results from shortage of dietary iodine
 Symptoms include swollen mass (goiter) at
anterior aspect of neck, and dyspnea and
difficulty swallowing with further enlargement of
goiter.
 Treatment includes one drop per week of
potassium iodide
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Thyroid Gland Diseases: Hyperthyroidism
Graves’ disease: diffuse goiter and over-production of
thyroid hormone that can result in life-threatening
condition
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Causes of Graves’ disease are unknown but it is thought to
be autoimmune in nature and there is a strong familial
predisposition for it.
Exophthalmos, the outward protrusion of the eyeball, can
be present with Graves’ disease. Other symptoms include
rapid heartbeat, insomnia, and weightloss, to name a few.
Treatment goal is to reduce thyroid hormone through
antithyroid drugs and beta-blockers, or for severe cases,
radioactive iodine or surgery.
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Thyroid Gland Diseases: Hypothyroidism
Cretinism: a congenital condition in children in which
the thyroid gland is absent or nonfunctional resulting
in mental or growth retardation
 Treated with thyroid hormone throughout life
Myxedema: severe condition that develops in older
child or adult; can result in life-threatening symptoms
including myxedema coma
 Symptoms include slowed metabolism, menorrhagia,
weight gain, muscular weakness, and tiredness
amongst others
 Treatment includes administration of levothyroxine
sodium
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Thyroid Gland Diseases:
Thyroid Cancer
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Painless lump or nodule on the thyroid gland
that is malignant.
Treatment is usually surgery to remove the
thyroid gland and any involved lymph nodes
and replacement hormone.
Anaplastic types may only be treated with
radiation and chemotherapy to prolong
survival.
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Parathyroid Gland Disease
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Hyperparathyroidism
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overproduction of PTH hormone, resulting in demineralization of bone
and release of excess calcium
symptoms include muscle atrophy, GI pain, and nausea amongst others
treatment is highly individualized based on cause
Hypoparathyroidism
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reduced production of PTH hormone, resulting in excessive calcium
deposits in tissue and decreased circulating calcium
treated with calcium replacement therapy with vitamin D (life-threatening
is treated with calcium gluconate IV)
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Adrenal Gland Diseases
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Cushing Syndrome
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increase in adrenal cortex secretion of cortisol
early signs and symptoms include weight gain,
hypertension, and emotional instability
other signs and symptoms: fatigue, muscle
weakness, change in body fat distribution, moon face,
fluid retention, edema, excessive hair growth, fertility
changes
treatment depends on cause: surgical removal or
radiation of tumor or adrenal gland; drug therapy to
suppress ACTH
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Adrenal Gland Diseases (cont’d.)
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Addison Disease
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partial or complete failure of adrenocortical
function
 onset usually gradual over weeks to months
 fatigue, weakness, gastrointestinal disturbances,
weight loss, fluid and electrolyte imbalances,
cardiovascular problems, depression, anxiety,
“bronzing” of skin tone
 treatment includes replacement of natural
hormones; increased fluid intake; control of salt
and potassium intake; and high
carbohydrate/protein diet
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Endocrine Dysfunction of Pancreas
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Diabetes Mellitus
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little or no insulin production in the pancreas
 transport of glucose to cells is impaired
 cells begin to use fats and proteins as energy
alternative
 blood glucose levels continue to increase,
resulting in state of hyperglycemia
 signs and symptoms include frequent thirst,
urination, weight loss, fatigue, increased appetite
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Endocrine Dysfunction of Pancreas (cont’d.)
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Diabetes Mellitus
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Type 1: early, abrupt onset before age 30 with
little or no insulin secreted
Type 2: more common form with gradual onset
after age 30, especially after age 55, with some
pancreatic function intact
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Warning Signs and
Interventions for
Diabetic Coma and
Insulin Reaction
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Endocrine Dysfunction of Pancreas (cont’d.)
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Diabetes mellitus treatment
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Goal is to normalize blood glucose levels and
minimize complications through:
• diet control
• exercise
• frequent blood and urine testing
• insulin injections or oral hypoglycemics
• weight loss (if overweight)
• preventive health care
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Endocrine Dysfunction of Pancreas (cont’d.)
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Gestational diabetes mellitus (GDM)
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Type 3: decreased ability to metabolize glucose
during pregnancy with onset around 24-28 weeks
of gestation; the condition usually disappears right
after delivery.
Treatment might include control of diet; limited
intake of simple sugars; oral hypoglycemic agents;
insulin
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Endocrine Dysfunction of Pancreas (cont’d.)
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Hypoglycemia
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abnormally low blood glucose level that can be
caused by excessive insulin secretion in the
pancreas, fasting, or medications
 signs and symptoms: sweating, nervousness,
hunger, weakness, dizziness, headache,
palpitations, confusion, visual disturbances
 if severe or untreated, can cause seizures, stupor,
coma, and death
 Treatment: acute requires intravenous infusion of
glucose; hormone glucagon; complex
carbohydrate/protein snack with stabilization
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Precocious Puberty
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For boys, puberty that begins before age 9
For girls, puberty that begins before age 8
Causes include tumors of the testes/ovaries,
hypothalamic or pituitary dysfunction or tumors,
and ingestion of hormones or sex steroids
Treatment depends on cause: no treatment if
idiopathic; hormone therapy to suppress sexual
maturation until appropriate time; treatment more
invasive if cause is testicular or brain tumor
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