Alterations of Hormonal
Regulation
Chapter 21
1
Elevated or Depressed Hormone
Levels
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
Failure of feedback systems
Dysfunction of an endocrine gland
Secretory cells are unable to produce, obtain, or
convert hormone precursors
The endocrine gland synthesizes or releases
excessive amounts of hormone
Increased hormone degradation or inactivation
Ectopic hormone release
2
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Target Cell Failure

Receptor-associated disorders
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Decrease in number of receptors
Impaired receptor function
Presence of antibodies against specific receptors
Antibodies that mimic hormone action
Unusual expression of receptor function
3
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Hormone Delivery
4
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Alterations of the HypothalamicPituitary System
5
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Diseases of the Posterior Pituitary

Syndrome of inappropriate antidiuretic
hormone secretion (SIADH)



Hypersecretion of ADH
For diagnosis, normal adrenal and thyroid
function must exist
Clinical manifestations are related to enhanced
renal water retention, hyponatremia, and
hypoosmolarity
6
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Diseases of the Posterior Pituitary

Diabetes insipidus
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
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Insufficiency of ADH
Polyuria and polydipsia
Partial or total inability to concentrate the urine
Neurogenic


Insufficient amounts of ADH
Nephrogenic

Inadequate response to ADH
7
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Diseases of the Anterior Pituitary

Hypopituitarism

Pituitary infarction
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
Sheehan syndrome
Hemorrhage
Shock
Others: head trauma, infections, and tumors
8
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Diseases of the Anterior Pituitary

Hypopituitarism

Panhypopituitarism
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
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ACTH deficiency
TSH deficiency
FSH and LH deficiency
GH deficiency
9
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Diseases of the Anterior Pituitary

Hyperpituitarism


Commonly due to a benign, slow-growing
pituitary adenoma
Manifestations



Headache and fatigue
Visual changes
Hyposecretion of neighboring anterior pituitary
hormones
10
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Diseases of the Anterior Pituitary

Hypersecretion of growth hormone (GH)

Acromegaly


Hypersecretion of GH during adulthood
Gigantism

Hypersecretion of GH in children and adolescents
11
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Hypersecretion of Growth
Hormone (GH)
12
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Diseases of the Anterior Pituitary

Hypersecretion of prolactin

Caused by prolactinomas


In females, increased levels of prolactin cause
amenorrhea, galactorrhea, hirsutism, and osteopenia
In males, increased levels of prolactin cause
hypogonadism, erectile dysfunction, impaired libido,
oligospermia, and diminished ejaculate volume
13
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Alterations of Thyroid Function

Hyperthyroidism


Thyrotoxicosis
Graves disease


Hyperthyroidism resulting from nodular thyroid
disease


Pretibial myxedema
Goiter
Thyrotoxic crisis
14
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Thyrotoxicosis (Graves’ Disease)
15
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Alterations of Thyroid Function

Hypothyroidism

Primary hypothyroidism
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Subacute thyroiditis
Autoimmune thyroiditis (Hashimoto disease)
Painless thyroiditis
Postpartum thyroiditis
Myxedema coma
Congenital hypothyroidism
Thyroid carcinoma
16
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Hypothyroidism
17
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Alterations of Parathyroid Function

Hyperparathyroidism

Primary hyperparathyroidism


Secondary hyperparathyroidism


Excess secretion of PTH from one or more
parathyroid glands
Increase in PTH secondary to a chronic disease
Hypoparathyroidism


Abnormally low PTH levels
Usually caused by parathyroid damage in thyroid
surgery
18
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Type 1 Diabetes Mellitus



Demonstrates pancreatic atrophy and specific
loss of beta cells
Macrophages, T and B lymphocytes, and
natural killer cells are present
Two types


Immune
Nonimmune
19
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Type 1 Diabetes Mellitus




Genetic susceptibility
Environmental factors
Immunologically mediated destruction of beta
cells
Manifestations

Hyperglycemia, polydipsia, polyuria, polyphagia,
weight loss, and fatigue
20
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Type 1 Diabetes Mellitus
21
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Type 1 Diabetes Mellitus
22
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Dysfunction of the Pancreas

Type 2 diabetes mellitus



Maturity-onset diabetes of youth (MODY)
Gestational diabetes mellitus (GDM)
Common form of diabetes mellitus type 2

Insulin resistance
23
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Type 2 Diabetes Mellitus
24
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Acute Complications of Diabetes
Mellitus



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
Hypoglycemia
Diabetic ketoacidosis
Hyperosmolar hyperglycemic nonketotic
syndrome (HHNKS)
Somogyi effect
Dawn phenomenon
25
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Diabetic Ketoacidosis
26
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Chronic Complications of Diabetes
Mellitus


Hyperglycemia and nonenzymatic
glycosylation
Hyperglycemia and the polyol pathway


Protein kinase C
Microvascular disease


Retinopathy
Diabetic nephropathy
27
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Diabetic Nephropathy
28
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Chronic Complications of Diabetes
Mellitus

Macrovascular disease


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Coronary artery disease
Stroke
Peripheral arterial disease
Diabetic neuropathies
Infection
29
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Diabetic Amputation
30
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Diabetic Neuropathy
31
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Alterations of Adrenal Function

Disorders of the adrenal cortex

Cushing disease


Excessive anterior pituitary secretion of ACTH
Cushing syndrome

Excessive level of cortisol, regardless of cause
32
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Cushing Disease
33
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Alterations of Adrenal Function

Disorders of the adrenal cortex

Hyperaldosteronism


Primary hyperaldosteronism (Conn disease)
Secondary hyperaldosteronism
34
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Primary Hyperaldosteronism
35
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Alterations of Adrenal Function

Disorders of the adrenal cortex

Adrenocortical hypofunction

Primary adrenal insufficiency (Addison disease)


Idiopathic Addison disease
Secondary hypocortisolism
36
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Alterations of Adrenal Function

Disorders of the adrenal cortex

Hypersecretion of adrenal androgens and
estrogens


Feminization
Virilization
37
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Virilization
38
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Alterations of Adrenal Function

Disorders of the adrenal medulla

Adrenal medulla hyperfunction

Caused by tumors derived from the chromaffin cells
of the adrenal medulla


Pheochromocytomas
Secrete catecholamines on a continuous or episodic
basis
39
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Pheochromocytoma
40
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