Chapter 21
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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
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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
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Hormone Delivery
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Alterations of the Hypothalamic-
Pituitary System
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Diseases of the Posterior Pituitary
 Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
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Hypersecretion of ADH
For diagnosis, normal adrenal and thyroid function must exist
Clinical manifestations are related to enhanced renal water retention, hyponatremia, and hypoosmolarity
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Diseases of the Posterior Pituitary
 Diabetes insipidus
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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
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Diseases of the Anterior Pituitary
 Hypopituitarism
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Pituitary infarction
 Sheehan syndrome
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Hemorrhage
Shock
Others: head trauma, infections, and tumors
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Diseases of the Anterior Pituitary
 Hypopituitarism
 Panhypopituitarism
 ACTH deficiency
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TSH deficiency
FSH and LH deficiency
GH deficiency
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Diseases of the Anterior Pituitary
 Hyperpituitarism
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Commonly due to a benign, slow-growing pituitary adenoma
Manifestations
 Headache and fatigue
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Visual changes
Hyposecretion of neighboring anterior pituitary hormones
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Diseases of the Anterior Pituitary
 Hypersecretion of growth hormone (GH)
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Acromegaly
 Hypersecretion of GH during adulthood
Gigantism
 Hypersecretion of GH in children and adolescents
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Hypersecretion of Growth
Hormone (GH)
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Diseases of the Anterior Pituitary
 Hypersecretion of prolactin
 Caused by prolactinomas
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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
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Alterations of Thyroid Function
 Hyperthyroidism
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Thyrotoxicosis
Graves disease
 Pretibial myxedema
Hyperthyroidism resulting from nodular thyroid disease
 Goiter
Thyrotoxic crisis
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Thyrotoxicosis (Graves’ Disease)
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Alterations of Thyroid Function
 Hypothyroidism
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Primary hypothyroidism
 Subacute thyroiditis
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Autoimmune thyroiditis (Hashimoto disease)
Painless thyroiditis
Postpartum thyroiditis
Myxedema coma
Congenital hypothyroidism
Thyroid carcinoma
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Hypothyroidism
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Alterations of Parathyroid Function
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Hyperparathyroidism
 Primary hyperparathyroidism
 Excess secretion of PTH from one or more parathyroid glands
 Secondary hyperparathyroidism
 Increase in PTH secondary to a chronic disease
Hypoparathyroidism
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Abnormally low PTH levels
Usually caused by parathyroid damage in thyroid surgery
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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
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Immune
Nonimmune
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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
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Type 1 Diabetes Mellitus
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Type 1 Diabetes Mellitus
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Dysfunction of the Pancreas
 Type 2 diabetes mellitus
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Maturity-onset diabetes of youth (MODY)
Gestational diabetes mellitus (GDM)
Common form of diabetes mellitus type 2
 Insulin resistance
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Type 2 Diabetes Mellitus
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Acute Complications of Diabetes
Mellitus
 Hypoglycemia
 Diabetic ketoacidosis
 Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
 Somogyi effect
 Dawn phenomenon
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Diabetic Ketoacidosis
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Chronic Complications of Diabetes
Mellitus
 Hyperglycemia and nonenzymatic glycosylation
 Hyperglycemia and the polyol pathway
 Protein kinase C
 Microvascular disease
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Retinopathy
Diabetic nephropathy
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Diabetic Nephropathy
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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
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Diabetic Amputation
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Diabetic Neuropathy
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Alterations of Adrenal Function
 Disorders of the adrenal cortex
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Cushing disease
 Excessive anterior pituitary secretion of ACTH
Cushing syndrome
 Excessive level of cortisol, regardless of cause
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Cushing Disease
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Alterations of Adrenal Function
 Disorders of the adrenal cortex
 Hyperaldosteronism
 Primary hyperaldosteronism (Conn disease)
 Secondary hyperaldosteronism
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Primary Hyperaldosteronism
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Alterations of Adrenal Function
 Disorders of the adrenal cortex
 Adrenocortical hypofunction
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Primary adrenal insufficiency (Addison disease)
 Idiopathic Addison disease
Secondary hypocortisolism
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Alterations of Adrenal Function
 Disorders of the adrenal cortex
 Hypersecretion of adrenal androgens and estrogens
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Feminization
Virilization
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Virilization
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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
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Pheochromocytoma
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