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ENDOCRINE PATHOPHYSIOLOGY

THYROID GLAND

FUNCTIONS:

♦ STIMULATES HEART ACTIVITY

♦ ↑ RESPIRATION

♦ STIMULATES GASTROINTESTINAL ACTIVITY

♦ ↑ CELLULAR METABOLISM

♦ ↑BODY TEMPERATURE

♦ REGULATION OF GROWTH & DEVELOPMENT

♦ MATURATION OF NERVOUS SYSTEM

♦ REQUIRED FOR Vit. B ABSORPTION

♦ REQUIRED FOR HEPATIC CONVERSION OF CAOTENES TO Vit.A

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REGULATION OF SECRETION OF T3 &T4

↓ T3 & T4

↓
HYPOTHALAMUS

↓
THYROID RELEASING HORMONE (TRH)

↓
ANTERIOR PITUITARY

↓
THYROID STIMULATING HORMONE (TSH)

↓
THYROID GLAND

↓
TRIIODOTHYRONINE (T3)
THYROXINE (T4)

↓
↑BLOOD LEVEL OF T3 & T4
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CONGENITAL
Cretinism
HYPO
THYROID
DISORDERS ACQUIRED
Myxedema

THYROTOXICOSIS

HYPER GRAVE’S DISEASE

THYROID STORM

GOITER: ↑ IN SIZE OF THYROID GLAND

- CAN OCCUR IN HYPOTHYROID, EUTHYROID, & HYPERTHYROID STATES

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CRETINISM

- CONGENITAL HYPOTHYROIDISM

- MOST COMMON CAUSE OF PREVENTABLE MENTAL RETARDATION

CAUSES:

• LACK OF THYROID GLAND

• ABNORMAL THYROID HORMONE SYNTHESIS

• DEFICIENT TSH SECRETION

MANIFESTATIONS:

NORMAL AT BIRTH

GROWTH IMPAIRMENT & MENTAL RETARDATION IF NOT TREATED

DIAGNOSIS:

NEONATAL SCREENING BETWEEN 1- 5 DAYS

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HYPOTHYROIDISM

• OLDER CHILDREN & ADULTS

CAUSES:

A). PRIMARY:

• THYROIDECTOMY

• AUTOIMMUNE – Hashimoto’s thyroiditis

• IODINE DEFICIENCY

• AFTER TREATMENT FOR HYPERTHYROIDISM

B). SECONDARY: ⇓ FUNCTION OF HYPOTHALAMUS & PITUITARY

CLINICAL MANIFESTATIONS:

• ⇓ B.M.R

• WEAKNESS & FATIGUE

• LOSS OF APPETITE

• WEIGHT GAIN

• COLD INTOLERANCE

• DRY, ROUGH, & YELLOW SKIN – Due to carotene deposition

• CONSTIPATION

• MENTAL DULLNESS
• LETHARGY ⇓ NERVOUS
• IMPAIRED MEMORY ACTIVITY

• ⇓ CVS FUNCTION – BRADYCARDIA

⇓ CARDIAC OUTPUT
• HYPOVENTILATION
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MYXEDEMA: SEVERE & LONG STANDING HYPOTHYROIDISM

• NON PITTING EDEMA – DUE TO ACCUMILATION OF

MUCOPOLYSACCHARIDE (HYDROPHILIC) SUBSTANCE IN THE
CONNECTIVE TISSUES

• PUFFY FACE
• ENLARGED TONGUE FLUID ACCUMULATION
• HOARSE VOICE
• NON-PITTING EDEMA
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INVESTIGATIONS:

• ⇓ SERUM T4
PRIMARY
• ⇑ T.S.H

• TRH STIMULATION TEST – SECONDARY

• ANTITHYROID ANTIBODIES- Hashimoto’s thyroiditis

TREATMENT:

• THYROXINE REPLACEMENT

• IF NOT TREATED - MAY PROGRESS TO MYXOEDEMATOUS COMA

• COLD EXPOSURE MAY BE A PRECIPITATING FACTOR

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THYROTOXICOSIS (HYPERTHYROIDISM)

CAUSES:

• ADENOMA OF THYROID

• ↑ TSH SECRETION

CLINICAL MANIFESTATIONS:

• ⇑ APPETITE

• WEIGHT LOSS

• DIARRHOEA

• HEAT INTOLERANCE

• DYSPNOEA

• ⇑ SWEATING – SILKY SKIN & HAIR

• CVS – TACHYCARDIA, ⇑ CARDIAC OUTPUT

• NERVOUSNESS
• IRRITABILITY
• RESTLESSNESS ⇑ NERVOUS ACTIVITY
• ANXIETY
• MUSCLE TREMOR

GRAVES’ DISEASE

• MOST COMMON CAUSE OF THYROTOXICOSIS

• HYPERTHYROIDISM +

• GOITRE +

• EXOPHTHALMOS (Bulging of eye balls)

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CAUSES:

• AUTOIMMUNE

• ABNORMAL STIMULATION OF THYROID BY THYROID – STIMULATING

ANTIBODIES THAT ACT THROUGH TSH RECEPTORS

• MAY BE ASSOCIATED WITH OTHER AUTOIMMUNE DISEASES LIKE –

MYASTHENIA GRAVIS, PERNICIOUS ANEMIA

• BETWEEN 20 – 40 YEARS

• WOMEN – 5 TIMES MORE

• EXOPHTHALMOS IS DUE TO EXOPHTHALMOS- PRODUCING ANTIBODY

• CAN CAUSE EYE PROBLEMS – PARALYSIS OF OCCULAR MUSCLES, VISUAL

LOSS, CORNEAL ULCERS

TREATMENT:

• SURGICAL REMOVAL OF PART OR ALL OF THE THYROID GLAND

THYROID STORM

• LIFE THREATENING FORM OF THYROTOXICOSIS

CAUSES:

• UNDIAGNOSED HYPERTHYROIDISM

• INADEQUATELY TREATED HYPERTHYROIDISM

PRECIPITATED BY- STRESS,

- DIABETIC KETOACIDOSIS

- CAN LEAD TO CONGESTIVE CARDIAC FAILURE

- HIGH MORTALITY RATE

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DISORDERS OF ADRENAL CORTEX

ADRENAL INSUFFICIENCY

PRIMARY SECONDARY
(Addison’s disease)

ADDISON’S DISEASE

• DUE TO DESTRUCTION OF ADRENAL GLAND

CAUSES:

• IDIOPATHIC ADRENAL ATROPHY

• TUBERCULOSIS

• FUNGAL INFECTION

• ADRENALECTOMY

MANIFESTATIONS:

• HYPERPIGMENTATION: SKIN BRONZED, BLUISH BLACK ORAL MUCOUS

MEMBRANE & GUMS

- DUE TO ⇑ ACTH

MINERALOCORTICOID DEFICIENCY:

• HYPONATREMIA

• HYPERKALEMIA

• HYPOTENSION

• SHOCK
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GLUCOCORTICOID DEFICIENCY:

• HYPOGLYCEMIA

• ⇓ TOLERANCE TO STRESS

• LETHARGY, WEAKNESS, DEPRESSION

GONADOCORTICOID DEFICIENCY:

• MENSTRUAL IRREGULARITIES

• LOSS OF AXILLARY & PUBIC HAIR

SECONDARY ADRENAL INSUFFICIENCY

CAUSES:

DUE TO DISORDER OF “HPA” SYSTEM

Eg:

• HYPOPITUITARISM

• SURGICAL REMOVAL OF PITUITARY GLAND

• SUPPRESSION OF “HPA” SYSTEM BY THERAPEUTIC GLUCOCORTICOIDS

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CUSHING’S SYNDROME

• DUE TO EXCESSIVE GLUCOCORTICOIDS

CAUSES:

• PITUITARY TUMOR – 2/3 0F THE DISEASE (Cushing’s disease)

• ADRENAL TUMOR

• ECTOPIC TUMOR – ACTH PRODUCING Ca OF BRONCHUS

• LONG TERM GLUCOCORTICOID THERAPY

CLINICAL MANIFESTATIONS:

• PROTRUDING ABDOMEN
• MOON FACE Altered fat metabolism
• BUFFALO HUMP

• MUSCLE WEAKNESS

• PURPLE STRIAE (Stretch marks)

• OSTEOPOROSIS

• HYPERGLYCEMIA – Diabetes mellitus

• GLYCOSURIA
• HYPERNATREMIA
• HYPOKALEMIA
• EDEMA
• HYPERTENSION
• GASTRIC ULCERS
• MENSTRUAL IRREGULARITIES
• ↑ SUSCEPTIBILITY TO INFECTIONS