Endocrine Disorders

3 Major Types of Endocrine Conditions

Hormone excess
-Tumor, autoimmune, genetic mutation

Hormone resistance- Usually genetic (lack of hormone receptor or ability to respond)

Hormone deficiency
-Gland destruction (autoimmune, infection, tomor)

Diagnosis of Endocrine Disorders

Endocrine Dysfunction

Hyperfunction - Excessive amount of hormone

Three levels of dysfunction

Hypofunction - Inadequate amount of hormone

Primary- Endocrine gland itself

Secondary- Abnormal pituitary activity

Tertiary- Dysfunction of hypothalamic origin

Causes

Neoplasia- Hypofunction or hyperfunction of gland itself or any endocrine tissue the gland affects

Endocrine-disrupting compounds (EDC)- Chemical in environment that can alter endogenous hormone functions

Autoimmune - Antibodies target endocrine gland, may cause hypofunction or hyperfunction

Suppression/stimulation tests

CT scan/MRI

Urinary collection over 24 hours

Urinary hormone levels assessed in some instances

Ultrasound

Immunoassays or blood levels of hormones most important

Treatments of Endocrine Disorders

Hormone replacement therapy
-Glucocorticoids, thyroid hormones, sex steroids, ADH

Suppression of hormone overproduction
-Medications, surgery, radiation

Hypopituitarism

One or more of the pituitary hormones

Panhypopituitarism

  • Complete loss of all pituitary hormones
  • Rare

Causes

Trauma, ischemia, and infarction can cause sudden loss of pituitary function (Sheehan’s syndrome)

Primary adenoma

  • Most common cause
  • Benign neoplasm
  • With growth can compress pituitary gland in sella turcica (Interfere with pituitary function)

Pituitary tumor, brain surgery, radiation of brain tumor, congenital disorder

Craniopharyngioma

  • Benign neoplasm close to pituitary gland or pituitary stalk

Pituitary apoplexy

  • Sudden destruction of the pituitary tissue due to infarction or hemorrhage into gland
  • Traumatic brain injury most common cause

Sheehan’s Syndrome

  • Ischemia or infarction of the pituitary after childbirth because of severe hemorrhage
  • Degree of necrosis correlates with hemorrhage
  • Develop deficiency of ACTH, TSH, FSH, LH, ADH, and PRL

Diabetes Insipidus (DI)

Lack of ADH or response to ADH

Dilute, large volume urine

Posterior pituitary hypopituitarism

Categories of disease

Central DI- Lack ADH from the posterior pituitary

Nephrogenic DI- Kidney fails to respond to ADH

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Hyperpituitarism

Pituitary adenoma

  • Most common cause
  • May produce ACTH, TSH, or GH
  • Prolactinoma most common form: secretes PRL

Large tumors may cause headaches and visual disturbances (because of proximity to optic nerves)

Goiter

May or may not present with thyroid dysfunction signs and symptoms

May develop with:
-Excess TSH
-Low iodine levels
-Goitrogens

Enlargement of the thyroid