ENDOCRINE DISORDERS

PATHOPHYSIOLOGY 2020-2021

l o gy Cres P. Quinzon RN MAN

y si o
ho ph
Objectives
◦ 12.1. Distinguish between the etiology and pathogenesis of
hypersecretion and hyposecretion of the following glands:
◦ Thyroid
◦ Adrenal
◦ 12.2. Discuss the pathogenesis of Diabetes Mellitus. (Type 1
and Type 2)
 Objectives
◦ 12.3. Explain the acute and chronic complications of diabetes in
terms of their etiology and pathogenesis:

Acute Chronic
Diabetic Ketoacidosis Neuropathies
Hypoglycemia Nephropathies
Retinopathies
Macro vascular
complications
Diabetic foot
 Self- Learning Activities
◦ Review the anatomy and physiology of endocrine system
◦ Review of Table 49.3: Manifestations of hypothyroid and hyperthyroid states
◦ Review Figure 49.6: Clinical manifestations of hypothyroidism
◦ Review Figure 49.7: Clinical manifestations of hyperthyroidism
◦ Review Figure 49.12: Clinical manifestations of primary and secondary
adrenal insufficiency
◦ Figure 49.13: Clinical features of Cushing syndrome
◦ Review table 50.3: Comparison of type 1 and type 2 DM
◦ Review Figure 50.10: Long term complications of DM
 Alterations in Thyroid Function
Hypothyroidism
Hypothyroidism is the disease state caused by
insufficient production of thyroid hormone by
the thyroid gland.
Etiology and Pathogenesis:
• Can be congenital
• Destruction or dysfunction of the thyroid gland
• can be a secondary disorder caused by
impaired pituitary function or as a tertiary
disorder caused by a hypothalamic
dysfunction.
• Thyroidectomy
• Medications ( drugs to treat manic depressive
states)
• Hashimoto disease ( autoimmune )
Hyperthyroidism
Hyperthyroidism (overactive thyroid) occurs
when your thyroid gland produces too much of
the hormone thyroxine.
Etiology and Pathogenesis:
• The most common cause of hyperthyroidism is
Graves disease (autoimmune)
• Other causes are multinodular goiter,
adenoma of the thyroid, and thyroiditis
• Iodine-containing agents can induce
hyperthyroidism as well as hypothyroidism.
• Thyroid crisis, or storm, is an acutely
exaggerated manifestation of the thyrotoxic
state.
Graves Disease
 Alterations in Adrenal Function
Hyposecretion
Addison’s Disease – adrenal insufficiency
Caused by destruction of the adrenal gland
Etiology and Pathogenesis:
• Autoimmune destruction is the most common
cause of Addison’s disease
• TB major cause of Addison's in USA
• Metastasis carcinoma
• Fungal infection
• Cytomegalovirus
• Adrenal hemorrhage
• AIDS
• Drugs that breakdowns glucocorticoids
Hypersecretion
Cushing Disease (excess glucocorticoid
production)
Etiology and Pathogenesis:
• Tumor of the pituitary gland
• Benign and malignant tumor of the adrenal
gland
• Long term therapy of glucocorticoid
preparations
10
Addison’s Disease Cushing’s Disease
Type 1 Diabetes Mellitus
◦ PATHOGENESIS:
◦ refers to a group of common metabolic disorders that share the characteristic of
hyperglycemia
◦ occurs more commonly in young people but can occur at any age.
◦ Auto-immune ---Immune-mediated destruction of the pancreatic beta cells
( insulin-producing cells)
◦ formerly known as “juvenile diabetes” and “insulin-dependent”
◦ lack of insulin, an elevation in blood glucose, and a breakdown of body fats and
proteins
◦ If it progress to adulthood it is called as latent autoimmune diabetes in Adults
( LADA). 12

◦ prone to ketoacidosis
 Type 2 Diabetes Mellitus

◦ PATHOGENESIS:
◦ accounts for the majority of cases of diabetes, approximately 90% to 95%
◦ Common in obese adolescents
◦ Genetic and environmental cause
◦ can have high, normal, or low insulin levels
◦ Insulin resistance (decreased ability of insulin to act effectively on target tissues,
especially muscle, liver, and fat)

13
Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus
◦ PATHOGENESIS:

Genetic and
Environmental
Insulin resistance
factors (Obesity
Autoimmune Destruction Insulin and Inactivity)
response of beta cells deficiency

Decreased Glucose
Hyperglycemia
uptake

14
 Acute Complications of Diabetes Mellitus

◦ Etiology and Pathogenesis:

◦ 1. Diabetic Ketoacidosis (DKA) - occurs when the body produces high
levels of blood acids called ketones
◦ Hyperglycemia - blood glucose levels >250 mg dL [13.8 mmol/L]),
◦ Ketosis - (<15 mEq/L [15 mmol/L]),
◦ Metabolic acidosis - (<7.3)
 Acute Complications of Diabetes Mellitus

◦ Etiology and Pathogenesis:

◦ 2. Hypoglycemia - cognitive impairment with a blood glucose
concentration of less than 60 mg/dL
◦ Etiology and Pathogenesis:
◦ error in insulin dose, failure to eat, increased exercise,
decreased insulin need after removal of a stress situation,
medication changes, and a change in insulin injection site
 Chronic Complications of Diabetes Mellitus
◦ Etiology and Pathogenesis:
◦ 1. Neuropathies - nerve damage that can occur if you have diabetes.
◦ thickening of the walls of the nutrient vessels that supply the nerve,
leading to vessel demyelinization of the cells accompanied by a
slowing of nerve conduction
 Chronic Complications of Diabetes Mellitus

◦ Etiology and Pathogenesis:

◦ 2. Nepropathies - leading cause of chronic kidney disease
◦ lesions in the diabetic kidney

Endothelial Formation of
damage of the
lesions in the Impaired Kidney
Hyperglycemia glomerular
membrane capillaries of blood flow failure
(thickened) kidneys
 Chronic Complications of Diabetes Mellitus

◦ Etiology and Pathogenesis:

◦ 3. Retinopathies – major cause of blindness
◦ characterized by abnormal retinal vascular permeability,
microaneurysm formation, neovascularization and associated
hemorrhage, scarring, and retinal detachment.
 Chronic Complications of Diabetes Mellitus

◦ Etiology and Pathogenesis:

◦ 4. Macrovascular Complications
◦ coronary artery disease, cerebrovascular disease, and peripheral
vascular disease.
◦ Approximately 50% to 75% of all people with type 2 diabetes die of
a macrovascular problem
 Chronic Complications of Diabetes Mellitus

◦ Etiology and Pathogenesis:

◦ 5. Diabetic Foot Ulcers
◦ occur as a result of neuropathy and vascular insufficiency.
◦ Cause:
◦ Non fitting shoes
◦ Trauma
◦ Improper weight bearing
◦ Due to impaired sensation ,patient with diabetic foot they need health
education to avoid recurrent injury and prevent further complication
Thank you..
◦Any Questions?