Endocrine system disorders

 Hyper and hypothyroidism

 Endemic (Iodine-Deficient) Goiter
 Thyroid Cancer
 The Parathyroid Glands
 Hyperparathyroidism
 Hypoparathyroidism
 Etc.
Glands of the Endocrine System
 Epidemiology
• In a population-based study the overall prevalence of
multinodular goiter was 0.84%, with a higher prevalence
in females (1.6%) compared with males (0.1%)

• In NHANES-III individuals (≥12 yr of age), the overall

prevalence of hyperthyroidism was 1.3%, with the lowest
prevalence among Hispanics and other ethnicities (0.7%
each) and highest among Whites (1.4%)
• In the Nurses’ Health Study, the overall incidence of
hyperthyroid Graves’ disease was 4.6 per 1000 females
during 12 yr.
 Assessment
• Health history—energy level, hand and foot size changes,
headaches, urinary changes, heat and cold intolerance,
changes in sexual characteristics, personality changes,
others
• Physical assessment—appearance including hair
distribution, fat distribution, quality of skin, appearance of
eyes, size of feet and hands, peripheral edema, facial
puffiness, vital signs
Palpating the thyroid gland from behind the client. (Source: Lester V. Bergman/Corbis)

5
 Diagnostic Evaluation
Serum levels of hormones
Detection of antibodies against certain hormones
Urinary tests to measure by-products (norepinephrine,
metanephrines, dopamine)
Stimulation tests—determine how an endocrine gland
responds to stimulating hormone. If the hormone responds,
then the problem lies w/hypothalmus or pituitary
Suppression tests—tests negative feedback systems that
control secretion of hormones from the hypothalamus or
pituitary.
 Overview of Endocrine system pathology

• symptoms of endocrine gland disorders are usually

due to increased hormone production, decreased
hormone production or mass lesions
• hypo-functioning of endocrine cells results in
decreased hormone levels
• hyperfunctioning of endocrine cells results in
increased hormone levels
• mass lesions are usually due to neoplasia or
hyperplasia
• Multiple endocrine neoplasia syndromes (MEN)
 Certain syndromes are characterized by multiple endocrine neoplasms

• MEN I (pituitary, parathyroid, pancreatic islet cell

neoplasia)

• MEN IIa (medullary thyroid carcinoma,

pheochromocytoma, parathyroid)

• MEN IIb (IIa + skin and mucosal nerve tumors)

 Pituitary gland pathology

• Pituitary adenoma
• benign neoplasm of endocrine cells in the anterior pituitary
• symptoms due to release of excess hormones or pressure effects of
mass (compression of pitutary stalk and/or optic chiasm)
• endocrine effects depend on what hormone produced by the
adenoma
• 80% of pituitary adenomas produce hormones Prolactinoma (LH)
• most common pituitary adenoma produces prolactin
• identified earlier in young reproductive female because present
with amenorrhea, galactorrhea, infertility (microadenoma)
• surgery or medical therapy (bromocryptine) to remove
 Pituitary adenoma

• Somatotropic adenomas
• neoplastic cells produce growth hormone
– gigantism results from excess growth hormone before growth
plates close
• generalized increase in body size with disproportionately long
legs, arms
– acromegaly results from excess growth hormone after puberty
• enlargement of hands, feet, jaw, tongue, and soft tissue)
• Corticotropic adenoma
– neoplastic cells produce adreno-corticotropin hormone
– Cushing’s disease refers to the syndrome resulting from excess
glucocorticoid release by the adrenal cortex due to excess
ACTH
 Pituitary hypofunction

• causes of pituitary hypofunction include

– congenital defect of pituitary gland (primary dwarfism)
– destructive tumor (pituitary adenoma)
– ischemia of the pituitary gland (Sheehan’s syndrome)
• symptoms
– weakness,
– Poor appetite,
– Weight loss,
– hypotension,
– amenorrhea
– secondary hypofunction of target organs
 Diabetes insipidus

• lack of ADH
• usually due to destructive lesion in
hypothalamus, pituitary
• unable to resorb water, large amounts of
hypotonic urine
 Pathology of the thyroid gland

• Thyroid hyperfunction (hyperthyroidism)

• major causes are Grave’s disease, some multinodular goiters, tumors
– autoimmune disease due to antibodies targeting the TSH receptor on
thyroid follicular cells
– AB binds to TSH receptor causing release of thyroid hormones
– more common in females
– associated with other autoimmune disease
• symptoms of hyperthyroidism
– restless,
– nervous,
– emotional lability,
– sweating,
– tachycardia,
– diarrhea,
– weight loss with increased appetite
 symptoms of hyperthyroidism

• restless,
• nervous,
• emotional lability,
• sweating,
• tachycardia,
• diarrhea,
• weight loss with increased appetite
• Exopthalmos occurs in Grave’s disease
Hyperthyroidism
 Hyperthyroidism
Clinical Manifestation

Medical Management

Pharmacotherapy

Surgical Management

Nursing Process The Patient With

Hyperthyroidism
 Thyroid Tumors
Tumors of the thyroid gland are classified on the basis of being
benign or malignant.

If the enlargement is sufficient to cause a visible swelling in the

neck, the tumor is referred to as goiter.

All grades of goiter are encountered, from those, that are barely
visible to those producing disfigurement.

Goiter either symmetrical and diffuse or nodular.

It might accompanied by hyperthyroidism (toxin); others are non

toxic goiters
Endemic (Iodine-Deficient) Goiter
 Management
Many goiters of this type decreased after correction of
iodine insufficiency.
When surgery is recommended, post operative
complications can be minimized by pre operative iodide
administration to reduce the size & vascularity of
goiter.

Prevention
Providing children in iodine-poor region with iodine
compounds.
Use of iodized salt.
 Thyroid hypofunction (hypothyroidism)

• major causes are:

– agenesis,
– surgery,
– thyroiditis,
– iodine deficiency
• Symptoms of hypothyroidism
– cretinism and dwarfism if occurs in perinatal period or
infant
– myxedema if occurs in older child or adult
– sleepy, tire easily, cold intolerance, constipation, weak
• Treat with thyroid hormone replacement
 Pathology of the parathyroid glands
Hyperparathyroidism
• major causes are parathyroid adenoma and
parathyroid hyperplasia
• symptoms of hyperparathyroidism (hypercalcemia)
– bones, stones, moans, abdominal groans
Hypoparathyroidism
• causes of include surgery, congenital hypoplasia
• symptoms of hypoparathyroidism (hypocalcemia)
– muscle spasms, irregular heart beat, cardiac arrest (if
severe)
 Pathology of the adrenal gland

• Adrenocortical hyperfunction-Hypercortisolism (Cushing’s syndrome)

• syndrome due to excess glucocorticoid hormones (cortisol)
• most common cause is exogenous steroids, other causes include
– adrenal hyperplasia or neoplasia
– hypersecretion of ACTH by pituitary gland (Cushing’s disease)
– ectopic ACTH (paraneoplastic syndrome)
• Dramatic appearance: central obesity, buffalo hump, moon
face, striae
• Hyperaldosteronism (Conn’s syndrome)
– syndrome due to excess mineralocorticoid hormone (aldosterone)
– causes include adrenocortical adenoma and adrenal hyperplasia
– present with hypertension and hypokalemia
 Cushing’s Support & Research Foundation
Easy bruising
Thinning skin
Symptoms Vary Poor wound healing
And may include
Acne
any number of these:
Purple striae
Hirsutism
Abdominal weight gain Female balding
Red, round ‘moon’ face Menstrual irregularity
Thinning extremities
‘Buffalo hump’ Sleep disorders
Excessive hunger
High blood pressure Excessive thirst
High blood sugar Frequent urination
Muscle weakness Sweating
Osteoporosis/Fractures
Infections Anxiety
Blood clots Confusion
Visual field defects Concentration loss
Memory loss
Depression
Suicidal thoughts
Illustration from Mayo Clinic Family Health Book, 2d. ed, 1996
Panic attacks

Courtesy of www.CSRF.com
 Pathology of the adrenal gland…
• Adrenocortical hypofunction
– usually autoimmune destruction of
adrenals, also due to Tb, malignancy
• Addison’s disease
– autoimmune destruction of adrenal
gland
– fatigue, weight loss, nausea, increased
infections, low Na, high K
 Diseases of Adrenal Medulla

• Neuroblastoma
– malignant neoplasm of neuroblasts (primitive cells) in
neonates, infant
– treatment with chemotherapy, surgery, radiation (90 %
cure)
• Pheochromocytoma
– a neoplasm (usually benign) derived from adrenal
medulla cells
– diagnosed on basis of dramatic clinical picture,
metabolites in urine
– treated by surgery