Patho Ch 25 and 9 week 1

• 1. Secrete hormones
• 2. Goal: regulate metabolism, growth, and homeostasis
• 3. Works with close coorperation of the nervous system

• 1. directly by blood tests
• 2. "inferred" under substances in blood

• 1. homeostasis
• 2. Fertility and reproduction

pathophysiologic changes

• 1. too much of a hormone being secreted (because of a tumor on a gland)
• 2. too little of a hormone being secreted (because of a tumor on a gland)
• 3. insensitivity of the target organ to the hormone

• 1. genetics
• 2. auto-immune destruction of a target hormone
• 3. aging/atrophy of the target organ

• 1. pituitary glands
• 2. hypothalamus
• 3. adrenal glands
• 4. gonadal

• 1. Somatrophin (GH) Growth Hormone
• 2. Adrenocorticotropic Hormone (ACTH)
• 3. Prolactin (PRL)
• 4. Thyroid-stimulating Hormone (TSH)
• 5. Follicle-stimulating Hormone (FSH)
• 6. Luteinizing Hormone (LH)

• *GROWTH HORMONE (Somatotropin)
• Growth/Repair

• *Adrenocorticotropic Hormone
• Stimulates adrenals to release cortisol

• 1. decreased immune response
• 2. anti-inflammatory

• *Prolactin
• 1. stimulates breast milk production
• 2. inhibits ovulation

• *Thyroid-stimulating hormone
• Stimulates Thyroid>metabolism

• *Follicle-stimulating hormone
• 1. Stimulates follicles in ovary to begin egg development
• 2. Stimulates estrogen release
• 3. MALES: stimulates spermatogenesis

• *Luteinizing hormone
• 1. Continues egg maturation
• 2. Continues Ovulation
• 3. MALES: stimulates testosterone production

Pituitary gland tumors

• 1. Adenoma
• 2. dwarfism
• 3. acromegly
• 4. gigantism
• 5. pheochromocytoma
• 6. Cushing's syndrome
• 7. Addison's disease
• 8. Hypothyroidism
• 9. Goiter
• 10. hyperparathyroidism
• 11. hypoparathyroidism
• 12. Syndrome of inappropriate ADH secretion
• 13. Diabetes insipidus
• 14. diabetes mellitus (DM)

• 1. A benign tumor on the adrenal medulla
• 2. Excess release of norepinephrine and epinephrine
• 3. A. hypertension
• B. cephalgia
• C. stressed feeling

• 1. pheochromocytoma
• 2. Cushing's syndrome
• 3. Addison's disease

Too much cortisol/glucocorticoids are released by the adrenal cortex.

• 1. pituitary tumor -> increase in ACTH
• 2. adrenal tumor
• 3. unknown cause
• 4. side effects of cortisone/steroid use

• 1. Increase in body fat/ "moon face"
• 2. depression/mood swings
• 3. fragile skin/easy bruising
• 4. decreased immune response-> increased risk of infections
• 5. stomach ulcers/ GI bleeding
• 6. increased blood sugar
• 7.loss of Ca++ in bone-> osteoporosis

headaches

bruise

vaccines

insulin injection

Antibiotics

steroid treatment

You must wean them off gradually until the body learns how to produce its own cortisol again.

Addison's disease

• 1. insufficient gluco-corticoids or mineralo-corticoids
• 2. Auto-immune response or tumor/infection of the adrenal cortex

• 1. hypoglycemia
• 2. fatigue
• 3. weight loss
• 4. decrease in Na+ in blood->water loss->hypotension->dizziness, at risk for syncope
• 5. increase in K+ in blood -> dysrhythmia

Decrease in Na+ in blood

hypotension

fainting

• 1. mineralocorticoid
• 2. hyperkalemia

irregular heartbeat

Supplemental steroids with frequent monitoring

benign endocrine tumor (most common pituitary disorder)

• 1. medication
• 2. surgery
• 3. radiation
• 4. simply monitor

• 1. dwarfism
• 2. acromegaly
• 3. gigantism

• 1. small bones (Usually proportioned)
• 2. normal IQ

Too little growth hormone

GH supplements in children before epiphyseal plates seal

Too much growth hormone

adenoma

• 1. large bones
• 2. thickening of skull
• 3. large jaw&tongue

It can lead to a person becoming diabetic because it causes insulin resisitance

• 1. insulin resisitance
• 2. high blood glucose
• 3. high blood pressure
• 4. CV disease

Too much GH BEFORE puberty (Very large, tall person)

• 1. hypothyroidism
• FORMS:
• A2.myxdema
• B3. Hashimoto's disease
• C4. Cretinism
• 5. hyperthyoidism
• 6. goiter

Low thyroid functioning

• 1. genetics
• 2. aging (esp in females)
• 3. auto immune disease

• 1. Increased TSH
• 2. decreased T₃ and T₄

Tumor

Triidothyronine

Thyroxine

• 1. myxedema
• 2. Hashimoto's disease
• 3. Cretinism

adults

Auto-immune

infants

• 1. increased weight gain
• 2. decreased energy
• 3. menstrual irregularities
• 4. depression
• 5. confusion
• 6. cold intolerance

Oral meds (synthetic thyroid hormone) for life. labs tests to monitor

oversecreting

Grave's disease

• 1. increased T₃
• 2. increased T₄

• 1. tumor
• 2. auto-immune disease

• 1. exopthalamus
• 2. decreased weight
• 3. nervousness
• 4. palpitations
• 5. tachycardia
• IF S&S are SEVERE:
• "thyroid storm" occurs

• An acute medical emergency:
• 1. increased body temperature
• 2. increased pulse
• 3. possible heart failure

bulging eyes

increased pulse

• 1. partial or total thyroidectomy
• 2. radioactive iodine injections to kill off some thyroid tissue
• 3. close monitoring of thyroid levels
• 4. Monitoring of PTH levels

Because treatment may have accidentally injured or removed all of the 4 parathyroid glands.

Enlarged thyroid

• 1. hyperthyroidism
• 2. hypothyroidism

• 1. hypoparathyroidism
• 2. hyperparathyroidism

Decreased Ca levels

• 1. auto-immune disease
• 2. thyroidectomy

• 1. decreased Ca levels
• 2. weak heart
• 3. muscle twitches

• 1. tumor
• 2. renal failure

• 1. increased Ca levels
• 2. kidney stones
• 3. dysrhythmia
• 4. osteoporosis

• Depending on cause:
• 1. includes surgery
• 2. supplements of D and Ca
• (must find reason for calcium imbalance as may be due to a bone tumor)

• IMBALANCES OF:
• 1. FSH
• 2. LH
• 3. PRL
• 4. estrogen
• 5. progesterone

• 1. menstrual and/or ovulatory irregularities in females
• 2. sperm irregularities in males

• 1. cause
• 2. age
• (example: FSH increases in menopause)

• 1. affect ovulation
• 2. affect cervical mucus
• 3. affect endometrial growth

endometrial inflammation

exogenous hormones

Hormones from outside the bodies natural production

• 1. the pill
• 2. depo-provera
• 3. norplant

• 1. sometimes inhibit ovulation
• 2. always make cervical mucus difficult for sperm to traverse
• 3. thins endometrail lining which fertilized egg needs to implant well

Certain ones can increase the risk of ectopic pregnancy

A substance or device which induces failure of pregnancy

substance which causes fetal defects

excessive menstrual blood loss

anemia

short or infrequent menstrual periods

bleeding in between menstrual cycles

Treatment depends on cause

sodium, raising BP

Syndrome of inappropriate ADH secretion

• 1. increased H₂O in blood (thus low Na levels)
• 2. confusion
• 3. electrolyte imblances

• 1. diuretics
• 2. Na pills
• 3. salty diet

Diabetes Insipidus

Because polyuria (excessive urination) mimics that seen with diabetes mellitus except there is NO glucose in the urine.

severe dehydration

ADH injections

insufficient insulin secretion by islets of langerhans in pancreas

insulin injections

insensitivity to insulin by target organ cells throughout body

Pills, if they do not work then insulin injections

• 1. genetics
• 2. obesity
• 3. pregnancy
• 4. auto immune

Hb_A1c

An asssessment of the average blood glucose levels within the last 60-90 days before the blood is drawn. Gives a better picture of a patients diabetes control.

6-7%

70-110 mg/dL

brain cells

1. insulin or its ability to work on target cells. 2. This causes the cells to not be able to carry on metabolic processes.

BS (blood sugar)

intracellular processes

DKA

Diabetic Keto Acidosis

it can get too low

not enough glucose enters the cell

• 1.intracellular glucose
• 2. hypoglycemia

• 1. high blood glucose levels
• 2. mobilization of lipids

• 1. confusion
• 2. drunken acting
• 3. weakness
• 4. pass out EVENTUALLY

sudden

GRADUAL

hypoglycemic!!!!! NOT DKA

• 1. Immediate oral glucose (6 lifesavers, 4 oz non-diet pop or juice, cake icing, glucose tablets)
• 2. glucagon injection (follow up with protein)

Uncertain cause

1. increased maternal BS-> extra glucose available to the fetus->LGA (Large for Gestational Age)

• 1. hypoglycemia
• 2. sudden drop in supply of glucose from the mother

Yes

Overgrowth of vaginal yeast

No

• 1. herpes simplex virus (HSV)
• 2. Human Papilloma Virus (HPV)

Only if caught early

• 1. removal of abnormal cells or RT(radiation therapy)
• 2. hysterectomy

benign fibroid tumor

overgrowth of myometrium of uterus

no

• 1. pressure
• 2. bleeding
• 3. interfere with getting or remaining pregnat

1. leiomyoma (benign fibroid tumor)

Varies with size, but they after skrink after menopause so surgery can be avoided.

• 1. obstructions
• 2. salpingitis
• 3. ectopic pregnancy

• 1. infection
• 2. scarring
• 3. congenital abnormalities

• 1. infertility
• 2. ectopic pregnancy

inflammation/infection of the fallopian tube

• 1. STD
• 2. vaginal infection migrating upward

vaginal/blood cultures

• 1. abdominal pain
• 2. fever
• 3. foul-smelling vaginal discharge
• 4. possibly peritonitis
• 5. septic shock

• 1. hospitalization for IV antibiotic therapy
• 2. remove IUD if present

• 1. possible infertility
• 2. ectopic pregnancies

implantation of fertilized egg outside uterus (usually implants in tube)

• 1. vaginal bleeding
• 2. abdominal pain

rupture of tube-> hemoperitoneum (blood in peritoneum)

blood in peritoneum

surgery

methotrexate (MTX) to dissolve blastocyte

• 1. benign cysts
• 2. ovarian cancer

• 1. pain
• 2. pressure
• 3. menstrual irregularities

• 1. hormones
• 2. surgery

• 1. bloating
• 2. backache
• 3. urinary frequency
• 4. dyspareunia (pain with intercourse)
• 5. vaginal discharge
• 6. bowel problems

• 1. surgery
• 2. RT
• 3. metatases

pain with intercourse

• 1. preclampsia
• 2. placenta previa
• 3. abruptio placenta

toxemia

excessively high BP OR excessive clotting of blood "disseminated Intravascular Clotting" (DIC)

kidenys leaking protein into urine

• 1. fluid retention
• 2. edema
• 3. headaches
• 4. "eclampsia" with seizures

hemorrhages throughout the body (can be fatal)

• 1. meds
• 2. induce pregnancy
• 3. rest

placenta implants too low, completely or partially covering cervix

• 1. painless bleeding
• 2. miscarriage

rest

placenta seperates from uterus before birth

• 1. painful bleeding
• 2. fetal distress

quick delivery