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25 Pathophysiology of the Endocrine System Cheat Sheet by

Hypercalcemia, Hypocalcemia, Osteoporosis, Diabetes mellitus, Obesity, Hyperthyroidism, Hypothyroidism, Hypercortisolemia

Hyperc­alcemia

Defini­tion: Above normal levels of calcium (Ca2+) in the blood
Risk factors & causes: Hyperp­ara­thy­roidism or malignancy
Signs & symptoms:
- Cognitive dysfunction
- Fatigue
- Muscle weakness
- Constipation
- Decreased appetite
- Polyuria (↑ urination)
- Polydipsia (excessive thirst)
Pathop­hys­iology & mechanism: Changes in Ca2+ concen­tration in the blood cause altera­tions in the balance of electrical charges of cell membranes leading to sluggish neuronal activity → ↓Ca2+ causes a ↓ in the permea­bility of collecting duct membrane in the nephrons → ↓ Ca2+ leads to increase in Na/Cl into tubule lumen (nephrons) with osmotic effects → leads to less water reabsorbed into the blood; & more water eliminated in the urine
Compli­cat­ions: Ca deposition in different parts of the body causing stones (uroli­thi­asis), flank pain (not specific)
Treatment: Medication & surgery

Hyperc­alcemia

Hyperc­alcemia (contnd)

Osteop­orosis

Defini­tion: Imbalance of bones formation & reabso­rption leading to brittle bones
Risk factors & causes:
- Females more likely
- Age
- White or Asian
- FHx
- Small body frames
Pathop­hys­iology & mechanism: In osteop­orosis imbalance in bone reabso­rption vs bone formation leading to a ↓ in bone density & bone mass → ↓ serum concen­tra­tions of vitamin D lead to a decrease in Ca2+ available for the minera­lis­ation of bone
Signs & symptoms:
- Pain (from fractures & other conditions associated with osteoporosis)
- Postural changes
- Fractures
- Loss of height
Compli­cat­ions: Bone fractures (mainly spine & hips)
Treatment: Prevention - Supple­ments & weight bearing exercise

Osteop­orosis

Hypoth­yro­idism

Defini­tion: Thyroid gland doesn't produce enough thyroid hormone (under­active thyroid)
Risk factors & causes:
- Autoimmune diseease
- Thyroid surgeery
- Radiation therapy
- Thyroiditis
- Medicine (e.g. lithium used to treat severe depression)
- Pituitary disorder (insuf­ficient produce of thyroi­d-s­tim­ulating hormone)
- Women, FHx, Type 1 diabetes
Pathop­hys­iology & mechanism: Impaired function of the gland & a ↓ in the secretion of thyroid hormones T3 & T4 → engages number of mechanisms (circled in red)
Signs & symptoms:
- Thinni­ng/­losing hair
- Eyebrow hair loss
- Puffy face
- Enlarged thyroid
- Dry & coarse skin
- Slow heartbeat
- Poor appetite
- Constipation
- Infert­ility / heavy menstruation
- Cool extrem­ities & swelling of the limbs
- Carpal tunnel syndrome
- Weight gain
- Poor memory
- Fatigue
Compli­cat­ions:
- Goiter
- Cardiac problems
- Periph­eeral neuropathy
- Infertility
- Birth defects
Treatment: Medica­ation

Hypoth­yro­idism

 

Hypoca­lcemia

Defini­tion: Low Ca2+ levels in the blood serum
Risk factors & causes:
- Hypoparathyroidism
- Vitamin D inadequacy or resistance
- Renal disease
- Terminal liver disease with vitamin D inadequacy
Pathop­hys­iology & mechanism: Ca2+ changes lead to a change in cell membrane polari­sation → ↓ in the threshold for cell depola­ris­ation causing an increase in neuronal excita­bility → Sx & SSx
Signs & symptoms:
- Paraes­thesia (burni­ng/­pri­ckling sensation)
- Numbness
- Chvostek's sign (twitching facial muscles)
- Trouss­eaus's sign (hand & wrist twitching)
Compli­cat­ions:
- Ventri­cular tachycardia
- Seizures
- Respir­atory disease
Treatment: Iv infusion & medication

Hypoca­lcemia

Diabetes mellitus

Defini­tion: Body can't produce enough insulin (high blood sugar levels)
Risk factors & causes: Unhealthy lifestyle → intrap­eri­toneal cavity accumu­lates visceral fat (endocrine organ that secrets 'bad' hormones)
Pathop­hys­iology & mechanism: Manifested by a state of resistance to the effects of insulin, conseq­uently →
- various organs are less able to use glucose as a source of energy
- There's hyperg­lyc­aemia leading to glucot­oxi­city, i.e. damage to pancreatic cell that produce insulin
- Deficient insulin causes diabetes
Signs & symptoms: Depend on the specific body system affected
- Frequent urination
- Excessive thirst
- Unexpl­ained weight loss
- Extreme hunger
- Sudden vision changes
- Tingling or numbness in the hands or feet
- Feeling very tired much of the time
- Very dry skin
Compli­cat­ions:
- Cardio­vas­cular disease
- Nerve damage
- Kidney damage
- Eye damage
- Foot damage
- Skin & mouth conditions
- Hearing impairment
Treatment: Prevention - Healthy diet & exercise

Diabetes mellitus

Hypert­hyr­oidism

Defini­tion: Thyroid creates excessive thyroid hormones → speeding up the body's metabolism
Risk factors & causes:
- Graves' diseases (attacks thyroid)
- Overactive thyroid nodules (toxic adenoma)
- Thyroi­ditis (inflamed thyroid)
- FHx
- Recent pregnancy
Pathop­hys­iology & mechanism: ↑ in production of thyroid hormone → abnormal ↑ in its endocrine effects over various organs & systems
=> Includes ↑ cardiac output, gut hyperm­oti­lity, CNS overst­imu­lation, increased thermo­gen­esis, ↑ in osmotic pressure behind the eyes & changes in the dermis & subcut­aneous tissues
Signs & symptoms: May occur in various body systems → eyes / systemic signs / heart / nervous system / GI system / nutrit­ional state / thermo­reg­ulation
Compli­cat­ions:
- Cardiac problems
- Brittlee bones
- Discol­oured / swollen skin
- Vision problems
Treatment: Medicine, therapy &/or surgery

Hypert­hyr­oidism

Hyperc­ort­iso­lemia

Defini­tion: Abnormal ↑ of cortisol in the blood → ↑ in the effects of cortisol on various systems of the body
Risk factors & causes: Cortisol is normally released in the blood in response to stress
Pathop­hys­iology & mechanism: ↑ in circul­ating cortisol → genera­lised catabolic state, i.e. the body breaks down / burns tissues & reserves in order to release energy → most systems are affected
Signs & symptoms:
- Easy bruising
- Suprac­lav­icular & dorsal fat pads
- Central obesity
- Round face
- Proximal muscle weakness
- Purple striae
- Hypertension
- Arrhyt­hmia, paralysis, cramps
- Hirsutism, acne
Compli­cat­ions: Affects all the systems

Hyperc­ort­iso­lemia

 

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