Elevated or Depressed Hormone Levels

Alterations of Hormonal Regulation
Elevated or Depressed Hormone Levels
Presentation by:Dr. Barry Goldberg
Associate Professor of Biology
Felician College

* Failure of feedback systems
* Dysfunction of an endocrine gland
* Secretory cells are unable to produce, obtain, or convert hormone precursors
* The endocrine gland synthesizes or releases excessive amounts of hormone



Elevated or Depressed Hormone Levels

* Increased hormone degradation or inactivation
* Ectopic hormone release

Target Cell Failure
* Cell surface receptor-associated disorders
o Decrease in number of receptors
o Impaired receptor function
o Presence of antibodies against specific receptors
o Antibodies that mimic hormone action
o Unusual expression of receptor function
* Intracellular disorders
* Circulating inhibitors



Hormone Delivery


Alterations of the Hypothalamic-Pituitary System
Diseases of the Posterior Pituitary

* Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
o Hypersecretion of ADH
o For diagnosis, normal adrenal and thyroid function must exist
o Clinical manifestations are related to enhanced renal water retention, hyponatremia, and hypo-osmolality

Diseases of the Posterior Pituitary
* Diabetes insipidus
o Insufficiency of ADH
o Polyuria and polydipsia
o Partial or total inability to concentrate the urine
o Neurogenic
+ Insufficient amounts of ADH
o Nephrogenic
+ Inadequate response to ADH
o Psychogenic

Diseases of the Anterior Pituitary

* Hypopituitarism
o Pituitary infarction
+ Sheehan syndrome
+ Hemorrhage
+ Shock
o Others: head trauma, infections, and tumors

Diseases of the Anterior Pituitary

* Hypopituitarism
o Panhypopituitarism
+ ACTH deficiency
+ TSH deficiency
+ FSH and LH deficiency
+ GH deficiency

o Commonly caused by a benign slow-growing pituitary adenoma
o Manifestations
+ Headache and fatigue
+ Visual changes
+ Hyposecretion of neighboring anterior pituitary hormones
* Hypersecretion of growth hormone (GH)
o Acromegaly
+ Hypersecretion of GH during adulthood
o Gigantism
+ Hypersecretion of GH in children and adolescents
* Hypersecretion of growth hormone (GH)
* Hypersecretion of prolactin
o Caused by prolactinomas
+ In females, increased levels of prolactin cause amenorrhea, galactorrhea, hirsutism, and osteopenia
+ In males, increased levels of prolactin cause hypogonadism, erectile dysfunction, impaired libido, oligospermia, and diminished ejaculate volume

Alterations of Thyroid Function
* Hyperthyroidism
o Thyrotoxicosis
o Graves disease
+ Pretibial myxedema
o Hyperthyroidism resulting from nodular thyroid disease
+ Goiter
o Thyrotoxic crisis
* Hyperthyroidism

Thyrotoxicosis (Graves Disease)
Alterations of Thyroid Function

* Hypothyroidism
o Primary hypothyroidism
+ Subacute thyroiditis
+ Autoimmune thyroiditis (Hashimoto disease)
+ Painless thyroiditis
+ Postpartum thyroiditis
+ Myxedema coma
o Congenital hypothyroidism
o Thyroid carcinoma

Hypothyroidism
Alterations of Parathyroid Function

* Hyperparathyroidism
o Primary hyperparathyroidism
+ Excess secretion of PTH from one or more parathyroid glands
o Secondary hyperparathyroidism
+ Increase in PTH secondary to a chronic disease
o Abnormally low PTH levels
o Usually caused by parathyroid damage in thyroid surgery
Type 1 Diabetes Mellitus

* Demonstrates pancreatic atrophy and specific loss of beta cells
* Macrophages, T- and B-lymphocytes, and natural killer cells are present
* Two types
o Immune
o Nonimmune
* Genetic susceptibility
* Environmental factors
* Immunologically mediated destruction of beta cells
* Manifestations
o Hyperglycemia, polydipsia, polyuria, polyphagia, weight loss, and fatigue

Dysfunction of the Pancreas

* Type 2 diabetes mellitus
o Maturity-onset diabetes of youth (MODY)
o Gestational diabetes mellitus (GDM)
o Common form of diabetes mellitus type 2
+ Insulin resistance

Acute Complications of Diabetes Mellitus

* Hypoglycemia
* Diabetic ketoacidosis
* Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)
* Somogyi effect
* Dawn phenomenon

Diabetic Ketoacidosis
Chronic Complications of Diabetes Mellitus
* Hyperglycemia and nonenzymatic glycosylation
* Hyperglycemia and the polyol pathway
o Protein kinase C
* Microvascular disease
o Retinopathy
o Diabetic nephropathy
* Macrovascular disease
o Coronary artery disease
o Stroke
o Peripheral arterial disease
* Diabetic neuropathies
* Infection

Alterations of Adrenal Function
* Disorders of the adrenal cortex
o Cushing disease
+ Excessive anterior pituitary secretion of ACTH
o Cushing syndrome
+ Excessive level of cortisol, regardless of cause

Cushing Disease
* Disorders of the adrenal cortex
o Hyperaldosteronism
+ Primary hyperaldosteronism (Conn disease)
+ Secondary hyperaldosteronism
* Disorders of the adrenal cortex
o Adrenocortical hypofunction
+ Primary adrenal insufficiency (Addison disease)
# Idiopathic Addison disease
+ Secondary hypocortisolism
* Disorders of the adrenal cortex
o Hypersecretion of adrenal androgens and estrogens
+ Feminization
+ Virilization
Virilization
* Disorders of the adrenal medulla
o Adrenal medulla hyperfunction
+ Caused by tumors derived from the chromaffin cells of the adrenal medulla
# Pheochromocytomas
+ Secrete catecholamines on a continuous or episodic basis

Elevated or Depressed Hormone Levels.ppt