Transcript Endocrine Disorders

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Collection of glands that secrete
hormones directly into the bloodstream.
› Adrenal glands, parathyroid glands, pancreas,
pineal gland, pituitary gland, ovaries, testes,
thymus gland, thyroid gland
(Hormone.org, 2012)
(Zelman, Tompary, Raymond, Holdaway, Mulvhill, 2010)
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TSH
T3
T4
Disruption of
hormones
› Hyperthyroidism
› Hypothyroidism
(NIDDK, 2006)
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Exophthalmos
Profuse perspiration
Hand tremors
Goiter
Weight loss
Nervousness/excitability
Rapid pulse
Polydipsia
Diarrhea
Insomnia
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Most common type:
Grave’s Disease
Insert Figure 12-9: Thyroid goiter. (Newscom)
(Zelman, Tompary, Raymond, Holdaway, Mulvhill, 2010)
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Most common type of hypothyroidism
› Hashimoto’s Disease
› The thyroid doesn’t make enough thyroid
hormone
› Symptoms:
 Fatigue, mental depression, feeling cold, weight
gain, dry skin and hair, constipation, menstrual
irregularities
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Most people have no symptoms
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4 types:
› Papillary – slow growing – easily treated –
rarely fatal
› Follicular – again slow growing – rarely fatal
› Medullary – less common – more aggressive
› Anaplastic – least common – most aggressive
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Medication
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Radioactive Iodine
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Surgery
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Prevention??
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Adrenal Insufficiency
› Adrenal glands
cannot produce
enough cortisol
 OR
› Pituitary gland fails to
produce enough
adrenocorticotropin
(ACTH)
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Symptoms:
› Chronic, worsening
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fatigue
Muscle weakness
Loss of appetite
Weight loss
Nausea/vomiting
Diarrhea
Craving for salty foods
Low blood glucose
Headache
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Caused by prolonged exposure of the
body’s tissues to high levels of the
hormone cortisol.
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Relatively rare but risk factors:
› Obesity
› Type 2 diabetes
› High blood pressure
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Signs & Symptoms:
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Rounded face
Upper body obesity
Increased neck fat
Bruise easily / poor
healing
Weakened bones
Fatigue
Increased
thirst/urination
Irritability / anxiety /
depression
(NIDDK, 2006)
Insert Figure 12-11: A patient with Cushing’s syndrome (A) before and (B) after
receiving treatment. (Sharmyn McGraw)
(Zelman, Tompary, Raymond, Holdaway, Mulvhill, 2010)
High Blood Glucose (Hyperglycemia)
In diabetes, blood glucose builds up
for several possible reasons…
Too little
insulin is
made
Cells can’t use
insulin well
American Diabetes Association
Liver releases
too much
glucose
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Type 1
› Pancreas makes too
little or no insulin
› Beta cell destruction
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Pre-diabetes
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Gestational Diabetes
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Type 2
› Cells do not use
insulin well (insulin
resistant)
› Beta cell
dysfunction
› Ability for pancreas
to make insulin
decreases over time
Number of Americans with
Diagnosed Diabetes, 1980-2011
Centers for Disease Control and Prevention www.cdc.gov/diabetes/statistics
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Currently affects about 29.1 million
Americans of all ages.
› About 9.3% of the population (U.S.)
› Estimated 8 million undiagnosed
› Hispanics/Latinos – about 13% diagnosed
› African Americans – about 13% diagnosed
› Asian Americans – about 9% diagnosed
(CDC, 2014)
(Oregon.gov, 2015)
Increased thirst
 Increased urination
 Blurry vision
 Fatigue
 Weight loss
 Nausea and vomiting
 More frequent infections
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Stage
Diabetes
Pre-diabetes
Normal
(ADA, 2015)
Test
Fasting glucose
2 hr glucose tolerance
>126 mg/dl
>200
<100 >126 mg/dl
>140 <200
60 <100
<140 mg/dl
A leading cause of blindness
 Leading cause of non-accident
amputations
 Kidney disease
 Nerve damage (peripheral neuropathy)
 Heart attack / stroke
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Treatment of Diabetes
No
medication
16%
Insulin only
12%
Insulin and
oral
medicatio
n
14%
Oral
medication
only
58%
National Diabetes Information Clearinghouse. National Diabetes Statistics, 2011. Available at:
http://diabetes.niddk.nih.gov/dm/pubs/statistics/
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“The best time to plant a tree is 20 years
ago. The second best time is now.”
 Chinese Proverb
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Good news with diabetes prevention
› Small steps matter
Cost-Effectiveness of Lifestyle Modification or
Metformin: DPP
 Active
interventions (vs placebo) would:
Intensive
Lifestyle
Metformin
11.1 years
3.4 years
20%
8%
Increase life
expectancy by
0.5 years
0.2 years
Cost per QALY
$1,124
$31,286
Delay onset of
type 2 diabetes by
Reduce incidence of
type 2 diabetes by
QALY = Quality Adjusted Life Years
Herman WH, et al for the Diabetes Prevention Program Research Group.
Ann Intern Med. 2005:142:323-332.