Transcript DISEASES OF THE ENDOCRINE SYSTEM

DISEASES OF THE ENDOCRINE
SYSTEM
DR HEYAM AWAD
ENDOCRINE SYSTEM
• HIGHLY INTEGRATED ORGANS.
• MAINTAIN HOMEOSTASIS.
• HORMONES…… AFFECT TARGET ORGANS…….
FEEDBACK INHIBITION.
DISEASES OF THE ENDOCTINR SYSTEM
• IMPAIRED SYNTHESIS.
• MASS LESIONS.
PITUITARY GLAND
• EMBRYOLOGIC ORIGIN OF PITUITARY???
PITUITARY GLAND
CONNECTIONS BETWEEN PITUITARY
AND HYPOTHALAMUS
• STALK…. NEURAL AXONS.
• VENOUS PLEXUS .
ANTERIOR PITUITARY
DISEASES OF PITUITARY
• HYPERPITUITARISM.
• HYPOPITUITARISM.
• MASS EFFECT.
HYPERPITUITARISM
CAUSES
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FUNCTIONAL ADENOMA… MOST COMMON.
HYPERPLASIA
CARCINOMA
NONPITUITARY TUMOURS… HOW?
HYPOTHALAMIC DISORDERS
HYPERPITUITARISM
SYMPTOMS
• DEPENDING ON THE HORMONE
OVERPRDUCED..
HYPOPITUITARISM
CAUSES
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ISCHEMIA
SURGERY
RADIOTHERAPY
INFLAMMATION
NON FUNCTIONAL ADENOMA
ALL CAUSE DESTRUCTION OF THE PITUITARY
MASS EFFECT
SIGNS AND SYMPTOMS
• RADIOLOGICAL ABNORMALITY OF SELLA
TURCICA.
• VISUAL FIELD ABNORMALITY.
• ELEVATED INTRACRANIAL PRESSURE…
HEADACHE, NAUSEA, VOMITING.
• CRANIAL NERVE PALSIES.
• SEIZURES
MASS LESIONS
• ACUTE HEMORRHAGE CAN OCCUR.
• CAUSES RAPID EXPANSION.
• NEUROSURGICAL EMERGENCY = PITUITARY
APOPLEXY.
PITUITARY ADENOMAS
* FUNCTIONAL OR NON FUNCTIONAL.
• FUNCTIONAL : USUALLY ONE CELL TYPE AND
ONE HORMONE.
• PITUITARY ADENOMAS = 10% OF ALL
INTRACRANIAL NEOPLASMS PRESENTING
CLINICALLY.
• CAN BE FOUND IN 25% OF ROUTUINE
AUTOPSIES.
PITUITARY ADENOMAS
MACRO ADENOMA > 1CM
MICROADENOMA < 1CM
PITUITARY ADENOMAS
MORPHOLOGY
ADENOMA
• CAN EXTEND LOCALLY .
• CAN CONTAIN AREAS OF HEMORRHAGE AND
NECROSIS.
PITUITARY ADENOMA
PITUITARY ADENOMAS
• PROLACTINOMA.
• SOMATOTROPH = GROWTH HORMONE
ADENOMA
• CORTICOTROPH CELL ADENOMA
• OTHERS.
PROLACTINOMA
• MOST COMMON HYPERFUNCTIONING
ADENOMA.
• HYPERPROLACTINEMIA: AMENORRHEA,
GALACTORRHEA, INFERTILITY.
OTHER CAUSES OF HYPERPRLACTINEMIA
• PREGNANCY,
• HIGH DOSE ESTROGEN THERAPY
• RENAL FAILURE
• HYPOTHYROIDISM
• HYPOTHEALAMIC LESION
• DOPAMINE INHIBITING DRUGS
SOMATOTROPH CELL ADENOMA
INCREASED GROWTH HORMONE SECRETION:
• GIGANTISM IF IN PREPUBERTAL CHILDREN.
• ACROMEGALY IN ADULTS.
GIGANTISM
ACROMEGALY
OTHER CAUSES OF EXCESS GH
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ABNORMAL GLUCOSE TOLERANCE
DM
HYPERTENTION
ARTHRITIS
OSTEOPOROSIS
CORTICOTROPH CELL ADENOMA
• IF FUNCTIONAL ADENOMA: INCREASED
CORTISOL = CUSHING DISEASE.
• CUSHING SYNDROME = HYPERCORTISOLISM
DUE TO ANY CAUSE.
NULL CELL ADENOMA
• NON FUNCTIONING ADENOMAS.
• CAUSE MASS EFECT.
HYPOPITUITARISM
• LOSS OF 75% OF THE ANTERIOR PITUITARY.
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CAUSES :
• NON SECRETORY P. ADENOMA
• ISCHEMIC NECROSIS OF PITUITARY.
• SURGERY OR RADIATION OF PITUITARY
• TB
• SACROIDOSIS
• METASTATIC TUMOURS TO PITUITARY
OTHER CAUSES
• HYPOTHALAMIC LESIONS CAN CAUSE
HYPOPITUITARISM.
• HYPOPITUITARISM ACCOMPANIED BY
POSTERIOR PITUITARY DYSFUNCTION IS
ALMOST ALWAYS RELATED TO HYPOTHALAMIC
LESION.
OTHER CAUSES
• POSTPARTUM NECROSIS OF THE ANTERIOR
PITUITARY = SHEEHAN SYNDROME.
• DURING PREGNANCY, THE ANTERIOR
PITUITARY ENLARGES MAINLY DUE TO
INCREASED PROLACTIN SECRETING CELLS.
• NO INCREASED BLOOD SUPPLY…. SO GLAND
VULNARABLE TO ISCHEMIC INJURY.
HYPOPITUITARISM
SYMPTOMS
• DEPEND ON THE SPECIFIC HORMONE
DEFICIENCY.
• GH.. GROWTH FAILURE IN CHILDREN
• GONADOTROPIN… AMENORRHEA AND
INFERTILITY.
• TSH… HYPOTHYROIDISM
POSTERIOR PITUITARY SYNDROME
• ADH AND OXYTOCIN ARE PRODUCED FROM
THE HYPOTHALAMIC NEURONS AND ARE
STORED IN THE AXONS OF THE POSTERIOR
PITUITARY.
ADH
• ACTS ON COLLECTING TUBULES OF KIDNEY TO
PROMOTE RESORPTION OF FREE WATER.
• IF ADH DEFICIENCY = DIABETES INSIPIDUS…
POLYURIA , POLYDYPSIA
• INCREASED ADH = SIADH… HYPONATREMIA.