Endocrine Lymphatic and Immune Disorders

8/4/2019 Endocrine Lymphatic and Immune Disorders

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Disorders -

Endocrine/Lymphatic/Immune

Systems

Compiled by Sen.T/Sr. Navuta


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Disorders of the Endocrine System

May be related to either anexcess or a deficiency of aspecific hormone

May be related to a defect at itsreceptor site

Onset of an Endocrine Disordercan be either slow and insidiousor abrupt and life-threatening


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Laboratory Testing for Endocrine

Functioning

Radioimmunoassay: competitive bindingassay test in which radioactively labeledamounts of hormones compete with

unlabeled hormones from plasma orserum for antibody binding sites.


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Urine Testing: measures hormone levelsand metabolites of specific hormones in

urine Usually done in a 24 hour urine collection

to better reflect the functioning of a gland

such as adrenal gland Certain hormones may require addition of

additives to the collection container

No unnecessary medications should beused by client during collection process


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24 Hour Urine Collection

Test starts when client first arises andurinates

The first specimen is discarded but time is

noted - (first specimen is not collectedbecause it is hard to tell how long it has beenin bladder)

Client adds all urine voided after that first

discarded specimen during next 24 hours Some hospital labs may have it put on ice


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Glucose Testing

Can be done via finger stick or

venous puncture

Glycosylated hemoglobin (HbA1c)value reveals the average bloodglucose level over a period of 2-3

months


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Radiographic Examinations Anterior, posterior and lateral skull x-ray

studies may be used to visualize sellaturcica (an indentation of sphenoid bonewhich houses the pituitary gland)

Erosion of this structure indicates invasionof the wall from an abnormal growth

CT and MRI scans can show extent of

growth or location of a tumor buried withinpituitary


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Radiographic Examinations

Size and shape of other glands andnearby structures may be visualizedby use of a contrast media

Angiography and Venography mayreveal structural abnormalities inblood vessels and ultrasonography of

thyroid gland can indicate whethernodules or masses are solid or cystic


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Pituitary Hypofunction

Caused by a deficiency of one or

more anterior pituitary hormones

Results in metabolic abnormalitiesand sexual dysfunction


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Pituitary Hypofunction

Interventions focus on replacement ofdeficient hormones to treat delayed

puberty


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Testosterone therapy is initiated withhigh-dose testosterone derivativesand continued until virilization isachieved (deepened voice, increased

chest, facial, pubic and axillary hairgrowth)

Dose is then decreased, but therapy

continues throughout lifetime


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Androgen therapy is avoided in men with

prostate cancer

Male fertility may be decreased and/ordepleted due to testosterone therapy

Side effects include: gynecomastia (male breasts)

baldness

prostatic hypertrophy


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Women may be treated with a combination of

estrogen & progesterone administered attheir menstrual cycle

The risk for hypertension or thrombosis is

increased with estrogen therapy especiallyif the woman smokes

Female fertility may be decreased andmedications are needed to induce ovulation


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Growth Hormone Deficiency changes tissue growth

patterns indirectly In children, GH deficiency leads to short stature &

other manifestations of growth retardation

GH deficiency in adults produces no obvious

anatomic changes - does increase rate of bonedestructive activity leading to thinner, more fragilebones

Adult clients may be treated with injections of GH,

although this treatment is rare


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Pituitary Hyperfunction

A condition of hormone oversecretion that occurswhen client has pituitary tumors or hyperplasias

Tumors usually arise from:

somatotropic cells (growth hormone) lactotropic cells (prolactin)

corticotropic cells (adrenocorticotrophic hormone)

Can also be caused by hypothalmic dysfunction


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Adenomas can develop in clients without afamily history or as part of a syndrome knownas multiple endocrine neoplasia

Multiple endocrine neoplasia is a familialdisorder inherited as an autosomal dominanttrait may include parathyroid and pancreatic

tumors


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Benign epithelial tumor, which is classified bysize, degree of invasiveness and hormonesecreted

As it grows, it compresses brain tissue

causing neurologic symptoms, as well asendrocrine symptoms (i.e. visual changes,headache and increased ICP)


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Prolactin secreting tumors are most commonof the Pituitary Adenomas

Produces excessiveprolactin inhibitingsecretion of gonadal steroids and

gonadotropins in men Men (gynecomastia due to low levels of

testosterone & muscle weakness)

Women (no production of breast milk, nomenses)


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Overproduction of Growth Hormone

Results in gigantism or acromegaly

Onset may be gradual, slow progression, andchanges may remain unnoticed for years

before diagnosis

Early detection and treatment is essential toprevent irreverible changes in the soft

tissues, such as those of the face, hands,feet and skin


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Enlarged hands and feet in an adult are anindicator of growth hormone excess

Although some changes are reversible after

treatment for overproduction of growthhormone, skeletal changes are permanent


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Gigantism

Onset of Growth Hormone Hypersecretionoccurs before puberty causing rapidproportional growth in the length of all bones

Back pain and arthralgias (joint pain) may besymptoms in response to bone changes


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Gigantism


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Acromegaly

Occurs after puberty and produces increasedskeletal thickness, hypertrophy of the skinand enlargement of many visceral organs

such as liver and heart.


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Acromegaly


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Acromegaly


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Cushings Disease

Caused by hypersecretion of Adrenocorticotrophichormone (ACTH)

Results in overstimulationof Adrenal Cortex

producing excessive amounts of glucocorticoids,mineralcorticoids and androgens

Clients have alterations of nitrogen, carbohydrateand mineral metabolism


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Cushings Disease


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Posterior Pituitary

Disorders of posterior pituitary are directlyrelated to a deficiency or excess of hormoneVasopressin (antidiuretic hormone - ADH)

Two disorders associated with ADHdeficiency or ADH excess are: Diabetes Insipidus

Syndrome of Inappropriate Antidiuretic Hormone

(SIADH)


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Diabetes Insipidus

Two clinical manifestations/signs that alertyou to possible endocrine disorder would be:

increased thirst

increased urination

Diabetes Insipidus is a disorder of watermetabolism caused by a deficiencyof ADH


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Diabetes Insipidus

Source of ADH insufficiency is caused eitherby: decrease in ADH synthesis

inability of kidneys to respond appropriately toADH

ADH deficiency results in excretion of largevolumes of dilute urine called polyuria

Hypernatremia is a potential problem


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Diabetes Insipidus

Dehydration caused by massivediuresiscaused by polyuria results in an increase inplasma osmolality causing thirst

However, if thirst mechanism is inadequate orabsent, or if person is unable to obtain water,dehydration becomes moresevere


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Types of Diabetes Insipidus

Nephrogenic diabetes insipidus is an inheriteddisorder where the renal tubules do not respond tothe action of ADH.

This results in inadequatewater reabsorption by

kidney Urine output is then increased and specific gravity is

decreased.

With effective treatment, urine output is effectively

decreased and specific gravity is increased


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Primary Diabetes Insipidus: caused by a

defect in Hypothalmus or Pituitary Glandresulting in a lackof ADH production orrelease

Secondary Diabetes Insipidus: resultsfrom tumors within/adjacent to hypothalmusor pituitary gland, head trauma, infectiousprocesses, surgical procedures or metastatic

tumors.


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Drug-related Diabetes Insipidus : causedby administration of lithium carbonate ordemeclocycline as these drugs can

interfere with kidneys response to ADH.


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Clinical Manifestations of Diabetes

Insipidus

Loss of free water produces expectedchanges in blood and urine tests

Initial step in diagnosis is to measure a 24

hour fluid I&O. Urine output during thisperiod must be more than 4 liters fordiagnosis. However, it may vary from 4-30

liters in a day


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Insipidus vs. Mellitus

Diabetes Mellitusis endocrine problemcaused by a decreased sensitivity of insulinreceptors to presence of insulin

Diabetes Insipidusis endocrine problemcaused by an insufficiency of AntidiureticHormone (ADH)


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Drug Therapy for Diabetes Insipidus

Client with permanent Diabetes Insipidus requireslife-long vasopressin therapy

Client is instructed to recognize poluria and

polydipsia signals for another dose of medication All clients taking vasopressin need to record daily

weights to identify weight gains


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Syndrome of Inappropriate Antidiuretic

Hormone (SIADH)

Occurs when vasopressin (ADH) is secretedwhen plasma osmolarity is low or normal

Decrease in plasma osmolarity normally

inhibits ADH production and secretion In SIADH, the feedback mechanisms that

regulate ADH do not function properly ADHcontinues to be released even when plasma

is hyposmolar


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As a result of ADH secretion, water is

retained, resulting in: dilutional hyponatremia

expansion of the extracellular fluid volume

Pulmonary disorders (including Emphysema &other chronic lung diseases) can cause SIADHeither by causing increased secretion of ADHor ectopic synthesis of ADH.


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Adrenal Gland Hypofunction

Addisons Disease is caused by an insufficiency of

adrenocortical steroids causing problems throughloss of mineralocorticoid (aldosterone) andglucocorticoid (cortisol) action

Reducedaldosterone secretion causes potassium,sodium and water imbalances:

Hyperkalemia

Hyponatremia Hypovolemia


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Lower adrenal andogen levels result in

decreased/loss of body/axillary/pubic hair(esp. in women) because adrenals producemost of androgrens in females

Excessive production of melanocyte-stimulating hormone increases pigmentationof skin and causes darkening of skin

It can cause vitiligopatchy areas ofdepigmentation of skin


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Acute Adrenal Insufficiency

Called Addisonian crisis a life-threateningevent in which physiologic need forglucocorticoid and mineralocorticoid

hormones is greater than the available supply Usually occurs in response to a stressful

event (surgery, trauma, severe infection)


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Hormone Replacement

Glucocorticoid and mineralocorticoiddeficiencies are completely corrected byreplacement therapy

Drug regimen is divided into thirds 2/3given in morning and 1/3 given in lateafternoon to mimic normal adrenal hormone

secretion rhythm


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Additional mineralocorticoid hormone may beneeded (such as Florinef) to maintain correctelectrolyte balance (esp. Na and Kcl)

Adjustments may be needed in hot weather

to compensate for sodium loss due toexcessive perspiration

Salt restriction or diuretic therapy should not

be started withoutconsidering whether itmight precipitate an adrenal crisis


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Endocrine Disorders: Thyroid,

Parathyroid and Pancreas


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Graves Disease

(Hyperthyroidism)

Also known as Toxic Diffuse Goiter

Autoimmune disorder antibodies orimmunoglobulins are made and attach to

thyroid stimulating hormone (TSH) receptorsites on thyroid tissue

Thyroid gland increases in size and

overproduces thyroid hormones


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Presentation:

Goiter (enlargement of the thyroid gland)

Exophthalmos (abnormal protrusion of the eyes

giving a wide-eyed startled look) Pretibial myxedema (dry, waxy swelling of the

front surfaces of the lower legs)


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Graves Disease


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Clients may have excessive tearing,

bloodshot eye appearance or have sensitivityto light.

Fine, soft, silky hair and smooth, moist skin

are common with hyperthyroidism. Emotional lability (mood instability) is often

experienced. Client may also appear

extremely restless, irritable and fatigued.


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Extremity muscle weakness, hyperactivedeep tendon reflexes or tremors

Not all clients with goiter have

hyperthyroidism A hallmark assessment finding: heat

intolerance


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Hypothyroidism

Decreased metabolism from low levels ofthyroid hormones

Can occur at any time throughout life span;

however most often occurs in womenbetween ages 30-60. Women are affected 7-10 times more than men

Link between diabetes mellitus and

development of hypothyroidism has beenestablished


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Most tissues and organs are affected by lowmetabolic rate

Cellular energy production is decreased and

many metabolites build up (compounds ofprotein and sugars)


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Cellular energy is decreased and metabolites buildup inside of cells, which increases mucous andwater, thus forming cellular edema and changesorgan texture.

Cellular edema is called myxedema because it isNOT formed from water alone. Nonpitting edemaforms everywhere

Myxedema coma is rare serious complication

M d


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Myxedema

H h idi


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Hypothyroidism

Client reports more time sleeping (14 -16 hrsper day)

Generalized weakness, anorexia, muscle

aches and paresthesias Constipation is common, as is cold

intolerance

Women have difficulty getting pregnant or

changes in menses; Men have problems withimpotence and fertility

H h idi


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Hyperparathyroidism

Primary hyperparathyroidism results when 1or more parathyroid glands does not respondto normal feedback of serum calcium

In 80-85% of cases, cause is benign tumor in1 parathyroid gland

H h idi


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Hyperparathyroidism

Client may develop renal calculi (kidney stones) anddeposits of calcium in soft tissue of kidney

Pathologic fractures, bone cysts and osteoporosis iscaused due to increased rate of bone destruction(osteoclastia)

Anorexia, nausea, vomiting, epigastric pain,constipation and weight loss are common when

serum calcium levels are high


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Peptic ulcer disease can result from elevatedserum gastrin levels (hypergastrinemia)caused by hypercalcemia.

Fatigue and lethargy may be present and willbecome more severe as calcium levels rise


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Disorders of the Lymphatic System


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El h ti i


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Elephantiasis

Immune System Disorders


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Immune System Disorders

Hypersensitivity

Autoimmune Disease

Immunodeficiency Diseases


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Type II (antibody-dependant cytotoxic)- as intransfusion reaction.

Type III (immune complex)- large antibody-antigen complexes that get trapped under the tunic

interna of blood vessels and cause inflammation. Type IV (delayed)- occur 12 to 72 hours after

exposure. Delay commonly associated with traveltime to lymph nodes. Cosmetics and poison ivy

hapten commonly do this.

Autoimmune Diseases


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Autoimmune Diseases

Failure of the immune system to distinguish self fromforeign antigens.

Immune systems produces antibodies against bodies

own tissues.

Causes:

- Cross reactivity fight against a foreign antigenleds to antibodies that attack self.

- Abnormal exposure to self-antigens in the blood

- Changes in the structure of self-antigens



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SCID Severe combined immunodeficiency disease

- congenital deficiency of both T and B cells.

- susceptible to opportunistic infections.

- Bubble babies

AIDS Acquired


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AIDS AcquiredImmunodeficiency diseases

Acquired after birth, likeHIV.

HIV targets helper T cells Without these cells, all 3

immune responses arehampered.

Most patients with AIDS

die of opportunisiticinfections.

HIV virus

T torial Q estions


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Tutorial Questions

Discuss the following conditions

- Diabetes Mellitus

- Goiter

- Cushings Syndrome

- Pancreatitis

- HIV/AIDS

- Systemic Lupus Erythmatosus


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Endocrine Lymphatic and Immune Disorders

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