Lecture 8 - Endocrine Pathologies Bio416K Spring 2010(2) LECTURE 9......

Disease characterized by persistent hyperglycemia

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Disease characterized by persistent hyperglycemia, losses in muscle and bone protein, edema and hypertension . So-called ‘cushingoid’ signs include a swollen “moon” face and redistribution of fat to the face, abdomen and posterior neck. Adrenal cortex hypersecretion may be caused by ACTH-releasing pituitary tumor or by tumor of the adrenal cortex. Most often results from clinical administration of pharmacological doses of glucocorticoid drugs. Treatment is removal of cause – be it surgical removal of tumor or discontinuation of drug.
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Addison’s Disease Hyposecretion of adrenal cortex hormones with deficits in both glucocorticoids and mineralocorticoids. Disease characterized by hypoglycemia, dehydration and hypotension, small hearts, and abnormal skin pigmentation. Fasting can cause fatal hypoglycemia. Most often due to autoimmune destruction of adrenal cortex. Corticosteroid replacement therapy is usual treatment for the disease.
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Pheochromocytoma Hypersecretion of adrenal medulla hormones (epinephrine) arising from a chromaffin cell tumor. Disease characterized by hyperglycemia, high blood pressure, rapid heart rate, intense nervousness, excessive sweating, heat intolerance. Uncontrolled sympathetic nervous system activity Surgical removal of tumor is an effective therapeutic strategy. Medications such as alpha-adrenergic and beta-adrenergic receptor antagonists often used.
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Diabetes Insipidus Characterized by excessive urination (polyuria, large amounts of severely diluted urine) and extreme thirst. Symptoms of diabetes insipidus are quite similar to those of untreated diabetes mellitus , with the distinction that the urine is not sweet as it does not contain glucose and there is no hyperglycemia (elevated blood glucose ). There are several forms of DI: Cranial diabetes insipidus (central or neurogenic) is a deficiency of ADH due to damage to the hypothalamus or pituitary due to a tumor , stroke , neurosurgery or some other much rarer cause. Nephrogenic diabetes insipidus is due to the inability of the kidney to respond normally to ADH. Many are hereditary causes due to mutations of the ADH receptor or the aquaporin 2 water channel. It can also be induced iatrogenically by various drugs. Patients with central diabetes insipidus respond to desmopressin . Desmopressin will be ineffective in nephrogenic diabetes insipidus.
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Diabetes Mellitus Results from either hyposecretion of insulin ( type 1 ) or target tissue hypo- sensitivity to insulin action or insulin resistance ( type 2 ). Without the actions of insulin, blood sugar levels remain high because glucose is unable to enter many cells.
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