Lesson: Pathology Endocrine #1

Lesson: Pathology Endocrine #1

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Diabetes Mellitus

*Two types of diabetes: Mellitus and Insipidus*

We will be looking ad Diabetes Mellitus Type 1 and Type 2

Symptoms of Diabetes Mellitus

• Main: increased thirst, urination, and hunger

• Others: blurred vision, drowsiness, nausea, decreased endurance during exercise

• Type 1: symptoms begin abruptly and dramatically, diabetic ketoacidosis, nausea, fatigue, vomiting, abdominal pain, coma, death

• Type 2: fatigue, dehydration, mental confusion, drowsiness, seizures

• Complications: stroke, diabetic retinopathy, heart attack, chronic kidney disease (diabetic nephropathy), diabetic neuropathy

Prediabetes

A condition in which blood glucose levels are too high to be considered normal but not high enough to be labeled diabetes.

Prediabetes carries a higher risk of future diabetes as well as heart disease.

Decreasing body weight by 5 to 10% through diet and exercise can significantly reduce the risk of developing future diabetes.

Type 1 Diabetes Mellitus

• Insulin-dependent diabetes or juvenile-onset diabetes

• The body's immune system attacks the insulin-producing cells of the pancreas; > 90% of them are permanently destroyed

• Pancreas produces little/no insulin

• 5 to 10% of diabetics: environmental, viral, autoimmune

Type 2 Diabetes Mellitus

• non-insulin dependent diabetes

• The pancreas produces insulin, however, the body develops resistance to the effects of insulin.

• Eventually, the pancreas ability to produce insulin decreases

• More at risk 2-3x: blacks, asian americans, american indians, spanish/latin americans

Diagnosis & Treatment

• Diagnosis: Blood glucose measurement, hemoglobin A1C, Oral glucose tolerance test, screening for diabetes

• Treatment: diet, exercise, weight loss, education

• TX type 1: insulin injections

• TX type 2: oral medication, insulin/other drugs by injection, insulin pump

• Monitoring: fingerstick glucose test, continuous glucose monitoring systems

Multiple Choice

Gestational diabetes occurs

• during pregnancy

• after a bout with shingles

• after birth

• after menopause

Multiple Choice

Type 2 diabetes can cause long-term damage in the

• kidneys

• eyes

• nerves

• all of the above

Multiple Choice

Patients with diabetes have an increased risk of all of the following EXCEPT

• Cataracts

• Infections

• Peripheral neuropathy

• Pancreatic carcinoma

Multiple Choice

The risk factors for type 1 diabetes include all of the following except:

• diet

• genetic

• autoimmune

• environmental

Multiple Choice

Your client was diagnosed with metabolic syndrome 4 years ago. Since then, he has changed his eating and exercise habits so that his blood sugar, cholesterol, and blood pressure are all in healthy range. The only remaining risk factor is his large waist. He would like to receive a massage to help him recover from injuries related to a recent motor vehicle accident. What accommodations does he need based on his history?

• He needs a doctor’s clearance to receive massage therapy because of cardiovascular risk

• He needs to check his blood sugar before and after each massage therapy session; have some juice handy in case he has a hypoglycemic episode

• This contraindicates rigorous massage therapy, but light, restrained work may be safe and appropriate

• This does not require any massage therapy accommodations, but his recent injury might.

Multiple Choice

an autoimmune disorder targets beta cells in the pancreas, which hormone would be directly affected?

• pancreatic amylase

• somatostatin

• glucagon

• insulin

Thyroid Disease

Hyperthyroidism, Hypothyroidism, Thyroid Cancer

Hyperthyroidism (Thyrotoxicosis)

• Overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions

• Graves is the most common cause; other causes toxic multinodular goiter, thyroiditis, single toxic nodule, drugs, iodine, overactive pituitary gland

Hyperthyroidism symptoms

• increased heart rate and blood pressure

• palpitations due to abnormal heart rhythms

• excessive sweating and feeling too warm

• hand tremors - shakiness AND nervousness AND anxiety

• frequent bowel movement AND/OR Change in menstrual periods

• weight loss despite increased appetite

• increase activity level despite fatigue and weakness

Thyroid storm: LIFE-THREATENING

Sudden extreme overactivity of the thyroid gland

life-threatening emergency

All body functions are accelerating to dangerously high levels putting severe strain on the heart causing arrhythmia, fast pulse, and shock.

Can also cause fever, extreme weakness, restlessness, mood swing, confusion, altered consciousness, enlarge liver, mild jaundice.

HYPOthyroidism

• The thyroid doesn't make enough hormone

• Visual symptoms: puffy eyes, puffy face, droopy eyelids, thin-rough-dry hair, rough-dry-scaly-thick skin, hoarse voice, slow speech

• Feeling symptoms: constipation, getting cold, tingling, hands hurt, slow heartbeat, confusion, forgetfulness, depression

Thyroid Cancer

- 4 types: papillary (most common/easy to cure), follicular, medullary, anaplastic (rarest & most deadly)

- first sign is a painless lump in your neck

- more common in women and people who have been treated with radiation

Symptoms: feeling of fullness in neck, a hoarse voice, cough, difficulty breathing

No known cause

Multiple Choice

A client comes in with abnormally high levels of T3 and T4, and abnormally low levels of TSH. Based on this information, you can guess that her problem originates in:

• pancreas

• thyroid gland

• anterior pituitary gland

• hypothalamus

Multiple Choice

Which of the following is NOT a common symptom of hypothyroidism?

• hair loss

• dry skin

• weight gain

• excessive hair growth

Multiple Choice

Which one of the following statements describes the underlying pathology of Grave’s Disease?

• Inflammation of the thyroid gland due to lymphocytic infiltration

• an autoimmune disease directed against thyroid stimulating hormone (TSH) receptors

• Consumption of ground beef which has been contaminated with thyroid tissue

• benign tumor of the thyroid gland which produces excessive amounts of thyroid hormones

Multiple Choice

Which of the following statements best describes Hashimoto’s Thyroiditis?

• destructive autoimmune disease caused by auto-reactive antibodies against thyroglobulin

• Inflammation of the thyroid gland as the result of a virus

• Iodine deficiency

• Consumption of ground beef which has been contaminated with thyroid tissue

Multiple Choice

What is the most common cause of hyperthyroidism?

• Grave's Disease

• Toxic thyroid adenom

• Thyroiditis

• Toxic multinodular goiter

Multiple Choice

A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition?

• weight loss

• weight gain

• intolerance to heat

• hair loss

Multiple Choice

extreme buldging of the eyes is called

• exopthalmos

• myedema

• acromegaly

• goiter

Obesity & Metabolic Syndrome

Obesity

• Having too much body fat. Obesity causes health problems. The more body fat you have, the higher your risk of health problems (diabetes, high blood pressure, heart disease, certain cancers)

• Causes: not enough physical activity, eating high-calorie foods, family members who are obese, been obese as a child, not losing pregnancy weight, menopause, eating disorders, certain medication, sleeping less than 6 hours, changes in normal germs in the intestine

• Symptoms: trouble breathing, snoring, skin problems, joint and back pain

Metabolic Syndrome

• A group of health problems that involve your metabolism and give you a higher chance of having heart disease, stroke, and diabetes

• 1) lots of fat around the waist - 2) high blood pressure - 3) high blood sugar - 4) high levels of fat in the blood

• Symptoms are related to complications: coronary artery disease, high blood pressure, diabetes

Dwarfism - GH deficiency

• Occurs when the pituitary gland does not produce enough growth hormone

• Causes: Idiopathic, brain tumor, a congenital disorder

• Symptoms/Signs: poor overall growth rate, delay in tooth development, delay in puberty, hypoglycemia, jaundice, micropenis, cleft palate

Multiple Choice

A disorder involving too much growth hormone as an adult is called

• acromegaly

• gigantism

• hyperthyroidism

• metabolic syndrome