Patho Exam 3 Wunderlich Review/Transcript
Mechanisms of Hormonal Regulation
Ch. 21 p. 644-668
Ch. 22 p. 669-712
When a hormone is in a hypo- or hyper- state, you
have to know what that hormone does.
The endocrine system works on a feedback
system. For instance, ACTH
(adrenocorticotropic hormone). If there is
low cortisol level in the blood, that causes
that pituitary gland to excrete ACTH. ACTH
then circulates and causes an increase in
urinary cortisol.
Most of the endocrine system and the release
of hormones is dependent on that feedback
system to be working properly. If it doesn’t,
then we get into the pathophysiology.
For example:
p. 673 Hyperpituitarism (Primary Adenoma)
o Pituitary adenomas are usually benign, rarely malignant, slow-growing tumors that arise
from cells of the anterior pituitary
o The brain is housed in that limited vault. As it grows, it begins to push on other
structures. We call that paradoxically.
o So, paradoxically the pressure produced by a pituitary adenoma is also associated with
decreased function of neighboring anterior pituitary cells, which results in hyposecretion
of hormones, such as anterior pituitary hormones. So, once again, it’s not so much the
tumor, but it’s that paradoxically.
p. 679 Hypothyroidism
Everything slows down. S/S: Sluggish,
lethargic feeling, fatigued. But the other thing
is their skin is dry and flaky, hair becomes dry
and coarse. And so some of those Sx can be
ignored. Because who isn’t fatigued? Look at
the facial features: Periorbital edema, or boggy
look under eyes. The other thing that we
associate hypothyroidism is that Bradycardia.
One more thing, so it’s not only the cardiac it’s
also the respiratory system. So, this is where
we start getting into trouble with our patients.
They get Dyspneic and hypoventilation, and
the clinical manifestation is increased PaCO2
, related to decreased ventilatory status. So they start hanging onto CO2. So that’s a very critical
sign that measures need to be taken to reverse the hypothyroidism.
p. 676 Hyperthyroidism (aka Thyrotoxicosis) Conditions
Everything is sped up. The classic sign is exophthalmos, bulging eyes. Increased heart rate,
tremor, anxious, feeling of doom (and pt not sure why). Most concerned about the arrhythmias
and tachycardia. One of the most common:
› Primary hyperthyroidism causes include Graves disease (type 2 hypersensitivity reaction)
Remember the Clinical Manifestations
p. 683 Hypoparathyroidism (low levels of PTH)
Calcium and phosphorus balance are regulated by the parathyroid. Calcium and phosphorus have
a reciprocal relationship. If there is decreased Ca++, PTH (parathyroid hormone) increases. It
increases that osteoclastic activity and tears down bones to get to the calcium. The body doesn’t
care about those bones. But it does care about the function of the cardiac system. Women have a
more fragile bone density than males, so they are prone to osteoporosis. Increased calcium levels
will suppress PTH, so feedback system is necessary for hormones to function properly.
p. 671 Diabetes Insipidus: insufficiency of ADH, leading to polyuria & polydipsia
› ADH- think “water”
› If there’s not enough ADH to hang onto
that water, you get polyuria. There’s
nothing to keep the water in, so the patient
experiences increased urination. Large
amounts of urinary output. (polyuria)
› This causes a hemoconcentration of
sodium so they’re hypernatremic. This can
come on suddenly. They’ll show
manifestations of hypernatremia related to
hemoconcentration.
› Thirst, extreme polydipsia.
› Need to differentiate DI from other polyuric states is because the treatment is different.
For instance, DM is a polyuric state but the pathophysiology is different so we need to
treat it differently.
Diabetes Mellitus
p. 693 Diabetic Ketoacidosis (DKA): serious complication of DM
o Usually when a patient is newly diagnosed with these signs and symptoms.
o #1 cause of DKA is infection
o They present with polyuria, but the cause of the polyuria is osmotic diuresis, associated
with extreme hyperglycemia. This causes the signs and symptoms.
o They are in a metabolic acidotic state because the cells in the body are not getting
glucose. You have to have insulin so the insulin grabs glucose molecules, takes it into the
cell, and the cell is happy. But, even though there’s lots of glucose in the body, there’s no
Mechanisms of Hormonal Regulation
Ch. 21 p. 644-668
Ch. 22 p. 669-712
When a hormone is in a hypo- or hyper- state, you
have to know what that hormone does.
The endocrine system works on a feedback
system. For instance, ACTH
(adrenocorticotropic hormone). If there is
low cortisol level in the blood, that causes
that pituitary gland to excrete ACTH. ACTH
then circulates and causes an increase in
urinary cortisol.
Most of the endocrine system and the release
of hormones is dependent on that feedback
system to be working properly. If it doesn’t,
then we get into the pathophysiology.
For example:
p. 673 Hyperpituitarism (Primary Adenoma)
o Pituitary adenomas are usually benign, rarely malignant, slow-growing tumors that arise
from cells of the anterior pituitary
o The brain is housed in that limited vault. As it grows, it begins to push on other
structures. We call that paradoxically.
o So, paradoxically the pressure produced by a pituitary adenoma is also associated with
decreased function of neighboring anterior pituitary cells, which results in hyposecretion
of hormones, such as anterior pituitary hormones. So, once again, it’s not so much the
tumor, but it’s that paradoxically.
p. 679 Hypothyroidism
Everything slows down. S/S: Sluggish,
lethargic feeling, fatigued. But the other thing
is their skin is dry and flaky, hair becomes dry
and coarse. And so some of those Sx can be
ignored. Because who isn’t fatigued? Look at
the facial features: Periorbital edema, or boggy
look under eyes. The other thing that we
associate hypothyroidism is that Bradycardia.
One more thing, so it’s not only the cardiac it’s
also the respiratory system. So, this is where
we start getting into trouble with our patients.
They get Dyspneic and hypoventilation, and
the clinical manifestation is increased PaCO2
, related to decreased ventilatory status. So they start hanging onto CO2. So that’s a very critical
sign that measures need to be taken to reverse the hypothyroidism.
p. 676 Hyperthyroidism (aka Thyrotoxicosis) Conditions
Everything is sped up. The classic sign is exophthalmos, bulging eyes. Increased heart rate,
tremor, anxious, feeling of doom (and pt not sure why). Most concerned about the arrhythmias
and tachycardia. One of the most common:
› Primary hyperthyroidism causes include Graves disease (type 2 hypersensitivity reaction)
Remember the Clinical Manifestations
p. 683 Hypoparathyroidism (low levels of PTH)
Calcium and phosphorus balance are regulated by the parathyroid. Calcium and phosphorus have
a reciprocal relationship. If there is decreased Ca++, PTH (parathyroid hormone) increases. It
increases that osteoclastic activity and tears down bones to get to the calcium. The body doesn’t
care about those bones. But it does care about the function of the cardiac system. Women have a
more fragile bone density than males, so they are prone to osteoporosis. Increased calcium levels
will suppress PTH, so feedback system is necessary for hormones to function properly.
p. 671 Diabetes Insipidus: insufficiency of ADH, leading to polyuria & polydipsia
› ADH- think “water”
› If there’s not enough ADH to hang onto
that water, you get polyuria. There’s
nothing to keep the water in, so the patient
experiences increased urination. Large
amounts of urinary output. (polyuria)
› This causes a hemoconcentration of
sodium so they’re hypernatremic. This can
come on suddenly. They’ll show
manifestations of hypernatremia related to
hemoconcentration.
› Thirst, extreme polydipsia.
› Need to differentiate DI from other polyuric states is because the treatment is different.
For instance, DM is a polyuric state but the pathophysiology is different so we need to
treat it differently.
Diabetes Mellitus
p. 693 Diabetic Ketoacidosis (DKA): serious complication of DM
o Usually when a patient is newly diagnosed with these signs and symptoms.
o #1 cause of DKA is infection
o They present with polyuria, but the cause of the polyuria is osmotic diuresis, associated
with extreme hyperglycemia. This causes the signs and symptoms.
o They are in a metabolic acidotic state because the cells in the body are not getting
glucose. You have to have insulin so the insulin grabs glucose molecules, takes it into the
cell, and the cell is happy. But, even though there’s lots of glucose in the body, there’s no
