Endocrine disorders

Total or partial hypopituitarism may result from disorders such as hemochromatosis (S72) or sarcoidosis (S26), which may raise serum alkaline phosphatase because of their effect on the liver. However, no correlation can be demonstrated in these conditions between serum alkaline 

Van E en Bosch et al. (VI) measured serum alkaline phosphatase in boys with delayed puberty who had been given very short courses of chorionic gonadotropin. The mean value almost doubled within 5 weeks of this medication. 

Riggs et al. (R20) showed that patients with acromegaly had normal serum alkaline phosphatase values. Stepan et al. (S66), similarly, found that hyperphosphatasemia is often absent in acromegaly. However, significantly elevated levels of the bone isoenzyme were demonstrated in 84 % of patients with elevated serum growth hormone values (S66). 

Talbot et al. (Tl) stated that patients with juvenile hypothyroidism have lower serum alkaline phosphatase values than age- and sex-matched controls, and that the values become normal after replacement therapy. Chertow et al. (C13), who studied 15 hypothyroid patients, found normal serum alkaline phosphatase activities in each case. 

Dalovisio et al. (D2) described three patients with subacute thyroiditis and serum alkaline phosphatase elevation. The values returned to within the reference range 8-12 weeks after the onset of symptoms. 

On completion of the following two case study, you will be able to  

Clinical Physiology and Pharmacology Farideh Javid and Janice McCurrie 

Q2 Which hormones are secreted by the thyroid gland Which is the most active of the thyroid hormones  

Q3 Draw a flow chart showing the mechanisms that control thyroid hormone release from the thyroid gland. 

Q4 Describe the characteristics of hyperthyroidism. Are the signs and symptoms experienced by Mrs Kay consistent with the pro hie of hyperthyroidism  

The syndrome of inappropriate antidiuretic hormone secretion, with resultant hyponatremia, may be induced by carbamazepine treatment. Alcoholic patients may be at greater risk for hyponatremia. 

Weight gain does not appear to be a side effect of carbamazepine therapy. 

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An endocrine disorder first described by the British Physician Thomas Addison in the mid 1800 s. The adrenal glands fail to produce sufficient amounts of glucocorticoid hormones (cortisol) and sometime mineralocorticoid (aldosterone). If left untreated it is life-threatening, the patient will show muscle weakness, hyperpigmentation and even depression. Typical treatment is hydrocortisone replacement therapy. 

Type 2 diabetes is a heterogeneous and progressive endocrine disorder associated with insulin resistance (impaired insulin action) and defective function of the insulin-secreting (3-cells in the pancreatic islets of Langerhans. These endocrine disorders give rise to widespread metabolic disturbances epitomised by hyperglycaemia. The present classes of antidiabetic agents other than insulin act to either increase insulin secretion, improve insulin action, slow the rate of intestinal... 

Category X) and lactation. The HMG-CoA reductase inhibitors are used cautiously in patients with a history of alcoholism, acute infection, hypotension, trauma, endocrine disorders, visual disturbances, and myopathy. 

People who should not work with organophosphate insecticides are those with organic central nervous system disease, mental disorders, epilepsy, pronounced endocrine disorders, respiratory conditions, cardiovascular diseases, circulatory disorders, gastroenteric diseases, liver or kidney disease, and chronic conjunctivitis and keratitis (Medved and Kagan 1983). 

Chronic diarrhea lasts for longer than 4 weeks. Most cases result from functional or inflammatory bowel disorders, endocrine disorders, malabsorption syndromes and drugs (including laxative abuse). In chronic diarrhea, daily watery stools may not occur. Diarrhea may be either intermittent or persistent. 

Endocrine disorders (hypogonadism and pituitary, adrenal, and thyroid disorders)... 

Medical disorders (e.g., chronic renal disease, anorexia nervosa, endocrine disorders)... 

Acanthosis nigricans A skin condition characterized by dark, thickened velvety patches, especially in the folds of skin in the armpits, groin, and back of the neck that is often associated with insulin resistance. Also may be associated with internal malignancy, endocrine disorders, and obesity. 

Secondary OA is associated with a known cause such as rheumatoid arthritis or another inflammatory arthritis, trauma, metabolic or endocrine disorders, and congenital factors. 

Uncommon causes of diabetes (1% to 2% of cases) include endocrine disorders (e.g., acromegaly, Cushing s syndrome), gestational diabetes mellitus (GDM), diseases of the exocrine pancreas (e.g., pancreatitis), and medications (e.g., glucocorticoids, pentamidine, niacin, and a-interferon). 

Disorders of the GI tract (e.g., irritable bowel syndrome or diverticulitis), metabolic disorders (e.g., diabetes), or endocrine disorders (e.g., hypothyroidism) may cause constipation. 

Thyroid function studies may be performed to determine the presence of metabolic or endocrine disorders. 

Bone marrow failure Anemia of chronic disease Renal failure Endocrine disorders Myelodysplastic anemias... 

Endocrine disorders Adrenal Addison s disease and Cushing s disease Diabetes mellitus Parathyroid hyper-/hypo-Reproductive ovary/testicle failure Thyroid hyper-/hypo-... 

Anxiety Disorder Due to a General Medical Condition with Panic Attacks. Many medical illnesses are associated with anxiety and even recurrent panic attacks. These include endocrine disorders, such as hyperthyroidism, hyperparathyroidism, hypoglycemia, and pheochromocytomas, inner ear (vestibular) dysfunction, seizure disorders, and cardiac (heart) disorders such as supraventricular tachycardia, mitral valve prolapse, and various arrhythmias, and carcinoid. A general physical examination, routine laboratory studies including electrolytes and... 

Levodopa must be used with caution in patients suffering from endocrine disorders such as diabetes mellitus. 

Polycystic ovary syndrome endocrine disorder characterised by amenorrhoea, hirsutism and infertility Porphyria inherited disorders presenting with increased production of porphyrins in the bone marrow Prostatic hyperplasia enlargement of the prostate Pseudomembranous colitis diarrhoea occurring in patients who received antibacterial agents, caused by the resulting overgrowth of anaerobic bacteria in the gastrointestinal tract... 

Endocrine disorders Primary or secondary adrenal cortical insufficiency (hydrocortisone or cortisone is the drug of choice synthetic analogs may be used in conjunction with mineralocorticoids in infancy, mineralocorticoid supplementation is important) congenital adrenal hyperplasia nonsuppurative thyroiditis hypercalcemia associated with cancer. 

Endocrine disorders Thyroid hormone therapy in patients with concomitant diabetes mellitus or insipidus or adrenal insufficiency (Addison disease) exacerbates the intensity of their symptoms. 

Endocrine disorders Peginterferon alfa-2a causes or aggravates hypothyroidism and hyperthyroidism. Hyperglycemia, hypoglycemia, and diabetes mellitus have developed in patients treated with peginterferon alfa-2a. 

Fever is common in, and often a sign of, infection irrespective of its cause. Other diseases, which cause fever, are tumours, non-infectious inflammations, endocrine disorders and thrombo-embolic disease. Drugs can cause fever, e.g. angiotension-II-antagonists, ACE inhibitors and phenytoin. 

Serious, acute hypersensitivity reactions, such as urticaria, angioedema, broncho-constriction, and anaphylaxis, may occur. Other rare reactions include pancreatitis, colitis, endocrine disorders (e.g., diabetes mellitus), hyperthyroidism or hypothyroidism, ophthalmologic, neuropsychiatric, autoimmune, ischemic, infectious, and pulmonary disorders. 

Isojarvi JI, Laatikainen TJ, Knip M, et al Obesity and endocrine disorders in women taking valproate for epilepsy. Ann Neurol 39 579-584, 1996... 

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