Hashimoto's thyroiditis

-Is the most common form of thyroid gland inflammation (thyroiditis) and the most frequent cause of decreased thyroid hormone production (hypothyroidism). It results from an autoimmune disorder, an attack on the thyroid gland by a person's own immune system.-Most common in women in middle age

-Symptoms :

.fatigue

.weight gain

.pale or puffy face

.feeling cold

.joint and muscle pain

.constipation

.dry and thinning hair

.heavy menstrual flow or irregular periods

.depression

.panic disorder

.slowed heart rate

.problems getting pregnant and maintaining pregnancy.

-Complications :

.thyroid lymphoma, generally the B-cell type

.non-Hodgkin lymphoma

-Risk factors :

.a family history of thyroid disorders is common

.with the HLA-DR5 gene

.associated with CTLA-4 (Cytotoxic T-lymphocyte Antigen-4) gene polymorphisms

.associated with autoimmune pathology seen in development of type I diabetes

.the incidence is increased in patients with chromosomal disorders, including Turner, Down's, and Klinefelter syndromes

Hyperparathyroidism

-Is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). The parathyroid hormone regulates calcium and phosphate levels and helps to maintain these levels

*Primary :

-Primary hyperparathyroidism results from a hyperfunction of the parathyroid glands themselves.

-Oversecretion of PTH due to :

.parathyroid adenoma

.parathyroid hyperplasia

.rarely, a parathyroid carcinoma.

*Secondary :

-Secondary hyperparathyroidism is due to physiological secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low or normal blood calcium levels). The most common causes are vitamin D deficiency and chronic kidney failure.

-Signs & Symptoms :

.weakness and fatigue

.depression, bone pain

.muscle soreness (myalgias)

.decreased appetite

.feelings of nausea and vomiting

.constipation

.polyuria, polydipsia

.cognitive impairment

.kidney stones

.osteoporosis ,Pathologic fractures,Osteomalacia)

.racquet nails (trachyonychia)

.Parathyroid adenomas are very rarely detectable on clinical examination

.rickets, osteomalacia and renal osteodystrophy.

Hypoparathyroidism

-Is decreased function of the parathyroid glands with underproduction of parathyroid hormone. This can lead to low levels of calcium in the blood

-Causes :

.after thyroid or parathyroid gland surgery (thyroidectomy)

.autoimmune invasion and destruction is the most common non-surgical cause. It can occur as part of autoimmune polyendocrine syndromes.

.absence or dysfunction of the parathyroid glands is one of the components of chromosome 22q11 microdeletion syndrome (other names: DiGeorge syndrome, Schprintzen syndrome, velocardiofacial syndrome).

.hemochromatosis (iron overload)

.magnesium deficiency

.idiopathic (of unknown cause), occasionally familial (e.g. Barakat syndrome (HDR syndrome) a genetic development disorder resulting in hypoparathyroidism, sensorineural deafness and renal disease)

Adrenal Cortex

-The adrenal cortex produces sreroids :

1.Glucocorticoids (cortisol)

2.Mineralocarticoids (which control potassium & sodium)

3.Androgens (sex hormones)

Cushing`s Syndrome

-Is a collection of signs and symptoms due to prolonged exposure to cortisol

-Symptoms :

.high blood pressure

.abdominal obesity but with thin arms and legs reddish stretch marks, a round red face, a fat lump between the shoulders

.weak muscles, weak bones (proximal myopathy)

.acne, and fragile skin that heals poorly

.changes in mood

.headaches

.chronic feeling of tiredness

.moon face

.excess sweating, dilation of capillaries

.hirsutism

.insomnia

.impotence in men

.amenorrhoea/oligomenorrhea and infertility

.hypercortisolism, which feeds back onto the hypothalamus resulting in decreased levels of GnRH release

.hypokalemia

.hypertension

.hypocalcemia

.hypercholesterolemia

.osteoporosis

.psychiatric symptoms

.ecchymosis

.immune suppression

.rapid weight gain

.irritability, or depression

.muscle and bone weakness

.memory and attention dysfunction

**Adrenocortical Insufficiency (Addison's disease)

-Is a rare, chronic endocrine system disorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids ”cortisol” and mineralocorticoids “aldosternone”)

-Addison's disease is associated with the development of other autoimmune diseases, such as type I diabetes, thyroid disease (Hashimoto's thyroiditis), and vitiligo

-Symptoms & Signs :

.sudden penetrating pain in the legs, lower back or abdomen

.severe vomiting and diarrhea, resulting in dehydration

.low blood pressure

.syncope

.hypoglycemia

.confusion, psychosis, slurred speech

.severe lethargy

.hyponatremia

.hyperkalemia

.hypercalcemia

.convulsions

.fever

.axillary hair loss

.hyperpigmentation of the skin

.ACTH is high

.causes small heart

.may be secondary to tuberculosis

.fatigue,weakness,anorexia,weight loss,dizziness

Hyperaldosteronism

-Is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalemia)

Pheochromocytoma

-Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure. It usually develops in the center (medulla) of one or both adrenal glands,and associated with paroxysmal hypertension

-Symptoms & Signs :

.abdominal pain

.chest pain

.irritability

.nervousness

.pallor

.palpitations

.rapid heart rate

.severe headache

.sweating

.weight loss

.hand tremor

.high blood pressure

.sleeping difficulty

.seizures

.visual disturbances

.abdominal pain,nausea,constipation

Gynecomastia

-Is a common endocrine disorder in which there is a benign enlargement of breast tissue in males

-Cause :

.Physiologic (M.C)

.liver cirrhosis

.bronchogenic carcinoma

.testicular atrophy

.digitalis therapy

.old age

.liver disease

.hyperthyroidism (hyperparathyroidism is not)

.methyldopa, cimetidine,spironolactone (Furosemide is not)

.puberty

.bronchogenic carcinoma

.klinfelter's syndrome

.digoxin therapy

Pituitary gland

*Anterior pituitary (adenohypophysis) :

.growth hormone

.thyroid-stimulating hormone (TSH)

.adrenocortitropic hormone (ACTH)

.prolactin hormone(PRL)

.gonadotropins (luteinizine hormone “LH” – follicle-stimulating hormone “FSH”)

.MCTH

*Posterior pituitary (neurohypophysis) :

.oxytocin

.antidiuretic hormone (ADH) also known as vasopressin

-Hormones are increased with stress :

.ACTH

.TSH

.Insulin

.Glucagon

Hypopituitarism

-Is the decreased secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain.If there is decreased secretion of most pituitary hormones, the term panhypopituitarism (pan meaning "all") is used

-Sheehan's syndrome

.Is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth

-Clinical Features :

.hypotension

.cold intolerance

.loss of secondary sexual characteristics

.infertility

.hair loss

.hypoglycemia

Hyperprolactinemia

-Is the presence of abnormally high levels of prolactin in the blood. Normal levels are less than 500 mIU/L for women, and less than 450 mIU/L for men.

-Causes :

.pregnancy,breast-feeding,stress

.drugs (M.C.C) ;phenothiazines,metoclopramide (maxolon),haloperidol,alpha-methyldopa (aldomet),oestrogens, cimetidine (Tagamet), narcotics

.micro-macroadenoma

.pititary adenomas (pituitary tumor)

.surgery,trauma

.hypothalamic disease

.chronic renal failure

.oral contraception

+Intrauterine contraceptive device is NOT

Acromegaly

-This disease is due to hypersecreation of GH (growth hormone) from a pituitary tumor / it presents between 30-50yrs old

-Clinical Features :

.features of a pituitary tumor (hypopituitarism + local mass effect)

.soft tissue swelling visibly resulting in enlargement of the hands, feet, nose, lips and ears, and a general thickening of the skin

.soft tissue swelling of internal organs

.seneralized expansion of the skull at the fontanelle

.pronounced brow protrusion, often with ocular distension (frontal bossing)

.pronounced lower jaw protrusion (prognathism) with attendant macroglossia (enlargement of the tongue) and teeth spacing

.pypertrichosis, hyperpigmentation, and hyperhidrosis may occur in these patients.

.acrochordon (skin tags)

.carpal tunnel syndrome

-Complications :

.severe headache

.arthritis and carpal tunnel syndrome

.enlarged heart

.hypertension

.diabetes mellitus (excess of GH leads to insulin resistance)

.heart failure

.kidney failure

.colorectal cancer

.compression of the optic chiasm leading to loss of vision in the outer visual fields (typically bitemporal hemianopia)

.increased palmar sweating and sebum production over the face (seborrhea)

.muscular weakness

Diabetes insipidus

-Is a condition characterized by excessive thirst and excretion of large amounts of severely dilute urine(>3L/day), with reduction of fluid intake having no effect on the concentration of the urine

-Symptoms & Signs :

.polyuria

.polydipsia

.dehydration

.hyper-natraemia

.fever,vomiting or diarrhea

-Causes :

.idiopathic

.congenital

.tumors (craniopharyngioma,metastasis,pituitary tumor)

.trauma (head injury)

.sarcoidosis

.vascular (sheehan`s syndrome,haemorrhage)

.infection (meningioencephalitis)

.drugs (lithium,demecolocycline,chronic renal disease,post-obstructive uropathy)

.occurs in histiocytosis

.can be familial disease

.can cause failure to thrive

.can cause developmental delay

GASTROENTEROLOGY

+Leukoplakia refer to A white patch

+causes mouth ulceration :

.herpes simplex type II

.syphilis

.crohn's disease

.behcet's disease

+causes macroglossia :

.hypothyroidism

.down's syndrome

.acromegaly

.amyloidosis

+features of herpetic stomatitis :

.vesicles and ulcers on the buccal mucosa as well as tongue and palate

.inflamed gums

.pain

.cervical lymph glands enlargement

Dysphagia

-Is difficulty in swallowing

-Odynophagia (is painful swallowing, in the mouth or esophagus. It can occur with or without dysphagia.

-Dysphagia may occur in :

.carcinoma of esophagus

.systemic sclerosis

.achalasia

.infections (candida esophagitis,HSV)

.gastric,pharyngeal,lung cancer

.aortic aneurysm

.diffuse esophageal spasm

.reflux esophagitis

.chagas` disease

Achalasia

-Failure of relaxation of the lower oesophageal sphincter

-Characterized by :

.difficulty in swallowing (progressive inability to swallow solids and liquids)

.sometimes chest pain

.dec. wight

.it occurs more in women about forty years of age

.regurgitation and aspiration pneumonia are common

-Diagnosis :

.esophageal manometry

.barium swallow radiographic studies.

.esophagogastroduodenoscopy EGD

-Treatment :

.pneumatic dilation or surgery (surgical myotomy)

.boulinum toxin

Date: 2016-04-22; view: 522