Thyroid, Parathyroid and Adrenal

Dysfunction

Prepared by Gabrielle Metelli & Kathleen Dixon - 2009

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Objectives

¾ Develop an understanding of the pathophysiology of disorders of the

thyroid, parathyroid and adrenal glands.

¾ Describe the clinical manifestations of disorders of the thyroid,

parathyroid and adrenal glands.

¾ Discuss treatment of these disorders, especially pharmacological

management.

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 Disorders of the thyroid gland

Thyroid hormone deficiency

¾ Hypothyroidism
¾ Hasmimoto’s thyroiditis

Thyroid hormone excess

¾ Hyperthyroidism
¾ Grave’s disease

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Thyroid hormone deficiency Clinical manifestations: TH

deficiency
¾ Thyroid hormones are produced by
the follicular cells of the thyroid ¾ Goitre
gland
¾ Slow onset of weight gain

¾ Thyroid hormones are

¾ Lack of appetite
¾ thyroxine or T4 and
¾ triiodothyronine or T3
¾ Weakness, fatigue and cold intolerance

¾ A deficiency of thyroid hormone ¾ Dry skin and coarse, brittle hair

¾ leads to hypothyroidism
¾ the most common form of which is ¾ Decreased GIT motility leading to
Hashimoto’s thyroiditis constipation and flatulence

¾ Hypothyroidism is the 2nd most ¾ Atherosclerosis

common endocrine disease in older
people
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 Clinical manifestations: TH Diagnosis and treatment: TH
deficiency deficiency

¾ Decreased cardiac output and Diagnosis

contractility ¾ Thyroid function tests for serum
TSH, T4, and T3
¾ Lethargy
¾ Serum antithyroid antibodies
¾ Hoarseness
Treatment
¾ Depression ¾ Oral thyroid hormone Levo-
thyroxine (L-thyroxine)
¾ Slowed mentation

¾ Myxoedema

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Thyroid hormone excess Clinical manifestations: TH excess

¾ May be mild or severe
Hyperthyroidism ¾ Increased heat production
¾ Is hyperfunction of the thyroid gland ¾ Increased appetite
leading to ¾ Weight loss
¾ excess secretion of thyroid hormone ¾ Diarrhoea
known as ¾ Sweating
¾ thyrotoxicosis ¾ Heat intolerance
¾ Shortness of breath
¾ Grave’s disease is the most common ¾ Tachycardia
form ¾ Palpitations
¾ Increased cardiac output
¾ Results from an autoimmune process ¾ Increased peripheral blood flow
which ¾ Tremor
¾ promotes excessive stimulation of the ¾ Restlessness
thyroid gland ¾ Mental health problems
¾ Exophthalmos
¾ Goitre

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Diagnosis: TH excess Treatment : TH excess

¾ Radioactive iodine (131 I)

¾ Clinical manifestations

¾ Thyroidectomy (subtotal)
¾ Reduced serum levels of TSH

¾ Drugs
¾ Increased levels of T4 & T3
¾ Thioureas - inhibit the
synthesis of thyroid hormone
¾ Antibody testing for antibodies to ¾ Carbimazole
the TSH receptor ¾ Propylthiouracil
¾ Beta-blockers
¾ Propranolol

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Disorders of the parathyroid glands

Parathyroid hypofunction
¾ hypoparathyroidism

Parathyroid hyperfunction
¾ hyperparathyroidism

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 Hypoparathyroidism Hypoparathyroidism

¾ a disorder of the parathyroid ¾ clinical manifestations result

glands resulting from a wide cross from:
section of causes ¾ deficient parathyroid
¾ Congenital - heavy metal damage hormone secretion
¾ Surgical - metastatic tumours ¾ hypocalcaemia
¾ Autoimmune – infection

¾ is a rare disorder affecting any age

group and either sex

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Clinical manifestations: Diagnosis: Hypoparathyroid

Hypoparathyroid
¾ tetany ¾ Diagnosis
¾ muscle cramps
¾ low serum calcium
¾ carpopedal spasm
¾ normal values are: 2.2 -
¾ convulsions 2.6 mmol/L or 8.8 -
¾ paresthesias 10.6mg/100mL
¾ tingling circumoral area
¾ hands ¾ high serum phosphate
¾ feet
¾ normal values are: 0.8 -
¾ prolonged QT interval 1.4 mmol/L or 2.5 - 4.3
¾ resistance to digitalis mg/100mL
¾ hypotension
¾ lethargy ¾ low serum PTH
¾ anxiety
¾ personality changes
¾ blurred vision
¾ defective teeth
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 Treatment: Hypoparathyroid
¾ acute hypoparathyroid tetany
¾ IV calcium gluconate
¾ oral calcium salts
¾ Vitamin D

¾ magnesium deficiency
¾ Magnesium

¾ chronic hypoparathyroidism
¾ oral calcium
¾ vitamin D

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Hyperparathyroidism Hyperparathyroidism

¾ primary hyperparathyroidism is ¾ Clinical manifestations result

caused by from:
¾ glandular hyperplasia of all 4 ¾ hypersecretion of parathyroid
glands or hormone
¾ adenoma or carcinoma of only 1 ¾ excess calcium
gland

¾ secondary hyperparathyroidism is
caused by
¾ hyperplasia of the parathyroids
glands from chronic renal failure

¾ mainly occurs in the over 50 age

group in women more commonly
than men

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 Clinical manifestations: Diagnosis & treatment:
Hyperparathyroid Hyperparathyroid
¾ can be asymptomatic ¾ Diagnosis
¾ osteoporosis ¾ increased serum calcium levels on
3 successive measurements
¾ osteopaenia
¾ elevated serum PTH levels
¾ renal calculi ¾ decreased serum phosphate levels
¾ gastric ulcers
¾ acute pancreatitis ¾ Treatment
¾ mental fatigue ¾ parathyroidectomy
¾ somnolence ¾ antihypercalcaemic drugs –
cinacalcet hydrochloride
¾ apathy
¾ anxiety
¾ depression
¾ psychosis

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Disorders of the adrenal gland

Adrenal hypofunction
¾ Addison’s disease -primary adrenal insufficiency
¾ Secondary adrenal insufficiency

Adrenal hyperfunction
¾ Cushing’s syndrome

Adrenal tumor
¾ Pheochromocytoma

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 Addison’s Disease

¾ Also known as primary adrenal insufficiency

¾ a rare disorder

¾ Autoimmune disorder
¾ all layers of the adrenal cortex are destroyed

¾ Clinical manifestations result from

¾ mineralocorticoid and glucocorticoid deficiency and
¾ ACTH excess

¾ Secondary adrenal insufficiency

¾ rapid withdrawal of therapeutically administered steroids

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Clinical manifestations: Addison’s Clinical manifestations: Addison’s

Disease Disease
¾ Develop slowly and progressively ¾ Cortisol deficiency results in:
¾ An inability to maintain blood
¾ Aldosterone deficiency results in: sugar levels leading to,
¾ Hypoglycaemia
¾ An inability to retain salt and water
leading to,
¾ Hyponatraemia ¾ ACTH excess results in:
¾ Orthostatic hypotension ¾ Overproduction of melanin leading
¾ Decreased cardiac output to,
¾ Hyperpigmentation of the skin
¾ Reduced excretion of potassium ¾ Note ACTH deficiency is present
leading to, in secondary adrenal insufficiency
¾ Hyperkalaemia
¾ Cardiac arrhythmias ¾ Acute adrenal crisis

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 Symptoms: Addison’s Disease Diagnosis & treatment: Addison’s
Disease
¾ Weakness
¾ Diagnosis
¾ Fatigue ¾ decreased levels of serum cortisol
¾ increased levels of serum ACTH
¾ Dehydration
¾ Treatment
¾ Weight loss ¾ lifetime replacement therapy with
a glucocorticoid (hydrocortisone)
¾ Anorexia ¾ a mineralocorticoid
(fludrocortisone)

¾ Hypoglycaemia

¾ Nausea and vomiting

¾ Bronze discolouration of skin folds,

pressure points, fingers and toes.
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Cushing’s Syndrome Clinical Manifestations: Cushing’s

Syndrome
¾ cushingoid appearance
¾ Manifestations result from cortisol
¾ central obesity
excess
¾ buffalo hump
¾ moon face
¾ Frequently occurs in adults 20 to 50 ¾ atherosclerosis
years ¾ muscle wasting
¾ thin weakened skin
¾ 4 main causes: ¾ osteoporosis
¾ most commonly a disorder of ¾ fractures
iatrogenesis ¾ purple/red striae
¾ adrenal tumors ¾ salt & water retention
¾ hypertension
¾ ACTH secreting tumors
¾ hyperglycaemia
¾ pituitary tumor
¾ increased infection
¾ gastric ulcers
¾ hirsutism
¾ psychosis
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 Diagnosis and treatment: Cushing’s Syndrome

¾ Diagnosis
¾ 24 hour urinary cortisol
¾ plasma cortisol levels
¾ dexamethasone suppression test

¾ Treatment
¾ surgical
¾ pharmacologic
¾ radiation

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Pheochromocytoma Clinical manifestations:

Pheochromocytoma
¾ tumour of chromaffin tissue ¾ release of hormones may be
paroxysmal rather than continuous
resulting in:
¾ most commonly located in the ¾ hypertension
adrenal medulla ¾ marked variability in blood
pressure
¾ tumours can be malignant ¾ 50% have paroxysmal episodes
¾ 50% have sustained
¾ headache
¾ rare disorder ¾ excessive diaphoresis
¾ palpitations
¾ clinical manifestations result from
¾ excess secretion of
catecholamines

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Diagnosis & treatment: Pheochromocytoma

¾ Diagnosis
¾ measurement of urinary catecholamines

¾ Treatment
¾ surgery

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