Diseases of the Endocrine System

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Endocrine disorders are classified in two ways: disturbances in the production of hormones, and the inability of tissues to respond to hormones. The first type, called production disorders, are divided into hypofunction (insufficient activity) and hyperfunction (excess activity). Hypofunction disorders can have a variety of causes, including malformations in the gland itself. Sometimes one of the enzymes essential for hormone production is missing, or the hormone produced is abnormal. More commonly, hypofunction is caused by disease or injury. Tuberculosis can appear in the adrenal glands, autoimmune diseases can affect the thyroid, and treatments for cancer—such as radiation therapy and chemotherapy—can damage any of the endocrine organs. Hypofunction can also result when target tissue is unable to respond to hormones. In many cases, the cause of a hypofunction disorder is unknown.

Hyperfunction can be caused by glandular tumors that secrete hormone without responding to feedback controls. In addition, some autoimmune conditions create antibodies that have the side effect of stimulating hormone production. Infection of an endocrine gland can have the same result.

One of the most common diseases of the endocrine systems is diabetes mellitus, which occurs in two forms. The first, called diabetes mellitus Type 1, is caused by inadequate secretion of insulin by the pancreas. Diabetes mellitus Type 2 is caused by the body's inability to respond to insulin. Both types have similar symptoms, including excessive thirst, hunger, and urination as well as weight loss. Laboratory tests that detect glucose in the urine and elevated levels of glucose in the blood usually confirm the diagnosis. Treatment of diabetes mellitus Type 1 requires regular injections of insulin; some patients with Type 2 can be treated with diet, exercise, or oral medication. Diabetes can cause a variety of complications, including kidney problems, pain due to nerve damage, blindness, and coronary heart disease. Recent studies have shown that controlling blood sugar levels reduces the risk of developing diabetes complications considerably.

Diabetes insipidus is caused by a deficiency of vasopressin, one of the antidiuretic hormones (ADH) secreted by the posterior lobe of the pituitary gland. Patients often experience increased thirst and urination. Treatment is with drugs, such as synthetic vasopressin, that help the body maintain water and electrolyte balance.

Hypothyroidism is caused by an underactive thyroid gland, which results in a deficiency of thyroid hormone. Hypothyroidism disorders cause myxedema and cretinism, more properly known as congenital hypothyroidism. Myxedema develops in older adults, usually after age 40, and causes lethargy, fatigue, and mental sluggishness. Congenital hypothyroidism, which is present at birth, can cause more serious complications including mental retardation if left untreated. Screening programs exist in most countries to test newborns for this disorder. By providing the body with replacement thyroid hormones, almost all of the complications are completely avoidable.

Addison's disease is caused by decreased function of the adrenal cortex. Weakness, fatigue, abdominal pains, nausea, dehydration, fever, and hyperpigmentation (tanning without sun exposure) are among the many possible symptoms. Treatment involves providing the body with replacement corticosteroid hormones as well as dietary salt.

Cushing's syndrome is caused by excessive secretion of glucocorticoids, the subgroup of corticosteroid hormones that includes hydrocortisone, by the adrenal glands. Symptoms may develop over many years prior to diagnosis and may include obesity, physical weakness, easily bruised skin, acne, hypertension, and psychological changes. Treatment may include surgery, radiation therapy, chemotherapy, or blockage of hormone production with drugs.

Thyrotoxicosis is due to excess production of thyroid hormones. The most common cause for it is Graves' disease, an autoimmune disorder in which specific antibodies are produced, stimulating the thyroid gland. Thyrotoxicosis is eight to ten times more common in women than in men. Symptoms include nervousness, sensitivity to heat, heart palpitations, and weight loss. Many patients experience protruding eyes and tremors. Drugs that inhibit thyroid activity, surgery to remove the thyroid gland, and radioactive iodine that destroys the gland are common treatments.

Acromegaly and gigantism both are caused by a pituitary tumor that stimulates production of excessive growth hormone, causing abnormal growth in particular parts of the body. Acromegaly is rare and usually develops over many years in adult subjects. Gigantism occurs when the excess of growth hormone begins in childhood.

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