Endoc, Pancreas, Thyroid
Endoc, Pancreas, Thyroid
1)First statement: JA
Second statement: Kylee
When GH-producing tumors occur in childhood, the disease that results is called
gigantism rather than acromegaly. A child's height is determined by the length of the so-
called long bones in the legs. In response to GH, these bones grow in length at the growth
plates—areas near either end of the bone. Growth plates fuse after puberty, so the
excessive GH production in adults does not result in increased height. Since our patient is
a 25 year old male and has passed through the stage of puberty, therefore, growth plates
have already fused causing no change in his height.
Normal Values:
BP: 120/80 mmHg
CR: 60-100/min
RR: 12-20/min
Blood Glucose: 100mg/dL
Serum Potassium: 3.5-5.0 mEq/L
Serum Sodium: 135-145 mEq/L
Serum Chloride: 96-106 mEq/L
Arterial Blood gas: pH 7.38-7.42
pCO2: 38-42 mmHg
HCO3: 22-28 mmol/L or mEq/L
Type 1 Diabetes is a catabolic disorder wherein circulating insulin is very low or absent, plasma
glucagon is elevated, and the pancreatic beta cells fail to respond to all insulin-secretory stimuli.
The pancreas shows lymphocytic infiltration and destruction of insulin-secreting cells of the
islets of Langerhans, causing insulin deficiency. Extreme insulin deficiency leads to osmotic
diuresis and dehydration as well as elevated free fatty acid levels and diabetic ketoacidosis
(DKA), which may be life-threatening.
Symptoms continue to progress to dehydration, resulting in low blood volume, increased pulse
rate, and dry flushed skin. The plasma pH begins to drop as acetone and ketones breakdown.
When the plasma level reaches 7.2, the respiratory center is stimulated, and the patient's
breathing becomes shallow and rapid (Kussmaul respiration) with a fruity odor. This is the
body's way of trying to prevent a further decline in pH. The increased loss of CO2 from the lungs
reduces plasma carbonic acid to acceptable levels. Metabolic acidosis occurs when the body's
buffer system is unable to maintain normal pH with the assistance of the respiratory
compensatory mechanisms.
Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and
develops when insulin levels are insufficient to meet the body’s basic metabolic requirements.
Insidious increased thirst (ie, polydipsia) and urination (ie, polyuria) are the most common early
symptoms of diabetic ketoacidosis (DKA). Fruity or acetone breath, nausea/vomiting,
dehydration, deep, rapid breathing (Kussmaul), lethargy, weakness, headache also can present
as symptoms of DKA.
- ketogenesis due to insulin deficiency leads to increased serum levels of ketones and
ketonuria
- acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic acids
that cause metabolic acidosis
- respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid
respirations (Kussmaul breathing)
- acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis
patients
Thyroid
1)Sha & Leandro
The T4 test and the TSH test are the two most common thyroid function tests. They’re usually
ordered together. The T4 test is known as the thyroxine test. A high level of T4 indicates an
overactive thyroid (hyperthyroidism). Symptoms include anxiety, unplanned weight loss,
tremors, and diarrhea. Most of the T4 in your body is bound to protein. A small portion of T4 is
not and this is called free T4. Free T4 is the form that is readily available for your body to use.
Sometimes a free T4 level is also checked along with the T4 test.
The TSH test measures the level of thyroid-stimulating hormone in your blood. The TSH has a
normal test range between 0.4 and 4.0 milli-international units of hormone per liter of blood
(mIU/L).
Since there is an increased amount of TSH (10 mIU/L) based on the laboratory result, this will
stimulate the thyroid gland to also produce an increased amount of thyroid hormone.
Figure 41-5
1. Iodide is actively transported into the gland against chemical and electrical gradients by
a sodium-iodide symporter (NIS) located in the basolateral membrane of thyroid
epithelial cells.
2. One iodide ion is transported uphill against an iodide gradient while two sodium ions
move down their electrochemical gradient. The driving force for this secondary active
transporter is Na+ / K+ ATPase
3. After entering the gland, iodide rapidly moves to the apical plasma membrane and is
transported into the lumen of the follicles by sodium-independent iodide/chloride
transporter called Pendrin
4. Iodide is oxidized and incorporated into tyrosine residues within thyroglobulin. A single
iodination forms MIT and a second iodination of the same residue produces DIT. [Two
DIT molecules = T4; One MIT and one DIT = T3] Coupling occurs between iodinated
tyrosines that remain part of the primary structure of thyroglobulin catalyzed by the
enzyme Thyroid Peroxidase
5. Once thyroglobulin has been iodinated, it is stored in the lumen of the follicle as colloid
6. Release of T4 and T3 into the bloodstream is initiated by endocytosis of colloid from the
follicular lumen by the processes of macro- and pinocytosis. Endocytotic vesicles fuse
with lysosomes and thyroglobulin is degraded
7. MIT and DIT molecules are rapidly deiodinated within the follicular cell by the enzyme
Iodotyrosine deiodinase -> specific for MIT and DIT and cannot use T4 and T3 as
substrates
8. T4 and T3 are transported across the basal side of the cell and enter the blood
Drugs:
1. Sodium Iodide
- Expression of NIS gene is inhibited by Iodide and stimulated by TSH
2. Propanolol
- Inhibits peripheral conversion of T4 to T3 (T4 is the primary product but T3 is the active
form)
- Peripheral conversion relies through the action of Thyronine-specific deiodinases
particularly Type 1 Deiodinase (D1), which occurs in tissues with high blood flow and
rapid exchange with plasma, such as the liver, kidneys, and thyroid gland.
3. Propylthiouracil
- Blocks peroxidase reactions therefore inhibiting iodination of tyrosine residues (Thyroid
peroxidase involved in iodine-tyrosine coupling - Step 4)
4. Methylprednisolone
- Also inhibits peripheral conversion (same with Propanolol)