Endocrine Emergencies - Thyroid & Pituitary Disorders

Summary

In this educational video, Professor Adam Thompson discusses endocrine disorders, focusing on growth hormone pathology, hypothyroidism, hyperthyroidism, and their various causes and symptoms. He covers conditions like gigantism, dwarfism, and thyroid diseases, including Graves' disease and Hashimoto's disease. The video also addresses emergencies like myxedema coma and thyroid storm, emphasizing the importance of recognizing and managing these life-threatening situations. Additionally, the professor touches on hyperparathyroidism, panhypopituitarism, and disorders of fluid regulation like diabetes insipidus and SIADH, providing a comprehensive overview of endocrine emergencies.

Takeaways

• 🌟 Growth hormone pathology involves over or under secretion from the anterior pituitary gland, leading to conditions like gigantism or dwarfism.
• 🔍 Over secretion of growth hormone results in acromegaly, typically diagnosed in young adulthood, while under secretion can lead to dwarfism.
• 👤 Hypothyroidism is characterized by a decrease in metabolism, whereas hyperthyroidism leads to an increase in metabolism.
• 🚺 Graves disease is the most common type of hyperthyroidism, predominantly affecting women and can lead to a hypermetabolic state.
• 🏥 Untreated hyperthyroidism can be fatal, presenting symptoms like increased appetite, weight loss, and heart issues.
• 🧬 Hashimoto's disease is an autoimmune disorder causing hyperthyroidism and is more common in women.
• 🌡 Myxedema coma is a severe form of hypothyroidism, often triggered by cold exposure, infection, or surgery, and is marked by a slowing metabolic process.
• 💊 Treatment for endocrine emergencies like myxedema coma requires supportive care, including managing airway, breathing, and circulation.
• 🩺 Hyperparathyroidism is indicated by an increase in parathyroid hormone, leading to high blood calcium levels and potential kidney stones or bone thinning.
• 💧 Diabetes insipidus and SIADH are endocrine disorders involving the regulation of body fluids, with diabetes insipidus being caused by a lack of ADH and SIADH by an excess.
• 📊 The management of diabetes insipidus may include synthetic ADH, while SIADH may require loop diuretics and hypertonic fluids.

Q & A

What are the two main problems associated with growth hormone secretion?

The two main problems associated with growth hormone secretion are over secretion and under secretion. Over secretion can lead to gigantism, while under secretion can result in dwarfism.

What is acromegaly and how is it diagnosed?

Acromegaly is a condition resulting from over secretion of growth hormone, usually diagnosed in young adulthood. It presents with abnormally large hands and facial features.

What is the most common type of hyperthyroidism and how does it affect the body?

Graves disease is the most common type of hyperthyroidism. It increases metabolism, leading to a hypermetabolic state, and can cause symptoms such as weight loss despite increased appetite, polydipsia, exophthalmos, and pretibial myxedema.

What are the potential complications of untreated hyperthyroidism?

Untreated hyperthyroidism can lead to heart failure due to the increased stress on the heart from the hypermetabolic state, along with tachycardia and increased blood pressure.

How does Hashimoto's disease differ from Graves disease?

Hashimoto's disease is another cause of hypothyroidism, not hyperthyroidism, and it results in the infiltration of T lymphocytes and plasma cells, leading to a decrease in thyroid function.

What is myxedema coma and what are its common triggers?

Myxedema coma is a life-threatening condition characterized by a severe decline in mental status due to hypothyroidism. It is often triggered by factors such as infection, exposure to cold, trauma, surgery, or certain medications.

What is the typical demographic for myxedema coma and when does it usually occur?

Myxedema coma typically occurs in women over the age of 60, usually during the winter season, due to the extreme cold.

What are the treatment considerations for a patient in myxedema coma?

Treatment for myxedema coma includes supportive care such as monitoring and managing airway, breathing, and circulation, treating hypothermia with passive rewarming, and avoiding sedatives, narcotics, and anesthetics if possible.

What is the difference between diabetes insipidus and diabetes mellitus?

While both conditions involve increased urination, diabetes insipidus is caused by a lack of antidiuretic hormone (ADH) leading to increased diuresis, whereas diabetes mellitus is a pancreatic pathology with high glucose levels in the urine.

What are the potential risks associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

SIADH can cause fluid retention, leading to hypertension, tachycardia, hyponatremia, seizures, and confusion due to an excess of ADH.

How does hyperparathyroidism affect blood calcium levels and what are its common symptoms?

Hyperparathyroidism is marked by an increase in parathyroid hormone, leading to hypercalcemia (increased blood calcium levels) and decreased phosphate levels. Symptoms can include fatigue, weakness, nausea, vomiting, confusion, and pathologic fractures.

Outlines

00:00

🌡️ Endocrine Disorders: Growth Hormone Pathology and Thyroid Conditions

Professor Adam Thompson discusses endocrine disorders, focusing on growth hormone pathology and thyroid conditions. He explains the consequences of both over-secretion and under-secretion of growth hormone, leading to gigantism or dwarfism, respectively. The lecture also covers hypothyroidism and hyperthyroidism, detailing the symptoms, causes, and treatments. Graves disease, an autoimmune disorder causing hyperthyroidism, is highlighted as the most common type, predominantly affecting women. The potential severity of hyperthyroidism, including heart failure due to increased metabolism, is also discussed. Additionally, Hashimoto's disease, another cause of hyperthyroidism, is mentioned, along with myxedema coma, a severe form of hypothyroidism.

05:02

🚑 Emergency Management of Hypothyroidism and Thyrotoxicosis

This section delves into the emergency management of hypothyroidism, particularly myxedema coma, emphasizing the high mortality rate if untreated. The symptoms, such as hypothermia and bradycardia, are outlined, along with the importance of supportive care, including ventilation and cardiac monitoring. The management of thyrotoxicosis, or an overactive thyroid, is also covered, with a focus on thyroid storm, a rare but life-threatening condition. The discussion includes the signs of thyroid storm and the use of beta blockers as a treatment. Hyperparathyroidism is introduced as a condition marked by increased parathyroid hormone, leading to hypercalcemia, with symptoms ranging from fatigue to kidney stones. The necessity of surgical intervention for severe cases is mentioned, along with pre-hospital care focusing on supportive measures.

10:04

💧 Diabetes Insipidus and SIADH: Water Regulation Disorders

The final paragraph discusses diabetes insipidus and the syndrome of inappropriate antidiuretic hormone (SIADH) secretion, which are distinct from diabetes mellitus. Diabetes insipidus is characterized by either a lack of antidiuretic hormone (ADH) or the kidneys' inability to respond to it, leading to increased urination and potential dehydration. SIADH, on the other hand, is caused by an excess of ADH, resulting in fluid retention, hypertension, and hyponatremia. The management strategies for both conditions are outlined, including the use of synthetic ADH for diabetes insipidus and loop diuretics for SIADH. The lecture concludes with a summary table contrasting the two conditions.

Keywords

💡Growth Hormone Pathology

Growth Hormone Pathology refers to disorders related to the secretion of growth hormone by the anterior pituitary gland. Over secretion leads to gigantism, where individuals become abnormally large, exemplified by Andre the Giant. Under secretion results in dwarfism, which is characterized by shorter stature and delayed development. This concept is central to the video's discussion on endocrine disorders as it sets the stage for understanding the impact of hormonal imbalances on physical growth and development.

💡Acromegaly

Acromegaly is a condition that arises from over secretion of growth hormone, typically diagnosed in young adulthood. It is characterized by abnormally large hands and facial features, such as prominent jawbones. The term is used in the script to illustrate the consequences of excessive growth hormone, emphasizing the importance of hormonal balance in maintaining normal physical characteristics.

💡Hypothyroidism

Hypothyroidism is a condition where there is a decrease in metabolism due to insufficient thyroid hormone production. The video describes it as a state of slowed metabolic processes, which can lead to weight gain, fatigue, and feeling cold. This term is crucial for understanding the impact of thyroid disorders on overall metabolism and body functions.

💡Hyperthyroidism

Hyperthyroidism is the opposite of hypothyroidism, where the thyroid gland is overactive, leading to an increased metabolic rate. The script mentions Graves disease as a common cause, which can result in symptoms like weight loss despite increased appetite, rapid heart rate, and bulging eyes. This keyword is important for understanding the effects of an overactive thyroid on various body systems.

💡Graves Disease

Graves disease is identified in the script as the most common type of hyperthyroidism. It is an autoimmune disorder causing the thyroid gland to enlarge and overproduce thyroid hormones. This condition is highlighted in the video to demonstrate how autoimmune responses can lead to endocrine disorders, affecting metabolism and other bodily functions.

💡Thyrotoxicosis

Thyrotoxicosis refers to a toxic condition caused by excessive levels of thyroid hormone in the body. The script explains that it can be caused by hyperthyroidism, a goiter, autoimmune disorder, or thyroid cancer. This term is significant as it encompasses a range of conditions that lead to an overactive thyroid, impacting the viewer's understanding of the complexity of thyroid-related disorders.

💡Hyperparathyroidism

Hyperparathyroidism is a condition marked by an increase in parathyroid hormone, leading to higher levels of blood calcium (hypercalcemia). The video mentions that it can result from a benign tumor on the parathyroid gland. This keyword is essential for understanding how hormonal imbalances from the parathyroid glands can affect calcium levels and bone health.

💡Hypoparathyroidism

Although not explicitly mentioned in the script, hypoparathyroidism is the counterpart to hyperparathyroidism, involving insufficient parathyroid hormone production, leading to low blood calcium levels. Understanding this term helps to appreciate the full spectrum of parathyroid disorders and their effects on calcium homeostasis.

💡Myxedema Coma

Myxedema coma, as discussed in the script, is a severe and potentially fatal complication of long-standing hypothyroidism. It is characterized by a decline in mental status, hypothermia, and a slowing of the metabolic process. This term is critical for understanding the extreme consequences of untreated hypothyroidism and the importance of timely diagnosis and treatment.

💡Diabetes Insipidus

Diabetes insipidus is a condition where the body is unable to regulate fluid due to a lack of antidiuretic hormone (ADH) or the kidneys' inability to respond to ADH. The script differentiates it from diabetes mellitus by pointing out the absence of glucose in the urine. This keyword is important for distinguishing between different types of diabetes and understanding their unique causes and symptoms.

💡SIADH

SIADH, or Syndrome of Inappropriate Antidiuretic Hormone secretion, is a condition where there is an excess of ADH, leading to fluid retention and hyponatremia. The video contrasts it with diabetes insipidus to illustrate the opposite effects of hormonal imbalances on fluid regulation. Understanding SIADH helps to grasp how hormonal excess can lead to serious health complications.

Highlights

Growth hormone pathology involves both over and under secretion issues.

Over secretion of growth hormone can lead to gigantism.

Under secretion of growth hormone can result in dwarfism.

Acromegaly is diagnosed in young adulthood due to over secretion.

Hypothyroidism is a decrease in metabolism, while hyperthyroidism increases it.

Graves disease is the most common type of hyperthyroidism.

Graves disease is ten times more common in women.

Graves disease can lead to a visible mass in the anterior part of the neck.

Hyperthyroidism can cause increased appetite with weight loss.

Exophthalmos is a symptom where eyes bulge out due to hyperthyroidism.

Hashimoto's disease is another cause of hyperthyroidism.

Hypothyroidism can lead to myxedema coma if left untreated.

Myxedema coma is often precipitated by infection, cold, or surgery.

Toxicosis is a toxic condition caused by excessive levels of thyroid hormone.

Hyperparathyroidism is marked by an increase in parathyroid hormone.

Diabetes insipidus is caused by a lack of ADH or the kidneys' inability to respond.

SIADH is an excess of ADH leading to fluid retention.

Management of endocrine emergencies requires supportive care.

Transcripts

[Music]

hello and welcome back to this

discussion on indica Emergencies I'm

Professor Adam Thompson let's get

started with this last and final video

so another endocrine disorder could be a

growth hormone pathology where the

anterior pituitary gland secretes growth

hormone the problems associated with

growth hormone secretion include both

over secretion or under secretion and

you can imagine the over secretion of

growth hormone would cause somebody to

be larger somebody with gigantism such

as Andre the Giant picture here on the

left and somebody with under secretion

of growth hormone may present with Dorf

ISM such as the person you see on the

right there tyrion lanister from Game of

Thrones obviously they are both extremes

of the conditions they are rare

conditions and usually the result of a

tumor over secretion results in

acromegaly a condition usually diagnosed

in young adulthood and again gigantism

is can present with abnormally large

hands and the face you know those jaw

bones come down and look a little bit

stronger as well as their facial

characteristics under secretion is rare

and is characterized by delayed

development growth again the lack of

treatment could lead to Dorf ism so I'm

gonna talk a little bit about

hypothyroidism and hyperthyroidism

hypothyroidism is a decrease in

metabolism and hyperthyroidism walk will

cause an increase in metabolism

approximately 20 million Americans have

a thyroid disorder Graves disease is

most common type of hyperthyroidism and

it increases the metabolism you know so

they have a hyper metabolic state it's

the most severe type of hyperthyroidism

as well and it's ten times more common

in women all right so much more common

in women over men and it tends to follow

a chronic course of remission and

relapse and it may be fatal if not

treated the autoimmune disorder in which

the thyroid gland hypertrophy Zoar

enlarges as its activity increases is

known as Graves disease it produces a

visible mass in the anterior part of the

neck this sometimes can lead to what

they call it

waiter overactive Glen secretes an

excessive amount of thyroxine thyroxine

is kind of the culprit here and other

signs and symptoms may include an

increase in appetite with obviously

market weight loss because of the hyper

metabolism polydipsia exophthalmos where

their eyes start to bulge out of their

skull pretibial mix edema which is an

orange peel appearance and non pitting

edema of the skin on the anterior part

of the leg below the knee and then

increased stress on the heart may

actually lead to heart failure because

that hyper metabolic state comes with it

some tachycardia increasing blood

pressure and all the things associated

with sort of a hyperstimulated state

Hashimoto's disease is another cause of

hyperthyroidism

it's also more common in women over men

results in the infiltration of T

lymphocytes and plasma cells it's out

only a disorder that affects the TSH

which is the thyroid stimulating hormone

receptors and hypothyroidism will follow

after antibodies destroy the follicles

mix edema coma occurs if the supply of

thyroid hormones become inadequate organ

tissues do not grow or mature and then

energy production will decline and

actions of other hormones are also

affected the adult hypothyroidism is

sometimes called mix edema patients

often have localized accumulations of

mucous material in the skin and it's

manifested by a slowing of the metabolic

process all right so hypothyroidism a

mix edema is a slowing of the metabolic

process so if you picture the opposite

sort of a hyperthyroidism you'll get

some of those same changes so where

hyperthyroidism will cause weight loss

hypothyroidism will cause more weight

gain the symptoms may be exhibited by

all organ systems the severity is going

to be consistent with the degree of

hormone deficiency and it could include

fatigue feeling cold again weight gain

with hypothyroidism dry skin sleepiness

it's often subtle and can be mistaken

for other

additions as well so the continued

decrease of hormone levels will actually

lead to what they call mix edema coma

and it's accompanied by a physiologic

decompensation that leads to peripheral

vasoconstriction it often is

precipitated by things like infection

exposure to cold trauma surgery and even

certain medications the hallmark though

of mix edema coma is the deterioration

of Mental Status that coma part right

most cases occurred during the winter in

women older than 60 so women older than

60 usually get this during the winter

because of the extreme cold consistent

finding is hypothermia absence of fever

in the presence of infection is common

alright so they might have they might

even be septic without a fever that we a

febrile with an infection hypothyroidism

decreases intestinal motility so

associated with a decreased metabolic

rate its overall decreased metabolic

rate mix edema coma is a metabolic and a

cardiovascular emergency if not

diagnosed and treated immediately the

mortality rates are approximately 40

percent almost half of these patients

end up dying if they're not treated

immediately as with all of these

endocrine emergencies mix edema coma is

gonna require supportive care you're

gonna treat the condition that you find

so you might not know that they're had

they have hypothyroidism or they're

suffering from mix edema coma however

you know how to treat a patient so

innovation of ventilation may be

indicated they have an altered mental

state they may even be completely

comatose so assess and manage their

airway as indicated monitor their

cardiac status because hypotension is

common amongst these patients and they

may respond well to IV crystalloids

if not consider a vasopressor agent like

norepinephrine or dopamine or even an

epinephrine drip you're gonna want to

treat the hypothermia but treat it

passively passive rewarming remember

that they have hypothyroidism and the

cause of the mix edema coma is

potentially or very commonly hypothermia

so rewarm them but don't aggressively

warm them because that can cause

vasodilation and even more hypotension

active rewarming is necessary for

hemodynamically unstable patients with

profe

hypothermia all right avoid sedatives

narcotics and anesthetics if possible

all right again moving from

hypothyroidism over to the next thing

tyro toxicosis which is sort of the

opposite of hypothyroidism back to a

type of hyperthyroidism it's a toxic

condition caused by excessive levels of

circulating thyroid hormone it may be

caused by hyperthyroidism

a goiter autoimmune disorder or thyroid

cancer thyroid storm is rare but it's a

life-threatening condition and it may

occur in patients with a thyrotoxicosis

it's usually triggered by a stressful

event or an increased volume of thyroid

hormones in the circulation and it may

present with the normal signs and

symptoms of hyperthyroidism as well as a

fever or severe tachycardia a nausea

vomiting an altered mental state or even

heart failure and it may be somebody

that goes into a reentry tachycardia

that you have to treat often even

pre-hospital beta blockers are a

treatment of choice for these patients

hyperparathyroidism is marked by an

increase in parathyroid hormone which

results in an increased level of blood

calcium hypercalcemia and decreased

phosphate levels the primary cause

results from the gland itself and

secondary causes occur somewhere else in

the body most common cause is a benign

neoplasia on the gland which is called

an adenoma some more signs and symptoms

of hyperparathyroidism include fatigue

weakness nausea vomiting confusion the

pathologic fracture secondary to the

thinning of the bones or kidney stones

due to the calcium changes surgery to

remove the enlarged gland is the

definitive management obviously that's

not done pre-hospital II it's a more

chronic condition that's gonna be done

at the hospital patients with mild forms

require monitoring of their calcium

blood levels and prehospital II we're

just going to manage airway breathing

circulation and provide supportive care

again you're treating what you find you

may not know that they have

hyperparathyroidism you just need to

know that this condition exists and

you're gonna treat

the symptoms as you find them so this

patient may present with nausea vomiting

confusion so you're always gonna do your

a ee i oh you tips on your altered

mental state patient get your blood

glucose identify the cause of the

ultimate low status if possible and then

treat the nausea with some antiemetics -

you know limit the vomiting as possible

and maybe even replenish their fluids if

they've become hypovolemic due to

dehydration next up we have a pretty

difficult condition to pronounce pan

hypopituitarism which is an inadequate

production or absence of the pituitary

hormones including your ACTH where's a

adrenocorticotropic hormone remember

that acts on the adrenal glands cortisol

thyroxine again that's your thyroid

gland luteinizing hormone very common

women follicle stimulating hormone again

FSH from women growth hormone we talked

about growth hormone disorders and then

ADH or antidiuretic hormone the clinical

presentation varies depending on which

one of those hormones they're lacking

next up we have diabetes insipidus and

SIADH diabetes insipidus was not

included in the other lecture on all the

other types of diabetes because it's

totally different diabetes insipidus and

SI d ADH are some of the same

characteristics as diabetes mellitus

however it's not a pancreatic pathology

the body is unable to regulate fluid

caused by a lack of ADH or antidiuretic

hormone central diabetes insipidus or

the kidneys are unable to respond

appropriately which is called

nephrogenic diabetes insipidus ADH

causes the kidneys to retain water

that's what it does it's anti diuretic

so it stops diuresis the lack of ADH

causes increased urination right so if

you don't have an antidiuretic hormone

you're gonna have increased diuresis and

this is seen and diabetes mellitus as

well one difference in di India between

di and diem diabetes insipidus and

diabetes mellitus is the amount of

glucose present in the urine with

diabetes insipidus

it's very diluted not much glucose in

the urine where with diabetes mellitus

we know that there's a lot of glucose in

the urine dehydration and electrolyte

imbalances may occur

risk of water intoxication and

hyponatremia are also possible in

extreme cases hypotension will occur and

management may include synthetic ADH

known as vasopressin that is

antidiuretic hormone and SIADH the

syndrome of inappropriate antidiuretic

hormone secretion excess of ADH results

in decrease in urinary output and a

systemic fluid overload

so with SIADH you have too much ADH and

causes fluid retention and may cause

hypertension tachycardia hyponatremia

seizures and confusion remember

hyponatremia because you have an

increased amount of fluid it's gonna

dilute the amount of so you're not

eliminating the sodium however the

amount of sodium is decreased

proportionately because more fluid less

sodium proportionately management may

include loop diuretics and hypertonic

fluids here's a simple table that kind

of explains both diabetes insipidus and

the syndrome of inappropriate ADH

secretion with diabetes insipidus you

have a decreased level of ADH one of

with SIADH you have a increased level of

ADH poly area or too much urination with

diabetes insipidus with SIADH you'll

have oliguria which is almost no

urination dehydration and hypotension

very common and diabetes insipidus and

then overload a fluid with SIADH so

they're kind of polar opposites of each

other and with that that kind of ends

our discussion on the indecorous please

watch all five videos if you haven't

already and you will be a master at

managing and recognizing these endocrine

emergencies