increased secretion of PTH

Primary hyperparathyroidism caused by adenoma Secondary hyperparathyroidism caused by chronic renal disease, renal osteodystrophy, and congenital anomalies
Hypercalcemia

Clinical Manifestations
Clinical Manifestations: (Box 46.9)- Nausea & vomiting- Delusions & confusion- Weakness & fatigue- Polyuria & polydipsia

Diminished secretion of PTH (parathyroid hormone)

Clinical Manifestations: (Box 46-8)- Dry, scaly, coarse skin with eruptions
- Hair often brittle
- Short, stubby fingers and toes
- Muscle contractions: tetany, carpopedal spasm,  laryngospasm, muscle cramps and twitching,  +Chvostek sign or Trousseau sign


https://www.youtube.com/watch?v=kvmwsTU0InQ

Results from autoimmune response to TSH receptors, but no specific etiology
Clinical Manifestations
- Emotional lability
- Physical restlessness
- Voracious appetite w/weight loss
- Tachycardia
- Warm, moist skin & heat intolerance
- Tremors
- Wide-eyed, exophthalmos (protruding eyeballs)

Diagnostic Evaluation
- Increased T3 and T4 levels
- Measurement of thyroid-stimulating immunoglobulin

Thyrotoxicosis – thyroid “storm”Onset of severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration. Progresses to delirium and coma.

Results from enlarged thyroid gland and is
most common thyroid disease in children

Clinical Manifestations
- Enlarged thyroid gland
- Tracheal compression
- Nervousness & irritability
- Increased sweating & hyperactivity

Results from enlarged thyroid gland and is
most common thyroid disease in children

Clinical Manifestations
- Enlarged thyroid gland
- Tracheal compression
- Nervousness & irritability
- Increased sweating & hyperactivity

Hypersecretion of antidiuretic hormone (ADH)

Clinical Manifestations - Body retains fluids
- Nausea & vomiting
- Anorexia
- Stomach cramps
- Irritability & personality changes

Undersecretion of antidiuretic hormone (ADH) or vasopressin

Clinical Manifestations - Polyuria & polydipsia
- Insatiable thirst
- Enuresis (in children)
- Irritability relieved by drinking water (infants)

most commonly treated with intranasal vasopressin

Clinical Manifestation Early sexual developmentBefore age 9 (boys) and age 7 (girls)

Hypothalamic-releasing factors stimulatesecretion of the gonadotropic hormonesLeydig cells secrete testosterone &Ovarian follicles secrete estrogen (Through FSH & LH)
This is known as the hypothalamic-pituitary-gonadal axis

Isosexual precocious puberty
- More common in girls
Central precocious puberty (CPP)
- Activated by GnRH
- Occurs in 80% of precocious puberty cases

Peripheral precocious puberty (PPP)
- More common in girls

Excess GH before closure of the epiphyseal shafts. Vertical growth is accompanied by rapid growth of muscles and viscera. Head enlargement occurs with delayed fontanel closure.

If over secretion of GH occurs after
epiphyseal shafts close, acromegaly occurs
Clinical Manifestations: - Overgrowth of head, lips, nose, tongue, jaw
- Separation of teeth
- Increased facial hair
- Thick, deeply creased skin - Increased risk of hyperglycemia & diabetes
Clinical Manifestations: - Overgrowth of head, lips, nose, tongue, jaw
- Separation of teeth
- Increased facial hair
- Thick, deeply creased skin - Increased risk of hyperglycemia & diabetes

Hypopituitarism (dwarfism)
Pituitary Hyperfunction (acromegaly, gigantism)
Precocious Puberty
Diabetes Insipidus
SIADH (Syndrome of Inappropriate ADH Secretion)

Diminished secretion of pituitary hormones which leads to gonadotropin deficiency with regression of secondary sex characteristics; GH (Growth hormone) deficiency

Clinical Manifestations: Children grow normal in 1st year then slowDentition delayed – underdeveloped jawSexual development delayedHeadaches & vision changes

**Most common cause of idiopathic hypopituitarism is
tumors in the pituitary or hypothalamic region.
Evaluation is aimed at isolating organic causes which may include hypothyroidism, over secretion of cortisol, gonadal aplasia, chronic illness, nutritional inadequacy, or hypochondroplasia

Diagnostic Evaluation:
- Family history - History of child’s growth patterns - Growth hormone (GH) stimulation testing