Health Literacy and Endocrine System Diseases
Knowledge and understanding of the medical terminology pertaining to some of the more common endocrine system diseases is an important aspect of health literacy. It can also aid in recognizing the need for professional evaluation and treatment. Prompt actions based on a recognized need can prevent undesirable consequences and promote better health care outcomes. Listed below are the medical terms and definitions of some of the most common endocrine system diseases. To augment your learning experience you can hear the medical pronunciation of the terms in bold font in the chronological order in which they appear. Just click the play button below.
Acromegaly – Is a rare condition in which there is enlargement of the bones of the hands, arms, feet, legs and head. It is the result of a tumor of the pituitary which produces too much growth hormone. The term for the condition in children is gigantism.
Addisonian crisis (acute adrenal crisis) – It is a life-threatening condition in which low levels of cortisol cause the abrupt onset of symptoms of Addison’s disease. It is the result of the sudden development of an absolute or relative deficiency of cortisol. The cause of cortisol deficiency might be primary Addison’s disease or secondary adrenal insufficiency. Cortisol helps the body deal with stress and is required in larger amounts during stressful circumstances. Therefore, even if baseline cortisol levels are normal or only somewhat low, stressful situations can lead to acute adrenal crisis if the glands are not able to appropriately increase their production of the hormone to meet the demands of the stress. The latter is oftentimes the case with iatrogenic adrenal insufficiency. Some common stresses that can lead to crisis are traumatic injuries, infections, surgery and dehydration. In addition to the abrupt onset of symptoms of Addison’s disease acute adrenal crisis is oftentimes associated with severe life-threatening drops in blood pressure.
Addison’s disease – Is a rare disorder in which there is deficient production of one or two important hormones by the adrenal glands. The hormones involved are cortisol and aldosterone. The deficiency might be in the production of just cortisol or both hormones. The problem can be in the glands themselves or in the anterior pituitary which produces adrenocorticotropic hormone (ACTH). Cortisol is a glucocorticoid which helps the body deal with stress and also aids in the regulation of its use of carbohydrates, proteins and fat as energy sources. Aldosterone is the mineralocorticoid which helps maintain the proper balance of fluid, salt and potassium in the body. It does so by stimulating the kidneys to reabsorb sodium and excrete potassium. It plays an important role in blood pressure regulation.
Some of the common signs and symptoms of Addison’s disease are fatigue, lightheadedness due to low blood pressure, salt craving, difficulty coping with stress, irritability, depression, heat or cold intolerance, muscle weakness, easy tanning and skin darkening, poor appetite, weight loss, nausea, vomiting and difficulty digesting food.
Other terms for the condition are adrenal insufficiency and adrenocortical insufficiency. If the problem is in the adrenal glands themselves it is termed primary adrenal insufficiency. If the problem is with the pituitary gland it is called secondary adrenal insufficiency. It is the result of decreased ACTH production.
Cushing’s disease – It is a form of Cushing’s syndrome caused by excessive production of cortisol. The cause is the excessive secretion of adrenocorticotropic hormone (ACTH). The source of the over secretion of ACTH is one or more benign tumors of the pituitary. Those tumors are called pituitary adenomas. Most individuals with the disorder have a single adenoma. The condition is five times more common in women than men. The clinical signs and symptoms of the disease are the same as for Cushing’s syndrome.
Cushing’s syndrome – Is a set of signs and symptoms resulting from excessive exposure to cortisol. Cushing’s disease is one cause of Cushing’s syndrome. Benign and malignant ACTH secreting tumors outside of the pituitary can also cause it. Common locations are the lungs and adrenal glands. Less common sites are the pancreas, thyroid and thymus. One of the more common causes of the syndrome is excessive cortisol exposure from the use of corticosteroid medications such as hydrocortisone, prednisone or dexamethasone.
Common signs and symptoms of Cushing’s syndrome are:
- Obesity (primarily in the abdominal region)
- Moon shaped face
- brittle bones
- Bone pain or tenderness
- Buffalo hump (a collection of fat between the shoulders and the base of the neck)
- Elevated blood pressure
- Elevated blood glucose
- Abnormal hair growth on parts of the body other than the scalp in women
- Irregular or absent menstrual periods in women
- Decreased sexual desire or impotence in men
- Muscle weakness fatigue
- Increased thirst
Diabetes insipidus (central diabetes insipidus) – Is a disorder in which the hypothalamus produces inadequate amounts of antidiuretic hormone (ADH). Since ADH is one of the many factors involved in regulating the balance of body fluid through its influence on fluid reabsorption in the kidneys its deficiency or absence can result in massive losses of fluid in the urine. Because of compensatory increased thirst individuals with the disorder drink large amounts of fluids. If that increased fluid intake does not match the increased urine output though dehydration can result. Free water loss exceeds salt loss. That results in hypernatremia.
Nephrogenic diabetes insipidus is a variant form of the disorder in which the hypothalamus produces normal amounts of ADH but a defect in the kidneys causes a blunted response to it. The end result is the same as with central diabetes insipidus. Diabetes insipidus has nothing to do with the glucose metabolism and should not be confused with diabetes mellitus.
Diabetes mellitus – It is a disorder of glucose and carbohydrate metabolism. The basic problem is glucose cannot adequately enter into cells to serve as a source of energy. Muscle cells, fat cells in a variety of other cells are affected. The problem can be deficient production of insulin by the pancreas or decreased sensitivity of the cells to the action of insulin, which is the stimulation of them to allow the entry of glucose. The term for this phenomenon is insulin resistance. The basis of the resistance is decreased responsiveness of the insulin receptors on cells. Diabetes mellitus can be a primary disease or secondary to other causes. The two primary forms are type 1 and type 2. There are a number of causes of secondary diabetes mellitus. The most common ones are as follows:
- Gestational diabetes
- Other endocrine problems such as acromegaly and Cushing’s syndrome
- Certain medications
- Pancreatic damage from inflammation (pancreatitis), trauma, or tumor
- Surgical removal of the pancreas
Type 2 diabetes mellitus is the most common form of primary diabetes mellitus. The term formally was adult onset diabetes mellitus because it developed primarily in adults. In recent years though, its frequency has been increasing in children and adolescents. The basic defect is insulin resistance. Over time though, the pancreas produces less insulin to the point that many with the disease have a problem with being able to produce enough insulin in response to meals. They thus have a dual defect of insulin resistance and insulin deficiency. Even though the disease early on can be treated with diet and/or pills insulin is required when the decline in the function of the pancreas reaches the point that it produces insufficient amounts of the hormone.
Type 1 diabetes mellitus develops primarily during adolescence or childhood but is less frequently diagnosed in adults. The basic defect with this form of diabetes is the inability of the pancreas to produce enough insulin, not only in response to meals but even in the fasting state. Because of the magnitude of the deficiency individuals with this form of the disease require insulin to sustain life. Without it they develop a life-threatening condition, diabetic ketoacidosis. Individuals with type 1 disease are more likely to be thin in contrast to those with type 2 disease who tend to be overweight or obese. Another important distinction is type I diabetes can never be treated with pills.
Gestational diabetes is a form of diabetes which occurs during pregnancy. The cause is not deficient insulin production or insulin resistance but a hormone that the placenta produces which counteracts the normal actions of insulin. It occurs in only 2% to 10% of pregnancies and subsides after childbirth. Women who experience it are more likely to develop type 2 diabetes mellitus at a later time. It requires insulin treatment if diet does not control the elevated blood glucose levels. A three hour glucose tolerance test establishes the diagnosis.
Diabetic ketoacidosis (DKA) – It is a life-threatening state which develops as a result of a marked insulin deficiency ± decreased food intake in individuals with type 1 diabetes mellitus. The primary problem is the inability to absorb sufficient glucose into cells. It develops as the body breaks down fat as an alternative source of energy for the cells. That process results in the formation of ketone bodies. Since ketone bodies are acids their accumulation in large amounts raises the acidity of the bloodstream to life-threatening levels. Additionally, the elimination of large quantities of glucose in the urine causes excessive secondary loss of fluid. The large fluid losses in turn cause electrolyte imbalances. Because of the combination of these problems ketoacidosis always requires hospitalization for intensive insulin therapy, fluid replacement, and electrolyte management. Diabetic coma can ensue if the condition is not appropriately recognized and treated.
Diabetic nephropathy – It is the damage to the kidneys apparently caused by diabetes mellitus. It develops in approximately 50% of individuals with long-standing disease. It is a leading cause of chronic kidney failure and the need for dialysis.
Hypoglycemia – It is low blood glucose of less than 70 mg/dl. Some common causes are:
- Taking too much insulin or oral diabetic medication
- Delayed or insufficient eating after taking insulin or oral diabetic medications
- Excessive alcohol ingestion
- Overwhelming infection
- Long-term starvation
- Kidney failure
- Certain diseases of the pituitary and adrenal glands
Typical symptoms of hypoglycemia are the following:
- blurred vision
- headache confusion
Reactive hypoglycemia is a condition in which the blood sugar tends to drop after eating. It is associated with the overproduction of insulin but the reason for the increase is unknown. It is occasionally occurs in individuals who have undergone gastric bypass surgery.
Graves’ disease – It is a form of hyperthyroidism in which there is generalized diffuse enlargement of the thyroid gland. Physical examination of the neck will oftentimes reveal the enlarged gland. It will also show up on a radioactive iodine scan of the thyroid. A main physical sign that distinguishes Graves’ disease from other forms of hyperthyroidism is exophthalmos. Blood test show elevated thyroid hormone levels.
Hashimoto’s thyroiditis – Is a generalized inflammatory enlargement of the thyroid gland. Many experts feel that its cause is the body’s unexplained production of antibodies directed against the gland. The condition is most common in individuals with significant prior radiation exposure. They include victims of the atomic bombing of Japan and the Chernobyl disaster. A thyroid scan will show increased uptake of radioactive iodine indicating increased activity within the gland. Because the chronic inflammation causes a gradual destruction of the glandular tissue the blood thyroid hormone levels are usually normal or low. With long-standing disease thyroid hormone levels are usually low and require thyroid replacement hormone medication. Hashimoto’s thyroiditis is the leading cause of hypothyroidism.
Hyperparathyroidism – It is overactivity of one or more of the parathyroid glands. Primary hyperparathyroidism is the excessive production of parathyroid hormone (PTH) by a benign tumor, a parathyroid adenoma. The tumor can be present in one or more of the four parathyroid glands. The excessive production of the hormone results in hypercalcemia. Secondary hyperparathyroidism is excessive production of parathyroid hormone in response to hypocalcemia. Two common causes of the low calcium resulting in secondary hyperparathyroidism are chronic kidney failure and vitamin D deficiency secondary to malabsorption. Vitamin D deficiency from inadequate intake can also be a cause. Primary or secondary disease can cause osteoporosis.
Hypoparathyroidism – It is a rare condition in which the parathyroid glands are not producing enough PTH. It results in low blood levels of calcium (hypocalcemia). Hypoparathyroidism is sometimes associated with tetany.
Hyperthyroidism – It is a state of overproduction of thyroid hormones (T3 and T4) by the thyroid gland. It can result from Graves’ disease, a single nodule in the thyroid gland, multiple nodules, or thyroiditis (inflammation of the thyroid gland).
Hypothyroidism – It is a state of underproduction or nonproduction of thyroid hormones by the thyroid gland. Common causes are Hashimoto’s thyroiditis, treatment of Graves’ disease with radioactive iodine, deficient intake of iodine, lithium and pregnancy. Deficient iodine in the diet is the number cause of hypothyroidism worldwide. But Hashimoto’s thyroididits is the number cause in the United States. Because the body’s metabolism slows down when thyroid hormone levels are too low a number of signs and symptoms might develop. A decreased heart rate, reduced libido, fatigue, sleepiness, poor memory and depression are some of the more common ones. Other signs and symptoms are cold intolerance, brittle nails, skin thickening, hair loss, constipation, muscle aches and weight gain. Myxedema coma is a life-threatening state of diminished brain function which develops on rare occasions in individuals with severe hypothyroidism. It occurs most commonly in elderly people.
Osteopenia – It is a state of reduced bone density or mass to a level less than normal. But the degree of reduction is not as marked as with osteoporosis. Many consider it to be a forerunner of the latter though. It is a result of the natural process of bone formation not keeping up with the natural process of bone destruction.
Prediabetes – It is a state of latent impairment of carbohydrate metabolism which does not fully meet the criteria for diabetes mellitus. It results in a blood glucose that is not normal but not as high as in diabetes. It does carry a greater than normal risk for the development of diabetes mellitus in the future though. Criteria for diagnosing it are:
- Fasting blood glucose of between 100 and 125
- 2-hour oral glucose tolerance test blood glucose between 140 and 199
- Hemoglobin A-1 C of between 5.7 and 6.4
Syndrome of inappropriate ADH (SIADH) – It is a state of the hypothalamus producing too much antidiuretic hormone (ADH). Because of inappropriately elevated amounts of the hormone the kidneys reabsorb a disproportionately increased amount of free water in relationship to the amount ingested and one’s existing fluid volume status and serum sodium level. That causes the secondary dilution of salt and other particles in the bloodstream. That dilution in turn causes the serum osmolality to drop. The diagnosis of the syndrome is made by measuring and comparing the serum sodium, serum osmolality and urine osmolality. Elevated urine osmolality in the face of low serum osmolality and/or low serum sodium confirms the diagnosis if there are no other explanations for the discordant values. Disorders of the brain, including injury and infection can cause it. Other common causes are lung cancer and certain medications.
Thyroid nodule –Is a lump of abnormal tissue in the thyroid gland. Most are benign but some are cancerous. Skinny-needle biopsy is required to determine if a nodule is benign or malignant.