Pathophysiology

Fractures

Definition: Complete or incomplete break in the structural continuity of a bone. Type of fractures: 1) Close (simple) Best treated with closed method unless there is indication to use open method once opened there are risks of infection 2) Open (compound) Definition: Fractures communicating outside through a rent in the skin Fracture with lacerated wound…

Menstrual disorders

Read from Dr. Sheila Rani’s notes! Normal menstruation normal volume 30ml – 80ml interval between cycles 28 days duration of flow 2-7 days Amenorrhea absence of menstruation in excess of 6 months Primary: Rokitansky’s syndrome no onset of menstruation by age 16 with normal sexual development no onset of menstruation by age with no normal…

Adrenal Disorders – Congenital Adrenal Hyperplasia

It is an autosomal recessive syndrome: Insufficient cortisol syntesis Increased ACTH production –> increases cortisol to maintain circulating levels Stress cortisol – inadequate Mineralocorticoid synthesis affected 21 beta-hydroxylase deficiency & 17 alpha-hydroxylase deficiency for steroid hormone production 21 beta-hydroxylase deficiency: (refer diagram) Coding gene at chromosome 8 Mineralocorticoid defect results in hyperkalemia, hyponatremia & low…

Adrenal Disorders – Pheochromocytoma

Pheochromocytoma: A catecholamine-producing tumour derived from the chromaffin cells (of the adrenal medulla/ outside the adrenal medulla) Dusky coloured tumor 10% tumour bilateral disease (10%) malignant (10%) located in chromaffin tissue OUTSIDE the adrenal gland (10%) arise in childhood (10%) familial (10%) recur after being resected (10%) Can be inherited as an autosomal dominant trait…

Adrenal disorders – Adrenocortical Insufficiency

Deficiency of any of the adrenocorticoid steroid hormones Hypoadrenalism Reduced adrenocortical function Deficient synthesis of steroid hormones ACTH deficiency – Can’t stimulate the adrenal cortex Primary Adrenocortical insufficiency Disease of the adrenal gland Acute: Adrenal crisis Sudden loss of adrenocortical function caused by: Bilateral adrenalectomy (as a treatment of cortical hyperfunction & hypertension) Septicaemia (from…

Adrenal disorders – Adrenogenital syndrome

Adrenal virilism: The development or premature development of male secondary sexual characteristics caused by male sex hormones (androgens) excessively produced by the adrenal gland. This disorder can occur before birth and can lead to sexual abnormalities in newborns. It can also occur in girls and women later in life. Boys will gain sexual maturation faster…

Adrenal Disorders – Hyperaldosteronism

Frequent in adult females Primary Hyperaldosteronism Also known as Conn’s Syndrome Overproduction of aldosterone Adrenal cortex lesion: -Adrenocortical adenoma -Adrenal carcinoma -Bilateral adrenal hyperplasia (in children) Associated with low plasma renin levels (positive feedback? due to increased blood volume from the action of aldosterone, initiating the renin-angiotensin-aldosterone system) Low K+ level (in exchange of Na+…

Adrenal Disorders – Cushing’s Syndrome

Cushing’s Syndrome Chronic hypercortisolism due to excessive production of cortisol 20-40 years of age 3 times higher frequency in women Pituitary Cushing’s syndrome Adrenal Cushing’s syndrome Ectopic Cushing’s syndrome Iatrogenic Cushing’s syndrome Pituitary Cushing’s syndrome (60-70%) Cushing’s disease Excessive ACTH, due to Pituitary lesion: corticotroph adenoma, multiple corticotroph microadenoma hypothalamic origin: excessive CRH secretion –>…

Diseases & Evaluation of the Hypothalamo-hypophyseal axis

Endocrinopathies are classified as primary, secondary, or tertiary. Primary endocrine disease inhibits the action of downstream glands/ target endocrine glands. Secondary endocrine disease is indicative of a problem with the pituitary gland. Tertiary endocrine disease is associated with dysfunction of the hypothalamus and its releasing hormones. Vasopression excess (SIADH) Causes: 1) Ectopic production by carcinoma…