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Clinical Aspects Of Endocrine Disorders: Symptomatology And Manifestations
A General Overview
Endocrine disorders may manifest with dysfunction of the gland at fault or secondary disturbances in other endocrine glands. Sometimes the presenting symptom may be a remote effect due to defective regulation of a metabolic process, e.g. secondary amenorrhea in hypopituitarism or Cushing’s syndrome. The structural changes in the endocrine glands do not always correlate with the severity of dysfunction. For example, gross functional defects may result from microadenomas of the pituiray whereas large tumours may not do so.
Abnormalities of growth
The rate of growth may be altered in physiological (e.g puberty) or pathological conditions. Heredity and encironmental factors play a major role in determining growth and development. Abnormalities of growth are common in endocrine disorders. Growth is brought about by increase in number and size of body cells. When considering disorders of growth, rate of growth is more important than the actual size of an individual. The maturation of organs and systems in the body constitutes development.
Endocrine dwarfism may be accompanied by abnormalities of sexual function and secondary sexual characteristics. Hypothyroidism, hypopituitarism, gonadal dysgenesis (XO), pseudohypoparathyroidism, adrenogenital syndrome, hypothalamic syndromes and Cushing’s syndrome are causes of impaired growth. Disparity between age and height, disparity in bone age, alteration of skeletal proportions and disorder in sexual development are features which suggest endocrine etiology. Endocrine causes of dwarfism have to be differentiated from constitutional dwarfism, primary bone disease, malnutrition, metabolic disorders and severe systemic diseases like renal and hepatic failure.
Excessive height may result from accelerated growth hormone activity or abnormalities of adrenal, ovarian or testicular hormones. Pituitary disorders cause gigantism as well as acromegaly. Hypogonadism causes abnormal increase in height and it is associated with eunuchoidism (arm span considerably greater than height and lower segment longer than upper segment). Disorders like Marfan’s syndrome and homocystinuria cause abnormally tall stature with other associated congenital abnormalities. Though gigantism is commonly the result of excessive growth hormone activity occurring in youg age, rarely it may be secondary to other cerebral disorders as well.
Obesity And Polyphagia
Increase in weight by 10% or more above the ideal weight caused by excessive accumulation of fat is called obesity. Common causes are overnutrition and reduction in physical activity. Prediabetics gain weight rapidly and this may be associated with polyuria. Obesity is common in Cushing’s syndrome, hypothalamic syndromes, insulinomas, hypothyroidism, polycystic ovaries syndrome and familial hyperlipidemia (type IV). Obesity is associated with delayed puberty in children. Unlike nutritional obesity, in endocrine obesity, the distribution of fat is distinctive.
Polyphagia is a common feature of diabetes mellitus and hyperthyroidism and it is accompanied by loss of weight. Polyphagia leading to pain in weight is seen in acromegaly and insulinomas. Hypothalamic disorders like craniopharyngioma and Laurence-Moon-Biedl syndrome may give rise to polyphagia, galactorrhea, hypogonadism and somnolence.
Finally, weight loss is of huge significance in considering endocrine diseases. Considerable weight loss inspite of increased intake of food is suggestive of diabetes mellitus, thyrotoxicosis and pheochromocytoma. Loss of weight is accompanied by loss of appetite in disorders like Addison’s disease, panhypopituitarism, anorexia-nervosa and psychiatric illnesses.
Nonspecific symptoms like anorexia, nausea, vomiting and diarrhea with considerable weight loss may be the features of metabolic disturbances occurring in diabetic ketoacidosis, adrenal crisis, thyrotoxic storm or hypercalcemia.
© 2014 Funom Theophilus Makama