Advanced Clinical And Systemic Features Of Endocrine Diseases
Sexual Maturation Disorder And Intantilism
Such symptoms include disorders of sexual maturation, delayed puberty, skeletal manifestations, urinary calculi, psychiatric symptoms and many more.
Disorders Of Sexual Maturation
Normally, boys attain sexual maturity before the age of 18 years and girls do so by the age of 16.
Sexual maturation before the age of eight years constitutes precocious puberty. Though rarely this may be a familial trait, more often it is due to some serious organic disease. Hypothalamic disturbances, congenital virilising adrenal hyperplasia, adrenal tumours and gonadal neoplasms are commonly associated with sexual precocity. Androgen therapy gives rise to sexual precocity in boys. Juvenile hypothyroidism in boys may be associated with pituitary enlargement and sexual precocity. Precocious puberty leads to premature fusion of the epiphyses and this results in dwarfism.
Delayed puberty (infantilism)
When there is failure to attain sexual development by the age of 18 years in boys and 16 years in girls, it is delayed puberty. Though it may be a familial trait, in some, often it is a manifestation of genetic or gonadal disturbances. In India, non-endocrine causes like malnutrition are responsible for delayed puberty among the poor socioeconomic groups. Hypothalamic lesions, pituitary lesions and gonadal dysgenesis (Klinefelter’s syndrome) are the common causes of infantilism in boys. Failure to attain puberty by the age of 18 is seen in girls with gonadal dysgenesis (Turner’s syndrome), pituitary and hypothalamic diseases and polycystic ovaries syndrome. Rare causes include congenital absence of uterus and vagina and pseudohermaphroditism.
Disturbance of sexual function
Impotence is the inability to get penile erection sufficient to perform the sexual act. Proper penile erection is a complex process requiring vascular, neural, and endocrime mechanisms. The sex-drive is termed libido. Impotence and loss of libido are commonly caused by psychogenic factors, but endocrine disturbances like testicular hypoplasia and testicular atrophy, hyperprolactinemia, Addison’s disease, thyrotoxicosis and feminizing tumours of the adrenal cortex may be associated with this symptom. Autonomic neuropathy occurring in diabetes mellitus, chronic alcoholism, central nervous system lesions and therapy with several drugs are the other common causes of impotence.
Psychiatric Symptoms, Tetany And Others
Several endocrine disorders give rise to changes in the bones which may be the presenting manifestations. The predominant manifestations of metabolic bone disorders are bone pains and muscular weakness. When patients present with bone pains, bone cysts, pathological fractures, bony deformities or x-ray evidence of bony abnormalities, hyperparathyroidism, Cushing’s syndrome, osteomalacia, rickets and osteoporosis should be looked for. Hyperthyroidism may occasionally manifest with several osteoporosis.
Several metabolic disorders lead to recurrent stone formation in the kidneys or other parts of the urinary tract. Calcium stones are seen in hyperparathyroidism, hypervitaminosis D, and sarcoidosis. Idiopathic hypercalciuria is a common cause of recurrent calcium stones in male children. Metabolic errors such as cystinuria, renal tubular acidosis, gout and oxaluria, may all be associated with urolithiasis.
Tetany may occur classically in hypocalcemia and less commonly in hypomagnesemia. It is clinically characterized by carpopedal spasms, Chvostek’s sign and Trousseau’s sign. Tetany is commonly seen in hypoparathyroidism, pseudohypoparathyroidism, osteomalacia, rickets, alkalosis and acute pancreatitis. Tetany is rapidly correctable by the intravenous administration of 10 ml of 10% calcium gluconate. Tetany unresponsive to the administration of calcium should suggest the possibility of hypomagnesemia.
Psychiatric symptoms may be prominent in several endocrine disorders. Confusion, behavioural disturbances, somnolence or coma may be seen in hypoglycemia, diabetic coma, hypopituitarism, hypothyroidism, Addison's disease, water intoxication and hypercalcemia. Mental changes are also common in hyperthyroidism, Cushing’s syndrome and hypoparathyroidism. In many cases, the higher functions return to normal levels when the endocrine disorder is controlled, but this need not be so in all cases.
The above symptoms are rare in the manifestation of endocrine diseases, but if they do occur, it is then indicative or an irreversible disorder or complication of the endocrine disorder.
© 2014 Funom Theophilus Makama