HMM 4401–
Endocrine and obesity
Ett sykehus
- nær deg og dine
Mission
Municipalities
Blefjell hospital is a community hospital caring for the
inhabitants of 16 municipalities.
Kongsberg
Sigdal
Rollag
Blefjell hospital offers emergency and elective care and diagnostics in
internal medicine, psychiatry, orthopedics and general surgery.
Øvre Eiker
Gynecological and obstetric services are differentiated between the
three units; Kongsberg, Notodden and Rjukan.
Flesberg
Private practice specialists offer services in eye diseases, ear, nose and
throat diseases, pediatrics etc.
Uvdal
Diagnostic services to in- and outpatients include clinical labs, X-ray
departments, physical therapy and a patient support unit (LMS)
Nome
Nore og
Notodden
Bø
Sauherad
Tinn
Hjartdal
Seljord
Kviteseid
Tokke
Vinje
Main endocrine diseases
• Heard of any endocrine or hormone diseases
• Know any hormones?
The endocrine systems
• Not one system but many
• Liver is an exocrine gland
• Has duct system to channel prduct
• Thyroid is an endocrine gland
• Blood transports hormones to target
• Endocrine systems are complex and give many
strange and rare diseases
Main endocrine diseases
• Heard of any endocrine or hormone diseases
• Know any hormones?
Function of the endocrine system
• What is a metaphor for some of the endocrine systems?
• Pituitary gland
• Thyroid and parathyroid
• Pancreas (alpha and beta)
• Adrenals
• Ovaries
• Testes
Function of the endocrine system
• What do some of the endocrine systems do?
• Pituitary gland – grand master, director
• Thyroid - metabolism
• parathyroid – calcium and bone
• Pancreas (alpha and beta) diabetes, blood glucose
• Adrenals –Salt and mineral balance, cushing disease
• Ovaries – female charachteristics, fertility
• Testes – male charachteristics, fertility
Function of hypothalamus - pituitary
• Brain controls
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everything!
Sends signals
- chemicalsto pituitary
Pituitary stimulate
or stop the “real”
producer
Blood lever of
hormone decide
stimulation
Function continued – many hormones
• Brain controls
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everything!
Antidiuretic
Cortisol
Endorphins
Growth hormone
Oxytocin
Prolactin
Luteinizing hormone
Thyroid
Function continued
• Brain controls
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everything!
Remember any
hormones??
Function continued – thyrotixicosis or
“high metabolism”
• Brain has lost
control!
• Thyroid is
producing
without control
Function of thyroid – if too hing
Function of thyroid – if too high!
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Fast pulse
High blood pressure
Warm
Nervous
Increased appetite and
weight loss
Bulging eyes
diarrhea
Function of thyroid – if too low
• Low metabolism
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• Cold, always freezing,
• Low pulse
• Depressed, apathy
Eat little, still over weight
Dry hair and skin
Tired
Hoarse voice
Constipation
Function of Adrenals
• Addisons disease: too little corticosteroids, loose salt
Low blood pressure
Fatigue
Death
Shock
Lack of stress response
Function of Adrenals
• Cushing disease: Too much corticosteroids, retain salt
Function of the endocrine system
• What do some of the endocrine systems do?
• Pituitary gland – grand master, director
• Thyroid - metabolism
• parathyroid – calcium and bone
• Pancreas (alpha and beta) diabetes, blood glucose
• Adrenals –
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• Salt and mineral balance, cushing disease
• Adrenalin, stress, fight and fligth
Ovaries – female charachteristics, fertility
Testes – male charachteristics, fertility
Function continued – many hormones
• Brain controls
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everything!
Antidiuretic
Cortisol
Endorphins
Growth hormone
Oxytocin
Prolactin
Luteinizing hormone
Thyroid
Complex systems and diagnosis
Diabetes
Diabetes
• Pancreas make insulin
• Too little insulin compared to body’s need = diabetes
• What is the difference between diabetes type 1 and 2?
Impaired glucose tolerance –
metabolic syndrome
• Too
Diabetes – common disease
• Blood sugar too high
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Fasting > 7,8 mmol
Non-fasting > 11 mmol
Repeated measurements if doubt
Give glucose and monitor response
• Causes:
• Too much sugar
• Too little insulin
• Too many cells to cover with insulin
Diabetes – complications
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Blood vessels – heart disese, stroke, impotence
Eyes – retinopathy, poor vision, blindness
Kidney – poor function, kidney failure, transplantation
Nerves – neuropathy, walking on pillow, pain
Autonomic nerve system –
• poor regulation of blood pressure and GI-system
• Skin – sores, infection, poor healing
• Blood – reduced immune system
• Connective tissue – thickens, contracts
What is atherosclerosis?
What is atherosclerosis, step by step
Eyes
GI-system
Diabetes and blood glucose
Practical work
• Measure blood sugar – before and after you eat or drink!
Diabetes and blood glucose
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Look at different insulin pens
If you lack insulin you must inject with meals
1,2 ,3, multi or pump
Even children can do this!
Metabolic syndrome
• Heigth in cm
• Weight in kg – but adjust for number given
Metabolic syndrome
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Heigth in cm
Weight in kg with +Waist – hip ratio
What is normal weight
How can we get a comparable number?
• Is 90 kg too much – what is relevant
• Muscle, fat, height, bone ??
Metabolic syndrome
• How get a comparable
number?
• BMI – calculate the groups’
manipulated BMI
Obestiy and nutrition
• Look at heights and weights, any obese??
• Any underweight??
Calories come from food, ? per gram??
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Sugar, starch, carbohydrates
Protein
Alcohol
Fat
• Man is able to starve,
• constructed for hunger,
• gain weight easily
Calories per gram??
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Sugar, starch, carbohydrates 4 kcal/g
Protein 4 kcal/g
Alcohol 7,2 kcal/g
Fat 9 kcal/g
Vitamins
Role of Vitamins in Health and Disease
Vitamin
Biochemical
Function
Deficiency
Prevention/Treatme
nt
Niacin
NAD, NADP
component
Pellagra
Hypercholesterolemi
a
B6
Transamination
cofactor
Convulsions
Carpal tunnel
syndrome
B12
Transmethylation
cofactor
Anemias
Cognitive
dysfunction
Folic
acid
Single carbon
transport
Megaloblastic
anemia
Hyperhomocysteine
mia
C
Hydroxylation cofactor
Scurvy
Oxidative stress
D
Calcium transport
Rickets
Osteoporosis
E
Antioxidant
Hemolytic anemia
Relative anergy
Weight reduction with low calorie diets
seldom lasting weight loss
Operation
to lose weight
Gastric banding
Gastric bypass
Take away intestine
Jaw closure
Baloons in stomach
Etc etc
Malnutrition even in Norway, USA
Percentage of Individuals with Diets that Meet the RDA: Problem
Minerals
Population Meeting Groups at Highest Risk for Not
Mineral
RDA, %
Meeting RDA
Calcium
13.5-25.3
Females (12-70+)
Phosphorus
33.7
Females (12-19)
Males (12-29, 50+), females (12Magnesium
17.9-33.5
70+)
Iron
22.1-27.7
Females (12-49)
Children (1-5), males (40+),
Zinc
12.4-32.7
females (6+)
Future advances
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Even more specific and costly intervention
Genetic therapy
Infection/Antibiotic theories
Immunology – tailor made medication
More technology
Better decentralized care and diagnostics
MRI, PET scan, etc.
Summary
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Endocrinology a complex subject
Many rare disases
Diabetes common life style disease
Tailor made medication
Life long diseases
Sometimes surgery, often medicine
Summary obesity
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Western affluent societies, major problem
Becoming world wide disease
Children and youngsters
Complicates all other diseases
Equipment must be larger
Beds must tolerate more kg
Personell must have lifting devices
Ambulances more muscle to lift person
Etc etc.
Few easy cures