Endocrine and Exocrine Disorders
Michel Goldberg*
Biomédicale des Saints Pères, Université Paris Descartes, France
Submission: November 08, 2019; Published: November 19, 2019
*Corresponding author: Michel Goldberg, Biomédicale des Saints Pères, Université Paris Descartes, Paris, France
How to cite this article: Michel Goldberg. Endocrine and Exocrine Disorders. OAJ Gerontol & Geriatric Med. 2019; 5(2): 555659. DO 10.19080/OAJGGM.2019.05.555659
Endocrine Disorders
Endocrine and exocrine hormones are due to secreting glands produced either in young or old patients. They are at the origin of numerous disorders due to endocrine or exocrine deregulations. The secretion of hormones is delivered directly through the blood circulation by blood capillaries. A hormone is a protein made by an endocrine gland. After being discharged into the bloodstream, it acts on a target organ to modulate its functioning (positive or negative feedback). Immune-mediated tissue destruction (or deregulations), is the cause of multiple common endocrine disorders. They are including adrenal disease, type 1 diabetes, Graves’ disease, Hashimoto thyroiditis, and Addison’s disease. Dental caries and periodontal disease are the most common oral diseases. Each disorder can be divided into a series of stages beginning with genetic susceptibility, environmental triggering events, and active autoimmunity, followed by metabolic abnormalities. A major portion of the genetic diseases suggests common genetic susceptibility in the HLA region. However, several disorders and mutations of transcription factors underlies topographic, anatomic, physiological, pathologic, etiologic and epidemiological disease susceptibility Devendra & Eisenbarth [1].
The main endocrine glands in vertebrates include hypothalamus, pituitary, adrenal, thyroid, ovary or testicle, parathyroid, thalamus, pancreas, and pineal gland. Endocrine disorders include autoimmune hormones metabolism, regulation of bone in mineral metabolism or store calcium and phosphate juxtaposed with the essential role of phosphate in the adverse effects of hyperphosphatemia. It is not surprising that a complex systems biology has evolved that permits crosstalk between bone and other organs to adjust phosphate balance and bone mineralization in response to changing physiological requirements Quarles [2]. During pregnancy, the placenta also plays the role of an endocrine gland. It becomes the main producer of steroid hormones. The hormones produced by these glandsmay be peptides or steroids such as estrogen, progesterone and testosterone or amino acid derivatives such as thyroid hormones. Newly discovered signaling pathways involved in the endocrine functions of bone, such as those mediated by the phosphaturia and 1,25(OH)2D-regulating hormone FGF23, and with the broader systemic effects associated with abnormalities of calcium and phosphate homeostasis. Endocrine disorders that occur in pregnancy [involving pituitary, ovarian and adrenal diseases [ACTH]), hypopituitarism, adreno-cortical hypofunction, Addison’s disease are also frequent van der Spuy & Jacobs [3]. Addison’s disease may also be caused by destruction of the adrenal glands by tuberculosis, metastatic carcinoma, fungal infection or amyloidosis. Patients have reduced rates of secretion of cortisol, aldosterone and sex steroids. Fatigue, anorexia is the most frequent complains, together with weight loss. The skin is hyperpigmented. The patient is prone to vomiting, dehydration and syncope.
Keywords: Endocrine Exocrine Hormones Addison’s disease Graves’ disease Mutations Autoimmunity Hyperphosphatemia Hypothalamus Pituitary
Exocrine Dysfunctions
Exocrine glands secrete substances, expelled distally from the cell body into an external environment (within the lumen of channels). Secretion occurs in exocrine glands through a secretory canal. Three types of glands are recognized: They were identified either as 1) merocrine gland (i.e. pancreas), 2) holocrine glands : the distal part of the cell loaded with the secretory product detaches from the epithelium and disintegrates at the moment of secretion inside the lumen, 3) apocrine glands are releasing the secretory-rich cell fragments. Sjogren’s syndrome is an autoimmune disorder characterized by dryness of the eyes and mouth exocrine gland dysfunction Key immunopathologic features include: (a) an increased prevalence of particular HLA-DR/DQ alleles; (b) induction of HLA-DR/DQ proteins on the epithelial cells in salivary and lacrimal gland biopsies; (c) infiltration of the glands by CD4+ T-cells that transcribe IL-2 and IFN-7; (d) induction of granzyme A and perforin in CD4+T-cells, suggesting a mechanism of cellular destruction of the glands; (e) clonal expansion of B-cells that use a particular light chain within the salivary gland; (f) production of autoantibodies against nuclear antigens SS-A (60 and 52 kDa) and SS-B (48 kDa), indicating a failure of normal tolerance mechanisms; and (g) increased frequency of B-cell non-Hodgkin’s lymphoma Fox [4]. In addition to the loss of secretory function in several epithelial cell types, autoantibodies, lymphocytic infiltrates in the secretory epithelia, increased apoptosis, and elevated levels of proinflammatory cytokines have been reported in patients with primary Sjogren Syndrome Yin et al, [5].
Immunologic Endocrine disorders
Devendra & Eisenbarth include type 1 diabetes, Grave’s disease, Hashimoto thyroiditis and Addison ‘s disease. Diabetes mellitus type IA is a terminology recommended for immunemediated diabetes with the destruction of the islet -cells of the pancreas. Non-immune-mediated diabetes with severe insulin deficiency is termed type 1B.
Adreno-cortical hyperfunction:(Cushing ’syndrome)
The body makes too much cortisol over a long period of time. Due to a medication or a tumor (produced by the pituitary gland), cortisol maintains the blood pressure, regulates the blood glucose (or blood sugar). It interferes with weight gain and fatty tissue deposits. Striations on the abdomen, breasts and arms, are noted together with a moon-shaped face. Women may present hirsutism and acne. They are amenorrhoeic. Congenital adrenal hyperplasia, and adrenal medulla takes also part of endocrine disorders namely in thyroid and parathyroid disease van der Spuy & Jacobs [6]
Diabetes type I and 2
Diabetes is characterized by an elevated level of glucose in the blood resulting from defects in insulin secretion. Type I diabetes results from insulin deficiency. Type 2 diabetes results of insulin resistance and, third group recently identified, display a gestational insulin secretory defect that results from abnormal glucose tolerance during pregnancy. There are 4 general categories of diabetes [Type 1 diabetes and type 2 diabetes forms, type 3 or gestational diabetes occurring specifically during pregnancy, and diabetes MODY types with 11 different forms, known as a result of genetic mutations]. Symptoms of marked hyperglycemia include polyuria, polydipsia, polyphagia, with weight loss, and blurred vision. Long-term complications of diabetes include retinopathy with potential loss of vision, nephropathy, amputations, and Charcot joints, autoimmune neuropathy causing gastrointestinal, genitourinary, cardiovascular symptoms and sexual dysfunction.
Periodontal disease is the sixth complication of diabetes mellitus. In addition to periodontal diseases such as gingivitis and periodontitis, the list of oral manifestations includes dental caries, salivary dysfunction (dry mouth or xerostomia), oralmucosal diseases (lichen planus, recurrent aphthous stomatitis, candidiasis, retinopathy and peripheral neuropathy). Type 1 diabetes may be treated with insulin injections. Type 2 diabetes treatment begin with weight reduction, a healthy diet, additional insulin, followed by a decrease in the conversion of fat to glucose, risk of heart attack, stroke, kidney disease, and nerve damage. Disabilities due to blindness, amputation, heart disease, and nerve damage exert play crucial role in the premature death of diabetic patients. A strong association was demonstrated between T2D and a low frequency missense variant in hepatocyte nuclear factor 1-alpha (HNF1A), a pancreatic transcription factor known to cause the MODY-3 variant of diabetes.
Hyper & Hypothyroidism
Diabetes mellitus type I and II implies high or low TDH, associated to underactive thyroid disease. They are the second most prevalent endocrine disease worldwide metabolism disease. Hypothyroidism or underactive thyroid occurs when the thyroid slows down the production of hormones needed for the elevated level of glucose. Hypothyroidism is characterized by deficient parathyroid hormone (PTH), weight gain, hair loss, bradycardia / diastolic hypertension; lethargy, menstrual irregularities, cognitive impairment, depression, constipation, goiter, dry skin, cold intolerance. It includes the following characteristics: thick lips, delayed tooth eruption, poor periodontal health, altered tooth morphology and delayed wound healing. The treatment implies the absorption of Levothyroxine (LT4) 50mcg daily. Hyperthyroidism is characterized by upregulated thyroid hormones, elevated blood pressure, tremor emotional instability, intolerance to heat, tachycardia, increased cardiac output, hypertension, increased appetite and weight loss, hair loss, palpitations / tachycardia / atrial fibrillation, menstrual irregularities, widened pulse pressure, nervousness/tremor/ anxiety, proximal muscle weakness, goiter, heat intolerance, diaphoresis, and hypertension Chandna & Bathla [7].
a) Disorders of the parathyroid hormone (PTH): In order to elucidate the possibly of an existing link between disorders of the endocrine system of the child and the two most prevalent oral diseases - dental caries and periodontal disease, the hypo and hyper parathyroid were examined Saminsky [8]
b) Hypoparathyroidism: prevalence of dental caries. Prevalence of enamel defects. The patients were suffering from low oral hygiene and cariogenic activity.
c) Hyperparathyroidism: cause bone loss, associated with loss of the radicular lamina dura.
d) The roles of vitamin D in the pathogenesis of autoimmune endocrine diseases, are including type 1 diabetes mellitus, Addison’s disease, Hashimoto’s thyroiditis, Graves’ disease and autoimmune polyendocrine syndromes. Vitamin D deficiency has a critical role in enamel, dentin, andoral bone formation. Delayed tooth eruption, abnormal high pulp volume/tooth volume ratio suggesting paurodontids, thin enamel layer, short roots, roots resorption, namely in the primary dentition rather than the permanent dentition. Does the supplementation with vitamin D prevent or treat autoimmune disease? The association of vitamin D and Addison’s disease (AD) is largely based on few observational studies. These preliminary results suggest that vitamin D may influence the genetic susceptibility of AD by modifying the immune response. The association between both VDR and CYP27B1 polymorphisms and a higher risk of T1DM. AD, and AITD reinforce the potential role of vitamin D in the pathogenesis of autoimmune endocrine diseases Altieri et al, [9]
Graves’ Disease (GD)
Hyperthyroidism (or an overactive thyroid) is implicated in autoimmune disorders. Thyroid produces more thyroid hormone than the body needs. The thyroid is a small butterfly-shaped gland in the front of the neck. Smoking affects pituitary, thyroid, adrenal, testicular and ovarian function, calcium metabolism and the action of insulin. The major salient clinical effects are the increased risk and severity of Graves’ hyperthyroidism and ophthalmopathy, osteoporosis and reduced fertility. Smoking also contributes to the development of insulin resistance and hence to type 2 diabetes mellitus Kapoor & Jones [10] Cigarette smoking is a risk factor for Graves’ hyperthyroidism and especially Graves’ ophthalmopathy. Graves’ ophthalmopathy is strongly associated with smoking.
Hashimoto’s thyroid (HT)
It is an autoimmune disorder that causes hypothyroidism or underactive thyroid. Many functions slow down. The thyroid gland is gradually destroyed. Over time the thyroid may enlarge, forming a painless goiter.
Osteoporosis
The bone becomes porous and fragile. The risk of fracture increases. Osteoporosis is not painful until the bone is broken. The risk of a broken bone due to the bone mineral density (BMD) increase with age (persons older than 65years).
Addison’s disease
The symptoms come slowly and may include abdominal pain, weakness, and weight loss. Low sodium, high potassium or low cortisol level. There is also a low level of aldosterone, and a high level of adrenocorticotrophic hormone (ACTH). In addition to hyperpigmentation of the skin, it is noted that patients display severe fatigue, weight loss, nausea, vomiting and abdominal pain, and muscle and joint pains.
Adrenal hypercortisolism
(Primary hyperaldosteronism). Within the field of endocrinology, exome sequencing has led to significantadvancements in our understanding of numerous disorders including adrenal disease, growth and pubertal disorders, type 2 diabetes, as well as a multitude of rare genetic syndromes with prominent endocrine involvement Dauber & de Bruin [11]
Cystic fibrosis
Multiple endocrine disorders are produced by diabetes, bone disease, short stature, and male hypogonadism. Bone mineral density and vitamin D levels should be monitored. Hypogonadism has been reported in 25% of men with CF. Endocrine complications can cause morbidity and mortality in CF and need to be appropriately detected and managed as part of the medical care of individuals with CF Blackman & Tangpricha 2016. In type 1 diabetes, hyperglycemia is due to complete or near-complete absence of insulin-producing β-cells in the pancreatic islets. In type 2 diabetes, hyperglycemia is due to a combination of reduced sensitivity to insulin and insufficient production of insulin. The causes of cystic fibrosis related bone disease are multi-factorial and include nutritional deficiencies of vitamin D, K and calcium, glucocorticoid use, sex steroid deficiency, an altered growth hormone axis, inflammation and the mutation of the CFTR gene itself.
Premature ovarian failure (POF)
The ovarian failure occurs before or after puberty. Amenorrhea, elevated gonadotropin levels. A series of glands produce hormones regulating the metabolism, growth and development, tissue function, sexual functions, reproduction, sleep, and mood. The 8 major glands of the endocrine system are the hypothalamus, pituitary, thyroid, parathyroid, adrenals, pineal body and the reproductive organs (ovaries and testes).
a) Hormones of the thyroid gland (THs): Two hormones are released that are the tri iodothyronine (T3) and thyroxine (T4). Cigarette smoking has multiple effects on the thyroid gland
b) Insulin
c) Estrogen Erα and ERβ belong to the steroid/thyroid hormone superfamily of nuclear receptors
d) Progesterone involves two signal sequences: one constitutive, the other is hormone dependent. The existence of the nucleo-cytoplasmic shuttle mechanism was confirmed by receptor transfer from one nucleus to the other in heterocaryons.
e) Prolactin is a protein hormone of the anterior pituitary gland promoting lactation in response to the suckling stimulus of hungry young mammals.
f) Testosterone was used for the treatment of hypogonadism
g) Serotonin are neurotransmitter that modulates neural activity and a wide range of neuropsychologicalprocesses. However, most serotonin is found outside the central nervous system, and virtually all of the 15 serotonin receptors are expressed outside as well as within the brain. Serotonin regulates numerous biological processes including cardiovascular function, bowel motility, ejaculatory latency, and bladder control. Serotonin may regulate some processes, including platelet aggregation, by receptor-independent, transglutaminase-dependent covalent linkage to cellular proteins.
h) Cortisol
7. Hormones produced by the pituitary gland (7)
a) Adrenocorticotropic hormone (ACTH)
b) Thyroid-stimulating hormone (TSH)
c) Luteinizing hormone (LH)
d) Follicle –stimulating hormone (FSH)
e) Prolactin (PRL)
f) Growth hormone (GH)
g) Melanocyte-stimulating hormone (MSH)
Complex interactions exist among the various components of the neuroendocrine system in order to maintain homeostasis, energy balance and reproductive function. These components include the hypothalamus-pituitary -adrenal and -gonadal axes, the renin-angiotensin-aldosterone system, the sympathetic nervous system and the pancreatic islets. These hormones, peptides and neurotransmitters act in concert to regulate the functions of many organs, notably the liver, muscles, kidneys, thyroid, bone, adrenal glands, adipocytes, vasculature, intestinal tract and gonads, through many intermediary pathways. Changes in the vitamin D endocrine system and bone turnover have been noted after oral vitamin D3 supplementation in healthy adults Hivik et al, [12] Vitamin D deficiency is a common endocrine disorder.
Enamel Hypoplasia is due to hypocalcemia, whereas dentin interglobular dentin is related to hypophosphatemia Nikiforuk & Fraser [13]. Children with chronic disorders of calcium and phosphate homeostasis display in hereditary vitamin Ddependency rickets conditions characteristics for hypocalcemia where the plasma calcium concentration was normal [14- 16]. Hypoparathyroidism or rachitic patients displayed an associated prevalence of caries in the primary teeth of children of underdeveloped countries [18-21].
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