Alteraciones Endocrinológicas en Ciertas Enfermedades Infecciosas.pptx

Alteraciones endocrinológicas en ciertas enfermedades, enfoque pediatrico.

1. Alteraciones Endocrinológicas en Ciertas Enfermedades Infecciosas Daniel Mauricio Mora Gómez Residente Pediatría - PUJ

2. Las infecciones afectan a multiples órganos generalmente limitándose un solo aparato, llegando a tener manifestaciones secundarias afectando el sistema endocrinológico. INTRODUCCIÓN

3. Sistema Inmunitario / Endocrino IL-6 interleucina-6 IL-1β interleucina-1β TNF-α factor de necrosis tumoral α Alteración en la comunicación bidireccional secundario a las citoquinas liberadas CRH hormona liberadora de corticotropina ACTH corticotropina Cortisol DHEA dihidroepiandronstenediona Esta respuesta inmunoendocrina conduce a una migración y reacción de las células inmunes contra el patógeno causante.

4. Concientizar a los profesionales en la salud en cuanto a las posibles asociaciones que se presentan entre el sistema endocrino y las infecciones virales, bacterianas, micóticas o parasitarias, y no descartarlas como procesos paralelos, y así, permitir un acercamiento más holístico evitando retrasos y fallas en el diagnóstico. OBJETIVO

5. Tuberculosis

6. Presencia M. tuberculosis 25% de población Gran causa de mortalidad Tuberculosis Alteración Diseminación generalizada Alteración endocrina Clinicamente significativo es raro Cronicidad Liberación prolongada de corticoides + reducción de DHEA Cambios respuesta Th1 a Th2

7. Tuberculosis ↑ Hormona de crecimento (GH) ↑ Hormona estimulante de tiroides (TSH) T4 normal; ↓ T3 Hiporexia y alteraciones en la utilización de lípidos Alteración hipotálamo, glándulas: pituitaria, tiroides, paratiroides, pancreática, los testículos u ovarios, y/o adrenales Enf. Addison, diabetes insípida, tuberculosis tiroidea, absceso selar, disfunción hipofisaria, cerebro perdedor de sal, hiper/hipocalcemia, etc.

8. Candidiasis

9. Candidiasis Pueden diseminarse de manera multisistémica ( tiroides e hipófisis , glándulas suprarrenales, páncreas y gónadas) Ptes. inmunosuprimidos incluyendo ptes. c on diabetes mellitus (DM) y síndrome de Cushing (SC). Agentes Comunes Mucormicosis Candidiasis Dermatofitosis

10. Deficiencia Th12 Defensa especifica contra C. albicans Candidiasis Candidiasis mucocutanea Manifestación más temprana Triada C andidiasis, hipoparatiroidismo crónico y la EA Poliendocrinopatía autoinmune - candidiasis - distrofia ectodérmica (APECED)

11. Candidiasis Disfunción Sexual masculina y reproductiva femenina Esteroides Inhibe síntesis de esteroidogénesis Suprarrenal Pseudohiperaldosteronismo, insuf. Suprarrenal, SIADH Glucocorticoides Altera sintesis y degradación MANEJO AZOLES

12. Toxoplasmosis

13. Toxoplasmosis Toxoplasmosis Testosterona ↑ Cambios comportamentales Conducta antisocial, agresividad y dominancia Inmunosupresión celular C aracterísticas > masculinas M ayor probabilidad de dar a luz a varones

14. Hay estudios que intentan relacionar el rol de la testosterona, progesterona, prolactina y el 17β-estradiol durante el embarazo en la regulación de la infección por T. gondii , se ha encontrado que existen factores hormonales protectores en modelos animales, hacen falta estudios en humanos. Toxoplasmosis

15. Hepatitis C

16. E nfermedad viral causada por el virus de hepatitis C (VHC). Poca conciencia de su diagnóstico, y baja tasa de manejo. Poco porcentaje es población pediátrica, aprox. 11 millones de pacientes <15 años con infección crónica por HC a nivel mundial Hepatitis C Trastornos Tiroideos I ncluye hipo/hipertiroidismo, tiroiditis de Hashimoto, o presencia de Ac antitiroideos asintomáticos Diabetes Mellitus tipo 2

17. Hepatitis C Factores de riesgo para aumento de Ac Tiroideos Predisposición genética Ingesta de yodo Deficit de selenio Exposición a dosis bajas de radiación Otras infecciones virales Infección crónica de Hepatitis C Ca papilar tiroideo

18. Hepatitis C Infección crónica de Hepatitis C DM tipo II ? Resistencia insulínica periférica Predisposición genética

19. A lteraciones de la GH, deficiencias de vitamina D, disfunción sexual. Hacen falta estudios para determinar las interacciones causales. Sigue sin existir una evidencia fuerte de que el virus llegue a alterar el eje hipotálamo-hipofisario. El IFN como manejo se ha asociado también a trastornos tiroideos. Hepatitis C

20. Virus y Endocrinología CMV, VZV, VIH Alteraciones hipotalámicas HSV ½, VIH, virus Hanta, SARS-CoV-2 y rubeola Hipofisitis Virus Hanta, VZV Hemorragia pituitaria HSV-1, VEB SIADH Virus Hanta, CMV, HSV, Coxsackie B1 Diabetes insípida

21. Fiebre Tifoidea

22. Fiebre Tifoidea Causada por S. typhi alta mortalidad en especial en la población pediátrica OmpA S. typhi SPI-18 Hemolisina

23. Malaria

24. I nfección parasitaria causada por el parásito Plasmodium falciparum o vivax. Tiene una presencia importante alrededor del mundo. Colombia es uno de los países con mayor prevalencia en las américas Malaria

25. Malaria ↑ Glucosa ↓ Citoquinas Tolerancia a enfermedad

26. Malaría Malaria Hiponatremia Diabetes insipida Hipercortisolemia Insuficiencia adrenal Hipotiroidismo Hiperglicemia Hipoglicemia SIADH

27. Conclusiones

28. Conclusiones E l proceso inflamatorio 2rio a la infección genera multiples alteraciones del aparato endocrino. Cualquier tipo de germen puede alterar diferentes ejes. Algunos patógenos alteran más una glándula de manera específica . La tiroides aparenta ser la glándula más afectada por las infecciones. Las hormonas pueden cambiar configuraciones dentro del patógeno . La fisiopatología de cómo la infección altera a las hormonas sigue requiriendo más estudio.

29. BIBLIOGRAFÍA Jubbin Jagan Jacob, Paul M. Infections in Endocrinology: Tuberculosis. Nih.gov. Published March 14, 2021. Accessed May 12, 2024. https://www.ncbi.nlm.nih.gov/books/NBK568566/ Somasundaram NP, Sonali S. C. Gunatilake. Infections in Endocrinology: Viruses. Nih.gov. Published Infections in Endocrinology: Tuberculosis - Endotext - NCBI Bookshelf March 14, 2021. Accessed May 18, 2024. https://www.ncbi.nlm.nih.gov/books/NBK568565/ Bhattacharya S, Suraj Kubiha, Tyagi P. Fungi and Endocrine Dysfunction. Nih.gov. Published June 25, 2021. Accessed May 13, 2024. https://www.ncbi.nlm.nih.gov/books/NBK572246/ Capalbo D, N. Improda, Esposito A, et al. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy from the pediatric perspective. PubMed. Published online November 1, 2013. doi: https://doi.org/10.3275/8999 Nima Zouei, Saeedeh Shojaee, Mehdi Mohebali, Keshavarz H. The association of latent toxoplasmosis and level of serum testosterone in humans. BMC research notes. 2018;11(1). doi: https://doi.org/10.1186/s13104-018-3468-5 Galván-Ramírez L, Adrián Fernando Gutiérrez-Maldonado, Verduzco-Grijalva F, Marcela J. The role of hormones on Toxoplasma gondii infection: a systematic review. Frontiers in microbiology. 2014;5. doi: https://doi.org/10.3389/fmicb.2014.00503 C Wendy Spearman, Dusheiko GM, Hellard M, Sonderup M. Hepatitis C. Lancet. 2019;394(10207):1451-1466. doi: https://doi.org/10.1016/s0140-6736(19)32320-7

30. BIBLIOGRAFÍA Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. Journal of hepatology. 2014;61(1):S45-S57. doi: https://doi.org/10.1016/j.jhep.2014.07.027 Caviglia GP, Rosso C, Fagoonee S, et al. Endocrine manifestations of chronic HCV infection. MINERVA ENDOCRINOLÓGICA. Published online September 27, 2017:321-329. doi: https://doi.org/pubmed Patrizia Burra. Liver abnormalities and endocrine diseases. Baillière’s best practice & research Clinical gastroenterology/Baillière’s best practice and research in clinical gastroenterology. 2013;27(4):553-563. doi: https://doi.org/10.1016/j.bpg.2013.06.014 Karavolos MH, Bulmer DM, Spencer H, et al. Salmonella Typhi sense host neuroendocrine stress hormones and release the toxin haemolysin E. EMBO reports . 2011;12(3):252-258. doi: https://doi.org/10.1038/embor.2011.4 Buck E;Finnigan NA. Malaria. Published July 31, 2023. Accessed May 23, 2024. https://pubmed.ncbi.nlm.nih.gov/31869175/ Field JW. Blood examination and prognosis in acute falciparum malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1949;43(1):33-48. doi: https://doi.org/10.1016/0035-9203(49)90022-x Leen Vandermosten, Pham TT, Sofie Knoops, et al. Adrenal hormones mediate disease tolerance in malaria. Nature communications. 2018;9(1). doi: https://doi.org/10.1038/s41467-018-06986-5 Resmi Premji, Nira Roopnarinesingh, Cohen J, Sen S. Cerebral Malaria: An Unusual Cause of Central Diabetes Insipidus. Case reports in endocrinology. 2016;2016:1-4. doi: https://doi.org/10.1155/2016/2047410

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32. TABLE OF CONTENTS PATHOLOGY You can describe the topic of the section here TREATMENT You can describe the topic of the section here CONCLUSIONS You can describe the topic of the section here ABOUT IT You can describe the topic of the section here DIAGNOSIS You can describe the topic of the section here RECOMMENDATIONS You can describe the topic of the section here 04 05 06 01 02 03

33. ABOUT IT You can enter a subtitle here if you need it 01

34. MERCURY It’s the closest planet to the Sun and the smallest one in the Solar System ABOUT THE DISEASES MARS Despite being red, Mars is actually a cold place. It’s full of iron oxide dust VENUS Venus has a beautiful name and is the second planet from the Sun

35. INTRODUCTION You can give a brief description of the topic you want to talk about here. For example, if you want to talk about Mercury, you can say that it’s the smallest planet in the entire Solar System

36. ABOUT THE DISEASES MERCURY Mercury is the closest planet to the Sun MARS Despite being red, Mars is actually a cold place JUPITER Jupiter is a gas giant and the biggest planet VENUS Venus is the second planet from the Sun

37. TYPE A Venus has a beautiful name and is the second planet from the Sun. It’s terribly hot CONCEPTS AND TYPOLOGY TYPE B Jupiter is the fourth-brightest object in the night sky and the biggest planet TYPE C Despite being red, Mars is actually a cold place. It's full of iron oxide dust TYPE D Saturn is a gas giant and has several rings. It's composed of hydrogen and helium

38. MARS Despite being red, Mars is actually a cold place. It's full of iron oxide dust PATHOLOGY MERCURY Mercury is the closest planet to the Sun and the smallest one in the Solar System VENUS Venus has a beautiful name and is the second planet from the Sun

39. Images reveal large amounts of data, so remember: use an image instead of a long text. Your audience will appreciate it A PICTURE ALWAYS REINFORCES THE CONCEPT

40. SYMPTOMS OF THE DISEASE DIFFICULTY SLEEPING Mercury is the smallest planet SENSITIVITY TO HEAT Jupiter is the biggest planet INCREASED SWEATING Saturn is a gas giant with rings WEIGHT LOSS Neptune is far away from Earth 02 03 04 01

41. RISK FACTORS Follow the link in the graph to modify its data and then paste the new one here. For more info, click here VENUS Venus is the second planet from the Sun JUPITER Jupiter is the biggest planet of them all SATURN Saturn is a gas giant and has several rings 20% 35 % 45 %

42. A PICTURE IS WORTH A THOUSAND WORDS

43. 500 Diagnoses per day 3,000 Consider stable per m onth 4,378 Person in treatment KEY NUMBERS

44. “This is a quote, words full of wisdom that someone important said and can make the reader get inspired.” —SOMEONE FAMOUS

45. MERCURY Mercury is the closest planet to the Sun DIAGNOSES MARS Mars is actually a very cold place VENUS Venus is the second planet from the Sun NEPTUNE It’s the farthest planet from the Sun JUPITER Jupiter is the biggest planet of them all SATURN It’s composed of hydrogen and helium

46. PREVENTION TYPE 1 OBSERVATION Mercury is the smallest planet EXAM Mars is actually a very cold place ROUTINE Jupiter is the biggest planet TYPE 2 OBSERVATION Venus has a very toxic atmosphere EXAM Neptune is far away from Earth ROUTINE Saturn is a gas giant with rings

47. TREATMENT MARS Despite being red, Mars is a cold place. It's full of iron oxide dust JUPITER Jupiter is a gas giant and the biggest planet in the Solar System 01 02

48. RECOMMENDATIONS You can describe what the patient shouldn’t do here You can describe what the patient shouldn’t do here You can describe what the patient shouldn’t do here You can describe what the patient shouldn’t do here You can describe what the patient should do here You can describe what the patient should do here You can describe what the patient should do here You can describe what the patient should do here

49. AWESOME WORDS

50. PREVALENCE VENUS Venus has a beautiful name and is the second planet from the Sun MERCURY Mercury is the closest planet to the Sun and the smallest one

51. 150,000 Big numbers catch your audience’s attention

52. Venus has a beautiful name and is the second planet from the Sun. It’s terribly hot, even hotter than Mercury, and its atmosphere is extremely poisonous. It’s the second-brightest natural object in the night sky after the Moon CONCLUSION

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