PATHO Final Exam Review, Week 8, CHAPTER 16 ENDOCRINE (Ginny)

Dan might have Cushing's Syndrome, and etiology is attributed to Pituitary tumor Large doses on glucocorticoids Adrenal cortex tumor All of the above None of the above

All of the above

Adrenal Medulla - PHEOCHROMOCYTOMA

Benign tumor of the adrenal medulla --secretes epinephrine, norepinephrine --May be single or multiple tumors Hypertension; intermittent or constant --Leads to headache, palpitations, sweating, anxiety NOTES: Page 422 - relatively rare tumor but "curable"

Chronic Issues with DM

Foot ulcers: Caused by neuropathy & vascular insufficiency Minor trauma undetected- ulcers in high pressure areas Infections: Common and often more severe in diabetics UTI, pyelonephritis Candidal infections Dental caries Gingivitis and periodontitis Cataract Opacification of the lens in eye- related to abnormal metabolism of glucose

Hypothyroidism- Manifestations

Goiter if cause is endemic iodine deficiency Intolerance to cold, mental sluggishness, slowed speech Lethargy and fatigue Decreased appetite with weight gain Myxedema in severe untreated hypothyroidism with non-pitting edema (typically pre- tibial), thickened tongue, puffiness of face Dx: low levels of T3 & T4, high TSH Myxedema coma: acute hypotension, hypoglycemia, and hypothermia results in loss of consciousness, life-threatening if untreated

Thyroid Disorders: Hyperthyroidism

Graves disease- an autoimmune disorder is the most common cause Mostly affects women over 30 Diffuse toxic goiter Hypermetabolism- intolerance to heat, sweating, increased appetite with loss of weight, warm flushed skin Increased stimulation of sympathetic nervous system- insomnia, palpitations , tremors Exophthalmos Dx: high levels of T3 & T4, low TSH

The aging body has less muscle mass and one of the hormones secreted by the pituitary responsible for this change is Prolactin TSH GH LH

Growth Hormone

HYDROCORTISONE (FROM NOTES)

commonly known as cortisol, is the most abundant glucocorticoid. Too much cortisol can trigger Cushing's syndrome while too little contributes to Addison's disease. Excessive secretion of glucocorticoids is linked to some types of diabetes. Continuous stress elevates glucocorticoids to levels that can impede other steroid hormones and hinder fertility.

HYPOTHALAMUS NOTES: The hypothalamus is known to control the pituitary. They have a "close relationship". It is also right on top of the optic chiasm and so a little pressure from overgrowth or inflammation could interfere with vision. The hypothalmus is involved in these body activities: Water balance Stress Hunger and satiety Reproduction Thermoregulation Sleep-wake cycles

is in control of pituitary hormones by releasing the following types of hormones: Produces ADH and Oxytocin, sends to posterior pituitary where stored until signaled for release Produces releasing and inhibiting hormones: Thyrotrophic-releasing hormone - plays an important role in the regulation of thyroid gland activity Growth hormone-releasing hormone - stimulates protein synthesis Corticotrophin-releasing hormone - main element that drives the body's response to stress. It is also present in diseases which cause inflammation. Gonadotropin-releasing hormone - stimulates the production of two more hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones are released into the general circulation and act on the testes and ovaries to initiate and maintain their reproductive functions. How does this happen? Neural pathways connect the hypothalamus to the posterior pituitary gland. The posterior pituitary makes up about 25% of the entire gland. It is the posterior portion that stores ADH and oxytocin, releasing upon command from hypothalamus.

Corticosterone (FROM NOTES)

works with hydrocortisone to regulate immune response and suppress inflammatory reactions. Excessive secretion of glucocorticoids is linked to some types of diabetes. Continuous stress elevates glucocorticoids to levels that can impede other steroid hormones and hinder fertility.

Key points: the word "hormone" comes from the Greek word meaning "to arouse activity". (NOTES)

*Hormones are secreted by endocrine glands, their effects on target organs and tissues tend to be more lasting than the short-lived effects precipitated by the autonomic nervous system. *Endocrine glands are differentiated from exocrine glands. *Hormones can be classified by action, source, or chemical structure. Hormones that are classified as "steroids" are lipid soluble and can enter into the cell, directly interacting with RNA to effect some kind of change. *Hormones that are classified as "nonsteroids" are water soluble, can't enter directly into the cell, and relies upon another messenger system to activate changes. *Typical communication technique between and among endocrine glands is the negative feedback system, acting much like a thermostat *Unlike other muscles, heart is controlled by hormones as well as by nervous system. *Pancreas is the largest hormone producing gland in the body, regulating glucose. Insulin when blood sugar is high, glucagon when blood sugar is low. Since glucose necessary for cellular respiration, and life itself, it is very important.

PITUITARY GLAND

- This gland is often referred to as the "master gland." *This gland is the "big kahuna" as they say in the islands. It is well connected to hypothalamus where a multitude of important functions are coordinated and directed. Recall hypothalamus is the control center for many autonomic functions of the PNS. Vascular connections between the hypothalamus and pituitary allow hypothalamic hormones to precipitate, or trigger, or turn on pituitary hormone secretion. The pituitary in turn greatly influences other organs in the body, and so a well functioning pituitary is vital to the overall well-being of a person. People with a pituitary tumor or pituitary issue have a lot more going on than a "simple" brain issue. The pituitary gland (small but mighty), rests in the sella turcica of the brain. Can get to it through your nose. Pituitary produces several hormones.

Actions of Insulin and Diabetes NOTES: Insulin is synthesized by pancreatic cells. Insulin is an anabolic hormone - it increases glycogen, protein & fat synthesis Most important stimulus for insulin synthesis & release is glucose itself

Actions of Insulin: Insulin increases glucose uptake by peripheral tissues (mainly striated muscle & adipocytes) Glucose uptake by other tissues e.g. brain, liver, kidney is independent of insulin Metabolic actions of insulin: *Oxidation of glucose for ATP production- muscle *Glucose stored as glycogen- liver & muscle *Glucose stored as fat- in adipose tissue *Inhibits gluconeogenesis in liver *Promotes protein synthesis

Complications of DM

Complications may be acute and/or chronic. Acute Complications *Hypoglycemia *Diabetic Ketoacidosis *Hyperglycemic Hyperosmolar State Chronic Complications *Microvascular *Macrovascular NOTES: Microvascular Kidney, Eye, Nerves Macrovascular Heart, Brain, PVD

Hypothyroidism additional Congenital issues:

Congenital hypothyroidism: Causes- Iodine deficiency in the mother during pregnancy Inborn defects in synthesis of thyroid hormones Cretinism *Is a manifestations of untreated congenital hypothyroidism *Severe mental retardation impaired growth, short stature *Neonatal screening for T4 & TSH now done & T4 supplements within 6 weeks of life- normal intelligence

Mark has uncontrolled hypertension that seems resistant to any medication. It is suspected he might have a pheochromocytoma, caused by Hyposecretion of ADH Hyposecretion of Calcitonin Hypersecretion of ACTH Hypersecretion of epinephrine

D - Hypersecretion of epi

Hyperglycemic Hyperosmolar Non-Ketotic Coma

Develops more frequently in those with type 2 diabetes Infection or high ingestion of carbohydrates triggers insulin deficit which is severe enough to cascade with symptoms but not severe enough to cause ketoacidosis. Hyperglycemia and Dehydration develop - severe cellular dehydration results in neurologic deficits, muscle weakness, speech difficulties, abnormal reflexes. Hyperglycemia >600mg/dl Hyperosmolarity >320mOsm/L Absence of ketoacidosis

Diabetes Insipidus and ADH:

Diabetes insipidus: deficiency of ADH Caused by head injury or surgery in region of pituitary or hypothalamus Results in polyuria, large volumes of dilute urine passed- severe dehydration

Growth Hormone Issues:

Dwarfism Deficit in growth hormone production/release Gigantism Excess GH prior to puberty and fusion of epiphysis Agromegaly Excess GH secretion in adults: gradual onset Often associated with a GH producing adenoma Bones become broader and heavier Soft tissue grows Enlarged hands and feet; change in facial features Secondary diabetes

FACTORS AFFECTING ENDOCRINE FUNCTION

Everyone's body undergoes changes, some natural and some not, that can affect the way the endocrine system works. Some of the factors that affect endocrine organs include aging, certain diseases and conditions, stress, the environment, and genetics. *Aging Despite age-related changes, the endocrine system functions well in most older people. However, some changes occur because of damage to cells during the aging process and genetically programmed cellular changes. These changes may alter the following: hormone production and secretion, hormone metabolism (how quickly hormones are broken down and leave the body), hormone levels circulating in blood target cell or target tissue response to hormones rhythms in the body, such as the menstrual cycle For example, increasing age is thought to be related to the development of type 2 diabetes, especially in people who might be at risk for this disorder. The aging process affects nearly every gland. With increasing age, the pituitary gland can become smaller and may not work as well. For example, production of growth hormone might decrease. Decreased growth hormone levels in older people might lead to problems such as decreased lean muscle, decreased heart function, and osteoporosis. Aging affects a woman's ovaries and results in menopause, usually between 50 and 55 years of age. In menopause, the ovaries stop making estrogen and progesterone and no longer have a store of eggs. When this happens, menstrual periods stop. *Diseases and Conditions Chronic diseases and other conditions may affect endocrine system function in several ways. After hormones produce their effects at their target organs, they are broken down (metabolized) into inactive molecules. The liver and kidneys are the main organs that break down hormones. The ability of the body to break down hormones may be decreased in people who have chronic heart, liver, or kidney disease. Abnormal endocrine function can result from: congenital (birth) or genetic defects, surgery, radiation, or some cancer treatments, traumatic injuries, cancerous and non-cancerous tumors, infection, autoimmune destruction (when the immune system turns against the body's own organs and causes damage) In general, abnormal endocrine function creates a hormone imbalance typified by too much or too little of a hormone. The underlying problem might be due to and endocrine gland making too much or too little of the hormone, or to a problem breaking down the hormone. *Stress Physical or mental stressors can trigger a stress response. The stress response is complex and can influence heart, kidney, liver, and endocrine system function. Many factors can start the stress response, but physical stressors are most important. In order for the body to respond to, and cope with, physical stress, the adrenal glands make more cortisol. If the adrenal glands do not respond, this can be a life-threatening problem. Some medically important factors causing a stress response are trauma (severe injury) of any type severe illness or infection, intense heat or cold, surgical procedures, serious diseases, allergic reactions. Other types of stress include emotional, social, or economic, but these usually do not require the body to produce high levels of cortisol in order to survive the stress. *Environmental Factors An environmental endocrine disrupting chemical (EDC) is a substance outside of the body that may interfere with the normal function of the endocrine system. Some EDCs mimic natural hormone binding at the target cell receptor. (Binding occurs when a hormone attaches to a cell receptor, a part of the cell designed to respond to that particular hormone.) EDCs can start the same processes that the natural hormone would start. .Other EDCs block normal hormone binding and thereby prevent the effects of the natural hormones. Still other EDCs can directly interfere with the production, storage, release, transport, or elimination of natural hormones in the body. This can greatly affect the function of certain body systems. >EDCs can affect people in many ways: disrupted sexual development decreased fertility birth defects reduced immune response neurological and behavioral changes, including reduced ability to handle stress *Genetics Your endocrine system can be affected by genes. Genes are units of hereditary information passed from parent to child. Genes are contained in chromosomes. The normal number of chromosomes is 46 (23 pairs). Sometimes extra, missing, or damaged chromosomes can result in diseases or conditions that affect hormone production or function. The 23rd pair, for example, is the sex chromosome pair. A mother and father each contribute a sex chromosome to the child. Girls usually have two X chromosomes while boys have one X and one Y chromosome. Sometimes, however, a chromosome or piece of a chromosome may be missing. In Turner syndrome, only one normal X chromosome is present and this can cause poor growth and a problem with how the ovaries function. In another example, a child with Prader-Willi syndrome may be missing all or part of chromosome 15, which affects growth, metabolism, and puberty. Your genes also may place you at increased risk for certain diseases, such as breast cancer. Women who have inherited mutations in the BRCA1 or BRCA2 gene face a much higher risk of developing breast cancer and ovarian cancer compared with the general population.

Cushings Syndrome

Excess cortisol may be caused by adenoma, but most often the cause is iatrogenic - health provider prescribing and administering large amounts of steroids Cushing syndrome is caused by an excessive level of glucocorticoids (cortisol) Appearance - round face, central obesity, fat pad between scapulae, thin limbs Fragile skin, purple striae Retention of sodium and water - hypertension Suppression of the immune response, delayed wound healing Increased catabolism of proteins - muscle weakness, osteoporosis Possible glucose intolerance - secondary diabetes

Pathology explaining primary types of thyroid disease: THYROID

Found in both women and men, the thyroid controls a person's metabolism. It is located in the front of the neck. Thyroid gland produces thyroid hormones thyroxine (T4) and triiodothyronine (T3). Thyroid hormones affect every cell and all the organs of the body. Too much thyroid hormone speeds things up and too little thyroid hormone slows things down. These hormones: Control the rate at which your body burns calories (your metabolism). This affects whether you gain or lose weight. Can slow down or speed up your heartbeat. Can raise or lower your body temperature. Change how fast food moves through your digestive tract. Affect muscle strength. Control how quickly your body replaces dying cells. (HORMONE SECRETED FROM THYROID GLAND IS) Calcitonin (also known as thyrocalcitonin) is a 32-amino acid linear polypeptide hormone produced in thyroid. The hormone participates in Ca2+ and phosphorus metabolism. In many ways, calcitonin counteracts the parathyroid hormone (PTH). *Calcitonin lowers blood Ca2+ levels in four ways: Inhibits Ca2+ absorption by intestines Inhibits osteoclastic bone activity Stimulates osteoblastic bone Inhibits renal tubular reabsorption of Ca2+ , allowing it to be excreted through urine However, effects of calcitonin that mirror those of PTH include the following: Inhibits phosphate reabsorption by kidney tubules Protects against significant calcium loss from skeleton during periods of calcium mobilization, such as during pregnancy and lactation. Can't protect from calcium mobilization when a bone malignancy starts destroying bone.

TESTES

Found in men, this gland produces testosterone, which promotes the growth of the penis as a male gets older as well as facial and body hair. Testosterone is also responsible for deepening the voice of a male during puberty. There are lots of non-scientific attributes of testosterone as well, but we will confine ourselves to learning about the primary functions supported by scientific evidence. Other functions of testosterone include: Maintaining sex drive Promoting production of sperm Maintaining healthy levels of muscle and bone mass There are several marketing drives targeting men who believe they have low "T". Most of this is all hype, designed to prey on the vulnerable older male who is beginning to question his masculinity as he ages. Don't fall for the advertising, and educate your patients.

OVARIES

Found in women, this gland produces both estrogen and progesterone, which promote the development of breasts. They also help a woman maintain healthy menstrual periods by regulating uterine endothelial lining. Estrogen levels are naturally reduced after menopause, primarily because the body no longer needs these levels for 1)attracting a mate and 2)supporting pregnancy. The biology hasn't kept up with our social changes! In the past, hormone replacement therapy has been given to minimize effects of hot flashes, sweats, chills, dizziness etc. and promote bone strength and skin/connective tissue integrity. Women (and men) love HRT because it sort of promotes a youthful image and minimizes the nasty symptoms of menopause. Problem is, HRT linked to heart disease and definitely cannot be given to women with history of breast cancer. Through a woman's life, estrogen and progesterone play key roles in defining and maintaining feminine characteristics. Female reproductive organs - increase in size External genitalia - deposition of fat in the mons pubis, enlargement of labia Vagina - change of the epithelial lining after puberty Uterus - thickening of the endometrium (inner lining of uterus) and development of endometrial glands Fallopian tubes - increase in ciliated epithelial cells in the fallopian tube to help push the ovum out Breasts - growth of the duct network of the breasts, increase in fat and stroma (tissue between lactiferous ducts and milk glands in breast) Bone - stimulate bone growth by reducing bone break down and increasing bone deposition Metabolism - increases the metabolic rate Fat deposition - increases deposition of fat in the subcutaneous tissues, particularly on the breast, thighs and buttocks Skin - increases vascularity, contributes to softer smoother skin Kidneys - electrolyte and water retention which is only prominent with high quantities of estrogen like during pregnancy Functions of Progesterone Uterus - increases secretory actions of the endometrial lining in preparation for pregnancy Fallopian tubes - increases secretions to nourish the rapidly developing fertilized ovum Breasts - promotes development of breast alveoli and lobules

THYROID DISORDERS

Goiter - enlargement of thyroid gland Endemic goiter *Hypothyroid condition in regions with low iodine levels in soil and food Goitrogens *Foods that contain elements to block synthesis of T3 and T4 Toxic goiter *Associated with hyperactivity of thyroid gland

The front anterior portion of pituitary produces:

Growth hormone (GH): This hormone, also called somatotropin, promotes growth in childhood. For adults, it helps to maintain healthy muscle and bone mass. FYI - don't take it to promote adult health. Furthermore, there is no oral route - true growth hormone must be administered by injection. Prolactin: In women, it stimulates milk production. In males, low levels are linked to sexual problems; however, most males make no use of the hormone. Still we all need it. Adrenocorticotropic (ACTH): This hormone promotes the production of cortisol in adrenal cortex, which helps to reduce stress, maintain healthy blood pressure and more. Thyroid-stimulating hormone (TSH): Just as the name implies, this hormone helps to regulate the body's thyroid, which is crucial in maintaining a healthy metabolism. Luteinizing hormone (LH): In women, this hormone regulates estrogen. In men, it regulates testosterone. Follicle-stimulating hormone (FSH): Found in both men and women. In women, it stimulates egg release. In men, helps ensure the normal function of sperm production.

ADRENAL GLAND

Hormones of the Adrenal Glands The adrenal cortex and the adrenal medulla have very different functions. Primary distinction: hormones released by the adrenal cortex are necessary for life; those secreted by the adrenal medulla are not. Adrenal Cortex (outer area protecting the "core") Mineralcorticoids - principle mineralcorticoid is aldosterone, which maintains balance of salt and water while helping control blood pressure. Do you remember our friend aldosterone? Glucocorticoids Hydrocortisone: Commonly known as cortisol, it regulates how the body converts fats, proteins, and carbohydrates to energy. It also helps regulate blood pressure and cardiovascular function. There are some diets that specifically target cortisol levels, theorizing that continuous stress leads to continuous cortisol release and thus enhanced glucose production for energy needed in fight or flight. Corticosterone: This hormone works with hydrocortisone to regulate immune response and suppress inflammatory reactions. We offer this as a localized injection sometimes to inflamed painful joints. Gonadacorticoids release small amounts of male and female sex hormones. However, their impact is usually overshadowed by the greater amounts of estrogen and testosterone so their role is easy to overlook unless there are issues! Adrenal Medulla (middle area, or inner area) - these hormones are released after the sympathetic nervous system is stimulated, which occurs when you're stressed. As such, the adrenal medulla helps you deal with physical and emotional stress. Epinephrine: Most people know epinephrine by its other name—adrenaline. This hormone rapidly responds to stress by increasing your heart rate and rushing blood to the muscles and brain. It also spikes your blood sugar level by helping convert glycogen to glucose in the liver. (Glycogen is the liver's storage form of glucose.) Norepinephrine: Also known as noradrenaline, this hormone works with epinephrine in responding to stress. However, it can cause vasoconstriction (the narrowing of blood vessels). This results in high blood pressure.

PTH - Hypoparathyroidism Leads to hypocalcemia *Weak cardiac muscle contractions *Increased excitability of nerves - spontaneous contractions of skeletal muscle- causes tetany Cause: Surgery or radiation in neck region

Hypoparathyroidism - leads to hypocalcemia, affecting nerves and muscles Low Ca++ = (usually autoimmune, congenital, surgical removal) weak cardiac muscles, excitable skeletal nerves with twitching - The Chvostek sign is a clinical sign of existing nerve hyperexcitability seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. High Ca++ = (usually due to adenoma, hyperplasia, secondary to renal failure) triggers forceful cardiac contractions, predisposes to kidney stones.. High PTH leads to causes calcium to leave bone, weakening the bone and leading to osteoporosis. Great image on p. 417 explaining effects of serum Ca++ and PTH Now remember the see saw - what is going to predictably happen to phosphorus levels????

Endocrine System

Hypothalamus Pituitary gland Adrenal glands Thyroid gland and parathyroid glands Pancreas Gonads Pineal gland Thymus

Hypothyroidism

Hypothyroidism - low levels of thyroid hormones Causes in adults: Hashimoto thyroiditis- an autoimmune destruction of thyroid follicles Iodine deficiency Radiation Surgical removal or treatment of gland

Pathology explaining DM

Insulin deficiency causes a catabolic state Unopposed secretion of hyperglycemic hormones & decreased uptake of glucose by tissues causes "hyperglycemia" Glucose level crosses renal threshold- glycosuria, which leads to osmotic diuresis- "polyuria" Loss of water & electrolytes- causes dehydration & triggers thirst centers- "polydipsia" Breakdown of fats & proteins- stimulates increased appetite- "polyphagia" Diabetic ketoacidosis- complication in Type1 DM- excessive lipolysis- increased FFAs- converted in the liver to ketone bodies

THYMUS What is different about the Thymus gland????

NOTES: This Thymus gland secretes hormones that are commonly referred to as humoral factors important in immune system. "Not necessary to know all of the hormones but need to know that this gland will not function maximally throughout a full lifetime. " Before birth and throughout childhood, thymus is instrumental in the production and maturation of T-lymphocytes or T cells. Thymus reaches its max at puberty and produces all of your T cells by the time you reach puberty. Remember T cells, the type of WBC called a lymphocyte that protects the body from infection? There are a number of different types of T-cells that act in many ways to identify, directly attack and destroy infectious agents. Along with other WBCs, they play a major role in the immune system. After they are produced in bone marrow, these cells spend some time maturing and developing in the thymus. After maturation, T-cells are present in the blood and in lymph nodes; and are affected by diseases of the immune systems such as AIDS and lymphoma. Some lymphocytes, regardless if they reside in the lymph nodes or thymus, can develop into cancers (known as Hodgkins disease and non-Hodgkins lymphomas). One disease that is due to thymus gland dysfunction is known as myasthenia gravis (muscle weakness on repetitive movements of the muscle); removing thymus in this disease helps a patient.  The thymus is special in that, unlike most organs, it is at its largest in children. Once you reach puberty, the thymus starts to slowly shrink and become replaced by fat. By age 75, thymus is little more than fatty tissue. I believe that the thymus may have a role in puberty but all information is about the T cell lymphocytes so that is what we will focus on for now.

Acute Complications - Hypoglycemia (insulin shock, severe hypoglycemia)

Now we begin to review acute conditions. Hypoglycemia is too little blood sugar. Recall that blood glucose is needed for metabolic cellular survival. How low can you go before major damage? Under 60 mg/dL has symptoms. Under 40 depending on other health conditions can lead to brain damage. Symptoms of Hypoglycemia Even without measuring blood glucose levels, symptoms of low blood sugar can be detected, provided you know what to look for early on. Early stage symptoms of hypoglycemia include: Unexplained perspiration Anxiety Feeling shaky or dizzy Paleness Unusual hunger

The back posterior pituitary portion stores and releases:

Oxytocin: This protein based hormone causes pregnant women to start having contractions at the appropriate time and also promotes milk flow in nursing mothers. Pitocin is a man-made version of oxytocin used for stimulating contraction of the uterus. Antidiuretic hormone (ADH): This hormone helps to regulate water balance in the body. Vasopressin is the corresponding man-made pharmaceutical, helping to prevent loss of water from the body by reducing urine output, promoting reabsorption of water into the body, and acts as vasoconstrictor.

PARATHYROID

Parathyroid gland secretes Parathyroid hormone (PTH) and is vital to proper bone development because it helps control both calcium and phosphorous levels in the body. As you may or may not recall, calcium and phosphorus are like on a seesaw. One goes up, the other goes down, and vice versa. The parathyroid gland is actually a group of four small glands located behind the thyroid gland. If blood calcium level is too low, the parathyroid glands release more PTH. This causes the bones to release more calcium into the blood and reduces the amount of calcium released by the kidneys into the urine. Also, vitamin D is converted to a more active form, causing the intestines to absorb more calcium and phosphorus. If the calcium level is too high, the parathyroid glands release less PTH, and the whole process is reversed. See saw.

Addison's Disease

President John F. Kennedy served his terms in Senate and White House with Addison's disease Adrenocorticoid secretions: glucocorticoids, mineralcorticoids, androgens Look at table on page 425 to compare Cushings and Addisons The prototypical person with Addison's has bronzed skin tones, altered distribution of hair and skin, hypoglycemia and postural hypotension, GI disturbances, weight loss, and fatigue/weakness The ADRENAL CRISIS precipitated in someone with Addison's will be profound fatigue, dehydration, vascular collapse, renal shutdown, low sodium, high potassium

Hyperparathyroidism

Primary causes: adenoma, hyperplasia, carcinoma of parathyroid gland Secondary to chronic renal failure (common cause) associated with decreased PO4 excretion- increased serum PO4 levels- cause decreased serum calcium which stimulates parathyroid glands Paraneoplastic syndromes- ectopic PTH released by a cancer Manifestations: Hyperparathyroidism results in hypercalcemia Predisposition to kidney stones Osteoporosis- bone pains & fractures

ENDOCRINE SYSTEM FUNCTION

Regulates metabolism Maintain salter, water and nutrient balance in the blood Control responses to stress Regulate growth, development and reproduction Produce hormones

mneumonic to help you remember the hormones produced by the Adrenal Cortex

S - Sugar - Glucocorticoids Hydrocortisone and Cortisone S - Salt - Mineralcorticoids Aldosterone S - Sex (Gonadacorticoids) Androgens

ENDOCRINE RELATED ORGANS

Several organs play a major role in helping the endocrine system to work well. Although these organs are not glands themselves, they do produce, store, and send out hormones that help the body to function properly and maintain a healthy balance. Placenta: Besides providing a connection between mother and fetus, the placenta is a special endocrine organ. It produces hormones that are similar to those produced elsewhere in the body. Human chorionic gonadotropin (hCG), estrogens, and progesterone are among the most important of these because they help maintain a normal pregnancy and prepare a woman's breasts for milk production and breastfeeding. In a normal pregnancy, hCG stimulates the ovary to produce estrogens and progestins and helps stimulate normal development of the fetal genitals. The estrogens in the placenta stimulate breast development, promote normal labor, and help produce a steady rise in prolactin. The progestins stimulate breast development and help reduce uterine muscle contractions until the baby has fully developed. Human placental lactogen increases the amount of blood glucose and lipids (fatty substances) circulating in the mother's blood to ensure there is a food source for the developing baby. Skin, Liver, and Kidneys: The skin, liver and kidneys work together to synthesize 1,25-diydroxyvitamin D (calcitriol), the active form of vitamin D, which helps maintain normal levels of calcium and phosphorus in the blood. In the skin, a molecule made from cholesterol is converted to vitamin D by exposure to ultraviolet rays from the sun. Vitamin D undergoes further chemical changes, first in the liver and then in the kidneys, to become calcitriol. Calcitriol acts on the intestine, kidneys, and bones to maintain normal levels of blood calcium and phosphorus. Stomach and Small Intestine: The digestive tract is the largest endocrine-related organ system in the body. It makes and secretes several different types of hormones that play a role in the body's metabolism. Gherlin and leptin are two hormones that have been shown to regulate appetite and may be important in obesity and weight disorders.

Acute Complications- Diabetic Ketoacidosis

Starts with a significant insulin deficiency, usually accompanied by excess glucagon (peptide that usually helps to keep blood sugar up when insulin is deficient) May be the first presenting feature of the disease-1-2d h/o polyuria, polydipsia, fatigue May be initiated by infection, stress, error in dosage Dehydration - due to high glucose levels in blood that spill into urine, changing osmotic pressure in urine that pulls more water Thirst, dry, rough oral mucosa; Warm, dry skin Heart rate - rapid, pulse may be weak and thready as vascular volume decreases Kussmaul's respiration ( rapid deep strenuous breathing) - due to metabolic acidosis and respiratory compensation, trying to blow off CO2 to partially compensate. Metabolic acidosis makes breathing at first rapid and shallow, however, when the situation worsens, various chemoreceptors stimulate deep slow, labored and gasping of breath. Involuntary air hunger. acetone breath - high concentration of ketone bodies leads to sweet, fruity breath Metabolic acidosis - ketoacids bind with bicarb ions in the buffer, leading to decreased serum bicarb levels, lower pH Lethargy, decreased responsiveness May lead to stupor & coma Electrolyte imbalances of Na (usually low), K (high) , Cl (low) Abdominal cramps, nausea, vomiting; lethargy, weakness

After a severe closed head injury, it has been determined that Chris no longer has a functioning hypothalamus. Which hormones are affected? (select all that apply) LH Glucagon TSH Prolactin Somatostatin Epinephrine

The hypothalamus is in control of pituitary hormones by releasing the following types of hormones: Produces ADH and Oxytocin, sends to posterior pituitary where stored until signaled for release Produces releasing and inhibiting hormones: Thyrotrophic-releasing hormone or TSH - plays an important role in the regulation of thyroid gland activity Growth hormone-releasing hormone - stimulates protein synthesis Corticotrophin-releasing hormone - main element that drives the body's response to stress. It is also present in diseases which cause inflammation. Gonadotropin-releasing hormone - stimulates the production of two more hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones are released into the general circulation and act on the testes and ovaries to initiate and maintain their reproductive functions.

The three major components of the endocrine system are GLANDS, HORMONES, and RECEPTORS

The major glands, as listed, are a common way to categorize functions and effects. The glands are endocrine glands, and they secrete hormones directly into the bloodstream to regulate a specified body function. That is the definition of an endocrine gland. What is the definition of an exocrine gland? Do you remember? You better know it for the test. Most hormones are some type of peptide chain or protein. The hormones are circulating freely, but soon meet up with their targeted receptors. At the receptors, the hormonal peptide chain or protein is then "activated", typically by an enzyme. The resulting biochemical reaction then produces a specified effect. Simple, right?

PANCREAS

The pancreas is a large gland located behind the stomach, nestled in the curve of the duodenum which is right where it needs to be. Most of the pancreas is an exocrine gland secreting pancreatic fluid into the duodenum after a meal. Lose your pancreas then you have to orally consume these salts and substances to assist with digestion. However, scattered through the pancreas are several hundred thousand clusters of cells called islets of Langerhans. The islets are endocrine tissues containing four types of cells. In order of abundance, they are the beta cells, which secrete insulin Beta cells have channels in their plasma membrane that serve as glucose detectors. Beta cells secrete insulin in response to a rising level of circulating glucose. Beta cells also secrete an Amylin peptide, whose actions supplements those of insulin to reduce the glucose in the blood. Some of its actions: inhibits the secretion of glucagon; slows the emptying of the stomach; sends a satiety signal to the brain. *alpha cells, which secrete glucagon; Glucagon acts principally on the liver where it stimulates the conversion of glycogen into glucose ("glycogenolysis") and fat and protein into intermediate metabolites that are ultimately converted into glucose ("gluconeogenesis"). *delta cells, which secrete somatostatin Somatostatin has a variety of functions. Taken together with glucagon, they work to reduce the rate at which food is absorbed from the contents of the intestine. Somatostatin is also secreted by hypothalamus and intestine. *gamma cells, which secrete pancreatic polypeptide which reduces appetite. Some diet pills are trying to target somatostatin levels.

PINEAL GLANDS

The pineal gland releases melatonin, which helps the body recognize when it is time to go to sleep. Also has something to do with recognizing light, (sometimes called the third eye), and sexual development. Researchers continue to learn more about this gland. Because of our relative ignorance about the pineal gland for so long, it became the object of mythical theories and attributions. Rene Descartes called it the "seat of the soul" because it appeared to be the only brain structure not composed of two symmetrical parts, although later analysis proved this to be untrue. Compounding these rumors was the fact that the pineal gland is lodged very deep in the brain, close to its center. Various shamans have claimed that the pineal gland secretes natural psychedelics and is somehow a connection between the earthly realm and a spirit world. These speculations are likely false. Interesting, but not important to us right now.

Pathology explaining symptoms of Diabetes Melitis

Type 1 Type 2 Pre-diabetes Latent autoimmune Maturity onset in young children, Diabetes insipidus *Central *Nephrogenic *Dipsogenic *Gestational NOTES: Prediabetes - fairly new category defined as A1C equal or greater than 5.7 (DM at 6.5) FBG equal or greater than 100 (DM at 126 or higher) OGGT - 140 -199 (DM 200 or greater) Latent autoimmune - late onset in adults of type 1 diabetes Maturity onset in young children - monogenic and autosomal dominant form of diabetes mellitus with onset of the disease often before 25 years of age: do your Punnets Square. Diabetes insipidus - diabetes not related to blood sugar levels but rather an insensitivity of kidneys to ADH. Kidneys unable to concentrate urine. There are four types of diabetes insipidus; 1) central (too little ADH), 2) nephrogenic (kidney tubule diseased), 3) dipsogenic (genetic component), and 4) gestational.

Types of DM

Type 1 Diabetes Mellitus: Autoimmune destruction of beta cells in pancreas Absolute deficiency of insulin- Insulin replacement required Acute onset in children and adolescents Genetic factors play a role. Type 2 Diabetes Mellitus: Caused by increased resistance of body cells to insulin and/or decreased production of insulin Onset is slow and usually in 40+ age Associated with obesity Component of the metabolic syndrome Increasing incidence in teens and young adults Oral hypoglycemic medications may be used

Glucocorticoids (FROM NOTES)

named for their role in releasing the sugar glucose. These hormones affect every system of the body and guide fundamental processes associated with converting sugar, fat, and protein stores to useable energy; inhibiting swelling and inflammation; and suppressing immune responses. Best known is their role in stress relief. Often called the "stress hormones," glucocorticoids fly into action to provide the energy needed for combating physical or emotional stress, including, but not limited to, fever, illness, injury, or safety threats. Their signals to liver, fat, and muscle speed up the chemical breakdown - or metabolism - of stored sugar, fat, and protein.

2. Mineralcorticoids

principle mineralcorticoid is aldosterone, which maintains balance of salt and water while helping control blood pressure. Do you remember our friend aldosterone? Acting mostly in the kidney, colon and salivary glands, aldosterone directs cells to retain sodium while excreting potassium and hydrogen ions in the urine. When sodium is retained, water is also retained, increasing the total amount of circulating blood and raising blood pressure. Blood pressure sensors in the kidney help to switch mineralocorticoid release on or off so that the right balance is maintained.

Gonadacorticoids

release small amounts of androgens which are converted elsewhere in the body to male (androgens) and female (estrogens) sex hormones. However, their impact is usually overshadowed by the greater amounts of estrogen and testosterone so their role is easy to overlook unless there are issues!