ENDOCRINE SYSTEM ANTERIOR PITUITARY GLAND Smctn

- Ductless glands - “Adenohypophysis” ghl

- Hormones into the blood - True pituitary gland
- “regulatory system” - Direct effector (GH, Prolactin)
- +/- mechanism - Tropic Hormone (TSH, LH, FSH, ACTH)
(+) System activity o Stimulate activity of another endocrine
 Synthesis  gland
FEEDBACK Production rate
(–) System activity 
 Synthesis  Growth Hormone
FEEDBACK Production rate o Most abundant among the pituitary
hormones
Hypothalamus-Pituitary-Thyroidal Axis o Controls growth
o Major stimulus
TRH TSH TH  Deep Sleep
o Major inhibitor
 Somatostasin
HORMONES
- Chemical signals released by specialized cells  Growth Hormone Deficiency (GHD)
to the bloodstream to their target tissue.  Idiopathic GHD
 Pituitary Adenoma
PINEAL GLAND GHD Test
 Melatonin Insulin Tolerance Test
o  pigment of cells o Confirmatory test
 Inhibits melanin o Does not  = diagnostic for GHD
o Sleep wake cycle Arginine Stimulation Test
 Inhibition: presence of light o Another confirmatory test
 Stimulus: absence of light Physical Activity Test/Exercise Test
o Screening
HYPOPHYSEAL HORMONES o GH level does not  = proceed to
 Corticotropin Releasing Hormone (CRH) confirmatory
STIMULATION

o ACTH
 Thyrotropin Releasing Hormone (TRH)  Acromegaly – overproduction of GH
o TSH & PRL Somatomedin C/ IGF-1
 Gonadotropin Releasing Hormone (GRH) o screening test
o FSH & LH o  IGF-1 = acromegaly
 Growth Hormone Releasing Hormone (GHRH) Oral Glucose Tolerance Test (OGTT)
o GH o Extraction every 30 mins for 2 hrs
INHIBITION

 Growth Hormone Inhibiting Hormone (GHIH)/ o No glucose suppression +  IGF-1

Somatostatin = acromegaly
o GH & TSH  Prolactin
 Dopamine/Elusive Prolactin Inhibiting Factor o Pituitary lactogenic hormone
o PRL o Direct effector hormone
o Inhibitor: Dopamine
PITUITARY GLAND   Prolactin Diseases
- “Master gland”  Hypogonadism
- All have circadian rhythm  Amenorrhea
 Galactorrhea
POSTERIOR PITUITARY GLAND
- “Neurohypophysis” Gonadotropins/Fertilizing Hormones
- Not capable of releasing hormone o Markers for fertility & menstrual cycle
- Releases & stores oxytocin & ADH disorder
o Magnocellular neurons – prod. of ADH  Follicle Stimulating Hormone (FSH)
o Paraventricular nuclei - prod. of oxytocin o Follicle maturation
 Oxytocin o Estrogen secretion
o  weak uterine contraction o Spermatogenesis
(Ferguson reflex)  Luteinizing Hormone (LH)
 Anti-Diuretic Hormone/Arginine Vasopressin o “Interstitial cell stimulating hormone”
o Regulate H2O balance by promoting  Leydig cells -  testosterone
reabsorption of H2O in renal tubules o Ovulation, final follicular growth

DIABETIC INSIPIDUS Male FSH Sertoli cells Spermatogenesis

 Deficiency of ADH GnRH LH Leydig cells Testosterone
 Polyuria Follice maturation,
1. Neurogenic DI/True DI Female FSH Granulosa cells
estrogen secretion
GnRH
-  ADH, normal receptor LH Corpus Luteum Progesterone
- Neuro = failure of pituitary gland
to release ADH  Thyroid Stimulating Hormone (TSH)/Thyrotropin
2. Nephrogenic DI o Synthesis of thyroid hormones (T 3, T4,
- Normal ADH, abnormal receptor Calcitonin)
- Nephro = renal resistance to the  Adenocorticotropic Hormone (ACTH)
action of ADH o Regulate adrenal androgen synthesis
produced in response to  cortisol
Overnight Water Deprivation Test o Highest @ 6-8am
o 8-12 hrs fasting & exogenous ADH o Lowest @ 6-11 pm
o Diagnostic for DI  Addison’s Disease
o Check urine osmolality o 90% destruction of adrenal
  osmolality = neurogenic DI cortex
  osmolality = nephrogenic DI o  cortisol,  ACTH
THYROID GLAND ADRENAL CORTEX Smctn
 Triiodothyronine (T3)  Cortisol ghl
o Most active  Principal glucocorticoid
o From tissue deiodonization of T4  Inhibits secretion of ACTH
 Tetraiodothyronine (T4)
o Most abundant URINARY METABOLITES
o Principal secretory product  17-hydroxycorticosteroid (17-HCS)
o “Prohormone” for T3 production o Porter-Silber = yellow
 Stimulus: Iodine & TSH  17-ketogenicsteroids (17-KS)
 Calcitonin o Zimmermann = reddish
 Prevents large  in blood Ca purple
  blood Ca levels
 Cushing’s Syndrome
AUTOIMMUNE THYROID DISEASE – Hypercorticolism
 Grave’s Disease – Gushing cortisol
o TSH Receptor Ab (TRAb)
o 1 hyperthyroidism CONFIRMATORY TESTS
o Thyroid binds to TRAb =  TH Low dose dexamethasone suppression test
 Hashimoto’s Disease Midnight plasma cortisol test
o Thyroperoxidase Ab (TPO) CRH stimulation test
o 1 hypothyroidism
o TPO seen as foreign & is attacked by SCREENING TEST
thyroid gland =  hormone production Overnight dexamethasone suppression test
Midnight salivary cortisol test
HYPERTHYROIDISM 24-hr urinary free cortisol test
 Grave’s Disease
o Exophthalmos – bulging of the eyes  Addison’s Disease -  cortisol,  ACTH
 Riedel’s Thyroiditis Insulin Tolerance
o Woody/stone hard thyroid o Confirmatory
o Dense fibrosis ACTH stimulation test
 Plummer’s Disease o Screening
o “T3 thyroxicosis”
o Multinodular goiter  Congenital Adrenal Hyperplasia
o Enzymes needed for synthesis of
HYPOTHYROIDISM cortisol
 Hashimoto’s Disease
o Nest of lymphoid tissue TYPES OF CAH
 Myxedema 21-hydroxylase
CYP21 Hirsutism
o Puffy or moon face def
o Mucopolyssacharide infiltration 11B-
 Cretinism hydroxylase CYP11B1 Virilization
o Congenital hyperthyroidism def
 Macroglossia – enlargement of
tongue (can be seen as well in 17-hydroxylase Male
CYP17
pt w/ Vit B12 deficiency. def Pseudohemaphroditism

3B-
o  T4 & TSH
hydroxysteroid Female
HSD3B2
dehydrogenase Pseudohemaphroditism
isomerase def.
PARATHYROID GLAND (PTH)
-  Ca levels
- Prevents hypocalcemia
o Regulates Ca in 3 Mechanism  Aldosterone
 Bone reabsorption of Ca  Most abundant mineralocorticoid
 Renal reabsorption of Ca  Regulates water
 Activation of Vit D3  Electroregulator
 Main determinant for renal secretion of
ADRENAL GLAND K+
 ADRENAL CORTEX
 Conn’s Disease - 1 hyperaldosteronism
 Zona Glomerulosa – mineralocorticoids
Saline Suppression Test
 Zona Fasciculata – glucorticoids
 confirmatory
 Zona Reticualis – sex hormones
Plasma Aldosterone
Concentration/Plasma Renin Activity
GO  MAKE (PAC/PRA ratio)
FIND  GOOD  Screening
REX  SEX  >30 = suggestive
 >50 = diagnostic
 ADRENAL MEDULLA – cathecolamines  Weak or Adrenal Androgens
 Dehydroepiandrosterone (DHEA)
 Androstenedione
 Virilization – dse associated in females
ADRENAL MEDULLA
 Norepinephrine/Noradrenaline
 Highest in brain
 Neuroblastoma – fatal malignant
tumor of the neural plate
Urinary Metabolites
o Vanillylmandelic acid (VMA)
o 3-methoxy-4-hydroxyphenylglycol
 Epinephrine/Adrenaline
 Produced from norepinephrine
 2 amine
 Comes only from adrenal medulla
 Flight/fight response
 Pheochromocytoma – tumor of the
adrenal medulla due to overproduction
of catecholamines
MISCELLANEOUS HORMONES Smctn
 Human Chorionic Gonadotropin ghl
o Fertility eval. In female
 Human Placental Lactogen
o Stimulates dev’t in mammary gland
 Gastrin
o Secretion of HCl by parietal cells
o Respond to vagal stimulation & food in
stomach
 Zollinger-Ellison Syndrome
 Gastric carcinoma
  gastrin =  HCl
 Serotonin
o Binds to platelets
o Stimulates vasoconstriction
o Released during coagulation to
stimulate vasoconstriction

Major Metabolite Urinary metabolite

o VMA o 5-HIAA
Minor Metabolites o 5-hydroxindoleacetic acid
o Metanephrine  Somatostatin
o Normethanephrine o “Growth hormone inhibiting hormone”
o Homovanillic Acid (HVA) o Inhibits G, glucagon & insulin
 Dopamine  Inhibin-A
 Highest in brain o “4th Down Syndrome Marker”
 1 amine o Inhibits FSH activity
Major metabolite
 Homovanillic Acid (HVA) HCG AFP
Inhibin A Estriol
GONADS
 Testosterone
o Growth & dev’t of reproductive system,
prostate & external genitalia
o Test male infertility through FSH, LH,
testosterone & semen analysis

 Hypogonadism
o  prolactin, /absence of secretory
activity of gondas
o Disproportionate upper & lower
segments

 Pre-testicular infertility
o 2 hypogonadism
o Hypothalamic/pituitary lesions
 Testicular infertitily
o 1 infertility
 Klinefelter’s Syndrome
 “XXY Syndrome”
 Azoospermia & Gynecomastia
 Varicocele
 Enlargement of veins in
scrotum
 Post-testicular infertility
o Problem in sperm fxn & transport
 Estrogen
o 2 sex female char.
o Breast dev’t
o Maturation of external genitalia

 Estrone (E1)
 Post menopausal
 Estradiol (E2)
 Pre-menopausal
 Most potent
 Ovarian fxn. assessment
 Estriol (E3)
 Maternal, women
fetoplacental viability
 Marker for down syndrome
 Progesterone
o Fertility eval. In women