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PITUITARY HORMONES
Anterior pituitary :
Prolactin
Growth hormone
TSH
FSH\LH
ACTH
PITUITARY HORMONES
Posterior pituitary :
Anti-Diuretic Hormone (ADH).
Oxytocin.
PROLACTIN
Source : anterior pituitary (lactotrophes).
Function :
stimulates milk production in breast.
Inhibits ovulation in females (by inhibiting
GnRH).
Inhibits Spermatogenesis in males (by
inhibiting GnRH).
PROLACTIN
TRHprolactin secretion (eg, in 1 or 2
hypothyroidism).
PROLACTIN
Dopamine agonists (eg, bromocriptine) inhibit
prolactin secretion and can be used in
treatment of prolactinoma.
Dopamine antagonists (eg, most
antipsychotics) and estrogens (eg, OCPs,
pregnancy) stimulate prolactin secretion.
Prolactin-related disorders
Hyper-prolactinemia : high level of prolactin in
the blood .
Causes :
Pregnency.
Chest wall stimulation
Renal failure
Hypothyroidism
Cutting of the stalk .
Drugs : dopamine antagonist.
Pituitary adenoma.
PROLACTINOMA
Benign , prolactin-producing pituitary
adenoma originates from lactotrophes.
Presentation :
Mass effect : headache , bitemporal
hemianopia , hypopituitarism.
Physiological effect : amenorrhea
(osteoporosis) , galactorrhea (female only) ,
decreased libido , infertility , gynecomastia.
PROLACTINOMA
Dx :
High level of prolactin
Exclude pregnancy and other secondary
causes.
MRI.
PROLACTINOMA
Treatment : dopamine agonist or
transsphenoidal resection.
GROWTH HORMONE
(SOMATOTROPIN)
SOURCE : anterior pituitary
Stimulates linear growth and muscle mass
through IGF-1 (somatomedin C) secretion by
liver.
insulin resistance (diabetogenic).
GROWTH HORMONE
(SOMATOTROPIN)
Released in pulses in response to growth
hormonereleasing hormone (GHRH).
Secretion
is increased during exercise, deep
sleep, puberty, hypoglycemia.
Secretion inhibited by glucose and
somatostatin release via negative feedback by
somatomedin.
GHRH analogue (tesamorelin) hiv-
associated lipodystrophy.
GROWTH HORMONE
(SOMATOTROPIN)
Hiv-associated lipodystrophy
GROWTH HORMONE RELATED
DISORDERS
Absence of GH dwarfism .
Excessive GH : acromegaly , gigantism.
ACROMEGALY
Mostly due to pituitary adenoma.
Presentation : large tongue with deep furrows
OSA , deep voice , large hands and feet ,
coarse facial features , prognathism, frontal
bossing, diaphoresis (excessive sweating)
oily skin .
DM ?
Increased risk of colorectal polyps and cancer.
ACROMEGALY
ACROMEGALY
ACROMEGALY
GIGANTISM
GH in children gigantism (
linear bone growth).
ACROMEGALY AND GIGANTISM
Death is due to heart failure.
ACROMEGALY AND GIGANTISM
Diagnosis :
serum IGF-1
Failure to supress GH after OGTT.
Brain MRI.
ACROMEGALY AND GIGANTISM
Treatment :
Resection of pituitary adenoma.
If not cured : octreotide or pegvisomant.
DWARFISM
Due to GH defeciency or GH receptor
deficiency (laron dwarfism)
LARON dwarfism
Defective growth hormone receptors
decreased linear growth.
high GH, low IGF-1.
Clinical features include short height, small
head circumference, characteristic facies with
saddle nose and prominent forehead, delayed
skeletal maturation, small genitalia.
LARON DWARFISM
LARON DWARFISM
Treatment :
Synthetic IGF-1
CALCIUM HOMEOSTASIS
Exists in 3 forms :
Ionized form (active form) 45%
Bound to albumin 40%
Bound to anions (PO4-) 15%
CALCIUM HOMEOSTASIS
Total calcium level is affected by albumin level
, every decrease in albumin by 1 leads to
decrease in total calcium by 0.8.
Hyperventilation ?
CALCIUM HOMEOSTASIS
Affected by 3 factores :
Vit. D
Parathyroid.
Calcitonin.
Vitamin D (cholecalciferol)
D3 from exposure of skin to sun, ingestion of
fish and plants.
D2 from ingestion of plants, fungi, yeasts.
Both converted to 25-OH in liver and to 1,25-
(OH)2 (active form) in kidney , or 24,25-(OH)2
which is Inactive.
Vitamin D (cholecalciferol)
increases absorption of dietary Ca2+ and
PO4 from GI and kidneys.
Enhances bone mineralization\resporption.
Increases resorption of the old bone to build
new one.
Vitamin D (cholecalciferol)
Regulation :
high PTH
low Ca2+
low PO4-
increase 1,25-(OH)2 production.
1,25-(OH)2 feedback inhibits its own
production.
Vitamin D (cholecalciferol)
Deficiency rickets in kids, osteomalacia in
adults.
PARATHYROID HORMONE (PTH)
Controls Min-to-min calcium level FAST.
PARATHYROID HORMONE (PTH)
increasesbone resorption of Ca2+ and PO4-.
increases kidney reabsorption of Ca2+ in distal
convoluted tubule.
d
ecreases reabsorption of PO4 in proximal
convoluted tubule.
increases 1,25-(OH)2 D3 (calcitriol) production
by stimulating kidney 1-hydroxylase in
proximal convoluted tubule.
PARATHYROID HORMONE (PTH)
PTH increases serum Ca2+, decreases
serum (PO4), increases urine (PO4 ),
increases urine cAMP.
PARATHYROID HORMONE (PTH)
increasesRANK-L (receptor activator of NH-B
ligand) secreted by osteoblasts and
osteocytes.
Binds RANK (receptor) on osteoclasts and
their precursors to stimulate osteoclasts and
Ca2+bone resorption (high alkaline
phosphatase)
PARATHYROID HORMONE (PTH)
Intermittent PTH release can also stimulate
bone formation.
Teriparatide : PTH analogue.
PARATHYROID HORMONE (PTH)
PTH-related peptide (PTHrP) functions like
PTH and is commonly increased in
malignancies (eg, squamous cell carcinoma of
the lung, renal cell carcinoma)
paraneoplastic hypercalcemia.
PARATHYROID HORMONE (PTH)
Regulation :
lowserum Ca2+ increasesPTH secretion.
highserum PO4 increases PTH secretion.
low serum Mg2+ increases PTH secretion.
very low serum Mg2+ d
ecreasesPTH
secretion.
PARATHYROID HORMONE (PTH)
Common causes of low Mg2+ include
diarrhea,aminoglycosides, diuretics, alcohol
abuse DADA
CALCITONIN
Source :Parafollicular cells (C cells) of thyroid.
Function :
decreases bone resorption of Ca2+.
regulation : high serum Ca2+ induces
calcitonin secretion Not important in
normal Ca2+ homeostasis.
Pt. with hypocalcaemia ??
PTH-related Disorders
HYPOPARATHYROIDISM
Due to accidental surgical excision of
parathyroid glands, autoimmune destruction,
or DiGeorge syndrome.
HYPOPARATHYROIDISM
Presentation : Sx of hypocalcemia cramps,
pain, paresthesias, carpopedal spasm, muscle
twitching or spasm ( trismus ..) , tetany.
Chvostek signtapping of facial nerve (tap the
Cheek) contraction of facial muscles.
Trousseau signocclusion of brachial artery
with BP cuff (cuff the Triceps) carpal spasm.
HYPOPARATHYROIDISM
Findings: low PTH, hypocalcemia,
hyperphosphatemia.