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  • 1. Chapter 4 Chemistry Studies Endocrinology
  • 2.
    • Consists of several glands located in various parts of the body
    • Specific Glands
      • Hypothalamus
      • Pituitary
      • Thyroid
      • Parathyroid
      • Adrenal
      • Kidneys
      • Pancreatic Islets
      • Ovaries
      • Testes
    The Endocrine System - Big Picture Hypothalamus
  • 3. Endocrine Glands
    • Controls many body functions
      • exerts control by releasing special chemical substances into the blood called hormones
      • Hormones affect other endocrine glands or body systems
    • Ductless glands
    • Secrete hormones directly into bloodstream
      • Hormones are quickly distributed by bloodstream throughout the body
  • 4. The Players
    • Pituitary
    • Hypothalamus
    • Thyroid
    • Parathyroid
    • Adrenal
    • Gonads
  • 5. The Hypothalamus
  • 6. Hypothalamus
    • Produces several releasing factors that stimulate anterior pituitary’s secretion of hormones.
    • Produces hormones that are stored in and released from posterior pituitary
  • 7. Hypothalamus
    • Also responsible for:
      • Regulation of water balance
      • Body temperature regulation (shivering)
      • Sleep-wake cycle
      • Autonomic functions
  • 8. Pineal Gland
    • Located within the Diencephalon
    • Melatonin
      • regulates the body’s internal clock
  • 9. Pituitary Gland
    • Small gland located on stalk hanging from base of brain – “ AKA” - Also Known As
    • “ The Master Gland”
      • Primary function is to control other glands.
      • Secretion is controlled by hypothalamus in base of brain.
  • 10. Pituitary Gland
    • Two areas
      • Anterior Pituitary
      • Posterior Pituitary
    • Structurally, functionally different
  • 11. Pituitary Gland
    • Anterior Pituitary
      • Thyroid-Stimulating Hormone (TSH)
        • stimulates release of hormones from Thyroid
        • abnormal conditions
          • hyperthyroidism
          • hypothyroidism
  • 12. Pituitary Gland
    • Anterior Pituitary
      • Growth Hormone (GH)
        • stimulates growth of all organs and increases blood glucose concentration
      • Adreno-Corticotrophic Hormone (ACTH)
        • stimulates the release of adrenal cortex hormones
  • 13. Pituitary Gland
    • Anterior Pituitary
      • Prolactin
        • stimulates milk production after delivery
      • Melanocyte Stimulating Hormone (MSH)
        • stimulates synthesis of melanin pigment in skin
  • 14. Pituitary Gland
    • Posterior Pituitary
      • Antidiuretic hormone (ADH)
        • Stimulates water retention by kidneys
          • reabsorbs water from distal convoluted tubules
        • Abnormal conditions
          • Undersecretion: diabetes insipidus (“water diabetes”)
          • Oversecretion: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
      • Oxytocin
        • Stimulates contraction of uterus at end of pregnancy (Pitocin®); release of milk from breast
  • 15. ADH acts on kidney No ADH Present- Collecting Duct is NOT permeable to water and large volume of urine is produced ADH Present- Collecting Duct is permeable to water and a small volume of urine is produced
  • 16.  
  • 17. Neurohypophysis
    • Two major hormones
    • Oxytocin
      • Stimulates contraction of uterine muscles
      • Stimulates release of milk by mammary glands
    • Vasopressin
      • Stimulates water re-absorption by kidneys
      • Stimulates constriction of blood vessels
  • 18. Oxytocin
    • Stimulates smooth muscle of uterus during childbirth
  • 19. ADH (antidiuretic hormone), vasopressin
      • Targets DCT and collecting tubules
      •  H 2 O reabsorption
      •  blood volume
      •  BP
      •  concentration of urine,
      •  urine volume
  • 20.  
  • 21. The Parathyroids
  • 22. Parathyroids
    • Located on posterior surface of thyroid
    • Frequently damaged during thyroid surgery
    • Parathyroid hormone (PTH)
      • Stimulates Ca 2+ release from bone
      • Promotes intestinal absorption and renal tubular reabsorption of calcium
  • 23. Parathyroids
    • Underactivity
      • Decrease serum Ca 2+
        • Hypocalcemic tetany
        • Seizures
        • Laryngospasm
  • 24. Parathyroids
    • Overactivity
      • Increased serum Ca 2+
        • Pathological fractures
        • Hypertension
        • Renal stones
        • Altered mental status
  • 25. Thymus Gland
    • Located in anterior chest
    • Normally absent by ~ age 4
    • Promotes development of immune-system cells (T-lymphocytes)
  • 26. The Adrenal Glands
  • 27. Adrenal Glands
    • Small glands located near (ad) the kidneys (renals)
    • Consists of:
      • outer cortex
      • inner medulla
  • 28. Adrenal Glands
    • Adrenal Medulla
      • the Adrenal Medulla secretes the catecholamine hormones norepinephrine and epinephrine
      • Epinephrine and Norepinephrine
        • Prolong and intensify the sympathetic
        • nervous system response during stress
  • 29. Adrenal Glands
    • Adrenal Cortex
      • Aldosterone (Mineralocorticoid)
        • Regulates electrolyte (potassium, sodium) and fluid homeostasis
      • Cortisol (Glucocorticoids)
        • Antiinflammatory, anti-immunity, and anti-allergy effects.
        • Increases blood glucose concentrations
      • Androgens (Sex Hormones)
        • Stimulate sexual drive in females
  • 30. Adrenal Glands
    • Adrenal Cortex
      • Glucocorticoids
        • accounts for 95% of adrenal cortex hormone production
        • Released in response to stress, injury, or serious infection - like the hormones from the adrenal medulla
  • 31. Adrenal Glands
    • Adrenal Cortex
      • Mineralcorticoids
        • regulates the concentration of potassium and sodium in the body
  • 32. The Thyroid Gland
  • 33. Thyroid
    • Located below larynx and low in neck
      • Not over the thyroid cartilage
    • Thyroxine (T 4 ) and Triiodothyronine (T 3 )
      • Stimulate metabolism of all cells
    • Calcitonin
      • Decreases blood calcium concentration by inhibiting breakdown of bone
  • 34. Thyroid
    • Works on a feedback loop with the Anterior Pituitary
      • more TSH = more T 3/4
      • more T 3/4 = less TSH
    TSH + T 3/4 - Note: There are numerous other feedback loops in the endocrine system. Too many to go over here.
  • 35. When Good Glands Go Bad Disorders of the Endocrine System
  • 36. Abnormal Thyroid Function
    • Hypothyroidism
      • Too little thyroid hormone
    • Hyperthyroidism (Thyrotoxicosis / Thyroid Storm)
      • Too much thyroid hormone
  • 37. Measurement of Serum Thyroid Hormones: T3 by RIA. thyroxine (T4) represents 80% of the thyroid hormone produced by the normal gland and generally represents the overall function of the gland. The other 20% is triiodothyronine measured as T3 by RIA -(radioimmunoassay) . Measurement of both hormones provides an accurate evaluation of thyroid function.
  • 38.
    • Pregnancy, estrogen therapy, and oral contraceptives all can stimulate increased production of TBG by the liver.
    • Androgens, kidney disease can lower TBG. These changes in TBG will affect the level of free T4 and thus thyroid hormone functions.
  • 39.
    • The T3U value may be useful in interpreting the other thyroid hormone test results.
      • A higher-than-normal T4 value combined with a high T3U value usually confirms the presence of hyperthyroidism.
      • A higher-than-normal T4 value combined with a low T3U value often occurs during pregnancy or in women who take birth control pills.
      • A lower-than-normal T4 value combined with a low T3U value usually confirms the presence of hypothyroidism.
      • A lower-than-normal T4 value combined with an increased T3U value may indicate kidney disease or long-term (chronic) illness. This can also occur normally in some healthy individuals.
  • 40. Measurement of Serum Thyroid Hormones: T4 by RIA. T4 by RIA (radioimmunoassay) is the most used thyroid test of all. The T4 reflects the amount of thyroxine in the blood. If the patient does not take any type of thyroid medication, this test is usually a good measure of thyroid function .
  • 41. Thyroid Binding Globulin. Most of the thyroid hormones in the blood are attached to a protein called thyroid binding globulin (TBG). unexplained high or low T4, or T3, it may be due to an increase or decrease of TBG. falsely elevate or lower the T4 level. These people are frequently misdiagnosed as being hyperthyroid or hypothyroid, but they have no thyroid problem and need no treatment.
  • 42.  
  • 43.
    • Lower than normal values may indicate hypothyroidism .
    • This can be caused by
    • thyroid disease (such as thyroiditis),
    • pituitary gland disease, or
    • destruction of the thyroid gland by surgery or radiation.
  • 44. Hyperthyroidism Excess amount of free Thyroid hormone. The symptoms Heat intolerance, nervousness, increased irritability, palpitations, weight loss with the same or increased food intake, and increased frequency of defecation. hyperkinesis, warm moist skin, a prominent stare and lid lag. The neurological exam may show a fine tremor and a fast return phase for the deep tendon reflexes. The cardiac exam tachycardia, although atrial fibrillation is also common, a prominent S4, and flow murmurs. The thyroid gland may be diffusely enlarged, nodular, or even normal in size.
  • 45.  
  • 46.  
  • 47. HYPERTHYROIDISM TSH Total T4 Free T4 T3 uptake
  • 48.  
  • 49. 23 y/o woman presents with the chief complaint of nervousness. She has a one month history of increased nervousness associated with a short temper, crying easily, and tremor. In addition she states she has lost 25 pounds without dieting, and is always hot. Her eyes protrude and feel dry. TSH ? Total T4 ? T3 ?
  • 50. Grave’s disease Is an autoimmune disease in which the immune system produces antibodies which stimulate the TSH receptors of the thyroid gland. The result is the non-suppressible overproduction of thyroid hormone, resulting in the clinical manifestations of hyperthyroidism.
  • 51.
    • Greater than normal values may indicate: Hyperthyroidism.
    • This can be caused by
    • Graves' disease
    • thyroiditis
    • goiter that contains one or more abnormal growths (nodules)
    • from receiving too much thyroid hormone medication.
  • 52. Primary Hypo thyroidism Occurs when disease of the thyroid gland prevents it from producing adequate amounts of thyroid hormone. all metabolic processes slow down. Patients are often fatigued, and may also have depression, decreased intellectual function, and, rarely, overt psychosis. Cold intolerance, dry skin, and constipation. The heart rate is often slowed, as is the relaxation phase of deep tendon reflexes. The T4 and Free T4 is low and the TSH is always high (usually greater than 20 mU/L) . T3 may be low/normal.
  • 53.  
  • 54.  
  • 55. HYPOTHYROIDISM TSH (sensitive test for 1 hypothyroidism) TOTAL T4 FREE T4 T3 Uptake
  • 56.  
  • 57. 43 y/o patient with the chief complaint of "decreased energy." She complains of fatigue, inability to finish tasks, sleeping more, yet always being tired. She has also noticed a decreased cold tolerance, constipation, and dryness of the skin. She comments that she is always cold, even in the summer. She has a positive family history for thyroid problems, but does not know the details TSH T3 T4
  • 58. Secondary hypo thyroidism Failure of the thyroid gland due to the inadequate production of Thyroid Stimulating Hormone (TSH). This can occur due to primary failure of the pituitary or as the result of hypothalamic dysfunction (tertiary hypothyroidism). Pituitary failure can result from destruction by pituitary and non-pituitary tumors, head trauma, radiation, postpartum infarction (Sheehan’s syndrome) or unknown causes (idiopathic). Patients with secondary hypothyroidism must be evaluated for pituitary tumors and other hormone deficiencies.
  • 59.  
  • 60. Hypothyroidism
    • Thyroid hormone deficiency causing a decrease in the basal metabolic rate
      • Person is “slowed down”
    • Causes of Hypothyroidism :
      • Hashimoto’s thyroiditis - autoimmune destruction
  • 61. Hypothyroidism
    • Cold intolerant
    • Hypotension, Bradycardia
    • Muscle weakness
    • Decreased respirations
    • Weight gain, Constipation
    • Non-pitting peripheral edema
    • Depression
    • Facial edema, loss of hair
    • Dry, coarse skin
    • Confusion, drowsiness, coma
    Appearance of Myxedema
  • 62. Hyper thyroidism
    • Excessive levels of thyroid levels cause hypermetabolic state
      • Person will “speed up”.
    • Causes of Hyperthyroidism
      • Overmedication with levothyroxine (Synthroid®)
      • Goiter (enlarged, hyperactive thyroid gland)
      • Graves Disease
  • 63. Hyperthyroidism
    • Nervousness, irritable, tremors, paranoid
    • Warm, flushed skin
    • Heat intolerant
    • Tachycardia - High output CHF
    • Hypertension
    • Tachypnea
    • Diarrhea
    • Weight loss
    • Exophthalmos
    • Goiter
  • 64.  
  • 65. Thyroid Storm/Thyrotoxicosis
    • Severe tachycardia
    • Heart Failure
    • Dysrhythmias
    • Shock
    • Hyperthermia
    • Abdominal pain
    • Restlessness, Agitation, Delirium, Coma
  • 66. Abnormal Adrenal Function
    • Hyperadrenalism
      • Excess activity of the adrenal gland
      • Cushing’s Syndrome & Disease
      • Pheochromocytoma
    • Hypoadrenalism (adrenal insufficiency)
      • Inadequate activity of the adrenal gland
      • Addison’s disease
  • 67. Hyper adrenalism
    • Primary Aldosteronism
      • Excessive secretion of aldosterone by adrenal cortex
        • Increased Na + /H 2 O
      • Presentation
        • headache
        • nocturia, polyuria
        • fatigue
        • hypertension, hypervolemia
        • potassium depletion
  • 68. Hyper adrenalism
    • Adrenogenital syndrome
      • “ Bearded Lady”
      • Group of disorders caused by adrenocortical hyperplasia or malignant tumors
      • Excessive secretion of adrenocortical steroids especially those with androgenic or estrogenic effects
      • Characterized by
        • masculinization of women
        • feminization of men
        • premature sexual development of children
  • 69. Hyper adrenalism
    • Cushing’s Syndrome
      • Results from increased adrenocortical secretion of cortisol
      • Causes include:
        • ACTH-secreting tumor of the pituitary (Cushing’s disease)
        • excess secretion of cortisol by a neoplasm within the adrenal cortex
        • excess secretion of cortisol by a malignant growth outside the adrenal gland (esp small cell lung ca)
        • excessive or prolonged administration of steroids
  • 70. Hyper adrenalism
    • Cushing’s Syndrome
      • Characterized by:
        • truncal obesity
        • moon face
        • buffalo hump
        • acne, hirsutism
        • abdominal striae
        • hypertension
        • psychiatric disturbances
        • osteoporosis
        • amenorrhea
  • 71. CUSHING SYNDROME
  • 72. Hyper adrenalism
    • Cushing’s Disease
      • Too much adrenal hormone production
        • adrenal hyperplasia caused by an ACTH secreting adenoma of the pituitary
      • “ Cushingoid features”
        • striae on extremities or abdomen
        • moon face
        • buffalo hump
        • weight gain with truncal obesity
        • personality changes, irritable
  • 73. Hyper adrenalism
    • Pheochromocytoma
      • Catecholamine secreting tumor of adrenal medulla
      • Presentation
        • Anxiety
        • Pallor, diaphoresis
        • Hypertension
        • Tachycardia, Palpitations
        • Dyspnea
        • Hyperglycemia
  • 74. Hypo adrenalism
    • Adrenal Insufficiency
      • decrease production of glucocorticoids, mineralcorticoids and androgens
    • Causes
      • Primary adrenal failure (Addison’s Disease)
      • Infection (TB, fungal, Meningococcal)
      • AIDS
      • Prolonged steroid use
  • 75. Hypo adrenalism
    • Presentation
      • Hypotension, Shock
      • Hyponatremia, Hyperkalemia
      • Progressive Muscle weakness
      • Progressive weight loss and anorexia
      • Skin hyperpigmentation
        • areas exposed to sun, pressure points, joints and creases
      • Arrhythmias
      • Hypoglycemia
  • 76. ADDISONS DISEASE
  • 77. ?
  • 78. END OF THE SECTION