A 30-year-old man presents with palpitations, tremors, weight loss, insomnia and eyeball protrusion. He is diagnosed with hyperthyroidism based on elevated T3 and T4 levels and low TSH. Clinical features include heat intolerance, sweating and diarrhea. A middle-aged woman has cold intolerance, hoarseness, weakness and weight gain. She has hypothyroidism confirmed by low T3 and T4 with high TSH. A 25-year old man has thickened hands/feet and a gorilla face. He has acromegaly from a growth hormone secreting pituitary tumor.

1. ENDOCRINOLOGY CHARTS
DISCUSSION

2. 1. Explain the mechanism of peptide hormone
action.
2. What are peptide hormones and steroid
hormones? Give examples.
3. Mention various second messengers.

3. 1. MECHANISM OF ACTION
Peptide hormones bind to the cell surface receptors and activate a series
of intracellular signal transduction systems.

4. Proteins and polypeptides, including hormones secreted by the anterior and posterior
pituitary gland, the pancreas (insulin and glucagon), the parathyroid gland (parathyroid
hormone), and many others
Peptide hormones- Insulin family- Insulin, IGF, Relaxin
Glycoproteins- LH, FSH, TSH, HCG
Growth hormone family- GH, prolactin, HPL
Secretin family- secretin,glucagon, VIP,GIP
Steroid hormones-
Steroids secreted by the adrenal cortex (cortisol), the ovaries(oestrogen and
progesterone) the testes(testosterone) and the placenta

5. • SECOND MESSENGERS-
 Adenylyl cyclase cyclic AMP system
 Membrane phospholipase – phospholipid system
 Calcium calmodulin system
 Guanylyl cyclase cyclic GMP system

6. 1. Mention the hormones of anterior and posterior pituitary.
2. What are the types of cells in anterior pituitary?
3. What is H-H-P system?

7. • Growth hormone or somatotropin Anti-diuretic hormone
• Thyroid stimulating hormone(TSH) Oxytocin
• Adrenocorticotropic hormone(ACTH)
• Follicle stimulating hormone(FSH)
• Luteinizing hormone(LH)
• Prolactin

8. TYPES OF CELLS IN ANTERIOR PITUITARY
• CHROMOPHOBE CELLS: agranular cells
• CHROMOPHIL CELLS: granular cells-acidphilic and basophilic cells
Five types of cells
Somatotropes- growth hormone(30-40%)
Lactotropes- Prolactin
Corticotropes-ACTH & BETA Lipotropin(20%)
Thyrotropes-TSH
Gonadotropes-LH&FSH
FOLICULOSTELLATE CELLS- Secretes IL-6

9. HHP SYSTEM
• Hypothalamo hypophyseal pituitary axis.
• Connection of hypothalamus with anterior pituitary by means of blood
vessels (portal hypophyseal vessels)
• Connected with posterior pituitary- neuron hypothalamo hypophyseal
tract

10. 1. Mention the hormones secreted by A and B.
2. Mention the action of hormones secreted by posterior pituitary.

11. • A- Paraventricular nucleus- oxytocin
• B- Supraoptic nucleus- ADH
ACTION
ADH- Increases the permeability of collecting duct and distal
convoluted tubule to water- conservation of water
OXYTOCIN- Milk ejection reflex
Parturition reflex

12. 1. Identify the picture.
2. Mention the clinical features of this condition

13. • ACROMEGALY- hypersecretion of growth hormone after fusion of epiphysis results in acromegaly
• CLINICAL FEATURES
Marked Enlargement in the bones of hands and feet
Prognathism-protrusion of lower jaw
Enlargement of membranous bones cranium, nose , bosses on forehead ,supraorbital ridges become
prominent
Increased heel pad thickness
Visual field changes- bitemporal hemianopia-due to enlarging tumor compresses the optic chiasma
ENLARGEMENT OF SOFT TISSUE ORGANS-
Tongue, liver and kidneys become enlarged

14. 1. Identify the picture.
2. Mention the clinical features of this
disease.
3. Mechanism of action of hormone

15. 1. Dwarfism- Deficiency of GH retarted growth in all parts of body
proportionately
2. Short stature
normal mental activity
plumpness
immature faces
delicate extremities
3.

16. Tyrosine kinase signalling –JAK2 STAT
PATHWAY

17. 1. Identify the picture.
2. Mention the clinical feature of this disease.
3. Mention two diagnostic tests for this
condition.

18. 1. Hyperthyroid- Exophthalmos
2. CLINICAL FEATURES
Heat intolerance
Tremors
Increased Sweating
Palpitation
Diarrhoea
Weight loss
Oligomenorrhea
muscle weakness and inability to sleep
Exophthalmos - protrusion of eyeball with lid retraction

19. TWO DIAGNOSTIC TEST
• Estimation of T3,T4,TSH
• T3, T4 ELEVATED
• TSH LOW
• ECG- Tachycardia and arrhythmia
• USG of thyroid-goitre

20. 1. Identify the picture.
2. Mention the clinical feature of this disease.
3. Mention two diagnostic tests for this condition.

21. 1. HYPOTHYROIDISM
2. CLINICAL FEATURES
Cold intolerance
Scaliness of skin
Extreme sluggishness, sleepiness
Constipation
Weight gain
Decreased sweating, bradycardia
yellowish skin
menorrhagia, infertility,impotence,delayed relaxation of
ankle jerk
3. Estimation of T3,T4,TSH

22. 1. Identify the picture.
2. Mention the clinical features of this disease.
3. How can this condition be prevented?

23. 1. Congenital hypothyroidism – fraternal twins 8 yrs of age
2. Skeletal growth is inhibited , disproportionate rate of growth , the soft tissues
enlarge successively ,child with obese, stocky and short appearance, pot belly,
protruding tongue,flat nose ,dry skin,sparse hair,lack of intelligence
3. Tongue becomes so large obstructs swallowing and breathing – guttural breathing
chokes the child
4. Treatment – maternal hypothyroidism treatment with thyroxine

24. 1. Mention the hormones regulating bone growth.
2. Mention the hormones regulating the bone resorption.
3. What is rickets?
4. Mention the clinical features of rickets.

25. • Hormones regulating bone growth
calcitonin, vitamin D
others- glucocorticoids, insulin, thyroid hormone
• Hormones regulating bone resorption
Stimulated by Parathormone, VIT D, cortisol, thyroxine,
prostaglandins, IL-1 & 6, TNF
RICKETS- VIT-D deficiency in children-defective calcification of bone matrix

26. RICKETS- VIT-D deficiency in children
• Defective calcification of bone matrix
• Craniotabes
• Frontal bossing and posterior flattening of skull
• Widening of wrist-widening of epiphysis
• Bowing of legs or knock knee
• Beading of Costochondral junction of ribs – rickety rosary
• Kyphosis and pelvic deformities
• Harrison sulcus-indentation of lower ribs at the site of attachment of diaphragm

27. 1. Identify the picture.
2.What is the cause and explain the mechanism of hormone action.
3. What are the diagnostic tests?

28. 1. HYPOCALCEMIC TETANY IN HAND CALLED CARPOPEDAL SPASM
2. CAUSE
HYPOPARATHYROIDISM- idiopathic or postoperative
MECHANISM OF ACTION
Stimulates bone Resorption, reabsorption from Ascending limb of loop of
Henle, reabsorption of calcium from GIT
Spasm of muscles at wrist joint
3. DIAGNOSTIC TEST- Serum Calcium, Level of PTH

29. 1. Identify the picture.
2. Mention the hormones secreted by different zones with their salient
actions

30. 1. Adrenal gland – three zones of cortex
2. ZONA GLOMERULOSA- Mineralocorticoids –aldosterone-increases the renal
tubular reabsorption of sodium and secretion of potassium
ZONA FASCICULATA- Glucocorticoids- cortisol, Corticosterone and sex steroids
stimulates gluconeogenesis ,decreases utilisation of glucose by cells and increases
blood glucose levels. Decreases protein stores increases catabolism, mobilises fatty
acids ,and has anti inflammatory effects.
ZONA RETICULARIS- Androgens, Estrogens, glucocorticoids

31. 1. Identify the picture
2. Write the salient features of this condition.
3. What is the mechanism of action of this hormone?

32. 1. Cushing syndrome- hypersecretion of cortisol
2. Centripetal obesity-deposition of fat more in abdomen and upper back, fat
deposition in lower neck and interscapular region gives typical appearance of
buffalo hump
Moon face
Hypertension
Hirsutism & amenorrhea
Reddish purple striae – deposition of fat causing rapid stretching of skin
resulting in striae
Poor wound healing – hyperglycemia
Osteoporosis

33. Mechanism of action

34. 3. MECHANISM OF ACTION
• The steroid hormone diffuses across the cell membrane and enters the
cytoplasm of the cell, where it binds with a specific receptor protein.
• The combined receptor protein–hormone then diffuses into or is
transported into the nucleus.
• The combination binds at specific points on the DNA strands in the
chromosomes, which activates the transcription process of specific genes to
form mRNA The mRNA diffuses into the cytoplasm, where it promotes
the translation process at the ribosomes to form new proteins.

35. 1. Identify the picture.
2. What are the different types of cells
and the hormones secreted by these
cells?
3. Write the salient features of these
hormones.

36. 1. Islets of Langerhans
2. α cells- glucagon- Increase blood glucose level
3. β cells- insulin- Decrease blood glucose level
4. δ cells- somatostatin- Inhibits secretion of insulin and glucagon
5. F cells or PP cells- Pancreatic polypeptide- inhibits exocrine
pancreatic secretion

37. 1. Explain the mechanism of action of insulin.
2. Explain the action of insulin on carbohydrate
metabolism.
3. What are the effects of hyperglycemia?

38. • Insulin binds to the α subunit of its receptor, which causes autophosphorylation of the β-subunit receptor, which in turn induces
tyrosine kinase activity.
• The receptor tyrosine kinase activity begins a cascade of cell phosphorylation that increases or decreases the activity of enzymes,
including insulin receptor substrates, that mediate the effects on glucose, fat, and protein metabolism. For example, glucose
transporters are moved to the cell membrane to assist glucose entry into the cell
• CARBOHYDRATE METABOLISM
• Insulin Promotes Muscle Glucose Uptake and Metabolism
• Storage of Glycogen in Muscle
• Insulin Promotes Conversion of Excess Glucose Into Fatty Acids and Inhibits Gluconeogenesis in the Liver.
• HYPERGLYCEMIA
polyuria, polydipsia, polyphagia, glycosuria, ketosis, acidosis, coma

39. ENDOCRINE CASE DISCUSSION

40. CASE DISCUSSION
1. A 30yrs old man comes to the outpatient clinic with complaints of
palpitation, fine tremors of the hand, loss of weight, insomnia and
protrusion of the eyeball.
 What is the diagnosis?
 Mention the clinical features of this condition.
 Mention two diagnostic tests for this condition

41. 1. Hyperthyroidism
2. CLINICAL FEATURES
Heat intolerance
Tremors
Increased Sweating
Palpitation
Diarrhoea
Weight loss
Oligomenorrhea
Muscle weakness and inability to sleep
Exophthalmos - protrusion of eyeball with lid retraction
3. Estimation of T3,T4,TSH

42. 2. A middle aged lady comes to OP clinic with complaints of intolerance
to cold, hoarseness of voice, muscle weakness, weight gain and slow
speech.
What is the diagnosis?
Mention the clinical features of this condition.
Mention two diagnostic tests for this condition.

43. 1. Hypothyroidism
2.CLINICAL FEATURES
Cold intolerance
Scaliness of skin
Extreme sluggishness, somnelence
Constipation
Weight gain
Deacreased sweating
yellowish skin
myxedema, menorrhagia, infertility
3. Estimation of T3,T4,TSH

44. 3. A 25yrs old man comes to the outpatient department with complaints
of broadening and thickening of hands and feet, gorilla like face,
protrusion of lower jaw.
What is the diagnosis?
What is the mechanism of action of this hormone?
Write the salient features of this condition

45. • ACROMEGALY- hypersecretion of growth hormone after fusion of
epiphysis results in acromegaly
• CLINICAL FEATURES
• Marked Enlargement in the bones of hands and feet
• Prognathism-protrusion of lower jaw
• Enlargement of membranous bones cranium, nose , bosses on forehead,
supraorbital ridges become prominent
• Increased heel pad thickness
• Visual field changes- bitemporal hemianopia-due to enlarging tumor
compresses the optic chiasma
• Enlargement of soft tissue organs-Tongue, liver and kidneys become enlarged

47. 4. A patient is admitted to the hospital with clinical features of
generalized convulsions, carpal spasm, spasm of laryngeal muscles and
facial muscles.
What is your diagnosis?
What is the cause?
What are the other clinical features of this case?
How will you treat?
Name the different signs of this disease

48. 1. TETANY- increased neuromuscular excitability
2. CAUSES
• Hypocalcemia
• Hypomagnesemia
• Alkalosis
3. OTHER FEATURES
• Parasthesias-tingling sensation in limbs and around mouth
• Visceral features- biliary spasm, bronchospasm, intestinal cramps , profuse
sweating
4. TREATMENT - 10% calcium gluconate 20 ml i.v for hypocalcemia
hypoparathyroidism-oral calcium salt and vit-D analogue
underlying cause of hypocalcemia

49. DIFFERENT SIGNS

50. 5. A 45yr old lady comes to the outpatient department with complaints
of polyuria, polydipsia and polyphagia. Her lab reports show fasting
blood sugar – 250mg and urine sugar showed ++.
What is the diagnosis?
Mention the causes for this condition
Mention the cause of polyuria, polydipsia and polyphagia

51. 1. TYPE II DIABETES MELLITUS
2. Decreased sensitivity of the target tissues to insulin - insulin
resistance
3. Polyuria- glycosuria
4. Polyphagia- satiety center inactivation-glucostatic theory
5. Polydipsia-thirst center stimulation

52. 6. In juvenile diabetes mellitus, the patient complaints of polyuria and
polydipsia
Explain the patho-physiology of polyuria and polydipsia.
Polyuria- glycosuria
Polydipsia-thirst center stimulation

53. THANK YOU
THANK YOU