Hormones
Hypothalamus |
releasing and inhibiting factors |
Pituitary Gland - anterior lobe |
GH, TSH, ACTH, FSH, LH, Prolactin |
Pituitary Gland - posterior lobe |
ADH (vasopressin), oxytocin |
Thyroid Gland |
T3, t4, calcitonin |
Adrenal Gland - medulla |
epinephrine, norepinephrine |
Adrenal Gland - cortex |
glucocorticoids, mineralocorticoids, sex hormones |
Gonads |
testes = testosterone // ovaries =estrogen, progesterone |
Pancreas |
insulin, glucagon, somatostatin, PP (including gastrin) |
Parathyroid Glands |
parathyroid hormone |
Hypothalamic Hormones // Pituitary Hormones
CRH |
increase ACTH |
GnRH |
increase FSH and LH |
PIH |
decrease prolactin |
GHRH |
increase GH |
GHIH |
decrease GH |
TRH |
increase TSH |
Pituitary Hormones
GH |
promotes tissue growth, increase bone, muscle and fat |
TSH |
promotes production and secretion of T3 & T4 in thyroid |
ACTH |
promotes secretion of glucocorticoids in adrenal cortex |
FSH & LH |
the gonadotropic hormones - promotes gamete production and sex hormones secretion in gonads |
Prolactin |
stimulates milk production in mammary glands |
--------- |
-------- |
ADH |
controls thirst and amount of urine produced by kidneys |
oxytocin |
stimulates uterine contractions in women and acts on mammary glands to release milk |
pituitary gland functions with a feedback loop
Thyroid Disorders
Goiter |
thyroid enlargement; causes = puberty/pregnancy, iodine deficiency (endemic goiter), hashimotos thyroiditis, goitrogens (food that suppress production of thyroid hormones) |
Hyperthyroidism |
Thyrotoxicosis, increased T3 & T4, decreased TSH |
Hypothyroidism |
Myxedema, decreased t3 & T4, increased TSH (primary) |
Hyperthyroidism results in... |
generalized increase in metabolic rate, heat intolerance, sweating, irritability, weight loss, increased appetite, exopthalmia, lid lag, tremor, hyperpigmentation, friable/fine hair, tachycardia, thyroid storm |
hypothyroidism results in... |
fatigue, depression, cold intolerance, dry skin, decreased intellectual function slow HR, constipation, enlarged tongue (macroglossia), malocclusion, gingivitis, rampant decay, candidiasis |
Graves Disease |
Hyperthyroidism, autoimmune disease; dx = TSI, elevated T3/T4 but low TSH, diffuse radioactive iodine uptake (thyroid scan) |
Graves disease clinical features - triad |
thyrotoxicosis, infiltrative opthalmopathy, localized dermopathy |
thyroid storm |
abrupt onset of hyperthyroidism; when exposed to stress or have graves disease; can lead to uncontrolled heart arrhythmias, pulmonary edema, CHF --> coma --> death |
childhood oral manifestation of thyroid storm |
premature loss of primary teeth and early eruption of permanent |
primary hyperthyroidism |
diffuse toxic goiter or tumor; serum levels show INCREASED T3/T4, BUT DECREASED TSH |
secondary hyperthyroidism |
TSH-producing pit. tumor; serum levels show INCREASED T3/T4 AND INCREASED TSH |
Cretinism |
congenital hypothyroidism; symptoms = coarse/dry skin, puffy, pale lips, impaired development of skeletal and CNS (results in dwarfism and mental retardation); oral manifestations = macroglossia, mouth breathing, underdeveloped mandible, overdeveloped maxilla, late eruption, enamel hypoplasia |
Juvenile Hypothyroidism |
primary hypothyroidism in children; mental sluggishness, dragging, cold intolerance, obesity, constipation |
Hashimoto's Thyroiditis |
primary hypothyroidism; characterized by lymphoid infiltrated and Hurthle cells |
primary vs. secondary hypothyroidism |
primary has INCREASED TSH // secondary has DECREASED TSH |
function of T3 & T4 = physical and brain growth and maturation, help oxygen consumption, elevated basal metabolic rate, increases body heat, upregulates metabolism, protein synthesis
function of calcitonin = helps Ca2+ absorption by bone and inhibit osteoclast resorption
low levels of circulation T3 & T4 --> no negative feedback to ant. pit. --> increase TSH --> trophic effect on thyroid gland --> GOITER
|
|
Pituitary Disorders
Hypopituitarism |
deficiency in one or multiple hormones; can result from inschemic injury or non-functional pituitary neoplasms |
Hyperpituitarism |
excessive secretion of hormones (adenoma, hyperplasia, carcinoma) |
Space Occupying Lesion (SOL) |
Sheehan Syndrome |
postpartum necrosis/postpartum hypopituitarism; hypertrophy/plasia of lactotrophs; results in enlargement of ant. pit. lobe; symptoms: agalactorrhea, amenorrhea, hot flashes, decreased libido; has features of both hypopituitarism (fatigue, intolerance to cold, constipation, weight gain, hair loss, low BP) and adrenal insufficiency (similar to addisons) |
Craniopharyngioma |
rare, benign tumor in children; develops from remnants of Rathke's pouch; a tumor mimicking the enamel organ of embryonic tooth |
Bitemporal Hemianopia |
bilateral loss of outer/peripheral visual fields, tunnel vision |
Pituitary Adenomas: -------- |
Prolactinoma |
most common type of functional adenoma; hyperpolactinemia; clincally- amenorrhea, galactorrhea, loss of libido, infertility |
Giantism |
GH adenoma - BEFORE closure of epihyses; juvenile, generalized increased body size with disproportioned limbs, CV problems; dx= elevated GH levels and CT positive pit tumor |
Acromegaly |
GH adenoma - AFTER closure of epiphyes; adult, coarse skin, enlargement of visceral organs, increase in facial bones (prognathism, flaring of teeth), CV problems, diabetes mellitus, hypertension, arthritis; dx= elevated GH levels and failure to suppress GH by oral load of glucose |
ACTH-producing adenoma |
thyrotrophs; results in hyperthyroidism |
pan-hypopituitarism: ---------------- |
diminished GH |
failure of growth --> Dwarfism |
diminished TSH |
hypothyroidism |
diminished LH/FSH |
failure of sexual maturity and fuunction (amenorrea, infertility) |
diminished ACTH |
Addison's Disease |
diminished ADH |
diabetes insipidus (excessive thirst and urination) |
Adrenal Gland Disorders
Hyperadrenalism |
excess cortisol production |
Hypoadrenalism |
decreased cortisol production?? |
Cushing Syndrome |
hyperadrenalism; ACTH-producing pituitary adenoma (60% of cases); clinical = weight gain, truncal obesity, hypertension, thinning skin, flushing of face, purple striae, easy bruising, hirsutism (excess hair), acne, osteoporosis, buffalo hump, moon faces, muscle weakness |
Hyperaldosteronism |
?? |
Addison's Disease |
chronic adrenocortical insufficiency; reduction/lack of cortisol and aldosterone; excess ACTH?; symptoms = tiredness, lack of energy, weight loss, GI disturbances, hypoglycemia, hyperpigmentation (bronzing), susceptible to infection |
primary vs secondary Addisons disease |
primary = reduction/lack of cortisol and aldosterone // secondary = due to deficiency of ACTH (hypothalamic/pituitary dysfunction) |
Waterhouse-Friderichsen syndrome |
caused by overwhelming sepsis due to bacterial infection, usually Neisseria meningitidis; symptoms = rapid hypotension leading to shock, DIC, wide spread purpura on skin, acute and rapid adrenocortical insufficiency |
Adrenal Crisis |
hypotension, weakness, collapse, N/V, headache, fever; tx = hydrocortisone |
Pheochromocytoma |
tumor of adrenal medulla; catecholamines-producing tumor arising from medullary paraganglionic cells (chromophine cells); clinical = epinephrine increase HR and force of contraction, relaxation of bronchiolar smooth muscle and glycogenolysis |
Endocrine Pancreas Disorders
Gastrinoma |
gastrin-producing tumor in pyloric antrum and duodenum |
Glucagnoma |
glucagon-producing tumor (ultra cells) |
Insulinoma |
insulin-producing tumor (beta cells) |
Somatostatinoma |
somatostatin-producing tumor (delta cells) |
Zollinger-Ellison syndrome |
1 or more gastrinoma in duodenum; results in excess HCL production, leading to frequent peptic ulcers and hyperplasia of gastric mucosa |
islets of langerhans (pancreas) |
glucagon, insulin, somatostatin, PP cells, gherlin (epsilon cells) |
|
