Endo 1

  1. Posterior pituitary: Hormones?
    ADH and Oxytocin
  2. 4 ways of hormonal regulation
    • 1. Negative feedback: high levels inhibit, low levels stimulate
    • 2. Positive feedback: high levels stimulate, low level inhibit
    • 3. Nervous system: causes release of hormones
    • 4. Rhythms: hormones fluctuate, circadian rhythms
  3. Mechanisms
    of Hormonal Alterations
    1.      failed feedback systems

    • 2.      gland synthesize or release
    • too much

    • 3.      gland unable to produce
    • enough

    • 4.      hormone degraded or
    • inactivated before reaching target cell

    5.      target cells do not respond
  4. Syndrome of Inappropriate ADH
    • Definition: 
    • high levels ADH:  caused by
    • tumors, transient after surgery, meds, infections


    •   2.  Pathophysiology:  ADH released = H2O retention -> excess fluid
    • volume + dilutional hyponatremia.  Renin
    • suppressed causing dec in aldosterone and dec reabsorption of Na.  Net effect – hyponatremia, hypoosmolarity,
    • water retention
    • Clinical Manifestations

                a.  muscle weakness   

                b.  abdominal cramps

                c.  fatigue

                d.  headache

                e.  confusion

                f.  seizures


     4.  Diagnostic Tests

    a.       serum osmolarity

    b.      urine osmolarity

    c.       serum Na

    d.      urine output

      5.  Treatment

    a.       water restrictions

    b.      hypertonic saline solution

    • c.       chronic SIADH – meds to
    • inihibit ADH
  5. Diabetes
    1.      Definition:  insufficient ADH or dec action.  Types.  

    a.       neurogenic

    b.      nephrogenic

    c.       psychogenic


      2.  Pathophysiology: 

    • a.       neurogenic – dec in ADH
    • leads to excretion of large amount dilute urine

    • b.      nephrogenic – ADH OK but
    • collecting ducts don’t respond


      3.  Clinical Manifestations

    a.       polyuria

    b.      nocturia

    c.       inc thirst

    d.      fatigue


      4.  Diagnostic Tests

    a.       serum osmolarity

    b.      urine osmolarity

    c.       water deprivation study


      5.  Treatment

    a.       fluids

    b.      synthetic ADH

    c.       meds to enhance ADH
  6. Anterior
    Pituitary: hormones

    1.      growth hormone  (GH)

    • 2.      thyroid stimulating hormone
    • (TSH)

    • 3.      adrenocorticotropic hormone
    • (ACTH)

    4.      prolactin  (PR)

    • 5.      gonadotropic hormones (FSH,
    • LH)
  7. Hypopituitarism
    • Definition: 
    • absence of one hormone to complete failure of all


    •   2.  Pathophysiology:  infarctions -> tissue necrosis and
    • edema.  Tumors -> destruction of gland




      3.  Clinical Manifestations:  general

    a.       weakness  

    b.      HA 

    c.  sexual dysfunction

    d.  dec tolerance to stress

    e.  vision changes

    if all hormones absent – panhypopituitary

                a.   cortisol deficiency

                b.  thyroid deficiency

                c.   diabetes isipidus

                d.  gonadal failure

                e.  dec in GH 


     4.  Diagnostic Tests:



    •   5.  Treatment: 
    • hormone replacement
  8. Excess Growth Hormone
    • Definition:  GH promotes:  bone and cartilage growth, elevation of blood
    • glucose, protein synthesis and mobilizes glucose and fatty acids


    •   2.  Pathophysiology:  excess causes soft tissue and bony
    • overgrowth.  Before closure of epiphyses
    • = gigantism.  After closure =
    • acromegaly.  Metabolic effects –
    • hyperglycemia


      3.  Clinical Manifestations

                a.  enlargement of bones

                b.  back and joint pain

                c.  enlargement of soft tissue

                d.  cardiac problems

                e.  overactive sebaceous and sweat glands


      4.  Diagnostic Tests

    a.       GH

    b.      oral glucose test

    c.       MRI


      5.  Treatment

    a.       radiation

    b.      meds to dec GH
  9. Thyroid Gland : hormones

    1.      thyroxin T4:  90% = T4, converted to T3 at cell

    • 2.      triidothyronine T3 – active
    • form

    • T3 & T4 – affect metabolic rate, caloric
    • requirements, O2 consumption, CHO and fat metabolism, growth and dev’t of brain
    • function and NS activity

    •   3.  calcitonin: 
    • produced by C cells, helps regulate Ca levels
  10. Hyperthyroidism
    B.  Hyperthyroidism

    •   1.  Definition: 
    • inc thyroid hormone. 
    • Thyrotoxicosis – hypermetabolism from excess hormone 


      2.  Pathophysiology:

    •             Graves:  autoimmune disease – stimulation of thyroid
    • with antibodies against TSH receptors. 
    • Antibodies stimulate production of T3 and T4.

    •             Toxic
    • goiter:  cells or nodules that secrete
    • hormone


    1.      Clinical Manifestations:

    a.       nervousness, excitability

    b.      wt loss

    a.       inc HR, palpitations

    b.      SOB, in RR

    e.   heat intolerance, sweating

    f.  inc in GI motility

    g.  insomnia    

    h.  protrusion of eyeballs - exopthalmos   


    3.      Diagnostic Tests

    • T4, T3 levels
    • TSH level
    • Iodine uptake test 


    4.      Treatment:

    • remove thyroid – replacement
    • radiation
    • anti-thyroid meds
  11. Hypothyroidism

    1.      Definition:  dec production.  Primary or secondary


      2.  Pathophysiology: 

    a.       Primary:  diminished thyroid tissue cause dec TH

    b.      Secondary:  dec TSH due to pituitary

    • Cretinism – infancy – stunt growth and mental
    • retardation

    • Myxedema – adults – accumulation of hydrophillic
    • mucopolysaccharides in dermis - puffiness


      3.  Clinical Manifestations

                a.  sluggishness

                b.  fatigue

                c.  impaired memory

                d.  wt gain

                e.  cold intolerance

                f.  dec GI motility

                g.  dec HR

                h.  dec libido

                i.  fluid retention


    •   4. 
    • Diagnostic Tests

    a.       T4, T3 levels

    b.      TSH levels


    •   5.  Treatment: 
    • hormone replacement
  12. Parathyroid Gland
    A.  Function

    • Secrete parathyroid hormone (PTH) – regulates
    • calcium level


    B.  Hyperparathyroidism 

      1.  Definition – excess PTH – Ca levels inc


      2.  Pathophysiology:

    a.       primary:  tumor

    b.      secondary:  response to chronically low Ca levels

    • c.       tertiary:  hyperplasia of gland, loss of sensitivity to
    • Ca


      3.  Clinical Manifestations

                a.  fractures

                b.  muscle weakness

                c.  metabolic acidosis 

                d.  n/v, constipation

                e.  insulin resistance

                f.  kidney stones


      4.  Diagnostic Tests

                a.  PTH

                b.  serum Ca

                c.  serum phosphate

                d.  urine pH

                e.  bone density


      5.  Treatment

                a.  surgery

                b.  diuretics

                c.  meds that dec resorption of Ca from bone
  13. Hypoparathyroidism
    • 1. 
    • Definition:  dec in PTH, rare,
    • seen after thryoid surgery, also with hypomagnesium


      2.  Pathophysiology:  dec in PTH causes dec in serum Ca levels






     3.  Clinical Manifestations: 

                a.  muscle spasms

                b.  hyperreflexes

                c.  tetany

                d.  seizures

                e.  laryngeal spasms

                f.  dry skin, hair loss


      4.  Diagnostic Tests

                a.  PTH level

                b.  serum Ca levels

                c.  serum phosphate level


    3.      Treatment:

    a.       Ca supplements

    b.      Vit D
Card Set
Endo 1
for patho