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Bio217: Pathophysiology Class NotesProfessor Linda Falkow
Unit V: Endocrine System Disorders
Chap. 17: Mechanisms of Hormonal RegulationChap. 18: Alterations of Hormonal Regulation
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Mechanisms of Hormonal Regulation
Chapter 17
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The Endocrine System
• Components– Glands located around the body that secrete
chemical messengers (_________)
• Functions– Works with _______to regulate and integrate
metabolism and maintain homeostasis
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Hypothalamus (“heart of the endocrine system”)
• Center for integrating endocrine and ANS • Regulates endocrine glands via
_________and ___________ pathways• Posterior Pituitary Anterior Pituitary
(neural pathways) (hormonal control)
• ADH (antidiuretic hormone) ACTH (adrenocorticotropic horm.)• Oxytocin TSH (thyroid stim. hormone)
LH (luteinizing hormone)FSH (follicle stim. hormone) also GH (growth horm.) and PRL (prolactin)
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Negative Feedback- regulates the endocrine system by ________________ overproduction of hormones
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Lipid-Soluble Hormones
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Hormone Binding at Target Cell
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Anterior Pituitary Hormones
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Endocrine disorders
• May be caused by– Hypersecretion or hyposecretion of hormones– Hyporesponsiveness of hormone receptors– Gland inflammation– Tumors of glands
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Adrenal glands• Embedded in fat superior to each kidney• Adrenal cortex:
– 1. Aldosterone (_________________) – regulates Na+ reabsorption & excretion of K+
– 2. Cortisol (______________)• - stimulates gluconeogenesis• - protein breakdown and fatty acid mobilization• -suppression of immune system• - increased stress response• - maintains BP and CV fcn.
– 3. Adrenal androgens & estrogens (_______________)
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Aldosterone
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– Adrenal medulla• Epinephrine & Norepinephrine (catecholemines)
–- produce VC–- _______ response (“fight or flight”)
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Catecholamines
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Thyroid and Parathyroid Glands• Thyroid gland
– Located in anterior neck ; two lobes lie on either side of the trachea
– Secrete Iodine – containing hormones• ____________ – nec. for growth & dev.; increase metabolism• ____________ – regulates blood Ca++ levels
• Parathyroid glands– 4 glands located on posterior aspect of thyroid– Secrete _________
• Regulates blood Ca++ levels
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Thyroid and Parathyroid Glands
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Endocrine Pancreas
• The pancreas is both an __________ and _________ gland
• Contains pancreatic islets (of Langerhans)– Secretion of glucagon and insulin– Cells
• Alpha—glucagon ( nec. when fasting _________ BG)• Beta—insulin (released after a meal _________BG,
stim. protein syn. and fatty acid uptake & storage)
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Endocrine Pancreas
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Concept Check
• 1. Organs that respond to a particular hormone are called:– A. target organs C. responder organs– B. integrated organs D. hormone attach organs
• 2. The hypothalamus controls the anterior pituitary by:
A. Nerve impulses C. Regulating hormones
B. PG D. None of the above
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3. In a negative feedback mechanism controlling thyroid hormone secretion, which is the nonregulatory hormone?•A. TRH C. thyroxine•B. TSH D. All of the above are regulatory for
thyroid homone secretionMatching:
____ 4. ACTH a. Mammary glands
____ 5. TSH b. Adrenal cortex
____ 6. TRF c. Thyroid gland
____ 7. prolactin d. Ant. pit.
Matching: a. Influence inflam. response
___ 8. Epi b. Causes fight or flight response
___ 9. Glucocorticoids c. Controls Na+, H+, K+
___ 10. Mineralcorticoids d. Act as minor sex hormones
___ 11. Gonadocorticoids
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Alterations of Hormonal Regulation
Chapter 18
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Elevated or Depressed Hormone Levels
• Failure of feedback systems• Dysfunction of an endocrine gland
• Secretory cells are unable to produce, obtain, or convert hormone precursors
• The endocrine gland synthesizes or releases excessive amounts of hormone
• abnormal hormone levels
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Endocrine Disorders
• Pituitary disorder of water metabolism (diabetes insipidus)
• 3 Thyroid gland disorders (goiter, hyperthyroidism,
hypothyroidism)
• Pancreatic disorder (diabetes mellitus: type 1 and type 2)
• 2 Adrenal disorders (Addisons’s and Cushing’s syndrome)
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Elevated or Depressed Hormone Levels
• Increased hormone degradation or inactivation
• Ectopic hormone release
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Diseases of the Posterior Pituitary
Diabetes insipidusDeficiency of _________ (aka vasopressin)Polyuria (4-16 L/day) and polydipsiaPartial or total inability to concentrate urineCauses: drugs or injury to posterior pituitary; lesions
in hypothalamus, infundibulum or post. pit.Normally ADH is syn. in hypothalamus and stored in
post. pit. ADH is released when plasma osmolality increases increased permeability to dct and cd in kidney increased reabsorption of water.
When ADH is missing: results in increased excretion of water large amt. of dilute urine
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Diabetes Insipidus
Pathophysiology:– Patients not able to concentrate urineDeficiency of ADH ___________ vol. of dilute urine ____________ if fluids are not replaced
Treatment: replacement of ADH
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Alterations of Thyroid FunctionGoiter = enlargement of thyroid gland
not due to inflammation or neoplasm Classified as:
nontoxic (increased demand for TH during adolescence, pregnancy or menopause) and
toxic (due to long term nontoxic, occurs in elderly)Please pass the iodine
Endemic goiter due to insufficient dietary iodine insufficient production of TH
Too much of a good thingSporadic goiter due to ingestion of goitrogenic
foods* ( inhibit thyroxine) or drugs
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Goiter
• Pathophysiology• Decreased iodine plus impaired synthesis of
TH responsiveness of thyroid to TSH• Increased mass and cell activity may
overcome mild thyroid impairment (Patient has goiter but normal fcn.)
• If severe impairment goiter and hypothyroidism
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Alterations of Thyroid Function
• Hyperthyroidism
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Hyperthyroidism or thyrotoxicosis (Graves Disease)
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Graves’ Disease• How grave is Graves’ disease?• Graves’ disease is most common type • Autoimmune, 30-60 years old, family history
of thyroid abnormalities• Thyroid-stimulating antibodies bind to TSH
receptors• Thyroid storm (thyrotoxic crisis)
Overproduction of T3 and T4 increased SNS activity( tachycardia, vascular collapse, hypotension,
coma, death)
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Graves’ disease• Signs & Symptoms• Enlarged thyroid• Exophthalmos (_______________)• Nervousness, weight loss w/ increased appetite
• Treatment• Antithyroid drugs (propylthiouracil, methimazole)• 131 I (radioactive iodine therapy)• Surgery
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Alterations of Thyroid Function• Hypothyroidism
– Thyroid deficiency (decreased T3 and T4) metabolic processes slow (may be problem with thyroid, pituitary, or hypothalamus)
– Primary hypothyroidism – due to disorder of thryoid– Secondary hypothyroidism –due to failure to stimulate
thyroid– Causes: thyroidectomy, radiation, not enough TSH
(from pituitary) or TRH (from hypothalamus)– Symptoms: fatigue, wt. gain, facial puffiness, dry skin,
bleeding tendencies
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Pathophysiology• Loss of thyroid tissue decreased TH, increased TSH
and goiter (primary)• Decreased TSH from pituitary most commonly due to
tumors (secondary)• Myxedema- composition of dermis is changed (puffiness)• Myxedema coma - depressed respiratory system ,
decreased cardiac output, bradycardia & hypotension• Treatment: TH replacement gradually (levothyroxine)
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Hypothyroidism
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Diabetes Mellitus
• Body does not produce or use _________ properly• Results in hyperglycemia
• Type 1 (IDDM = insulin-dependent)• Type 2 (NIDDM = non-insulin-dependent)
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Type 1 diabetes• Pathophysiology (Type 1)
– Islet cell (beta cell) destruction no insulin production– Autoimmune (genetic & environmental)– Nonautoimmune (idiopathic)
• Symptoms – Lack of insulin ______________ occurs w/ 89-90% destruction
of beta cells; excess glucagon by alpha cells– Glucosuria, polyuria, polydipsia– Ketoacidosis due to fat and protein metabolism DKA coma
• Treatment: Insulin, meal planning and exercise, Hb A1C
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Type 2 diabetes mellitus• Pathophysiology
– Idopathic, genetic and environmental factors– Insulin resistance in target tissues– Overproduction of glucose via gluconeogenesis– Obesity
• Symptoms– Recurring skin infections– Visual changes (blurred vision, retinopathy)– Paresthesias – Fatigue (poor eating)
• Treatment– Personalized meal plan & exercise
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Acute Complications of Diabetes Mellitus
• Hypoglycemia (insulin shock- decr. BG levels)
• Diabetic ketoacidosis _______ – dec. insulin levels elevated BG levels fat mobilized
• Somogyi effect – hypoglycemia followed by hyperglycemia (rebound)
• Dawn phenomenon – early morning elevated BG
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Diabetic Ketoacidosis
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Chronic Complications of Diabetes Mellitus
• Hyperglycemia• Microvascular disease
– Retinopathy– Diabetic nephropathy
• Macrovascular disease– Coronary artery disease– Stroke– Peripheral arterial disease
• Diabetic neuropathies• Infection
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Alterations of Adrenal Function• Disorders of the adrenal cortex
– Cushing disease• Excessive anterior pituitary secretion of ________
– Cushing syndrome• Cluster of abnormalities due to excessive levels of cortisol
(glucocorticoid)• Wt. gain, muscle weakness, fatigue, buffalo hump, thin
extremities, bruise easily
• Treatment:– Radiation, drugs, surgery depending on cause
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Cushing Disease
A. Before onset of Cushing syndromeB. 4 months later
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• Addison’s disease – (adrenal insufficiency or hypofunction)– ____________ mineralcorticoid, glucocorticoid, and
androgen secretion– Cause – usually from autoimmune process
• Idiopathic, TB, removal of adrenals, neoplasms, infections
– Adrenal crisis• Inadequate or nonresponsive hormone therapy• Extreme stress• hypoglycemia, hypotension coma death
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Concept Check
• 1. Which clinical symptoms are shared by DM and diabetes inspidus?
– A. Elevated blood and urine glucose levels– B. Inability to produce ADH– C. Inability to produce insulin– D. Polyuria
• 2. Graves disease is:– A. Hyperthyroidism– B. Associated with autoimmunity– C. Characterized by ophthalmopathy– D. All of the above
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• 3. A 24-year old female with a history of “juvenile onset” diabetes is found in a stupor. She has cold, clammy skin, what is most likely the cause of her condition?– A. Hyperglycemia– B. Insulin shock– C. Renal failure– D. retinopathy
4. Common signs and symptoms of DM include all of the following except:
– A. Hyperglycemia– B. Blurred vision– C. Increased muscle anabolism– D. polyuria
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Matching:
• ___ 5. Cushing disease A. Excess cortisol • ___ 6. Goiter B. Enlarged thyroid• ___ 7. Addison disease C. Adrenal
hypofunction