1. Chapter 32 Disorders of Endocrine Function
Essentials of Pathophysiology
Chapter 32 Disorders of Endocrine Function

2. Pre lecture quiz true/false
Hypopituitarism is characterized by a decreased secretion of pituitary hormones.
Hypothyroidism is evidenced by an increased metabolic rate, restlessness, irritability, tachycardia, diarrhea, and heat intolerance.
Primary adrenal insufficiency, or Addison disease, is caused by destruction of the adrenal gland.
Moon facies, buffalo hump, obesity, amenorrhea, and increased facial hair are manifestations of Cushing syndrome.
Addison disease is a temporary condition.

3. Pre lecture quiz Acromegaly Cushing Graves growth puberty
In children, _____________ hormone deficiency interferes with linear bone growth, resulting in short stature or dwarfism.
When growth hormone excess occurs in adulthood or after the epiphyses of the long bones have fused, the condition is referred to as ______________.
Precocious ______________ is the early activation of the hypothalamic-pituitary-gonadal axis, resulting in the development of appropriate sexual characteristics and fertility.
______________ disease is a state of hyperthyroidism that is often accompanied by goiter and exophthalmos.
______________ syndrome refers to the manifestations of excess cortisol.
Acromegaly
Cushing
Graves
growth
puberty

4. Hypothalamus- Pituitary Axis
Releasing hormones from hypothalamus tell the pituitary what to release into the blood
Trophic hormones from the pituitary tell specific peripheral glands to grow and produce their hormones
Releasing Hormones
Trophic Hormones

5. Hormone Disorders
Tertiary: abnormality in stimulation from the hypothalamus
Secondary: abnormality in stimulation from the pituitary
Primary: abnormality in the gland

6. Pituitary Hormones Growth ACTH FSH TSH hormone and LH stimulates
adrenal
stimulate
thyroid
cortex
gonads

7. Question
Which hormone(s) stimulate the ovaries and testes? GH
FSH and LH
TSH
ACTH and GH

8. Answer
FSH and LH
Rationale: Gonads are sex organs (ovaries and testes). These organs are stimulated by follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

9. The Hypothalamus Controls Growth Hormone Release
GH secretion stimulated by:
Hypoglycemia, fasting, starvation
Stress
GH inhibited by:
Increased glucose levels, free fatty acid release, and obesity
Cortisol
Hypothalamus
Next Slide
GHIH
GHRH
Somatostatin
stimulates
inhibits
Anterior pituitary
Growth
hormone

10. Growth Hormone Sitimulated BY ?
Hypoglycemia, fasting, starvation, Stress ??
It would seem that adequate energy supply would be needed for Growth ?
A baseline level of GH exists during normal nutrition mildly stimulated by Deep Sleep, Exercise, and Protein Consumption. GH stimulates IGF-1
During fasting etc. and increased release of GH occurs due to a decrease in GHIH.
This produces a protective effect preventing muscle wasting by stimulating lipolysis and FFA metabolism maintaing blood glucose for the CNS
Without GH significantly more muscle wasting occurs

11. Functions of Growth Hormone
Promotes Growth
Inhibits Insulin

12. Growth Hormone Deficiency
Idiopathic GH deficiency
Lacks hypothalamic GHRH
Pituitary tumors, agenesis of the pituitary
Cannot produce GH
Laron-type dwarfism
Hereditary defect in IGF production

13. In childhood: gigantism In adulthood: acromegaly
Growth Hormone Excess
In childhood: gigantism
In adulthood: acromegaly

14. Question
Tell whether the following statement is true or false. GH deficiency may result in dwarfism.

15. Answer
True Rationale: Laron-type dwarfism is caused by a genetic inability to produce normal amounts of GH. Not True. Normal GH abnormal IGF

16. The Hypothalamus Controls Gonadal Hormone Release
Excessive GnRH secretion can be stimulated by:
Hypothalamic tumors
Pituitary tumors
Giving high levels of GnRH causes the pituitary to become less responsive and reduces the effects of abnormal GnRH secretion
hypothalamus
GnRH
stimulates
anterior pituitary
FSH LH
production of gametes
and gonadal hormones

17. Thyroid Control Thyroid releases T3 and T4
Both are carried by binding proteins
T3 stimulates metabolism
T4 is inactive until converted into T3 in the tissues
Both exert negative feedback on the hypothalamus
Why?

18. Thyroid Insufficiency Due to Lack of I
T3 and T4 are not made
There is no negative feedback to the hypothalamus
TRH and TSH continue to be made
If it is able, the thyroid will grow in response to the TSH

19. Thyroid Imbalances Hypothyroidism Congenital Acquired
Hashimoto thyroiditis
Thyroidectomy
Hyperthyroidism (thyrotoxicosis)
Graves disease
Thyroid tumors

20. Question
Tell whether the following statement is true or false. Simple goiter is caused by increased production of thyroid hormone.

21. Answer
False Rationale: Simple goiter is the result of iodine (I) insufficiency. Since I is necessary in order to produce thyroid hormone, a deficiency results in low serum levels of T3 /T4. This causes TSH to stimulate the thyroid gland to make more hormone (which it cannot do because it needs I). The cells of the thyroid gland hypertrophy in an effort to function (make thyroid hormone).

22. Major Adrenal Cortical Hormones
Cortisol
What can cause Cortisol Stimulation?
Hypothalamus releases ??
Causes the Anterior Pituitary to release ??
Causes the adrenal cortex to release ??

23. Major Adrenal Cortical Hormones
Hypothalamus
Corticotropin-releasing
hormone (CRH)
Negative
Anterior pituitary
feedback
Negative
Adrenal corticotrophic
feedback
hormone (ACTH)
Adrenal
cortex
Cortisol
Testosterone
Aldosterone

24. Actions of Cortisol cortisol Increases catabolism plasma immune/
proteins
inflammatory
increased
systems
suppressed
muscle
breakdown
SNS response
increased
free fatty
acids
blood glucose
increased
increased

25. Adrenal Cortical Disorders
Adrenal cortical insufficiency: inability to make all three hormones
Primary adrenal cortical insufficiency (Addison disease)
Secondary adrenal cortical insufficiency
Acute adrenal crisis
Excessive adrenal secretion
Glucocorticoid hormone excess (Cushing syndrome)
Hyperaldosteronism
Congenital adrenal hyperplasia
Decreased cortisol synthesis; other hormones may be increased or decreased

26. Clinical Manifestations of Addison Disease (chronic adrenal insufficiency)
Author: Add text?

27. Clinical Manifestations of Cushing Syndrome (high levels of cortisol in the blood)

28. Scenario Three men have adrenal problems.
One has hypoaldosteronism, one has an inability to make cortisol, and one has an inability to make testosterone.
Question:
Which of them is most likely to develop:
Hypotension?
High CRH levels?
Hypoglycemia?
Hypervirilization?
Decreased libido?
Hyperkalemia?

29. Scenario Two women have benign pituitary tumors.
One woman has lost weight and complains of being hot all the time; she presents as thin and nervous, with tachycardia and exophthalmos
The second woman has gained weight in her abdomen and presents with a round face and thin arms and legs with stretch marks; she says that at her last checkup her doctor told her she was prediabetic
Question:
What hormones are being secreted by the pituitary tumors in these patients? Why?