1. PHYSIOTHERAPY IN ENDOCRINE PATHOLOGY
FUNCTIONAL ANATOMY AND PHYSIOPATHOLOGY OF HYPOTHALAMUS AND ADENOHYPOPHISIS
PHYSIOTHERAPY IN ENDOCRINE PATHOLOGY

2. Outline and objectives of the course
HYPOTHALAMUS
-Describe the location, structure and function of the hypothalamus
-Describe the hormons of the hypothalamus
HYPOPHISIS
Hormones of the adenohypophisis
Regualation of the AdenoHy hormones
Hormones of the neuroHy
Pituitary disorders
-Explain the functions of anterior pituitary hormones and how they are regulated
-Explain the functions of posterior pituitary hormones and how they are regulated
- Summarise the characteristics of pituitary disorders

3. HYPOTHALAMUS - STRUCTURE

4. OVERVIEW Located inferior to the talamus
Represents the ventral region of the midbrain
Center of homeostasis

5. GENERAL PRESENTATION
The hypothalamus (from Greek ὑποθαλαμος = under the thalamus) is a region of the mammalian brain located below the thalamus, forming the major portion of the ventral region of the diencephalon and functioning to regulate certain metabolic processes and other autonomic activities.
The hypothalamus links the nervous system to the endocrine system via the pituitary gland, also known as the "master gland," by synthesizing and secreting neurohormones, often called releasing hormones, as needed that control the secretion of hormones from the anterior pituitary gland — among them, gonadotropin-releasing hormone (GnRH). The neurons that secrete GnRH are linked to the limbic system, which is primarily involved in the control of emotions and sexual activity. The hypothalamus also controls body temperature, hunger, thirst, and circadian cycles.

6. GENERAL PRESENTATION
The hypothalamus co-ordinates many seasonal and circadian rhythms, complex patterns of neuroendocrine outputs, complex homeostatic mechanisms, and many important stereotyped behaviours. The hypothalamus must therefore respond to many different signals, some of which are generated externally and some internally. The hypothalamus is thus richly connected with many parts of the CNS, including the brainstem reticular formation and autonomic zones, the limbic forebrain (particularly the amygdala, septum, diagonal band of Broca, and the olfactory bulbs, and the cerebral cortex).

7. FUNCTION The hypothalamus is responsive to:
Light: daylength and photoperiod for generating circadian and seasonal rhythms
Olfactory stimuli, including pheromones
Steroids, including gonadal steroids and corticosteroids
Neurally transmitted information arising in particular from the heart, the stomach, and the reproductive tract
Autonomic inputs
Blood-borne stimuli, including leptin, ghrelin, angiotensin, insulin, pituitary hormones, cytokines, plasma concentrations of glucose and osmolarity etc
Stress
Invading microorganisms by increasing body temperature, resetting the bodys thermostat upward.

8. The hypothalamus is a very complex region, and even small nuclei within the hypothalamus are involved in many different functions. The paraventricular nucleus contains oxytocin and vasopressin neurons which project to the posterior pituitary, but also contains neurons that regulate ACTH and TSH secretion (which project to the anterior pituitary), gastric reflexes, maternal behavior, blood pressure, feeding, immune responses, and temperature.

9. Hypothalamic nuclei - Lateral Area Medial Area Anterior Anterior
Lateral preoptic nucleus
Lateral nucleus Part of supraoptic nucleus
Tuberal
Lateral nucleus Lateral tuberal nuclei
Posterior
Lateral nucleus
Medial Area
Anterior
Medial preoptic nucleus Supraoptic nucleus Paraventricular nucleus Anterior nucleus Suprachiasmatic nucleus
Tuberal
Dorsomedial nucleus Ventromedial nucleus Arcuate nucleus
Posterior
Mammillary nuclei (part of mammillary bodies) Posterior nucleus

10. Hormones of the hypothalamus
Corticotropin-releasing hormone (CRH)
Dopamine
Gonadotropin-releasing hormone (GnRH)
Growth hormone releasing hormone (GHRH)
Somatostatin
Thyrotropin-releasing hormone (TRH)
Hypocreatin
Antidiuretic Hormone (ADH)

11. HT role in obesity
An important aspect of hypothalamic autonomic control with regard to the endocrine system is the control of food intake. The effects of obesity on endocrine function can be widespread and endocrine abnormalities can cause obesity. A number of hormones play central roles in the control of food intake

12. Measures of obesity
Three main experimental measures of fat mass in man have been used for many years. They require the determination of body density, water or potassium content and the assumption that the body composition can be divided into fat and fat-free or lean body mass with certain characteristics. These techniques are relatively costly, time-consuming and do not give information on the distribution of the fat.
Techniques such as bioelectrical impedance rely on the fact that fat is not as good an electrical conductor as lean body mass. It is cheap but also does not allow an assessment of the distribution of the fat mass.
Imaging techniques such as CT or MR allow the determination of fat from a number of tomographic 'slices' of the body. The distribution of the fat mass can be calculated.
Simple anthropomorphic measurements such as height and weight allow the calculation of body mass index (BMI), whilst calipers can be used to measure subcutaneous fat.
BMI = body weight (in kg)/height2 (in m)
Waist/hip circumference * = ratio of waist circumference to that of the hips

13. HIPOPHYSIS (pituitary gland)
O,5-0,8 G
anterior pituitary (adenohypophysis)
posterior pituitary (neurohypophysis)
Regulated by hypothalamus – providing anatomical and physiological connections between nervous and endocrine system

14. ADENOHYPOPHYSIS NEUROHYPOPHYSIS
Connected with the hypothalamus via the hypophyseal portal system
NEUROHYPOPHYSIS
Connected with the hypothalamus via the hypophyseal tract

15. HORMONES OF THE ADENOHYPOPHISIS
Somatotropin (growth hormone)
Prolactin
Gonadotropines: follicle-stimulating hormone (FSH); luteinizing hormone (LH)
Thyroid stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)

16. Thyrotropin
Stimulates the thyroid gland to synthetize and secrete its hormones
(triiodothyronine – T3; thyroxine – T4)
Regulation by negative feedback ( high concentration of T3 and T4 in blood)

17. Gonadotropines (FSH, LH)
FSH stimulates the maturation of an ovum each month during a female reproductive years
Stimulates maturation of sperm in males
Stimulates production of estrogen hormones
Regulation by negative feedback ( high concentration of estrogensin blood)

18. LH
Stimulates ovulation and causes follicular cells to produce progesterone which stimulates nidation and mammary gland development
In males stimulates development of interstitial cells (Leydig) of testis; stimulates production of testosterone

19. Somatotropin Acts directly on some cells to stimulate growth
Acts indirectly on others to release proteins (insulin like growth factor I)
Promotes calcium absorbtion from intestine
Works with insulin and thyroid hormones to promote collagen synthesis

20. Increase the rate at wich cells take up aminoacids and use them to synthetise proteins
Stimulate free fatty acid release from fat cells and glycogen breakdown in the liver
Stimulate growth to adult size

21. Bone and muscle loss associated with reduced strength in aging may be due to declining GH after age 50.
At age 30 – body mass: 10% bone, 30% muscle, 20% fatty tissue
At age 75 - body mass: 8% bone, 15% muscle, 40% fatty tissue

22. Corticotropin(ACTH)
Acts on the cortex of the adrenal gland to regulate synthesis and secretion of several of its hormones, especially glucocorticoids
Glucocorticoids stimulate the release of fatty acids and glucose into the blood and help the body to resist stress and inflamation
Regulation by negative feedback ( high concentration of cortisol in blood)

23. Prolactin
Stimulates milk secretion in mammary glands previously prepared for milk production by other hormones – estradiol, progesterone, corticosteroids, insulin

24. Beta-lipoprotein Has been isolated from the anterior pituitary gland
Endorphins and enkefalins can be made from it in the anterior pituitary or in the brain directly

25. Melanocyte stimulating hormone
Secreted in small quantities by the intermediate lobe of pituitary gland
Role in skin pigmentation

26. Regulation of the adenohypophyseal hormones
By neurohormones secreted by hypothalamus (releasind and inhibiting)
Tropic hormones from the anterior pituitary regulate other glands such as the thyroid, adrenal cortex, gonads
Hormones from these glands act by negative feedback to inhibit the release of both tropic and hypothalamic hormones
Neural signals elicited by sexual arousal, stress, anxiety, trauma, variations in the light-dark cycle and the sucking of a breast-fed infant also regualte hypothalamus hormones

27. Hypothalamic hormones that regulate secretion of adenoHY
Abreviation
Function
Thyrotropin releasing hormone
TRH
Stimulates release of TSH
Corticotropin releasing hormone
CRH
Stimulates release of ACTH
Gonadotropin releasing hormone
GnRH
Stimulates release of FSH and LH
Growth hormone releasing hormone
GHRHH
Stimulates release of GH
Growth hormone inhibiting hormone (somatostatin)
GHIH
Inhibits release of GH
Prolactin releasing hormone
PRH
Stimulates release of prolactin
Prolactin inhibiting hormone
PIH
Inhibits release of prolactin

28. Hormones of the neurohypophysis
2 chemically similar peptide hormones, ocytocin and antidiuretic hormone are called neurosecretions because are synthetised in hypotalamic neurons and stored in the neuroHY
When action potentials causes their release from axons they enter the blood and act as hormones.

29. Oxytocin
Stimulates contraction of smooth muscle in the uterus and the contractile cells around mammary gland ducts
Is relased during sexual intercourse, labor, lactation

30. Antidiuretic hormone (ADH)
Also called vasopresine
Prevents excess water loss in urine
In high concentrations constricts blood vessels
Decreases osmotic pressure and the urine volume
Increases the blood volume

31. Pituitary disoders Disorder Possible cause Hormone Excess or
defficiency
Effects
Pituitary dwarfism
Destruction or congenital defficiency of GH production cells GH
Small, well proportioned body, sexual imaturity
Gigantism
Pituitary tumor before adult size is reached
excess
Large, well proportioned body
Acromegaly
Pituitary tumor after adult size is reached
Disproportionate increase in thickness of bones of face, hands and feet
Panhypopituitarism
Tumor or thrombus
all
Depressed thyroid, adrenocortical and gonad function
Diabetes insipidus
Damage to the hypothalamus
ADH
Excessive excretion of dilute urine
High ADH blood level
Excessive stimulation of ADH-secreting neurons or pituitary tumor
Excessively dilute blood and low sodiun concentration in plasma

32. Reminder Glands Hormones Target cells Major effects Negative feedback
disorders
Adeno
hypophisis
Growth hormone (somatotropin)
Most cells
growth, maintanence of adult size, protein synthesis, release of fats and glucose into blood
Blood nutrient level
Dwarfism, gigantism, acromegaly
Prolactin
Mammary glands
Secretion of milk
Follicle stimulating hormone(FSH)
Ovaries
Testes
Maturation of ova; production of estrogen
Maturation of sperm
Estrogen
Inhibin
Luteinizing hormone (LH)
Release of ova; production of progesterone
Development of interstitial cells and production of testosterone
Progesterone
Testosterone
Adrenocorticotropic hormone (ACTH)
Adrenal cortex
Release of hormones from adrenal cortex
Cortisol
Thyroid stimulating hormone (TSH)- thyrotropin
Thyroid gland
Synthesis and release of T3, T4
T3, T4

33. Reminder Glands Hormones Target cells Major effects Negative feedback
Neurohypophisis
Oxytocin
Smooth muscle of uterus and mammary ducts
Cause uterine contraction and release of milk
Antidiuretic hormone (ADH)-vasopresin
Kidney tubules
Smooth muscle of blood vessels
Water reabsorbtion
Constrict blood vessels and raise blood pressure

34. REFERENCES
Avramescu ET, Rusu L., Ciupeanu – Calugaru D., 2005, Human Anatomy, Universitaria Publishing House, Craiova,
Bello M., Testing the effects of growth hormone releasing hormone, Research Resources 9, no 10:1, 1985
Creager J., 1992, Wm. C. Brown Publisher
Lechan, R., Neuroendocrinology of pituitary hormone regulation, Endocrinology and Metabolism Clinics 16, no 3:475, 1987