The

Endocrine
System

1
 Endocrine System
• The endocrine system is all the organs of the
body that are endocrine glands.
• An endocrine gland secretes hormones.
• Hormones are molecules that are secreted into
the blood.
• Hormones are substances that are secreted by
one group of cells that affects the physiology of
another group of cells (organs). The endocrine
system is controlled by the pituitary gland and
the hypothalamus.
• Compared to most other organs in the body,
endocrine organs are well vascularized.
• VIDEO http://www.youtube.com/watch?v=HrMi4GikWwQ

2
 The Endocrine System
• A system of ductless glands
– Secrete messenger molecules called
hormones
• Interacts closely with the nervous
system
• Endocrinology – study of hormones
and endocrine glands

3
 Major Endocrine Glands
• Hypothalamus
• Pituitary Gland
• Thyroid Gland
• Parathyroid Glands
• Thymus Gland
• Adrenal Glands
• Pancreas
• Ovaries
• Testes
• Pineal Gland
4
 Endocrine Organs
• Scattered throughout the body
• Pure endocrine organs
– Pituitary, pineal, thyroid, parathyroid,
and adrenal glands
• Organs containing endocrine cells
– Pancreas, thymus, gonads, and the
hypothalamus
• Richly vascularized
5
 6
Figure 25.1
 Endocrine System
• The endocrine system is a series of glands that
release a hormone into the plasma, where it is
dissolved and transported throughout entire body
within 60 seconds.
• Every cell is exposed to the hormone, but not
every cell responds to it. For a cell to be able
to respond to a hormone, the cell must have
a functional hormone receptor. A cell that
responds will do so in various ways. The cells in
the heart, pancreas, and brain respond to
epinephrine differently. One thing that always
happens is that a cell will change its
physiology in response to a hormone. 7
 Hormones
• Hormones can be synergistic; aldosterone and
antidiuretic hormone (ADH) both help increase volume
of fluid in body to raise blood pressure.
• Some hormones are antagonists; Atrial natriuretic
peptide (ANP, produced by heart cells) is released when
you have high blood pressure. It causes the kidney to
secrete more water, so blood pressure can decrease.
That is the opposite of ADH, which makes you urinate
less.
• Some hormones are permissive; you need one in order
for a second to do its job well. Thyroid hormone is
permissive for growth hormone (you need thyroid
hormone in order for GH to work). Not enough thyroid
hormone can cause stunted growth, even if enough
growth hormone is present. 8
 Hormones
• Basic hormone action
– Hormones are made by the
gland’s cells, possibly stored,
then released
– Circulate throughout the body
vasculature, fluids

http://www.megalo-media.com/art/ccolor3.html
– Influences only specific tissues:
target cells that have a receptor
for that particular hormone
– A hormone can have different
effects on different target cells:
depends on the receptor
– Some hormones are
“permissive” for the actions of
another (TH for GH)
Ultimate goal: alter cell activity What would happen if there was
by altering protein activity in a defect in the hormone
the target cell. receptor on the target cell
membrane? The hormone might
be fine, but doesn’t work. 9
 Target Cell
• A target cell is only a target cell if it is has a
functional receptor (a protein) for the
hormone. At home, you may watch TV with
either a cable or satellite dish. Satellite waves are
exposed to those homes with cable, but only
those with dishes receive the signal. The target
cell’s receptor serves to convert the signal into a
response.
• Receptors are proteins, which can be inside the
cell or on its membrane. What would happen
if there were a gene defect in the DNA code
for a receptor? The receptor becomes faulty,
and will not respond to the hormone. The
receptor will also not function properly if the cell
is exposed to excess salt, heat, or pH. 10
 What is a
“receptor”?
• It is a protein made by the target cell
(protein synthesis after gene
expression) What would
happen if there
• The protein is made, then inserted were a gene
into plasma membrane, or found in defect in the
cytoplasm or nucleoplasm DNA code for a
receptor?
• The active site on the protein “fits”
What would
the hormone happen if the
• Acts to convert the signal into a receptor
response protein was
denatured?
11
 What happens to
hormones?
• Endocrine glands secrete hormones
into the plasma. Then, several
different events could occur.
• It could bind to its receptor on the
target cell, causing a change.
• Or, it could be destroyed by enzymes
in the plasma.
• It could land in the kidneys and be
filtered out before reaching its
target.
12
 What happens to a hormone once it’s
secreted?
Carrier-bound
hormone

Endocrine Free Hormone

cell Hormone receptor

• Degraded in bloodstream
• May be activated (turned
from T3 to T4) Hormone Biological
Degradation or
• May be excreted by kidneys/ removal
effects
liver
• May reach a target cell and
cause a cell response
• May need carrier to reach
13
target cell
 Control of Hormone
Secretion
• The endocrine system is controlled
by the pituitary gland and the
hypothalamus.
• Always controlled by feedback loops
• Concentration declines below a
minimum: more hormone is secreted
• Concentration exceeds maximum:
Hormone production is halted

14
Control of Hormones Release: Three Mechanisms

15
Figure 25.2a-c
 Humoral Trigger
• Something in the blood is being monitored. When the level
of that substance is too high or low, it stimulates the
release of the hormone.
• Examples are insulin, glucagon, parathyroid hormone,
and aldosterone.
• When you eat, glucose gets high, releases insulin, which
tells cells to take in the sugar. Excess sugar is then
converted to glycogen, which is the storage form.
• When glucose is low, glycogen is broken back down to
glucose and released into the blood.
• When blood calcium is low, parathyroid gland hormone tells
the intestinal cells to absorb more calcium, and kidneys to
reabsorb more Ca++, and stimulates osteoclasts to degrade
bone matrix so calcium goes into blood. 16
 Neuronal Trigger
• Examples are oxytocin, ADH
(neurohypophysis hormones) and
Epinephrine (adrenal medulla
hormone)

17
 Hormonal Trigger
• This is when one endocrine gland
releases a hormone that stimulates
another endocrine gland to release
its hormone.
• Examples are any of the
hypothalamus or anterior pituitary
hormones, and also the adrenal
cortex (steroid) hormones (except
aldosterone) and thyroid hormone.
18
 Hypothalamus
• This is located at the base of the brain. It
is part of the limbic system, which controls
the autonomic nervous system and the
endocrine systems.
• The hypothalamus controls the endocrine
system by controlling the pituitary gland.
– Secretes releasing hormones to cause the
pituitary to release hormones
– Secretes inhibiting hormones to turn off
secretion of pituitary hormones

19
 The Pituitary Gland
• This is located in the sella tursica (totally encased
in bone), which gives you a clue as to how
important this gland is.
• The adenohypophysis portion of the pituitary
gland (anterior lobe) actually develops from an
embryonic pouch that grows upward from the
ectoderm of the pharynx!
• One type of diabetes (insipidus) can be caused by
trauma to the pituitary gland.
• A tumor of the pituitary gland can lead to
blindness because it is so close to the optic
chiasma.

20
 The Pituitary Gland
• Secretes nine major hormones
• Attached to the hypothalamus by the
infundibulum (stalk)
• Two basic divisions of the pituitary
gland
– Adenohypophysis (anterior lobe)
– Neurohypophysis (posterior lobe)

21
 Thalamus

Hypothalamus

Optic
chiasm
Infundibulum

Pituitary
gland

22
 23
Figure 25.3a-c
 The Adenhypophysis
• Growth hormone (GH)
– Causes the body to grow
• Prolactin (PRL)
– Stimulates lactation (milk production) in
females
– Stimulated lacrimation (desire to cry)
– Decreased in adolescent males so it
decreases desire to cry
• Thyroid Stimulating Hormone (TSH)
– Causes the thyroid gland to release thyroid
hormone

24
 The Adenhypophysis
• Adrenocorticotropic hormone (ACTH)
– Acts on adrenal cortex to stimulate the release of
cortisol
– Helps people cope with stress
• Melanocyte-stimulating hormone (MSH)
– Darkens skin pigmentation
– Increases during pregnancy
– Also has effects on appetite and sexual arousal
• Follicle-stimulating hormone (FSH)
– Present in males and females, affects both
– Stimulates maturation of sex cells
• Luteinizing hormone (LH)
– Induces ovulation in females
– Induces testosterone in males

25
 Study Tip to remember the hormones
secreted by the anterior pituitary gland
• “Melons grow and produce through late fall” stands for the
hormones made in the anterior pituitary.

• Melanocyte stimulating hormone (MSH)

• Growth Hormone (GH)
• Adrenal corticotropic Hormone (ACTH)
• Prolactin (PRL)
• Thyroid stimulating hormone (TSH)
• Luteinizing Hormone (LH)
• Follicle stimulating Hormone (FSH)

26
 The Neurohypophysis
• This is a continuation of the brain; cell
bodies of special neurons in the
hypothalamus have axons which go to
the neurohypophysis and synapse on
capillaries there. Instead of releasing
neurotransmitter, they release
hormones.
• Oxytocin
– Childbirth contractions
• Antidiuretic hormone (ADH)
– Signals kidneys to increase water
reabsorption
27
Figure 25.6
 The Neurohypophysis
The
neurohypophysis
is a continuation
of the brain

28
Figure 25.6
 HYPOTHALAMUS
• Some people say the pituitary gland
is the master gland because it
controls the many other endocrine
glands, but the hypothalamus
controls the anterior pituitary gland,
so really, maybe the hypothalamus is
the Master Gland.

29
 Pineal Thalamus
gland

Hypothalamus

Optic
Pituitary chiasm
Infundibulum
gland
30
 Hypothalamus Regulation
• The hypothalamus produces hormones
which affect the anterior pituitary, for
example:
• Thyroid Stimulating Hormone Releasing Hormone
(TSH-RH)
– Causes adenohypophysis to secrete TSH
– TSH affects thyroid gland to secrete TH
• Thyroid Stimulating Hormone Inhibiting Hormone
(TSH-IH)
– Causes adenohypophysis to stop secreting TSH
so thyroid gland stops secreting thyroid
hormone
• The hypothalamus affects the adenohypophysis,
31
and that’s about it.
Some Hypothalamus Hormones
• Growth Hormone Releasing Hormone (GH-RH)
• Prolactin Releasing Hormone (PRL-RH)
• Thyroid Stimulating Hormone Releasing
Hormone (TSH-RH)
• Adrenocorticotropic Hormone Releasing
Hormone (ACTH-RH)
• Melanocyte Stimulating Hormone Releasing
Hormone (MSH-RH)
• Follicle Stimulating Hormone Releasing
Hormone (FSH-RH)
• Luteinizing Hormone Releasing Hormone (LH-
RH)
32
More Hypothalamus Hormones
• Growth Hormone Inhibiting Hormone (GH-IH)
• Prolactin Inhibiting Hormone (PRL-IH)
• Thyroid Stimulating Hormone Inhibiting
Hormone (TSH-IH)
• Adrenocorticotropic Hormone Inhibiting
Hormone (ACTH-IH)
• Melanocyte Stimulating Hormone Inhibiting
Hormone (MSH-IH)
• Follicle Stimulating Hormone Inhibiting
Hormone (FSH-IH)
• Luteinizing Hormone Inhibiting Hormone
(LH-IH)
33
 Pituitary Disorders
• Diabetes insipidus
– Not enough ADH (anti-diuretic hormone; a
diuretic takes out excess fluid from the body)
– Because they lack ADH, the person urinates
frequently (polyuria), so they are thirsty and
drink a lot of water (polydipsia). Their blood
glucose is normal.

34
 Pituitary Disorders
• Hypersecretion of GH in children
• Gigantism (overall growth)
• Hypersecretion of GH in adults
– Acromegaly: enlarged hands and feet
• Hyposecretion of GH
– Pituitary dwarfism
– Proportions are normal, overall size is small

35
 GROWTH HORMONE
• GH needs for thyroid hormone (TH) to be
present. GH stimulates all cells to increase
protein synthesis, fat utilization, and
gluconeogenesis.
• Gigantism is the result of excess GH during pre-
puberty and acromegaly is the result of excess
GH after growth plates closed.
• The genetic determination of a person’s height
has multiple genes involved, so parents might be
tall and have smaller children. There are no rules
to predict it. A child may also be small due to a
defect in the placenta, blocking nutrients during
development. 36
 Gigantism
Robert Wadlow 8’11” Sandy Allen 7’7”

37
Acromegaly

38
Acromegaly

39
Pituitary Dwarfism

40
 The Thyroid Gland
• Located in the anterior neck, inferior
to thyroid cartilage
• Largest pure endocrine gland
• Produces two hormones
– Thyroid hormone (TH)
– Calcitonin

41
The Thyroid Gland

42
Figure 25.7a
 The Thyroid Gland
• Thyroid hormone (TH)
– Acts on most cells of the body
– Increases metabolic rate
– Controlled by hormonal mechanism
– Iodine is needed to make TH
• Calcitonin
– Lowers blood calcium levels in children
– Slows osteoclasts to allow for bone deposition
(Vitamin D is synthesized and secreted by the
dermis)

43
 Thyroid Gland
• The functional unit of the thyroid gland is
the thyroid follicle. The cells making up the
perimeter of the follicle are called follicular
cells. They make and secrete the light purple
liquid within the follicle, called colloid. Colloid is
water, filled with a lot of protein called
thyroglobulin, which is made by the follicular
cells. Since thyroglobulin is a protein, there is a
gene that codes for it, so there can be genetic
mutations that affect its production.
• TSH is what stimulates the follicular cells to
make thyroglobulin. TSH also increases the
size of the follicular cells to accommodate all this
protein. 44
Thyroid Follicle with Thyroid Hormone

45
Figure 25.7c
Thyroid Gland

46
 Thyroglobin
• When thyroglobulin is made, it is
exocytosed from the follicular cell and
stored outside of the cell, in the follicle. As
it moves across the cell membrane, a
peroxidase enzyme attaches iodine to
the tyrosine (amino acid) portion of the
thyroglobulin. This process is iodination.
• After TSH stimulation, the follicular cells
drink it back into the cell, and another
enzyme comes along and chops up the
long thyroglobulin protein into smaller
pieces, each with some iodine on them. 47
 Thyroglobin
• If a segment has two iodines, it is
called T2. If there are 3 iodines
attached, it is called T3
(Triiodothyronine). If it has 4
iodines it is T4 (thyroxine). The T3
and T4 are then released into the
bloodstream. Those thyroglobulin
segments that have only 1-2 iodines
are recycled for parts and are not
released. 48
 Thyroglobin
• T4 is the most abundant form, but it is inert
(inactive). T3 has robust activity in the cell.
So, T3 gets used first by the body cells. T4 takes
longer to be ready; one iodine has to drop off. As
T3 is used up, T4 is being converted to more T3.

• To make thyroid hormone, you need iodine in

your body. Iodized salt has enough to meet this
need. Iodine is brought into the follicular cells,
gene expression occurs, thyroglobulin is made.
Without enough iodine in the diet, thyroid
hormone cannot be made, no matter how much
TSH is present.
49
 Thyroid Gland

• Thyroid follicles- hollow

structures surrounded by
follicular and parafollicular
cells
• Follicular cells produce
Thyroglobulin (TG)
• Building block of TH,
chemically attaching I- to
tyrosine.
• In plasma, TH needs a
“carrier molecule” or it will be
cleared from body
Tyrosine: a bulky amino acid
containing a large benzyl ring.

50
 Thyroid Hormone Synthesis & Secretion
• Link two tyrosine
aa’s together and
add iodine

• Thyroid hormone
(TH) controls
metabolic rate and
protein synthesis
– Thyroxine – T4 :
(93%)
– T3:
triiodothyronine
(7%); 4x as
potent
• Active form

Figure 76-3 Chemistry of thyroxine and triiodothyronine formation. 51

 TS Ratio
• The TS ratio is the amount of iodine
in thyroid /iodine in serum.
• There are 30x more iodine ions in
the thyroid gland than in the plasma.
• ATP is used to bring iodine into cells
against its electrical gradient.

52
 PTU
• People with hyperthyroidism can
take a drug called PTU
(Propylthiouracil), which inhibits TH
production by blocking the
peroxidase enzyme that joins the
iodine to the tyrosine. It results in
lower thyroid hormone levels.

53
•TG is booted out of the cell (exocytosis) and stored inside the hollow chamber
of the follicle. “Colloid”
•When follicular cells receive signal to secrete (from TSH made in the pituitary),
they take up TG (endocytosis), cleave off the TH from TG, and secrete it into
blood (exocytosis.)
PTU is an anti-
thyroid drug
which blocks
the peroxidase
process.

54
Figure 76-2; Guyton & Hall
What are the
“actions” of
TH?
Increases GI motility
Increases mental activity
Increases endocrine activity
Promotes growth and brain
development in the fetus
and young children
Stimulates fat metabolism
Excites CNS
Causes sleep difficulty

55
 Thyroid Hormone Effects
• All cells respond to thyroid hormone,
increasing their metabolic rate (heart
speeds up, beats with greater force, more
nutrients are used, etc).
• Too much thyroid hormone is
hyperthyroidism; these people are thin
and active.
• When levels of TH are too low, it is called
hypothyroidism; these people are
overweight, move slowly, have no energy.
56
Effects of Thyroid Hormone
• TH also stimulates neurons; the person
feels more alert, observing their
environment with more interest. When
there is too much TH, they get muscles
tremors and increased blood glucose
levels (hyperglycemia).
• With not enough TH, they lose interest,
become sluggish, they get low blood
glucose levels (hypoglycemia).

57
 Thyroid Hormone
• The major stimulus for the release of thyroid
hormone is hormonal (TSH from the pituitary
tells the thyroid gland that it needs to make more
thyroid hormone).
• What happens when TSH is released? Every step
in the process of making TH is increased:
Follicular cells become larger, metabolism
increases: increase in O2 use (especially in
mitochondria), heat is generated.
• TSH causes stimulation of sympathetic (beta)
receptors in the heart, causing increased force of
contraction and increased heart rate.

58
 Thyroid Hormone
• Thyroid hormone is partly made of iodine.
Iodine is essential for the formation of
thyroxin (T3). If a person doesn’t eat
enough iodine, they can’t make thyroid
hormone.
• The hypothalamus responds by putting
out more TSH-RH.
• The pituitary will respond by releasing
TSH.
• But the thyroid can’t respond by releasing
TH if it does not have the iodine to make
the hormone, so it the size of the follicle
grows  gland grows  GOITER. 59
 GOITER
• This is usually caused by too little
iodine in diet.
• That’s why salt is iodized.
• Iodine is only found in seafood, so if
salt wasn’t iodized, a lot of people
wouldn’t get enough iodine, and
there would be a lot of goiters.
• There are more problems with the
thyroid gland than any other organ.
60
Goiter

All you need is a

pinch per day of
salt. If you can’t
have salt, you can
take iodine drops. 61
 Role of Hypothalamus
• The hypothalamus is like the boss of a company;
the pituitary gland is like the boss’ manager, and
the thyroid gland is the worker.
• The boss tells the manager to tell the worker to
write more papers.
• The manager tells the worker to write more
papers.
• The worker writes more papers. The papers then
go out to every cell in the body. Some of the
papers land on the desk of the boss. When his
desk is covered with papers, he tells the manager
to stop the orders for more papers. If not enough
papers are on his desk, he tells the manager to
62
keep sending out the order for more papers.
This is what happens in the body:
• Hypothalamus (the boss) makes
TSH-RH (thyroid stimulating
hormone releasing hormone)
• Pituitary (the manager) makes
TSH (thyroid stimulating hormone)
• Thyroid gland (the worker)
makes TH (thyroid hormone)

63
Hypothalamus

TSH-RH

Pituitary
TSH

Thyroid

TH
64
 Thyroid Hormone
• The hypothalamus releases its hormone (TSH-
RH) to the pituitary, telling the pituitary to
release its hormone (TSH), which tells the thyroid
gland to release thyroid hormone (TH).
• When thyroid hormone is released, it will
circulate throughout the body, causing an
increase in metabolism in all of those cells. Some
of the TH will bind to receptors in the
hypothalamus, and then the hypothalamus knows
there is enough TH, and it will stop releasing
TSH-RH. Until the receptors in the hypothalamus
are bound with the resulting thyroid hormone,
the hypothalamus is not satisfied that there is
enough thyroid hormone present. 65
 What if the hypothalamus released its signal and
the thyroid released too much hormone?

• The hypothalamus will stop secreting

its releasing hormone. This is a
negative feedback signal.
• When very few TH receptors are
bound on the hypothalamus, it will
keep releasing its hormone. When its
thyroid receptors are saturated, will
stop. This is still a hormonal
mechanism of release, not humoral.
66
 Positive and Negative
Feedback
• The presence of thyroid hormone is what will stop the
hypothalamus from wanting more.
• This is negative feedback, which is what most hormones
have.
• The one hormone that uses positive feedback is
luteinizing hormone (LH) in females.
• When LH is released, it stimulates the release of more LH,
and more LH, until it reaches a maximum level, then
negative feedback kicks in. LH is the hormone that causes
fluid to rush into the follicle surrounding a woman’s egg,
and when enough fluid rushes in, the follicle pops like a
balloon, releasing the egg during her monthly ovulation.

67
 What if a gland disobeys the negative
feedback?
• Example: Thyroid gland is impaired by a tumor.
• A thyroid tumor might cause it to over-secrete or under-
secrete TH.
• Let’s start with an under-secreting thyroid tumor:
what happens to the other hormone levels?

Evaluate the hormone levels of

each of the three glands in order
of the arrows, starting with the
1
problem area (in this case, the
thyroid is the place with the
tumor).

2 The order of evaluation would

then be 3, 1, 2

3
68
 Under-secreting thyroid tumor

Hypothalamus TSH-RH will be high, since

only a few hypothalamus
TSH-RH receptors are bound

TSH levels will be high.

Pituitary
TSH

TH will be low
Thyroid (hypothyroidism)

TH
69
• Now let’s evaluate an over-secreting thyroid tumor:
what happens to the other hormone levels?

Evaluate the hormone levels of

each of the three glands in order
of the arrows, starting with the
1
problem area (in this case, the
thyroid is the place with the
tumor).

2 The order of evaluation would still

be 3, 1, 2

3
70
This combination Over-secreting thyroid tumor
tells you the source
of the problem is the
thyroid.
Hypothalamus TSH-RH will be low

TSH-RH

Pituitary TSH levels will be low.

TSH

TH will be high
Thyroid (hyperthyroidism)

TH
71
• Now let’s evaluate an Under-secreting pituitary
tumor: what happens to the other hormone levels?

Evaluate the hormone levels of

each of the three glands in order
of the arrows, starting with the
1
problem area (in this case, the
pituitary gland is the place with
the tumor).

2 The order of evaluation would

now be 2, 3, 1

3
72
 Under-secreting pituitary tumor

Hypothalamus
TSH-RH is high
TSH-RH

NOTE: If the
problem is the TSH, Pituitary TSH is low
we don’t bother TSH
injecting TSH, we
just give the
hormone that is
lacking: Thyroid
hormone.

Thyroid TH is low (hypothyroidism)

TH
73
• Now let’s evaluate an over-secreting pituitary tumor:
what happens to the other hormone levels?

The order of evaluation would still

be 2, 3, 1
1

3
74
 Over-secreting pituitary tumor

Hypothalamus
TSH-RH is low

TSH-RH

TSH is high
Pituitary
TSH

TH is high
Thyroid (hyperthyroidism)

TH
75
• Now let’s evaluate an under-secreting hypothalamic
tumor: what happens to the other hormone levels?

The order of evaluation would

now be 1, 2, 3
1

3
76
 Under-secreting
hypothalamic tumor

Hypothalamus
TSH-RH is low
TSH-RH

Pituitary TSH is low

TSH

TH is low (hypothyroidism)
Thyroid

TH
77
• Now let’s evaluate an over-secreting hypothalamic
tumor: what happens to the other hormone levels?

The order of evaluation would still

be 1, 2, 3
1

3
78
 Over-secreting
hypothalamic tumor

Hypothalamus
TSH-RH is high
TSH-RH

TSH is high
Pituitary
TSH

TH is high
Thyroid (hyperthyroidism)

TH
79
 Other Hormone Cycles
• The adrenal cortex has the same
cycle as thyroid hormone;
• The hypothalamus secretes ACTH-RH
(adrenocorticotropic releasing
hormone)
• The pituitary secretes ACTH
• The adrenal cortex secretes CH
(cortisol hormone).

80
Hypothalamus

ACTH-RH

Pituitary
ACTH

Adrenal Cortex

Cortisol
81
 Problems with Thyroid
• Goiter
– Too little iodine in the diet
• Hyperthyroidism
– Graves’ Disease is when hyperthyroidism
is caused by an autoimmune disorder.
– Leads to nervousness, weight loss,
sweating, and rapid heart rate.
• Hypothyroidism
– Decreases metabolism, causes obesity
82
 HYPERTHYROIDISM
(Most commonly caused by Graves Disease,
which is an autoimmune disease)
• Signs include thinness, eyes that stick
out like a bug (exophthalmoses).

83
 There are two ways to treat
Hyperthyroidism
• You can have the thyroid oblated (killed off) by drinking
radioactive iodine; it kills just thyroid tissue. As metabolic
rate slows, gains weight again. They can’t be around people
for 5 days, and they set off Geiger counters for months
afterwards. Then start on artificial thyroxin, need to figure
out what their set point is for normal.

• The other way (not so good) is to have the thyroid gland

surgically removed. However, the parathyroid glands are
often damaged or removed during this surgery. They often
intentionally leave some thyroid tissue behind, in hopes of
leaving enough parathyroid glands there. If too many of the
parathyroid glands are removed, calcium levels go down,
can go into cardiac arrest. Now the patient has to have two
hormones replaced.
84
 Hypothyroidism
This can be caused by
• Hashimoto’s thyroiditis (autoimmune)
• Iodine deficiency
• Tumor
• Defective enzyme in thyroid.

85
 Hypothyroidism
•– Hashimoto’s Thyroiditis - adult hypothyroidism
– Antibodies attack and destroy thyroid tissue
– Low metabolic rate and weight gain are
common symptoms
– Myxedema: non-pitting edema associated with
hypothyroidism
• Cretinism – hypothyroidism in children
– Short, disproportionate body, thick tongue and
mental retardation

86
 Hypothyroidism
Before and After Treatment

87
88
Cretinism (diminished mental ability)
• This term describes babies whose
MOTHER had the lack of iodine.
• Baby now cannot get iodine, and the
baby will have reduced growth and
intellectual ability.
• Once it is born and gets a healthy
diet, it still won’t go back to normal
because TH is necessary for proper
myelination and synaptic formation.
89
 Congenital Hypothyroidism
• Congenital hypothyroidism is the term for a
baby whose thyroid gland is not working correctly
(not secreting enough TH). The problem is only
with baby, not with the mom.
• Congenital hypothyroidism and cretin babies
have similar symptoms. Child will stay tiny
because GH does not work without TH.

• Know the difference between cretinism and

congenital hypothyroidism.

90
Cretinism

91
• Patients with Hashimoto’s
hypothyroidism often are deficient in
vitamin D.
• http://drclark.typepad.com/dr_david_clark/2012/07/hashimotos-
autoimmune-thyroiditis-and-vitamin-d-deficiency.html

92
 Diagnosing the etiology
(cause) of
hypo/hyperthyroidism

• Methods of measuring
plasma concentration of
hormones:
– RIA (radioimmunoassay)
– ELISA (enzyme-linked
immunosorbent assay)
• Sample a small amount of
patient’s blood; sent to lab
• Concentration is determined,
recorded as Pico molar
concentration

93
 RIA
• In a dish are antibodies against a hormone we want to
measure. Before adding blood, add the hormone with a
radioactive tag that can be recognized by those antibodies.
It forms a complex; wash away the unreacted hormone.
Then measure the radioactivity that is given off, this is the
saturation point (the starting point).
• Now add the patient’s blood sample. If it has a lot of the
hormone that is already attached, it will compete to push
off the radioactive hormone, and the radioactive signal will
drop proportionally. If the patient does not have much
hormone, there is not much decrease in radioactivity. This
is an inverse relationship. The RIA test is expensive and
dangerous, so ELISA is preferred.

94
 ELISA
• Pregnancy test is an example of an ELISA test.
• On the strip are antibodies. If pregnant, a hormone binds to the
receptor. When the strip gets wet, a second set of antibodies
move over the pregnancy hormone. The substrate, when cleaved,
precipitates out of solution; it gives you a color, and a new line
appears, turning the negative into a plus sign. If no hormone is
present, there is no second set of antibodies, the enzyme is not
cleaved, no color change.
• Is she a little or a lot pregnant? Well, there is no in-between, so is
this test not considered quantitative? Actually, it can be
quantitative: Suppose she had sex only a few hours ago. The test
would be negative, since it takes 7 days for zygote to implant into
uterus, which is when hormone levels are high enough for
detection. If she is 6 months pregnant, the response time is
faster. Since the response time is faster in the presence of higher
hormone levels, we can quantify the pregnancy also. The parasite
chomping into uterine artery can cause bleeding, seems like a
period. She may be shocked to find out she’s pregnant.
95
Parathyroid
Glands

• Four glands
imbedded on the
posterior surface
of the thyroid
gland

96
Figure 25.8a
 Parathyroid Glands
• Parathyroid hormone (PTH)
• Increases blood concentration of Ca2+
• There are three ways that the parathyroid gland raises blood
calcium levels
1) Stimulates osteoclasts to move bone calcium from the
skeleton to the bloodstream
2) Stimulates the kidneys to stop excreting calcium
3) Stimulates the intestines to absorb more calcium from diet
• Activates vitamin D which increases calcium uptake by
intestines

97
 PARATHYROID GLANDS
• The antagonist of parathyroid hormone is
calcitonin, which is produced in the thyroid
gland, and stimulates osteoblasts to take calcium
from the blood and deposit it in bone.
• Parathyroid hormone is released by a humeral
mechanism.
• If blood calcium levels are low, parathyroid
hormone is released.
• If blood calcium levels are high, parathyroid
hormone stops being released.

98
 THYMUS GLAND
• Hormones produced by this organ
stimulate the production of T cells (a
type of white blood cell).
• This gland is mostly active in children
under the age of three.

99
 The Adrenal Glands
• Located on the superior surface of
the kidneys
• Two endocrine glands in one
– Adrenal medulla – a knot of nervous
tissue within the gland. Secretes
catecholamines.
– Adrenal cortex – bulk of the adrenal
gland. Secretes most of the steroid
hormones.
100
 Adrenal glands
MECHANISM OF RELEASE
• Both adrenal glands together weigh only one
gram!
• They use neuronal, hormonal, and humoral
mechanisms.
• The adrenal medulla uses a neuronal
mechanism, since it is an extension of the
nervous system. If the cells there are detached,
they will differentiate into a neuron!
• The adrenal cortex uses a hormonal
mechanism, except aldosterone uses a
humoral mechanism.

101
The Adrenal Gland

102
Figure 25.9a
 The Adrenal Glands
• Located on the superior surface of the kidneys
• Two endocrine glands in one (different embryological
origin)

– ADRENAL MEDULLA – a knot of sympathetic

nervous tissue
• Secretes catecholamines (mostly epinephrine)
– Active in “fight, flight, and fright” response

– ADRENAL CORTEX – bulk of the adrenal gland

• Secretes aldosterone (salt and water balance for
blood pressure)
• Secretes androgens and estrogens (sex
hormones)
• Secretes cortisol (anti-stress and anti-inflammation
hormone)

103
 The Adrenal Medulla
• Secretes catecholamines such as
epinephrine and norepinephrine:
ADRENALIN (AKA epinephrine “above the
kidney”; Greek).
This is the neurotransmitter for the sympathetic
nervous system.
The adrenal medulla also has sympathetic
neurons which synapse on it, so when you are
spooked, the neurons fire and stimulates the
adrenal medulla to release more epinephrine
to increase the effects of the sympathetic
nervous system. 104
 Adrenal Medulla
• The adrenal medulla releases catecholamines (epinephrine and
norepinephrine).
• These catecholamines are released when the sympathetic nervous system
is activated (“fight or flight”).
• When you run from a predator, is that when you want insulin to take
glucose from blood? No, you want to keep it there so the brain can get the
glucose. The brain needs to think of a way to escape, and thinking burns
glucose.

• Therefore, epinephrine is antagonistic to

insulin
• Cells that don’t get the glucose during fight or flight break down fatty
acids to get their ATP. These fatty acids will be taken to the liver for
gluconeogenesis to elevate the depleted blood glucose levels. Glycogen
will also be broken down to glucose to elevate the depleted blood glucose
levels.
• Epinephrine has the same effect as the sympathetic nervous system:
– Heart rate and force increases.
– Digestion slows
– respiratory passages open (bronchiole dilation)
105
– BP goes up (from vasoconstriction in less-needed organs).
 Adrenal Cortex layers
• The bulk of the adrenal gland
is the adrenal cortex. It has
layers, from superficial to
deep: “GFR”
• G = Zona glomerulosa:
makes aldosterone
• F = Zona fasciculate
• R = Zona reticularis
– The zona fasciculate and
zona reticularis both make
sex hormones and cortisol
• (Don’t confuse this mnemonic
with “GFR” in the kidney,
which stands for glomerular
filtration rate)

106
 Adrenal Cortex
• Secretes a variety of hormones- all are steroids
(steroids are made from cholesterol) and are grouped
into three main categories:
– Glucocorticoids
• Cortisol – secreted in response to ACTH from the
pituitary gland. Cortisol stimulates fat and protein
catabolism to use for gluconeogenesis.
– Mineralocorticoids
• Aldosterone -Sodium/water reabsorbed
– Androgens and Estrogens
• Male sex hormones (Androgens)
• Female sex hormones (estrogen)

107
 The Adrenal Cortex
• CORTISOL helps the body deal with stressful situations
like fasting, anxiety, trauma, and infection. It keeps the
blood protein and glucose levels high enough to support
the brain’s activities and affects the metabolic rate. When
the brain perceives a stressful situation, the
hypothalamus tells the pituitary to secrete ACTH, which
travels to the adrenal gland and signals it to release
cortisol to most of the cells of the body. It is also known
as hydrocortisone, which decreases inflammation.
• ALDOSTERONE increases blood volume during
hemorrhage or drop in blood pressure. It causes kidney
to reabsorb more sodium; water follows with it, so the
blood volume increases.
• SEX HORMONES for the opposite sex: Males produce
estrogen here, and females produce testosterone.
108
 Cortisol: Hormonal
Hypothalamus
Mechanism
ACTH-RH
• ACTH-RH is released by the
hypothalamus.
• ACTH is released by pituitary.
• Cortisol (also called corticotropic
hormone or CT).
• Cortisol affects almost all cells in
body.
Pituitary
ACTH
• Note: When ACTH plus cholesterol
is present, you can take cortisol
and turn it into aldosterone if you
need to.
– It does not do this unless the
blood pressure is too low,
because aldosterone is under
a humeral mechanism
Adrenal Cortex (turned on by high blood
levels of potassium or A2).
Cortisol
109
 Glucocorticoids (cortisol)
• Glucocorticoids (GC) are a class of steroid hormones that
bind to the glucocorticoid receptor (GR), which is present in
almost every cell in the body.
• The name glucocorticoid (glucose + cortex + steroid)
derives from their role in the raising glucose levels, their
synthesis in the adrenal cortex, and their steroidal
structure. They suppress the immune system (they are
anti-inflammatory).
• Cortisol (also known as hydrocortisone) is one of the most
important glucocorticoids.
• Others are prednisone, prednisolone, dexamethasone, and
triamcinolone, which are also commonly used medicines for
anti-inflammation.

110
 Effects of Increased
Glucocorticoids
• Cortisol is called an anti-stress hormone because it does
several things:
• Stimulates protein and fat catabolism (breakdown)
– The breakdown products are then taken to the liver for
gluconeogenesis in the liver
• Inhibits glucose uptake by the body but not the brain
• It elevates blood glucose (diabetogenic effect)
• It suppresses the immune response
– That means it is an anti-inflammatory agent
• It is prescribed as a medicine to suppress inflammation and
the immune system.

111
 Cortisol
• Cortisol (also known as corticosterol and also known
as hydrocortisone)
• The hypothalamus releases ACTH-RH, pituitary releases
ACTH, adrenal gland releases cortisol. The adrenal gland
also can release androgens, estrogens, and aldosterone. All
of those might be released if there is excess ACTH.
• When there is an intense need to make cortisol in
response to stress, and if the body cannot keep up
with the demand for cortisol, excess ACTH might be
shunted into the androgen/estrogen production
pathway, so that androgens/estrogens are secreted
instead of cortisol.
• Excess androgens do not affect males, but females
might develop more masculine features.
• Excess estrogens do not affect females, but males
might develop more feminine features.
112
• What is “stress” that causes cortisol production? Stress can
be emotional or physical. Examples of physical stress can
range from fighting an infection to having a minor injury
that needs to remodel tissue.
• Cortisol tells tissues to stop using glucose (except brain),
and to break down fatty acids instead, in order to get their
energy.
• Cortisol also tells the skeletal muscle to start breaking
down, and to release the free amino acids into
bloodstream.
• The liver takes in these free amino acids and fatty acids
and converts them into new glucose molecules that you did
not acquire from your food. Since these are new glucose
molecules being formed, this process is called
gluconeogenesis (“generation of new glucose”).
• The new glucose molecules are released back into the blood
(blood glucose levels rise) so the other tissues can have
some energy. 113
 Prednisone
• If a person has a lot of cortisol or prednisone in
their body, blood sugar levels rise too much, and
sugar spills out in the urine. They have
symptoms of diabetes, although that is not their
disease. You have some cortisol in you now to
help maintain normally elevated blood
glucose levels between meals.
• In high doses only, exogenous (medicinal)
prednisone may be given for asthma
because it suppresses smooth muscle from
constricting, and bronchioles cannot close up.
What would you predict their endogenous
(naturally made by the body) prednisone
hormone levels to be, without the inhaler? Low
114
 Prednisone
• Prednisone makes you hungry. You also
have a hard time sleeping because brain is
stimulated. If you abruptly stop taking
prednisone, the person gets the same
symptoms as Addison’s disease (low cortisol
levels). Their BP drops, blood glucose drops,
can go to hospital. A person on high dose
for 4 or more weeks must be tapered off.
• There are two ways to use prednisone: high
dose, short duration (okay to stop abruptly)
• Lower dose, longer duration (need to wean
off). 115
 Genetic Influence
• The gene code you got from parents is
different from theirs, but not a lot. But the
expression of your genes can be very
different because of how they lived their
life.
• How much activity, smoking, and weight
gain has gone on before puberty will
damage stem cells, and can silence or
activate a gene.
• The children of these people can have
genetic differences because of this. 116
 Physical Abuse causes loss
of adaptability to stress
• Children exposed to severe physical abuse
are more likely to commit suicide later;
their DNA is methylated, causing a
reduced number of glucocorticoid
receptors.
• They cannot bind cortisol, cannot deal
with stress like other people.
• If you don’t eat too much, or smoke or
drink, your children and grandchildren will
live 30 years longer, and live healthier
lives. 117
 Aldosterone
Aldosterone (a mineralocorticoid) targets
the cells of kidney, increases the amount of
salt and water that is reabsorbed.
• It elevates blood pressure.
• The Z. Glomerulosa makes aldosterone. It
has a humeral release mechanism. A
few things trigger it, especially high
potassium plasma levels and A2. That
signals the kidneys to reabsorb sodium,
and water comes with it and that
increases blood volume. How does this
118
happen?
 How Low BP is Raised
• When baroreceptors detect low blood pressure,
the kidney releases an enzyme called renin,
which cuts Angiotensinogen into angiotensin-1
(A1), which travels through blood to the
pulmonary capillary bed, where cells have
angiotensin converting enzyme (ACE) that cuts
A1 into A2 (the active form).
– Any word that ends in –ogen means it is a longer,
inactive protein, called a zymogen.
– To become activated, they need to be cut by an enzyme
into a smaller segment.
• These high levels of A2 stimulates the adrenal
cortex to make more aldosterone, and also
stimulates the pituitary gland to release ADH.
119
• This will raise the blood pressure.
Prednisone,
cortisone, cortisol,
and aldosterone
are all similar in
structure. One
can be used to
make the others.

If ACTH is demanding
more cortisol, but the
body cannot make
enough, it may start
making
androgens/estrogens
instead.
120
 Sex (Male and Female)
Hormones
• Male and Female sex hormones are
present in both males and females; the
pituitary gland affects these hormones in
both sexes.
• Male sex hormones (androgens, such as
testosterone) are made in the testes of
males, and made in the adrenal gland of
females.
• Female sex hormones are made in the
ovary of females and in the adrenal gland
of males. 121
 Androgens
• Androgens are called male sex hormones because they
cause male secondary sexual characteristics to develop,
such as facial hair and low voice.
• The main steroid secreted by the adrenal gland that makes
sex hormones is called DHEA.
• DHEA can be converted into testosterone or estrogen.
• A large amount of testosterone is made in the testes in
males.
• A small amount of testosterone is made in adrenal cortex in
males and females.
• If the adrenal cortex hyper-secretes testosterone and other
androgens, it won’t impact a male, because the testes
make more than that already.
• However, in females, hypersecretion causes masculinization
(such as facial hair and low voice). 122
 Estrogen
• Estrogens are one of the female sex hormones because
they cause female secondary sexual characteristics to
develop, such as breasts.
• A large amount of estrogen is made in the ovaries in
females.
• A small amount of estrogen is made in adrenal cortex in
males and females.
• The androgen, DHEA, can be converted into estrogen.
• If the adrenal cortex hypersecretes estrogen, it won’t
impact a female’s sex characteristics, because the ovaries
make more than that already.
• However, in males, hypersecretion causes feminization
(such as breast development).

123
 Hypothalamus

ACTH-RH

Pituitary Gland

ACTH

Adrenal Cortex

Cortisol

124
Hypothalamus

ACTH-RH

Pituitary
ACTH

Adrenal Cortex

Cortisol
125
 What if a gland disobeys the negative
feedback?
• Example: Adrenal gland is impaired by a tumor.
• An adrenal gland tumor might cause it to over-secrete or
under-secrete cortisol.
• Let’s start with a cortisol under-secreting adrenal
gland tumor: what happens to the other hormone levels?

Evaluate the hormone levels of

each of the three glands in order
of the arrows, starting with the
1
problem area (in this case, the
adrenal gland is the place with
the tumor).

2 The order of evaluation would

then be 3, 1, 2

3
126
 Cortisol Under-secreting
adrenal gland tumor

Hypothalamus ACTH-RH will be high

ACTH-RH

ACTH levels will be high.

Pituitary
ACTH

Cortisol will be low

Adrenal Gland (hypoadrenalism)

Cortisol
127
• Now let’s evaluate a cortisol over-secreting adrenal
tumor: what happens to the other hormone levels?

Evaluate the hormone levels of

each of the three glands in order
of the arrows, starting with the
1
problem area (in this case, the
adrenal gland is the place with
the tumor).

2 The order of evaluation would still

be 3, 1, 2

3
128
This combination Over-secreting adrenal tumor
tells you the source
of the problem is the
adrenal gland
Hypothalamus ACTH-RH will be low

ACTH-RH

Pituitary ACTH levels will be low.

ACTH

Cortisol will be high

Adrenal Gland (hyperadrenalism)

Cortisol
129
• Now let’s evaluate an ACTH Under-secreting pituitary
tumor: what happens to the other hormone levels?

Evaluate the hormone levels of

each of the three glands in order
of the arrows, starting with the
1
problem area (in this case, the
pituitary gland is the place with
the tumor).

2 The order of evaluation would

now be 2, 3, 1

3
130
 ACTH Under-secreting
pituitary tumor

Hypothalamus
ACTH-RH is high
ACTH-RH

Pituitary ACTH is low

ACTH

Adrenal Gland Cortisol is low

Cortisol
131
• Now let’s evaluate an ACTH over-secreting pituitary
tumor: what happens to the other hormone levels?

The order of evaluation would still

be 2, 3, 1
1

3
132
 ACTH Over-secreting
pituitary tumor

Hypothalamus
ACTH-RH is low

ACTH-RH

ACTH is high
Pituitary
ACTH

Cortisol is high
Adrenal Gland

Cortisol
133
• Now let’s evaluate an ACTH-RH under-secreting
hypothalamic tumor: what happens to the other hormone
levels?

The order of evaluation would

now be 1, 2, 3
1

3
134
 Under-secreting
hypothalamic tumor

Hypothalamus
ACTH-RH is low
ACTH-RH

Pituitary ACTH is low

ACTH

Cortisol is low
Adrenal Gland

Cortisol
135
• Now let’s evaluate an over-secreting hypothalamic
tumor: what happens to the other hormone levels?

The order of evaluation would still

be 1, 2, 3
1

3
136
 Over-secreting
hypothalamic tumor

Hypothalamus
ACTH-RH is high
ACTH-RH

ACTH is high
Pituitary
ACTH

Cortisol is high
Adrenal Gland

Cortisol
137
 Adrenal Gland
• The adrenal cortex also makes
aldosterone and sex hormones.

138
 Hypothalamus

ACTH-RH The Adrenal Cortex

makes two other
types of hormones

Pituitary
ACTH

Adrenal Gland

Testosterone Cortisol Aldosterone

in females, (Raises (raises blood
Estrogen in blood pressure)
males glucose)

139
 Hypothalamus

ACTH-RH So when ACTH is

elevated, and the body
cannot make enough
cortisol, aldosterone will
Pituitary increase, and
ACTH testosterone will be
made in females instead,
and estrogens will be
made in males.
Adrenal Gland
The person will have
high blood glucose and
high blood pressure, and
females develop facial
Testosterone Cortisol Aldosterone hair while males develop
in females, (Raises (raises blood breasts.
Estrogen in blood pressure)
males glucose)

140
 Adrenal Gland Disorders
• Cushing’s syndrome/Disease
– Hypersecretion of cortisol
– High blood glucose
– High blood pressure
– Round “moon” face and “buffalo hump”
• Addison’s disease
– Hyposecretion of cortisol
– Low blood glucose
– Low blood pressure results
– Also get hyperpigmentation 141
 CUSHING’S DISEASE
• Excess ACTH caused only by a pituitary
tumor. Patient has excess cortisol, high
blood pressure, high blood glucose,
and too much aldosterone is produced.
More salt and water is reabsorbed by the
kidney, so the blood volume increases. In
this disorder, the hypothalamus (ACTH-
RH) levels are low, the other hormone
levels (ACTH, cortisol, androgens, and
aldosterone) are high.
142
 ACTH Over-secreting
pituitary tumor

Hypothalamus
ACTH-RH is low

ACTH-RH

ACTH is high
CUSHING’S Pituitary
DISEASE
ACTH

Cortisol is high
Adrenal Gland (hyperadrenalism)

Cortisol
143
 CUSHING’S SYNDROME
(Andrenogenital Syndrome)
• Excess cortisol secretion, but not caused
by the pituitary gland. It could be caused
by primary hyperadrenalism (adrenal
gland is not working right), an adrenal
tumor, or even by a tumor in the lungs
that releases ACTH (called an ectopic
ACTH producing tumor).
• In Cushing’s Syndrome, all adrenal
cortical hormones (cortisol,
androgens, and aldosterone) are
elevated, but ACTH-RH and ACTH 144
levels are low.
 Over-secreting adrenal tumor

Hypothalamus ACTH-RH will be low

ACTH-RH

Pituitary ACTH levels will be low.

ACTH

Cortisol will be high

CUSHING’S (hyperadrenalism)
Adrenal Gland
SYNDROME
Cortisol
145
 Excessive Adrenal Hormones
Cushing’s Disease- pituitary tumor
(excess ACTH)

Cushing’s Syndrome
•Ectopic ACTH producing tumor
(lungs)
•Iatrogenic (side-effect of some
medical treatment)
•Primary hyperadrenalism
•Over-secreting adrenal tumor-, all
adrenocortical hormones elevated;
Andrenogenital syndrome
Signs/symptoms: buffalo hump, moon
face, muscle loss/weakness, thin skin with
striae, hyperglycemia, immune suppression

146
Symptoms of Cushing’s Disease and Cushing’s
Syndrome

•Fat deposition around waist (central obesity),

scapula (buffalo hump), and “moon” shaped
face. There is muscle loss and weakness (cortisol
tells muscles to break down), thin skin with striae,
(High levels of cortisol leads to destruction of
collagen, get thin and striae on skin),
hyperglycemia, immune suppression. Excessive
amounts of adrenal stimulation causes release of
male steroids, causing male secondary
characteristics, but only in females. Adult onset
disease in females causes masculinization,
including facial hair, thicker jaw and skull.
147
Cushing’s Syndrome

148
Cushing’s Syndrome

149
 Central Obesity
• The immediate cause of obesity is net energy imbalance—the organism consumes
more usable calories than it expends. The fundamental cause of obesity is a
combination of the organism's genes and environment. Obesity plays an important
role in the impairment of lipid and carbohydrate metabolism shown in high-fat diets.
It has also been shown that the quality protein intake in a 24-hour period is inversely
related to percent central abdominal fat. Quality protein uptake is defined as the ratio
of essential amino acids to daily dietary protein.
• The fat cells in the greater omentum will release their fatty acids and trigycerides
into the portal circulation, where the blood leads straight to the liver. Thus, the
excess of triglycerides and accumulate there. In the liver, most of it will be stored as
fat. This concept is known as 'lipotoxicity'. Hypercortisolism, such as in Cushing's
syndrome also leads to central obesity. Many prescription drugs, such as
dexamethasone and other steroids, can also have side effects resulting in central
obesity, especially in the presence of elevated insulin levels.
• The prevalence of abdominal obesity is increasing in western populations, due to a
combination of low physical activity and high-energy diets. Waist measurement is
and height and weight are used to determine a person’s health. BMI will illustrate the
best estimate of your total body fat, while waist measurement gives an estimate of
risk of obesity-related disease.

150
 Congenital adrenal
hyperplasia
• Congenital adrenal hyperplasia (CAH) in a
female fetus causes the clitoris to enlarge and
the labia major fuse into a scrotal sac. These
babies have a mutation in a gene, some enzyme
is not expressed which is required to convert
cholesterol into corticosteroids, so cholesterol is
shunted to the pathway that is not compromised:
androgen production. Boys are not affected; girls
need a surgery and cortisol for life, will be fine. If
the presence of ACTH is driving the pathway, and
it is blocked at this enzyme, the ACTH can only
be used to make androgens.
151
 CAH- Excessive and
•
Deficient?
Congenital Adrenal
Hyperplasia (CAH)
– Autosomal recessive
trait (congenital)
– Deficiency of any of the
five enzymes necessary
for cortisol production.
– Increased ACTH (leads
to adrenal hyperplasia)
MAP IT!
– Leads to overstimulation
of adrenal androgen
pathways.
– Males seldom diagnosed
at birth, females have
ambiguous genitalia http://www.dshs.state.tx.us/newborn/cah2.shtm
(enlarged clitoris, fused
labia, etc).
– With treatment,
surgery, sex
characteristics and
fertility is normal 152
 ADDISON’S DISEASE
• Also called Primary Adrenal Insufficiency and
hypoadrenalism; mainly see effects in the hands, fingers,
and gums.
• Addison’s disease may be caused by anything that disturbs
the production of adrenal hormones (for some reason,
Tuberculosis attacks the adrenal glands as well as the
lungs, and can cause hypoadrenalism).
• In Addison’s disease, the adrenal cortex does not respond
to pituitary orders. Cortisol levels are low, but pituitary
ACTH and hypothalamus ACTH-RH hormones are
high.
• Symptoms of Addison’s disease are decreased
glucose levels, a drop in blood pressure from water
and salt imbalance, and darkening of the skin.
153
 Cortisol Under-secreting
adrenal gland tumor

Hypothalamus ACTH-RH will be high

ACTH-RH

ACTH levels will be high.

Pituitary
ACTH

PRIMARY Cortisol will be low

Adrenal Gland (hypoadrenalism)
ADRENAL
INSUFFICIENCY Cortisol
(adrenal gland 154
is the problem)
 ACTH Under-secreting
pituitary tumor

Hypothalamus
ACTH-RH is high
ACTH-RH

SECONDARY
ADRENAL Pituitary ACTH is low
INSUFFICIENCY ACTH
(pituitary is the
problem)

Adrenal Gland Cortisol is low

Cortisol
155
 Why do you get skin pigmentation from excess
ACTH?
• ACTH is a peptide (protein) hormone, synthesized
from a larger protein called POM-C (Pro-
opiomelanocortin). From the large POM-C
protein, you cut out one segment, called ACTH,
and another segment called MSH (melanocyte
simulating hormone). When the ACTH levels
increase but you still need more, POM-C cleavage
continues to occur, and more MSH is generated
at the same time. When MSH is in excess, you
get darker skin (hyperpigmentation).
• People with Addison’s disease have high levels of
ACTH, so they get darker skin.

156
Addison’s Disease
• Thirty-two-year-old man with
Addison's disease with
generalized hyperpigmentation,
most marked on areas exposed
to sunlight, such as face and
neck. Courtesy of David N Orth,
MD.

157
 Adrenal Gland Deficiencies
• Primary Adrenal Insufficiency: Addison’s Disease
– primary hypoadrenalism; entire adrenal gland
is destroyed due to atrophy or autoimmune
disorder
– Tuberculosis –disease attacks adrenal gland
– ACTH is increased
• Secondary adrenal insufficiency
– deficiency of ACTH
– Rapid withdrawal of pharmacologic doses of
cortisol
• Signs/symptoms: Water/salt imbalance, plasma
volume depletion, low blood glucose,
pigmentation, Addisonian crisis (low blood
pressure, low blood glucose, need to go to the
hospital)
158
Adrenal Gland Deficiencies

159
 Secondary Adrenal
Insufficiency
• In Secondary Adrenal Insufficiency, the
problem is in pituitary; it is not secreting enough
ACTH, maybe because of a tumor. Cortisol levels
drop, but hypothalamus ACTH-RH increases.
• A person can also get secondary hypoadrenalism
from rapid withdrawal of cortisol meds.
• Symptoms are the same as for primary adrenal
insufficiency, except blood tests show that
pituitary ACTH levels are low, cortisol is
low, and hypothalamus ACTH-RH is high.

160
 ACTH Under-secreting
pituitary tumor

Hypothalamus
ACTH-RH is high
ACTH-RH

The difference between

primary and secondary
adrenal insufficiency is
the ACTH level
SECONDARY
ADRENAL Pituitary ACTH is low
INSUFFICIENCY ACTH
(pituitary is the
problem)

Adrenal Gland Cortisol is low

Cortisol
161
 Cortisol Under-secreting
adrenal gland tumor

Hypothalamus ACTH-RH will be high

ACTH-RH

The difference between

primary and secondary
adrenal insufficiency is
the ACTH level
ACTH levels will be high.
Pituitary
ACTH

PRIMARY Cortisol will be low

Adrenal Gland (hypoadrenalism)
ADRENAL
INSUFFICIENCY Cortisol
(adrenal gland 162
is the problem)
 SUMMERY

Hypothalamus

ACTH-RH

Pituitary
ACTH

Adrenal Gland

Testosterone Cortisol Aldosterone Addison’s 2° adrenal Cushing’s Cushing’s

Disease insufficiency Syndrome Disease
in females, (Raises (raises blood (1° adrenal Pituitary (1° adrenal (2° adrenal
Estrogen in blood pressure) insufficiency) gland is the hyperplasia) hyperplasia)
Adrenal gland Pituitary
males glucose) problem Adrenal gland
gland is the
is the is the
problem problem problem
163
 Conn’s syndrome
(hyperaldosteronism)
• Too much aldosterone is secreted.
• Too much salt and water is
reabsorbed, person develops high
blood pressure.
• Cortisone levels are not effected, so
they do not have elevated blood
glucose.

164
 The Pineal Gland
• Shaped like a pinecone
• Pinealocytes secrete melatonin
– A hormone that regulates circadian
rhythms (sense of daytime and night;
it regulates sleep cycle)
• “Pineal sand” is radiopaque
– Mineral deposits within pineal gland.
– Used as a landmark to identify other
brain structures in X-Rays

165
Pineal Sand

166
 The Pancreas
• Is an endocrine and exocrine gland
– Exocrine cells – acinar cells – secrete
digestive enzymes into a duct.
– Endocrine cells – pancreatic islets (islets
of Langerhans)
• About one million islets – scattered
throughout the pancreas
• Secrete insulin
• Secretes glucogon

167
Pancreas

168
Pancreas

169
Pancreas
Acinar cells
(secrete
enzymes)

Islet of
Langerhans
(secretes
insulin and
glucagon)
170
 Endocrine Hormones
of the Pancreas
• Glucagon
• Signals liver to break down glycogen into
glucose
• Raises blood sugar
• Insulin
• Signals most body cells to take up glucose
from the blood
• Promotes storage of glucose as glycogen in
liver
• Lowers blood sugar
171
Regulation of Blood Glucose Levels
• When blood glucose is high, the pancreas secretes insulin,
which tells the cells to take in the sugar from the
bloodstream. If the blood sugar levels remain high, the
excess sugar is taken to the liver and converted to
glycogen for storage.
• When blood glucose is low, the pancreas secretes
glucagon, which tells the liver to take the glycogen and
break it back down into glucose and release it into the
bloodstream.
• Gluconeogenesis is when the liver takes fatty acids (leftover
from fat metabolism) and joins them to amino acids (from
broken down proteins), and makes new glucose molecules
that you did not get from eating glucose. These new
glucose molecules are then released into the bloodstream
to elevate blood glucose levels.
• Summary:
– When blood glucose is high, insulin lowers blood glucose levels.
– When blood glucose is low, glucagon causes glycogen breakdown 172
and gluconeogenesis to raise blood glucose levels.
 Diabetes
• DIABETES INSIPIDUS
– pituitary gland does not secrete antidiuretic hormone, or
the kidney does not respond to the hormone. It can be
caused by damage to the pituitary or kidney damage.
• DIABETES MELLITUS
– hereditary lack of insulin secretion in the pancreas, or
resistance to insulin by the body’s cells.
• Type I diabetes (insulin dependent, develops in children)
– Destruction of pancreatic islets by autoimmune
disorders.
– Need insulin injections daily throughout life.
• Type II diabetes (not insulin dependent, develops in
adults)
– Consequence of obesity: cells are less sensitive to
insulin.
– Initially treated with diet and exercise.
– Oral medicines or injected insulin may be needed.
173
174
• Type 1 Diabetes VIDEO
• Type 2 Diabetes VIDEO

175
 The Gonads
• Ovaries
– Secrete progesterone
• Prepares uterus for pregnancy
– Secrete estrogen
• Female secondary sex characteristics
• Stores enough for several months
• Testes
– Secrete androgens (e.g. testosterone)
• Promotes the formation of sperm
• Maintains secondary sex characteristics
• Testes are the primary sex organs in the male, NOT
the penis

176
177
 DANGERS OF STEROIDS
• Steroids that weightlifters take are synthetic testosterone,
and they are taken in doses 100x larger than a
prescription, so they are dangerous.
• Although they increase muscle size, they increase rage and
aggression, cause kidney and liver disease, cancer, severe
acne, high blood pressure, high cholesterol, impotence,
baldness, decreases the size of testicles and causes a low
sperm count and sterility.
• In males, it causes baldness and increases the breasts.
• In women it causes hair on their face and chest, and
decreases the breasts.
• In children, it stunts the growth.
• In everyone, they can shorten the life span by several
decades.
178
Steroids or Photoshop?

179
 News Articles
• Effects of Stress
• http://ehealthmd.com/library/stress/STR_affect.html

• Effects of Steroids on Behavior

• http://kidshealth.org/parent/emotions/behavior/steroids.html#

• Facts about steroids

• http://www.drugabuse.gov/infofacts/Steroids.html

180
 Other Endocrine Glands
• Many of the glands we talked about have no other function
than to make hormones. But almost all organs are
endocrine glands in addition to their other functions.
• Heart pumps blood and produces hormones
• Liver makes enzymes, produces hormones
• GI tract digests food and produces hormones.
• Kidney: excretes wastes, produces hormones
• Dermis Involved in vitamin D synthesis, makes hormones
• Bones stores calcium and produces hormones.
• Placenta oxygenates and produces hormones.

• The only thing that does NOT make hormones are epithelial
glands that have ducts (hormone glands are by definition
without ducts).

181
 The rest of this PPT is not
on the test or quiz
Other Hormones are made in these organs
• Heart
• Liver
• GI tract
• Kidney
• Dermis
• Bones
• Placenta

182
 Heart Hormones:
Natriuretic Peptides
• In response to a rise in blood pressure, the heart releases two peptides:
• A-type Natriuretic Peptide (ANP)
• This hormone is released from stretched atria (hence the "A").

• B-type Natriuretic Peptide (BNP)

• This hormone is released from the ventricles. (It was first discovered in brain tissue;
hence the "B".)

• Both hormones lower blood pressure by

• relaxing arterioles
• inhibiting the secretion of renin and aldosterone
• inhibiting the reabsorption of sodium ions by the kidneys.
• The latter two effects reduce the reabsorption of water by the kidneys. So the
volume of urine increases as does the amount of sodium excreted in it. The net effect
of these actions is to reduce blood pressure by reducing the volume of blood in the
circulatory system.

• These effects give ANP and BNP their name (natrium = sodium; uresis = urinate).

183
 Liver Hormones
• Angiotensinogen (precursor molecule
that will raise blood pressure)
• Thrombopoietin (stimulates
development of platelets)
• Hepcidin (blocks the release of iron from
intracellular stores in the body so iron is
not lost, especially during bacterial
infections. Bacteria often need to take our
iron to sustain themselves)

184
 GI tract Hormones
• Stomach secretes
– Gastrin (Tells parietal cells to secrete HCl)
• Duodenum secretes
– Secretin (tells pancreas to secrete bicarbonate)
– CCK (Tells pancreas to secrete digestive
enzymes, and gallbladder to release bile)
– GIP (Tells pancreas to release insulin and also
causes fat to be broken down into fatty acids)
– Motilin (Initiates peristalsis and tells chief cells
in stomach to secrete pepsinogen).

185
 Kidney Hormones
• Erythropoietin (EPO): Stimulates production of
red blood cells
• Calcitriol (Vitamin D3): Promotes the
absorption of calcium from food in the intestines
• Renin: Converts angiotensinogen (from liver)
into angiotensin-1, and also tells ACE (lung
enzyme) to cut angiotensin-1 into angiotensin-2,
which causes vasoconstriction, which raises blood
pressure.
• Adenosine: Causes vasoconstriction of afferent
arterioles in the glomerulus. This decreases water
loss, and increases blood pressure.
186
 Dermis Hormone
• When ultraviolet radiation strikes the skin, it triggers the
conversion of dehydrocholesterol (a cholesterol derivative)
into calciferol.
• Calciferol travels in the blood to the liver where it is
converted into a precursor of vitamin D3.
• This compound travels to the kidneys where it is converted
into calcitriol (vitamin D3). This final step is promoted by
the parathyroid hormone (PTH).
• Calcitriol acts on the cells of the intestine to promote the
absorption of calcium from food, and it also acts on bone to
mobilize calcium from the bone to the blood.
• Although called a vitamin, calciferol qualifies as a hormone
because it is made in certain cells, carried in the blood, and
affects target cells.
187
 Bone Hormones
• Fibroblast Growth Factor (Tells
kidneys to reduce phosphate
reabsorption)
• Osteocalcin (lowers blood glucose
and decreases fat deposition)

188
 Placenta Hormones
• Human Chorionic Gonadotropin (hCG)
ensures that the corpus luteum continues to
secrete progesterone so the endometrial lining
won’t slough off. hCG also suppresses the
maternal immunologic response so that placenta
is not rejected.
• Human Placental Lactogen promotes
mammary gland growth in preparation for
lactation.

189
 Sample Study Chart
Hormone Where Made Target Organ Effect

ADH Posterior Kidney Increases water

pituitary reabsorption
Parathyroid Parathyroid Bone, kidney, Increases blood calcium
gland intestines levels

Thyroid Thyroid gland Most cells Increases metabolic rate

ACTH Anterior Adrenal cortex Stimulates release of

pituitary cortisol
Cortisol Adrenal cortex Most cells Affects glucose and protein
blood levels and
metabolic rates
190
 STUDY TIP
• Learn the summary list first (2
pages) before you tackle the
flashcards!
• Sample question:
– What hormones are antagonistic to
insulin?
• GH
• Cortisol
• Epinephrine
191