ENDOCRINOLOGY Target hormone acts on another hormone

Properties of Hormones
Endocrine System 1. Biosynthesized s
- It produces hormone which directly 2. Operates at vanishingly small
goes into the blood and delivered concentration in the blood
into the target organ. - Even in low level, it can still create
- These hormones are a messenger or changes to its target site
like the TV anchors that broadcast 3. Short half-lives
message throughout the body - Once they transmit and create
changes to the target site, its levels
Examples of hormones: will go low
1. Aldosterone 4. Has multipoint control and operate
- It released to the body and goes to at a number of target organs
its target site which is KIDNEY - Multiple target organs s
2. Erythropoietin 5. Feedback-regulated
- The production of this hormone - Hormones regulated themselves
happens in the kidney, Its target site - Once their target activity is reached,
is in the bone marrow for the their level will decrease
erythropoiesis.
Feedback Mechanism
Functions of Hormones - Controls or regulate the metabolic
1. Homeostasis of chemical activity of the hormones
composition of the ECF and ICF 1. Positive Feedback Mechanism
- Electroneutrality of homeostasis of
ECF and ICF
- Once they reach the target site, it - There is a production of activity that
will bind receptor. This will be the continues to increase in order to
time that the hormone will transmit promote the desired effects
the message, making changes to the - EX: release of oxytocin hormone for
target site. the preparation for childbirth
Hormones that regulates for the
production of calcium 2. Negative Feedback Mechanism
- PTH, Calcitonin, calcitriol, and
Aldosterone
2. For metabolism, growth, fertility, - Opposite for Positive feedback
and response to stress - Most hormone are controlled by this
- Growth hormone and thyroid mechanism
hormone - The increase of product will result to
3. Regulation decrease the activity system
a. Reproductive processes - The hormone feedback to decrease
- Testosterone and estrogen its own production
b. Energy production and - EX: LH
metabolic rate
c. Production of certain hormones
Hormones Classification According to Hormones classification according to
Action chemical composition/structure
1. Endocrine Hormones - Peptides and Proteins
- Traditional hormones - Steroids
- secreted in one location - Amines
- Released into the circulation; then - Eicosanoids
will bind to specific receptor for Generally there are 2 types of hormones:
activity of their target site Group 1 & 2
2. Paracrine Hormones
- Classical hormone 1. Peptides and Proteins
- Secreted in the endocrine cells - Synthesized and stored in the form
- Released in interstitial space; will of secretory granules
bind to specific receptor in adjacent - Effects of these hormones is in outer
cell and affects its activity surface of the cell
3. Autocrine Hormones - It cannot cross the cell membrane
- Secreted in the endocrine cells because of its large size
- Released in interstitial space - It is water soluble and unbound to
- Binds to the specific receptor carrier protein
resulting to self-regulation a. Glycoprotein
4. Juxtacrine Hormones - Large chains of AA (chains are more
- Secreted in the endocrine cell and than 100)
remain in relation to plasma - CHO-group (bound to more than 1
membrane carbohydrates
- There is direct cell to cell contact EX:
5. Intracrine Hormones - FSH, LH, TSH,HcG
- Intra means: inside b. Polypeptides
- Secreted in the endocrine cells - Chains of AA (chains are less than
6. Exocrine Hormones 100)
- Secreted in the endocrine cells - Angiotensin and RAA system
- Released in the lumen of gut involved
7. Neurocrine Hormones 2. Steroids
- Secreted in the neurons - Lipid molecules
- Released in the extracellular space - Common precursor in cholesterol
8. Neuroendocrine Hormones - Secreted in the adrenal glands,
- Secreted in the neurons ovaries, testes, and placenta
- Released from the nerve endings - Hydrophobic hormone (insoluble to
water)
Hormone-receptor binding - Steroidal drugs can promote
- Very specific carcinoma and cancer
- Concentration dependent Estrogen- 18 carbons atoms
- Reversible Androgen- 19 carbons atoms
- Hormones requires receptor than Glucocorticoids, Mineralocorticoids,
can be found in their target organ Progestins – 21 carbons atoms
 3. Amines Hormone production
- Derived from AA - Most hormone are secreted as
- This is mediator of steroid and parent precursors except for
protein hormones polypeptides which is less than 100
3 groups amino acids
1. Catecholamines - Pre-prohormone contains leader
- Epinephrine and norepinephrine sequence called signal sequence,
secreted by adrenal medulla which will cleaved from pre-
- Derived from tyrosine prohormone after insertion into ER.
2. Thyroid hormones (T3 & T4) Within the secretory vesicle,
- Derived rom tyrosine prohormone will cleaved
3. Melatonin enzymatically to as smaller active
- Derived from tryptophan hormone
Ex:
4. Eicosanoids - Increased blood sugar level, insulin
- Derived from arachidonic acid will be synthesized in beta cell as
- It has 20 carbon molecules pre-proinsulin to become proinsulin.
Ex: Prostaglandin, prostacyclin, Proinsulin will cleaved through
thromboxane enzymatically by proteases forming
C-peptide and insulin which is the
Hormones classification according to active form of insulin
function
1. Releasing hormones Testosterone is the most potent or
- Found in the hypothalamus active androgen of the male
- Promotes production of anterior
pituitary hormones Mechanism of Hormone
2. Inhibiting hormones 1. Target cell must have specific
- Suppresses the secretion/activity by receptors
another organ 2. Combination of receptor with the
- Produced from hypothalamus or GI ligand must cause specific sequence
tract of changes in target cells
3. Tropic Hormones - Combine with the regulatory
- For growth and activity of other molecule
endocrine glands 3. There must be a mechanism to
- Ex: TSH will produced which will quickly turn-off the action of the
cause hypertrophy (growth) of the regulator
thyroid glans - Specifically the negative feedback
4. Effector Hormones Mechanism of Group II hormones
- Produced by all other endocrine 1. Group II hormone are outside the
glands except for anterior pituitary cell. They bind ti the receptors
gland and hypothalamus outside of the plasma membrane
- Responsible for physiologic changes 2. Signal transduction or binding
- Once these hormones is released, it phenomena. In order to have signal
creates an activity
 transduction there is a need of G- Signal of Hormone Secretion
protein and adenylate cyclase. 1. Neural signals
GTP is requirement for activation of - Majority of the endocrine gland are
G-protein regulated by this
3. Once G-protein is activated, it will EX:
stimulate the enzyme adenylate - PTH produced whenever there is low
cyclase which will produce cAMP calcium
(acts as second messenger) - Insulin is release when there is high
4. cAMP will proceed inside the cell to level of glucose
inhibit 1 or more enzymes to modify - Calcitonin is produce when there is
intracellular metabolic processes. high calcium
2. Tropic hormones
IP3 (Inositol triphosphate) - Hormones which stimulate their
- second messenger for Group II target organ to release effector
Calmodulin hormones
- calcium binding proteins 3. Variation in blood osmolality
1. Hormone receptor binding 4. Presence of food
2. Coupling with phospholipase C by
Gp Hormones regulators
3. Cleaving of PIP2 into IP3 and DAG 1. CNS
4. Mobilization intracellular (stored in - Is responsible for secreting
the cell) Ca++ from the ER for neurotransmitter
activation of cAMP 2. Hypothalamus
5. Activation of protein kinase C - Secretes hormones that regulates of
- Due to the action of DAG the anterior pituitary gland
- Activation of protein kinase C is - Epinephrine will release in the
further activated by calcium adrenal medulla to suppress stress
6. Cellular responses level or fear
- IP3 is a second messenger, cAMP
will also activated HYPOTHALAMUS
- It locates above the pituitary gland
Mechanism of Group I Hormones - Connected with posterior pituitary
1. Steroidal Hormones: gland
intracytoplasmic receptor - It sends message through the
- Inside the cell, it can be in the pituitary stalk
cytoplasm or nucleus - It connected with anterior pituitary
2. Once bound: Migration to DNA gland through hypophyseal portal
- Zinc + cysteine-rich DNA binding site system
- Zinc is an activator - It secretes vasopressin and oxytocin
3. Synthesis of mRNA and proteins - Vasopressin/AVD which is involved
- Before synthesis, endocrine glands in maintaining the balance in ICF and
should receive proper signal first ECF
 Hypophyseal hormones releases: - Melatonin decreased skin
- TRH: Thyroid-releasing hormone pigmentation and it is derived from
- Gn-RH: Gonadotropin-releasing tryptophan
hormone Function of Melatonin
- Somatostatin or GHIH: Growth 1. Circadian rhythm regulation
hormone-inhibiting hormone 2. Inhibits pituitary-gonadal axis
- GH-RH: Growth hormone-releasing 3. Treatment for jetlag
hormone 4. Treatment of insomnia
- PIF: Prolactin inhibiting factor 5. Anti-oxidant activity

Hypothalamus is involved in Serotonin

inhibiting/promoting the release of pituitary - Neurotransmitter
hormones - Melatonin metabolism by product
Hormones of Hypothalamus - Excreted in urine
1. CRH- Corticotropin releasing - Rich in platelets and GIT
hormone Melatonin and Serotonin are hormones of
2. TRH- Thyrotropin releasing hormone Pineal gland
3. GnRH- Gonadotropin releasing
hormone PITUITARY GLAND
4. PIF (Dopamine) - Master gland or hypophysis
- Prolactin inhibiting hormone - Without pituitary gland growth
5. PRF processes in the body will be
- Prolactin releasing hormone affected
6. GHRH - Found in the Turkish Saddle
- Growth hormone-inhibiting - Other name is Hypophysis or
hormone undergrowth because is can be
7. GHIH found under the hypothalamus
- Growth hormone-releasing hormone - Pituitary hormones have circadian
8. MIF rhythm
- Melanocyte inhibiting factor Lobes of Pituitary Gland
9. AVD/vasopressin 1. Anterior pituitary
- Increase of renal absorption of (Adenohypophysis)
water in the kidney 2. Intermediate lobe (Pars
10. Oxytocin intermedialis)
- For mild production 3. Posterior pituitary
- Child birth (Neurohypophysis)
Hormones of the hypothalamus are
released to regulate the hormones Anterior Pituitary
produced by the pituitary gland. - True endocrine gland
- It has big portion
PINEAL GLAND - From Rathke’s pouch
- Attached to the midbrain - It regulates and secrets hormone
- Releases Melatonin Hormones produced:
- Peptides and glycoproteins
 Decreased level:
- Hyperglycemia, Obesity, Hypothyrodism
GH is antagonize of insulin
Method of measurement
- Chemiluminescent IA immunoassay
- <7 ng/mL
Tropic hormones pass through the GH stimulate the liver to secrete
infundibulum to anterior pituitary gland somatomedins (IGF) Insulin like growth
(Adenohypophysis), this will help control factor
their own production through negative feed 2 Types
going to hypothalamus. Thus it inhibits the 1. Somatomedin A or IGF II
hypothalamic hormones - Development of brain, liber, and
- Hormones from pituitary gland kidney
needs for gwoth, once removed, 2. Somatomedin C or IGF I
growth stops
Hormones of Anterior Pituitary Gland Growth Hormone Disorders
- GH, Gonadotropins, TSH, ACTH Growth Hormone Deficiency
1. Idiopathic GHD
GROWTH HORMONE - Common in children
- Somatotropin - Dwarfism; no intellectual defect
GH-RH (somatocrinin) - Abnormal size of pituitary gland
- Amount of hormone to release 2. Pituitary GHD
GHIH (somatostatin) - Common in adults
- Regulates and duration of secretory GHD diagnostic Test
activity 1. Screening Test Physical activity test
- Growth hormone are erratic and (exercise test)
happens for a short period of time - If decreased need for confirmatory
Lipolysis 2. Confirmatory tests (require 24 hour
- Provides oxidative substrate for or nighttime monitoring):
peripheral tissue but conserve - Insulin Tolerance Test- Gold
glucose for CNS Standard
Major stimulus - Arginine Stimulation Tests- second
- Deep sleep confirmatory test
Major Inhibitor - If patient failed to increased 5 ng/mL
- Somatostatin (GHIH) for adults or 10 ng/mL for children,
- Phy there is a GH deficiency
Physiologic stimuli (increased GH level): - Patient must need to rest 30 mins
stress, fasting and high CHON diet before collection and it requires
Pharmacologic stimuli (increased GH level): fasting
sex steroids, apomorphines and levodopa
Increased Level: Acromegaly
- Acromegaly, Chronic malnutrition, - Over production of growth hormone
Renal disease, Cirrhosis, Sepsis - >50 ng/mL
- Gigantism
 - It is because of pituitary tumor TSH
- Acromegaly is fatal because of risk - Thyrotropin
of heart disease - Promotes thyroid hormone
- To evaluate: compare your past synthesis
pictures - It has alpha and beta subunit
Acromegaly Diagnostic Test - Beta subunit is responsible for
1. Screening Test transport of specific information
- IGF-2 is increased in acromegaly. going the binding receptor
IGF-1 is low in GH deficiency. - Levels of TSH can evaluate infertility
2. Confirmatory Test: Glucose
suppression test Adrenocorticotropic Hormone (ACTH)
- OGTT (75g glucose) - Secreted when the cortisol level is
Interpretation low
- Normal if less than 1 ng/mL - Regulator of adrenal androgen
Acromegaly: synthesis
- Fails to decline less than 1 ng/mL - Highest level: 6-8am
- Failure to suppressed below 0.3 - Lowest level: 6-11pm
ug/L; elevated IGF1 - Right time to collect sample: after 8
For suppression tests: am and before 6 pm
No suppression of GH = acromegaly Increased in:
Suppressed GH but Normal IGF-1 = exclude - Addison’s disease
acromegaly - Ectopic tumor
Suppressed GH but Increased IGF-1 = - After protein-rich meals
requires follow-up and further testing - Acute stress (physical and
psychological)
GONADOTROPINS Diagnostic Test
- Gonadal hormones - Pre-chilled EDTA tubes
- Marker for fertility and menstrual - Do not used glass which could
cycle disorder decreased the level of ACTH
- FSH and LH ae present in both - Ideal Collection is 8-10 am
Gonadotropins: Follicle Stimulating
Hormone (FSH) PROLACTIN (PRL)
- Spermatogenesis - Pituitary lactogenic hormone
- Elevation of this is for diagnosis for - Related to lactogen and GH
premature menopause - Stress hormone is direct effector
Gonadotropins: Luteinizing Hormone (LH) - Promoting the breast development
- Synthesis of androgen, estrogen, - Maintains lactation
progesterone - Major inhibitor is Dopamine
- Increase of FSH and LH after Tumor, inflammation and trauma can
menopausal period: Lack of estrogen increased PRL level
Normal level:
1-20 ng/mL (Male)
1-25 ng/mL(Female)
Hypogonadism - It start with one and all will be
- Elevated level of prolactin affected
Prolactinoma Order of hormone disappearance:
- Is a type of tumor - GH and gonadotropins (FSH and LH)
- Direct secretes PRL - TSH, ACTH, and PRL
- Associated with Hypogonadism; this Group I are small in size, do not need
will results to anovulation (no second messenger to elicit intracellular of
ovulation) cell
Increased PRL Group II requires second messenger, found
- Pituitary adenoma in extracellular
- Infertility
- Amenorrhea Caused by :
- Galactorrhea acromegaly Pituitary Tumors
- Renal failure - Presence of tumors
- Polycystic ovary syndrome - It requires treatment thus it can
- Cirrhosis destruct pituitary gland. As this
- 1 and 2 hypothyroidism happen gland will be affected
For men high PRL will reduced libido or Ischemia
erectile dysfunction - Sheehan’s syndrome (Post-partum
- As we age, PRL level increases pituitary gland necrosis)
- Highest level: 4-8 am, 8-10 pm - Decreased blood supply
- Enlarged pituitary
Laboratory Evaluation - Blockage of flow of blood
1. Obatain TSH and fT4( free T4) - Hemorrhagic shock for pregnant
- To eliminate primary patient
hypothyroidism as cause of elevated
PRL NEUROHYPOPHYSEAL HORMONE
2. Three samples must be extracted - Released in the posterior pituitary
- Every 20-30 mins interval gland
- Avoid the physiologic stimuli - Transported in the membrane
3. Physiologic and Pharmacologic bound vesicle in the pituitary stalk
stimuli: or infundibulum
Rarely exceed 200 ng/mL - Stimulated by hypothalamus
Once it exceeds 200, something is
wrong with the gland. OXYTOCIN
- Non-peptide hormone
Hypopituitarism - Similar with AVD/vasopressin
PANHYPOPITUITARISM - Initiates formation of cGMP and
- Complete loss of function of cAMP
pituitary gland - Stimulates muscle contraction
- It can be either problem in pituitary during delivery and lactation
gland or hypothalamus - Synthetic preparation, to increase
- Involvement of 1 or more hormone weak uterine contractions?
Dopamine also function for milk production
Oxytocin plays a huge role in regulating the
mother’s behavior in response to baby’s Diabetes mellitus:
crying. The baby’s crying can stimulate the - blood and urine glucose levels are
release of oxytocin. elevated
Baby cries -> increased oxytocin -> the - 3P’s + increased blood glucose level
mother will feel that it is time to breastfeed Diabetes insipidus
her baby - normal blood and urine glucose level
-Once the baby is placed in the breast of the - 3P’s but with normal glucose level
mother, it triggers oxytocin
DI is a deficiency of ADH
AVP(vasopressin) Types of DI
- Non-peptide hormone 1. Nephrogenic DI
- Target organ: distal convoluted and - Normal ADH but impaired ADH
collecting tubules receptor I the kidney
- Major Function: maintenance of - Kidney fails to respond
osmotic homeostasis 2. Neurogenic DI
- Regulation of water balance - True DI
- Decreased urine production by - ADH deficient, Abnormal ADH
promoting reabsorption of water by receptor
renal tubules - Problem is pituitary gland
- Hyponatremia and hypotension lead
to aldosterone production Overnight water deprivation Test
- Decreased blood pressure will lead - Or Concentration Urine
to release of ADH or vasopressin - Ability to produce concentrated
- It has 2 receptor urine
AVP secretion - 8-12 hours water deprivation, with
- ADH is low, pituitary will be hourly measurement of urine
stimulated to secret AFH osmolality
AVP release - 8-12 hours after: urine osmolality
- There is already released of ADH but fails to elevate above 300 mOsm/kg
it only need to be released Nephrogenic DI
- After administration of exogenous
Mechanism of ADH (Group II hormone) ADH, kidney will act to conserve
- ADH coupled to phospholipase C water
Neurogenic DI
Hyposecretion of ADH - Administered ADH has little to no
Diabetes Insipidus effect n renal H2O reabsorption
- Destruction of neurohypophysis or
hypothalamus THROID GLAND
ADH deficiency - Butterfly shaped gland
- Will lead to polyuria or increase - 2 lobes, below the larynx
production of urine - Production of thyroid hormone and
- For diabetes insipidus it can reach calcitonin
up to 3 liters
 1. Triiodothyronine (T3)
Two types of Cells - Most active thyroid hormone
1. Follicular cells - Produced from the tissue
- thyroid hormones deiodination of T4
2. Parafollicular cells or C cells - Conversion takes place in liver and
- calcitonin kidney
Suppress- cuboidal in shape - Principal application: Diagnosis of T3
Increased- Columnar in shape thyrotoxicosis
Thyroglobulin - Better indicator for the recovery and
- major component of colloid recurrence of hyperthyroidism
- thyrosin - Confirmation of the diagnosis of
Thyroid Hormone Synthesis hyperthyroidism
- iodine is most important element for - T3-low or absent
biosynthesis of thyroid hormone 2. Thyroxine (T4)
- MIT and DIT are the building blocks - Has the major fraction of organic
of thyroid hormones. iodine in the circulation
- MIT: monoiodotyrosine - Principal secretory product
- DIT: diiodotyrosine - Pro-hormone for T3
Iodination of tyrosine - all circulating T4 originates in the
- Formation of DIT and MIT thyroid gland, 100%
Outer side of the follicle - Serum T4 level, is a good indicator of
- Transport of iodine to the thyroid thyroid secretory rate
cell - Elevated level of T4 inhibits the TSH
Inside the thyroid cells secretion
- Diffusion of iodine across the cell to TSH, Follicular cells, Ingestion if colloid
the apical side of the follicle droplets, Digestion of droplets by
Core of the colloid intracellular lysosomes, T3 & T4,
- Iodide is catalyzed by TPO (thyroid Bloodstream
peroxidase) TRH- TSH- Anterior pituitary gland
Concentrated iodide (Adenohypophysis)- Thyroid hormones T3 &
- oxidized and bound to tyrosyl T4, negative feedback for regulation
residues
- binding iodine and tyrosine Protein binding of thyroid Hormone
- production of DIT and MIT - 0.04% for T4 and 0.4% for T3
- T3 and T4 that are unbound to
Thyroglobulin matrix holding T3 and T4 proteins are available for hormonal
TSH- will stimulate the production of T3 & activity
T4 - protein that are bound to hormones
Inside the follicular cells are inactivated
- digestion of droplets by intracellular - fT3 and fT4 are the activated form
lysosome into T3 and T4 which are circulating freely
DIT + DIT = T3 - bound protein cannot enter cells
DIT+MIT= T4 and so they only function as storage
Major Thyroid Hormone sites
Thyroid hormone binding proteins - Problem in the pituitary gland, no
1. Thyroxine Binding Globulin problem with thyroid gland
- Transport majority of T3 but also - fT4 and TSH are elevated
total T4 Hyperthyroidism Disorders
- 70-75% Thyrotoxicosis
2. Thyroxine Binding Prealbumin a. T3 thyrotoxicosis
(transthyretin) - Plummer’s disease
- Low affinity to T3, Only for T4 - Increased fT3, normal fT4, low TSH
3. Thyroxine Binding Albumin b. T4 thyrotoxicosis
- Transport T3 but little amount of T4 - Normal/low fT3, increased fT4, low
TSH
Hypothalamic Pituitary Thyroid Axis 1. Grave’s Disease
- Controls the product and secretion - Primary hyperthyroidism
of thyroid hormones - Diffuse toxic goiter (most common
- TRH-TSH-Thyroid Hormones cause of thyrotoxicosis)
- TSH (thyrotropin) - Production of antibodies that
activates TSH receptor, an
From hypothalamus, TRH will release TSH autoimmune disorder
from pituitary gland, TSH will stimulate to Clinical feature
release thyroid hormone - Bulging of the eyes (Exophthalmos)
- Inflammation (Pretibial myxedema)
Thyroid Autoantibodies Diagnostic test
- TPO (thyroid peroxidase), involves in - TSH receptor antibody test
tissue destruction (Hashimoto’s 2. Riedel’s Thyroiditis
disease) - Thyroid turns into woody or stony
- Tg (thyroglobulin) hard mass
- TR (TSH receptor), involved in - The thyroid is harden
Grave’s disease 3. Subclinical hyperthyroidism
Thyroid Hormone Disorders - No clinical symptoms
Hyperthyroidism - TSH is low, normal fT3 and fT4
- Excessive level of thyroid hormone 4. Subacute granulomatous thyroiditis
Symptoms - De Quervain’s thyroiditis
- Tachycardia - Also known as painful thyroiditis
- Tremors - Associated with neck pain, low grade
- Heat intolerance fever, swings in thyroid functions
- Unexplained weight loss test
- Emotional lability - Absent of TPO
- Menstrual changes - Elevated ESR (Inflammation) and
Types of Hyperthyroidism thyroglobulin
1. Primary Hyperthyroidism
- Problem is with the thyroid gland Hypothyroidism
- T3 and T4 are elevated but low TSH - Insufficient thyroid hormones
2. Secondary Hyperthyroidism - Treated with levothyroxine (used for
replacement therapy)
 Symptoms - Physical deformity, and learning
- Bradycardia disabilities
- Weight gain - Defective development of function
- Coarsened skin of gland caused by hypothyroidism
- Cold intolerance Screening test
- Mental dullness - T4
Primary Hypothyroidism Confirmatory
- Iodine deficiency - Elevated TSH
- Decreased T3 and T4 Subclinical Hypothyroidism
- Can cause ablation or destruction of - Absent of clinical symptoms
thyroid gland - Mild form of hypothyroidism (does
Other causes: not produce enough thyroid
- Surgery, radioactive iodine, radiation hormones
exposure, lithium (inhibits the - TSH is low of slight normal
iodine), Hashimoto’s disease,
myxedema Laboratory Test for thyroid Function
1. Hashimoto’s Disease TRH stimulation Test
- Chronic autoimmune thyroiditis - Increased TRH, Hypothyroidism
(long term) - Decreased TSH, Hyperthyroidism
- Common cause of hypothyroidism 1. TSH Tests
- Thyroid replaced by nest of - Detection for thyroid dysfunction
lymphoid tissue - Early detection of hypothyroidism
- Elevated TSH and positive for TPO Increased TSH
antibody - Primary hypothyroidism
2. Myxedema - Hashimoto’s thyroiditis
- Non-pitting swelling of skin - Chronic autoimmune thyroiditis
- Skin infiltration by - Common cause of secondary
mucopolysaccharides hyperthyroidism
- Myxedema coma, sever form Decreased TSH
Symptoms: - Primary hyperthyroidism
- Puffy face, weight gain, slow speech, - Secondary and tertiary
dry yellow skin hypothyroidism
Hyperthyroidism: weight loss - Grave’s disease
Hypothyroidism: weight gain 2. Tg Assay
- Post operative marker for thyroid
Secondary Hypothyroidism Cancer
- Pituitary destruction or tumor 3. Reverse T3
- Decreased T3, T4, TSH - Useful in identification of euthyroid
Tertiary Hypothyroidism sick syndrome
- Problem in hypothalamus 4. FTI (free thyroxine index)
- Low T3, T4, and TSH - Indirectly measures amount of fT4 in
Congenital Hypothyroidism blood
- Cretinism - Equilibrium relationship between
bound T4 and FT4
 5. Total T3, fT4, fT4
FT4
- Differentiation of drug induced TSH
elevation of hypothyroidism
Total T3 or FT3
- Confirmation of hyperthyroidism
6. T3 Uptake
- Number of available binding sites of
TBP
- It does not measure the level of T3
but only TBG
- Inversly proportional with the
relationship with TBG
7. TBG
- Identification between
hyperthyroidism and euthyroidism
- Hyperthyroidism, increase T4 and
normal TBG
- Euthyroidism, Increased T4 and TBG
Elevated TBG, increased T3 and T4
Estrogen, elevated TBG
Androgen, decreased TBG
8. Fine needle aspiration
- Most accurate tool for evaluation of
presence of thyroid nodules
9. Recombinant TSH
- Test for presence of residual or
recurrent disease
10. Tanned Erythrocyte
Hemagglutination
- Positive if presence of agglutination
11. Serum Calcitonin
- Tumor marker for MTC (medullary
thyroid carcinoma)
- Calcitonin monitoring done 6
months before surgery
Notes:
- FT4 and TSH is best marker for
thyroid status
- FT3 and FT4 is significant indicators
for thyroid function
Euthyroid Sick syndrome
- no problem with thyroid gland
hAdrenal insufficiency o High acth baseline
- Low absent- ACTH o Low aldo or no stimulation
Cortisol § Hyperpigmentation
Peak at 6-8 am Hypercortisolism
-nadir- Midnight (2-14 ug/dL) Cushing’s disease
- Tumor of pituitary
If decreased at 8 am along with increase - Dec aldosterone costisol
ACTH Cushing’s syndrome
<3ug/dl in the morning à this is highly - Non pituitary tumor
suggestive of adrenal sufficiency - Inc cortisol

Diagnostic test: ACTH stimulation test o Ectopic tumor

§ Lung carcinoma
Step 1. Ist blood extraction: fasting cortisol
and ACTH - Both high cortisol
- Pinaka taas conc sang cortisol à 8 - Inc ACTH and aldoesterone
am
Step 2. Iv infusion of cosyntropin Cushing’s Syndrome à Cushing’s disease
- Synthetic ACTH hormone - Caused by a tumor in the pituitary
- Normal induvial after injection à gland
increase
Step 3. Blood extraction after 30 and 60 Symptoms Cushing’s syndrome
minutes for serum cortisol - Weight gain
o Sobra glucose some ma
Normal response: convert sa fats
Cortisol level is 18 ug/dl à increase of o Excessive fast production =
equal to or more than 7 ug/dl from baseline less utilization
in either 30 or 60 mins in post – cosyntropin § Fat pad/ buffalo fats
administration - Slow healing of cuts
o Increase glucose à damaged
- Kung guba ang f zone affected ang nerve endings
glucose conc - Increase risk of infections
- Fatigue
Diagnostic test: metyrapone suppression - Glucose intolerance
test o Increase glucose à increase
Normal response: decrease level to <5 cortisol
ug/dL o Indi ma regulate so gasige
- Naggive metyrapone à decrease taas
cortisol in normal px
Primary AI Causes of Cushing’s syndrome
- Elevated ACTH à low cortisol - Iatrogenic
Low cortisol - Pituitary adenomas
- None to minimal costisol - Malignancies
o Primary adrenal insufficiency - Cell lung carcinoma
 - … • Bed ridden px
Increased ACTH level • Wala effort or
- Cushing’s disease stress
- Ectopic • Painful à
increase
Decreased o Major metabolite
- CS related to an adrenal tumor à § Vanillylmandelic acid
long term use of steroid (VMA)
- Condition affecting the pit gland o Minor metabolites
- Side effect of pit gland § Metanophrines
§ Normetanephrines
Adrenal medulla § Homovanillic acid
- Epinephrine à dasig mag open (HVA)
airways, fast acting - Norepinephrine
o 10 seconds - Dopamine
- Catecholamines à g2 hormones o Feel good hormones
Degradation of catecholamine o Sa urine present à wala na
- Breakdown breakdown
- In preparation of elimination and for
storage Drugs (marijuana) à high
- Removal of tyrosine from - Euphoria
epinephrine à dihydroxymandelic o Targets CNS
acid Pheochromocytoma
- Ultimate end product à VMA in - Indwelling catheters à collection
urine
- Immediate percussor of VMA: Ganglioma
Doma, meta and norme - Increased Norepinephrine
- Parent molecule à epi and nor - Normal of epinephrine

Elimination of catecholamine Metarophpone inhibited hydroxylase

- Uptake by the non-neuronal cells - Involved in reproductive hormone ?
- Reuptake into secretory cells Gonads
o Present sa urine na - Testes and ovaries
- Degradation - E1, Estrone
- E2, estradiol
Catecholamines - E3, estriol
- Epinephrine - Andrenal androgens are weak or
o Comes only from adrenals inactive
o Flight or fight - CBG, corticosteroid binding globulin,
o Inc glucose conc (mobilizer or transporter)
o Tgl à(lipase) FA + glycerol - GHDG
§ Monoacylglycerol Steps
§ Urine from indwelling 1. Pulsatile generation
catheter Why need a pattern
 - To maintain the value or maintain
the average value, this will lead to
hypogonadism
Nadir, lowest concentration
Primary gonadosism
- Increase testosterone
- Compensatory mechanism
Second
- Low testosterone
- Because low gonadotropin
Tertiary
- Low testosterone
- Because of low GnRH