— 60 ot =p Endocrinology and Metabolic Homeostasis ‘The functions of the body are regulated by two major control systems: the nervous system, discussed In Chapter 18, and the endocrine system. The endocrine system, also called the hormonal system, regulates the metabolic functions of the body including the rates of ‘chemical reactions in cells, the secretion of chemical substances called hormones, growth, and homeostasis, The endocrine system allows the body to coordinate the actions of many organs at the same time, and it is vital to normal growth and survival. Endocrinology is the medical study of the structure and workings of the endocrine system, the associated diseases and conditions, and their treatment. A physician who specializes in the diagnosis and treatment of endocrine disorders is called an endocrinologist. THE STRUCTURE AND FUNCTION OF THE ENDOCRINE SYSTEM A gland is any organized collection of cells that secrete or excrete a substance. The body contains two types of glands: endocrine glands and exocrine glands. The endocrine glands secrete chemical substances directly into the bloodstream. On the other hand, the exocrine glands send their output through ducts. We have already talked about some of the endocrine glands and many of the exocrine glands. Examples of endocrine glands that have been previously discussed include the ovaries and testes. Examples of previously mentioned exocrine glands include the sweat, mucous, salivary, lacrimal, and mammary glands. In this chapter, you I leam more about the endocrine glands. ‘The endocrine system consists of glands that sccrete hormones. These glands are not anatomically contiguous with each other like most organ systems. However, they are connected in a functional sense through hormones, chemical messengers that are carried by the blood from glands to the cells upon which they act. Each hormone binds with particular receptors, which are contained in specific target tissues. Each hormone has its own receptor, and the two interact much like a lock and key. When a hormone binds with its receptor, the receptor initiates specific biological activities. ‘The exact activities depend on the hormone itself. Figure 19-1 shows the anatomic locations of the major endocrine glands. Some organs that are endocrine glands also serve other important functions. One such organ is the kidney. Hypothalamus and Pituitary Gland ‘The hypothalamus is part of the brain, but it is considered an endocrine gland because it releases its hormones into the blood to act at sites outside the brain. The primary function of the hypothalamus is to control the actions of the pituitary gland. The pituitary gland sits in the sella turcica, a bony cavity at the base of the brain. Physiologically, the pituitary gland is divided imo the anterior pituitary gland (adenohypophysis) and the posterior pituitary gland (neurohypophysis). In the past, the pituitary gland was thought of as the “master gland” because it sends out instructions for other ‘glands to secrete hormones. However, we now know that the hypothalamus directs the behavior of the pituitary gland. The hypothalamus receives instructions from the central nervous system concerning what hormones the pituitary should secrete. Because the release of these hormones is controlled by neurons, they are called neurohormones. After receiving these instructions, the hypothalamus sends hypothalamic-releasing hormones to the pituitary where they stimulate the release of other hormones that act throughout the body. is ‘There are also hypothalamicinhibiting hormones that have the opposite effect, decreasing the & | amount of hormones released. iples of releasing and inhibiting hormones are given in Table 19-1. Table 19-2 contains a list of the major hormones. You will want to refer to this table as we «|| ' el discuss the different glands. For internal use only I ar ‘Scanned with CamSeannerfee % e ‘eee } CUuUDLUCC CE Cee SEEECECE an a a | 4000 Figtre 19-1 Tho Endocrine System TABLE 19-1 Major Relea: Hypothalamus \g and Inhibi Jol Tost (mate) ing Hormones Produced by the Hormone Hormone Affected | Effect ‘corticotropin-releasing hormone (CRA) ACTH stimulate dopamine PRL, LH, FSH, TSH_ | inhibit gonadotropin-releasing hormone (GnRH) | LH, FSH, PRL stimulate [_growth hormone-releasing hormone (GHRH) | GH stimulate ‘somatostatin GH. TSH inhibit thyrotropin-releasing hormone (TRH) TSH, PRL stimulate TABLE 19-2 Major Hormones Hormone: Endocrine Major function gland ‘Adrenocorticotropic anterior pituitary | Stimulates the adrenal cortex to secrete hormone (ACTH) hormones that control metabolism. ‘aldosterone adrenal cortex | Regulates sodium, potassium, and acid excretion by ki ‘androgen adrenal cortex ‘Stimulates activity of the male secondary sexual organs, encourages development of male characteristics, and plays a role in the sex drive in both sexes. antidiuretic hormone (ADH_| secreted by or vasopressin) posterior Regulates amount of fluid in body tissue by | controlling water excretion by the kidneys. For internal use only ‘Scanned with CamSeannerloz son Up | yf Pp l= pituitary ee Miyroid | Promotes uptake of calcium by bones, thereby lowering calcium level inthe blogg hal owes Regulates blood sugar, sess response oe the immune system, epinephrine ‘adrenal medulla | Regulates cardiovascular function and responses to physi , ‘exythropoictin Tidney ‘Stimulates red blood cell production, follicle-stimulating anterior pituitary | Stimulates development and maturation oF hormone (FSH) ovarian follicles s0 ova can be released, [Glucagons | pancreas | Raises blood glucose concentration, growth hormone (GH) or | anterior pituitary | Stimulates body and bone growth, human growth hormone GH) insulin pancreas (islets | Controls the rate of carbohydrate metabolig of Langerhans) _ | and lowers blood glucose concentration Tuteinizing hormone (LH) | anterior pituitary | Stimulates ovaries to ripen and release ova Melatonin pineal Believed to affect onset of puberty and the: wake-sleep cycle. Norepinephrine adrenal medulla | Regulates responses to physical Sess acy ap a vasopressor. oxytocin (ONT, ONY) secreted By ‘Stimulates milk release so that breast Tecdincy posterior can occur: increases uterine motility. 8 pituitary Parathyroid hormone (PTH | parathyroid Regulates calcium level in blood. or parathormone) prolactin (PRL) | anterior pituitary | Promotes breast growth and milk synthesis releasing hormones (RH) | hypothalamus —_ | Causes secretion of hormones by the pituitary renin kidney ‘Stimulates aldosterone production and increases blood pressure. Two hormones, antidiuretic hormone and oxytocin, are secreted by the posterior pituitary gland. Antidiuretic hormone (ADH), also called vasopressin, helps the kidneys to reabsorb water from the renal tubules and also plays a role in controlling blood pressure. Oxytocin helps milk flow when breast feeding and also plays a role in the birth process. The anterior pituitary gland secretes a number of vital hormones. Growth hormone (GH) promotes growth of the entire body by affecting protein formation, cell multiplication, and cel] differentiation. Thyroid-stimulating hormone (TSH) controls the rate of secretion of triiodothyronine (T3) and thyroxine (T4) by the thyroid gland, which in tum controls the rate of metabolism in cells. Adrenocorticotropie hormone (ACTH) acts on the adrenal glands to secrete other hormones that control metabolism. The gonadotropic hormones are sent from the anterior pituitary gland to the gonads and include follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The anterior pituitary also releases prolactin, which regulates breast growth, milk synthesis, and some reproductive functions in males. Adrenal Glands ‘The adrenal glands sit on top of the kidneys and thus are also known as the suprarenal glands, ‘Their anatomic location and structure can be seen in Figure 19-2. Each adrenal gland contains two separate endocrine glands: the adrenal cortex and the adrenal medulla. The adrenal cortex is the outer part of the adrenal gland and synthesizes aldosterone and cortisol, both of which are corticosteroids, as well as androgens. Aldosterone regulates sodium, potassium, and acid excretion by the kidneys. Cortisol affects metabolism, stress response, and the immune system, For internal use only ‘Scanned with CamSeanner a Naa sleet lalon a LIPPPPE PPI RD — wap pp faaeeeeddceedededveee: at a} ee eoeee af ooo 0 vovboud 4 \ swan 163 The androgens produced by the adrenat cortex (such as testosterone) are less potent than the androgens from the testes. Androgens stimulate activity of the male secondary sexual orgins, encourage development of male characteristics, and play a role in the sex drive in both sexes. ‘The adrenal medulla is the inner part of the adrenal gland and secretes two hormones, epinephrine and norepinephrine, also known as catecholamines. These catecholamines act neurotransmitters for sympathetic nerves, but are considered hormones because they are released into the blood. Adrenal glands Figure 19-2 The Adronal Glands Thyroid Gland The thyroid gland is located in the lower part of the neck wrapped around the front of the trachea as seen in Figure 19-3. It secretes three hormones, thyroxine (T4), triiodothyronine (T3), and calcitonin. T3 and T+ increase the rates of chemical reactions in almost all cells of the body, thus increasing metabolism. Calcitonin promotes the uptake of calcium in the bones and thereby decreases calcium concentration in blood. Jathmus of tryroid Lateral lobe of thyroid gland Tracheo Figure 19-3. The Thyroid Gland (Anterio! Viaws For internal use only ‘Scanned with CamSeannera 16d Parathyroid Glands ‘There are four parathyroid glands, wo inferior and two superior, located on the posterior surface of the thyroid gland as shown in Figure 19-4. They produce and secrete parathyroid hormone (PTH), also known as parathormone. PTH controls the calcium concentration in the blood by regulating calcium absorption from the intestines, excretion of calcium by the kidneys, and release of calcium from the bones. JSP, Pancreas ‘The pancreas, whose digestive functions were discussed in Chapter 14, also serves important endocrine functions. Islets of Langerhans are collections of endocrine cells within the pancreas that secrete insulin and glucagon. Insulin, a hormone essential for life, converts glucose to glycogen for storage in the liver and muscles, thus lowering the amount of glucose in the blood and controlling the rate of metabolism of most carbohydrates. Glucagon promotes the conversion of glycogen {0 glucose in the muscles and liver to maintain a baseline blood glucose level and to supply the body with glucose for enerey purposes when there is an energy crisis, Somatostatin is a hormone produced in the pancreas, as well as the brain, Somatostatin helps regulate numerous hormones including insulin, and lowers the production and secretion of growth honnone and thyroid-stimulating hormone. Kidneys The kidneys are important in regulating fluids, electrolytes, and plasma pH and are also considered part of the endocrine system because of the three hormones they release. Renin is released by the kidneys to stimulate aldosterone production and to increase blood pressure Enythropoietin is produced by the kidneys and released into the blood where it promotes the production of erythrocytes, or red blood cells. Vitamin D is made in the kidneys and increases calcium absorption by the intestine. =) Thyroid corsage ‘Superice parathyreid glands ~—— a eo esl} =. “Thyroid glans (posters view) ia Inferce pavashyi glands Troehas Figure 19-4 Tho Patattyrold Glands and Posterior View of Thyroid Gland Pineal Gland and Thymus Gland Two other glands, the pineal gland and the thymus gland, will only be discussed briefly. The pineal gland is in the central portion of the brain. Its exact function is not clearly understood, but it secretes a substance called melatonin that is believed to influence the onset of puberty and affect the wake-sleep cycle of humans. The thymus gland is located behind the stemum, and like the pineal gland, Tittle is known about it. It secretes thymosin, which promotes the development and functioning of the immune system in newboms. This gland is relatively large in a child but shrinks as one ages. Pi PL | DPPP For internal use only 4 ee P| ‘Scanned with CamSeanner] / eee eee e eceee LJ J J Ff J) ecce eee © vuuuugegee - METABOLIC HOMEOSTASIS Metabolism is the total of all chemical and physical changes that occur in body tissu must be closely regulated to maintain homeostasis. It consists of two processes: anabolism and catabolism. Anabolism involves building complex substances (proteins) from simple substances. It requires energy and occurs in all cells as they maintain themselves, divide to form new cells, and produce substances such as hormones. Catabolism is the process of breaking down larger molecules into smaller ones, resulting in the release of energy. For the average person, food and fluid intake and energy expenditure can vary considerably from one day to the next. Nonetheless, a healthy person's metabolism is able to closely regulate the body's internal environment. Body fluid volume, electrolyte and mineral concent the pH of blood all remain within narrow limits when functioning properly. Hormones play a vital role in maintaining homeostasis. For example, if the level of calcium in the blood is below normal, additional parathyroid hormone will be secreted, causing calcium in the bones to be released into the blood stream. In the average person, water comprises about 60% of body weight. This water is found in culating blood, inside cells, and between cells. It contains crucial electrolytes, such as sodium and potassium, along with other molecules, including glucose and bicarbonate. The kidneys play an important role in maintaining the required balance of these substances by either retaining water or excreting it in the uri e, the body must properly use ingested foods. The products of digestion include amino acids, glucose, and fatty acids. Glucose and fatty acids supply the energy requirements of the body. Glucose is a product of carbohydrate metabolism. Amino acids are produced when protein is digested. Amino acids act as the building blocks for formation of new tissue and repair of existing tissue, Proteins and amino acids provide energy only in emergency situations. If too much fat (lipid) is released into the blood, hyperlipidemia may occur, a condition that can lead to heart disease. Likewise, diabetes mellitus is caused by the body's inability to properly regulate the blood glucose level and can lead to major organ damage. In order to function properly, the body must continually perform a delicate balancing act. EXAMINING THE ENDOCRINE SYSTEM Assessment of the endocrine system is made largely through discovering pattems of symptoms that may signify an endocrine disorder. These symptoms may be recognized by physical examination and through taking a careful history. An astute examiner can screen the patient for some of the common endocrine diseases by performing a focused physical examination. Likewi Diabetes mellitus (DM) is suspected in patients complaining of polyuria, excessive thirst (polydipsia), excessive hunger (polyphagia), weakness, fatigue, and blurred vision. Weight loss may be one objective sign present on physical examination. If there is suspicion of diabetes. a Dlood sample should be obtained tor glucose screening. Patients presenting with acute mental status changes or comi should be tested for diabetic ketoacidosis (DKA). Thyroid dysfunction may be detected on exam by the presence of a goiter (a chroni Ronearcinogenic enlargement of the thyroid gland), which may indicate either hyperthyroidism oF hypothyroidism. The thyroid should be palpated for nodules and auscultated for a bruit if enlarged. Symptoms of severe hypothyroidism include a dull. puffy face. dry skin, and thin, dry har. Hyperthyroidism may result in exophthalmos (protrusion of the eyeballs). In addition. the Patient’ may report cold intolerance with hypothyroidism or “heat intolerance with Hsperthyroidism. Laboratory tests are needed to confirm the presence and type of thyroid 'ysfunction once it is suspected. Adrenal insufficiency, or Addison disease, is suggested in patients with weakness, weight loss. hausea, vomiting, darkened skin, and postural hypotension. Cushing syndrome is often characterized by obesit easy bruising, ankle edema, and decreased or absent menstrual cycles. The examiner may notice a round face with red cheeks due to the excess For interaal use only ‘Scanned with CamSeanner== jess 166 production of adrenal hormones. Also, excessive hair growth, or hirsutism, may be present Growth hormon Dehydration (below vomitin disturbances stature may be normal for a given child or it may be due to a ind diarrhea, or illnesses stich as renal disease and diabetes insipidus, dehydration include decreased skin turgor, hypotension, and tachycardia. Electrolyte may produce muscle weakness, mus Mory tests are required to confirm adrenal cortical dysfunction. y be suspected by visual inspection of the patient. Deer ick of growth hormone. who have had nausea, normal water content) may be present in patien pasms, confusion, nausea, and hi DISEASES AND CONDITIONS OF THE ENDOCRINE SYSTEM A list of the most common conditions and disea: 3. In general, the conditions can be grouped acco: improperly. For instance, pituitary disorders include dwarfism, gigantism, acromegal diabetes insipidus. Dwarfism is reduced growth in height, lead of the endocrine system is given in Table 19- ig t0 the endocrine gland that is functioning 1g to short stature, from deficient growth hormone output. Gigantism is the opposite, when an increase in growth hormone causes abnormally tall stature. In adu s, whose growth is complete, an increas enlargement and thickening of the feet, hands, fac due to an overfunctioning of t in growth hormone leads to acromegaly, a and head. Likewise, thyroid diseases can be ¢ thyroid gland, as in hyperthyroidism, or an underfunctioning, a in hypothyroidism. Hyperthyroidism is characterized by many symptoms, including rapid pulse. heat intolerance, eye changes, weight loss, TABLE 19-3 Endocrinologic and Metabolic Conditions and Diseases Condition or Disease acidosis ‘Acromegaly ‘Addison disease and fatigability. Description | Blood pH is below normal (less than 7.34) and is therefore acidic. Hypersecretion of pituitary growth hormone in adults whose growth is complete, leading to thickening of skull bones and peripheral body parts. Also known as adrenocortical insufficiency because the adrenal cortex atrophies. Characterized by weight loss, weakness, fatigue, hypoglycemia, and heart changes. adenoma [A benign neoplasm of cells that may function as a gland. : ‘alkalosis Blood pH is above normal (greater than 7.45) and is therefore basic, or alkalotic. ‘eretinism Hypothyroidism in infants that may lead to abnormalities iflef untreated, Cushing syndrome Dehydration diabetes insipidus diabetes mellitus (DM) ‘Hyperfinction of the adrenal cortex that leads to such symptoms aS moon face, trunkal obesity, weakness, hypertension, kidney damage psychiatric disturbances, and others. Excess loss of water from the bod Chronic excretion of large amounts of dilute urine, usually due 10 inadequate vasopressin (ADH). Disease in which plasma glucose control is defective because of insulin deficiency or decreased target-cell response to insulin. The categories of diabetes mellitus listed in Table 19-4. Table 19-5 lists the methods of classifying diabetes mellitus during pregnancy. diabetic ketoacidosis diuresis etic acidosis or diabetic conta. Increase in urine ex: sign of chronic interstitial nephritis. For internal use 0 | ‘Scanned with CamSeanner 23? 2 dy, STII IT "aL _} TT n nn nD ——— rn| 7 = _ 167 ‘The condition of veing abnormally undersized. There are many types | and causes, one of which is lack of growth hormone. euthyroid goiter ‘An enlargement of the thyroid gland, not due to neoplasm. Also called a goiter. ‘galactorthea The secretion of milky discharge, primarily in women and rarely in men. Gigantism ‘A condition of abnormal size or overgrowth of the entire body or any of its parts, which can be due to excess growth hormone occurring, prior to the fusing of endplates to bones. ‘glucosuria ‘Urine with an abnormal concentration of glucose. Also called glycosuria. Graves disease ‘An autoimmune disorder characterized by an increase in metabolic . weakness, severe weight loss, goiter, exophthalmus, or pretibial (shin) myxedema. Hypothyroidism due to autoimmune destruction of the thyroid gland. ‘An abnormal amount of hair, particularly in women. xcessive calcium in the serum, almost always caused by hyperparathyroidism or malignancy. hyperglycemia Plasma glucose concentration increased above normal levels, which is the common feature of diabetes mellitus, and can lead to organ and tissue damage. hyperkalemia | High serum potassium often due to a defect in renal excretory abi which may lead to cardiac toxicity, flaccid paralysis, and hypoventilation. Several types of disorders characterized by increased levels of lipoproteins in the plasma. Can lead to cardiovascular disease. Also called /yperlipoproteinemia hypernatremia High plasma sodium that may lead to thirst, weakness, fatigue, neurological deficits. and oceasionally coma or death. hyperparathyroidism | Excessive amounts of parathyroid hormone, resulting in hypercalcemia, and leading to disturbances of bones, kidneys, intestines, and the central nervous system hhyperpituitarism Excessive secretion of hormones from the anterior lobe of the pituitary gland, It can lead to growth-related conditions such as Hashimoto thyroid hirsutism hyperealcemia ecedeeddededeevere a OvLuubUCCUCCCCCce a i a = muscle spasms due to hypocalcemia, Typopituitarsm secretion of hormones by ihe anterior lobe of the pitulary acromegaly and gigantism. ff hyperthyroidism cessive activity of the thyroid gland with an increase in seerelion OF thyroid hormone, resulting in weight loss, weakness, and other | symptoms. hypocalcemia Low total serum calcium, which may result in muscle spasms, | lethargy, and acute confusion. May also be chronic. ts [ igpogiyeemia [Plasma glucose concentration is below nonmnal levels | hypokalemia Low serum potassium, which may lead to heart archythanias, muscle weakness, mental changes, and death cardiovascular disease. Also called hypolipoproteinemua. | iyponatremia Low plasma sodium. Acutely it may eause coma, seizures, and death. | hhypoparathyroidism | Deficient secretion of parathyroid hormones, resulting in severe | n of LH. FSH. G Lasgoipiaidian | Diminished actisiy-ot the Wiyroid gland wath a desrease in production | hypottiy Lorthyroid hormones. . "| ; | For internal use only’ 4 * a ‘Scanned with CamSeanner~—r po body fluids aU! u bonate concentration in the body ~ |__| by accumulation of acids or abnormal loss of bases. as metabolic alkalosis Tnereased pH duc to high bicarbonate conceniration in body fut gh from excessive intake of alkaline substances and loss of acid throw urination or vomiting. “ed by tumors of multiple endocrine Inherited disorder of three distinct types, characteria “Sipple neoplasia (MEN) multiple endocrine glands as well as neural tumors. Also called syndrome. myxedema Hypothyroidism developed during adulthood and characterized bY hard edema of subcutaneous tissues, fatigue, mental slowness, O18 intolerance, muscle weakness, and dry hair. ‘obesity [Excessive accumulation of fat in the body. ‘papillary carcinoma | The most common type of thyroid cancer. pheochromocytoma ‘A neoplasm of the adrenal medulla (chromaffin cells) leading to increased epinephrine and norepinephrine secretion and resulting iP severe hypertension. polyphagia ‘The condition of hunger or increase in appetite. respiratory acidosis | Acidosis (too much acid) caused by retention of carbon dioxide, due to inadequate pulmonary ventilation. respiratory alkalosis | Alkalosis (100 much base) resulting from abnormal loss of CO2 due to hyperventilation. Tay-Sachs disease ‘An inherited fatal disorder characterized by the body's inability to properly process fat with deposition of fats in central and peripheral nerves tetany Muscle twitches or spasms resulting from an increase in nerve impulses due to hypocalcemia, thyroid cancer Carcinoma of the thyroid gland. There are four main types: papillary. follicular, medullary, and undifferentiated. [thyroiditis Inflammation of the thyroi thyrotoxicosis ‘A disease caused by excessive quantities of thyroid hormones. Hypothyroidism may be manifested as fatigue, weight gain, mental sluggishness, and cold intolerance. In addition, cancer of the thyroid is a relatively common disease. The parathyroid glands may also be overactive or underactive, resulting in hyperparathyroidism and hypoparathyroidism respectively. ‘The major adrenal disorders include Cushing syndrome, Addison disease, and pheochromocytoma. Cushing syndrome is caused by an overexposure to cortisol or corticosteroids. It is more common in women and can lead to such characteristics as trunkal obesity, fragile skin, osteoporosis, mental disturbances, hirsutism, and menstrual changes. Addison disease is also known as chronic adrenocortical insufficiency and results when the adrenal glands do not produce sufficient corticosteroids. Hyperaldosteronism results in hypertension and hypokalemia (abnormally low levels of potassium in the blood). Diabetes mellitus is actually a group of disorders that have hyperglycemia as a common feature and affects about 100 million people worldwide. Type 1 diabetes accounts for 10% of cases and is due to the immune system attacking the cells in the pancreas that produce insulin. This type is sometimes referred to as insulin-dependent diabetes mellitus because it requires the ‘administration of exogenous (originating outside the body) insulin for survival. Type 2 diabetes begins in adulthood as insulin production and cellular response decreases. This type does not always require insulin but can frequently be controlled by dict, exercise, and glucose-lowering drugs. Therefore. it is sometimes referred to as non-insulin-dependent diabetes, While these two types of diabetes present differently, the h kidney damage, blindness, and nerve damage are the same. The types of diabetes are summarized in Table 19-4, For internal use only ‘Scanned with CamSeanner { JITI SISTA YY JJ aecenee) KEELES.vet /e/e/wale/ek ee eceded / 3 a LOUCUOUCLUHCOCCEE | | | , 169 it is divided into six classes (A-F). as When diabetes mellitus is present during preghanc.. shown in Table 19~ TABLE 19-4 Categories of Diabetes Mellitus [Category Description ‘ype limmune | Formerly known as insulin-dependent diabetes mellitus (IDDM). Requires mediated diabetes | the use of insulin since the pancreas produces little to none. Occurs typically during childhood or adolescence; most common type of diabetes mellitus diagnosed before age 30. type? Formerly known a5 non-insulin-dependent diabetes mellitus (NIDDM). ‘Affects the way in which the body uses food. Typically diagnosed in patients over 30 years of age. type 3 Diabetes mellitus with other conditions or syndromes. Glucose levels between normal and diabetic. type 4 impaired glucose tolerance act) type 3 gestational | A carbohydrate intolerance that develops in 2% to 5% of all pregnancies diabetes and disappears when a pregnancy is over. TABLE 19-7 Normal Endocrine Values Hormone or chemical tested Normal serum lab values ‘ACTH <70 parm ADH £22 pg/mL with serum osmolality <285 mOsm/kg 3.8 S pg/mL with serum osmolality > 290 mOsm/kg ‘aldosterone Supine: < 16 ng/dL Upright: 4-31 ng/aL. contisol £22 meg/dL morning specimen) 3-17 megidl. rafterncon specimens contisol, free 20-90 mep/day epinephrine <120ngi. estrone (follicular hormone) male: 29-81 pg/mL female: follicular phase: 37-152 pe/mL midcycle: 72-200 pg/mL. oteal phase: 49-114 pp/mL. ‘postmenopausal: < 65 pg/mL. FSH male: 20-70 yr 09-18 1U/L > TO yr. 28-885 TUL female: follicular phase. 1.1-9.6 1U/L midcycle 22.209 LUA luzal phase 0.8-7 5 TUL Pregnancy <09 1UA. postmenopausal 44-95 810A, cu <8 ng/mL glucagon 50-200 pesml. For internal use only ‘Scanned with CamSeanner< 110 mgidl. lasting Fo-125 mg/d. (random insotin ctl, ua male: 20-70 yr: 13-129 1UA. > 70 yr 113.564 1 female: follicular phase: 08.25.81. smidcycle: 2557.3 1UA. Iuteal phaso: 0.8-27.1 10. pregnancy: < 4 IU/L S postmenopausal: $523 TU « mate: ~ 2-18 agent. female: ‘nonpregnant: 3-30 ag/ml. pregnant: 10-209 ng/mt. postmenopausal: 2-20 ng/ml. 11-54 pofmt. Ts free: 230-420 pid. reverse: 26-189 ngidl. total: 60-181 ngidt free: 0.818 ng/dL. total: 45-125 meg/al. male: 194.833 ng/aL female: < 62 ngiiL 05.4.7 melU/mL. 170 sldcose prolactin PTH Ts testosterone. total TSH PHARMACOLOGY Most endocrine drugs can be broadly classified into groups listed in Table 19-8. Anabolic steroids are used to build muscle mass, increase strength, and improve endurance. Although the use of anabolic steroids is illegal in professional sports, some athletes still take them. Medically, in counteracting the wasting syndrome common in advanced AIDS. their anti- they are helpfi Corticosteroids, or synthetic steroids from the adrenal cortex, are prescribed f inflammatory effects. Hormonal drugs vary widely in their functions, from promoting normal growth and development in dwarfism to regulating water loss in diabetes insipidus. Antithyroid medications decrease levels of T3 and T4 in patients suffering from hyperthyroidism, while patients with hypothyroidism often need thyroid replacement drugs to correct T3 and T4 s previously mentioned, individuals with type | diabetes mellitus require insulin in, but most use deficiencies. in order to survive. Some people with type 2 diabetes mellitus also require ins oral antidiabetic drugs to control serum glucose levels. TABLE 19-8 Classifications of Endocrinologic and Metabolic Drugs Classification Examples Usage ‘antithyroid drug Inhibits the production of T3 and T4 in the thyroid gland to treat hyperthyroidism. ‘methimazole, propylthiouracil, radioactive sodium iodide 131 ‘corticosteroid Replaces corticosteroids in adrenocortical insufficiency. ‘cortisone, dexamethasone, fludrocortisone, hydrocortisone, methylprednisolone. prednisolone. prednisone, triamcinolone Tormone Produces effects on body systems, such as skeletal growth in children with ‘desmopressin (DDAVP). lypressin, somatrem, somatropio. For internal use onl)” ‘Scanned with CamSeanner> fase oo oes HOS M* 9 slal J @/ of & ] ddddd ] ldd eeece ee cee } a | ooo b4 00 ipidus. dwarfism and water balance in diabetes ] vasopressin ~ insulin survival. Replaces pancreatic insulin, which is a major metabolic regulator necessary for insulin lispro, neutral protami Hagedorn (NPH), regular insulin, ultralente oral antidiabetic drugs ‘Acts by stimulating the pancreas to produce more insulin, increasing the number of insulin receptors, oF inhibiting digestion of glucos treat type 2 diabetes mellitus. ‘acarbose, chlorpropamide, glimepiride, glipizide, glyburide, metformin, tolazamide, Used to | tolbutamide thyroid Replaces the thyroid hormon T4 in patients with hypothyroidism. TS and | desiccated thyroid, levothyroxine, liothyronine, liotrix Abbreviations replacement drug Abbreviation Meaning ABGs ‘arterial blood gases ‘ACTH ‘adrenocorticotropic hormone ‘ADH ‘antidiuretic hormone BS blood sugar Ca ‘calcium Di | diabetes insipidus; diagnostic imagi DKA diabetic ketoacidosis DM [diabetes mellitus FBS fasting blood sugar FSH follicle-stimulating hormone GH ‘growth hormone hGH human growth hormone GIT ‘glucose tolerance test IDDM insulin-dependent-diabetes mellitus IGT impaired glucose tolerance K potassium LDL low-density lipoprotein LH luteinizing hormone MEN multiple endocrine neoplasia Na sodium NIDDM non-insulin-dependent diabetes mellitus: NPH | neutral protamine Hagedom (insulin) OcTT oral glucose tolerance test ‘OXT, OXY | oxytocin PBI protein-bound iodine PGH pituitary growth hormone PRL prolactin PTH parathyroid hormone RAI radioactive iodine RAIU radioactive iodine uptake RH teleasing hormone Ts ‘triiodothyronine Ts thyroxine TSH thyroid-stimulating hormone For internal use only ‘Scanned with CamSeanner172 CORBINIRGIESHS toTenns USSU heScHneleay, ei Form Pp Meaning Examplo(s) adeno [ sind Steno, adenectomy or adrenlo adrenal glands (See also advenal/a) | adrenocoriicowropie oy ‘adrenal/o | adrenal glands (see also adren/o) | adrenalectomy. a ae — oe =a oh calelo calcium caleemia ~T * ‘gluco sugar (see also glyco) ‘plucose, glucagon a glyco, ‘sugar (see also gluc/o) hyperglycemia Cun ‘gonad/o sex glands gonadotropic l hormon/o | hormone hormonal oP Pancreave | pancreas Dancreatie, pancreatitis ~ Parathyroid/o | parathyroid gland parathyroidectomy on pituitar’e | pituitary gland Rypopituitarism - hyo thyroid gland (see also thyroid/e) | thyrowopin, thyroxine “1 thyroid/o | thyroid gland (see also thyv7o) | thyroiditis, hyperthyroid =| ; PRPS PP PPPL p PPL PI For internal use only | ‘Scanned with CamSeanner