Questions Alerts!

Common questions in pharmacy exam is to ask!

 Hormone of anterior and posterior pituitary gland, thyroid hormone, Insulin,

corticosteroid hormones.
 Hypothyroid and hyperthyroidism symptoms. Lab investigations of serum TSH
 Hypoglycemia and hyperglycemia symptoms. Insulin function, pathophysiology of
diabetes.
 Hypo corticosteroids (Addison diseases) and hyper corticosteroids (Cushing's disease).
 Menstrual cycle; follicular phase, ovulation phase and luteal phase changes in hormone
levels and physiological functions of these stages.
 Menopause symptoms and management symptoms.

 
Endocrine System

Consists of a group of organs that have no ducts and therefore are also known as Ductless
glands that secrete hormones directly into the blood stream.
Major endocrine glands: Pituitary Gland (present under hypothalamus), the master endocrine
gland. Testes, Ovaries, Thyroid Gland (neck), Adrenal Gland (on kidney), Pancreas Gland
(endocrine and exocrine). Other glands include Parathyroid Gland (neck), Thymus Gland (chest)
and Pineal Gland (brain).
Pituitary Gland; Located at the base of the brain. Consists of two parts: anterior lobe and
posterior lobe. It is sometimes known as the master gland. It controls the functions of other
endocrine glands and is in turn controlled by the hypothalamus.
 

QAlerts!
Endocrine Hormones
Endocrine Types of hormone Target tissue Physiologic actions
gland

Hypothalamus Houses releasing and Anterior Controls release of anterior

inhibiting hormones pituitary pituitary hormone.

Anterior Thyroid-stimulating hormone Thyroid Q.) Production of thyroid

Pituitary gland (TSH) hormone (T 4 and T3, and
calcitonin).

Adrenocorticotropic (ACTH) Adrenal cortex Secretion of cortisol

Growth hormone (GH) Bones; soft Stimulates growth of bones

tissues and soft tissues
 Follicle-stimulating hormone
(FSH)
Luteinizing hormone (LH)
Prolactin
Posterior Vasopressin (antidiuretic
Pituitary gland hormone)
Q.) Oxytocin(formed in
hypothalamus and stored in
posterior pituitary gland).
Pineal Q.) Melatonin
Thyroid Thyroid hormone (Triiodo T 3
and levothyroxine T 4 ), and
calcitonin (C-cells).
Parathyroid Parathyroid hormone (PTH)
Females; ovary Promotes growth of ovarian
follicle;Stimulates estrogen
Males: Testes secretion
Stimulates sperm production
Females: Ovary Q.) Stimulates ovulation.
Stimulates progesterone
secretion
Males. Testes Stimulates testosterone
secretion
Females: breast Promotes breast
development;
Q.) stimulates milk secretion.
Prolactin is synthesized and
secreted by lactotrope cells
in the anterior pituitary gland,
breast and the deciduas.
Kidney Causes water retention
Uterus Causes contraction
Breasts Causes ejection of milk
Brain; anterior Sets the body’s “time
pituitary; clock”.Causes sleep in
reproductive response to darkness.
organs; possibly Q.) Pineal gland shrinks or
other sites. calcified with
aging.Melatonin is connected
with our circadian system
rhythm and environment.
Most cells Increases the metabolic rate;
necessary for normal growth
and development.
Q.) Calcitonin takes Ca from
Blood → Bones.
Bone; kidney; Increase amount of calcium
intestine
in the bloodstream, amount
of phosphate in the
bloodstream.
 Q.) PTH =  Ca (by bone
resorption), hypocalcemia
stimulate release of PTH.

Q.) PTH = phosphate

Thymus Thymosin T lymphocytes Enhances the production of T

lymphocytes.
Shrink after puberty.

Pancreas Insulin Secreted from beta Most cells Promotes use and storage of
cells nutrients particularly glucose,
after eating.Hyperglycemia
stimulate insulin release.

GlucagonSecreted from Most cells Maintains glucose levels in

alpha cells the bloodstream during
periods of no food.
Q.) Severe hypoglycemia
stimulates glucagon release.

Somatostatin and Digestive Inhibits digestion and

gastrinSecreted from delta
cells
F cells? pancreatic
polypeptides
system absorption of nutrients.
Inhibit secretion of insulin,
glucagon and gastrin.
Somatostatin is antagonist of
growth hormone and thus
opposes growth hormone
(GHIH).

Q.) Adrenal Epinephrine → nor- Kidney Increases Na + retention and

Medulla epienphrine K + excretion

Q.) Adrenal Zona Aldosterone Kidney Increases Na+ retentionand

cortex glomerulosa Q.) K + secretion.
(out)

  Z. fasciculata Cortisol Most cells Increases glucose in the

bloodstream

Z. reticularis Androgens Females: bone Puberty growth spurt and sex

and brain drive in females.

Testes (male) Testosterone Male sex Stimulates production of

organs; body as sperm; responsible for
a whole. development of sex
characteristics. Promotes sex
drive.

Ovaries Estrogen Female sex Stimulate uterine and breast

 (female) organs; body as growth; responsible for sex
a whole characteristics.

Progesterone Uterus Prepares for pregnancy

***
 
Negative Feedback

The negative feedback occurs when a hormone feedback to

decrease production of its own hormone.
 
Positive Feedback

The positive feedback occurs when a hormone feedback to

increase its own production.

QAlerts!
Thyroid Hormone
Thyroid Gland

Secretes thyroid hormones LEVOTHYROXINE (T 4):, TRIIDOTHYRONIN (T 3 ) AND CALCITONIN,

which in turn controls the body’s metabolic rate.
Thyroxin or Levothyroxine Naturally occurs in levo (L) isomer form produced in the thyroid
gland.Synthesis of thyroid hormones is stimulated by TSH.

Levothyroxine T 4 Converts in the liver and other organs to Tiiodothyronin T 3 by

Q.) deiodination (deiodinase). Controls the rate of metabolism in the body.
 
Triiodothyronine (T 3):

Q.) Metabolically active form or active thyroid hormone. The iodide pump (trap) is present in
thyroid follicular epithelial cells. Actively transports iodine into the thyroid follicular cells for
incorporation into thyroid hormones.

 
 
Calcitonin (a peptide):Hypocalcemia hormone.

 Secreted by parafollicular cells (C-cells).

 Reduces blood calcium ion concentration by moving Ca from blood to bones.
 Used in treatment of osteoporosis associated vertebral fracture.
 Q.) Hypercalcemia stimulates calcitonin production.

 
Functions of Thyroid Hormones
Question Alerts!
 Growth and development
 Proper function of all body system
1. Conversion of T 4 to T3
 Maintenance of all body tissues. Carbohydrate, fat,
by deiodination.
protein, and vitamin metabolism (Basal Metabolic
2. Calcitonin production is
Rate).
stimulated by?
 Affects the secretion of other hormones (insulin, NE,
Epi, cortisol, estrogen and testosterones.

Mechanism of Action

 At the target cell, proteases split protein carrier off from the thyroid hormone and most
of T4 is deiodinated to T 3.
 T3 (and probably some T4) enter the cell through membrane transport proteins and bind
to a specific nuclear receptor.

 
  Hypothyroidism Hyperthyrodism

  Thyroid gland is under active and Overactive thyroid gland causing an

produces insufficient thyroid abundance of thyroid hormone.
hormone. Thyrotoxicosis is the general term for
over activity of the thyroid gland.

Q.) Fatigue Heat intolerance

Symptoms Sensitivity to cold Dry flaky skin and Profuse sweating (excessively sweating)
Coarse hair Diffusely enlarged nontender goiter.
Slowed speech (deep voice) Nervousness, irritability, anxiety and
Puffy face, hands, feet Hearing loss insomnia
Decreased libido Weight loss in spite of increased appetite
Weight gain Tremor and muscle weaknessTachycardia
Constipation (Palpitation)
Impaired memory Diarrhea
Hypertension, bradycardia Slow Oily skin
return of deep tendon reflexes

Diseases Q.) Hashimoto(autoimmune, the
most common type of
hypothyroidism. Common on in
elderly).
Q.) Surgical removal of thyroid.Iodine
deficiency.
Myxedema is severe hypothyroid
condition. If untreated Myxedema
and coma may develop.
Dwarfism Mental retardation
Q.) Graves’ disease (diffuse toxic goiter)
the most common form of
hyperthyroidism, autoimmune disorder. 
Antibodies (long-acting thyroid
stimulators) bind to and activate TSH
receptors.
Plummer’s disease (toxic nodular goiter).

Q.) Serum The most sensitive test for detecting

TSH assay serum TSH
the hypothyroid state.  serum TSH

Free This is not separate test but  

thyroxin estimation of free T4 level
index (FTI) mathematical interpretation of
relationship of RT3U and serum
T4levels.

(Free T4 ) T4 indicates hyperthyroidism

Serum free thyroxine  FT4

(TT3 ) Disproportionate rise indicated

Serum total triiodothyronine TT 3 hyperthyroidism.
Useful in early detection and rule out of
hyperthyroidism

Pregnancy Levothyroxine is used to Methimazole or propylthiouracil the

treat.Adequate dose thyroxin, treatment of choice.
necessary for development of the
fetal brain.

Q.) Serum >5.5 mU/L Q.) <0.3 mU/L

TSH

Treatment Levothyroxine (Synthroid, Eltroxin) Methimazole, Propylthiouracil, Lugol

solution.
Q.) Thyroid function tests (normal serum TSH is 0.3 to 5.5 mU/L).
 

QAlerts!
Parathyroid Hormone
Parathyroid Glands

Four tiny glands in the posterior surface of the thyroid gland, which is positioned on the
esophagus, produce parathyroid hormone (PTH), which regulates the calcium metabolism in
the body.
 
Parathyroid Hormone

Q.) Hypocalcemia stimulates parathyroid hormone production and Ca stimulates vitamin D

activation and Ca stimulates Calcitonin.

Hypercalcemia = Stimulate Calcitonin production

Hypocalcemia = Stimulate PTH production.

Q.) Stimulate reabsorption calcium in kidney and inhibit reabsorption of phosphate.

Stimulate production of 1, 25-(OH)-Vitamin D.

There is 3-way relationships with calcium, vitamin D and parathyroid hormone. When vitamin D
levels are extremely low in the body, the parathyroid gland is affected and usually tried to
compensate by releasing more of the parathyroid hormone. This PTH helps deposit calcium
into bone. Vitamin D causes calcium to be absorbed from the gut into bloodstream.

                                                               

Low Vitamin D
                                                          
                                   RELEASE PTH
 

1. PTH Efflux of calcium from bones.

2. Loss of Calcium in urine (decrease excretion of calcium & stimulate Vit.D 3 formation).
3. Absorption of calcium from intestine.

 
Hypoparathyroidism Hyperparathyroidism

Decrease production of PTH Increase production of PTH

Decrease blood calcium Increase blood calcium levels (Primary
Increase blood phosphate levels hyperparathyroidism exacerbates
Causes convulsions hypercalcemia by increasing renal synthesis
Causes hypokalemia of 1, 25 dihydroxy
Causes neuromuscular irritability vitamin D, which consequently reduces bone
formation, increases bone resorption and
increases intestinal absorption of dietary
calcium.)
Decrease blood phosphate levels
Causes muscle weakness
Causes muscle atrophy
Causes fatigue

Q.) PTH hormone Ca absorption in intestine via activation of vitamin D and reabsorption of
Ca in kidney.
Q.) The level of calcium in body is managed by calcitonin which decreases calcium levels and
parathyroid hormone which increases the calcium levels.
 
Pancreas

Q.) Pancreas is present in upper right side of the body and spread to left side. In the pancreas,
the islets of Langerhans the acini which produces digestive enzymes. Islets produce 3 types of
hormones;

 Insulin produced by beta cells of islets of langerhans.

 Glucagon produced by alpha cells.
 Somatostatin and gastrin produced delta cells (extra pancreatic cells).

QAlerts!
Insulin
Insulin

Insulin is peptide with 51 amino acid chain. Stored in vesicles in combination with zinc. Half-life
insulin is 3 to 5 min controls blood glucose concentration.

Q.) Insulin (tyrosine kinase receptors): insulin secretion when blood glucose, amino acids
and fatty acids).

 
Question Alerts!

1. Insulin & glucagons released from? Beta cell & alpha cells
2. Epinephrine released? Adrenal medulla
3. Aldosterone hormones released from? Outer layer of adrenal cortex
4. Aldosterone antagonist spironolactone act on collecting duct and prevent K+ secretion
causes hyperkalemia.

 Increase glucose uptake into cell.

 Glycogenesis: Increased glycogen storage in liver, and muscle.
 Decrease gluconeogenesis: Decrease synthesis of glucose from non-carbohydrate
source.     
 Lipogenesis: Fat/triglyceride storage (adipose tissue).
 Insulin promotes K + uptake into the cell.

glucose
uptake
glycogenesi
s

gluconeog
enesis.

Glycogenol
ysis

 
Glucagon
Stimulated breakdown of glycogen to glucose (glycogenolysis) in the liver thus increase blood
glucose levels.
 
Diabetes Mellitus

After a meal or a snack, the pancreas secretes insulin and signals the body to absorb glucose
so blood sugar does not spike.
 
Types of diabetes:

 Insulin-Dependent/Type 1 (IDDM):  Due to impaired insulin production.

 Non-Insulin Dependent/Type 2 (NIDDM): Due to fat, liver, and muscles cells do not
respond properly to insulin,
 Gestational diabetes (i.e. glucose intolerance w/onset during pregnancy).
 Secondary Diabetes (e.g. pancreatic disease).

 
Q.) Insulin requirement increase Insulin requirement decrease

Heavy meals Physical activity

Emotional Stress Exercise
Infections
Pregnancy

 
  Hypoglycemia Hyperglycemia

AUTONOMICFPG Q.) Sweating, palpitation, fatigue, Polyphagia, polyuria,

<4 mmol/L<70 hungry, tremors (shaking). hyperglycemia, glycosuria,
mg/dL polydipsia.

CNS Confusion, nervousness, disorientation,  

 FPG <2-3 dizzy, anxious, headache, irritable,
mmol/L<50 mg/dL blurred vision.

Treatment Glucose Tab, Dextrose Tab  

  Stimulates Secretion of Glucagon Stimulates Secretion of

Insulin

FPG: Fasting blood glucose level (8 hours without calories intake); Normal glucose FPG: 5 to 6
mmol/L or 90 to 120 mg/dL.
 
Diabetes Insipidus (DI)

Q.) Anti diuretic hormone (vasopressin) deficiency causes diabetesinsipidus Insufficient ADH
due to dysfunction of hypothalamic nuclei (e.g. tumors, hydrocephalus, histiocytosis, trauma).
Passage of large volumes of dilute urine. Decrease in ADH causes large volume of dilute urine,
polyuria, polydipsia and polyphagia.

Treatment: Anti diuretic hormone

 
Diabetes insipidus central Diabetes insipidus nephrogenic

There is NO ADH production ADH present but kidney does not respond.

Autoimmune Acquired or drugs (lithium)

 
Thymus Gland

Regulates the development of T-lymphocytes in immune system.

 
Pineal Gland

 Small cone shaped gland and the smallest of all glands located in mid brain
 Q.) Large in children and begins to shrink at puberty.
 Only brain structure that does not come in a pair
 Q.) Produces melatonin and dimethyl tryptamine in the dark.

 
Functions

 Influences circadian rhythms e.g. sleepand temperature

 Sexual development and regulates the mating behavior
 Regulates day and night cycle.

 
Adrenal Gland
 

QAlerts!
Corticosteroids
Two adrenal glands one on top of each kidney.
 
Adrenal Control by Hormones HYPER HYPO
gland

Adrenal Sympathetic(chromaffin Epinephrine Hypertension Hypotension

medulla cells) (adrenaline) Pheochromocytoma

Cortex: Renin-angiotensin Aldosterone(↑N a/H 2O Ascites Hyperkalemia

outer &↓K +)

Middle ACTH Corticosteroids Q.) Cushing Q.) Addison

layer Syndrome Disease

Inner ACTH Androgens Gynecomastia Hypogonadism

layer

RAAS: Renin-Angiotensin Aldosterone system.

 
Q.) Hypo corticosteroids

Addison's disease is chronic adrenal insufficiency, or hypercortisolism.

Causes auto immune reaction, HIV and tuberculosis.
Signs and symptoms: Chronic fatigue that gradually worsens, Muscle weakness, weight loss
and loss of appetite, nausea, diarrhea, or vomiting.
Treatment:  Replacement of missing cortisol and fludrocortisones.
 
Q.) Hypercorticosteroids

Cushing's syndrome or hypercortisolism or hyperadrenocorticism is caused by high levels of

cortisolin the blood. Cushing syndrome or disease caused by a pituitary tumor that releases too
much adrenocorticotropin, stimulating the adrenal gland to over produce cortisol.
Signs and symptoms: Rapid weight gain, moon face, buffalo hump, reduced libido and easy
bruising.
Treatment: Removal of adrenals. Post operative steroid replacement (hydrocortisone or
prednisolone).
 
Ovaries

Produces two hormones estrogen and progesterone.

Estrogen: Controls the development of female sex characteristics and reproductive system.
Progesterone: Prepares the lining of the uterus for implantation of a fertilized egg.
 
  HYPER  HYPO (menopause)

Estrogen18- Weight gain

Q.) Hot flushes, night sweat, dry skin, mood
CARBON Increase risk of blood clot,
swings, vaginal atrophy, dryness, bone loss,
STEROIDS mood changes, breast cancer,
yeast infection. Urinary incontinence.
headache, edema

Progestins Most of symptoms of estrogen Infertility, vaginal bleeding or spotting.

21-CARBON deficiency. +Breast

 
STEROIDS tenderness, acne

  Combined oral contraceptives

Menopause symptoms
side effects
 
Ovulation Cycle and Menstruation

During the menstrual cycle estrogen is produced by the ovarian follicles. After ovulation
estrogen is produced by the corpus luteum. During pregnancy ovulation does not occur. It is
suppressed by high levels of estrogen and progesterone's.
                                                               
Menstrual cycle

Follicular Q.) Ovulation

Luteal phase
phase phase

Day 1 to 13
Day 14 Day 15 to 28
or variable

Estrogen LH and Progesterone

elevated FSH

Ovulation day =
Uterine
  cycle length- 14
contraction
days.

Ovulation day = cycle length- 14 days.

 
Question Alerts!

Ovulation Tests detects?LH

Pregnancy test detects? hCG
 
Q.) Pregnancy Test

Human chorionic gonadotropin (hCG) hormone levels are elevated in first 3 months of
pregnancy (first trimester).
Progestin's in pregnancy is produced by ovaries, corpus luteum and placenta.
 
Menopause

Cessation of menstrual periods for at least 6 months to 1 yearis referred as menopause.

Occurs when the ovaries stop producing estrogen. Ovarian follicles are depleted at
approximately 51 years of age.

Q.) Most common vasomotor symptoms:Hot flashes, night sweat, mood swings, sleeplessness,
lethargy, and depression. Urogenital atrophy (this leads to dryness of the vagina, dyspareunia
(painful intercourse).
 
TIPS

1. Adrenal medulla 2. Pituitary gland 3. Posterior pituitary gland

4. Diabetes insipidus 5. Glucose 6. H 2O + CO 2

7. Excessive urination 8. Outer adrenal cortex 9. Sensitivity to cold

 10. Bradycardia 11. Weight gain 12. Glycogen

13. Constipation 14. Dry skin 15. Weight loss

16. Tachycardia 17. Diarrhea 18. Sensitivity to heat

19. Sweating 20. Palpitation 21. Fatigue

22. Polyphagia 23. Polyurea 24. Blurred vision

25. Polydipsia        
 

 Glycolysis; Glucose →(           )

 Glycogenesis; Glucose →(           )
 Glycogenolysis; Glycogen →(          )
 Gluconeogenesis: fats & proteins →(          )
 Epinephrine is released from? (        )
 Aldosterone is released from? (          )
 ACTH is secreted by? (             )
 Oxytocin is secreted from? (         )
 ADH is secreted from? (          )
 Deficiency of ADH gives... (         )
 Symptom of diabetes insipidus (           )
 Symptoms of diabetes mellitus (          )
 Symptoms of hypoglycemia (         )
 What hormones are released from posterior pituitary gland? (      )
 Hypothyroidism laboratory investigation include (             )
 Epinephrine is released from? (        )
 Aldosterone is released from? (          )
 Testosterone to 5-hydroxy testosterone is catalyzed by?  (          )
 Diabetes mellitus symptoms? (         )
 Hypoglycemia symptoms? (           )
 Symptoms of hyperthyroidism? (           )
 Symptoms of hypothyroidism? (            )
 Symptoms of Cushing syndrome? (              )
 Addison disease is → (            )