Semi-Final

c
C lL iI n
N iI C
c Aa lL lesson 01
Clinical Instructor:
c
C hHe E Mm Ii Ss Tt R
rY y Anna Marie Taguilan, RMT

Endocrinology
Maintain the constancy of chemical
composition of extracellular and
Ee n
nd do oc c rr i n ee
i n intracellular fluids
Ss y
y ss t
te m
e m
A network of ductless glands of
internal secretions FF ee ee dd bb aa cc kk
It is the regulatory system of the body
SS yy ss tt ee m
m
It is regulated by means of control of
hormone synthesis rather than by
degradation
positive
an increase in the product also
increases the activity of the
hho
orrm
moon
nees
s system and the production rate

Chemical compounds secreted into the Gonadal hormones

blood that affect target tissues generally Thyroidal hormones
at a site distant from original production Adrenocortical
They play an important role in the hormones
growth and development of an organism
They are regulated by the metabolic
activity either positive or negative
feedback mechanism

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c
C lL iI N
n i
I Cc Aa Ll lesson 01

c Hh e m Ii Ss Tt Rr Yy
Clinical Instructor:
C E M Anna Marie Taguilan, RMT

negative secreted in endocrine cells and

remains in relation to plasma
an increase in the product decreases Juxtacrine membrane
acts on immediately adjacent
the activity of the system and the cell by direct cell-to-cell
production rate contact

secreted in endocrine
LH cells and released into
Exocrine lumen of gut and
affects their function
secreted in neurons and
t
T yYp PeE sS Oo Ff released into extracellular

h O
H o rR MmO o n
N Ee Ss Neurocrine space
binds to receptor in nearby
Aa Cc Tt I iOo Nn cell and affects its function

secreted in 1 location and secreted in neurons and

release into blood released from nerve
Neuroendocrine
Endocrine circulation endings
binds to specific receptor to interacts with receptor of
elicit physiological response cells at distant site

secreted in endocrine cells and

released into interstitial space 33 c
C lL A
asS sS e
E Ss
Paracrine binds to specific receptor in
adjacent cell and affects its
function
Oo Ff Hh OorRMmO on NeE Ss
secreted in endocrine cells and
sometimes released into
Autocrine interstitial space
binds to specific receptor on
Steroid Hormones
cell of origin resulting self Synthesized by adrenal glands, gonads, and placenta
regulation of its function Synthesized from cholesterol as needed, not stored,
lipid-soluble

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 Semi-Final
c
C lL iI N
n i
I Cc Aa Ll lesson 01
Clinical Instructor:
c H
C h eE Mm Ii Ss Tt Rr Yy Anna Marie Taguilan, RMT

Need a carrier protein to circulate in the blood

Mechanism of action: Free hormone is transported Glycoprotein hormones, FSH, LH, TSH,
across cell membrane to interact with intracellular and hCG, composed of alpha and beta
receptor; complex binds to chromatin, producing
chains; alpha chains identical and beta
mRNA; mRNA initiates production of proteins that
chains unique for each hormone
carry out the function attributed to the specific
hormone.
Clinically significant hormones: cortisol, aldosterone,
testosterone, estrogen, and progesterone hormone a) Peptide hormones synthesized as
synthesis is regulated through negative feedback by
prohormone, cleaved to produce
another hormone (e.g., cortisol/ACTH).
circulating hormone (e.g., insulin)

Hormone synthesis is regulated through

protein hormones
Synthesized by anterior pituitary, placenta,
pancreas, and parathyroid glands
Synthesized, then stored in the cell as
secretory granules until needed
Not need carrier proteins to enter blood; water
soluble
Mechanism of action: Protein hormones
interact with a cell membrane receptor. This
activates a second messenger system and
then cellular action.
Clinically significant hormones: follicle-
stimulating hormone (FSH), luteinizing hormone
(LH), thyroid-stimulating hormone (TSH), human
chorionic gonadotrophin (hCG), insulin,
glucagon, parathyroid hormone, growth
hormone, and prolactin.
change in analyte concentration in serum
(e.g., insulin/glucose) and negative feedback
by another hormone (e.g., testosterone/FSH).
Amine hormones
Synthesized by thyroid and adrenal glands
Synthesized from amino acids
Some require a carrier protein while others do not
Mechanism of action: Epinephrine and norepinephrine do
not bind to carrier proteins and interact with the receptor
site on the cell membrane. Thyroxine and triiodothyronine
circulate bound to carrier proteins, with the free hormone
being transported across the cell membrane to interact
with the intracellular receptor.
Clinically significant hormones: epinephrine,
norepinephrine, thyroxine, and triiodothyronine
Hormone synthesis is regulated by nerve stimulation,
another hormone (e.g., thyroxine/TSH), and negative
feedback.

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 Semi-Final
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C l Ii N
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C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

stimulates secretion of thyroid-stimulating hormone

m eetthh o
M od d ss f foor r (TSH) and prolactin

qu
Q uaan ntt ii ff yy iinngg Dopamine
Hh o
orrm mo on ne e ss
inhibits prolactin release
Enzyme-Multiplied Immunoassay Technique(EMIT) Somatostatin (Growth Hormone
Fluorescent Immunoassay (FIA) Inhibiting Hormone)
Fluorescent Polarization Immunoassay (FPIA) inhibits secretion of TSH and GH
Chemiluminescent Immunoassay (CLIA)
Antidiuretic Hormone (ADH)
Electrochemiluminescence Immunoassay (ECLIA)
(Arginine Vasopressin)
High-Performance Liquid Chromatography (HPLC)
produced by supraoptic and paraventricular nuclei
of the hypothalamus
HH YY PP OO TT HH AA LL AA M
M UU SS transported to the posterior pituitary for storage

Corticotropin-Releasing
hormone (CRH)
Oxytocin
stimulates secretion of adrenocorticotropic produced by supraoptic and paraventricular
hormone (ACTH) nuclei of the hypothalamus
Gonadotropin-releasing transported to the posterior pituitary for
hormone (GnRH) storage
stimulates secretion of follicle-stimulating
hormone (FSH) and luteinizing hormone (LH) ANTERIOR PITUITARY
Growth hormone-releasing
Adrenocorticotropic Hormone (ACTH)
hormone (GHRH)
(Adenohypophysis/ Adenohypophyseal system)
stimulates secretion of growth hormone (GH)
Thyrotropin-releasing corticotropin-releasing hormone stimulates
hormone (TRH) secretion of ACTH, which in turn stimulates
synthesis of cortisol
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C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

Increased Decreased hypothalamus controls the release of growth

Cortisol Cortisol hormone from the anterior pituitary with growth
hormone-releasing hormone, which is stimulatory,
ACTH Decreased
Decreased Increased
Increased and somatostatin, which is inhibitory
has direct effect on metabolism in numerous tissues:
CRH Decreased
Decreased Increased
Increased
antagonistic effect to insulin in
*ACTH and cortisol exhibit diurnal relationship to glucose metabolism
variation, with highest levels in the
morning and lowest levels in late stimulates gluconeogenesis in the liver
afternoon to early evening.

stimulates lipolysis
Growth hormone/ Somatotropin

promotes protein synthesis

gLUCAGON
ACTH
GROWTH
GROWTH HORMONE
HORMONE reference
R E F E R E N C E Rrange
ANGE
Basal Level: 2-5 ng/mL
CORTISOL
CORTISOL
INSULIN Increased Decreased
Cortisol Cortisol
EPINEPHRINE Familiar
CHILDREN Gigantism
Gigantism Familiar
Tumor
Tumor
TYROSINE Irradiation
Irradiation
ADULT Acromegaly
Acromegaly Pituitary
Pituitary
Gg A
aGgc
CiI EeTt
Adenoma
Adenoma

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c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT
decreased
levels
Prolactin
-may be caused by a tumor that
secreted by pituitary lactotroph cells and
released upon stimulation from TRH
compresses or replaces normal
release of this hormone is inhibited by dopamine pituitary tissue
functions include: -seen in panhypopituitarism
initiates and maintains lactation (loss of all anterior pituitary
effects reproduction through ovarian and function)
testicular steroidogenesis
affects the immune system
increased
levels
Follicle-stimulating
may be caused by pituitary adenomas that
produce prolactin, trauma, inflammation, hormone
chronic renal failure, and as a side effect of
the administration of certain drugs (e.g., Gonadotropin - FSH AND LH
tricyclic antidepressants, phenothiazines,
reserpine) Tropic Hormones - Acth, fsh,TSH,LH
RESULTS TO HYPOGONADISM

Luteinizing hormone
FOR MALES- helps the laydig cells to
produce testosterone
FOR FEMALES- for ovulation and final
Kaya pa follicular growth

Thyroid-stimulating
hormone
diba?
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 Semi-Final
c L
C l Ii N
n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

POSTERIOR PITUITARY
ddeeCcRr EeAas
SeEd
D
neurohypophyseal
Neurohypophyseal
ll e
e v
veel
l
Ssystem
ystem

Not true endocrine glands results to polyuria, causing

diabetes insipidus and
Not capable of producing the hormone it is
polydipsia
only capable of releasing it
controls water homeostasis by
Antidiuretic Hormone affecting the permeabilityof the release of this hormone is
collecting tubules of the kidney stimulated by uterine stretch
(ADH) / Vasopressin and enhancing water
resorption,which makes the Oxytocin receptors which in turn
urine more concentrated and stimulates uterine
the blood more dilute contractions during childbirth
raises blood pressure by the action of suckling
stimulating musculature stimulates tactile receptors
ofarterioles and capillaries,
affects uterine contraction, and that promote the secretion of
promotes intestinal muscle oxytocin, which causes
contraction ejection of breast milk
IiN
n Cc RrEeAaSsEeDd present in males, but its
function is unknown
l
Le v EeLl
E V
adrenal glands
*Syndrome of Inappropriate
ADH Secretion (SIADH)
-occurs when there is -located above each kidney
uncontrolled secretion of
ADH without any known
stimulus for such release
*shaped like pyramids
ADH is released even though the blood
volume is normal or increased and plasma Aadrenal
D R E N A L CcO
oRrT
tEeX
x
osmolality is low may be caused by ectopic
tumor production of ADH as in small cell
carcinoma of the lung, central nervous system
(CNS) disease, pulmonary disease, or as a produces steroid hormones
side effect of administration of certain drugs Outer portion of the gland,
composed of three layers
*Color:yellow

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C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

Zona glomerulosa Androgens

outermost layer, secretes mineralocorticoids,
with aldosterone being the major hormone. -required for sexual function
Zona fasciculata (contribution from the adrenal glands
is minimal as compared to the gonads)
second layer, secretes glucocorticoids, with
cortisol being the major hormone.
Aldosterone
Zona reticularis
third layer, secretes sex hormones, controls the retention of Na+(Sodium),
principally the androgens. Excessive CP(Creatine Phosphokinase), and
production of androgens causes virilization. H2O(Water), the excretion of K+ and H+ and,
therefore, the amount of fluid in the body
adrenal
A medulla
DRENAL m edulla production is controlled by the renin-
angiotensin system of
produces amine hormones the kidney (When the juxtaglomerular apparatus
Inner portion of the gland
secretes catecholamines (synthesized of the kidney detects low serum sodium or
from tyrosine by chromaffin cells of pressure changes in the blood perfusing the
the adrenal medulla, brain, and kidneys, due to decreased blood pressure or
sympathetic neurons) blood volume, renin is produced.)
*Color: dark mahogany *Renin is a protein that acts on angiotensinogen to
produce angiotensin I.
33 GgRrOou
UPpSs Oo Ff s
StTe E RrOo IiDd *Angiotensin I which is acted on by angiotensin-
HhOoR
rMmOoN
n EeSs Ssecreted
ECRETED converting enzyme to catalyze the formation of
angiotensin II.
Y Aadrenal
Bby DRENAL G g LlAaN nDdSs
*Angiotensin II stimulates the secretion of
aldosterone and is a potent vasoconstrictor.
Mineralocorticoids -functions to increase salt and water
conservation
regulate salt balance
through renal tubular retention of Na+ and Cl~
Glucocorticoids and H2O secondarily and
to promote excretion of K+ and H+
assist with carbohydrate metabolism
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C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

overall effect is vasoconstriction, which increases

secondary
blood pressure (BP), and Na+ retention, which
promotes increase in blood volume (BV) renin- angiotensin
RENIN-ANGIOTENSIN
increase in BP and B V suppresses secretion of systemdisorder
system disorder
renin and, thus, the synthesis of aldosterone
excess production of renin
Rr EeFf Ee Rr EeN
nCc Ee malignant hypertension
RrAaNn Gg Ee Ss renin-secreting renal tumor
Adult supine: 3-16 ng/dL
Adult upright: 7-30 ng/dL
*Blood levels of aldosterone are higher in the morning.
Hypoaldosteronism

Hyperaldosteronism

primary attrro
A opph
hyy ooff a
adrenal
drenal
gglands
lands
a d r e n a l disease
Adrenal disease Addison disease
aldosterone- secreting adrenal atrophy of adrenal glands with depressed
production of aldosterone and the
adenoma (Conn syndrome)
glucocorticoids
aldosterone- secreting adrenal causes decreased secretion of aldosterone
carcinoma, and cortisol, increased ACTH, increased
or hyperplasia of adrenal cortex (3-MSH, decreased blood glucose;
decreased Na+ and Cl~, and ncreased K+
congenital deficiency of 21- hydroxylase
enzyme

tara review
sa 7/11
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 Semi-Final
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c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT
Low levels of plasma cortisol promote ACTH release.
Cortisol Elevated levels of plasma cortisol inhibit ACTH
release.
physiological effects include:
anti-insulin effects on carbohydrates that result Rr Ee Ff Ee Rr Ee N
nCce E
in increased blood glucose Levels Rr Aa N nG geE Ss
*(GACIET)(Glucagon, Acth, Growth
Reference Ranges Total Cortisol:
Hormone,
8 AM: 5-23 mcg/dL
Cortisol, Insulin, Epineprine, Tyroxine)
3 PM: 3-16 mcg/dL
*All - hyperglycemic except insulin which is
*Cortisol and ACTH exhibit diurnal variation!
hypolycemic
*Cortisol -Hyperglycemic agent
Hypercortisolism
*Gluconeogenesis- Non carbohydrate
source is primary
converted into glucose 6- phosphate
*Lypolysis- Fat decomposition Adrenal adenoma or carcinoma
*Lypogenesis- Formation of fatty acids from Exogenous administration of
carbohydrates cortisol
*Glycogenolysis- Conversion of glycogen to Cushing
glucose syndrome
*Glycolysis- Conversion of glucose
molecules to lactate or pyruvate
Increased gluconeogenesis
increased lipolysis secondary
increased protein catabolism Excessive production of ACTH
decreased protein synthesis
due to pituitary tumor
decreased antibody formation
Ectopic production of ACTH by
suppressed inflammatory response
regulation of cortisol: The hypothalamus secretes nonendocrine tumor
corticotropin- releasing hormone and the anterior Cushing disease
pituitary secretes adrenocorticotropic hormone,
which controls cortisol production via a feedback
loop. Jerielyn Grace Bumarlong Blas
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Anna Marie Taguilan, RMT

Hypocortisolism SsIiGgNnSs A
aNnDd
primary SsYy M
mPpTtOoMm Ss
Atrophy of adrenal gland Increased serum cortisol
Cortisol lacks diurnal variation
Autoimmune disease
Hyperglycemia
Tuberculosis
Decreased ACTH
Prolonged high- dosage cortisol Weight gain in the face (moon face) and abdomen
therapy Buffalo hump back
Thinning of skin
Easy bruising
secondary Hypertension
Muscle wasting
Pituitary Decreased immune
response
hypofunction

CUSHING
Syndrome VS. Disease
CUSHING SYNDROME
Syndrome Disease
results from cortisol excess
Cortisol Increased
Increased Increased
Increased
regardless of cause
ACTH Decreased
Decreased Increased
Increased
due to pituitary tumor

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 Semi-Final
c L
C l Ii N
n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

Epinephrine
Iincreased
N C R E A S E D Llevels
E V E L S Oof
F
mobilizes energy stores by converting glycogen Eepinephrine
P I N E P H R I N E Aand
ND
to glucose, which allows the voluntary muscles Nnorepinephrine
OREPINEPHRINE
to have greater work output; released in
response to low blood pressure, hypoxia, cold
exposure, muscle exertion, and pain

Norepinephrine PHEOCHROMOCYTOMA
Tumor of the adrenal medulla
functions as a neurotransmitter affecting the Usually benign
vascular smooth muscle and heart; released Plasma epinephrine and norepinephrine
primarily by the postganglionic sympathetic nerves
can be quantified using Fluorometric
Methods
Dopamine VMA can be quantified using
Colorimetric/Spectrophotometric
-functions as a neurotransmitter in the
Methods
brain affecting the vascular system
*Epinephrine and norepinephrine are
metabolized into metanephrine and NEUROBLASTOMA
Tumor of the adrenal medulla
normetanephrine and then to final end
Malignant tumor
product vanillylmandelic acid (VMA). Some
Occurs in children
metanephrine and normetanephrine along Produces epinephrine and norepinephrine
with the end product VMA are excreted in along with dopamine
the urine.
a m
m uun
n a
a Characterized by increase in HVA and VMA

ngg a
a kk a urinary excretion

Hiin
H
e h
h !
!
May be quantified using HPLC, Gas

i
ssaaggllitt b
b e Chromatographic and Spectrophotometric
methods
*HVA- end product of dopamine metabolism

Jerielyn Grace Bumarlong Blas

@jxrxxlyn - Jeryang 2022
 Semi-Final
c L
C l Ii N
n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

OVARIES
Ovaries are part of the hypothalamic- Three Primary
pituitary-gonadal axis. EstrogenS
The anterior pituitary secretes follicle-
(most abundant estrogen
stimulating hormone, which stimulates growth Estrone in menopousal women)
of the ovarian follicles and increases the Matanda- ini one
plasma estrogen level. FSH is under the -principal estrogen
control of gonadotropin-releasing hormone. Estradiol synthesized by the ovaries
*most potent estrogen
The anterior pituitary secretes luteinizing *most abundant in pre
hormone, which stimulates production of menopausal women
Trio- You, Husband and Baby
progesterone at ovulation. LH is under the Estriol
control of GnRH.
Estrogens and progesterone exert negative
feedback to the hypothalamus and pituitary, Progesterone
which controls FSH and LH synthesis.
*estrogen found in maternal urine
Abnormal synthesis of estrogens may be
*major estrogen secreted in placental
caused by the ovaries (primary disorder) or
secreted by the ovarian follicles, mainly the
as a secondary disorder due to a primary
corpus luteum following ovulation, and by the
disorder of the pituitary or hypothalamus.
placenta in pregnancy to maintain the uterus

Estrogens
secreted by the ovarian follicles and by the
placenta in pregnancy (and to a much
lesser extent by the adrenal glands and
testes)
Ffunctions
UNCTIONS
Promotes development and maintains the female
reproductive system, including the uterus, fallopian
tubes, and vagina
Responsible for development and maintenance of
secondary female sex characteristics (e.g., breast
development, maturation of external genitalia, fat
deposition, termination of bone growth)

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E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

changes
C H A N G E S Iin N Luteal phase (second half)
Hhormones
O R M O N E S Dduring URING characterized by progesterone promoting
menstrual
M E N S T R U A L Ccycle YCLE endometrium tissue to accept the fertilized
ovum; progesterone measurements clinically

1. In the first half of the menstrual cycle, FSH useful to confirm ovulation
promotes growth of ovarian follicles and an
increase in estrogen (low in first 7 days of HYPERESTRINISM
cycle).
2. Estrogen peaks at midcycle, causing a decrease females
in FSH but promoting the LH surge at midcycle. Precocious puberty:Ovarian tumor, hypothalamic
3. LH triggers ovulation, which is followed by a tumor, adrenal tumors (rare); may be difficult to
decrease in estrogen and LH levels. determine
4. The follicle becomes the corpus luteum, which Infertility and irregular menses: Polycystic ovaries,
produces estrogen and progesterone. estrogen- producing ovarian tumors, disorders of
the hypothalamus or pituitary
5. Lack of fertilization (thus absence of human
Postmenopausal bleeding: Cervical or endometrial
chorionic gonadotropin) causes the corpus
carcinoma,estrogen- producing ovarian tumors,
luteum to degenerate along with decrease in the
exogenous estrogen consumption
estrogen and progesterone levels. Progesterone
falls to the initial low level of the follicular phase
males
about 24 hours prior to onset of menstruation.
Testicular atrophy
6. Menstruation occurs, and then the cycle begins
Enlargement of the breasts.
again.
7. Menstrual cycle

Follicular phase (first half)

characterized by estrogen stimulating
growth of the uterine lining; progesterone
levels are low

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 Semi-Final
cC lL iI n
N iI c
C aA lL lesson 01

cC hH eE mM iI S
s tT r
R y Y Clinical Instructor:
Anna Marie Taguilan, RMT

HYPOESTRINISM HYPERPROGESTERONEMIA

prevents menstrual cycle from occurring

Ovarian
Ovarian insufficiency
insufficiency

can be primary or secondary to disorders of HYPOPROGESTERONEMIA

the hypothalamus or pituitary causes infertility and abortion of fetus

Delayed puberty EeSsTtRrOoG nSs i

Primary amenorrhea due to lack of ovarian
function or secondary to disorders of the
hypothalamus or pituitary
Amenorrhea
occurs at menopause, with radiation or
chemotherapy, severe stress, intense
athletic training, excessive weight loss
Turner
Turner syndrome
syndrome
a genetic defect in females where there is
partial or complete loss of one of the two X
chromosomes, resulting in nonfunctional
ovaries; exogenous estrogen can be
administered to develop secondary sex
characteristics
g EeN INn
Ppregnancy
REGNANCY
Placenta is the main source of estrogen
synthesis during pregnancy, making
primarily estriol.
Placenta requires a precursor compound
that can only be made by the fetal adrenal
glands, the hydroxylated form of DHEAS
(16a-OH dehydroepiandrosteronesulfate);
placenta lacks the enzyme 16a-hydroxylase.
Use maternal estriol blood level/urine
excretion to assess fetoplacenta status.
*we can use blood or maternal urine for
assessing fetoplacental status

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E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

TESTS
TESTS USED
USED TO
TO ASSESS
ASSESS
FETOMATERNAL
FETOMATERNAL STATUS
STATUS
Triple Test
consists of:
1. alpha1-fetoprotein (AFP)
2. unconjugated estriol (uE3)
3. human chorionic gonadotropin (hCG)
Maternal blood sample collected at 16-18
weeks gestation
Triple test helps to estimate risk of Down
syndrome. Following pattern is suggestive
of increased risk:
1. Decreased AFP (made by fetal liver;
found in maternal blood)
2. Decreased uE3(Estriol) (made by joint
effort of fetus and mother)
3. Increased hCG (made by placenta)
*Interpretation utilizes MoMs:
Multiples of the Median
*Definitive testing would follow:
Amniocentesis and Chromosome Analysis
Quadruple/Quad Test
consists of:
1. alpha1-fetoprotein (AFP)
2. unconjugated estriol (uE3)
3. human chorionic gonadotropin (hCG)
4. inhibin A- a polypeptide hormone which
would be increased in Down syndrome;In
pregnancy, it is produced by the
fetoplacental unit; function is to inhibit
production of FSH
PLACENTA
synthesizes and secretes estrogens,
progesterone, human chorionic gonadotropin,
and human placental lactogen
HH uu m
m aa nn CC hh oo rr ii oo nn ii cc
GG oo nn aa dd oo tt rr oo pp ii nn
prolongs the viability of the corpus luteum,
which synthesizes progesterone and
estrogens in early pregnancy until the
placenta can assume the function
levels are highest in the first trimester
used to monitor success of surgery and
chemotherapy

B e h, ka pe
mu n a t ay o
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E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

qualitative
Q UALITATIVE
TESTOSERONE
Testes are part of the hypothalamic-
measurement
M EASUREMENT
pituitary-gonadal axis.
The anterior pituitary secretes follicle-
used to detect pregnancy
stimulating hormone, which stimulates
utilize
spermatogenesis. FSH is under the control of
monoclonal antibody to detect hCG in
GnRH.
1-2 days following fertilization
The anterior pituitary secretes luteinizing
hormone, which stimulates production of
quantitative
Q UANTITATIVE testosterone. LH is under the control of
measurement
M EASUREMENT GnRH.
Through negative feedback to the
increased hypothalamus, increased levels of
Hydatidiform mole testosterone shut off FSH and LH synthesis.
Choriocarcinoma Abnormal synthesis of testosterone may be
pre-eclamptic toxemia caused by the testes (primary disorder) or
as a secondary disorder due to a primary
decreased disorder of the pituitary or hypothalamus.
Threatened abortion *MOST POTENT ANDROGENS
Ectopic pregnancy
Testosterone
HH uu mm aa nn PP ll aa cc ee nn tt aa ll
LL aa cc tt oo gg ee nn (( HH PP LL )) principal male sex hormone
functions with HCG to produce estrogen and secreted by the testes (and to a much lesser
progesterone during pregnancy extent by the adrenal glands and ovaries)
level rises throughout gestation and reaches its Functions:
highest level near term promotes development and maintains the male
reflects integrity of placental function, so serial reproductive system
analysis may be helpful in high-risk pregnancies responsible for development and maintenance
decreased HPL suggestive of placental of secondary male sex characteristics (e.g.,
malfunction and potential fetal distress facial and body hair, muscle development)
Jerielyn Grace Bumarlong Blas
@jxrxxlyn - Jeryang 2022
 Semi-Final
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n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

HYPERANDROGENEMIA Congenital Adrenal

Hyperplasia(CAH)
A D Uu Ll Tt
a d caused by an enzyme defect of 21-
M
mAa Ll Ee Ss hydroxylase
no observable symptoms prevents cortisol production and
results in accumulation of cortisol
Pprepubertal
repubertal precursors, including 17-ct-
M
mAaLlEeSs hydroxyprogesterone (17-OHP)
precocious puberty occurs (may be characterized by increased blood
caused by hypothalamic tumors, levels of 17-OHP and ACTH and
congenital adrenal hyperplasia, decreased cortisol.
testicular tumor) HYPOANDROGENEMIA

Ff ee m m aa ll ee
cc hh ii ll dd rr ee nn Aa Dd Uu Ll Tt
M
m Aa Ll E e Ss
development of male secondary sex
impotence and loss of secondary sex
characteristics/virilization occurs
characteristics occurs
(increased androgen production by
ovaries or adrenals as androgens are Pprepubertal
repubertal
estrogen precursors in females)
M
mAaLlEeSs
delayed puberty

Jerielyn Grace Bumarlong Blas

@jxrxxlyn - Jeryang 2022
 Semi-Final
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c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

composed of two lobes that consist of

PP RR II M
M AA RR YY two types of cells:
AA NN DD RR OO GG EE NN EE M
M II AA
causes include infections, tumors,
Ffollicular
ollicular
congenital disorders (Klinefelter Ccells
ells
syndrome)
single layer of epithelial cells arranged
KLINEFELTER SYNDROME
spherically to create a follicle
Male possesses an extra X make and secrete thyroid hormones
chromosome (XXY). Characteristics ✔ T4: L-thyroxine
include tall with long extremities, small ✔ T3: L-triiodothyronine
testes, gynecomastia, infertility, and ✔ Rt3: reverse T3; biologically inactive
low IQ.
parafollicular
p araFollicular
PP RR II M
M AA RR YY
cells
C ells
AA NN DD RR OO GG EE NN EE M
M II AA
causes include primary hypofunction secrete calcitonin, which is involved
disorders of the pituitary or with calcium regulation
hypothalamus, which in turn cause Function of
decreased synthesis of LH and FSH Thyroid Hormones
THYROID GLAND Thyroid hormones aid in regulation of
located in trachea-larynx area several metabolic functions, including
*BUTTERFLY SHAPED GLAND rate of O2 consumption and heat
production, growth, sexual maturity, and
protein and carbohydrate metabolism.

Jerielyn Grace Bumarlong Blas

@jxrxxlyn - Jeryang 2022
 Semi-Final
c L
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n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

hy
H yp po
otth
haal am
la miicc- Thyroid hormones
Ppituitary
ituitary-
Tthhyyrro
oi d a
id Axxiiss ✔ circulate in blood bound to thyroxine-binding
globulin (TBG), thyroxine-binding prealbumin, and
Thyrotrophin-releasing hormone (TRH) is
thyroxine-binding albumin
released by hypothalamus and stimulates
anterior pituitary to secrete thyroid- TBG
TBG
stimulating hormone.
TSH is a polypeptide hormone that ✔ principal carrier protein
originates in the anterior pituitary gland.
FT3 and FT4
TSH regulates synthesis and release of free hormones
the thyroid hormones. ✔ physiologically active
Secretion of TSH is regulated by TRH,
somatostatin, free T3 (FT3), and free T4
T3
T3
(FT4). ✔ 4-5X more metabolically potent in the tissues
than T4
Somatostatin
Somatostatin *T3- MOST ACTIVE THYROID HORMONAL
ACTIVITY
✔ inhibitory factor

FT3
FT3 and
and FT4
FT4 Tt h
hyyr roo iid
d
✔ stimulate hypothalamus to secrete somatostatin Aanntt iibbo
oddii ee ss
✔ exert negative feedback to the anterior
pituitary to inhibit TSH secretion
Thyroid-stimulating
It is estimated that 40% of secreted T4
immunoglobulins (TSI)
undergoes enzymatic monodeiodination
in tissues to produce T3 and classified as thyrotropin-receptor antibodies
approximately 45% is converted to rT3, (TRAbs)
they bind to TSH receptor sites and activate
which is biologically inactive.
thyroid epithelial cells
@jxrxxlyn - Jeryang 2022 Jerielyn Grace Bumarlong Blas
 Semi-Final
c L
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n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

Thyroid
Thyroid
THYROID
THYROID STORM
STORM
antimicrosomal
antimicrosomal
antibodies
antibodies (TMAbs)
(TMAbs) Life-threatening complication of
cause tissue destruction uncontrolled thyrotoxicosis
analysis is generally directed to measurement of Ss EeCcO oNnDdA a RrYy Oo R
r
antithyroid peroxidase antibodies (TPOAbs) TtEeRrTtIiAaRrYy
(detected in Hashimoto thyroiditis and in Graves (A L IiNnCcRrEeAaSsEe)
a Ll l
disease)
increased levels of TSH (pituitary disorder) or
Antithyroglobulin increased levels of TRH (hypothalamus
antibodies (TgAbs) disorder), respectively

do not cause damage to the gland HYPERTHYROIDISM

HYPERTHYROIDISM characterized by enlarged thyroid gland
characterized by weight and muscle loss, (goiter), impaired speech and memory, fatigue,
fatigue, heat intolerance, nervousness, weight gain, personality changes, cold
exophthalmos intolerance, increased serum cholesterol and
LDL
PpRrIiM
mAaRrY
y PpRrIiM
mAaRrYy
( Aa Ll Ll DdEeCcRrEeAaSsEeD
d
total T3, total T4, FT3, and FT4 are h)
EeXxCcEePpTt TtSs H
increased in the serum; TSH is decreased
in the serum total T3 (TT3), total T4 (TT4), FT3, and FT4
are decreased in the serum; TSH is increased
THYROTOXICOSIS
THYROTOXICOSIS in the serum
Increased serum levels of thyroid HASHIMOTO
HASHIMOTO DISEASE
DISEASE
hormones
Most common cause of primary
GRAVES DISEASE hypothyroidism; chronic autoimmune
thyroiditis; TPOAb, TMAb, and TgAb present
Most common cause of thyrotoxicosis;
exhibits diffuse toxic goiter; autoimmune
disorder with TRAb and TSI present
Jerielyn Grace Bumarlong Blas
@jxrxxlyn - Jeryang 2022
 Semi-Final
c L
C l Ii N
n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

CONGENITAL
HYPOTHYROIDISM/CRETINISM
meetthhoo d
M dss
oo ff
meeaass u
M ur r ee mmeennttss
If untreated in first 3 months of life, irreversible ff o
or r:
neurological and mental deficiency occurs

MYXEDEMA TOTAL THYROID

HORMONE AND TSH
Advanced form of hypothyroidism
Ss Ee Cc O Competitive immunoassays
onNd Da Ar RY y
Oo R
r Enzyme immunoassays
t
Te ERrTt Ii Aa Rr Yy Chemiluminescence immunoassays
lack of TSH (pituitary disorder) or lack of
TRH (hypothalamus disorder), respectively
DIRECT MEASUREMENT
OF FREE THYROID HORMONE

SORRDE
DISO
DI ELAATE
DERRSS RREL TEDD Direct equilibrium dialysis
Ultrafiltration methods
THEE TH
TO TH
TO LANNDD
OIDD GGLA
THYYRROI
INDIRECT METHODS FOR
ESTIMATING FREE
TOTAL  TOTAL  THYROID HORMONES
CLINICAL CONDITION T4 T3
FT4 TSH
Two-step microparticle capture immunoassays
Primary




One-step immuno-chemiluminometric assays
Hypothyroidism
*With availability of highly sensitive TSH assays,
Secondary




TSH testing is used to screen for thyroid disorders
Hypothyroidism
and to follow success of treatment protocols. TSH
Primary  reflects the physiological action of the thyroid

Hyperthyroidism hormones at the level of one of its target tissues,

Secondary 

the pituitary gland. The secretion of TSH by the

Hyperthyroidism pituitary gland is very sensitive to changes and
Primary  l l
reflective of such changes in thyroid hormone



ma
ma
Increase TBG No
r
No
r concentration in the blood.
Primary 

m
al
a
l *Euthyroid refers to a normal functioning thyroid
rm


r
Decrease TBG o o
N N gland in the presence of an abnormal concentration
Jerielyn Grace Bumarlong Blas
@jxrxxlyn - Jeryang 2022
 Semi-Final
c L
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n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

of thyroxine-binding globulin (TBG). A

primary increase in the concentration of TBG is
seen in conditions such as pregnancy and
estrogen therapy. This manifests as an increase
in total T4, but the individual has normal levels of
FT4 and TSH due to negative feedback
regulation to the anterior pituitary being intact. A
primary decrease in the concentration of TBG is
seen in conditions such as nephrotic syndrome,
decreased protein production, and ingestion of
certain drugs. This manifests as a decrease in
total T4, but the individual has normal levels of
FT4 and TSH due to negative feedback
regulation to the anterior pituitary being intact.
*An electrochemiluminescence immunoassay can
be used for the T uptake (TU) test, which
measures the unsaturated serum binding capacity
of TBG; or, rephrased, TU measures available
binding sites on TBG. Thyroid hormone binding
ratio (THBR) expresses a ratio of T uptake in a
patient's serum with a normal or reference serum.
a. There is an inverse relationship between
THBR levels and the concentration of TBG.
When the serum concentration of TBG is
increased (as in euthyroid primary increase
in TBG), THBR is decreased.
Konti
Konti nalang
nalang
beh!
beh! Kaya
Kaya pa
pa yan!
yan!
Jerielyn Grace Bumarlong Blas
@jxrxxlyn - Jeryang 2022
b. The Free T4 index (FT4I) is an indirect
estimation of the free T4 concentration in
serum adjusted for any interference that may
be caused by an abnormality in the binding
proteins.
Free T4 index (FT4I) = Total T4 X THBR
PARATHYROID
GLAND
(SMALLEST ENDOCRINE GLAND IN BODY)
four parathyroid glands are located bilaterally
on or near the thyroid gland capsule
composed of chief cells (synthesize, store, and
secrete parathyroid
hormone (PTH)) and oxyphil cells
it is synthesized as a preprohormone
its amino N-terminal third is biologically active
in the blood, intact PTH has half-life of <5
minutes
Ffunctions
UNCTIONS
Aids in the regulation of calcium and phosphate,
having direct action on bone and kidney and
indirect action on the intestines through vitamin D.
Increases the serum calcium level by increasing
calcium resorption from bone, increasing calcium
reabsorption in the renal tubules, and increasing
intestinal absorption of calcium by stimulating
production of vitamin D.
 Semi-Final
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c H
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E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT
In kidneys, PTH increases calcium
reabsorption in the distal tubule and decreases MEASUREMENT OF PTH
reabsorption of phosphate in the proximal
DURING SURGERY FOR
tubule, resulting in phosphaturia.
In intestines, PTH promotes absorption of ADENOMA RESECTION
calcium and phosphate by stimulating OF THE PARATHYROID
increased production of 1,25(OH)2D. GLANDS
In bone, PTH stimulates bone resorption
(alters osteoclasts) or bone formation (alters
assists the surgeon in determining completeness
osteoblasts); elevated PTH increases bone
of the resection based on the rapid fall of PTH
resorption.
need pre-incision baseline sample as surgery
Combined effects cause calcium increased,
starts, second baseline sample following
phosphate reduced (SERUM) and phosphate
exposure of the gland, and post-excision sample
increased, calcium increased due to larger
drawn 10 minutes following gland removal
filtered load overriding increased tubular
at 10 minutes post-excision, the PTH level should
reabsorption (URINE).
fall to 50% or less of the pre-incision value or
*Increase in serum free calcium reduces secretion
the value at the time of gland resection
of PTH through negative feedback, conversely
if the PTH remains increased and such a
decrease in serum free calcium stimulates
decrease does not occur or if the PTH rises
secretion of PTH.
again after what initially appeared to be a
decrease, multigland disease or ectopic
QUANTIFICATION OF production needs to be investigated
PTH IN PLASMA:
HYPERPARATHYROIDISM
(EDTA preferred—stabilizes PTH) by
measuring different forms of the hormone: PpRr IiM
mAaR
rYy
intact PTH, N-terminal PTH, mid-molecule PTH, results in increased blood calcium
and C-terminal PTH may be caused by:
Electrochemiluminescence Immunoassay (ECLIA) Parathyroid adenoma (tumor)
measures intact PTH using a sandwich Parathyroid carcinoma
technique Hyperplasia.
Reference Range: 15-65 pg/Ml
Jerielyn Grace Bumarlong Blas
@jxrxxlyn - Jeryang 2022
 Semi-Final
c L
C l Ii N
n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT

ss eecco
onnd
daar
ryy zo
Z o ll l
l ii n
ngge
err-- E
elllliissoon
n
sy ynnddrro omm ee
presents with low blood calcium levels
an elevated gastrin level accompanied by gastric
may be caused by:
hyperacidity; caused by gastrinomas, duodenal,
Vitamin D deficiency
or pancreatic endocrine tumors that secrete
Chronic renal failure
gastrin
HYPOPARATHYROIDISM ✔ SEROTONIN
Synthesized from tryptophan and secreted by the
results in decreased calcium and increased
enterochromaffin cells in the gastrointestinal
phosphate blood levels
tract.
may be caused by:
A smooth muscle stimulant and vasoconstrictor
Osteomalacia
that is transported by platelets.
Autoimmune disease
Metabolized by the liver to to 5-hydroxyindole
Inborn errors of metabolism
acetic acid (5-HI A A)..
Unintentional removal during thyroid
surgery.
GG AA SS TT RR OO II NN TT EE SS TT II NN AA LL PANCREAS
✔ GASTRIN IS SECRETED BY THE Eendocrine
NDOCRINE
STOMACH IN RESPONSE TO THE VAGUS Ffunctions
UNCTIONS
AND FOOD ENTERING THE STOMACH. Islets of Langerhans secrete the following
Maximum secretion occurs in the stomach at hormones into the blood
pH 5-7. insulin
Gastrin stimulates secretion of gastric HC1 glucagon
and pancreatic enzymes. gastrin
Acidification of the antrum of the stomach somatostatin
causes a decrease in gastrin secretion. exocrine
ExOCRINE

malapit na sa
Ffunctions
UNCTIONS
-Digestive fluid containing bicarbonate and

katotohan!!!
digestive enzymes is made in the acinar cells
and secreted into the duodenum.

Jerielyn Grace Bumarlong Blas

@jxrxxlyn - Jeryang 2022
 Semi-Final
c L
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n Ii Cc Aa Ll lesson 01

c H
C h e
E Mm Ii Ss Tt Rr Yy Clinical Instructor:
Anna Marie Taguilan, RMT
Secretion of the digestive fluid is regulated by
the vagus nerve and the endocrine hormones HYPERINSILUNEMIA
cholecystokinin and secretin. may be caused by insulinomas (insulin-producing
✔ Digestive Enzymes: tumors of the (3-cells of the pancreas)
Lipase Hypoglycemia
Amylase
Trypsin HYPOINSILUNEMIA
Chymotrypsin lack of insulin or ineffective insulin
Elastase Diabetes mellitus
Collagenase,
Leucine aminopeptidase GLUCAGON
Nucleases.
synthesized in the islets of Langerhans by the a-
cells and secreted into the blood when the blood
INSULIN glucose level is low
synthesized in the islets of Langerhans by the it increases blood glucose by promoting
(3-cells and secreted into the blood when the glycogenolysis in the liver and gluconeogenesis
blood glucose level is elevated secretion of glucagon is promoted by exercise,
it lowers blood glucose by binding to cell stress, and amino acids and inhibited by insulin
membrane receptors, which increases
membrane permeability in the liver, muscle, HYPERGLUCAGONEMIA
and adipose tissue associated with glucagon-secreting tumors
affects glucose metabolism by promoting (malignant and have usually metastasized by the
glycogenesis and lipogenesis while inhibiting time they are diagnosed) of the pancreas.
glycogenolysis
it is inhibited by epinephrine and
norepinephrine release and certain drugs
Yasshh! Natapos mo beh!
(e.g., thiazide, dilantin, diazoxide) pahinga na,
tapos tara na sa
bishop at rodriguez!
Jerielyn Grace Bumarlong Blas
@jxrxxlyn - Jeryang 2022