SGD - 3

ENDO I
1. Differentiate the following types of chemical messengers and give an example for
each type:

a. endocrine hormone
-

Chemical substances that are synthesized by the endocrine glands

and are released in the
body fluids upon stimulation They act on target .

cells far from the

secretory cells An example is norepinephrine .

b. paracrine hormone
-

Chemical substances that synthesized

are by the endocrine glands
but are released in the interstitial fluid only They act located
. on
target cells
near each other .

Examples are insulin Y

glucagon
c. neuroendocrine hormone
Chemical substances that are synthesized by the neuroendocrine
gland
-

but are released in the blood only and not the synaptic cleft
Examples in .

are Oxytocin { Anti diuretic hormone .

2. Discuss the MOA of the different classes of hormones (peptides, steroi , biogenic
amine).
Peptide hormones act on cell surface receptors that ion channels
-

open ,
cause rapid
electrical responses and facilitate
exocytosis of hormones or neurotransmitters .

They
also activate second messenger systems at the cell membrane Steroid hormones
- the other .

,
on

hand , act on intracellular receptors in cell nuclei to regulate gene expression and protein
hormones can also affect cell surface events via receptors at or near the
synthesis Steroid
-

roles in the body and

cell surface Biogenic amines have several important biological
.
.

constitute the first step of protein hormone and nucleic acidsynthesis An example is .

Dopamine where in itstimulates D and Da receptor which leads to vasodilation andpromotes

,

renal blood flow to preserve glomerular filtration

3. Discuss the mechanisms that regulate the secretory function of the different
endocrine glands. Give an example for each mechanism.
Hormone production and release primarily
are controlled by negative
feedback This is done
. increasing by the level of hormones therefore
resulting
of its further release There 3 other mechanisms utilized for regulation
to inhibition . are
,

" " "

humoral stimuli hormonal stimuli i' neural stimuli

" ''
"
.

, '

Humoral stimuli refers to the control of hormone release in response to changes the ECF in .

An example is when blood glucose level rises insulin is released Hormonal stimuli refers to the ,
.

release of hormone in response to another hormone An example is when the

stimulate the anterior portion of the pituitary gland The anterior
.

hypothalamus produces hormones that

pituitary gland will then release hormones that regulate
.

hormone production of other glands

endocrine glands to produce hormones
Lastly Neural
.

stimuli is when the Nervous

, system directly stimulates the
Examples are
.
hormones Epinephrine and Norepinephrine What happens here .

is the nervous system sends

signal to the adrenal medulla

This material is downloaded for Richmond A. Amurao (20200015401)

at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
136
 Case I:

A 48 year old man complaining of impotence sought medical attention. Over the
years, he experienced increasing difficulty with maintaining and more recently achieving
an erection. Further questioning revealed that he was also shaving less frequently. The
patient‟s shoe size had increased from a 9-C to 11-EEE over the past 5 years and his
dental plate had to be altered three times in 6 years. Recently, friends have remarked
on changes in his appearance. The patient also admitted to tingling of his fingers and
joint pains.
On physical examination, he had coarse facial features with a bulbous nose and
a beetle-browed look. The tongue was enlarged and teeth were wide spaced. Testing of
visual fields showed a loss of both lateral (temporal) fields. The hands and feet were
enlarged with spadelike fingers. The liver was enlarged. Laboratory studies showed a
fasting plasma glucose level of 150 mg/dl. Fasting growth hormone (GH) was 40 ng/ml
and it did not decrease after administration of an oral glucose load. On magnetic
resonance imaging, a large pituitary mass protruded upward from the sella turcica.

Diagnosis - Acromegaly

Questions:

1. What has caused the changes in the patient‟s facial features, tongue, hands, feet and
liver?
-

It is caused by too much secretion of Growth Hormone of the patient or more known ,
as

Acromegaly In acromegaly bones increase in size This includes the faces hands and feet
.

,
.

Also it causes thickening of soft tissues of the body wk includes the tongue When Growth
.

,
.

Hormone is secreted to the blood stream : it stimulates the liver Therefore too much GH resulted to
.

Enlarged liver .

2. Discuss the mechanism of action of GH.

Growth hormone
in the Anterior
synthesized and secreted
is by theSoma to trophy cells
Pituitary Gland It has 2 effects
.

,
Direct t indirect .

In the direct effect from when growth hormone bind to the

it results
,
receptor of the target
cell An example is on Fat cells receptors which when GH binds to it stimulation of breakdown
.

, of lipids
happens In indirect effect , i tis mediated
,
.

a hormone secreted from the liver ¥ other tissues in

primarily
by an insulin like growth factor I -
-

to growth hormone
response .

The major role of growth hormone in stimulating body growth is to

stimulate the liver and other tissues to secrete IGF I IGF I stimulates -
.
.

proliferation of chondrocytes ( cartilage cells ) resulting in bone growth , .

This material is downloaded for Richmond A. Amurao (20200015401)

at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
137
 3. What are the factors/mechanisms that regulate GH secretion?
Growth hormone is released in 2 ways Diu rat Pattern where in GH release is
at peak early in the
,

before morning and lowest at waking up daytime ,

and
pulsatile
secretion , which means
increasing and decreasing Factors that
trauma stress exercise I excitement
.

affect GH secretion are

, ,
,
w le causes stimulation
,
aging obesity inhibitory hormones wk causes inhibition
,

and , ,
.

Secretion of Growth Hormone is controlled by the hypothalamus by alsosecreting

hormones The Growth Hormone Releasing Hormone
.
or GARA and Growth Hormone Inhibitory
Hormone or somatostatin .

4. Give the direct and indirect actions of GH.

Direct action of Growth Hormone occurs when G It directly binds to the
specific receptors . Anexample is when GH binds to fat cells to
break down fat What happens here is
that GH enhances conversion of fats to
.

energy Another one is on carbohydrate use , where in GH induces insulin resistance

.

therefore decreasing glucose utilization .

involves the ones

In direct Action of Gilt IGF will then mediated by of
IGF -
I . Growth hormone stimulates

liver to produce liver to form IGF

I .
-

stimulate growth various tissues .

and also stimulate osteoblasts and chondrocytes activity to bone growth

increase .

differentiation andproliferation
IGF I also plays
-
major role in muscle growth , promoting
a the
of myoblast that gives rise to muscle cells .

5. What is the hormonal effect of glucose administration on the plasma GH level and
why did it not change in this patient?
In normal situations , high glucose inhibits Growth Hormone .

Administration of
glucose then supposed to decrease GH levels
.

is .

But due to the patients

of GH which results to increase secretion of
Acromegaly ,
there is high secretion
insulin .
Therefore
the oral
glucose load given to the patient did not take
effect .

This material is downloaded for Richmond A. Amurao (20200015401)

at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
138
 Case II:

A 30 year old woman sustained multiple injuries, including a skull fracture, in an

automobile accident. Although initially in a coma, she gradually regained
consciousness. Five days later she abruptly developed frequent urination and thirst with
a subsequent measured fluid intake and output of 8 L/day. Physical examination was
unremarkable except for slightly dry mucous membranes. Vital signs were normal.
Routine urinalysis was normal; no red blood cells were present. Urine osmolality was 75
mOsm/kg. After 8 hours of water deprivation, during which she lost 4% of her body
weight, she continued to excrete 150 ml/hr and urine osmolality stabilized at 125
mOsm/kg at this time, serum osmolality was 310 mOsm/kg and serum sodium was 155
mEq/L. Serum creatinine was 0.8 mg/dl and blood urea nitrogen was 10 mg/dl. There
was no glucose in her urine.

Questions:

1. Discuss the MOA of ADH

Anti diuretic hormone or
arginine vasopressin ,
is produced in the hypothalamus
and is stored the posterior pituitary It is a hormone that conserves body
on
gland .

water by reducing water loss in urine ADH after release will then bind to Vz receptors on the
.

cells of the Dott , collecting ducts ofthe kidney wk promotes Huo reabsorption It also .

stimulates water reabsorption by stimulating water channels

"
insertion of "

into membrane
or a
quaporins

2. What are the factors that regulate ADH secretion?

Factors that regulate ADH secretion are first the stimulating factor which is increase in

extracellular fluid osmolarity examples are dehydrated patients hypovolemic f- hypotension

patients the other one is inhibitory factors which are decreased extracellular osmolarity
,
,

hypertensive and hypervolcanic patients and patients w/ increase alcohol intake

,

3. Differentiate: Central DI and Nephrogenic DI.

Central Diabetic Insipidus is a disorder in ADH secretion wherein a deficiency
in ADH is encountered , due to a defeat or trauma in the hypothalamus or
pituitary gland ,

Nephngendc Diabetic Insipidus is disorder ADH secretion wherein is

in there
while a a

complete or partial resistance of the kidneys to ADH

-

4. What is likely to happen when ADH is administered to the patient?

The ADH administration would be effective for the patient is
for she had
experiencing Central Diabetes Insipidus not ne phonegenic
his brain,
an injury in the skull wk may damaged specifically the hypothalamus or the
pituitary gland And in Central DI it can be connected through exogenous
.
,

administration of ADH for there is only presence of low secretion of ADH

This material is downloaded for Richmond A. Amurao (20200015401)

at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
139