CLINICAL

CHEMISTRY II
ENDOCRINOLOGY: INTRODUCTION

Prepared by: lggrmt23

ENDOCRINOLOGY
PART 2
ANTERIOR PITUITARY GLAND
CONTINUATION..
Learning Outcome
1. Classify the hormones correctly
2. Explain the importance of feedback loop in the secretion of
hormones
3. List the hormones and their role in disease dx and px
management
4. Discuss general principle of the dynamic function test
Learning Outcome
5. Compare screening test with confirmatory test in aid of disease
identification
6. Discuss patient preparation, sampling and methods used in the
measurement of hormones including the assay interferences
 ANTERIOR PITUITARY GLAND
PROLACTIN
● It also seen in non-lactating women, men and children, but the
serum level in these individuals (20 ng/mL) are lower than those
in pregnant women (1st trimester <80 ng/mL, 2nd trimester <169,
ng/mL, 3rd trimester <400 ng/mL)
● Secretion of prolactin is under control of the Prolactin Inhibiting
Factor (PIF) or Dopamine that comes from the hypothalamus.
 ANTERIOR PITUITARY GLAND
PROLACTIN
● If dopamine levels decline, prolactin is secreted and vice versa.
● No Prolactin Stimulating Hormone has been identified but TRH
(thyrotropin releasing hormone hormones) has been shown to
induce increased of PRL levels.
 ANTERIOR PITUITARY GLAND
LABORATORY ANALYSIS
❏ RIA = mtd of choice
❏ Fresh, non-hemolyzed serum = preferred sample
❏ Should be frozen immediately after collection
❏ The time the specimen was drawn must be carefully recorded
since PRL levels are highest in the morning.
 ANTERIOR PITUITARY GLAND
LABORATORY ANALYSIS
❏ It increases also if px is under stress
 ANTERIOR PITUITARY GLAND
GROWTH HORMONE (GH)
● Also referred to as somatotropin
● Among the anterior pituitary hormones GH has the highest
concentration
● GH is anabolic in most tissue. It stimulates the synthesis of new
proteins
● However, in adipocytes, growth hormone exhibits a catabolic
action by stimulating lipolysis.
 ANTERIOR PITUITARY GLAND
GROWTH HORMONE (GH)
● In the GH axis, the liver is stimulated by the GH to produce
somatomedins which are also known as insulin-like growth factor
(IGF)
● There are 2 types found in human plasma, namely:
1. Somatomedin A or IGF 11
2. Somatomedin C or IGF 1
 ANTERIOR PITUITARY GLAND
GROWTH HORMONE (GH)
● The compound that was known as somatomedin B is actually an
acidic glial cell growth factor and not one of the somatomedins.
● GH stimulates the production of IGF 1 by the liver
● IGF 1 binds to receptors on the cartilage and bone cells to
stimulate DNA synthesis and cell growth
 ANTERIOR PITUITARY GLAND
LABORATORY ANALYSIS
● RIA = mtd of choice
● Fresh serum = specimen of choice
● EDTA and heparinized plasma
● Reference range:
Female = <10 ng/mL
Male = <2 ng/mL
 ANTERIOR PITUITARY GLAND
GONADOTROPINS
● The follicle-stimulating hormone (FSH) and Luteinizing hormones
(LH) are produced by the by the gonadotroph cells in the anterior
pituitary gland.
● These gonadotropins regulate sex cells and sex hormones from
the gonads in both sexes
● The major stimulator for their secretion is the gonadotropin
releasing (GnRH) produced by the hypothalamus
 ANTERIOR PITUITARY GLAND
GONADOTROPINS
● FSH, LH, TSH and hCG are similar in structure and comprise a
group called the glycoprotein hormones.
● Each consists of two chains called α and β chains held together by
disulfide bonds with attached carbohydrate group
● The α chains that lends specificity to each of these hormones.
 ANTERIOR PITUITARY GLAND
GONADOTROPINS
● In females, FSH and LH are released in varying amounts during
the menstrual cycle
● Highest level of both are obtained just before ovulation on about
day 14 of the cycle.
● FSH stimulates the follicle growth as well as the growth and
development of the ovum
● As the cells of the follicle grows, they produce estrogen.
 ANTERIOR PITUITARY GLAND
GONADOTROPINS
● Estrogen has a positive feedback effect on the secretion of GnRH.
● After ovulation, LH stimulates the follicle to become a corpus
luteum
● Once formed, the corpus luteum produces progesterone
 ANTERIOR PITUITARY GLAND
GONADOTROPINS
● In male, the FSH aids in spermatogenesis which occurs in the
seminiferous tubules of the testes.
● The Leydig or Interstitial cells respond to LH and produce
testosterone.
● LH and FSH in the males are not secreted in a cyclic pattern as in
females.
 ANTERIOR PITUITARY GLAND
LABORATORY ANALYSIS
● The method of choice is RIA which is highly specific
● Serum and plasma may be used as the specimen
● In women, interpretation of the results may be difficult unless the
time of menstrual cycle is noted.
 ANTERIOR PITUITARY GLAND
THYROID STIMULATING HORMONE (TSH)
● This is also produced by the anterior pituitary gland
● It stimulates the thyroid gland to produce T4 and T3
● The TSH secretion is controlled in part by the TRH from the
hypothalamus
 ANTERIOR PITUITARY GLAND
ADRENOCORTICOTROPIC HORMONE (ACTH) /CORTICOTROPIN
● The primary target of this hormone is the adrenal cortex
● It initiates steroid genesis with cortisol as the final product.
● ACTH production is regulated by a negative feedback exerted by
increased levels of cortisol and the stimulation caused by
corticotropin-releasing hormone (CRH) from the hypothalamus
 ANTERIOR PITUITARY GLAND
LABORATORY ANALYSIS
● RIA = mtd of choice
● EDTA or heparinized plasma
● ACTH is unstable in whole blood and adheres to the sides of glass
tubes.
● For proper separation of the plasma, specimen should be spun
the first time in a refrigerated centrifuge, removed, and then
centrifuged again.
 ANTERIOR PITUITARY GLAND
LABORATORY ANALYSIS
● This removes additional formed elements that may include
proteolytic enzymes that could breakdown ACTH during freezing
and thawing process.
● The specimen should be frozen if there is delay in analysis
● ACTH is lowest at approximately midnight and highest at around
8 AM.