ENDOCRINOLOGY

Dr. Franz Lenard D. Barreto RMT., MD.

OBJECTIVE

• Determine the Origin of the Hormone

• Determine the Function of the Hormone
• Determine the Assessment of the Hormone
• Determine the Disorders of the Hormone
IMPORTANT SOURCES OF HORMONES

• Pituitary Gland
• Thyroid Gland
• Parathyroid Gland
• Adrenal Gland
• Gonads
GROWTH HORMONE

• Also known as Somatotropin

• Pituitary cells producing GH comprises 1/3 of pituitary weight
• Release is stimulated by GHRH & inhibited by Somatostatin
• Functions:
Amphibolic Hormone
Antagonizes Insulin
Promotes Gluconeogenesis
Stimulates Lipolysis
Enhance protein Synthesis
MODIFIERS OF GROWTH HORMONE SECRETION

STIMULANTS INHIBITORS

Sleep Glucose Loading

Exercise Beta Agonist
Physiologic Stress Alpha Blocker
Amino Acids Emotional/Psychogenic Stress
Hypoglycemia Nutritional Deficiencies
Sex Steroids Insulin Deficiency
Alpha-Agonist Thyroxine Deficiency
Beta-Blockers
ASSESSMENT

• ORAL GLUCOSE SUPRESSION TEST

Steps:
1. Do an overnight fast
2. Load 100gm of Glucose
3. GH measured at time 0, 60 min, 120 min
Interpretation:
1. If GH is decreased or not detected – Normal
2. If GH is increased or detected – Patients with Acromegaly or GH tumor releasing.
• STIMULATION TEST TO ASSESS GH DEFICIENCY
1. Insulin Induced Hypoglycemia
2. GHRH & L-arginine Combined Infusion
3. L-arginine infusion with oral DOPA
If more than 3-5 ng/ml; normal
ACROMEGALY

• Due to pathologic or autonomous excess of Growth Hormone

• Usually due to a tumor in the pituitary
• Instances:
If (+) GH producing tumor before Epiphyseal Plate Closing : GIGANTISM
If (+) GH producing tumor after Epiphyseal Plate Closing : Tissue Overgrowth
• 40% of cases is associated with increase Prolactin
• Dx: Elevated GH suppression test result and elevated IGF-I
GROWTH HORMONE DEFICIENCY

• Occurs on both Children and Adult

• All GH deficient are of small stature; not all small stature have GH deficient
• Most common genetic cause of GH deficiency: GHRH deficiency
PROLACTIN

• Considered a stress hormone

• Major regulation is inhibition of release (unlike others-stimulation) by Dopamine a.k.a: Prolactin Inhibitory
Factor
• Causes of increase: Phenothiazines, Butyrophenones, Metoclopramide, Reserpine, Tricyclic Antidepressants,
Methyldopa, Antipsychotics that inhibits Dopamine, Disrupted pituitary stalk, TRH, Estrogen, Exercise
• Function: Lactation (Production of Milk)
• Effect of Excess: Hypogonadism
• Usual Size: 23 kD
PROLACTINOMA

• Most common type of Functional Pituitary Tumor

• Symptoms depends on age and sex.
• Macroprolactinoma: Production of a 150 kD Prolactin
HYPOPITUITARISM
• Complete loss of function –
Panhypopituitarism
• Usually caused by pituitary tumors or
treatment of the tumor
• Diagnosis of deficiency is based on the level
of problem
POSTERIOR PITUITARY HORMONES

• OXYTOCIN
• VASOPRESSIN
OXYTOCIN

• Cyclic Nonapeptide
• Big part on Childbirth
• Secretion responds to a positive feedback loop (TWICE: MORE & MORE)
-In Maternal Uterine Contraction, as the oxytocin concentration rises during labor,
posterior pituitary is triggered to release more oxytocin for a stronger contraction.
VASOPRESSIN

• A cyclic Nonapeptide
• Main Function is Control Renal Water Excretion.
• A.k.a: Antidiuretic Hormone
Presence of Vasopressin : Concentrated Urine
Absence of Vasopressin : Diluted Urine
• Also promotes Clotting by promoting release of Factor VII & Von Willebrand Factor
• What are the triggers for Vasopressin Release:
Increase Osmolality (284 mosm/kg)
Decrease in Blood Volume or Blood Pressure (5-10% fall of arterial blood pressure)
Note: The decrease in blood pressure has a greater effect of release in Vasopressin than
increase in Osmolality
DIABETES INSIPIDUS

• Vasopressin Deficiency
• Characterized by Polydipsia and Polyuria
• total Deficiency is rare and idiopathic cases accounts for 30%
• How to Diagnose:

1. inappropriate decrease in Vasopressin and Elevated Osmolality

2. Water Deprivation Test
patient has no intake of water and Series of measurement of Plasma and Urine Osmolality is measured.
3. Desmopressin test
Diminish of symptoms (Polyuria and Polydipsia) shows a positive response