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neurotransmitter
SHORT-TERM;
QUICK
RESPONSE
target cell with receptor
➢ The interaction between the hormone and its receptor triggers a cascade of biochemical reactions in
the target cell that eventually modify the cell’s function or activity.
PURPOSE:
CLASSIFICATION OF HORMONES
HORMONE-RECEPTOR REGULATION
• High concentrations of hormones can affect certain unintended actions through a receptor – effector
pathway different from but homologous to normal signaling mechanisms.
• Example: Increased levels of cortisol (glucocorticoid) may cause it to perform mineralocorticoid
function
Hormone Multi-specificity - Excessively increased levels of hormones may cause relative changes to
related hormones produced in the same organ.
GROWTH HORMONE
• Somatomedins/Insulin-like
Growth Factor – indirect
effect
o Produced and secreted
primarily by the liver
o Similar subunit with
insulin
o Anabolic hormone:
GROWTH
o Binds to insulin receptors
o Increase Protein, RNA,
and DNA
o Increase protein intake
and decrease glucose
uptake
• Elevated plasma growth
hormone levels
• Growth hormone facilitates
the movement of free fatty
acids
INTERPRETATION:
Laboratory Diagnosis - Considerations: • Persistent increase = ACROMEGALY
• Fasting (with 30 minutes rest prior to
• If decreased:
collection)
• If increased, do confirmatory test: o Insulin Tolerance Test: insulin
Overnight Fasting Serum induced hypoglycemia – gold standard
• Give 100 grams OGT after taking basal o Arginine Stimulation Test: GHRH
GH coupled with L-arginine
• Take serum sample is taken at zero, **Failure to increase GH more than 5 ng/ml
60min and 120min (Adult) and 10ng/ml (Children) indicates GH
deficiency
PROLACTIN
• Effector hormone
• Initiates and maintains lactation PROLACTIN DISORDERS:
• Decreased Levels:
• Promotes breast tissue development o Menstrual Irregularity, infertility, amenorrhea,
• Major inhibitor: Dopamine and galactorrhea
• Highest: 4am, 8am, 8pm, and 10pm o Iatrogenic: aldomet, phenothiaines, reserpine
• Increased Levels
o >150 ng/mL indicate prolactinoma
LABORATORY DIAGNOSIS
•Considerations: Overnight Fasting, and blood
MANAGEMENT OF PROLACTINOMA:
collected 3 - 4 hours after the individual • depends on the size of the tumor
awakened (macroadenomas [tumor size >10 mm or
• Usually tested with Thyroid Hormone Panel microadenomas [tumor size < 10 mm].
o If Increased Thyroid • Dopamine Agonist for macroprolactinoma –
bromocriptine mesylate (parlodel) or
Releasing Hormone =
cabergoline (dostinex) for macroprolactinoma.
Idiopathic Thyroid Stimulating
Galactorrhea – Hormone = Prolactin
lactation occurring in o If tertiary increase: Thyroid Releasing Hormone = Thyroid Stimulating
women with normal Hormone = Prolactin
prolactin. o If secondary increase: Thyroid Stimulating Hormone = Prolactin
o If primary increase:
Oxytocin and Vasopressin - the
Thyroxin and Triiodothyronine but
synthesis of each of these hormones is
decreased Prolactin
tightly linked to the production of
neurophysin and it is plausible they have
POSTERIOR PITUITARY GLAND
an autocrine or a paracrine function.
• An outgrowth of the hypothalamus composed of
neural tissue.
• Hypothalamic neurons pass through the neural stalk and end in the posterior pituitary.
• Does not have cells that produce hormones
• Oxytocin and Antidiuretic Hormone/Vasopressin synthesized in the supraoptic and
paraventricular nuclei of the hypothalamus and transported to the neurohypophysis via their axons
in the hypothalamoneurohypophyseal tract.
ANTIDIURETIC HORMONE/VASOPRESSIN
• Peptide hormone about 2.3 to 3.1 pg/ml
• Increases distal convoluted tubules and collecting ducts’
water permeability
• Promotes water homeostasis
• Regulated by plasma osmolality and blood pressure
LABORATORY DIAGNOSIS
• Overnight Water Deprivation Test
(Concentration Test)
o 8 to 12 hours water deprivation
o Urine osmolality does not rise
above 300 mOsm/kg
• Normal ADH Level: 1 to 5 pcg/ml
TREATMENT
• Desmopressin intake (Neurogenic
and Gestational DI)
• Carbamazepine (Neurogenic DI)
• Hydrochlorothaizideor
Indomethacin (nephrogenic)
THE CORTEX
• The yellow outer region
• Major site of steroid production
• Utilized cholesterol as precursor for steroids
• Cyclopentanoperhydrophenanthrene Ring
ZONES OF CORTEX
• Outermost layer • Mineralocorticoids:
ZONA • Comprises 10% of the cortex Aldosterone
GLOMERULOSA • Secretes the mineralocorticoids • Potassium
(response to RAAS)
• Middle layer • Glucocorticoid: Cortisol
ZONA
• Comprises 75% of the cortex • ACTH
FASICULATA
• Secretes Glucocorticoids
• Innermost layer (before • Androgens (Weak):
ZONA medulla) Androstenedione and
RETICULARIS • Comprises 10% of the cortex Dehydroepiandrosterone
• Secretes androgens • ACTH
Go Find Romie Make Good Sex
METYRAPONE TEST
TREATMENT
• Cortisol injection • Metyrapone - 11 B-Hydroxylase inhibitor (cortisol precursor)
• Hydrocortisone
• Alternative confirmatory for secondary and tertiary adrenal
• Prednisone/Prednisolone
insufficiency
• Normal result: Increase of ACTH; increase urine cortisol
• Positive result: Decrease of ACTH
HYPERCORTISOLISM LAB. DIAG.
ADRENAL HYPERFUNCTION/HYPERCORTISOLISM
• Screening Test – 24SOI
– Cushing’s Syndrome o 24-Hour Urinary Free Cortisol
o Overnight Dexamethasone
• Corticosteroid or ACTH treatment – Cushing’s Test
Syndrome o Salivary Cortisol Test
• Pituitary Hypersecretion – Cushing’s Disease o Insulin Hypoglycemia Test
• Adrenal Adenoma/Carcinoma • Confirmatory Test – Late
Midnight Cable
• Ectopic ACTH Secretion
o Low-Dose Dexamethasone
Test
o Midnight Plasma Cortisol
DEXAMETHASONE PROCEDURE
o CRH Stimulation Test
• Administered 1mg to suppress
early morning cortisol at 11pm
• Low Dose: 1 to 2mg HYPERCORTISOLISM TREATMENT:
• High Dose: 8mg
• Adrenalectomy
NOTE: Suppressed total cortisol <3.6 • Drugs that block steroid synthesis (ketoconazole,
ug/dL: 8am to 9am = negative test metyrapone, and amino glutethimide)
• Anti-neoplastic drugs (Mitotane)
CATECHOLAMINES
• Sympathetic Preganglionic activation
• Release of Acetylcholine
• Depolarization of chromaffin cells
• Exocytosis of all the vesicle contents