ENDOCRINOLOGY Hormones

BY: ANGELICA S. PANGA-AN, RMT • Produced by specialized cells secreted into the blood
Endocrine system stream then travel through the blood circulation to target
• A network of ductless glands that secrete chemical tissues or effectors.
messenger called Hormones. • Secretions are controlled by Hypothalamus.
• Main regulatory functions; • Two chemical categories;
o Regulates the rate of Metabolism. o Lipid-soluble hormones
o Control of Food intake and digestion ▪ Are small molecules, nonpolar, and include
o Influences the development of Tissues steroid Hormones, thyroid hormones and fatty
o Ion regulation acids derivative hormones.
o Regulate the Heart rate and blood pressure ▪ Travel in the bloodstream attached to
o Regulates the levels of blood glucose and other binding protein
nutrient in the blood ▪ Breakdown products are excreted in the
o Control of reproductive functions urine or the bile.
o Regulates uterine contractions and Milk release o Water-Soluble Hormones
o Immune system regulation ▪ Are large and polar molecules; they include
• Composed of Endocrine glands and specialized endocrine protein hormones, peptide hormones and
cells. most amino acid derivative hormones.
▪ Has short half-lives, rapidly degraded by
Proteases.
• Feedback mechanisms:
o Positive feedback system
▪ Increased in product resulting to elevation
of activity and production rate
o Negative feedback system
▪ Increased in the product results to
decreased activity and production rate.
• Types of hormones Action
o Autocrine
▪ Self-regulation of its function. Ex,
eicosanoids
 o Paracrine
▪ Secreted into extracellular fluid; has a Pineal glands
localized effect on other tissues. Ex. • Small endocrine gland located within the brain.
Somatostatin, histamine, eicosanoids. • Secretes melatonin that increases the pigmentation of
o Neurotransmitter the skin and also regulates the circadian rhythm of the
▪ Produces by neurons and released into body.
extracellular space or from nerve ending; ex. Pituitary gland
Acetylcholine, epinephrine • Also called hypophysis. Also known as the “Master Gland’
o Endocrine • Lies posterior to the optic chiasm and is connected to the
▪ Secreted into the blood by specialized cells; hypothalamus by a stalk called the infundibulum.
binds to specific receptor to elicit physiological • It has two parts;

response. Ex. Thyroid hormones, growth

hormone, insulin, epinephrine, estrogen and etc,
o Exocrine
▪ Secreted in endocrine cells and released into lumen of gut;
it affects their function.
Hypothalamus
• Portion of the brain located
in the walls and floor of the
third ventricle.
• The link between the
nervous system and o Anterior pituitary (Adenohypophysis)
endocrine system. ▪ Made up of epithelial cells derived form the
• The supraoptic and embryonic oral cavity
paraventricular nuclei ▪ The “True endocrine gland”
produce vasopressin and ▪ Hormones secreted by this anterior lobe
oxytocin are either peptides or glycoproteins.
• The neurons in the anterior o Posterior pituitary (Neurohypophysis)
portion release hypophyseal ▪ Is an extension of the brain and is composed
hormones: TRH, Gn-RH, of nerve cells.
somatostatin, GH-RH, PIF
 ▪ Capable of releasing hormones oxytocin and ▪ Hormones are released in response to serum
vasopressin but not capable of producing it, osmolality and by suckling.
hormones are synthesized in the ▪ Hormones are controlled by the CNS.
magnicellular neurons of supraoptic and
paraventricular nuclei of hypothalamus.
▪ Serve as storage site for ADH and oxytocin
Hypothalamus
Hormone Site of action Main action Physiologic stimuli Increased Decreased Other description

Thyrotropin- Anterior Releases TSH and

releasing hormone Pituitary gland prolactin
Gonadotropin- Anterior Releasing LH and FSH
releasing hormone Pituitary gland
Corticotropin- Anterior Releases ACTH and
releasing hormone Pituitary gland Beta-lipotropic
hormone
Growth hormone- Anterior Releases growth
releasing hormone Pituitary gland hormone
Somatostatin or Anterior Inhibit the release of
growth hormone Pituitary gland different hormone- GH,
inhibiting hormone TSH, gastrin,
vasoactive intestinal
polypeptide, gastric
inhibitory polypeptide,
secretin, motilin,
glucagon and insulin
Prolactin-releasing Anterior Releases of prolactin
hormone Pituitary gland
Prolactin-inhibiting Anterior Suppression of
factor Pituitary gland synthesis of PRL

Anterior Pituitary Gland

Thyroid-stimulating Thyroid Stimulation of thyroid
hormone hormone
Follicle-stimulating Ovary and growth of follicle with
hormone testis LH, secretion of
estrogen and ovulation
development of
 seminiferous tubules;
spermatogenesis
Luteinizing Hormone Ovulation; formation of
corpora lutea; secretion
of progesterone,
stimulation of
interstitial tissue,
secretions of
androgens.
Prolactin or Mammary Proliferation of
lactotropin glands mammary gland,
initiation of milk
secretion, antagonist of
insulin action
Growth hormone or Liver and Production of insulin- Major: sleep Hypersecretion leads to Hyposecretion Glucose
somatotropin peripheral growth factor-1 which Stress, fasting and GIGANTISM and leads to suppression test
tissues promotes growth high protein diet ACROMEGALY(>50ng/mL) DWARFISM is used for
Chronic malnutrition, Idiopathic GH suspected cases
renal disease, cirrhosis def.- most of acromegaly
and sepsis common in Method:
children Chemiluminescent
immunoassay
Hyperglycemia, RV: <7ng/mL
obesity and
hypothyroidism
Adrenocorticotropic Adrenal cortex Stimulation of
hormone or adrenocortical steroid
corticotropin formation and
secretion
Alpha-melanocyte Skin Dispersion of pigment
stimulating hormone granules, darkening of
skin
Beta-endorphin Brain Endogenous opiate;
raising of pain
threshold and influence
on extrapyramidal
motor activity
Leu-enkephalin and Brain Same as beta-
met-enkephalin endorphin
 Posterior Pituitary Gland
Vasopressin or Arterioles, Elevation of blood Hyperosmolar plasma Def. causes DI Characterized:
Antidiuretic renal tubules pressure, water (nephrogenic or Polyuria, with Low
hormone reabsorption central) urine specific
gravity
Oxytocin Smooth muscle Contraction, action in Suckling, skin-to-
of uterus and parturition and sperm skin or crying
mammary transport; milk ejection
glands

Pineal Gland
Serotonin or 5- Cardiovascular, Neurotransmitter;
hydroxytryptamin respiratory and stimulation or inhibition
gastrointestinal of various smooth
system; brain muscles and nerves
Melatonin Hypothalamus Suppression of
gonadotropin and
growth hormone
secretion; induction of
sleep
Thyroid gland • In tissue, peripheral deiodination of T4. T4 is
converted into the active form T3 using enzyme thyroid
• Butterfly-shaped organ
deiodinase.
located on the lower
portion of the neck • Hypothyroidism
• Left and right lobes are o Decreased basal metabolic rate, increased weight
separated by isthmus gain, decreased appetite, bradycardia,
• Two cells type; hypoventilation, general appearance; myxedema,
o Follicular cells – deep voice, impaired growth among children,
produces mental retardation in infant, somnolence and
metabolic increased Cholesterol and TAG
hormone T3 and o Primary hypothyroidism decreased T3 and T4,
T4 increased TSH levels
o Parafollicular cells – also known as perifollicular o Secondary decreased T3, T4 and TSH.
cells or C-cells; produces calcitonin. Increased/normal TRH
• Thyroid Hormone productions is regulated by o Tertiary hypothyroidism decreased T3, T4, TSH,
Hypothalamus, Pituitary gland, thyroid gland axis. and TRH
• Thyroid follicles are circular structures inside that o Autoimmune disorders Primary: hashimoto’s
thyroid that encloses a colloid matrix known as thyroiditis – anti-microsomal antibodies: anti-
thyroglobulin (Protein matrix rich in the amino acid thyroglobulin.
tyrosine) • Hyperthyroidism
• Inside the follicle iodine binds with tyrosine by enzyme o Increased basal metabolic rate, decreased weight
thyroid peroxidase (TPO) gain, heat intolerance, increased appetite,
• Two types of iodine acquired from the diet: tachycardia and palpitation, general appearance;
o Monoatomic iodine, when bind to tyrosine leads to exophthalmos, enlarged thyroid, restlessness,
the monoiodotyrosine (MIT) formation decreased blinking, hyperkinesis and increased
o Diatomic iodine, when bind to tyrosine leads to the Alkaline phosphatase.
formation of diiodotyrosine (DIT) o Autoimmune disorders Primary: Grave’s disease-
• T4 is more concentrated than T3 but T3 are more anti-TSH receptor antibodies.
biologically active than T4.
• T3 thyrotoxicosis (Plummer’s disease)
 o Increased total T3 and increased free T3, normal Adrenal Glands
total T4 and normal free T4; decreased TSH and
• Paired organs, located above the kidneys
increased T3U
• Two major parts: outer cortex and inner medulla
• Euthyroid Sick syndrome
o Characterized by normal/non-dysfunctional
thyroid, but unusually low T3/T4; often found in
critically-ill, hospitalized patients.
• Congenital hypothyroidism
o Inadequate thyroid hormone production in
newborn due to anatomic defect in the gland,
inborn error of thyroid metabolism, or iodine def.;
can lead to cretinism
• Protein Carriers for Thyroid Hormone • Adrenal cortex: produces steroid Hormones; aldosterone,
o Thyroxine-binding globulin- major protein carrier androstenedione, cortisol, dehydroepiandrosterone (DHEA),
for thyroid hormones at 70-75%
dehydroepiandrostenedione sulfate and 17-
o Thyroxine-binding prealbumin (TBPA) at 20% hydroxyprogesterone
o Thyroxine-binding albumin (TBA)-transport 10% o Three zones:
o Thyroid Hormone Binding Ratio measures the ▪ G-zone or zona glomerulosa – outermost layer, salt
amount of available bindings sites in TBG. regulation, produces aldosterone; critical for sodium
Decreased in Hypothyroidism and increased in
retention. Major mineralocorticoid.
Hyperthyroidism. ▪ F-zone or zona fasiculata – middle layer, sugar
regulation, produces cortisol, major glucocorticoid.
▪ R-zone or zona reticularis – inner layer, produces weak
androgens.
• Adrenal medulla: Produces catecholamines ( epinephrine and
norepinephrine) and dopamine
• Aldosterone
o Major mineralocorticoid; regulated by Renin-
Angiotensin-Aldosterone System.
 o Renin secreted by the kidney, cleaves angiotensin o Cushing’s syndrome – hyperglycemia and increased
I from renin substrate (angiotensinogen) cortisol level, buffalo hump and moon-face
produced by the liver. appearance.
o Angiotensin I is converted to angiotensin II by ▪ Screening test;
angiotensin-converting enzyme (ACE) mainly by • 24-hr urinary free cortisol
lungs. • Overnight dexamethasone
o Angiotensin II increases peripheral vascular suppression test
resistance and, together with angiotensin III, • Plasma or salivary midnight cortisol
stimulates aldosterone secretion, which result in level
sodium retention and increased plasma volume. o Cushing’s Disease – Medical cause of Cushing’s
o Hyperaldosteronism: increased blood sodium, syndrome. This occurs when a tumor on the
decreased blood potassium levels. The patient will pituitary gland causes the gland to produce too
be hypernatremic, hypokalemic, and exhibit a mild much ACTH.
metabolic alkalosis o Adrenal Cushing’s Disease – occurs when adrenal
o Hypoaldosteronism decreased blood sodium, glands develop a tumor. The adrenal tumor is
increased blood potassium levels composed of cortisol-producing cells, which
o CONN syndrome: a condition of primary excess amounts of the hormone compared to what
aldosteronism arising from over-secretion of is normally produced. At this case, the normal
aldosterone by an adrenal cortical adenoma. Pituitary will sense the excess cortisol and will
• Cortisol stop making ACTH.
o Major glucocorticoid, capable of increasing blood o Addison’s disease -Hypoglycemia and decreased
glucose levels cortisol levels.
o Exhibit diurnal variation: 6:30-8am increased, low o Congenital adrenal hyperplasia – group of
in late afternoon/evening 4pm. inherited disorders in which def. of enzymes( 21-
o Production through HPAA- Corticotrophin- alpha-hyroxylase def.) that catalyze the
releasing hormone which stimulate that pituitary biosynthesis of cortisol result in compensatory
gland to release corticotrophin (ACTH: hypersecretion of corticotropin and subsequent
adrenocorticotropic hormone) stimulates the adrenal hyperplasia as well as excessive androgen
adrenal gland to produce cortisol. production. Associated in low levels of cortisol,
high levels of ACTH.
Endocrinology of Reproductive system and o Hormone marker of pregnancy in women. Elevated
in the first trimester and decreased during
Pregnancy second and third trimester.
• Testosterone o Continuously elevated HCG is found in Down
o Most potent male sex hormone. Marker for syndrome, Choriocarcinoma and Molar Pregnancy
masculinity.
o Continuously low HCG levels in may indicate
• Estrogen ectopic pregnancy.
o Mainly produced in the ovaries. o Marker of testicular carcinoma in males.
o Three forms: o Tumor marker for gestational trophoblastic
▪ Estrone
disease, germ cell tumor, choriocarcinoma
▪ Estradiol- most potent female sex
hormones
Endocrinology and Bone Metabolism
• Calcitonin
▪ Estriol -Produced by pregnant women.
o Promotes calcium deposition; moves calcium from
Serves as a marker of stability of
the blood towards the bone
fetoplacental unit in pregnant women.
o Marker of medullary thyroid carcinoma; Usually
▪ Quadruple test for down syndrome
decreases blood calcium levels
o Quadruple test for Down syndrome
• Parathyroid Hormone
▪ Human Chorionic gonadotropin- increased
o Promotes calcium resorption; moves calcium from
▪ Inhibin A - increased
bone into the blood.
▪ Urinary estriol - decreased
o Usually increases blood calcium levels and
▪ Alpha fetoprotein- decreased
decreases blood phosphate levels.
o Kober reaction is used for analysis of estrogens.
o Parathyroid hormone-related protein is a
It uses hydroquinone and hot concentrated
substance similar to PTH, produced in certain
sulfuric acid as reagents.
malignancies such as breast, lung and kidney
• Human Chorionic Gonadotropin
cancers. It mimics the action of PTH, thereby
o Produced by the placenta. It is a glycoprotein
causing hypercalcemia and suppressed PTH
that has a similar structure TSH, FSH and LH
production
they are differentiated based on their beta
o Hyperparathyroidism
subunits.
▪ Primary- high PTH leading to high calcium.
Eg. Adenoma or glandular hyperplasia
 ▪ Secondary – low calcium leading to high argentaffin cells; bananas can cause false positive result
PTH. Eg. Renal failure, vit. D def., in 5-HIAA measurement.
Pseudohypoparathyroidism, acute • Gastrin – Produced by G-cells, stimulates the parietal
pancreatitis cells of the stomach to produce hydrochloric acid;
o Hypoparathy roidism increased in Zollinger-Ellison Syndrome
▪ Primary – Low PTH leading to low calcium. • Erythropoietin – Hormones responsible for RBC
Eg. Parathyroid gland aplasia, destruction production and maturation; produced by the kidneys in
and removal response to tissue hypoxia; decreased in Polycythemia
▪ Secondary – High calcium leading to low vera.
PTH.
Serum Serum PTH Urine Urine
Calcium Phospha calcium Phosphate
te

Primary Increas Decreas Incre Increa Increase

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Seconda Decreas Varies Incre Normal Increase
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hyperpar increas
athyroidi e
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Hypercal Increas Decreas Decre Increa increase
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Other Hormones
• Serotonin – 5-hydroxyindole acetic acid is a metabolite
of serotonin; increases in carcinoid tumors involving