Overview of Cell Communications

• Four principal mechanisms of communication between cells

– Gap junctions
• Pores in cell membrane allow signaling molecules, nutrients, and
electrolytes to move from cell to cell
– Neurotransmitters
• Released from neurons to travel across synaptic cleft to second cell
– Paracrine (local) hormones
• Secreted into tissue fluids to affect nearby cells
– Hormones
• Chemical messengers that travel in the bloodstream to other tissues
and organs
Endocrine System Components
• Endocrine system - glands, tissues, and cells that
secrete hormones
• Endocrinology – the study of this system and the
diagnosis and treatment of its disorders
• Endocrine glands – organs that are traditional
sources of hormones
• Hormones - chemical messengers that are
transported by the bloodstream and stimulate
physiological responses in cells of another tissue
or organ, often a considerable distance away
Major Endocrine Organs

Figure 16.1
Comparison of Endocrine and Exocrine Glands
• Exocrine glands
– Have ducts carry secretion to an epithelial surface or
the mucosa of the digestive tract – ‘external
secretions’
– Extracellular effects (food digestion)

• Endocrine glands
– No ducts
– Contain dense, fenestrated capillary networks which
allows easy uptake of hormones into bloodstream
– ‘Internal secretions’
– Intracellular effects such as altering target cell
metabolism
 Hormones
• Hormones – chemical substances secreted by cells
into the extracellular fluids
– Regulate the metabolic function of other cells
– Have lag times ranging from seconds to hours
– Tend to have prolonged effects
– Are classified as amino acid-based hormones, or
steroids
Comparison of Nervous and Endocrine Systems (Differences)
• Both serve for internal communication
– Nervous - both electrical and chemical
– Endocrine - only chemical
• Speed and persistence of response
– Nervous - reacts quickly (1 - 10 msec), stops quickly
– Endocrine - reacts slowly (hormone release in seconds or
days), effect may continue for weeks
• Adaptation to long-term stimuli
– Nervous - response declines (adapts quickly)
– Endocrine - response persists (adapts slowly)
• Area of effect
– Nervous - targeted and specific (one organ)
– Endocrine - general, widespread effects (many organs)
 Endocrine organs
• Hypothalamus
• Pituitary gland
• Pineal gland
• Thymus gland
• Thyroid gland
• Adrenal gland
• Parathyroid gland
• Pancreas
• Gonads 17-7
Anatomy of Hypothalamus
• shaped like a flattened funnel
• forms floor and walls of third ventricle of the brain
• regulates primitive functions of the body from water
balance and thermoregulation to sex drive and
childbirth
• many of its functions carried out by pituitary gland
 Hypothalamic Hormones
• Nine hormones produced in hypothalamus
– Seven regulate the anterior pituitary
– Two are released and stored in the posterior pituitary
• Seven releasing and inhibiting hormones stimulate or
inhibit the anterior pituitary
– TRH: Thyrotropin Releasing Hormone
– CRH: Corticotropin Releasing Hormone
– GnRH: Gonadotropin Releasing Hormone
– GHRH: Growth Hormone Releasing Hormone
– GHIH: Growth Hormone Inhibiting Hormone
(Somatostatin)
– PRH:Prolactin Releasing Hormone
– PIH: Prolactin Inhibiting Hormone
 Hypothalamic Hormones
– TRH, CRH, GnRH, and GHRH are releasing hormones
that affect anterior pituitary secretion of TSH, PRL,
ACTH, FSH, LH, and GH
– PIH inhibits secretion of prolactin, and somatostatin
inhibits secretion growth hormone & thyroid
stimulating hormone by the anterior pituitary (see table
17.3)
 Hypothalamic Hormones
• Two other hypothalamic hormones are :-
• Oxytocin (OT)
• Antidiuretic Hormone (ADH)
– Both stored and released by posterior pituitary
– Right and left paraventricular nuclei produce oxytocin
(OT)
– Supraoptic nuclei produce antidiuretic hormone (ADH)
– Posterior pituitary does not synthesize them
FIGURE 17.7

Hypothalamus–Pituitary Complex
The hypothalamus region lies inferior and anterior to the thalamus. It connects to the pituitary
gland by the stalk-like infundibulum. The pituitary gland consists of an anterior and posterior
lobe, with each lobe secreting different hormones in response to signals from the
hypothalamus.
 Pituitary Gland (Hypophysis)
• Suspended from hypothalamus by a stalk – infundibulum

• Location and size

– Housed in sella turcica of sphenoid bone
– Size and shape of kidney bean

• Composed of two structures with independent origins and

separate functions
– Adenohypophysis (anterior pituitary)
• Arises from hypophyseal pouch (outgrowth of pharynx)
– Neurohypophysis (posterior pituitary)
• Downgrowth from brain
 Adenohypophysis & Neurohypophysis
• Adenohypophysis (anterior lobe)constitutes anterior three-quarters
of pituitary
– Has two segments:
• Anterior lobe (pars distalis)
• Pars tuberalis small mass of cells adhering to stalk
– Linked to hypothalamus by hypophyseal portal system -
Primary capillaries in hypothalamus connected to secondary
capillaries in adenohypophysis by portal venules
• Hypothalamic hormones regulate adenohypophysis cells
• Neurohypophysis (posterior lobe) constitutes the posterior one-
quarter of the pituitary
– Nerve tissue, not a true gland
• Hypothalamic neurons secrete hormones that are stored in
neurohypophysis until released into blood
FIGURE 17.8

Posterior Pituitary
Neurosecretory cells in the hypothalamus release oxytocin (OT) or ADH into the
posterior lobe of the pituitary gland. These hormones are stored or released into the
blood via the capillary plexus.
FIGURE 17.9

Anterior Pituitary
The anterior pituitary manufactures seven hormones. The hypothalamus produces separate
hormones that stimulate or inhibit hormone production in the anterior pituitary. Hormones
from the hypothalamus reach the anterior pituitary via the hypophyseal portal system.
 Anterior Pituitary Hormones
• Two gonadotropin hormones that target gonads
– FSH (follicle stimulating hormone)
• Stimulates secretion of ovarian sex hormones, development of ovarian follicles,
and sperm production
– LH (luteinizing hormone)
• Stimulates ovulation, stimulates corpus luteum to secrete progesterone,
stimulates testes to secrete testosterone
• TSH (thyroid stimulating hormone)
– Stimulates secretion of thyroid hormone
• ACTH (adrenocorticotropic hormone)
– Stimulates adrenal cortex to secrete glucocorticoids
• PRL (prolactin)
– After birth stimulates mammary glands to synthesize milk, enhances
secretion of testosterone by testes
• GH (growth hormone)
– Stimulates mitosis and cellular differentiation
 Posterior Pituitary Hormones
• Produced in hypothalamus
– Transported by hypothalamo-hypophyseal tract to
posterior lobe. Releases hormones when hypothalamic
neurons are stimulated
• ADH (antidiuretic hormone)
– Increases water retention thus reducing urine volume and
prevents dehydration
– Also called vasopressin because it can cause
vasoconstriction
• OT (oxytocin)
– Surge of hormone released during sexual arousal and orgasm
• Stimulate uterine contractions and propulsion of semen
– Promotes feelings of sexual satisfaction and emotional
bonding between partners
– Stimulates labor contractions during childbirth
– Stimulates flow of milk during lactation
– Promotes emotional bonding between lactating mother and
infant
Feedback Loops
• Negative feedback -
increased target organ
hormone levels inhibits
release of hormones
example TSH

•Positive feedback -
stretching of uterus
Increases OT release,
causes contractions,
causing more stretching
of uterus, etc. Until
delivery
Hormones from other endocrine
glands
 Pineal Gland
• Pineal gland - attached to roof of third ventricle beneath the
posterior end of corpus callosum
• After age 7, it undergoes involution (shrinkage). Down 75%
by end of puberty. Tiny mass of shrunken tissue in adults
• May synchronize physiological function with 24-hour
circadian rhythms of daylight and darkness

– Synthesizes melatonin from serotonin during the night

• May regulate timing of puberty in humans

• Seasonal affective disorder (SAD) occurs in winter or
northern climates
– Symptoms - depression, sleepiness, irritability and
carbohydrate craving
– 2 to 3 hours of exposure to bright light each day reduces the
melatonin levels and the symptoms (phototherapy)
 Thymus
• Thymus plays a role in three systems: endocrine, lymphatic, and
immune
• Bilobed gland in the mediastinum superior to the heart
– Goes through involution after puberty
• Site of maturation of T cells important in immune defense
• Secretes hormones (thymopoietin, thymosin, and thymulin) that
stimulate development of other lymphatic organs and activity of T-
lymphocytes
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Thyroid

Trachea

Thymus
Lung

Heart

Diaphragm

Liver
(a) Newborn

Figure 17.8 a-b (b) Adult

 Thyroid Gland
• The largest endocrine gland, located in the
anterior neck, consists of two lateral lobes
connected by a median tissue mass called the
isthmus. The major hormones of this gland
are;-thyroid hormone and calcitonin.
• Composed of follicles that produce the
glycoprotein thyroglobulin. Colloid
(thyroglobulin + iodine) fills the lumen of the
follicles and is the precursor of thyroid
hormone (T3 and T4)
• Other endocrine cells, the parafollicular cells,
produce the hormone calcitonin
FIGURE 17.12
Thyroid Gland
The thyroid gland is located in the neck
where it wraps around the trachea.
(a) Anterior view of the thyroid gland.
(b) Posterior view of the thyroid gland.
(c) The glandular tissue is composed
primarily of thyroid follicles. The
larger parafollicular cells often appear
within the matrix of follicle cells. LM ×
1332. (Micrograph provided by the
Regents of University of Michigan
Medical School © 2012)
 Thyroid Hormone
• Thyroid hormone – major metabolic hormone
• Consists of two related iodine-containing
compounds
– T4 – thyroxine/tetraiodothyronine; has two tyrosine
molecules plus four bound iodine atoms
– T3 – triiodothyronine; has two tyrosines with three
bound iodine atoms
 Effects of Thyroid Hormone
• TH is concerned with:
– Glucose oxidation
– Increasing metabolic rate
– Heat production
• TH plays a role in:
– Maintaining blood pressure
– Regulating tissue growth
– Developing skeletal and nervous systems
– Maturation and reproductive capabilities
 Calcitonin
• A peptide hormone produced by the
parafollicular, or C, cells
• Lowers blood calcium levels in children
• Antagonist to parathyroid hormone (PTH)
• Calcitonin targets the skeleton, where it:
– Inhibits osteoclast activity (and thus bone
resorption) and release of calcium from the bone
matrix
– Stimulates calcium uptake and incorporation into
the bone matrix
 Parathyroid Glands
• Tiny glands embedded in the posterior aspect of
the thyroid
• Cells are arranged in cords containing oxyphil and
chief cells
• Chief (principal) cells secrete PTH
• PTH (parathormone) regulates calcium balance in
the blood
FIGURE 17.15

Parathyroid Glands
The small parathyroid glands are embedded in the posterior surface of the thyroid
gland. LM × 760. (Micrograph provided by the Regents of University of Michigan
Medical School © 2012)
Effects of Parathyroid Hormone
• PTH release increases Ca2+ in the blood as it:
– Stimulates osteoclasts to digest bone matrix
– Enhances the reabsorption of Ca2+ and the secretion of
phosphate by the kidneys
– Increases absorption of Ca2+ by intestinal mucosal
• Rising Ca2+ in the blood inhibits PTH release
Effects of Parathyroid Hormone

Figure 16.12
FIGURE 17.17

Adrenal Glands
Both adrenal glands sit atop the kidneys and are composed of an outer cortex and an inner
medulla, all surrounded by a connective tissue capsule. The cortex can be subdivided into
additional zones, all of which produce different types of hormones. LM × 204. (Micrograph
provided by the Regents of University of Michigan Medical School © 2012)
 Adrenal (Suprarenal) Glands
• Adrenal glands – paired, pyramid-shaped organs
atop the kidneys
• Structurally and functionally, they are two glands
in one
– Adrenal medulla – neural tissue that acts as part of the
SNS
– Adrenal cortex – glandular tissue derived from
embryonic mesoderm
 Adrenal Cortex
• Synthesizes and releases steroid hormones
called corticosteroids
• Different corticosteroids are produced in each
of the three layers
– Zona glomerulosa – mineralocorticoids
(chiefly aldosterone)
– Zona fasciculata – glucocorticoids
(chiefly cortisol)
– Zona reticularis – gonadocorticoids
(chiefly androgens)
 Mineralocorticoids
• Regulate electrolytes in extracellular fluids
• Aldosterone – most important mineralocorticoid
– Maintains Na+ balance by reducing excretion of
sodium from the body
– Stimulates reabsorption of Na+ by the kidneys
• Aldosterone secretion is stimulated by:
– Rising blood levels of K+
– Low blood Na+
– Decreasing blood volume or pressure
Other factors influencing Aldosterone Secretion
• Renin-angiotensin mechanism – kidneys
release renin, which causes convertion of
angiotensin I(produced by liver) into
angiotensin II that in turn stimulates
aldosterone release. This mechanism is used by
the kidneys to control blood pressure and blood
volume.

• Atrial natriuretic peptide (ANP) – inhibits

activity of the zona glomerulosa
 Glucocorticoids (Cortisol)
• Help the body resist stress by:
– Keeping blood sugar levels relatively constant
– Maintaining blood volume and preventing water shift
into tissue
• Cortisol provokes:
– Gluconeogenesis (formation of glucose from
noncarbohydrates)
– Rises in blood glucose, fatty acids, and amino acids
 Sex steroids
• Sex steroids
– Androgens – sets libido throughout life; large role in
prenatal male development (includes DHEA which
other tissues convert to testosterone)
– Estradiol – small quantity, but important after
menopause for sustaining adult bone mass; fat converts
androgens into estrogen
 Adrenal Medulla
• Made up of chromaffin cells that secrete
epinephrine and norepinephrine
• Secretion of these hormones causes:
– Blood glucose levels to rise
– Blood vessels to constrict
– The heart to beat faster
– Blood to be diverted to the brain, heart, and skeletal
muscle
 Adrenal Medulla
• Epinephrine is the more potent stimulator of the
heart and metabolic activities
• Norepinephrine is more influential on peripheral
vasoconstriction and blood pressure
FIGURE 17.18

Pancreas

The pancreatic exocrine function involves the acinar cells secreting digestive enzymes that are transported into the small
intestine by the pancreatic duct. Its endocrine function involves the secretion of insulin (produced by beta cells) and
glucagon (produced by alpha cells) within the pancreatic islets. These two hormones regulate the rate of glucose metabolism
in the body. The micrograph reveals pancreatic islets. LM × 760. (Micrograph provided by the Regents of University of
Michigan Medical School © 2012)
 Pancreas
• A triangular gland, which has both exocrine
and endocrine cells, located behind the
stomach
• Acinar cells produce an enzyme-rich juice
used for digestion (exocrine product)
• Pancreatic islets (islets of Langerhans)
produce hormones (endocrine products)
• The islets contain two major cell types:
– Alpha (a) cells that produce glucagon
– Beta (b) cells that produce insulin
 Glucagon
• A 29-amino-acid polypeptide hormone that is a
potent hyperglycemic agent
• Its major target is the liver, where it promotes:
– Glycogenolysis – the breakdown of glycogen to
glucose
– Gluconeogenesis – synthesis of glucose from lactic
acid and noncarbohydrates
– Release of glucose to the blood from liver cells
 Insulin
• A 51-amino-acid protein consisting of two amino
acid chains linked by disulfide bonds
• Synthesized as part of proinsulin and then excised
by enzymes, releasing functional insulin
• Insulin:
– Lowers blood glucose levels
– Enhances transport of glucose into body cells
– Counters metabolic activity that would enhance blood
glucose levels
 The Gonads
• Ovaries and testes are both endocrine and exocrine
– Exocrine product – whole cells - eggs and sperm
(cytogenic glands)
– Endocrine product - gonadal hormones – mostly steroids

• Ovarian hormones
– Estradiol, progesterone, and inhibin

• Testicular hormones
– Testosterone, weaker androgens, estrogen and inhibin
 Gonads: Female
• Paired ovaries in the abdominopelvic cavity
produce estrogens and progesterone
• They are responsible for:
– Maturation of the reproductive organs
– Appearance of secondary sexual characteristics
– Breast development and cyclic changes in the uterine
mucosa
 Gonads: Male
• Testes located in an extra-abdominal sac (scrotum)
produce testosterone
• Testosterone:
– Initiates maturation of male reproductive organs
– Causes appearance of secondary sexual characteristics
and sex drive
– Is necessary for sperm production
– Maintains sex organs in their functional state
 Growth Hormone
• GH has widespread effects on the body tissues especially cartilage,
bone, muscle, and fat
• Induces liver to produce growth stimulants like insulin-like growth
factors (IGF-I) or somatomedins (IGF-II)
• Functions:
• Protein synthesis increases -- boosts transcription of DNA,
production of mrna, amino acid uptake into cells, suppresses
protein catabolism
• Lipid metabolism increased – fat catabolized by adipocytes
(protein-sparing effect) – provides energy for growing tissues
• Carbohydrate metabolism – by mobilizing fatty acids for
energy, GH produces glucose-sparing makes glucose
available for glycogen synthesis and storage
• Electrolyte balance – promotes na+, K+, & cl- retention by
kidneys, enhances ca+2 absorption in intestine
 Growth Hormone
– Bone growth, thickening, and remodeling
influenced, especially during childhood and
adolescence
– Secretion high during first two hours of sleep
– Can peak in response to vigorous exercise
– GH levels decline gradually with age
– Average 6 ng/ml during adolescence, 1.5 ng/mg in
old age
• Lack of protein synthesis contributes to aging
of tissues and wrinkling of the skin
 Other Hormone-Producing Structures

• Heart – produces atrial natriuretic peptide (ANP),

which reduces blood pressure, blood volume, and blood
sodium concentration
• Gastrointestinal tract – enteroendocrine cells release
local-acting digestive hormones
• Placenta – secretes estrogen, progesterone and other
hormones which influence the course of pregnancy
 Other Hormone-Producing Structures
• Kidneys – secrete erythropoietin, which signals the production of
red blood cells
– secrete renin that converts angiotensinogen to angiotensin I
• Skin – produces cholecalciferol, the precursor of vitamin D
• Adipose tissue – releases leptin, which is involved in the sensation
of satiety, and stimulates increased energy expenditure
• Liver – involved in the production of at least five hormones or their
precursors
– converts cholecalciferol into calcidiol
– secretes angiotensinogen (a prohormone)
• precursor of angiotensin II (a regulator of blood pressure)
– secretes 15% of erythropoietin (stimulates bone marrow)
– hepcidin – promotes intestinal absorption of iron
– source of IGF-I that controls action of growth hormone
Classes of Hormones & Hormone
Mode of Action
 Hormone Classes
• Three chemical classes Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

– Steroids OH
H

• Derived from cholesterol

CH3 H2 N C COOH

CH2
CH3

• Secreted by gonads and adrenal glands I I

O

• Estrogens, progesterone, testosterone, Testosterone O

cortisol, corticosterone, aldosterone, CH3

OH

I I

DHEA, and calcitriol OH

Thyroxine

– Peptides and glycoproteins HO HO

OH

CH CH2 NH CH2

• Created from chains of amino acids (a) Steroids

Estradiol
HO

(b) Monoamines
Epinephrine

• Secreted by pituitary and hypothalamus Pro

Thr Tyr
Phe
Asn
Cys Tyr Asn
Glu
Leu

• Oxytocin, antidiuretic hormone,

Lys Phe
S Gln
Gly
Thr Gly Tyr
lle

releasing and inhibiting hormones, and

Arg Leu
S Val
Glu
Ser
Glu

anterior pituitary hormones

Insulin Gly Cys
Cys S Gln
S
lle
Val Cys

– Monoamines (biogenic amines)

Ser
Thr Cys
Leu
S
Tyr
Val Tyr Leu

• Derived from amino acids

Arg S
Ala
Asp lle
Glu
His Val
Leu His Ser Gly Cys Leu
Pro Phe
His

• Secreted by adrenal, pineal, and thyroid

Angiotensin II
Gln

Asn

glands (c) Peptides Phe

Val

• Epinephrine, norepinephrine, melatonin,

and thyroid hormone Figure 17.14 a-c 17-53
 Hormone Mode of Action
• Hydrophobic hormones
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
– Penetrate plasma membrane
and enter nucleus
Hydrophilic
hormone
Receptor in
plasma
Target
cell
– Act directly on the genes
membrane changing target cell
Transport physiology
protein
– Estrogen, progesterone,
Free
Second-
messenger thyroid hormone act on
hormones activation
nuclear receptors
– Take several hours to days to
show effect due to lag for
protein synthesis
Bound
hormone
Hydrophobic • Hydrophilic hormones
hormone
Receptor in – Cannot penetrate into target
Tissue fluid nucleus
cell
Blood
– Must stimulate physiology
indirectly
Figure 17.20
 Hormone Mode of Action
• Most monoamines and peptides are hydrophilic
– Mix easily with blood plasma
– Water soluble
– Need receptors in cell membrane as they cannot directly enter
plasma membrane. Uses Indirect mode of action

• Steroids and thyroid hormone are hydrophobic

– Need receptors inside the cells because these being hydrphobic can enter
the cells. Uses direct mode of action
– Bind to intracellular transport proteins (albumins and
globulins synthesized by the liver).
– Activate an intracellular receptor
– The activated hormone receptor complex directly signals dna
to synthesize specific proteins
FIGURE 17.4

Binding of Lipid-Soluble Hormones

A steroid hormone directly initiates the production of proteins within a target cell. Steroid hormones easily diffuse
through the cell membrane. The hormone binds to its receptor in the cytosol, forming a receptor–hormone
complex. The receptor–hormone complex then enters the nucleus and binds to the target gene on the DNA.
Transcription of the gene creates a messenger RNA that is translated into the desired protein within the cytoplasm.
FIGURE 17.5

Binding of Water-Soluble Hormones

Water-soluble hormones cannot diffuse through the cell membrane. These hormones must bind to a surface cell-membrane
receptor. The receptor then initiates a cell-signaling pathway within the cell involving G proteins, adenylyl cyclase, the
secondary messenger cyclic AMP (cAMP), and protein kinases. In the final step, these protein kinases phosphorylate
proteins in the cytoplasm. This activates proteins in the cell that carry out the changes specified by the hormone.
 Enzyme Amplification
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. • Hormones are
Small stimulus extraordinarily potent
chemicals
Hormone • One hormone molecule
can trigger the synthesis
of many enzyme

Reaction cascade (time)

cAMP and
protein kinase
molecules.
Activated enzymes • Very small stimulus can
produce very large effect
Metabolic product
• Circulating
concentrations very low
Great effect
Figure 17.24
 Paracrine Secretions
• Paracrines - chemical messengers that diffuse short distances
and stimulate nearby cells
– Unlike neurotransmitters not produced in neurons
– Unlike hormones not transported in blood

• A single chemical can act as a hormone, paracrine, or even

neurotransmitter in different locations

– Histamine
• From mast cells in connective tissue
• Causes relaxation of blood vessel smooth muscle

– Nitric oxide
• From endothelium of blood vessels, causes vasodilation
 Endocrine Disorders
• Variations in hormone concentration and target cell
sensitivity have noticeable effects on body
• Hyposecretion – inadequate hormone release
– Tumor or lesion destroys gland or interferes with its ability to
receive signals from another gland
• Head trauma affects pituitary gland’s ability to secrete ADH
– Diabetes insipidus - chronic polyuria
• Hypersecretion – excessive hormone release
– Tumors or autoimmune disorder
• Toxic goiter (graves disease) – autoantibodies mimic effect of TSH on
the thyroid causing thyroid hypersecretion
 Pituitary Disorders
• Hypersecretion of growth hormone (GH)
– Acromegaly - thickening of bones and soft tissues in adults
• Especially hands, feet and face
– Problems in childhood or adolescence
• Gigantism if hypersecretion
• Pituitary dwarfism if hyposecretion – rare since growth
hormone is now made by genetically engineered bacteria

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Age 9 Age 16 Age 33 Age 52

Figure 17.27 1-5 From Clinical Pathological Conference Acromegaly, Diabetes, Hypermetabolism, Protein Use and Heart Failure in American
Journal of Medicine, 20:133, 1986. Copyright © 1986 by Excerpta Media, Inc.
 Thyroid Gland Disorders
• Congenital hypothyroidism (decreased TH)
– Hyposecretion present a birth (formerly cretinism)
– Treat with oral thyroid hormone
• Myxedema (decreased th)
– Adult hypothyroidism
– Treat with oral thyroid hormone
• Goiter – any pathological enlargement of the thyroid gland
– Endemic goiter
• Dietary iodine deficiency, no TH, no - feedback, increased
TSH stimulates hypertrophy
– Toxic goiter (graves disease)
• Autoantibodies mimic the effect of TSH on the thyroid
causing hypersecretion
• Overgrown thyroid produces functional TH
FIGURE 17.14

Goiter
(credit: “Almazi”/Wikimedia Commons)
 Parathyroid Disorders
– Hypoparathyroidism
• Surgical excision during thyroid surgery
• Fatal tetany in 3 - 4 days due to rapid decline in
blood calcium level

– Hyperparathyroidism - excess pth secretion

• Parathyroid tumor
• Bones become soft, fragile, and deformed
• Ca2+ and phosphate blood levels increase
• Promotes renal calculi formation
 Adrenal Disorders
• Cushing syndrome - excess cortisol secretion
– hyperglycemia, hypertension, weakness, edema
– rapid muscle and bone loss due to protein catabolism
– abnormal fat deposition
• moon face and buffalo hump

• Adrenogenital syndrome (AGS)

– adrenal androgen hypersecretion (accompanies Cushing)
– enlargement of external sexual organs in children and
early onset of puberty
• newborn girls exhibit masculinized genitalia
– masculinizing effects on women
• increased body hair, deeper voice and beard growt
 Cushing Syndrome
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Figure 17.29b
(b)
From: Atlas of Pediatric Physical Diagnosis, 3/e by Zitelli & Davis, fig 9-17 1997, with permission from Elsevier
 Diabetes Mellitus
• Most prevalent metabolic disease in world
– Disruption of metabolism due to hyposecretion or
inaction of insulin
– Symptoms:
• Polyuria (excess urine output), polydipsia (intense thirst)
and polyphagia (hunger)
• Revealed by elevated blood glucose, glucose in urine and
ketones in the urine
• Transport maximum – limit to how fast the
glucose transporters can work to reabsorb
– Excess glucose enters urine and water follows it
• Causes polyuria, dehydration, and thirst
 Types of Diabetes Mellitus
• Type 1 (IDDM) – 5 to 10% of cases in US
• Major cause is lack of insulin
– insulin is always used to treat Type 1
• insulin injections, insulin pump, or dry insulin inhaler
• monitoring blood glucose levels and controlled diet
– autoantibodies attack and destroy pancreatic beta cells

• Type 2 (NIDDM) – 90 to 95% of diabetics

• Major cause is resistance to insulin means unresponsiveness of
target cells to insulin
• treated with weight loss program and exercise since:
– oral medications improve insulin secretion or target cell
sensitivity