Endocrine Physiology (Lea) Flashcards
Homeostasis is controlled by what two systems?
Nervous System
Endocrine System
Functions of both the nervous and endocrine system
1) communicate, 2) integrate, and 3) organize the body’s response to a changing internal or external environment
With the endocrine system, messengers are ___.
hormones
With the endocrine system, messengers travel through ___.
ECF
With the endocrine system, responses are ___.
slow and widespread
With the endocrine system, duration of action is ___.
long
With the nervous system, messengers are ___.
neurotransmitters
With the nervous system, messengers travel through ___.
chemicals or electric pathways
With the nervous system, responses are ___.
fast, precise, and specific
With the nervous system, duration of action is ___.
short
The purpose of the endocrine system is to ___
regulate behavior, growth, metabolism, fluid status, development and reproduction
Endocrine function is mediated by ___
hormones
Hormones are _____
messengers that transport information from one set of cells to another
Endocrine Function – target site is ____
a distant cell
Ex: Adrenal Gland
Paracrine Function – target site is ___
a neighboring cell of a different type
Ex: pancreatic alpha cells influencing pancreatic beta cells
Autocrine Function – target site is ____
on the secreting cell itself and/or an identical neighboring cell
Peptide or Protein Hormones
The majority of hormones
Prehormones and prohormones are synthesized in endocrine cells
Stored in secretory granules within endocrine glands
Secreted out of the endocrine gland via exocytosis into ECF
Includes insulin, growth hormone, vasopressin, angiotensin, prolactin, erythropoietin, calcitonin, somatostatin, adrenocorticotropic hormone, oxytocin, glucagon, and parathyroid hormone
Amine or Amino Acid-Derivative Hormones
Includes serotonin, thyroid hormones and catecholamines
Serotonin is synthesized from ___
tryptophan
Thyroid hormones and catecholamines (epinephrine, norepinephrine, dopamine) are derived from ______
tyrosine
Steroid Hormones
(derived from, duration, examples)
Either Derived from cholesterol or are like cholesterol in chemical structure
Compartmentalized in the endocrine cell (not in secretory granules)
Released via simple diffusion (not exocytosis)
Circulating steroid hormones are bound to transport proteins to protect from metabolism andrenal clearance
Long duration of action
Includes cortisol, aldosterone, estrogen, progesterone, testosterone and active metabolites of Vitamin D
Hormone Receptor Activation (how does it work)
Hormone receptors are located either on the surface of cells or inside
The activation of hormone receptors on the cell membrane triggers an enzyme system that generates an intracellular signal, also known as a second messenger
Examples of second messengers includes the cyclic adenosine monophosphate (cAMP) system (steps of how it works)
Hormone receptor occupation activates the plasma membrane enzyme adenyl cyclase
Adenyl cyclase catalyzes adenosine triphosphate (ATP) to cAMP
cAMP acts as second messenger
cAMP may activate intracellular enzymes, modify cell-membrane permeability or transport, or alter gene expression
Ex: TSH, vasopressin, parathyroid hormone, glucagon, FSH, and luteinizing hormone
Other examples of second messenger systems include ____
calcium and cyclic guanosine monophosphate
Thyroid and steroid hormones
(how do they produce their effects)
- Thyroid and steroid hormones produce the desired target cell response by interacting with specific intracellular hormone receptors
- Thyroid and steroid hormones are lipophilic and enter target cells via simple diffusion and/or special transport mechanism
- Thyroid and steroid hormones interact with DNA to suppress or enhance gene transcription/translation
Simple Steps of the Second Messenger System
- Agonist activates membrane bound receptor
- G-protein is activated and produces effector
- Effector stimulates second messenger synthesis
- SEcond messenger activates intercellular process
Hormone receptors are constantly being ___
destroyed and created
The quantity of hormone receptors present is often inversely related to ___
the concentration of circulating hormone
Downregulation =
a sustained elevated plasma concentration of a given hormone results in a decrease in receptors per cell on the target site
Upregulation
a sustained low plasma concentration of a given hormone results in an increase in receptors per cell on the target site
The synthesis and secretion of hormones are regulated by _____.
neural controls, biorhythms and feedback mechanisms
Neural controls = ___
Stress, emotions and senses may influence the release of hormones
Biorhythms = __
hormonal release may be circadian, weekly, or seasonal
Negative Feedback control
virtually all hormones are controlled by negative feedback loops
Negative feedback acts to limit or terminate the production and secretion of a given hormone once the appropriate response has occurred
Ex: Parathyroid hormone is controlled by calcium; insulin and glucagon are controlled by blood glucose
Positive feedback loop
Positive feedback is when a given hormone response initiates signals amplifying hormone release
Ex: Luteinizing hormone that precedes ovulation is stimulated by LH
PITUITARY GLAND
AKA the hypophysis
Master endocrine gland
Pea-sized
Resides in the sella turcica of the sphenoid bone
Connected to the hypothalamus via the hypophyseal stalk
HYPOTHALAMUS
An important regulator of the pituitary gland
Influences the pituitary gland based on integrates information from pain, emotions, energy needs, water balance, olfactory, and electrolyte levels
Image of Pituitary Gland
Anterior Pituitary Lobe is AKA ____ and releases which hormones?
Adenohypophysis
Releases: follice-stimulating hormone, luteinizing hormone, adrenocorticotropic hormone, thyroid stimulating hormone, prolactin, and growth hormone
*think of the pneumonic “FLAT PIG”
Function of Follicle-Stimulating hormone
stimulates ovarian follicle development in females and spermatogenesis in males
Function of Luteinizing Hormone
induces ovulation and corpus luteum development in females and stimulates the testes to produce testosterone
Function of Adrenocorticotropic Hormone
regulates the growth of the adrenal cortex and the release of cortisol and androgenic hormones of the adrenal gland
Function of Thyroid Stimulating Hormone
controls the growth and metabolism of the thyroid gland and the secretion of thyroid hormone
Function of Prolactin
promotes mammary gland development and milk production by the breasts. Also, inhibits the secretion of LH and FSH
Function of Growth Hormone
promotes skeletal development and body growth and regulates protein and carbohydrate metabolism
Thyrotropin-releasing hormone comes from the ____ and corresponds with _____ at what site?
Hypothalamus and corresponds with thyroid-stimulating hormone (TSH, thyrotropin) at the anterior pituitary with its target site being the thyroid gland
Corticotropin-releasing hormone comes from the ____ and corresponds with _____ at what site?
Hypothalamus and corresponds with adrenocorticotropic hormone (ACTH, cotricotropin) at the anterior pitutary with its target site being the adrenal gland
Gonadotropin releasing hormone comes from the ____ and corresponds with _____ at what site?
Hypothalamus and corresponds with follicle stimulating hormone and luteinizing hormone at the anterior pituitary with their target sites being the Gonads (testes/ovaries)
Prolactin releasing factor comes from the ____ and corresponds with _____ at what site?
Hypothalamus and corresponds with Prolactin at the Anterior Pitutary with its target site being the breast
Both Growth hormone-releasing hormone and Growth hormone-inhibitoing hormone come from the ____ and corresponds with ___ at which target site?
Hypothalamus and corresponds with growth hormone at the anterior pitutary with its target site being all tissues
What is the etiology of hyposecretion at the anterior pituitary lobe?
Pituitary tumors, Sheehan syndrome, trauma, radiation
What will we see clinically with a patient with Panhypopituitarism?
Decrease thyroid function
Depression of glucocorticoid production
Suppression of sexual development
Macroadenomas may cause compression of adjacent structures and result in diplopia, visual loss, facial numbness
Sheehan’s Syndrome
AKA postpartum pituitary gland necrosis, is hypopituitarism caused by ischemic necrosis due to blood loss and hypovolemic shock after giving birth.
For patients who are having hyposecretion due to a mass near the pituitary gland, what is the treatment option?
Surgical intervention to control bleeding, decompression or removal of tumor may be warranted
Transsphenoidal approach a common route
Most problems with the anterior pituatary gland = ___
hypersecretion
Most pituitary tumors are hypersecreting adenomas
Prolactin, ACTH and GH are the most common hormones hypersecreted
Discuss the deviations from normal function with growth hormone.
Hyposecretion
Dwarfism – deficient GH during childhood
Hypersecretion
Gigantism – increased and sustained hypersecretion of GH during childhood (before closure of growth plates) and thereafter
Acromegaly – sustained hypersecretion of GH after adolescence
What is acromegaly?
Skeletal overgrowth (enlarged hand and feet, prominentprognathic mandible)
Soft-tissue overgrowth (enlarged lips, tongue, and epiglottis)
Overgrowth of internal organs
Glucose intolerance
Surgical Treatment
Microsurgical removal of pituitary tumor (transsphenoidal route)
Anesthetic Considerations for the patient with Acromegaly
VAE precautions
Identify appropriate fitting mask
Challenging airway r/t macroglossia , hypertrophy of epiglottis, obstructive teeth, enlarged thyroid gland
Smaller ETT r/t subglottic narrowing
Challenging nasal intubation r/t enlarged turbinate
Thorough cardiac evaluation r/t cardiomyopathy, dysrhythmias and htn
r/f entrapment neuropathies (e.g. carpal tunnel syndrome)
Confirm ulnar artery flow prior to catheterization of radial artery related