ERS03 04 05 Introduction To Endocrine System And Hormones + Physiological Action Of Hormones + Regulation Of Endocrine Secretion Flashcards

1
Q

Components of Endocrine / Hormonal system

A
  1. Glands
    - specialised group of ***cells that makes and secretes hormones
    - not necessarily have to be an organ
    - located throughout the body (brain, kidney, reproductive organs)
  2. Hormones
    - produced by glands
    - released into bloodstream / extracellular fluid surrounding cells
    - >50 kinds
    - regulate biological processes (e.g. homeostasis, growth, metabolism, mood, sleep cycle)
  3. Receptors
    - recognise / respond to hormones —> trigger action
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Location of major endocrine glands

A
  1. Hypothalamus, Pituitary gland
    - Vasopressin, Oxytocin (hypothalamus —> posterior pituitary)
    - GnRH, TRH, Dopamine, GHRH, CRH (hypothalamus)
    - LH, FSH, TSH, Prolactin, GH, ACTH (anterior pituitary)
    - other regulatory hypothalamic hormones —> regulate anterior pituitary secretion
  2. Pineal gland
    - melatonin
  3. Thyroid, Parathyroid gland
    - T3, T4, Calcitonin (thyroid)
    - PTH (parathyroid)
  4. Thymus (undergo involution with age)
    - thymosins (regulate immune response)
  5. Pancreas
    - insulin
    - glucagon
  6. Adrenal gland
    - **adrenocorticosteroid: aldosterone, cortisol, androgen (cortex)
    - **
    adrenomedullary catecholamine: NE, E (medulla)
  7. Placenta
    - human chorionic gonadotropin (HCG, maintenance of corpus luteum during pregnancy)
  8. Ovary, Testicle
    - estrogen, progesterone, inhibin
    - testosterone, inhibin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mode of action of hormones

A
  1. Endocrine signalling:
    - act on distant cells through bloodstream
    - **ductless gland, secrete products into bloodstream
    (vs Exocrine gland: secrete products into **
    ducts/channels, carry to outside of body / into body cavity)
  2. Paracrine signalling:
    - enter ***extracellular region and act on cells next to secreting cells
    - without entering bloodstream
  3. Autocrine signalling:
    - act on same cell that secreted them
    - the hormone regulate its own secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Structural classifications of hormones

A
  1. Amino acid derivatives
    - from modifications of ***a.a —> Tyrosine (e.g. T3, T4, Epinephrine), Tryptophan (e.g. melatonin)
    - small molecules
    - t1/2: from mins to a few days (e.g. T4 bind to Thyroxine-binding globulin (vs T3) —> lower clearance —> longer t1/2)
  2. Peptide / Protein hormones
    - **chains of a.a. (e.g. Insulin)
    - synthesised in **
    rER as precursors (contain signal peptide that direct them into ER)
    —> post-translational processing into active hormone (e.g. cleave away signal peptide / further modification)
    - water soluble
    - **stored in intracellular vesicles in large amount before released via exocytosis
    - **
    short t1/2 in blood: mins (∵ water soluble —> no need to bind to carrier protein)
    - ***quickest effect
  3. Steroid hormones
    - derived from **cholesterol (e.g. cortisol)
    - lipid soluble
    - synthesised in **
    sER **on demand (∵ can pass through lipid membrane easily)
    - most bind to carrier proteins (e.g. albumins, globulins)
    - **
    longer t1/2: hours
    - ***slowest effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mechanism of action of hormones

A
  1. Specificity
    - A hormone can only trigger a reaction in specific target cells bearing specific receptor for that hormone (lock and key hypothesis)
    - bind to receptors in a particular cells
    —> receptor carries out instruction by hormones
    —> alter cell’s existing proteins / turning on genes to build new protein
  2. High affinity
    - hormone receptors with high affinity (sensitivity) toward the hormone (∵ exist as trace amount in blood stream)
  3. Hormone receptors: Surface of cell / Within cell depend on type of hormone
  • Water-soluble (peptide / protein)
    —> repelled by lipid membrane
    —> bind to receptors on **cell surface (plasma membrane)
    —> **
    2 responses: **Cytoplasmic response (e.g. trafficking of transporter / signalling transduction) + **Nuclear response (e.g. changing gene expression)
  • Lipid-soluble (steroid)
    —> diffuse through plasma membrane
    —> bind to receptors **within cell
    —> **
    1 response ONLY: **Nuclear response (receptors are mainly **transcription factors: bind to target gene and regulate gene transcription)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Signal transduction of Steroid hormone receptors

A

Steroid receptors:

  • ***Transcription factors (bind to promoter region)
  • contain **DNA binding site + **Transcriptional activation site

Steps:
Binding of hormone to receptor
—> Dissociation of repressor protein
—> Without repressor protein
—> Hormone-receptor complex translocated to nucleus
—> Steroid receptors form dimers (2x Hormone-receptor complex) after binding to hormone
—> **Dimerised complex act as transcription factor
—> bind to a DNA sequence: **
“Hormone Response Element” (HRE) on target gene promoter region
—> induce / suppress gene expression
—> ***slow response

Example: Estrogen receptor (reproduction, CVS function, bone integrity, cognition, behaviour)

MOA:
Upon binding estrogen
—> cytosolic ER undergo dramatic ***decrease in surface hydrophobicity
—> important for entering nucleus + recruit specific transcriptional co-regulatory proteins + binding to estrogen-response element in promoter region of estrogen-responsive genes

Drugs acting on steroid receptors are either Agonists / Antagonists:

  • Antagonists: Tamoxifen for breast cancer (Estrogen stimulate of proliferation of mammary cells)
  • Agonists: Raloxifene (selective agonist for estrogen receptor α) for prevention of osteoporosis in postmenopausal women (Estrogen inhibit bone turnover by ↓ osteoclasts-mediated bone resorption, ↑ osteoblast-mediated bone formation)

Conclusion:
When a receptor binds to hormone
—> receptor undergo conformational change
—> allow productive interaction with other components of cells
—> alteration in physiologic state of cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Signal transduction of Peptide hormone receptors

A

Binding of hormone to receptor
—> Generation of ***2nd messengers within cells

Signal transduction depends on type of cell surface receptors involved:

  1. GPCR (e.g. PACAP, glucagon, oxytocin, vasopressin receptors)
    - 7-transmembrane-spanning receptors: antiparallel
  • N-terminal for binding to hormone + 3 extracellular loops + 3 intracellular loops + C-terminal for binding to intracellular signalling molecules
  • respond to ligands by undergoing dynamic conformational changes in **TM domain
    —> alter their ability to communicate with intracellular signalling partner
    —> TM6 swings away to prevent steric hindrance
    —> allow docking of intracellular signalling protein onto 3rd intracellular loop
    —> **
    activation of associated G protein by **exchanging GDP bound to G protein (Gα) for GTP
    —> **
    Gα subunit dissociate from β and γ subunits
    —> the type of intracellular signalling pathways activated depends on type of Gα subunit
    —> ***Gαs (↑ cAMP), Gαi (↓ cAMP), Gαq (activation of Phospholipase C)
  1. Enzyme-linked / Catalytic receptors
    - Extracellular ligand binding domain
    - Transmembrane helix
    - Cytoplasmic domain: ***intrinsic enzyme activity / associate directly with enzyme (e.g. Tyrosine kinase, Tyrosine phosphatase, Serine/Threonine protein kinase)

MOA:
Upon ligand binding
—> receptor dimerised
—> conformational change transmitted via transmembrane region
—> activate enzyme activity intracellularly
—> **activate 2nd messenger (PI3K, PLC, Ras, JAK)
—> signalling cascades
—> changes in gene expression
—> **
slow response (hours)

Conclusion:
Responses of Enzyme-linked receptor require ***many intracellular signalling steps
—> changes in cell proliferation, differentiation, survival, migration etc.
—> disorders in enzyme-linked receptor / abnormalities in signalling pathway are fundamental events in cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

GPCR: Vasopressin receptor V2R

A

Binding of ADH at extracellular interface
—> conformation changes in TM6, 3rd intracellular loop
—> Gαs stimulation
—> ↑ cAMP
—> protein kinase A activation
—> Cytoplasmic response: ↑ insertion of AQP2 on apical membrane + Nuclear response: ↑ AQP2 expression and production
—> changing water permeability of collecting tubule cells
—> ↑ water reabsorption

Conclusion:
Hormones affect physiology of target tissue by inducing protein express (Nuclear response) / changes in membrane permeability (Cytoplasmic response)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Enzyme-linked receptor: Insulin receptor

A
  • member of Tyrosine kinase family of transmembrane signalling protein
  • 2 subunits linked by disulphide bond
    —> α subunit (x2): ligand binding
    —> β subunit (x2): protein kinase which catalyse phosphorylation of proteins
  • binding of insulin onto α-subunit
    —> phosphorylation of β-subunit (autophosphorylation)
    —> docking centre for recruitment of different substrate adaptors (e.g. insulin receptor substrate 1 (IRS-1))
    —> nucleus for assembly of other signal transduction particles
    —> activation of other enzymes ultimately mediate insulin’s effect
  • **2 main pathways of insulin signalling by Insulin receptor:
    1. PI3K/AKT pathway
  • IRS-1
  • ***metabolic effects of insulin (blood glucose regulation)
  1. Ras/ERK pathway
    - ***cell growth and differentiation induced by insulin
    - defective IRS-1 / hyperinsulinaemia —> direct to Ras/ERK pathway —> high risk of cancer

Conclusion:
Hormones can act via control of intracellular enzyme activity —> different pathways —> different responses within cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Purpose of learning MOA of hormones

A
  1. Many steps after initial hormone binding to receptor
    - potential places where REGULATION can take place
  2. Hormonal signals can be AMPLIFIED along cascade
    —> multiple intracellular signals are produced for every receptor that is bound
  3. Create opportunities for target cells to INTEGRATE information it receives from different stimulus (e.g. receptor A / receptor B)
    —> specific response elicited is determined by the cell rather than hormone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hormone interaction at whole body level

A

Coordinated interplay of different body systems + Integration of multiple hormonal signals (overall effect can be greater/smaller than individual effect of hormone)
—> Maintain integrity of the internal environment upon exposure to changing external environment

4 ways of hormone interaction:
1. Redundant effect

  1. Reinforcement effects
  2. Antagonistic effects
  3. Permissive effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. Redundant effect
A
  • different hormones produce same effect
  • ***safe-guard mechanisms for very important physiological functions (allow other mechanisms to compensate)
  • produce ***synergistic outcome —> combined action to produce effects greater than sum of individual effects

e.g. epinephrine (a.a hormone), glucagon (peptide hormone), cortisol (steroid hormone)
—> all can ↑ blood glucose
—> act synergistically during prolonged fasting / flight/fight response to rapidly restore/↑ blood glucose level
—> actions are not identical though —> function with ***different time constant!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Reinforcement effect
A

Same hormone act in different tissues to induce different responses
—> at the end reinforce each other at whole body level (e.g. Cortisol)
OR
Same hormone induced different responses in single cell
—> at the end reinforce each other (e.g. Aldosterone)

e.g. Cortisol
1. breakdown of proteins into a.a. in muscle —> ↑ a.a. supply to liver
2. breakdown of fat in adipose tissue —> ↑ glycerol supply to liver
3. ↑ production of glucose from a.a. + glycerol in liver
4. ↓ sensitivity to insulin
Overall effect: ↑ blood glucose level

e.g. Aldosterone (single cell molecular level)
- bind to mineralocorticoid receptor (MR) in distal tubule cells —> different gene expression:
1. Na/K-ATPase expression on basolateral membrane (Na back to circulation, K into cell)
2. Na channel (ENaC) expression on apical membrane (Na into cell)
3. K channel (ROMK) expression on apical membrane (K out into filtrate)
Overall effect: Na reabsorption + K excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. Antagonistic effect
A
  • hormones acting to return body conditions to within acceptable limits from opposite extremes i.e. one hormone oppose action of another
    —> dual control
    —> more precise regulation than through negative feedback

e. g. Insulin vs Glucagon
- reduce glucagon cannot reduce blood glucose —> require insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. Permissive effect
A

Presence of one hormone at a certain concentration
—> enhance responsiveness of target organ to another hormone
—> i.e. one hormone control expression of receptor of another hormone

e.g. Estrogen induce expression of progesterone receptor in uterus during proliferative phase
—> Estrogen induces proliferation of uterine endometrium + endometrium to express progesterone receptor
—> once Corpus luteum produce Progesterone
—> Progesterone act on same cell to exert its effect:
—> development of uterine endometrium (maintain thickness), including blood vessels formation —> prepare for implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Rhythms of Hormone secretion (Pulsatile, Diurnal, Cyclic)

A
  • Hormone concentration in blood plasma fluctuate
  • Vary widely over course of a day

3 secretion rhythms:
1. Pulsatile secretion
- hormones released in **short bursts / episodic manner
- regulated by physiological stimuli (e.g. insulin, GnRH)
- **
change pulse frequency —> change hormone response (e.g. low frequency GnRH —> stimulate FSH secretion, high frequency GnRH —> stimulate LH secretion)
(記: 低頻FSH, 高頻LH)
- pulsatile release to ***prevent dilution of hormone in blood (vs one-off dose)

  1. Diurnal secretion
    - e.g. cortisol vs melatonin
    - cortisol peak shortly after waking
    - melatonin peak at night
    - circadian clock —> coordinate behavioural, endocrine, metabolic function to adjust to time of day
  2. Cyclic secretion
    - secreted in complicated cycles with respect to some bodily events e.g. menstrual cycle
    - cyclic changes in hormonal levels control —> orchestrate events of menstrual cycle
  3. FSH induce Estrogen production by ovary (Proliferative phase)
  4. ↑ Estrogen level —> ↑ LH production —> ovulation
  5. Corpus luteum produces Estrogen + Progesterone
  6. Absence of fertilisation —> Corpus luteum decay —> ↓ Estrogen + Progesterone —> uterus lining shedding —> onset of menses
17
Q

Regulation of hormone secretion (Humoral + Hormonal + Neural stimuli)

A
  1. Humoral stimuli
    - release of hormone in response to **changes in extracellular fluids / blood-borne chemicals
    - e.g. PTH secretion in response to **
    Ca level
    - e.g. insulin secretion in response to high ***blood glucose
    —> unstimulated state: pancreatic β cell ATP-sensitive K channel are open
    —> keep resting membrane potential ~ -60mV
    —> high extracellular glucose
    —> glucose enters cell by diffusion through glucose transporter
    —> ATP production
    —> suppress and close ATP-sensitive K channel (also inhibited by Meglitinides, Sulfonylureas —> do not work in type 1 DM)
    —> no K efflux
    —> depolarisation
    —> opening of voltage-gated Ca channel
    —> ↑ cytosolic Ca
    —> Insulin release
  2. Hormonal stimuli
    - one hormone secreted in turn stimulate secretion of another hormone
    - e.g. ***Hypothalamic-pituitary axis
    —> Releasing / Inhibiting hormone —> Tropic hormone —> Hormone from target endocrine cell)
  • **Arcuate nucleus:
  • GH-releasing hormone / Somatostatin —> GH (Somatotroph)
  • GnRH —> FSH, LH (Gonadotroph)
  • Dopamine —> inhibit Prolactin (Lactotroph)
  • **PVN:
  • Corticotropin releasing factor —> ACTH (Corticotroph)
  • Thyrotropin-releasing hormone —> TSH (Thyrotroph)
  • **Magnocellular neurons in PVN, SON:
  • ADH (produced by Hypothalamus)
  • Oxytocin (produced by Hypothalamus)
  1. Neural stimuli
    - nervous system directly stimulate endocrine glands to release hormones
    - e.g. NE/E secretion from adrenal medulla (innervated by SNS) in response to stress
    —> ACh (Presynaptic neuron) bind to nicotinic receptor on Chromaffin cell (act as Postsynaptic neuron)
    —> Ca influx —> Tyrosine hydroxylase —> Tyrosine —> DOPA —> Catecholamine release
18
Q

Feedback system

A
  1. Positive feedback (closed loop)
    - reinforce (increase) changes in controlled condition
    - e.g. Oxytocin secretion during childbirth to cause contraction of uterine muscle
    —> uterus contraction
    —> nerve impulse send to hypothalamo-pituitary axis
    —> posterior pituitary secrete oxytocin
    —> stimulate uterus to contract more vigorously
  2. Negative feedback (closed loop)
    - consequence of hormone secretion act on secretory cell to inhibit further secretion
    - e.g. glucose production by glucagon
    —> ↓ blood glucose stimulate α cells of islets of Langerhans to release glucagon
    —> ↑ blood glucose
    —> ↓ glucagon secretion after restoration of blood glucose concentration
    —> high blood glucose require antagonistic hormone (i.e. insulin) to work
  3. Complex negative feedback system
    - Long loop / Short loop / Ultra-short loop
    - Allow fine-tuning of hormone secretion
    - Minimise changes in hormone secretion even if one component not functioning normally

Hypothalamo-pituitary axis:

Long loop:

  • Target organ —(-ve)—> Anterior pituitary
  • Target organ —(-ve)—> Hypothalamus

Short loop:
- Anterior pituitary —(-ve)—> Hypothalamus

Ultra-short loop:
- Hypothalamus —(-ve)—> Hypothalamus

E.g. Thyroid hormone secretion

  • TRH —> TSH (Anterior pituitary)
  • TSH —> Thyroid hormone (Thyroid gland)
  • TRH/TSH inhibited by too much Thyroid hormone

Closed loop negative feedback control:
- maintain condition at state of constancy near pre-determined set-point (i.e. homeostatic equilibrium)
- set-point can be **temporarily adjusted by changing demands from body
- set-point deviation mainly achieved by intervention of some additional signal from **
outside (usually nervous system)
- e.g. Epinephrine can override glucose set point by inhibiting insulin secretion + stimulating glucagon secretion
—> stimulate stimulatory signal + removing inhibitory signal —> Push-pull mechanism

19
Q

Feedforward system

A

Feed-forward control (open loop)

  • ***Anticipatory response in later stage of pathway (positive / negative)
  • Open loop: no feedback to control the input
  • no regulatory method

e.g. Cephalic insulin response to meal ingestion
- ↑ insulin even before blood glucose ↑
- Presence of food in oral cavity stimulate Vagus nerve activation
—> Parasympathetic pre-ganglionic neuron
—> Vagus nerve
—> Activation of post-ganglionic neuron in pancreatic islets
—> Preabsorptive insulin response (prior to nutrient absorption in first 10 mins of food ingestion)

Conclusion:

  • External factors operate via ***Open loop (Feedforward control mechanism)
  • Internal factors operate via ***Close loop (Feedback control mechanism)
20
Q

Regulation of hormone activity

A
  1. Conversion of hormone to active / inactive form
  2. Regulation of hormone receptors
    - Priming effect
    - Desensitisation
  3. Hormone clearance
    - Liver enzymes
    - Kidney enzymes
    - Enzymatic processes inside target cell
21
Q
  1. Conversion of hormone to active / inactive form
A

Some hormones are secreted as ***prohormone (inactive precursor)
—> must be activated
e.g. Angiotensinogen —(Renin)—> Angiotensin I —(ACE)—> Angiotensin II (within circulation)

Hormone can also be converted to ***inactive form to decrease its activity
e.g. T4 (inactive) —> T3 (active) (within target cells)
—> Outer ring 5’ deiodination —(deiodinase I / II)—> active T3
—> Inner ring 5 deiodination —(deiodinase I / III)—> inactive T3 (reverse T3)
Deiodinase I: liver, kidney, thyroid
Deiodinase II: brain, anterior pituitary, thyroid
Deiodinase III: brain, placenta, fetal tissue

22
Q
  1. Regulation of hormone receptors
A

Hormone-receptor interactions are saturable
—> ***receptor number is limiting factor (limited, finite number)

More receptors available to interact with hormone
—> more likely there will be a response
—> biological effect is proportional to amount of complex that forms

  1. Priming effect (receptor up-regulation)
    —> hormone can induce more of its own receptors expression in target cells
    e.g.
    Low frequency GnRH —> ↑ FSH production
    High frequency GnRH pulse —> stimulate more GnRH receptor in anterior pituitary —> higher response (↑ sensitivity of anterior pituitary) —> ↑ LH production
  2. Desensitisation (receptor down-regulation)
    - occur after long exposure to high levels of hormone
    - internalisation of receptor-hormone complex
    —> ↓ cell surface receptors
    —> ↓ sensitivity of cells to hormone

e.g. growth hormone downregulates its own receptor
—> targeting receptor to internalisation
—> enzymatic degradation

23
Q
  1. Hormone clearance
A

Hormone signals turned off after serving their purpose
—> prevent prolonged exposure of target cells to hormones

Process of lowering hormone levels in blood (little regulation):

  1. Degradation by liver enzymes + Excretion in bile
    - peptide hormones: proteolysis
    - steroid hormones: reduction, hydroxylation, oxidation, decarboxylation, esterification (conjugated to steroid hormones to enhance water solubility)
  2. Degradation by kidney enzymes + Excretion in urine
    - primary route of excretion of hormone degradation products
  3. Removal by enzymatic processes inside target cell
    - via internalisation of hormone-receptor complex
    —> lysosomal degradation of hormone

**Theoretical calculation of metabolic clearance rate (MCR):
Metabolic clearance rate (ml/min)
= Rate of disappearance of a hormone from plasma / Concentration of hormone in plasma
= **
Urine production x Conc in urine / Concentration in plasma

Hormone t1/2:
Lipid-soluble hormones: longer (∵ carrier protein)
Water-soluble hormones: shorter (fluctuation by pulsatile secretion)

24
Q

Endocrine disorders

A

Too much / Too little hormone

Causes of endocrine disorders:

  1. Problems in secreting gland (e.g. tumour: too much, infection: too little) —> Primary disorder
  2. Problems in endocrine feedback system (mostly hypothalamic-pituitary axis) —> Secondary / Tertiary disorder
  3. Autoimmune disorder (e.g. Type 1 DM, Graves’ disease)
  4. Genetic disorders (e.g. Kallmann syndrome, Cretinism)
25
Q

Testing for Endocrine disorders

A

Isolated hormone test is not accurate (∵ hormone levels fluctuate)

Stimulation / Suppression testing:

  • a dynamic test
  • substance measured before + after administration of another substance to determine if levels are stimulated / suppressed

Excess hormone suspected = Suppression test (睇下撳唔撳到)

  1. Dexamethasone suppression test
  2. Captopril suppression test

Deficiency hormone suspected = Stimulation test (睇下刺唔刺激到)

  1. ACTH stimulation test
  2. TRH stimulation test

General aspects considered when interpreting hormone measurements:

  1. Hormone levels should be evaluated with their ***appropriate regulatory factors (e.g. Releasing factors, Tropic hormones)
  2. Urinary excretion of hormone metabolites ***over 24 hours in individuals with normal renal function&raquo_space;> one-time plasma-level measurement (in estimate of hormone secretion)
  3. Target hormone excess should be evaluated with appropriate tropic hormone to rule out ***ectopic hormone production
  4. **Simultaneous elevation of pairs —> a **hormone-resistance state / ***autonomous secretion by pituitary
26
Q

Suppression test

A
  1. Dexamethasone suppression test

Normal:
administer Dexamethasone
—> suppress ACTH
—> ↓ Cortisol

Cushing’s syndrome:
- no ↓ Cortisol (adrenal cortex overproducing cortisol)

  • low dose test: differentiate patient from normal people
  • high dose test: distinguish Cushing’s disease (Pituitary hypersecretion of ACTH) from Cushing’s syndrome (Primary / Non-pituitary ACTH secreting tumour)
  1. Captopril suppression test
    - measure plasma Aldosterone

Normal:
Captopril inhibit ACE
—> ↓ Aldosterone

Primary hyperaldosteronism (Conn syndrome):
- no ↓ Aldosterone, but ↓ Renin level (∵ -ve feedback) (↑ aldosterone / renin ratio)
27
Q

Stimulation test

A
  1. ACTH stimulation test
    Normal: injected ACTH —> ↑ Cortisol
    Adrenal insufficiency: no ↑ Cortisol
  2. TRH stimulation test
    Normal: injected TRH —> ↑ TSH
    Secondary hypothyroidism (pituitary problem): no ↑ TSH
    Tertiary hypothyroidism (hypothalamic problem): delayed ↑ TSH
28
Q

***Level of Endocrine disorder

A

Pituitary hormone ↑, Target hormone ↓ —> Primary disorder (failure of target organ to secrete/produce hormone)

Pituitary hormone ↓, Target hormone ↓ —> Secondary disorder (anterior pituitary failure)

***Pituitary hormone ↑, Target hormone ↑ —> Autonomous secretion of pituitary hormone / Resistance to negative feedback from target hormone

Pituitary hormone ↓, Target hormone ↑ —> Autonomous secretion by target organ (e.g. tumour) (normal -ve feedback to pituitary)

Tertiary disorder: Hypothalamic disorder

29
Q

Treatment for Endocrine disorders

A
  1. Medication
    - synthetic hormones
    - chemotherapy (for cancer of endocrine gland)
  2. Surgery / Radiation therapy