Physiology Flashcards
What is the command centre of the endocrine system?
hypothalamus-pituitary complex
What is the function of the hypothalamus-pituitary complex?
The complex secretes several hormones that directly produce responses in target tissues, as well as hormones that regulate the synthesis and secretion of hormones in other glands
What are the hormones produced by the posterior pituitary hormone?
ADH
Oxytocin
What is the target of ADH?
Kidneys, sweat glands, circulatory system
What is the effect of ADH?
Water balance
What is the target of oxytocin?
Female reproductive system
What is the effect of oxytocin?
Triggers uterine contraction during childbirth
What are the anterior pituitary hormones?
LH
FSH
TSH
PRL
GH
ACTH
What is the target of LH?
Reproductive system
What is the target of FSH?
Reproductive system
What is the target of TSH?
Thyroid gland
What is the target of PRL?
Mammary gland
What is the target of GH?
Liver, bone and muscles
What is the target of ACTH?
Adrenal glands
What are the effects of LH?
Stimulates production of sex hormones by gonads
What are the effects of FSH?
Stimulates production of sperm and egg
What are the effects of TSH?
Stimulates the release of thyroid hormone. TH regulates metabolism
What are the effects of PRL?
Promotes milk production
What are the effects of GH?
Induces targets to produce insulin-like growth factors. IGFs stimulate body growth and a higher metabolic rate
What are the effects of ACTH?
Induces targets to produce glucocorticoids which regulate metabolism and the stress ressponse.
How is prolactin secreted?
- The exception is prolactin, which is under tonic inhibition by hypothalamic dopamine (rather than controlled by an activating hormone)
- In a non-pregnant women, prolactin secretion is inhibited by prolactin-inhibiting hormone (PIH), which is actually the neurotransmitter dopamine, and is released from neurons in the hypothalamus
- Only in pregnancy do prolactin levels rise in response to prolactin-releasing hormone (PRH) from the hypothalamus
- Secretion of PRH regulated by a ‘short-loop’ negative feedback
- Effects of PRL mediated by the prolactin receptor
What are the usual pituitary tests?
TSH, fT4, LH, FSH, testosterone, GH, IGF-1, PRL
When is dynamic endocrine testing used?
- Hormone excess - suppression test
- Hormone deficiency - stimulation test
What is the stimulatory test for cortisol levels?
Synacthen (synthetic ATCH)
- Check cortisol at 0, 30 and 60 mins
- Normal: cortisol rises by 150 and reaches 500
What is the stimulatory test of insulin stress or prolonged glucagon?
Insulin stress test or prolonged glucagon test
- Cortisol and GH response every 30 min for 2-3 hours
- Normal cortisol >500
- Normal GH >7ug/l
Describe water deprivation tests
- Check serum and urine osmolarities for 8hr, and then 4hr after giving IM DDAVP
- If Ur/serum osmol ratio >1.9 then it is normal, otherwise DI
What is produced in the zona glomerulosa?
aldosterone
Where is cortisol (glucocorticoids) synthesised?
zona fasciculata
Where is DHEA and androstenedione synthesised and what is it converted to?
DHEA and androstenedione in the zona reticularis which can be converted into testosterone and dihydrotestosterone in the peripheral tissues by 5⍺ reductase
How is cortisol and androgen production regulated?
regulated by hormones produced by hypothalamus and anterior pituitary gland - HPA axis
How is aldosterone regulated?
- regulated by renin-angiotensin-system
- Activated in response to decreased blood pressure
What is the function of aldosterone?
Leads to production of angiotensinogen II which causes direct (vasoconstriction) and indirect (aldosterone) methods of BP elevation
What is the mechanism of action of corticosteroids?
- Bind to intracellular receptors (primarily nuclear)
- Receptor/ligand complex binds DNA to affect transcription
What are the classes of steroid receptors?
- Glucocorticoid
- Mineralocorticoid
- Progestin
- Oestrogen
- Androgen
- Vitamin D
What are the major cortisol actions in the circulatory system?
- ↑ cardiac output
- ↑ blood pressure
- ↑ renal blood flow and GFR
What are the major cortisol actions in the CNS?
- Mood lability
- Euphoria/psychosis (in excess)
- ↓ libido
What are the major cortisol actions in the bone/connective tissue?
- Accelerates osteoporosis
- ↓ serum calcium
- ↓ collagen forming
- ↓ wound healing
What are the major cortisol actions immunologically?
- ↓ capillary dilation/permeability
- ↓ leucocyte migration
- ↓ macrophage activity
- ↓ inflammatory cytokine production
What are the major cortisol actions metabolically?
- Carbohydrate: ↑ blood sugar
- Lipid: ↑ lipolysis, central redistribution
- Protein: ↑ proteolysis
What are the clinical applications of corticosteroids?
- 3 main principles of use:
- Suppress inflammation
- Suppress immune system
- Replace treatment
- Can be given orally, IV, IM and topically
- Role in treatment of:
- Allergic disease - asthma/anaphylaxis
- Inflammatory disease e.g. rheumatoid arthritis, IBD
- Malignant disease
What is the mechanism of action of aldosterone?
Effects via mineralocorticoid receptor - expressed primarily in the kidneys but also in the salivary glands, gut and sweat glands