• Steroid Homrones (Produced by Adrenal Gland)
• Sex Hormones
• Thyroid Hormones

• Interact with chemical receptors ON CELL wall
  • Effects occur within minutes
• Interact with chemical receptors INSIDE CELL wall
  • Effects takes several hours to occur

• Regulate overall metabolic rate throughout the body
• Regulate storage, conversion, & release of energy
• Regulate fluid & electrolyte balance
• Initiate coping responses to stressors
• Regulate growth & development
• Regulate reproduction processes

• Nervous System
• Rhythm
• Feedback systems

• Primary
  • Disease of the gland itself
• Secondary
  • Disease of the regulator gland (Pituitary)
• Tertiary
  • Hypothalamic Dysfunction  (in brain - hypothalamus)
  • Hormone producing tumors (Adenomas)

• Anterior
• Posterior

Posterior Pituitary hormones

• Antidiuretic Hormone (ADH)
  • stimulates kidneys
• Oxytocin
  • stimulates uterus & mammary glands

SIADH

(Syndrome of Inappropriate Antidiuretic Hormone)

Malignancy

-Especially small cell lung cancer

• ACTH (adrenocorticotropic hormone)
  • stimulates adrenal gland
• TSH (thyroid stimulating hormone)
  • stimulates thyroid gland
• GH (growth hormone)
  • stimulates bones
• FSH (follicle stimulating hormone) & LH (luteinizing hormone)
  • stimulates testis and ovaries

• transfrontal (front of gland)
• subcranial  (back of gland)
• oronasaltransshenoidal
  • up through upper lip, nasal cavity

• T3, T4
• Calcitonin

• Produced by thyroid gland in response to high calcium levels
• Causes calcium to be deposited in bones

• Mild
• Cretinism
• Myxedema
• Hashimotos's Thyroditis

• Very common
• Especially amoung older women
• Due to aging
• Treated with synthroid or levothyroxine
  • can cause tachycardia

• Thyroid deficiency present at birth
• Results in mental retardation
• preventable with replacement therapy
• All newborns screened at birth

• Severe hypothyroidism
• Can lead to myxedema coma

• Immume system attacks thyroid gland
• inflammation occurs
• Common

• Known as Graves Disease
• Auto immune disease

• Nervous
• Excitable
• Irritable
• Can't sit still
• Tachycardia
• Flushed
• Weight Loss
• Tremors
• Bulging eyes (Exophthalmos)

Bulging eyes

seen in Graves disease

• Treat symptoms
• Radioactive Iodine
• Surgury

• "Tyroid Storm"
• Thyrotoxic Crisis
• Severe hyperthyroidism
• Abrupt onset
• Life Threatening
• Precipitated by emotional or physical stress

• Regulates serum calcuim & phosphorus leves
• Inhibits bone formation by releasing Ca⁺ into blood
• Stimulates Ca⁺ resorption through kidneys and excretion of phosphorous
• Coverts Vit.D to an active form so Ca⁺ can by used

• Increased Ca⁺ absorption through GI tract, kidneys
• Results in kidney stones & decalcification of bone
  • Ca⁺ drawn out of bone into blood
• Can be life threatening
• Blood phosphorus is decreased

• Surgery
• Medication (treat symptoms)
• Goal is to prevent bone loss

• Tetany  (tremors)
• Trousseau's sign
  • occluse blood flow in arm - carpal spasm results
• Chvosstek's sign
  • tapping of facial nerve - spasm of mouth, nose, eye

• Vitamin D
• Ca⁺ suppliments

• center of adrenal gland
• secretes catecholamines
  • epinephrine (adrenalin) & norepinephrine
• part of automatic nervous system
  • fight or flight response

• Tumor on the adrenal gland
• excessive catecholamines excreted
• causes hypertension, headache, diaphoresis, palpitations
• Similar to panic attacks
• High blood pressure makes it dangerous
• Surgery needed

• Outer portion of adrenal gland
• Secrets adrenalcortical hormones (Steroids)

• Glucocorticoids
• Mineralcorticoids
• Androgens

• Cortisol
  • Most abundant & most potent
• Influences glucose metabolism & inflammatory process
• Necessary for life
• Allows to deal with prolonged stress
• ACTH stimulates release
• Given to patients to decrease inflammatory & allergic responses
  • Cortex will atrophy due to negative feedback

• Aldosterone
  • primary steroid
  • long term regulator of Na level
• Major effect is on fluid & electrolyte balance

• Sex hormones
• Mainly male sex hormones

• Adrenalcortical insufficiency
• Slow onset
• Symptoms:  fatigue, GI distress, muscle weakness, brown skin, electrolyte imbalances
• Usually autoimmune
• Can also occur with sudden discontinuation of exogenous therapy.

• Severe insufficiency of adrenalcortical hormone
• Usually acute onset
• Shock & death can occur
• Hormone replacement needed.

• Adrenalcortical overproduction
  • Especially glucocorticoids
• Increase glucose production
• Obesity & hypertension crisis occurs
• Protein loss leads to muscle wasting
• Diagnosed with 24hr urine for free cortisol
• Treat underlying cause

Difference between

Crushing's Disease -vs- Crushing's Syndrome

• Crushing's Disease
  • usually caused by a tumor
• Crushing's Syndrome
  • occurs with high doses of synthetic corticosteroid therapy

• Excessive production of aldosterone
• Excess Na reabsorbtion
  • water retained
  • Na level may be diluted out
• Excess K⁺ and Hydrogen ion are lost
  • results in hypokalema & alkalosis
• BP rises, muscle cramping, polyuria, & polydipsia, headache
• Usually due to a tumor

• Suppresses inflammation & autoimmune reactions
• Controls allergic reactions & transplant rejection
• Good for short-term therapy
• Long term:
  • glucose intolerance, fatty face
• Need to taper gradually due to negative feedback
• Those on long term need extra boost during stress