Primary:  problem is with the end organ

Secondary:  problem is with the pituitary

Tertiary:  problem is with the hypothalamus

How do we treat conditions of excess/deficient amounts of GH?

Deficient:  exogenous growth hormone (pills, shots etc.)

Excess:  Surgery of the pituitary tumor (if there), medications that block GH release (somatostatin) or block GH receptors.

Deficient:  Lactation failure

Excess: Galactorrhea, breasts are producing milk when they are not supposed to be

Gonadal suppression, FSH and LSH levels are decreased, causing the gonads to turn off (women earlier than men, but both are effected!)

Females: Amenorrhea (absence of period) and galactorrhea (inappropriate lactation)

Males:  Reduced libido (sex drive), muscle mass decrease, reduced facial hair, erectile dysfunction, gynecomastia (enlargment of breast tissue)

Iatrogenic (pharmacologic): prednisone increases cortisol

Secondary Adrenal Hyperplasia:  ACTH secreting tumor of the pituitary (Cushing's Disease) or ACTH secreting lung cancer

Primary Adrenal hyperplasia:  idiopathic, benign or malignant neoplasm, and congenital (enzymatic effect)

T3 and T4.  T3 is the more functional form (T4 is converted to T3 in periphreal tissues) and then increase energy utilization, protein synthesis, and sensitivity to other hormones

All cells have receptors that accept T3.  So the whole body will suffer if there is no T3.

TRH stimulates the release of TSH and prolactin.

TSH stimulates the thyroid to produce T3 and T4.  This creates a negative feedback loop.

Goiters:  enlargement of the thyroid gland

Cancer of the thyroid gland

Hyperthyroidism and Hypothyroidism

TSH very low or non-detectable, T4 leveslare very high, sometimes auto immune disorder tests are positive

Graves Disease:  most common type (60-80%) results from auto-antibodies that bind to and activate TSH receptors, female to male ratio is 8:1, exophthalmos (protrusion of the eyes) occurs in 20-40% of patients

Toxic Nodular Goiter: cause is unknown, low iodide may contribute, female to male ratio is close to 1:1, exophtalmos does NOT occur

Primary thyroidism: failure of the thyroid (99% of all cases!!!!!)

Secondary thyroidism:  due to failure of pituitary to release normal amounts of TSH

Hypo leads to poor memory, inability to concentrate, hair loss, weight gain, and cold intolerance.

Both you will see weakness, fatigue, dry skin, and mentrau irregularities.

Iatrogenic (treatment induced)

Hashimoto thyroiditis:  most common type of hypothyroidism!!! (1/1000) female to male ratio is 4:1, mean age diagnosis is 60, autoimmune disorder in which thyroid infilltrated with T and B cells kills T3/4, treat t with thyroxide (T4) pills daily

Drug induced

Dietary

What do the parathyroid release and what are its main functions?

What are some symptoms of low calcium levels?

What are some symptoms of high calcium levels?

LOW:  Tetay, carpopedal spasms, tingling of the lips and hands, anxiety, personality changes, chronic low calcium will lead to osteoporosis

HIGH:  fatigue, anorexia, nausea, weight loss, bone pain, urinary stones, psychosis, pancreatitis

Iatrogenic  (if you have one gland, it can prevent this)

Autoimmune Hyoparathyroidism:  quite rare, present in childrood, autoimmune thyroid and adrenal gland disease usually presents with it (multiconditional)

Primary:  uncommon disorder, usually > age 50, female to male 3:1, usually due to PTH secreting parathyroid adenoma (tumor), occasionally due to hyperplasia or carcinoma, part of the MEN Syndrome (multiple eondocrine neoplasia)

Secondary: seen frequently with chronic renal disease, main problem is falling vitamin D production, falling Ca2+ levels stimulate the parathyroids to secrete PTH

Inhibits catabolic actions:  inhibits glycogen breakdown, amino acids and fatty acid breakdown into keytones

Promotes anabolic actions: promotes glycogen production and storage, trigrliceride synthesis in fat cells, and protein sythensis in muscle cells

Big thing.....Glucagon is usually OPPOSITE in effect of insulin

Desribe the 2 (major) types of Diabetes.

Type I:  autoimmune disorder, rapid loss of beta cells, trigger may be virus or toxin, mumps, coxsackie B4 virus most type I's are < 25 years old

Type II:  very slow loss of beta cells, genetic predisposition, obesity (60-70%), more common of the 3, most type II's are > 25 years old

Polydipsia, polyuria, and polyphagia....they also seem to have weight loss, fatigue/malaise

May experience death from acute ketoacidosis!....also a disease which makes you pretty much suseptable to other chronic conditions

Also seems to be the most common causation of blindness in the United States

Also the number one causation for amputations in the United States

Desribe Ketoacidosis.

In 1922, who was the first person/child treated for Diabetes successfully with insulin?

They inhibit sodium glucose transport -2 in the proximal tubules which enhances glucose excretion in urine

The side effects would be weight loss, maintaining of glucose better, but because you are excreting out alot of glucose, it acts as food for bacteria, therefore, increasing the chances for urinary tract infections.