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Hypothalamus ((Pituitary (Anterior (GH (Excess GH Gigantism Acromegaly…

- - - - GH
        
        Function
        
        Increase amino acid uptake to the cell & protein synthesis
        
        Lipolysis
        
        Protein anabolic - produces nitrogen & Phosphorus
        
        Epiphseal growth
        
        Incease calcium absorption in gut
        
        Insulin resistance
        
        Sodium retention
        
        Excess GH
        
        Gigantism
        
        Acromegaly
        
        S&S
        Somatic
        increase growth,prognatism, organomegaly, nerve compression, excessive sweating acne, hypertension
        Metabolic
        DM, glucose intolerance, hyperphosphatemia, hypercalcemia
        Local
        headache, bitemporal hemianopia, diabetes insipidus
        
        Lab
        
        Screening- serum GH, serum IGF-1
        
        Confirmatory- OGTT ( high glucose suprress GH production)
      - Prolactin
        
        Function
        
        Stimulate milk production from mammary gland
        
        Testosterone and sperm production
      - FH
        
        Function
        
        Stimulating the growth of ovarian follicle
        
        Sperm production
      - TSH
        
        Thyroid Gland
        
        Hormones
        
        Follicular - T4 & T3
        
        Parafollicular (C cell)- Calcitonin
        
        Hypothyrodism
        
        Causes
        Acquired
        
        Chronic autoimmune hashimoto thyroditis
        Infiltraton of cytotoxic t cell and b cell. t cell destroys the parencyhma , b cell produces anti tsh receptor that blocks thyroid action
        
        Radiation
        
        Thyroidectomy
        
        Iodine deficiency
        
        heamochromatosis
        
        Antithyroid drug
        
        Congenital
        
        Congenital goiter (agenesis, thyroid dyshormogenesis,hypothalamic--pituitary hypothyrodism, maternal TRAB)
        cyanosis, prolonged hyperbilirubinemia, pooor feeding, umbiliccal hernia, large frontalle, delayed skeletal maturation
        
        S&S
        Cold intolerance, weight gain, depression, hoarseness, dry skin, constipation, brittle hair, increase libido, periorbital oedema, sinus bradycardia, decrease body tempt
        Myxoedema coam- hypothermia and stupor
        
        Function (calcitonin)
        
        Decrease serum amino acid
        
        Decrease calcium absorption in intestine
        
        inhibit bone resorption
        
        Inhibit reabsorption of calcium in kidney
        
        Hypethyroidsm
        
        S&S
        Heat intolerance, loss weight, irritability, sinus tachycardia, sweating, shaky and nervousness, diarrhea, tremors, eye finding
        Thyroid storm
        
        Causes
        
        Grave disease
        thyrotoxicosis, autoimmune antiibody , thyroid stimulating immunoglobulin (tsi) mimics thyroid action
        
        Toxic multinodular goiter- lumpy bumpy
        
        Sub Acute thyroiditis
        d/t viral infection
        
        Toxic single adenoma
        hyperfunctioning follicular thyroid adenoma
        
        Thyroid carcinoma
        
        Medullary- amyloid deposit, polygonal, spindle-shaped cells, yellow nodule on the apex of right lobe
        
        Papillary- Orphan Annie (ground glass) & psammoma bodies
        
        Follicular- Resemble normal histo apperance
        
        Anaplstic- Giant cell, multinucleated w mitosis, sarcomatous appereance
      - LSH
        
        Function
        
        Conversion on ovarian follicle to corpus letuem. Corpus letuem then secrets strogen and progesterone
        
        Stimulate the leydig cell in testes to secretes testosterone
      - ACTH
        
        Adrenal Gland
        
        Medulla
        
        Cathecolamine
        
        Cortex
        
        Glomerulosa
        Aldosterone - sodium retention
        
        Fasiculata
        Cortisol- increase hepatic gluconeogenesis, ( fat,carb and protein metabolism, amino acid and fatty acid needed for hepatic glycose production), suprress immune response, supress inflammatory reaction, respond to stress
        
        Reticularis
        Androgen- Sex hormone
        
        Disease
        
        Primary hyperaldosteronism (Conn Syndrome)
        
        Causes- Adrenal hyperlasia, adrenal tumor, familial hyperaldosteronism 1 and 2
        S&S- Hypertension and hypokalemia
        Lab - Screening - biochemical, Aldosterone-plasma renin activity
        Confirmatory- oral soodium loading test, sodium infusion test , FIT, captopril challenge test
        
        Disease
        
        Hypercortisolism( Cushing Syndrome)
        
        Causes
        Exogenous- TX w corticosteroid
        Endogenous- pituitary tumur, adrenal tumour, ectopic ACTH production
        
        S&S
        TO,buffalo hump moon face , DM, Acne and hirsutism, hypertension, bone pain, muscle wasting, skin pigmentation, thinning of skin and purple striae
        Lab
        Low dose dexamethosone, Serum ACTH , High dose dexamethasone
        
        Disease
        
        Adrenal hypofunction (Addison Ds)
        destruction or dysfunctional of he entire adrenal gland
        
        Causes
        
        Congenital- Congenital adrenal hyperplasia (21 hydroxylase)
        
        idiopathic autoimmune
        
        Granulomatous disease ( TB, Sarcoidosis)
        
        Malignancy 4,Hemochromatosis
        
        Drug 6. Infection- CMV, kaposis sarcoma
        
        S&S
        Hyperkalemia, skin pigmentation, dizizness of postural hypotension, nausea & vomitting
        Lab- synacthen (Synthetic ACTH)
        
        Adrenal Medulla Tumour
        
        pheochromocytoma
        6 p ( hypertension, pain, sweeting, anxiety). Test ( HMMA, VMA)
        
        neuroblastoma- Round blue cell
        
        3.Ganglioneuroma
    - - Oxytoxin
        
        Function
        
        Milk ejection reflux
        
        Uterus contraction during childbirth
        
        Help in ejaculation
      - ADH
        
        Function
        
        Water retention
    - - Causes
        
        Tumours - Pituitary tumour, craniopharyngioma, cerebral tumour
        
        Hypothalamus- Functional disturbance ( anoxia nervosa), Tumour, defects in releasing hormone
        3.Vascular- Severe hypotension, postpartum necrosis ( sheehan's syndrome) infarction
        
        Infection- menigitis ( TB & syphilis)
        
        Iatrogenic - radiation and surgery
        
        Trauma
        
        Miscellaneous- sarcoidosis, haemochromatosis
      - Clinical features
        
        GH - growth retardation, hypoclycemia, reduce muscle bulk
        
        Prolactin- failure of lactation
        3.LH &FSH- delayed puberty, oligomenorrhea, genitilia and breast atrophy, testiscular atrophy, loss of libido
        4.ACTH- hypotension, loss of body weight, hypoglycemia , decrease skin pigmentation
        
        Thyroid - weight gain, cold intelorance, fatigue
        
        ADH- polyuria,polydipsia,increase serum osmolality ad decrease urine osmolality
      - Lab investigation
        
        Insulin stress test
        
        Combine anterior pituitary functional test
        3.fluid deprivation test
    - - Causes
        
        Pituitary tumour
        
        Hypothalamic disorder that causes excess secretion
      - Effect & complication
        
        Effect from excess hormone secretion
        
        Intracranial sol - headache, vomiting, visual defects
        
        Compression of optic chiasma- bitemporal hemianopia
        
        Destruction of pituitary- hypopit