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Endocrine Disorders (Sheehan's syndrome (Lack of blood to CNS…

- - - - Solid
      - Sometimes there is calcification or hemorrhage
    - - Full of CSF
  - - - Deficiency of the hormones controlled by ACTH
        
        Cortisol
        
        Androgen
        
        Aldosterone
        
        Addison's Syndrome
    - - Child
        
        Dwarfism
      - Adult
        
        Failure of cell proliferation and cell growth
        
        Delayed tissue regeneration
    - - Deficiency of FSH and LH
        
        Female
        
        Infertility
        
        No menstruation/ovulation
        
        Male
        
        Infertility
        
        Erectile dysfunction
        
        Testosterone deficiency
        
        Reduction of secondary sex characters
        
        Child
        
        Delayed puberty
    - - Parasympathetic
        
        Digestive problems
        
        Malabsorption
        
        Maldigestion
        
        Constipation
        
        Diarrhea
        
        Vitamin deficiency
- - - - AKA Glucocortisol
      - Decreases inflammation from hemorrhage
    - - Trans-Sphenoidal
        
        Enter through the nose to the basal brain from the bottom
      - Trans-frontal
        
        Enter through the frontal bone and directly enter the basal brain where the pituitary gland is located
- - - - Receptor disorder
        
        Affected TSH due to damaged G protein receptor
      - Autoimmune disorder
        
        Graves disease
      - Tumor of thyroid gland, CNS, hypothalamus, pituitary gland, or hypophyseal (pituitary) gland
      - Post Hashimoto's thyroiditis (10%)
      - Tissue manipulation during surgery
    - - Blood test
        
        Increased total and free T3T4
        
        Over saturation of carrier proteins causes free T3T4
        
        High T3T4 causes low TSH and TRH levels
        
        Low TRH causes low prolactin
      - Causes
        
        Tumor in thyroid gland
        
        Autoimmune disease
        
        Infection
        
        Tissue manipulation
      - SS
        
        Palpitation (alpha 1)
        
        Hypertension (alpha 1)
        
        Heart disease
        
        Excess sweating (alpha 1)
        
        Feeling hot
        
        Weight loss from high metabolism
        
        Nervousness
        
        Anxiety
        
        Agitation
        
        Oily skin an hair
        
        Sleep disorder
      - Graves disease
        
        Autoimmune disease
        
        T lymphocytes are sensitized to thyroid gland antigens
        
        T lymphocytes stimulate B lymphocytes to synthesize antibodies
        
        Antibodies block the TSH receptor site
        
        Follicle cell becomes irritated
        
        Overstimulation of colloid and oversecretion of T3T4
        
        Overactive thyroid gland
        
        SS
        
        Goiter
        
        Present in hyper and hypothyroidism
        
        Severe inflammation of the thyroid gland
        
        Hyperthyroidism: tissue is active and becomes larger due to overuse
        
        Hypothyroidism: thyroid hormone compensates for underperformance of gland
        
        Can also be due to iodine deficiency
        
        Infiltration of antibody in joints causes joint pain
        
        Infiltration of antibody in retro orbital and periorbital areas causes exopthalmia (large eyes) and periorbital edema (puffy eyes)
        
        Puffy face
        
        Edema in lower limb
        
        Excess sweating
        
        Weight loss from high metabolism
        
        Eye movement issues because antibodies accumulate in the extraocular muscles
        
        Antibodies destroy follicular cells and colloid
        
        Palpitations
        
        Heart disease
        
        Diarrhea, frequent bowel movements
        
        Insomnia
        
        Blood test
        
        Increased T3T4
        
        Increased TSH/TRH
        
        Decreased prolactin
        
        Antibodies are present exclusively in Grave's disease
        
        Treatment
        
        Antithyroid drugs (Thiodamides) such as Propylthiouracil, which inhibits organification and oxidation
        
        In severe cases where the antibodies destroy everything, surgically remove the thyroid gland via thyroidectomy
    - - Arrhythmia
        
        Heart can't beat strongly and eject the right amount of blood into the aorta
      - Hypertrophic ventricle
        
        Occupies the internal environment and reduces end diastolic volume (140 mL) due to hypertrophied muscle
      - Heart failure in the long term
    - - CNS problem, either in the hypothalamus or pituitary gland
      - When the hypothalamus is involved
        
        Increased TRH, TSH, and T3T4
        
        Hyperprolactinemia
      - When there is a tumor
        
        Hypothalamus function is affected
        
        Sleep disorder
        
        Appetite changes
        
        Memory/learning issues
        
        Nervousness
        
        Weight loss
      - Differential diagnosis between Secondary Hyperthyroidism and Graves disease
        
        High TRH, TSH, T3T4 in secondary hyperthyroidism and grave's disease
        
        High prolactin in secondary hyperthyroidism
        
        Low prolactin in Grave's disease
      - Specific tumor of anterior pituitary thyrotroph cells
        
        Leads to oversecretion of TSH
        
        Feedback is given to decrease TRH
        
        T3T4 levels increase because of high TSH
  - - - Cause
        
        Deficiency of maternal T3T4
      - Treatment
        
        Hormone replacement from first day of life
        
        Thyroxine treatment
        
        Measure TSH levels in the filter paper specimen. TSH is usually elevated
        
        Measure T4 after 2 days of life
      - SS
        
        Mental retardation
        
        Bone growth retardation
        
        Walking problem
        
        Learning disorder
        
        Obesity
        
        Speech/motor/sensory disorder
        
        Hypotension
        
        Heart disease
        
        Sometimes heart failure
      - Blood test
        
        Low T3T4
        
        Low sex hormones
        
        High TSH
        
        High TRH
        
        High prolactin
    - - Problem with thyroid gland
      - Tissue destruction by tumor can also affect parathyroid gland
      - Blood levels
        
        Decreased T3T4
        
        Decreased PTH
        
        Increased TSH/TRH
        
        Hypocalcemia
      - SS
        
        Goiter
        
        Weight gain/obesity due to low metabolism
        
        Memory/Learnimg disorders
        
        Hypotension
        
        Feeling tired
        
        Weakness
        
        Sleep disorder
        
        Feeling cold
        
        Dry skin/hair
        
        Fragile hair
        
        Hypocalcemia
        
        Constipation
        
        Low cardiac output/bradycardia
    - - Autoimmune disease
      - Blood levels
        
        Low T3T4
        
        High TSH
        
        Antibodies in the blood
      - More common in women
      - All previously mentioned SS
      - 90% becomes hypothyroidism
    - - Problem with hypothalamus or anterior pituitary gland
      - Blood levels
        
        Low T3T4
        
        Low TSH/TRH
      - Causes
        
        Tumor
        
        Tissue manipulation
        
        Head trauma
        
        Craniopharyngioma
        
        Suprasellar tumor
      - All previously mentioned SS
      - Sheehan's syndrome
  - - - Acute
      - Streptococcus, Enterobacter
    - - Subacute
      - Viral infection of thyroid gland
      - Tenderness, pain, and inflammation of the thyroid gland
      - Disturbs the esophagus due to inflammation
      - Treatment
        
        Bedrest
        
        Antiinflammatory drugs like Aspirin and Ibuprofen
        
        Resolves over a few weeks
        
        Some patients become hypothyroid after inflammation goes down and will need thyroid hormone replacement
    - - 5 - 9% of women who have recently given birth
      - Temporary. Resolves within 6 months
      - No SS but thyroid gland function is affected
    - - 90% becomes hypothyroidism
      - 10% becomes hyperthyroidism
      - Activation of B lymphocytes, CD4, and CD8 cells
      - T cells produce cytokines TNF (tumor necrosis factor), Interleukin 1, and Interferon gamma
  - - - 60% of all thyroid cancers
      - Develops in iodine containing thyroid-hormone producing cells
      - Slow growth
      - Forms mushroom shaped pattern
    - - Develops in iodine containing thyroid hormone producing cells
      - Surrounded by a thin capsule
    - - Develops in non-iodine containing thyroid hormone producing cells
      - Slow growth
      - Spread to other parts of the body
    - - Most dangerous type
      - Fast growth
      - Spreads to other parts of the body
    - - Thyroidectomy
- - - - Hyperparathyroidism
      - Removes excess calcium from bone, which changes bone density and increases osteoporosis risk
    - - Hypoparathyroidism
      - Failure of activation of vitamin D
      - Vitamin D deficiency changes bone density because of failure of calcium absorption by bone
    - - Sex hormone deficiency
      - Genetic disorder, congenital hypocalcemia
      - Diet problem
      - Culture, atmosphere, and environment can affect puberty
  - - - Osteomalacia
        
        Leads to osteoporosis
    - - Ricketts
        
        Changes bone development
  - - - Acute
      - Uncontrolled PTH production
      - Result of parathyroid adenoma or parathyroid hyperplasia
      - Generalized disorder of calcium, phosphate, and bone metabolism due to increased PTH
      - Hypercalcemia
      - Hyperphosphatemia
    - - Chronic
      - PTH is continuously produced in response to chronic low levels of serum calcium
      - Response to renal failure
    - - Blood levels
        
        Increased PTH
        
        Hypercalcemia
        
        Excess calcium affects all muscles
        
        Smooth muscles of blood vessels
        
        Increased blood pressure from vasoconstriction
        
        Skeletal muscles
        
        Spasm leading to muscle weakness
      - Nervousness
      - Palpitation, increased heart rate, extrasystole, arrhythmia, extra ventricular contraction
        
        Calcium is important for depolarization phase, especially SA and AV node
      - Kidney stone (from calcium accumulation)
      - Atherosclerosis (calcification of blood vessels)
      - Osteoporosis
      - Osteopenia (first sign of osteoporosis)
      - Pancreatitis (can affect digestive system)
      - Peptic ulcer
        
        Could be due to hypercalcemia accelerating peristalsis, motility, and irritation to tissue, accelerating the ulcer
  - - - Deficiency of PTH
        
        Post surgery
        
        Congenital
        
        Hypomagnesemia (magnesium is needed for PTH synthesis)
      - Lack of active PTH
      - PTH resistance
    - - Low blood calcium
      - High blood phosphate
    - - Due to deficiency of calcium
      - Postsynaptic compartment of muscle tissue compensates for the calcium deficiency
      - Continuous depolarization of sodium-potassium channel in postsynaptic compartment
      - Calcium remains in cytoplasm, leading to muscle spasm
    - - Spasm of facial muscles
      - Third branch of facial nerve, buccal branch, has spasm of lips when it is tapped
      - Positive sign for calcium deficiency
      - Could be due to vitamin D deficiency or hypoaldosteronism
      - Affects tiny muscles
      - Painful spasm because there is no relaxation phase
      - Leads to muscle weakness
  - - - Blood tests
        
        Hypocalcemia
        
        Hyperphosphoatemia
      - Ectopic calcification
      - Ossification (formation of new bone)
      - Short hands and feet
      - Round face
      - Last two fingers are shorter
      - Obesity
    - - None, it's a genetic disorder
      - PTH administration has no effect
- - - - Tumor of lactotroph cells and somatotroph cells in anterior pituitary
      - Prolactin oversecretion
        
        Galactorrhea
        
        Oversecretion of milk due to prolactin oversecretion
        
        Abnormal in nonpregnant female
        
        Males: secretion from mammary glands, not milk
        
        Positive sign for prolactin issues
        
        Supression of FSH and LH
        
        Female
        
        Infertility
        
        Lack of menstruation/ovulation
        
        Male
        
        Infertility
        
        Missing secondary sex characters
      - Growth hormone oversecretion
        
        Acromegaly
        
        Occurs in adults
        
        Affects small bones in the face, hands, and feet
        
        Affects soft tissue such as lips, periorbital area (puffy eyes), nose, tongue
        
        Risk for cardiovascular disease
        
        Gigantism in children
    - - ACTH oversecretion
        
        Stimulates cortisol, aldosterone, and androgen
        
        Cushing's syndrome
      - TSH oversecretion
        
        Secondary hypothyroidism
        
        Palpitation
        
        Hypertension
        
        Anxiety
        
        Excess sweating
        
        Sleep disorder
        
        Oily skin/hair
      - FSH and LH oversecretion
        
        Affected ovulation and menstruation
        
        Erectile dysfunction
    - - No function
- - - - Affected exocrine and endocrine systems
      - Pancreatitis
    - - Inflammation
      - Mucus and water accumulation
      - Malabsorption/maldigestion
      - Severe diarrhea
    - - Infertility
    - - Erectile dysfunction
      - Infertility
      - Contents
        
        Testicular artery
        
        Chromaster muscle
        
        Vas Deferens
    - - Severe cases can lead to death in newborns
      - Obstruction of respiratory airway
  - - - Oversecretion of chloride into the lumen
        
        Sodium moves into the lumen along with chloride
        
        Osmotic pressure in the lumen increases due to excess solute accumulation
        
        Water moves from the cell into the lumen
        
        White blood cells are drawn to the lumen over time
        
        White blood cells lead to local inflammation
        
        1 more item...
- - - - Add the primary antibody
        
        Primary antibody will bind to the antigen and form the antibody-antigen complex
        
        Add the secondary antibody
        
        Secondary antibody detects the primary antibody
        
        By measuring the amount of the secondary antibody you can measure the amount of a hormone
- - - - Deficiency of ADH from CNS (hypothalamus or posterior pituitary gland)
    - - V2 receptor in the kidney can't accept ADH
      - Bipolar disorder treatment is lithium, which blocks V2 receptors
    - - Polyuria (frequent urination)
      - Polydipsia (extreme thirst)
      - Nocturia (needing to pee at night)
      - Hypernatremia
        
        Polyuria leads to concentrated blood, sodium is not diluted
        
        Not an increase in blood sodium
      - No hyperglycemia
        
        Differential diagnosis for diabetes mellitus
    - - For diabetes due to taking lithium for bipolar disorder, stop taking the medicine
      - If the case is a tumor, remove the tumor
      - Central diabetes may be controlled with synthetic vasopressin (desmopressin)
  - - - Hyperglycemia
      - Polydipsia
      - Polyuria
      - Polyuria
      - Hypertension
      - Vasculopathy (blood vessel destruction)
      - Kidney destruction
- - - - SS
        
        Blood levels
        
        Hyperglycemia
        
        Decreased blood potassium
        
        Hypernatremia
        
        Hypertension
        
        Central obesity (moon face, big belly, fat in shoulders)
        
        Anxiety
        
        Fragile skin
        
        Cortisol affects skin collagen
        
        Hirstutism (facial hair growth in female)
        
        Thin upper and lower limbs
        
        Cortisol breaks down protein in muscles
        
        Infertility in females
        
        Osteoporosis due to low estrogen in females
        
        Acidic urine (hydrogen ions in urine)
        
        Risk for steroid diabetes
        
        Hyperglycemia
        
        Polydipsia
        
        Polyuria
        
        Hypertension
        
        Vasculopathy (blood vessel destruction)
        
        Kidney destruction
        
        Striae on trunk, butt, arms, legs, or breasts
        
        Due to fragile skin and affected collagen
      - Primary Cushing's syndrome
        
        Problem is in adrenal cortex
        
        Low ACTH
      - Secondary cushing's syndrome
        
        Problem is in hypothalamus, anterior pituitary, or small cell carcinoma of the lung
        
        Oat cell carcinoma, small cell carcinoma of the lung, lung tumor, ectopic cushing's
        
        SS
        
        Mucus secretion
        
        Fresh blood in mucus
        
        Dyspnea, especially at night
        
        Coughing
        
        Increases ACTH levels
        
        Causes secretion of ADH, causing water toxicity
        
        Temporary cushing's disease
        
        Happens when someone takes cortisol treatment for another disorder, such as dermatitis
        
        Weight gain
        
        Increased appetite
        
        Hypertension
        
        SS
        
        Increased ACTH and CRH if there is a CNS tumor
        
        If there is coughing, check the lungs (oat cell carcinoma)
      - Oversecretion of aldosterone, cortisol, and androgen
      - Diagnosis
        
        Dexamethasone suppression test
        
        24 hour urinary cortisol measurements
        
        CT scan of adrenal gland and MRI of pituitary gland are performed when tests return positive
    - - Deficiency of cortisol, androgen, and aldosterone
      - Secondary Addison's disease
        
        Problem is with hypothalamus or anterior pituitary
        
        Tumor in anterior pituitary corticotroph cells that destroys ACTH
        
        Autoimmune
        
        Tissue manipulation
        
        Infection
        
        Treatment
        
        Glucocorticoid replacement, Prednisone
      - SS
        
        Fatigue/sleep disorder
        
        Weakness
        
        Anorexia
        
        Nausea/vomiting
        
        Body hair loss
        
        Anxiety
        
        Inflammation
        
        Blood levels
        
        Low cortisol
        
        Low androgen
        
        Low aldosterone
        
        High ACTH
        
        High CRH
        
        High POMC
        
        Hypotension
        
        Hyponatremia
        
        Hypoglycemia
        
        Weak immune system
        
        Pain
        
        Weight loss
        
        Acidic metabolism (excess hydrogen ions)
      - Primary Addison's disease
        
        Problem is with adrenal cortex
        
        Tumor
        
        Bacterial infection
        
        Tissue manipulation
        
        Autoimmune condition
        
        Unique SS
        
        Hyperpigmentation
        
        Palmar and dorsal regions of the hand, and face
        
        POMC gives rise to ACTH and MSH
        
        Decrease of adrenal cortex hormones stimulates POMC to produce more ACTH and consequently more MSH
        
        Hyperkalemia
      - Diagnosis
        
        Check androgen, cortisol, aldosterone, ACTH, CRH, POMC, and MSH
        
        ACTH test, CRH test, Dexamethasone test
        
        X ray to check for tumor
    - - Conn's Disease
        
        Primary Hyperaldosteronism
        
        Tumor in zona glomerulosa causes aldosterone oversecretion
        
        Blood tests
        
        High aldosterone
        
        Leads to increased ACTH
        
        Hypernatremia
        
        Hypokalemia
        
        Potassium in urine
        
        Low renin-aldosterone ratio
        
        SS
        
        Hypertension
        
        Headache
        
        Vomiting
        
        Vertigo
        
        Nosebleed
        
        Anxiety
        
        Sleep disorder
        
        Tetany
        
        Muscle spasm
        
        No relaxation of muscle after spasm causes muscle weakness
        
        Can be caused by calcium deficiency
        
        Mechanism
        
        Cell body of neuron releases ACTH
        
        Calcium channels receive stimulus and open
        
        1 more item...
        
        Treatment
        
        Laparoscopic removal of tumor from adrenal cortex
        
        Spironolactone
        
        Blocks aldosterone receptors
        
        Leads to percocious puberty
      - Secondary Hyperaldosteronism
        
        Renin oversecretion due to tumor
        
        Overstimulation of angiotensin 2 leads to oversecretion of aldosterone
      - Hypoaldosteronism
        
        Aldosterone deficiency
        
        Causes
        
        NSAID's
        
        ACE inhibitors
        
        Cyclosporine
        
        Heparin
        
        Any disease that can impair aldosterone release
        
        Hyporenemic hypoaldosteronism
        
        Primary adrenal insufficiency
        
        Adrenal enzyme defect
        
        Pseudohypoaldosteronism
        
        Genetic disorder of aldosterone resistance
        
        Differential diagnosis
        
        Compare plasma renin activity and serum aldosterone levels
        
        SS
        
        Hyponatremia
        
        Hyperkalemia
        
        Reduction in renin secretion
        
        Acidic metabolism because hydrogen remains in the blood
        
        High level of hydrogen increases CO2
        
        High level of CO2 increases hydrogen
        
        High hydrogen levels leads to risk for hypercapnia (decreased CO2)
        
        Oxygen deficiency in brain tissue
        
        Patient may have coma
        
        Hypotension
        
        Vertigo
        
        Headache from hypotension
        
        Sleep disorder
        
        Treatment
        
        Avoid drugs that aggravate the syndrome
        
        Florinef/Fludrocortisone
        
        Manages severe insufficiency with significant hyperkalemia and metabolic acidosis
    - - Cortisol
        
        Cortef
        
        Oral cortisol administered at twice the normal dose
        
        Administer 1/3 of a daily dose three times a day
      - Prednisolone
        
        5 times more active than cortisol
        
        1/2 daily dose administered twice daily
      - Treatment during stress
        
        Additional treatment and increased dosage may be needed
    - - Androgen insensitivity syndrome
        
        Receptor becomes resistant to androgen
        
        X linked disorder
        
        SS
        
        Normal testosterone levels
        
        Male fetus fails to masculinize
        
        External genitalia is feminine
        
        Secondary female sex characters may appear at puberty
        
        Patient is male, but the body shape is female
        
        Normal sexually, but infertile
        
        Intersexuality differential diagnosis
        
        Intersexuality can be congenital due to antimullerian hormone
        
        Either antimullerian deficiency syndrome or androgen insensitivity syndrome
  - - - Tumor of adrenal medulla
      - Produces excess epinephrine and norepinephrine
      - SS
        
        Excess sweating
        
        Palpitation, tachycardia
        
        Hypertension
        
        Anxiety
        
        Sleep disorder
        
        Headache
        
        Vomiting
        
        Nosebleed
        
        Weight loss
        
        Pain in lower chest/upper abdomen
        
        Heat intolerance
      - Tests
        
        MRI
        
        CT Scan
        
        Blood test for differential diagnosis
- - - - Depression
      - Anxiety
      - Stress
      - Chronic pain
      - Chronic inflammation
      - Chronic headache
      - Back ache
    - - Exercise
      - Light therapy
        
        Increases serotonin and endorphins
      - Spicy food
    - - Treatment: Replace serotonin
      - Similar signs to bipolar disorder, but it's called a depression
  - - - Genetic disorder
      - Mutation to gene structure on chromosome 2
    - - Malabsorption
      - Maldigestion
      - Affected appetite
      - Obesity
      - Defect of MC1R gene on chromosome 16
        
        Red hair
        
        POMC related obesity
        
        Increased appetite
        
        Pale skin
        
        Hypopigmentation
      - ACTH deficiency
        
        Adrenal cortex insufficiency
        
        Secondary addison's disease
        
        Hypotension
        
        Body hair loss
        
        Hypoglycemia
        
        Anxiety
        
        Inflammation
- - - - Oversecretion of sex hormones leads to early onset of puberty
  - - - Suppresses FSH and LH by blocking G protein coupled receptor
      - Controls aldosterone,causing a decrease in blood pressure
- - - - Not feeling thirsty, so you don't drink water
      - Dehydration
      - Increase in osmotic pressure
      - Decrease in blood volume
      - Hypotenson
      - Increase in blood sodium
      - Hypokalemia
      - Increased heart rate to compensate for lower blood volume, tachycardia, palpitations
      - Renal failure, affected kidneys
    - - If patient is alert, administer water by mouth
      - 0.45% saline IV
  - - - Tumor in hypothalamic nucleus
      - Hypovolemia (low blood volume)
      - Hypotension
      - Cortisol deficiency
        
        Causes excess ADH secretion
        
        Cortisol increases blood pressure (increased TPR)
    - - Water intoxication due to excess fluid absorption
      - Severe headache
      - Nausea
      - Anorexia
      - Vomiting
      - Edema in brain leads to precoma
        
        Anxiety
        
        Confusion
        
        Difficulty forming words
      - Convulsions
      - Severe hyponatremia
      - Fluid retention
        
        Over time fluid can get into the interstitial and intercellular space, causing blood pressure to appear normal
    - - Reduce total fluid intake
      - Chronic cases treated with demeclocycline, an ADH antagonist
- - - - Stress
      - Dopamine deficiency
      - Hypothyroidism
      - Tumor
      - Medicine
        
        Prostate cancer is treated with estrogen, which suppresses sex hormones and stimulates prolactin
    - - Dopamine agonists are effective for many cases
  - - - Amenorrhea
      - Infertility
      - Galactorrhea
      - Secretion of milk from mammary glands
      - Visual field defects if tumor spreads outside the sella turcica
    - - Erectile dysfunction
      - Infertility
      - Secretion of milk from mammary glands
      - Aspermia
      - Visual defects
    - - Bromocriptine (dopamine agonist)
      - Surgery if there is resistance to dopamine treatment
- - - - During pregnancy
        
        Congenital dwarfism
        
        During childhood
        
        Dwarfism
        
        After puberty
        
        Affects soft tissue regeneration
        
        Receptor in bone tissue stimulates proliferation of cartilage tissue
        
        During puberty, sex hormones close the epiphyseal plate of bone. Growth hormone no longer has an effect on bone development
        
        In adults
        
        Hyperlipidemia
        
        Hypertension
        
        Risk for osteoporosis
        
        Local obesity
    - - Mental retardation (affects CNS development)
      - Bone development retardation
      - Soft tissue development retardation (heart problems)
      - Can affect genital organ development (infertility)
    - - Growth hormone replacement
  - - - During childhood
        
        Gigantism
        
        During adulthood
        
        Acromegaly
    - - Periorbital edema (puffy eyes)
      - Changes in small bones of face (mandible, zygomatic, maxillary)
      - Puffy hands
      - Changes in hands, feet, and face
      - Large tongue
      - Heart problems
      - Visceromegaly (increased size of internal organs: liver, heart, thyroid)
    - - Irritation of growth hormone receptor
      - Tumor of CNS somatotroph cells
      - Acidophilic stem cell adenomas
        
        Secretes growth hormone and prolactin
    - - Octreotide acetate, synthetic somatostatin to control growth hormone
      - Surgery to remove tumor
- - - - Tumor in anterior pituitary
      - Tumor in hypothalamus
      - Mutation to receptor structure for sex hormones
      - Mutation to receptor structure for GnRH
      - Kallman's syndrome
  - - - Embryo genetic disorder
      - Child has GnRH deficiency
        
        Embryonic GnRH or mother stem cells for GnRH could not develop well
        
        Mother cells could not migrate from their origin in the olfactory area to the hypothalamus
    - - No FSH/LH
      - No sperm produciton
      - No secondary sex characters
      - Infertility
      - No menstruation/ovulation
      - No sex hormones
    - - GnRH
      - FSH/LH
      - Testosterone
      - Estrogen
      - Progesterone
      - Androgen
- - - - Postmenopausal women and older men
      - Sex hormones maintain bone density
- - - - Anterior pituitary tumor
      - Feedback from peripheral system
      - High T3T4, dopamine, or glucocorticoids
      - Head trauma
      - Genetic disorder
      - TSH receptor resistance leading to secondary hypothyroidism
- - - - Headache
      - Vomiting
      - Seizures
      - Sometimes hypogonadism, regression of secondary sex characters
      - Diabetes insipidus from tumor invasion of hypothalamus and posterior pituitary gland
      - Affected pituitary stalk can increase prolactin secretion by decreasing dopamine