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Questions and Answers

What are the two regulatory systems that control body homeostasis?

The nervous system and the endocrine/hormonal system.

What are organs called that secrete hormones?

Endocrine glands

What is the function of the endocrine system?

Regulation of behavior, growth, metabolism, fluid and electrolyte status, development, and reproduction.

Match the following types of hormone action with their descriptions:

<p>Endocrine function = Transmission of a hormonal signal through the bloodstream to a distant target cell Paracrine function = A hormone that signals act on a neighboring cell of a different type Autocrine function = The secreted hormone acts on the producer of the cell itself</p> Signup and view all the answers

Into what is the hormone secreted in endocrine glands?

<p>Extracellular fluid</p> Signup and view all the answers

What are the three major categories that hormones are classified into?

<p>Tyrosine amino acid derivatives</p> Signup and view all the answers

What is the first category of hormones based on chemical structure?

<p>Proteins or peptides</p> Signup and view all the answers

What is the second category of hormones based on chemical structure?

<p>Tyrosine amino acid derivatives</p> Signup and view all the answers

What is the third category of hormones based on chemical structure?

<p>Steroids</p> Signup and view all the answers

What types of hormones are water-soluble?

<p>Most catecholamines and protein hormones</p> Signup and view all the answers

Why are steroid and thyroid hormones bound to transport proteins?

<p>For protection from metabolism and renal clearance.</p> Signup and view all the answers

What is the half-life of thyroid hormone?

<p>1-6 days</p> Signup and view all the answers

What is the half-life of insulin?

<p>7 minutes</p> Signup and view all the answers

Where are protein, peptide, and catecholamine hormone receptor sites located?

<p>Surface of the target cell membrane</p> Signup and view all the answers

Where are steroid hormone receptor sites located?

<p>Target cell cytoplasm</p> Signup and view all the answers

Where are thyroid hormone receptor sites located?

<p>Target cell nucleus</p> Signup and view all the answers

What is the function of the activated enzyme in hormone receptor binding?

<p>It generates intracellular signals known as second messengers.</p> Signup and view all the answers

Thyroid and steroid hormones enter target cells by simple diffusion or through special transport mechanisms.

<p>True</p> Signup and view all the answers

Thyroid and steroid hormones are stored in secretory granules.

<p>False</p> Signup and view all the answers

What type of hormone interaction with the DNA in the cell nucleus do thyroid and steroid hormones cause?

<p>Both enhancement and suppression</p> Signup and view all the answers

What types of hormones act by binding to cell membrane receptors?

<p>Peptide, protein, and catecholamine hormones.</p> Signup and view all the answers

What types of hormones act by binding to intracellular receptors?

<p>Thyroid and steroid hormones.</p> Signup and view all the answers

What is the half-life of an insulin receptor?

<p>7 hours</p> Signup and view all the answers

The destruction and replacement of hormone receptors is always a natural process.

<p>False</p> Signup and view all the answers

Hormone receptors are directly proportional to the circulating hormone levels.

<p>False</p> Signup and view all the answers

What is down-regulation of hormone receptors?

<p>A decrease in hormone receptor levels in response to an increase in circulating hormone levels.</p> Signup and view all the answers

What is up-regulation of hormone receptors?

<p>An increase in hormone receptor levels in response to a decrease in circulating hormone levels.</p> Signup and view all the answers

What can cause insulin resistance?

<p>High blood sugar levels, obesity, and type 2 diabetes.</p> Signup and view all the answers

What hormone helps prepare the uterus for pregnancy?

<p>Progesterone</p> Signup and view all the answers

Which of the following hormones are stimulated by stress?

<p>All of the above</p> Signup and view all the answers

Deep general anesthesia or regional anesthesia completely eliminates the stress response to surgery or trauma.

<p>False</p> Signup and view all the answers

What are the three types of biorhythms?

<p>Circadian, monthly, and seasonal.</p> Signup and view all the answers

Give an example of a circadian biorhythm.

<p>The daily release of glucocorticoids.</p> Signup and view all the answers

Give an example of a monthly biorhythm.

<p>The menstrual cycle in females.</p> Signup and view all the answers

Give an example of a seasonal biorhythm.

<p>Thyroxine production, which is lower in the winter and higher in the summer.</p> Signup and view all the answers

What is the primary mechanism controlling hormone secretion from endocrine glands?

<p>Negative feedback loops.</p> Signup and view all the answers

Positive feedback loops are more common than negative feedback loops.

<p>False</p> Signup and view all the answers

What is the function of hypothalamic hormones?

<p>They stimulate the release of pituitary hormones.</p> Signup and view all the answers

What is the function of pituitary hormones?

<p>They stimulate the release of hormones from peripheral target cells.</p> Signup and view all the answers

What is the function of hormones produced by peripheral target cells?

<p>They provide feedback to either the pituitary gland or the hypothalamus, or both, to inhibit the secretion of further hormones.</p> Signup and view all the answers

The pituitary gland is located at the base of the brain.

<p>True</p> Signup and view all the answers

The hypothalamus is larger than the pituitary gland.

<p>False</p> Signup and view all the answers

What is the function of the hypophysial stock?

<p>Connects the pituitary gland to the hypothalamus</p> Signup and view all the answers

The pituitary gland is divided into an anterior and a posterior lobe.

<p>True</p> Signup and view all the answers

Which lobe of the pituitary gland makes up 80% of its weight?

<p>Anterior lobe</p> Signup and view all the answers

How many peptide hormones are secreted by the anterior pituitary gland?

<p>Six</p> Signup and view all the answers

What is the function of growth hormone?

<p>Promotes skeletal development and body growth.</p> Signup and view all the answers

What is the function of corticotropin?

<p>Regulates the growth and development of the adrenal cortex.</p> Signup and view all the answers

What is the function of thyroid stimulating hormone?

<p>Controls the growth and metabolism of the thyroid gland.</p> Signup and view all the answers

What is the function of follicle stimulating hormones?

<p>Stimulates ovarian follicle development in females and spermatogenesis in males.</p> Signup and view all the answers

What is the function of luteinizing hormone?

<p>Induces ovulation and corpus luteum development in females and stimulates the testes to produce testosterone in males.</p> Signup and view all the answers

What is the function of prolactin?

<p>Promotes mammary gland development and milk production in breasts, and it inhibits the synthesis and secretion of follicle stimulating hormone and luteinizing hormone.</p> Signup and view all the answers

Prolactin synthesis is markedly increased during pregnancy.

<p>True</p> Signup and view all the answers

Synthesis of anterior pituitary hormones is controlled by signals from the posterior pituitary gland.

<p>False</p> Signup and view all the answers

What are the hypothalamic neurohormones released into?

<p>The capillary bed of the hypothalamus.</p> Signup and view all the answers

What is the specialized vascular system that carries hypothalamic hormones to the anterior pituitary gland?

<p>The hypothalamic-hypophyseal portal vessels.</p> Signup and view all the answers

Where are hypothalamic hormones released at the anterior pituitary gland?

<p>Capillary sinuses located among the glandular cells</p> Signup and view all the answers

Anterior pituitary hormones can either have an inhibitory or a stimulatory effect.

<p>True</p> Signup and view all the answers

What is the function of thyrotropin-releasing hormone?

<p>It stimulates the secretion of TSH and prolactin.</p> Signup and view all the answers

What is the function of corticotropin-releasing hormone?

<p>It causes the release of adrenocorticotropic hormone.</p> Signup and view all the answers

What is the function of growth hormone-releasing hormone?

<p>It causes the release of growth hormone.</p> Signup and view all the answers

What is the function of growth hormone inhibitory hormone?

<p>It inhibits the release of growth hormone.</p> Signup and view all the answers

What is the function of gonadotropin-releasing hormone?

<p>It causes the release of luteinizing hormone and follicle-stimulating hormone.</p> Signup and view all the answers

What is the function of dopamine?

<p>It inhibits the release of prolactin.</p> Signup and view all the answers

What is the function of growth hormone?

<p>Stimulates protein synthesis and overall growth.</p> Signup and view all the answers

What is the function of thyroid stimulating hormone?

<p>Stimulates the synthesis and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3).</p> Signup and view all the answers

What is the function of adrenocorticotropic hormone?

<p>Stimulates the synthesis and secretion of adrenocortical hormones, primarily cortisol.</p> Signup and view all the answers

What is the function of prolactin?

<p>Promotes the synthesis and secretion of prolactin and other adrenocortical hormones.</p> Signup and view all the answers

What is the function of follicle stimulating hormone?

<p>Causes growth of follicles in the ovaries and promotes sperm maturation in the testes.</p> Signup and view all the answers

What is the function of luteinizing hormone?

<p>Stimulates testosterone synthesis in the testes, triggers ovulation, and promotes estrogen and progesterone synthesis in the ovaries.</p> Signup and view all the answers

What is the function of antidiuretic hormone?

<p>Increases water reabsorption by the kidneys and causes vasoconstriction.</p> Signup and view all the answers

What is the function of oxytocin?

<p>Stimulates uterine contractions during labor and milk ejection from the breast during lactation.</p> Signup and view all the answers

What is the function of thyroxine (T4) and triiodothyronine (T3)?

<p>They increase the rates of chemical reactions in most cells, increasing body metabolic rate.</p> Signup and view all the answers

What is the function of calcitonin?

<p>Promotes the deposition of calcium into bones and decreases extracellular fluid calcium ion concentration.</p> Signup and view all the answers

What is the function of cortisol?

<p>It regulates the metabolism of proteins, carbohydrates, and fats. It also has anti-inflammatory effects.</p> Signup and view all the answers

What is the function of aldosterone?

<p>It increases renal sodium reabsorption, potassium secretion, and hydrogen ion secretion.</p> Signup and view all the answers

What is the function of norepinephrine and epinephrine?

<p>They have the same function as sympathetic stimulation.</p> Signup and view all the answers

What is the function of insulin?

<p>It promotes glucose entry into many cells, controlling carbohydrate metabolism.</p> Signup and view all the answers

What is the function of glucagon?

<p>It increases the synthesis and release of glucose from the liver into the body fluids.</p> Signup and view all the answers

What is the function of parathyroid hormone?

<p>It controls serum calcium ion concentration by increasing calcium absorption by the gut and kidneys and releasing calcium from bones.</p> Signup and view all the answers

What is the function of testosterone?

<p>It promotes the development of the male reproductive system and male secondary sexual characteristics.</p> Signup and view all the answers

What is the function of estrogen?

<p>It promotes growth and development of the female reproductive system, female breasts, and female secondary sexual characteristics.</p> Signup and view all the answers

What is the function of progesterone?

<p>It stimulates the secretion of &quot;uterine milk&quot; by the uterine endometrial glands and promotes the development of the secretory apparatus of breasts.</p> Signup and view all the answers

What is the function of human chorionic gonadotropin?

<p>It promotes the growth of the corpus luteum and the secretion of estrogens and progesterone by the corpus luteum.</p> Signup and view all the answers

What is the function of human somatomammotropin?

<p>It probably helps promote the development of some fetal tissues, as well as the mother’s breasts.</p> Signup and view all the answers

What is the function of renin?

<p>It catalyzes the conversion of angiotensinogen to angiotensin I, acting as an enzyme.</p> Signup and view all the answers

What is the function of 1,25-dihydroxycholecalciferol?

<p>It increases intestinal absorption of calcium and bone mineralization.</p> Signup and view all the answers

What is the function of erythropoietin?

<p>It increases erythrocyte production.</p> Signup and view all the answers

What is the function of atrial natriuretic peptide?

<p>It increases sodium excretion by the kidneys, thereby reducing blood pressure.</p> Signup and view all the answers

What is the function of gastrin?

<p>It stimulates hydrogen chloride secretion by parietal cells in the stomach.</p> Signup and view all the answers

What is the function of secretin?

<p>It stimulates pancreatic acinar cells to release bicarbonate and water.</p> Signup and view all the answers

What is the function of cholecystokinin?

<p>It stimulates gallbladder contraction and the release of pancreatic enzymes.</p> Signup and view all the answers

What is the function of leptin?

<p>It inhibits appetite and stimulates thermogenesis.</p> Signup and view all the answers

What is the function of insulin?

<p>It promotes glucose entry into many cells, effectively controlling carbohydrate metabolism.</p> Signup and view all the answers

What is the function of glucagon?

<p>It increases the synthesis and release of glucose from the liver into the body fluids.</p> Signup and view all the answers

The cyclic AMP signaling system is the most widely studied second messenger system.

<p>True</p> Signup and view all the answers

Which of the following hormones use cAMP as their second messenger?

<p>All of the above</p> Signup and view all the answers

The enzyme phosphodiesterase catalyzes the hydrolysis of cAMP and terminates its intracellular actions.

<p>True</p> Signup and view all the answers

The enzyme adenosyclase is activated by the binding of a hormone to its receptor.

<p>True</p> Signup and view all the answers

Growth hormone exerts its primary effects through a specific target gland.

<p>False</p> Signup and view all the answers

What is the primary target of growth hormone?

<p>The liver.</p> Signup and view all the answers

What are the other tissues affected by growth hormone besides the liver?

<p>Skeletal muscle, heart, skin, visceral organs.</p> Signup and view all the answers

Growth hormone directly stimulates linear bone growth.

<p>False</p> Signup and view all the answers

What is the most obvious effect of growth hormone?

<p>Its effect on the skeletal frame.</p> Signup and view all the answers

Where is epiphyseal cartilage located?

<p>At the ends of long bones.</p> Signup and view all the answers

Osteoblasts are responsible for bone resorption (breakdown).

<p>False</p> Signup and view all the answers

Study Notes

The Endocrine System & Anesthesia

  • Body homeostasis is controlled by two regulatory systems: the nervous system and the endocrine system.
  • Endocrine glands secrete hormones directly into the extracellular fluid.
  • Exocrine glands secrete their products through ducts.
  • Examples of endocrine glands: pituitary, thyroid, parathyroid, adrenal, pancreas, ovaries, testes, and placenta.
  • Examples of exocrine glands: salivary and sweat glands.

Hormones

  • Hormones are signaling molecules, or chemical messengers.
  • Endocrine function: hormones travel through the bloodstream to a distant target cell.
  • Paracrine function: hormones act on a neighboring cell of different type.
  • Autocrine function: hormones act on the precursor cell itself-
  • Cytokines are peptides that can act as autocrine, paracrine or endocrine.
  • Examples of endocrine function: pituitary gland to adrenal glands.
  • Examples of paracrine function: pancreas alpha cells to beta cells.
  • Hormones can be classified into three major categories:
    • Proteins or peptides
    • Tyrosine amino acid derivatives
    • Steroids

Peptide or Protein Hormones

  • Water-soluble peptide hormones have a protein structure.
  • Synthesized in endocrine cells as pre-hormones or pro-hormones.
  • Processed and stored in secretory glands until needed.
  • Stimulus to secretion causes exocytosis of the hormone into extracellular fluid.
  • Examples: insulin, growth hormone, ADH, ACTH, parathyroid hormone, and oxytocin.

Tyrosine Amino Acid Derivatives

  • Derived from the amino acid tyrosine.
  • Examples: thyroid hormones (thyroxine, triiodothyronine), catecholamines (dopamine, epinephrine, norepinephrine).
  • Thyroid hormones are stored in the thyroid.
  • Catecholamines are stored in the adrenal medulla.

Steroid Hormones

  • Lipid-soluble, derived from cholesterol or structurally similar to cholesterol.
  • Examples: cortisol, aldosterone, estrogen, progesterone, testosterone, and active metabolites from vitamin D.
  • Steroid hormones are not stored in discrete secretory granules but are released into extracellular fluid by simple diffusion.

Hormone Transport

  • Most catecholamines and protein hormones are water-soluble and circulate freely.
  • Steroids and thyroid hormones are bound to transport proteins.
  • Protein binding protects hormones from metabolism and renal clearance.
  • Thyroid hormone is 99% protein-bound with a half-life of 1-6 days.
  • Insulin is not protein-bound with a half-life of 7 minutes.

Hormone Receptor Activation

  • Hormone receptor locations:
    • On the cell membrane (protein, peptides, catecholamines)
    • In the cytoplasm (steroids)
    • In the nucleus (thyroid)
  • Hormone binding to a cell membrane receptor activates enzyme systems or second messengers, which carry the hormone signal to the inside of the cell.

Hormone Secretion Regulation

  • Neural controls: pain, emotion, smell, touch, injury, stress, sight and taste, can alter hormone release.
  • Biorhythms: intrinsic oscillations that can be circadian, monthly or seasonal.
  • Feedback mechanisms: regulate hormone levels when the desired response is achieved.

Negative Feedback Hormone Regulation

  • Acts to limit or terminate the production and secretion of a hormone.
  • Negative feedback from a target cell product to the hormone producer limits hormone excess.
  • Important in the regulation of hormones of the hypothalamus and pituitary gland.

Positive Feedback Hormone Regulation

  • Less common.
  • A given hormone response initiates signals amplifying more of its own release.
  • Examples include LH surge that precedes ovulation in females and oxytocin release during childbirth.

Pituitary Gland

  • The master endocrine gland.
  • Located at the base of the brain, in the sella turcica.
  • Connected to the hypothalamus by the hypophyseal stalk.
  • Divided into anterior and posterior lobes.

Anterior Pituitary Lobe

  • Makes up 80% of the pituitary gland.
  • Secretes six peptide hormones: growth hormone, ACTH, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin.

Posterior Pituitary

  • Communicates with the hypothalamus via neural pathways.
  • Secretes antidiuretic hormone (ADH; vasopressin) and oxytocin.
  • ADH regulates water reabsorption in the kidneys.
  • Oxytocin stimulates milk ejection and uterine contractions.

Antidiuretic Hormone (ADH)

  • Acts on specific receptors in the kidney to increase water reabsorption.
  • It also results in vasoconstriction at high concentrations.
  • It is regulated by a variety of factors:
    • Increased plasma osmolarity
    • Decreased blood volume
    • Decreased blood pressure
    • Stress
    • Nausea
    • Vomiting
    • Medications

Diabetes Insipidus (DI)

  • Inadequate ADH secretion or resistance of the kidneys to ADH, resulting in excessive dilute urine output.
  • Neurogenic (Central) DI: insufficient ADH production.
  • Nephrogenic DI: kidneys do not respond to ADH.

Hypersecretion of Antidiuretic Hormone (SIADH)

  • Excess ADH secretion, despite normal or low plasma osmolarity.
  • Excessive water retention leads to hemodilution (low sodium)
  • Symptoms include, headache, lethargy and mental confusion, nausea, vomiting, seizures, and even coma

The Adrenal Glands

  • Located superior to each kidney.
  • Consist of two tissues: Adrenal Medulla and Adrenal Cortex.
  • Adrenal Medulla: central part (20%), produces catecholamines (epinephrine and norepinephrine).
  • Adrenal Cortex: outer part, produces steroid hormones. Mineralocorticoids, glucocorticoids, and androgens.

Adrenal Cortex Hormones

  • Mineralocorticoids (e.g., aldosterone): regulate salt and water balance, primarily affecting kidneys.
  • Glucocorticoids (e.g., cortisol): affect virtually every cell in the body, play a major role in metabolism, involved with stress response
  • Androgens (e.g., DHEA): precursors to other hormones with varying effects.

Control Mechanisms of Aldosterone Secretion

  • Increased potassium concentration is a major trigger.
  • Increased angiotensin II is a major trigger.
  • Increased sodium concentration tends to decrease stimulation.
  • Increased atrial natriuretic peptide (ANP) has a modest inhibitory effect.

Aldosterone Functions

  • Crucial role in maintaining electrolyte (Na+, K+, and H+) balance.
  • The renin-angiotensin system plays a major role in regulating aldosterone's secretion and affects its blood pressure effects.

Primary Aldosteronism (Conn Syndrome)

  • Excessive aldosterone production, typically from an adrenal adenoma.
  • Leading cause of secondary hypertension.
  • Characterized by hypertension, hypokalemia, and metabolic alkalosis.

Excess Glucocorticoid - Cushing Syndrome

  • Excessive cortisol production that results in a variety of health problems.
  • Causes can be an ACTH-dependent adenoma, adrenal adenomas, or a non-pituitary tumor that produces ACTH.
  • Symptoms include: central obesity, thin extremities, moon face, purplish skin striae, muscle weakness, easy bruising, hypertension, and increased blood glucose.

Adrenocortical Insufficiency - Addison Disease

  • Inadequate production of glucocorticoids and/or mineralocorticoids
  • Most common cause is autoimmune adrenalitis
  • Symptoms range from muscle weakness and fatigue, anorexia, nausea, vomiting, constipation, and abdominal pain, to severe hypotension and shock.

Thyroid Gland

  • Located anterior to the trachea between the cricoid cartilage and suprasternal notch.
  • Secretes essential thyroid hormones: T3 and T4.

Iodide Trapping

  • Thyroid gland actively concentrates iodide from the bloodstream 30 times greater than in blood stream.
  • Transports iodide into the follicle cells to begin synthesis of thyroid hormones.

Thyroid Hormone Formation

  • Tyrosine molecules are combined with iodine within a protein called thyroglobulin.
  • The most important hormone T4, but T3, is more potent.

Thyroid Hormone Release

  • TSH stimulates release of T3 and T4.
  • Hormones are cleaved from thyroglobulin and secreted.
  • T3 is more potent than T4.
  • T4 is a prohormone for T3.

Hyperthyroidism

  • Excess thyroid hormone production.
  • Common symptoms include increased metabolic activity.
  • Causes of Graves' Disease: autoimmune stimulation of the thyroid gland

Hypothyroidism

  • Insufficient thyroid hormone production.
  • Common symptoms include reduced metabolic activity.
  • Causes range from autoimmune destruction of the thyroid gland to dietary iodine deficiency.

Myxedema Coma

  • Life-threatening condition in patients with severe hypothyroidism.
  • Triggered by a profound stressor such as infection or surgery.
  • Characterized by hypothermia, hypoventilation, hypotension, and altered mental status.

Pancreas

-Dual function organ with exocrine function (digestion) and endocrine function (hormone production)

Islets of Langerhans

  • Endocrine cells that secrete hormones directly into the bloodstream, for crucial metabolism-regulation
  • Responsible for synthesizing several hormones, including insulin and glucagon by beta cells and alpha cells respectively.

Glucose

  • Primary fuel for the body's cells.
  • Its breakdown via glycolysis provides energy for all cellular functions.
  • Tightly regulated by hormones like insulin and glucagon.

Effects of Insulin on Carbohydrate, Protein, and Fat Metabolism

  • Carbohydrates: insulin promotes glycogen storage in the liver and muscle, prevents gluconeogenesis and inhibits glycogenolysis.
  • Protein: insulin stimulates protein synthesis from amino acids and inhibits protein breakdown.
  • Fats: insulin promotes fat storage, blocks lipolysis and the breakdown of stored triglycerides into fatty acids.

Insulin Secretion

  • Stimulators: increased glucose, amino acids in the blood.
  • Inhibitors: low glucose, somatostatin, cortisol, and growth hormone among others.

Glucagon

  • Antagonistic to insulin; raises blood glucose levels.
  • Promotes glycogenolysis and gluconeogenesis in the liver (breaks down glycogen to release glucose into the blood, creating new glucose from non-carbohydrates).
  • During fasting, glucagon is essential for maintaining between-meal blood sugar

Diabetes Mellitus

  • Characterized by chronic hyperglycemia.
  • Two main types: Type 1 (absolute insulin deficiency) and Type 2 (relative insulin deficiency.
  • Can lead to various complications.

Diabetic Ketoacidosis (DKA)

  • Accumulation of ketones in the body due to a profound lack of insulin: leading to severe metabolic acidosis.

Hyperglycemic Hyperosmolar State (HHS)

  • Characterized by hyperglycemia, but without ketoacidosis.
  • More commonly occurs in adults and is associated with an acute illness.

Anesthetic Management of the Diabetic Patient

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