Chapter13.pptx

Chapter 13 Altered Hormonal and Metabolic Regulation Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Hormones Control via the hypothalamic–pituitary axis Feedback (positive and negative loops) Patterns of hormone secretion, metabolism, elimination Recept...

Chapter 13 Altered Hormonal and Metabolic Regulation Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Hormones Control via the hypothalamic–pituitary axis Feedback (positive and negative loops) Patterns of hormone secretion, metabolism, elimination Receptor binding Action on target organs and glands Copyright © 2023 Wolters Kluwer · All Rights Reserved The Hypothalamic–Pituitary Axis Copyright © 2023 Wolters Kluwer · All Rights Reserved Negative Feedback Loop Copyright © 2023 Wolters Kluwer · All Rights Reserved Positive Feedback Loop Copyright © 2023 Wolters Kluwer · All Rights Reserved Mediating Cell-to-Cell Communication Paracrine pathway Autocrine pathway Endocrine pathway Synaptic pathway Neuroendocrine pathway Copyright © 2023 Wolters Kluwer · All Rights Reserved Stress Response Neurologic response  Autonomic system  Cerebral cortex   Limbic system Thalamus  Hypothalamus  Reticular activating system Hormonal response  Corticotropin-releasing hormone  ACTH  Cortisol  Catecholamines  Epinephrine  Norepinephrine  Dopamine Copyright © 2023 Wolters Kluwer · All Rights Reserved General Adaptation Syndrome Alarm stage Resistance stage Exhaustion stage Copyright © 2023 Wolters Kluwer · All Rights Reserved Altered Hormone Function Impairment of endocrine gland Lack of/excessive hormone synthesis Impaired receptor binding Impaired feedback mechanisms Impaired cell response to hormones Copyright © 2023 Wolters Kluwer · All Rights Reserved General Manifestations of Altered Hormone Function Hypopituitarism  Constipation  Gradual onset  Cold intolerance  Fatigue  Weakness  Anorexia  Sexual dysfunction  Growth impairment  Dry skin Hyperpituitarism  A wide range of manifestations, depending on hormones elevated  See Table 13.2 Copyright © 2023 Wolters Kluwer · All Rights Reserved Diagnosing Altered Hormone Function History and physical examination Laboratory tests o Serum and urine hormone levels o Hormone suppression and stimulation tests o Serum electrolyte, glucose, and calcium levels Imaging studies Genetic testing Copyright © 2023 Wolters Kluwer · All Rights Reserved Treating Altered Hormone Function Dependent on cause Hormone excesses o Removal of tumor secreting ectopic hormone o Removal of part or all of endocrine gland o Medications that block effects of hormone Hormone deficits o Medications that stimulate release or replace hormone Copyright © 2023 Wolters Kluwer · All Rights Reserved Application of the Concepts of Altered Hormonal and Metabolic Function SIADH Hypothyroidism Diabetes insipidus Cushing syndrome Hyperthyroidism Addison disease Copyright © 2023 Wolters Kluwer · All Rights Reserved Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved SIADH Pathophysiology Excess production and release of ADH. Most common cause: tumor secreting ectopic ADH. ADH promotes water retention intracellularly. Water accumulates in cells, altering function. Sodium is diluted in extracellular space. Result: hypotonic hyponatremia. Copyright © 2023 Wolters Kluwer · All Rights Reserved SIADH Clinical Manifestations Decreased urine output (concentrated) Severity of symptoms depends on serum sodium levels o Anorexia, nausea, vomiting, headache o Irritability, disorientation, cramps, weakness o Psychosis, gait disturbances, seizures, coma Copyright © 2023 Wolters Kluwer · All Rights Reserved SIADH Diagnostic Criteria Hyponatremia (serum sodium