Introduction to Endocrinology PDF

Introduction to Endocrinology * noticed Covid increment in DM the mechanism of that We after cases -> an...

Introduction to Endocrinology * noticed Covid increment in DM the mechanism of that We after cases -> an is Covid causes an inflammatory process that interferes in insulin binding to causing DM another pathway is the inflammatory process affecting its receptors , interaction ! the post receptor example is the level of pathology in endocrine diseases , an # We have to define hypo parathyroidism 3rd Psuedopsuedo hypoparathyroidism end Psuedo hypo parathyroidism normal receptor 35 Hypoparathyroidism > - Parathyroid hormone level > - Love is , due to organ damage or normal but is normal but problem in winding iatrogenic with low promblem in post receptor parathyroid hormone receptor binding interaction * Most of endocrine diseases are multisystemic diseases ! Endocrine disease causes clinical syndromes with symptoms and signs involving many organ systems. The emphasis of the clinical examination depends on the gland or hormone that is thought to be abnormal. Diabetes mellitus and thyroid disease are the most common endocrine disorders. Endocrinology -very common concerns the synthesis, secretion and action of hormones. especially North in These are chemical messengers released from endocrine glands that coordinate the activities of many different cells. Endocrine diseases can therefore affect multiple organs and systems. Some endocrine disorders are common, particularly those of the thyroid, parathyroid glands, reproductive system and β cells of the pancreas. For example, thyroid dysfunction occurs in more than 10% of the population in areas with iodine deficiency, such as the Himalayas, and 4% of women aged 20–50 years in the UK. We loss with good p # aetite => DM/ hyperthyroidism/man absorption - reaches 590 and - * In normal person blood sugar fallsto 78 you fee hungry , after eating doesto satiety happens why DM Pt doesn't satiety , despite BS reaching 100-500 = Cglucose  sprimary hyperparathyroidism) #importandenywita case ↳ hypothyroidism Lepheochromocytoma > - Cushing syndrome  be secreted in hypoglycemia * Glucagon will Functional anatomy and physiology : immediately Some endocrine glands, such as the parathyroids and pancreas, respond directly to metabolic signals, but most are controlled by hormones released from the pituitary gland. Anterior pituitary hormone secretion is controlled in turn by substances produced in the hypothalamus and released into portal blood, which drains directly down the pituitary stalk. - ApHyn Posterior pituitary hormones are synthesised in the hypothalamus and transported down nerve axons, to be released from the posterior pituitary. Hormone release in the hypothalamus and pituitary is regulated by numerous stimuli and through feedback control by hormones produced by the target glands (thyroid, adrenal cortex and gonads). These integrated endocrine systems are called ‘axes. disease you have to exclude others -When we have autoimmune , # Resistant PT - not responding to maximum thropy despite being on 5 anti-hyper tensive drugs including Las #25 yus old pt with HPF , suspect It disturbance in Conn's syndrome which usually causes dat retention and excretion of 1* important it's * Catt is so cut cardine and CNS related to function * Remember the negative feedback # There are binding globulins which bind to hormones, pree the ones are physiologically active !  A wide variety of molecules can act as hormones, including peptides such as insulin and growth hormone, glycoproteins such as thyroid-stimulating hormone, and amines such as Adrenal noradrenaline (norepinephrine). The biological effects of Medulla hormones are mediated by binding to receptors. Many receptors are located on the cell surface. These interact with various intracellular signalling molecules on the cytosolic side of the plasma membrane to affect cell function, usually through changes in gene expression. Some hormones, most notably steroids, triiodothyronine (T3) and vitamin D, bind to specific intracellular receptors. The hormone/ receptor complex forms a ligand-activated transcription factor, which regulates gene expression directly binding to receptor # For hormones to work , there are two stages -> hormone ↳ impairmentinteractionhormonation ceptor ! The classical model of endocrine function involves hormones synthesized in endocrine glands, which are released into the circulation and act at sites distant from those of secretion. However, additional levels of regulation are now recognized. Many other organs secrete hormones or contribute to the peripheral metabolism and activation of prohormones. A notable example is the production of oestrogens from adrenal androgens in adipose tissue by the enzyme aromatase. Some hormones, such as neurotransmitters, act in a paracrine fashion to affect adjacent cells, or act in an autocrine way to affect behavior of the cell that produces the hormone.  * First you have to consolidate your diagnosis , then define Endocrine pathology: the level of pathology Pathology arising within the gland is often called ‘primary’ disease (e.g. primary hypothyroidism in Hashimoto’s thyroiditis), while abnormal stimulation of the gland is often called ‘secondary’ disease (e.g. secondary hypothyroidism in patients with a pituitary tumour and thyroid-stimulating hormone deficiency). Some pathological processes can affect multiple endocrine glands; these may have a genetic basis (such as organ-specific autoimmune endocrine disorders and the multiple endocrine neoplasia (MEN) syndromes) or be a consequence of therapy for another disease (e.g. following treatment of childhood cancer with chemotherapy and/or radiotherapy). hormone causing sweating tachycardia themor,ut loss diathed # Thyrotoxicosis mean in thyroid , , , , while hyperthyroidism means the gland is hyperactive ↳ got all thyrotoxic its have hyperthyroidism * In Grave's disease we have hyperthyroidism - thyrotoxicosis despite having proper feedback Sometimes # in case of thyroiditis following the pharyngitis , the inflammation secretes stored thyroid hormones # so signs symptoms # investigation same but underlying cause 100 % different and management 100 % different microtumers like insulinemas can't common remember the insulinma case , very > - , be seen neither by C or MRI causing severe hypoglycemic and even death ! *  * Random measurement of growth hormone Investigation of endocrine disease : useless needs is so a special technique Biochemical investigations play a central role in endocrinology. Most hormones can be measured in blood but the circumstances in which the sample is taken are often crucial, especially for hormones with GuRH + pulsatile secretion, such as growth hormone; those that show diurnal variation, such as cortisol; or those that demonstrate monthly variation, such as oestrogen or progesterone. Some hormones are labile and need special collection, handling and processing requirements, e.g. collection in a special tube and/or rapid transportation to the laboratory on ice. Local protocols for hormone measurement should be carefully followed. Other investigations, such as imaging and biopsy, are more frequently reserved for patients who present with a tumor. The choice of test is often pragmatic, taking local access to reliable sampling facilities and laboratory measurements into account. disease measure Cushing we # Cortisol is maximum in morning , so in suspicion of se mess fact cortisol at midnight - > CT with contrast Presenting problems in endocrine disease : Endocrine diseases present in many different ways and to clinicians in many different disciplines. Classical syndromes are described in relation to individual glands in the following sections. Often, however, the presentation is with non-specific symptoms (Box 18.3) or with asymptomatic biochemical abnormalities. In addition, endocrine diseases are encountered in the differential diagnosis of common complaints discussed in other chapters of this book, including electrolyte abnormalities (Ch. 14), hypertension (Ch. 16), obesity (Ch. 19) and osteoporosis (Ch. 24). Although diseases of the adrenal glands, hypothalamus and pituitary are relatively rare, their diagnosis often relies on astute clinical observation in a patient with non-specific complaints, so it is important that clinicians are familiar with their key features. #Both thyroid and parathyroid hormones can causeosteoporosis * Morbid obesity not responding to medication Hypothyroidism  and causes& cat interferes with ADH high Polyuria ,raisas Brake up from chair , comb hair  CAUSES OF HORMONE EXCESS Syndromes of hormone excess can be caused by neoplastic growth of endocrine cells, autoimmune disorders, and excess hormone administration. Benign endocrine tumors, including parathyroid, pituitary, and adrenal adenomas, often retain the capacity to produce hormones, reflecting the fact that these tumors are relatively well differentiated. Many endocrine tumors exhibit subtle defects in their “set points” for feedback regulation. For example, in Cushing’s disease, impaired feedback inhibition of adrenocorticotropic hormone (ACTH) secretion is associated with autonomous function. to * Normally when cortisol 4 , there should be angative feedback disease to stop stimulating or secreting ACTH , but in Cushing's pitratory this is impaired  CAUSES OF HORMONE DEFICIENCY Most examples of hormone deficiency states can be attributed to glandular destruction caused by autoimmunity, surgery, infection, inflammation, infarction, hemorrhage, or tumor infiltration. Autoimmune damage to the thyroid gland (Hashimoto’s thyroiditis) and pancreatic islet β cells (type 1 diabetes mellitus) are examples of relatively common endocrine diseases. Mutations in a number of hormones, hormone receptors, transcription factors, enzymes, and channels can also lead to hormone deficiencies. to ischemia and * Shechah's syndrome DDH leading infarction : Ex of - > - how to know it's shechwn's or hypothyroidism ?! pitratory inforction , => Check breast feeding , if she has milk secration then hypothyroidism cue. in Shecham we have destruction of gland  early insulin resistance - TCDM An HORMONE RESISTANCE & If insulin Most severe hormone resistance syndromes are due to inherited defects in membrane receptors, nuclear receptors, or the pathways that transduce receptor signals. These disorders are characterized by defective hormone action despite the presence of increased hormone levels. In complete androgen resistance, for example, mutations in the androgen receptor result in a female phenotypic appearance in genetic (XY) males, even though LH and testosterone levels are increased.