1.

Endocrine Function
The main function of endocrine glands is to secrete hormones
directly into the bloodstream. Hormones are chemical substances that
affect the activity of another part of the body (target site). In essence,
hormones serve as messengers, controlling and coordinating
activities throughout the body.

Upon reaching a target site, a hormone binds to a receptor, much like

a key fits into a lock. Once the hormone locks into its receptor, it
transmits a message that causes the target site to take a specific
action. Hormone receptors may be within the nucleus or on the
surface of the cell.

Ultimately, hormones control the function of entire organs, affecting

such diverse processes as growth and development, reproduction, and
sexual characteristics. Hormones also influence the way the body
uses and stores energy and control the volume of fluid and the levels
of salts and sugar in the blood. Very small amounts of hormones can
trigger very large responses in the body.

Although hormones circulate throughout the body, each type of

hormone influences only certain organs and tissues. Some hormones
affect only one or two organs, whereas others have influence
throughout the body. For example, thyroid-stimulating hormone,
produced in the pituitary gland, affects only the thyroid gland. In
contrast, thyroid hormone, produced in the thyroid gland, affects cells
throughout the body and is involved in such important functions as
regulating growth of cells, controlling the heart rate, and affecting the
speed at which calories are burned. Insulin, secreted by the islet cells
of the pancreas, affects the processing (metabolism) of glucose,
protein, and fat throughout the body.

Most hormones are proteins. Others are steroids, which are fatty
substances derived from cholesterol.

Major Hormones
Where Hormone Function
Hormone Is
Produced
Pituitary Antidiuretic hormone Causes kidneys to retain water
gland (vasopressin) and, along with aldosterone,
helps control blood pressure
  Corticotropin (ACTH) Controls the production and
secretion of hormones by the
adrenal glands
  Growth hormone Controls growth and
development; promotes protein
production
  Luteinizing hormone Control reproductive functions,
and follicle- including the production of
stimulating hormone sperm and semen, egg
maturation, and menstrual
cycles; control male and female
sexual characteristics (including
hair distribution, muscle
formation, skin texture and
thickness, voice, and perhaps
even personality traits)
  Oxytocin Causes muscles of the uterus
and milk ducts in the breast to
contract
  Prolactin Starts and maintains milk
production in the ductal glands
of the breast (mammary glands)
  Thyroid-stimulating Stimulates the production and
hormone secretion of hormones by the
thyroid gland
Parathyroid Parathyroid hormone Controls bone formation and the
glands excretion of calcium and
phosphorus
Thyroid Thyroid hormone Regulates the rate at which the
gland body functions (metabolic rate)
  Calcitonin In people, function is unclear; in
other species, regulates calcium
balance
Adrenal Aldosterone Helps regulate salt and water
glands balance by retaining salt and
water and excreting potassium
  Cortisol Has widespread effects
throughout the body; especially
has anti-inflammatory action;
maintains blood sugar level,
blood pressure, and muscle
strength; helps control salt and
water balance
  Dehydroepiandrostero Has effects on bone, mood, and
ne (DHEA) the immune system
  Epinephrine and Stimulate the heart, lungs, blood
norepinephrine vessels, and nervous system
Pancreas Glucagon Raises the blood sugar level
  Insulin Lowers the blood sugar level;
affects the processing
(metabolism) of sugar, protein,
and fat throughout the body
Kidneys Erythropoietin Stimulates red blood cell
production
  Renin Controls blood pressure
Ovaries Estrogen Controls the development of
female sex characteristics and
the reproductive system
  Progesterone Prepares the lining of the uterus
for implantation of a fertilized
egg and readies the mammary
glands to secrete milk
Testes Testosterone Controls the development of
male sex characteristics and the
reproductive system
Digestive Cholecystokinin Controls gallbladder
tract contractions that cause bile to
enter the intestine; stimulates
release of digestive enzymes
 from the pancreas
  Glucagon-like peptide Increases insulin release from
pancreas
  Ghrelin Controls growth hormone
release from the pituitary gland;
causes sensation of hunger
Adipose (fat) Resistin Blocks the effects of insulin on
tissue muscle
  Leptin Controls appetite
Placenta Chorionic Stimulates ovaries to continue to
gonadotropin release progesterone during
early pregnancy
  Estrogen and Keep uterus receptive to fetus
progesterone and placenta during pregnancy

The major glands of the endocrine system, each of which produces one or more
specific hormones, are the hypothalamus, the pituitary gland, the thyroid gland, the
parathyroid glands, the islets of the pancreas, the adrenal glands, the testes in men,
and the ovaries in women. During pregnancy, the placenta also acts as an
endocrine gland in addition to its other functions.

Major Endocrine Glands

Not all organs that secrete hormones or hormonelike substances are considered part of the
endocrine system. For example, the kidneys produce the hormone renin to help control
blood pressure and the hormone erythropoietin to stimulate the bone marrow to produce
red blood cells. In addition, the gastrointestinal system produces a variety of hormones
that control digestion, affect insulin secretion from the pancreas, and alter behaviors, such
as those associated with hunger. Fat (adipose) tissue also produces hormones that
regulate metabolism and appetite. Additionally, the term "gland" does not mean that the
organ is part of the endocrine system. For example, sweat glands, glands in mucus
membranes, and mammary glands secrete substances other than hormones.

Pathophysiology of Diabetes Mellitus

ADH--anti-diuretic hormone--works to tell your body to retain water. It's commonly released in
higher quantities at night when you sleep.....and is why it's not normal to go to the bathroom
while sleeping.

Diabetes Insipidus results when either 1) the body doesn't release ADH or 2) the kidneys don't
respond to ADH. It results in having to urinate large quantities frequently (3-5x normal) of urine
that is dilute. To compensate for all the fluid loss, those affected will drink a lot. There are
treatments for it.

*Diabetes Insipidus (DI) is a disorder in which there is an abnormal increase in urine output,
fluid intake and often thirst.  It causes symptoms such as urinary frequency, nocturia (frequent
awakening at night to urinate) or enuresis (involuntary urination during sleep or "bedwetting"). 
Urine output is increased because it is not concentrated normally.  Consequently, instead of
being a yellow color, the urine is pale, colorless or watery in appearance and the measured
concentration (osmolality or specific gravity) is low.

*Diabetes Insipidus is not the same as diabetes mellitus ("sugar" diabetes).   Diabetes Insipidus
resembles diabetes mellitus because the symptoms of both diseases are increased urination and
thirst.  However, in every other respect, including the causes and treatment of the disorders, the
diseases are completely unrelated.   Sometimes diabetes insipidus is referred to as "water"
diabetes to distinguish it from the more common diabetes mellitus or "sugar" diabetes.

*Diabetes Insipidus is divided into four types, each of which has a different cause and must be
treated differently.  The most common type of DI is caused by a lack of vasopressin, a hormone
that normally acts upon the kidney to reduce urine output by increasing the concentration of the
urine.  This type of DI is usually due to the destruction of the back or "posterior" part of the
pituitary gland where vasopressin is normally produced.  Hence, it is commonly called pituitary
DI.   It is also known as central or neurogenic DI.  The posterior pituitary can be destroyed by a
variety of underlying diseases including tumors, infections, head injuries, infiltrations, and
various inheritable defects.  The latter can be recognized by the onset of the DI in early
childhood and a family history of parents, siblings or other relatives with the same disorder. 
Nearly half the time, however, pituitary DI is "idiopathic" (that is, no cause can be found despite
a thorough search including magnetic resonance imaging or MRI of the brain) and the underlying
cause(s) is (are) still unknown.  Pituitary DI is usually permanent and cannot be cured but the
signs and symptoms (i.e. constant thirst, drinking and urination) can be largely or completely
eliminated by treatment with various drugs including a modified from of vasopressin known as
desmopressin or DDAVP.  Because pituitary DI is sometimes associated with abnormalities in
other pituitary hormones, tests and sometimes treatments for these other abnormalities are also
needed.

*Occasionally, a lack of vasopressin can also develop during pregnancy if the pituitary is slightly
damaged and/or the placenta destroys the hormone too rapidly.  This second type of vasopressin
deficiency is called gestagenic or gestational DI and is also treatable with DDAVP but, in this
case, the deficiency and the DI often disappear 4 to 6 weeks after delivery at which time the
DDAVP treatment can usually be stopped.  Often, however, the signs and symptoms of DI recur
with subsequent pregnancies.

*The third type of DI is caused by an inability of the kidneys to respond to the "antidiuretic
effect" of normal amounts of vasopressin.  This type of DI is usually referred to as nephrogenic
DI and can result from a variety of drugs or kidney diseases including heritable genetic defects. 
It cannot be treated with DDAVP and, depending on the cause, may or may not be curable by
eliminating the offending drug or disease.  The heritable form, for example, lasts for life and
cannot be cured at present.  However, there are treatments that can partially relieve the signs and
symptoms of nephrogenic DI.

*The fourth form of DI occurs when vasopressin is suppressed by excessive intake of fluids. 
The latter is usually referred to as primary polydipsia and is most often caused by an abnormality
in the part of the brain that regulates thirst.   This subtype is called dipsogenic DI and is difficult
to differentiate from pituitary DI particularly since the two disorders can result form many of the
same brain diseases.  The only sure way to tell them apart is to measure vasopressin during a
stimulus such as fluid deprivation or to observe the effects of DDAVP treatment.  In dipsogenic
DI, DDAVP also eliminates the excessive urination but, unlike pituitary DI, it does not
completely eliminate the increased thirst and fluid intake.  Thus, it also results in water
intoxication, a condition associated with symptoms such as headache, loss of appetite, lethargy
and nausea and signs such as an abnormally large decrease in the plasma sodium concentration
(hyponatremia).   Because of this and the current lack of a way to correct the underlying
abnormality in thirst, dipsogenic DI cannot be treated at present, although the most troubling
symptoms, nocturia, can be safely relieved by taking small doses of DDAVP at bedtime.   The
other subtype of primary polydipsia is due not to abnormal thirst but to psychosomatic causes
and is often referred to as pyschogenic polydipsia.   It cannot be treated at present.

SIADH is the opposite: the body secretes ADH when it shouldn't. Thus, water is retained when it
should be excreted. This often leads to electrolyte disturbances (such as sodium levels). Causes
include head injury/trauma, meningitis, cancer (especially lung cancer), some infections and
some drugs.

Syndrome of Inappropriate antidiuretic Hormone (SIADH)

• The syndrome of inappropriate secretion of ADH (SIADH) is characterized by the non-

physiologic release of ADH, resulting in impaired water excretion with normal sodium
excretion

• SIADH is associated with disease that affect osmoreceptor in the hypothalamus

• SIADH is characterized by:

– fluid retention

– serum hypo-osmolarity

– dilutional hyponatraemia

– hypchloremia

– concentrated urine in the presence of normal or increased intravascular volume

– normal renal function

• Symptoms are headache, nausea, vomiting, abnormal neurological signs and impaired
consciousness

• In severe cases there can be coma & death

• Neurological signs may be present if hyponatraemia is severe or if it develops rapidly

• These signs include:

– Cheyne-Stokes respiration, drowsiness, disorientation, delirium, seizures, and

coma

• Hyponatraemia and hypo-osmolarity lead to acute edema of the brain cells

• An increase in brain water content of more than 5-10% is incompatible with life

• Associated clinical manifestations correlate with serum sodium levels

– initially

• thirst, dyspnea on exertion, fatigue and changed sensorium

– as serum sodium falls below 120mEq/l

• symptoms are more severe with

• vomiting

• abdominal cramps, muscle twitching

• Seizures

• Diagnosis of SIADH is made by simultaneous measurement of urine & serum osmolarity

REQUIREMENT
In
 MEDICSL
SURGICAL /
METABOLISM
(Endocrine)
Submitted to:
Mr. Kristopher Calma

Submitted by:
Cherrylyn B. Raytos / NR-32