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PCOS and Metformin:

PCOS: hormonal imbalance, thus more androgen produce affect the development of ova (anovulatory cycle)
insulin insensitivity increasing androgen levels to try to decrease insulin, give metformin
Metformin: used in T2DM
o Decreased androgen levels
o Weight loss in obesity
** action is most on utilization of blood glucose by different body organs
** have FBS checked first (will not work on impaired glucose tolerance

Dangers of Steroid Use
Synthetic testosterone: taken 100x the dose
Effects
o Increase muscle size (tubig, not really mass)
o Increase rage and aggression
o Kidney and liver disease
o Impotence and sterility: decrease size in testicles and causes low sperm count
o Baldness for men, chest and facial hair for women
o Enlarged breasts for men, decrease size for women
Chronic use
o Formation of acne
Pustules and secondary bacterial infection
o Loss of mass, and gains weight
Increased deposition of fat
o Poor outcome

POSTERIOR PITUITARY HORMONES
Oxytocin and vasopressin (antidiuretic hormone ADH)
o Actions: stimulate smooth muscle contraction and maintain water homeostasis
o Synthesized in the nerve cell bodies of hypothalamus (paraventricular: oxytoxcin & supraventricular:
ADH)
o Stored in secretory granules of the PP (neurohypophysis)

Oxytocin
Disorders: rarely seen and diagnosed, clinical determination is rarely done
FERGUSSON reflex: oxytocin secretion stimulated by stretching of the cervix and vagina during parturition
Actions:
o Uterine contractions late in labor
o Role in homeostasis of placental site after delivery
o Milk ejection reflex
Acts on myoepithelium not on the gland cells
Figure:

ADH
Evaluate water homeostasis
o Detect the presence of sodium in the serum
o Detect serum osmolarity
Synthesized within the paraventricula and supraoptic nuclei of the hypothalamus
Function: to maintain osmotic homeostasis by regulating water balance
Secretin stimulated by:
o Changes in osmolality and intravascular volume
o Others: nausea, cytokine IL-6 hypoglycaemia, hypercarbia, nicotine

ADH Action on Kidney:
Main effect is in the collecting duct (which is not permeable to water) becomes permeable to water and only
a small volume of urine is produced

Figure:
Main stimulus: dehydration triggers osmoreceptors in the hypothalamus increased ADH synthesis
release in the PP reduce urine, increased vasoconstriction
Homeostasis: negative feedback to ADH

Disorders
1. Diabetes Insipidus
Passage of large volumes of dilute urine (>2.5L/day) with elevated plasma osmolality
Classification
o Neurogenic: absent or decreased ADH secretion from the hypothalamus or PP
o Nephrogenic: due to renal resistance to the actions of ADH
DX: Water Deprivation Test
o Preferred diagnostic test to detect DI
o Take 3-4 hours
o Hourly collection of plasma and urine: tested for osmolality
o Administration of exogenous ADH
o Neurogenic DI: low ADH levels
Responsive to exogenous ADH administration: kidney rapidly conserves water
o Nephrogneic DI: normal or increased ADH levels
Little or no response to exogenous ADH administration
2. SIADH/ Syndrome of Inappropriate ADH Secretion
Result of continued inappropriate natriuresis (Na is excessively secreted in the urine)
o Hyponatremia associated with a hyperosmolar urine
ADH secretion stimulated by:
o Physiologic triggers: nausea, pregnancy, hypoglycaemia, intracranial hypertension, mechanical
ventilation and hypoxia
o Disease: hypothyroidism, glucocorticoid mineralocorticoid deficiency
** Thyroid hormone synthesis: decreased TH low blood volume secretion of ADH
** Glucocorticoid and mineralocorticoid: deficient state of mineralocorticoid affects cortisol level
Dx: Water Load Test
o Get baseline
o Loading of water
o Urine sample every hour for 5 hours
o Interpretation
Normal: excretes 80-90% of the administered water load within 4 hours
SIADH: failure to excrete administered water increase water volume in the
circulation problem in ADH secretion
r/o intake of medications and other conditions
Diagnosis of SIADH
o By exclusion
r/o other causes for hyponatremia
may manifest as paraneoplastic syndrome
r/o: CNS trauma or infection, lung disease or intake of medications






Disorder Serum sodium and
osmolarity
Urine sodium and
osmolarity
Serum ADH
Neurogenic DI Normal to high Low Low
Nephrogenic DI Normal to high Low Normal to high
SIADH Low Normal high
** excessive water intake: psychogenic

Hormone Where made Target organ Effect/Dx test
ADH Posterior Pituitary Kidney Increases water
reabsorption/water load or
water suppression test
Parathyroid Parathyroid Gland Bone, kidneys, intestine Increase blood calcium
levels/calcium
Thyroid Thyroid Gland Most cells Increases metabolic
rate/TSH FT4
ACTH Anterior Pituitary Adrenal cortex Stimulates release of
cortisol/dexamethasone
test
Cortisol Adrenal cortex Most cells Affects glucose and
proteins/ levels and
metabolic dexamethasone
test