ENDOCRINE SYSTEM

Medical Surgical Nursing

 CONTENTS:
Thyroid and Parathyroid Hormones LOPEZ, Jerlyn May L.
Posterior Pituitary LOPEZ, Britany Alaine R.
Adrenal Cortex MACUJA, Jc Renz B.
Heart MADJID, Dana T.
Adipose Tissue MADJID, Zerfa-Nishreen T.
Kidneys MABALOT, Paula Jeremy D.G.
Adrenal Medulla MADJID, Ayeza Saphia T.
Ovaries, Testes, Placenta MANALO, Anne Marielle A.
Pancreatic Islet Cells MAMOGAY, Ma. Lourdette A.
Anterior Pituitary LUCAS, Marizen D.

EXCESS THYROID DEFICENCY

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Endocrine System
RLE 1 Section 6
HYPERTHYROIDISM is a Thyroid hormones: Chemical substances made by the thyroid gland, which is located in the
condition in which the thyroid front of the neck. This gland uses iodine to make thyroid hormones, which are essential for the HYPOTHYROIDISM is a
gland is overactive and makes function of every cell in the body. They help regulate growth and the rate of chemical reactions condition in which the body lacks
excessive amounts of thyroid (metabolism), and are involved in the circadian rhythms that govern sleep, among other sufficient thyroid hormone. Since
hormone. The thyroid gland is an essential functions. the main purpose of thyroid
organ located in the front of your The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3). hormone is to "run the body's
neck and releases hormones that Thyroid stimulating hormone (TSH), which is produced by the pituitary gland, acts to stimulate metabolism," it is
control your metabolism (the hormone production by the thyroid gland. The pituitary gland is stimulated to make TSH by the understandable that people with
way your body uses energy), hypothalamus gland in the brain. this condition will have
breathing, heart rate, nervous The thyroid also makes the hormone calcitonin, which is involved in calcium metabolization symptoms associated with a
system, weight, body and stimulating bone cells to add calcium to bone slow metabolism.
temperature, and many other
functions in the body. When the There are two fairly common
thyroid gland is overactive Test Abbreviation Typical Ranges causes of hypothyroidism. The
(hyperthyroidism) the bodys Serum thyroxine T4 4.6-12 ug/dl first is a result of previous (or
processes speed up and you may Free thyroxine fraction FT4F 0.03-0.005% currently ongoing) inflammation
experience nervousness, Free Thyroxine FT4 0.7-1.9 ng/dl of the thyroid gland, which
anxiety, rapid heartbeat, hand Thyroid hormone binding ratio THBR 0.9-1.1 leaves a large percentage of the
tremor, excessive sweating, Free Thyroxine index FT4I 4-11 cells of the thyroid damaged (or
weight loss, and sleep problems, dead) and incapable of
Serum Triiodothyronine T3 80-180 ng/dl
among other symptoms. producing sufficient hormone.
Free Triiodothyronine l FT3 230-619 pg/d The most common cause of
Anxiety Free T3 Index FT3I 80-180 thyroid gland failure is
Irritability or moodiness Radioactive iodine uptake RAIU 10-30% called autoimmune
Nervousness, hyperactivity Serum thyrotropin TSH 0.5-6 uU/ml thyroiditis (also called
Sweating or sensitivity to high Thyroxine-binding globulin TBG 12-20 ug/dl T4 +1.8 ugm Hashimoto's thyroiditis), a form
temperatures TRH stimulation test Peak TSH 9-30 uIU/ml at 20-30 min of thyroid inflammation caused
Hand trembling (shaking) by the patient's own immune
Serum thyroglobulin l Tg 0-30 ng/m
Hair loss system.

Missed or light menstrual periods Fatigue

Weakness
Weight gain or increased
difficulty losing weight
Coarse, dry hair
Dry, rough pale skin
Hair loss
Cold intolerance
Muscle cramps and frequent
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RLE 1 Section 6
 muscle aches
Constipation
Depression
Irritability
Calcitonin is a hormone that is produced and released by the C-cells of the thyroid gland. Its
Memory loss
There does not seem to be any biological function in humans is unclear.
Abnormal menstrual cycles
effect on the body as a result of Calcitonin is a hormone that is produced in humans by the parafollicular cells (commonly
known as C-cells) of the thyroid gland. Calcitonin is involved in helping to regulate levels of Decreased libido
having too much calcitonin.
calcium and phosphate in the blood, opposing the action of parathyroid hormone. This means
that it acts to reduce calcium levels in the blood. However, the importance of this role in There does not seem to be any
Medullary thyroid cancer is a effect on the body as a result of
humans is unclear, as patients who have very low or very high levels of calcitonin show no
rare type of cancer that arises having too little calcitonin.
adverse effects.
from the C-cells in the thyroid Patients who have had their
Calcitonin reduces calcium levels in the blood by two main mechanisms:
gland that secrete calcitonin. It is thyroid gland removed, and have
sometimes associated undetectable levels of calcitonin
with multiple endocrine 1. It inhibits the activity of osteoclasts, which are the cells responsible for breaking down
in their blood, show no adverse
neoplasia type 2a and multiple bone. When bone is broken down, the calcium contained in the bone is released into
symptoms as a result of this.
endocrine neoplasia type the bloodstream. Therefore, the inhibition of the osteoclasts by calcitonin directly
2b. Patients with medullary reduces the amount of calcium released into the blood. However, this inhibition has
thyroid cancer have high been shown to be short-lived.
calcitonin levels in their
bloodstream. However, it is
important to note that these 2. It can also decrease the resorption of calcium in the kidneys, again leading to lower
high calcitonin levels are a blood calcium levels.
symptom of this condition and
not a contributing factor. Manufactured forms of calcitonin can be given to treat Pagets disease of bone and
sometimes hypercalcaemia and bone pain. However, with the introduction
of bisphosphonates, their use is now limited.
Basal reference ranges for some calcitonin chemiluminescent assays: Less than 8.8 pg/mL
(ng/L) in males; less than 5.8 pg/mL (ng/L) in females; less than 0.5 pg/ml (ng/L) in athyroidal
individuals
Peak calcium infusion (IMMULITE 2000 calcitonin assay): Less than or equal to 130 pg/mL in
males; less than or equal to 90 pg/mL in females

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RLE 1 Section 6
 EXCESS PARATHYROID DEFICIENCY
Calcium metabolism is affected
by three hormones. They The parathyroid glands are important in tightly controlling calcium levels in the HYPOCALCEMIA is low levels of
are parathyroid bloodstream. Because of this, calcium levels are generally very stable. This is important to calcium in the blood. In health,
hormone, vitamin ensure the nervous system and the bodys muscles can work properly, and also that bones various hormones keep the blood
D and calcitonin (which only has remain strong. calcium levels within a narrow
a minor effect). Calcium is range, but changes in the level
introduced to the body through of these hormones or reduced
Parathyroid hormone is secreted by the parathyroid glands and is the most important
the diet and is found particularly consumption of calcium in the
regulator of calcium levels in the blood and within the bones.
in dairy products. Most diets will diet can lead to the calcium level
contain a sufficient daily intake dropping too low.
of calcium. The bodys main The main target organs where parathyroid hormone exerts its effects are the bones and
calcium stores are in the bones, the kidneys. When needed, parathyroid hormone is released by the parathyroid glands into
the blood and causes the bones to release calcium and increase levels in the bloodstream. It The parathyroid glands sense
although calcium can be found
also causes the kidneys to stop calcium being lost in urine as well as stimulating the kidneys the amount of calcium in the
to some degree in most parts of
to regulate vitamin D metabolism. blood and produce increased
the body.
amounts of parathyroid
A mild rise in calcium levels will
hormone if the calcium level
generally cause very few PTH plays an active role in the intestines, resulting in the conversion of vitamin D into its
drops. This hormone helps to
symptoms or none at all. active form (PTH increases the activation of 25-hydroxy vitamin D to 1,25-dihydroxy vitamin D
reduce the loss of calcium in the
Moderate hypercalcaemia can in the kidneys), which then stimulates the intestines to absorb both calcium and phosphorus.
urine and releases some calcium
cause a number of symptoms The reference range for PTH is as follows:
from the bone if
including nausea, vomiting, Normal - 10-65 pg/mL or 10-65 ng/L
necessary. These two hormones
constipation,
combined normally maintain the
lethargy, depression, weakness,
blood calcium level within the
vague joint pains, feeling
normal range.
excessively thirsty, increased
frequency of urination,
abdominal pain and kidney Many people with hypocalcaemia
stones which might cause lower will have no symptoms at all,
back pain. especially if they have had the
Severe hypercalcaemia can condition for some time. Most
cause headaches, heart rhythm people who do have symptoms
disturbances, confusion and, will note tingling around the
ultimately, coma. mouth and pins and needles or
numbness in the hands. Muscle
stiffness and cramps commonly
Primary occur, whilst confusion,
HYPERPARATHYROIDISM is difficulties in breathing, heart
the inappropriate excess problems and locking of muscles
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RLE 1 Section 6
production and release
(secretion) of too in a fixed position (tetany) occur
much parathyroid hormone from only when the calcium level is
one or more of the very low.
four parathyroid glands.
Parathyroid hormone has two
HYPOPARATHYROIDISM is a
main actions: one is to stimulate
rare condition in which not
the breakdown of bone so the
enough parathyroid hormone is
calcium and phosphate crystals
produced by the parathyroid
which make the bones rigid are
glands resulting in low calcium
broken down along with the bone
levels in the bloodstream.
structure. This releases calcium
and phosphate into the
bloodstream. Its other action is Most commonly,
to increase calcium reabsorption hypoparathyroidism is caused by
in the kidney and to increase damage to parathyroid glands
phosphate excretion by the during neck surgery. The
kidney. By doing this, commonest non-surgical cause is
parathyroid hormone increases destruction of the parathyroid
the levels of calcium in the blood glands by the bodys immune
when calcium levels are system. In very rare cases, the
low. However, parathyroid glands are destroyed
when excess parathyroid by irradiation, usually as a result
hormone is produced, calcium of treatment of a tumour, or rare
levels stay abnormally high. diseases that attack the
parathyroid glands.
Some people are born with
hypoparathyroidism (congenital)
and sometimes the cause is
unknown (idiopathic).

EXCESS POSTERIOR PITUITARY (NEUROHYPOPHYSIS) DEFICIENCY

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RLE 1 Section 6
Syndrome of inappropriate
antidiuretic hormone
secretion (SIADH) is
characterized by excessive
release of antidiuretic
hormone from the posterior
pituitary gland or another
source. The increase in blood
volume (hypervolemia) often
results in
dilutional hyponatremia in which
the plasma sodium levels are
lowered and total body fluid is
increased. Although the sodium
level is low, SIADH is brought
about by an excess of water
rather than a deficit of sodium.
Hyperpituitarism is a condition
due to the primary
hypersecretion of pituitary
hormones, it typically results
from a pituitary adenoma.
Children with hyperpituitarism is
rare, disruption of growth
regulation, either because of
hormone hypersecretion or
because of manifestations
caused by local compression of
the adenoma can occur.
Oxytocin is released from the paraventricular
nucleus in the hypothalamus. Oxytocin is one of the few hormones that create a positive Diabetes insipidus (DI) is
feedback loop. a condition characterized
by excessive thirst and excretion
In healthy males, plasma oxytocin level in the morning after overnight fasting was 3.5 1.7 of large amounts of severely
pg/ml, which was higher during sleeping than during waking. dilute urine, with reduction of
fluid intake having no effect on
In females with normal menstrual cycle, plasma oxytocin levels in the morning after overnight the concentration of the urine.
fasting were significantly higher (4.5 2.6 pg/ml (mean SE)) in the follicular phase than
they were (2.1 1.3 pg/ml) in the luteal phase (p<0.01).
There are different types of DI,
each with a different set of
Antidiuretic hormone (ADH, also known as vasopressin), the majority of which is released
causes. The most common type
from the supraoptic nucleus in the hypothalamus. ADH acts on the collecting ducts of
in humans is the neurological
the kidney to facilitate the reabsorption of water into the blood.
form, called central DI (CDI),
ADH controls water balance and blood pressure.
which involves a deficiency of
arginine vasopressin (AVP), also
Normal values for ADH can range from 1 - 5 pg/mL
known as antidiuretic hormone
(ADH). The second common type
of DI is nephrogenic diabetes
insipidus (NDI), which is due to
kidney or nephron dysfunction
caused by an insensitivity of
the kidneys or nephrons to ADH.
Sheehan's syndrome, also
known as Simmond's
syndrome, postpartum
hypopituitarism or postpartum
pituitary gland necrosis,
is hypopituitarism (decreased
functioning of the pituitary
gland), caused
by ischemic necrosis due
to blood loss and hypovolemic
shock during and after childbirth.
Pickardt
syndrome (also Pickardt's
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 syndrome or PickardtFahlbusch
syndrome) denotes a rare form
of tertiary hypothyroidism that is
caused by interruption of
the portal
veins connecting hypothalamus
and pituitary.

Hypopituitarism is the
decreased (hypo) secretion of
one or more of the
eight hormones normally
produced by the pituitary
gland at the base of the brain.
EXCESS ADRENAL CORTEX DEFICIENCY
Cushing Syndrome Glucocorticoids (Cortisol) Addisons Disease
- Arrest of growth; central - Muscle weakness,
type of obesity with anorexia, GI symptoms,
buffalo hump in the neck fatigue, emaciation, dark
and supraclavicular pigmentation of the
areas, heavy trunk, and mucous membranes and
relatively thin the skin, hypotension,
extremities; skin is hypoglycemia, low
fragile and easily serum sodium and high
traumatized, serum potassium,
ecchymoses and striae depression, emotional
develops; (+) sleep lability, apathy,
disturbances; muscle confusion.
wasting and
osteoporosis, kyphosis, Addisonian crisis: hypotension,
backache and cyanosis, fever, nausea,
compression fractures of vomiting, signs of shock. Slight
the vertebrae; overexertion, exposure to cold,
hypertension and heart acute infection, or a decrease in
failure; (+) moon-faces, salt intake may lead to
oiliness of the skin and circulatory collapse, shock, or
acne, hyperglycemia or death.
over diabetes may
develop, (+) weight gain,

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RLE 1 Section 6
 slow healing of wounds,
bruises
Virilization appearance of
masculine traits and recession of
feminine traits: hirsutism, breast
atrophy, menses ceases, the
clitoris enlarges, voice deepens

Mineralocorticoids (Aldosterone)

Hyperaldosteronism or
Conns syndrome
Low renin levels, high blood
pressure causing poor vision or
headaches; hypokalemia causing
muscular weakness, muscles
spasm, tinging sensations,
periods of temporary paralysis;
extreme thirst and frequent
Hypoaldosteronism
urination.
- Hyperkalemia, sodium
wasting, hypotension,
Androgenital Syndrome
Androgen circulatory insufficiency
Masculinization in women,
Psuedohypoaldosteronism
feminization in men, premature
sexual development in children
Levels of aldosterone are
actually elevated but the body
fails to respond to aldosterone
stimulation therefore mimicking
hypoaldosteronism

Androgen Deficiency
- Male: reduced sexual
desire, hot flushes and
sweating,
gynaecomastia, lethargy
and fatigue, depression,
reduced muscle mass
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RLE 1 Section 6
 and strength, increased
body fat, particularly
around the abdomen,
weaker erections and
orgasms, reduced
amount of ejaculate, loss
of body hair, reduced
bone mass, therefore
increased risk of
osteoporosis.

Female: lethargy, loss of muscle

mass and strength, loss of libido,
lack of motivation, low emotional
state, lowered mood.

EXCESS HEART DEFICIENCY

- Elevated levels of ANP Atrial natriuretic peptide - ANP levels are decreased
are found during in chronc heart failure
hypervolemic states, - Synthesized, stored and released by muscle cells of the atria of the heart in response and with the use of
congestive heart failure, to increased atrial pressure, angiotension II stimulation, endothelin sympathetic medications such as urea
acute heart failure, stimulation, pregnancy, hypoxia and increased cardiac filling pressures. and prazosin.
paroxysmal atrial
tachycardia, - Reduces plasma volume by at least 3 mechanisms: increase renal excretion of sodium
subarachnoid and water, vasodilation and increased vascular permeability Plasma hormone levels also are
hemorrhage and small decreased in hypothyroidism and
cell lung cancer. growth hormone secretion.

Plasma hormone levels also are

increased in hypercortisolism,
hyperaldosteronism,
thyrotoxicosis and vasopressin

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RLE 1 Section 6
and inappropriate antidiuretic
hormone secretion.

EXCESS ADIPOSE TISSUE DEFICIENCY

Obese people have Leptin
Leptin Receptor Deficiency
unusually high levels of - Synthesized mainly by adipocytes of the white adipose tissue and the synthesized
amount correlate the quantity of the adipose tissue in the body. - a condition that causes
leptin. This is because in - Leptin extensively regulates the energy intake and expenditure by its influence over severe obesity beginning in the
some obese people, the feeding behavior, appetite, hunger and energy metabolism. first few months of life. Affected
brain does not respond to - It passes through the hepatoencephalitic barrier and has an anorexigenic effect on individuals are of normal weight
leptin, so they keep eating hypothalamus, suppressing appetite and increasing the energy expenditure. at birth, but they are constantly
hungry and quickly gain weight.
despite adequate (or
The extreme hunger leads to
excessive) fat stores, a chronic excessive eating
concept known as leptin (hyperphagia) and obesity.
resistance. Beginning in early childhood,
affected individuals develop
abnormal eating behaviors such
as fighting with other children
over food, hoarding food, and
eating in secret.
- People with leptin
receptor deficiency also have
hypogonadotropic
hypogonadism, which is a
condition caused by reduced
production of hormones that
direct sexual development.
Affected individuals experience
delayed puberty or do not go
through puberty, and they may
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 be unable to conceive children
(infertile).

Adiponectin
Adiponectin deficiency
- It influences the metabolism of sscarides and lipids, increasing the sensitivity of
tissues to insulin. - predisposes toward
- Its effects leads to an increased transport and utilization of glucose and free fatty metabolic syndrome,
acids in muscles, liver and adipose cells. characterized by obesity, insulin
- Marked weigt loss - Inhibits glucogenesis in liver. resistance, impaired glucose
causes increase in tolerance, hyperlipidemia, and
adiponectine - Adiponectin appears to promote an insulin-sensitizing effect cardiovascular morbidity.
- -Prevents - Obese people have lower
- increasing the availability of adiponectin might reverse insulin resistance and thereby
development of decrease the risk of diabetes. blood levels of adiponectin than
atherosclerosis especially normal weight individuals.
at early stages of its - Low adiponectin levels
formation. are more strongly associated
- Decrease the risk of with the amount of visceral fat
than subcutaneous fa
obesity- related diseases
- Increasing evidence
indicates that resistin plays
important regulatory roles apart
from its role in insulin resistance
Resistin
and diabetes in a variety of
- It is formed by cells of the immune system
biological processes:
- Reduces the glucose tolerance and insulin sensitivity.
atherosclerosis and
- implicated in the pathogenesis of obesity-mediated insulin resistance and T2DM (Type
cardiovascular disease (CVD),
II diabetes mellitus)
non-alcoholic fatty liver disease,
autoimmune disease,
malignancy, asthma,
inflammatory bowel disease and
chronic kidney disease.

- Evidence suggests that

- enhances insulin resistin is involved in
sensitivity and strongly pathological processes leading to
improves glucose- CVD including inflammation,
endothelial dysfunction,
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stimulated insulin
secretion by stimulating thrombosis, angiogenesis and
Akt phosphorylation smooth muscle cell dysfunction.
without altering IRS2
phosphorylation.
- Decreases the risk
for DM type 2 and other
obesity related disease.

EXCESS KIDNEYS DEFICIENCY

polycythemia vera Erythropoietin * caused by Chronic Kidney
persistent leukocytosis, glycoprotein Disease
persistent thrombocytosis, Stimuli such as bleeding or moving to high altitudes (where oxygen is scarcer) trigger the
unusual thrombosis, release of erythropoietin. Anemia, rheumatoid arthritis,
splenomegaly, and It is produced by the peritubular capillary endothelial cells in response to hypoxia. AIDS, cancer, ulcerative colitis,
erythromelalgia It acts on the bone marrow to increase the production of red blood cells. sickle cell disease, and in
premature neonates
Iron-deficiency anemia. Calcitriol
Anemia due to 1, 25 dihydroxicholecalciferol; the active form of vitamin D Anemia due to chronic
thalassemia. Stimulates the small intestine for protein synthesis allowing absorption of Ca2+ and kidney disease or other
Hemolytic anemia. phosphates. chronic diseases
Anemia due to bone This ensures the availability of Ca2+ and phosphate for bone growth. (eg,rheumatoid
marrow suppression. Simultaneously activates osteoblasts to synthesize collagen. arthritis, HIV infection)
Secondary polycythemia is an enzyme, which catalyzes the conversion of plasmatic angiotensinogen to angiotensin I Polycythemia vera
Pregnancy After transfusion
Testosterone therapy Renin Estrogen therapy
a protein and proteolytic enzyme
Dehydration. primary function is to eventually cause an increase in blood pressure, leading to restoration
Vomiting. of perfusion pressure in the kidneys.
Decreased appetite. affects blood pressure indirectly and is part of the first stage of the renin-angiotensin-
Irritability. aldosterone-system.
Constipation. Renin secretion is also stimulated by sympathetic nervous stimulation, mainly through beta-
Fatigue. 1 adrenoceptor activation. Osteomalacia, Ricketts,
Muscle weakness.
Metastatic calcification
of the soft tissues.

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RLE 1 Section 6
 Adrenal glands that do
not make enough
hormones (Addison
diseaseor other adrenal
gland insufficiency)
Bleeding (hemorrhage)
Heart failure.
High blood pressure
caused by narrowing of
the kidney arteries
(renovascular
hypertension)
Liver scarring and poor aldosteronism
liver function (cirrhosis)
EXCESS ADRENAL MEDULLA DEFICIENCY
Increase in epinephrine Epinephrine, more commonly known as adrenaline, is a hormone secreted by the
Suffering from too little
stimulates the heart, raises medulla of the adrenal glands. Strong emotions such as fear or anger cause
adrenaline is very unusual.
blood pressure, constricts small epinephrine to be released into the bloodstream, which causes an increase in heart
Among other things, it would
blood vessels, releases sugar rate, muscle strength, blood pressure, and sugar metabolism. This reaction, known
result in an inability to prepare
stored in the liver, and relaxes as the Flight or Fight Response prepares the body for strenuous activity. In
the body for action in response
certain involuntary muscles medicine epinephrine is used chiefly as a stimulant in cardiac arrest, as a
to a stressful or physically
while it contracts others. These vasoconstrictor in shock, and as a bronchodilator and antispasmodic in bronchial
demanding situation.
changes in the body prepare it asthma. Epinephrine is found in small amounts in the body and is essential for
for "fight or flight," meaning the maintaining cardiovascular homeostasis because of its ability to divert blood to
body is more alert, physically tissues under stress.
stronger, and has greater
energy. The person is now better
prepared to face the danger at
hand (fight) or escape from the
danger or stress (flight).

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 Low energy, depression, fatigue,
little interest in life, fibromyalgia,
chronic fatigue syndrome
Overproduction of adrenaline is
rare. Too much adrenaline can be Norepinephrine, also called noradrenaline, substance that is released
caused by a variety of things, predominantly from the ends of sympathetic nerve fibres and that acts to increase
including a rare tumour of the the force of skeletal muscle contraction and the rate and force of contraction of the
adrenal medulla (a heart. The actions of norepinephrine are vital to the fight-or-flight response,
phaeochromocytoma). whereby the body prepares to react to or retreat from an acute threat
Symptoms may include rapid
heartbeat, high blood pressure,
anxiety, weight loss, excessive
sweating and palpitations.
Anxious hyper-alert, paranoid,
loss of appetite, insomnia, panic
attack ADHD and eating
disorders.

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EXCESS OVARIES & PLACENTA DEFICIENCY

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Common cause: too much
estrogen levels, prolonged use of
medication such as estrogen
replacement therapy, low
progesterone levels
May lead to the following
problems:
Weight gain
Menstrual problems such
as light or heavy bleeding
Worsening or
premenstrual syndrome
Fibrocystic breasts (non-
cancerous breast lumps)
Fibroids (non-cancerous
tumors) in uterus
Fatigue
Loss of libido
Feeling depressed or
anxious
Difficulty with memory
Trouble sleeping
Estrogen Common cause: menopause,
Responsible for female physical features and reproduction surgical removal of ovaries
Responsible for changes such as growth of breasts, pubic hair, underarm hair
Helps control menstrual cycles and is important in childbearing
Keeps cholesterol in control Signs and Symptoms:
Protects bone health Menstrual periods that are
Affects brain (including mood), bones, heart, skin, and other tissues less frequent or that stop
3 main types: Hot flashes or night sweats
Estradiol most common type in women of childbearing age Trouble sleeping
Estriol main estrogen during pregnancy Dryness and thinning of
Estrone only estrogen the body makes after menopause vagina
Low sexual desire
Mood swings
Dry skin
Some women get menstrual
migraine bad headache
before their menstrual
period

Conditions related to high

estrogen:
For example, elevated estrogen
levels are a risk factor for breast
cancer.
High levels over a long period of
time could also cause
endometrial cancer.

Common cause:
Multiple pregnancy, use of birth

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control pills, prolonged use of
hormonal replacement therapy
Progesterone Common cause: stress,
High progesterone levels are prepares the endometrium for the potential of pregnancy after ovulation xenohormones, synthetic
associated with congenital triggers the lining to thicken to accept a fertilized egg. progestin
adrenal hyperplasia, molar prohibits the muscle contractions in the uterus that would cause the body to reject an
egg. abnormal menstrual cycles or
pregnancies, luteal ovarian cysts
While the body is producing high levels of progesterone, the body will not ovulate. may struggle to conceive
and in certain ovarian cancers.
prepares the breasts for milk production. because the progesterone does
not trigger the proper
Sign and Symptoms:
environment for a conceived egg
Moodiness to grow.
Irritably At higher risk for miscarriage or
breast tenderness pre-term delivery because the
muscle ache hormone helps maintain the
Vaginal dryness pregnancy.
Feeling depressed
Bloatedness Signs and Symptoms:
Loss of libido Abnormal uterine bleeding
Irregular or missed periods
Spotting and abdominal pain
during pregnancy
Frequent miscarriages
Headache
Hot flashes
Mood changes

In addition, low progesterone

levels can cause too-high levels
of estrogen, which can decrease
sex drive, contribute to weight
gain, or cause gallbladder
problems.

At higher risk for miscarriage or

pre-term delivery because the
Increases the risk of developing hormone helps maintain the
breast cancer pregnancy.

Signs and Symptoms:

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Sign and Symptoms: Abnormal uterine bleeding
Moodiness Irregular or missed periods
Irritably Spotting and abdominal pain
breast tenderness during pregnancy
muscle ache Frequent miscarriages
Vaginal dryness Progestin Headache
Feeling depressed support of the endometrium to provide an environment conducive to fetal survival Hot flashes
Bloatedness suppression of contractility in uterine smooth muscle Mood changes
Loss of libido Potently inhibit secretion of the pituitary gonadotropins luteinizing hormone and follicle
stimulating hormone. This effect almost always prevents ovulation from occurring during
pregnancy.

elevated estrogen levels are a

risk factor for breast cancer.
High levels over a long period of
time could also cause
endometrial cancer.
Estrogen (estriol)
Stimulate growth of the myometrium and antagonize the myometrial-suppressing activity
of progesterone
presentations of low estrogen
Stimulate mammary gland development
levels include hot flashes,
headaches, lowered libido, and
breast atrophy. Reduced bone
density leading to secondary
osteoporosis and atrophic
changes such as pH change in
A high hCG level can indicate: the vagina.

Miscalculation of pregnancy major risk factors for developing

dating uncomplicated urinary tract
Molar pregnancy infections
Multiple pregnancy Protein Hormones:
Human chorionic gonadotropin
helps a womans eggs to mature and be released from the ovaries A low hCG level can indicate:
binds to the luteinizing hormone receptor on cells of the corpus luteum, which prevents
luteal regression Miscalculation of pregnancy
produced during pregnancy, serves as the signal for maternal recognition of pregnancy dating
Prevents infertility and help nourish growing fetus Possible miscarriage or

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Common causes:
Multiple pregnancies (twins or
more)
Placental site trophoblastic
tumor
Intact molar pregnancy
Diabetes
Rh incompatibility
High levels of circulating relaxin
are associated with premature
birth, presumably via its effects
on the rupture of the foetal
membranes and the opening of
the cervix.
This is likely due to the effects
of relaxin at the level of the
cervix, via upsetting the balance
in the maintenance of cervical
connective tissue architecture.
blighted ovum
Ectopic pregnancy
Human placental lactogen
regulates and coordinates fetal growth and metabolism and maternal metabolism
stimulate human milk production
breaks down fats from the mother to provide fuel for the the growing baby. It can lead to Common causes:
insulin resistance and carbohydrate intolerance in the mother. Toxemia
Aborting hydatidiform mole
Choriocarcinoma
Placental insufficiency
Relaxin
acts synergistically with progesterone to maintain pregnancy.
causes relaxation of pelvic ligaments at the end of gestation and may therefore aid in
parturation. Low levels of relaxin will lead to
In some of the species in which relaxin is known to be produced, it is produced by the tension and stiffening of
placenta, while in others, the major source is the corpus luteum. muscles. It disrupts connective
tissue function.
It can cause fibromyalgia and
myofascial pain during
pregnancy.
May contribute to scleroderma,
where the skin thickens and
hardens. This is caused by the
development of fibrosis and
scarring on the skin, which also
occurs in the lung, stomach and
blood vessels.
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 .

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 EXCESS TESTES DEFICIENCY
Common causes: Testosterone Common causes:
Excessive use of testosterone main sex hormone in men injury, infection, or loss of the
hormone replacement therapy controls male physical features testicles, chemotherapy or
responsible for the growth of the penis and testes, growth of facial, pubic, and body radiation treatment for cancer,
May be associated with hair, deepening of the voice, building muscles and strong bones, and getting taller dysfunction of the pituitary gland
hyperthyroidism, adrenal or or hypothalamus, prolonged use
of medications especially
testicular tumor, or precocious
hormonal replacement therapy
puberty, congenital andrenal
hyperplasia
May be associated with
Klinefelter's Syndrome,
Signs and Symptoms: hemochromatosis,
Acne or oily skin inflammatory diseases such as
Prostate swelling sarcoidosis, chronic kidney
Breast enlargement failure, cirrhosis of the liver
Worsening of sleep stress, alcoholism, obesity
apnea (trouble breathing while
sleeping) Signs and Symptoms:
Fluid retention a drop in libido
Decreased testicle size erectile dysfunction
Decrease in sperm count low sperm count
Increase in red blood enlarged or tender
cells breasts
decreased muscle and
bone strength, less energy, and
lower fertility.
Too much testosterone might
decreased sense of well
lead to high levels of estrogen being
and cause mood swings, water
retention, high blood pressure, low testosterone levels may lead
breast sensitivity or even to decrease in muscle mass, with
growth, and hair loss an increase in body fat, changes
in cholesterol levels, decrease in
hemoglobin and possibly mild
anemia, fragile bones
(osteoporosis), decrease in body
hair, changes in cholesterol and
lipid levels

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EXCESS PANCREATIC ISLET DEFICIENCY

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Hyperinsulinemia or excessive Insulin Diabetes Mellitus
insulin secretion is most It is a key player in the control of intermediary metabolism and it also organizes the use of This is a chronic disorder of
commonly a consequence of fuels for either storage or oxidation. Through these activities, insulin has profound effects on carbohydrate, fat, and protein
insulin resistance, associated both carbohydrate and lipid metabolism, and significant influences on protein and mineral metabolism. It is due to
with type 2 diabetes or the metabolism. Consequently, derangements in insulin signalling have widespread and inadequate insulin production or
metabolic syndrome. More devastating effects on many organs and tissues. increased resistance to insulin.
rarely, hyperinsulinemia results The cause is unknown and the
from an insulin-secreting tumor predisposing factors are as
(insulinoma) in the pancreas. follows:
Stress
Hyperinsulinemia due to Heredity
accidental or deliberate injection Viral infections
of excessive insulin is dangerous Autoimmune disorders
and can be acutely life- Women who are
threatening because blood levels multigravida with large
of glucose drop rapidly and the babies
brain becomes starved for Complications:
energy (insulin shock). Diabetic Retinopathy
Diabetic Nephropathy
Diabetic Neuropathy
There are 2 types of Diabetes
Mellitus:
1. Type 1 Diabetes Mellitus
- also called Insulin Dependent
Mellitus (IDDM), juvenile-onset,
brittle or unstable DM
- onset is before 30 years of age
- the client appears thin due to
inability of the body to obtain
glucose from carbohydrates
therefore, the body breaks down
fats and protein for glucose
supply
- the client is prone to diabetic
ketoacidosis (DKA)
2. Type II Diabetes Mellitus
- also called Non-Insulin
Dependent Diabetes Mellitus
(NIDDM), maturity onset, ketosis-
resistant DM
- onset is after age 30 years
- with relative lack of insulin or
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 resistance to the action of
insulin; usually insulin is
sufficient to stabilize fat and
protein metabolism but not to
deal with carbohydrate
metabolism
- the client appears obese
- the client is prone to
hyperglycemic, hyperosmolar,
non-ketotic coma (HHNC) this
is extreme hyperglycemia
without acidosis that may also
result in dehydration and
vascular collapse

Hyperglycemia
- this is the technical term for
high blood glucose
- this is characterized by an
abnormally high blood glucose
level, usually more than 120
mg/dl
- this happens when the body
has too little insulin or when the
body can't use insulin properly
Signs & Symptoms:
High blood glucose
High levels of sugar in the
urine
Frequent urination
Increased thirst
Hyperglycemia
This is the technical term for
high blood glucose (blood sugar).
High blood glucose happens
when the body has too little
insulin or when the body can't
use insulin properly.
Signs & Symptoms:
Glucagon - High blood glucose
It has a major role in maintaining normal concentrations of glucose in blood, and is often - High levels of sugar in
described as having the opposite effect of insulin. That is, glucagon has the effect of the urine
increasing blood glucose levels. - Frequent urination
- Increased thirst
Hypoglycemia
- is a condition characterized by
abnormally low blood glucose
(blood sugar) levels, usually less
than 70 mg/dl
- may also be referred to as an
insulin reaction, or insulin shock
Signs & Symptoms:
Shakiness
Nervousness or anxiety
Sweating, chills and
clamminess
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 Irritability or impatience
Confusion, including
delirium
Rapid/fast heartbeat
Lightheadedness or
dizziness
Hunger and nausea
Sleepiness
Blurred/impaired vision
Tingling or numbness in
the lips or tongue
Headaches
Weakness or fatigue
Anger, stubbornness, or
Somatostasin sadness
Excessive somatastatin levels It can also be known as growth hormone-inhibiting horomonw (GHIH) or somatotropin release- Lack of coordination
in the bloodstream may be inhibiting factor (SRIF) or somatotropin release-inhibiting hormone. It was first discovered in
Nightmares or crying out
caused by a rare endocrine hypothalamic extracts and identified as a hormone that inhibited secretion of growth hormone.
during sleep
tumor that produces Subsequently, somatostatin was found to be secreted by a broad range of tissues, including
pancreas, intestinal tract and regions of the central nervous system outside the Seizures
somatostatin, called
hypothalamus. Its function relating to Pancreas is to inhibit secretion of pancreatic hormones Unconsciousness
somatostatinoma.
Too much somatostatin in the such as insulin and glucagon.
blood results in the extreme
Excessive secretion of growth
reduction in secretion of
many endocrine hormones. hormone and TSH.
Cushings syndrome
An example of this
(hypercortisolism)
suppression of insulin
- If the pituitary gland secretes
secretion from the pancreas
too much ACTH, the adrenal
leading to raised blood
glands may release too much
glucose levels and eventually
cortisol. Cortisol regulates the
Diabetes Mellitus.
metabolism of proteins, fats and
As stomastatin inhibits many carbohydrates. It is also
function of the involved in the bodys
gastrointestinal tract, its inflammatory and immune
overproduction may also responses. Symptoms of
result in the formation of Cushings disease may include
gallstones, intolerance to fat accumulation of fat in the upper
in the diet and diarrhea. body, excessive facial hair in
women, pink or purplish stretch
Hypoglycemia marks on the abdomen, and a
Diabetes Mellitus (Type I or tendency to bruise easily. The
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II) bones may become fragile and
tend to break more easily.
Acromegaly
-Secretion of excessive amounts
of growth hormone (GH) in
adults may cause the hands and
feet to grow. It may also cause
the facial structure to change
the jaw and brow may stick out
and the nose, tongue and lips
may get bigger. The skin may
become thick, coarse, and oily. It
can cause irregular periods in
women and erectile dysfunction
in men. Other symptoms may
include sleep and visual
problems, headaches, fatigue
and weakness. Acromegaly can
also raise the risk for high blood
pressure, diabetes mellitus,
heart attack, and certain types
of cancer. In children and
adolescents, excessive levels of
growth hormone can result in a
condition called gigantism.
Children with this condition may
have unusually long arms and
legs and may grow to heights of
7 to 8 feet or more.
Prolactinoma
-A tumor on the pituitary known
as a prolactinoma may cause
the gland to secrete too much
prolactin. High levels of prolactin
can disrupt normal reproductive
functions in men and women by
interfering with hormones
produced by the testes and
ovaries. A prolactinoma can
cause women who are not
pregnant or nursing to
experience tenderness of the
breasts and start to produce
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 breast milk (galactorrhea). Their
menstrual periods may become
irregular or might stop
altogether. Women may become
infertile or lose interest in
having sex. Having intercourse
may be painful due to vaginal
dryness.
For men, the most common
symptom of prolactinoma is
erectile dysfunction. Men also
may experience a decrease in or
loss of sex drive, lower fertility,
or loss of energy. In rare cases,
men may secrete milk from their
breasts. In rare cases, when the
prolactinoma is large, blindness
or difficulty seeing can occur.

Hyperthyroidism
-If the pituitary adenoma causes
overproduction of thyroid
stimulating hormone (TSH), the
thyroid gland will become
hyperactive. Symptoms may
include nervousness, a rapid or
irregular heartbeat, weight loss
and fatigue or muscular
weakness.

Hyperglycemia
Hyperinsulinemia

EXCESS ANTERIOR PITUITARY DEFICIENCY

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 Growth Hormone Growth hormone deficiency is
caused by low or absent
In cases of acromegaly, the
secretion of growth hormone
excess growth hormone is from the pituitary gland. This can
produced by a tumor of the be caused by congenital (a
pituitary gland called adenoma. condition that is present at birth)
Secretion of growth hormone by or acquired (a condition that
occurs after birth) conditions.
a pituitary tumor is not
Congenital growth hormone
controlled by the feedback loop. deficiency may be associated
The end result is an excess of with an abnormal pituitary gland,
IGF-1, which causes abnormal or it may be part of another
tissue growth. Too much IGF-1 syndrome. In normal aging, there
is a decrease in the amount of
causes the bone growth that
growth hormone secreted each
leads to changes in physical day and in the pattern of
appearance and function. It secretion. It is not clear if this is
causes thickening of soft tissues clinically important or requires
such as skin, tongue, and any additional administration.
Acquired causes of growth
muscles. Enlargement of the
hormone deficiency include
tongue can lead to breathing infections; brain tumors; and
problems and sleep apnea. injury, surgery, or radiation to
Overgrowth of muscles can the head.
entrap nerves, causing pain
syndromes such as carpal
tunnel syndrome. Excess IGF-1
causes enlargement of organs
such as the heart, which can
result in heart failure and
rhythm disorders. Excess
growth hormone changes the
way the body processes sugar
and fats. This can
cause diabetes and high levels
of fats such as triglycerides in
the blood. This in turn can lead

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 Adrenocorticotropic hormone
to atherosclerosis and heart
disease Cushing's syndrome related to
an adrenal tumour. Cushing's
The effects of too much syndrome due to steroid
adrenocorticotropic hormone are medication
mainly due to the increase in Conditions affecting the pituitary
cortisol levels which result. gland, eg, hypopituitarism. Side-
Higher than normal levels of effect of pituitary surgery or
adrenocorticotropic hormone radiation therapy. Too little
may be due to: adrenocorticotropic hormone
could lead to a poorly
Cushing's disease this is the functioning adrenal gland or
most common cause of even Addisons disease, due to
increased adrenocorticotropic insufficient production of
hormone. It is caused by a non- cortisol. Symptoms may include
cancerous tumour called fatigue, dizziness (especially
an adenoma located in the upon standing), weight loss,
pituitary gland which produces muscle weakness, mood
excess amounts of changes and darkened areas of
adrenocorticotropic hormone. skin.
(Please note, Cushings disease
is just one of the numerous
causes of Cushings syndrome).
A tumour, outside the pituitary
gland, producing
adrenocorticotropic hormone
(also called ectopic
adrenocorticotropic hormone
tumour).
Addison's disease (although
cortisol levels are low,
adrenocorticotropic hormone
levels are raised). Thyroid- stimulating hormone
Congenital adrenal
hyperplasia (a genetic disorder
with inadequate production of
cortisol, aldosterone or both).

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If a person has too much, this
may indicate that their thyroid
gland is not making enough
thyroid hormone, ie, they have If a person has too little thyroid
an underactive thyroid gland or stimulating hormone, it is most
hypothyroidism. People with an likely that their thyroid gland is
underactive thyroid often feel making too much thyroid
lethargic, experience weight gain hormone, ie, they have an
and feel the cold. Their thyroid overactive thyroid or
gland may enlarge to produce hyperthyroidism, which is
goitre. suppressing the thyroid
stimulating hormone. People
Follicle- stimulating hormone with an overactive thyroid have
the opposite symptoms to those
with hypothyroidism, ie, they
lose weight (despite increasing
the amount they eat), feel too
In women, follicle stimulating
hot and can experience
hormone levels also start to rise
palpitations or anxiety. They may
naturally in women around the
also have a slightly enlarged
menopausal period, reflecting a
thyroid gland.
reduction in function of the
ovaries and decline of oestrogen
and progesterone production. In women, a lack of follicle
There are very rare pituitary stimulating hormone leads to
incomplete development at
conditions that can raise the
puberty and poor ovarian
levels of follicle stimulating function (primary ovarian
hormone in the bloodstream. failure). In this situation ovarian
This overwhelms the normal follicles do not grow properly and
negative feedback loop and can do not release an egg, thus
cause ovarian leading to infertility. Since levels
hyperstimulation syndrome of follicle stimulating hormone in
in women. Symptoms of this the bloodstream are low, this
include enlarging of the ovaries condition is called
and a potentially dangerous hypogonadotrophic-
accumulation of fluid in the hypogonadism. Sufficient follicle
abdomen (triggered by the rise stimulating hormone action is
in ovarian steroid output), which also needed for proper sperm
production. In the case of
leads to pain in the pelvic area.
complete absence of follicle

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 stimulating hormone in men,
Luteinizing hormone lack of puberty and infertility due
to lack of sperm (azoospermia)
can occur. Partial follicle
stimulating hormone deficiency
in men can cause delayed
puberty and limited sperm
production (oligozoospermia),
but fathering a child may still be
possible. If the loss of follicle
stimulating hormone occurs after
Too much luteinising hormone puberty, there will be a similar
can be an indication of infertility. loss of fertility.
Since the secretion of luteinising
hormone is tightly controlled by
the hypothalamic-pituitary- Too little luteinising hormone will
gonadal axis, high levels of also result in infertility in both
luteinising hormone in the men and women, as a critical
bloodstream can indicate level of luteinising hormone is
decreased sex steroid production required to support testicular or
from the testes or ovaries (eg, as ovarian function. In men, an
in premature ovarian failure). example of a condition where
Polycystic ovary syndrome is a low levels of luteinising hormone
common condition in women are found is Kallmanns
associated with high levels of syndrome, which is associated
luteinising hormone and reduced with a deficiency in
fertility. In this condition, an gonadotrophin-releasing
imbalance between luteinising hormone secretion from the
hormone and follicle stimulating hypothalamus. In women, a lack
hormone can stimulate of luteinising hormone means
inappropriate production of that ovulation does not occur. An
testosterone. Genetic conditions, example of a condition which
such as Klinefelters syndrome can be caused by too little
and Turner syndrome, can also luteinising hormone
result in high luteinising is amenorrhoea.
hormone levels. Klinefelters
syndrome is a male-only disorder
and results from carrying an
extra X chromosome (so that
men have XXY, rather than XY

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chromosomes). As a result of
this, the testes are small and do
not secrete adequate levels of
testosterone to support sperm
production. Turner syndrome is a
female-only disorder caused by a
partial or full deletion of an X
chromosome (so that women
have XO, rather than XX). In
affected patients, ovarian
function is impaired and
therefore luteinising hormone
production increases to stimulate
ovarian function.

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