ENDOCRINE GLANDS

PITUITARY GLAND HYPOTHALAMUS

TESTES
OVARIES THYROID ADRENAL GLANDS PARATHYROID PANCREAS

HYPOTHALAMUS

PITUITARY GLAND
Anterior Growth hormone-stimulates growth of bone and muscle ACTHFSH-(female)-stimulates growth of ovarian follicle, ovulation (male)-stimulates sperm production LH-(female)-production of estrogen and progesterone (male)-secretion of testosterone Posterior ADH-increases water reabsorption in the kidney OXYTOCIN-contration of uterus and milk ejection

PITUITARY GLAND

Elevated fasting
growth hormone
Statural growth is impaired Height age is more retarded than bone age
rhGH treatment: CHILDREN:: rise in growth velocity and an increase in body weight and midarm muscle circumference ADULT: affect protein metabolism and bone

decreased degradation Increased secretion

Delayed bone age and sexual maturation are beneficial for statural growth is prolonged. To induce growth include adequate dialysis, inc nutritional intake, correction of metabolic acidosis and administration of rhGH.

No adverse effect on glucose tolerance or creatinine clearance The accelerated growth does not hasten bone age maturation thus preserving growth potential

THYROID
T3-triiodothyronine- increase the metabolic rate, increase protein and bone turnover, increase responsiveness to catecholamines; necessary for fetal and infant growth and development T4-thyroxineCalcitonin-lowers blood calcium and phosphate levels

THYROID

Free and total T3 and T4 concentrations are usually normal or low Reduction in T3 concentration is due to decrease in the peripheral synthesis of T3 to T4

Free T3 reduced during acidosis and associated with elevated markers of inflammation
Free T4 may be high due to the effect of heparin used in anticoagulation during hemodialysis , which inhibits T4 binding to its binding proteins increased thyroid volume higher prevalence of goiter, mainly in women Also, thyroid nodules and thyroid carcinoma are more common

KIDNEY
1,25-hydroxyl vitaminD3-stimulates calcium absorption from the intestine Renin- activates RAAS Erythropoietin increases RBC production

KIDNEY

Low 25 hydroxyl D3 levels

Depressed plasma concentration of 1, 25(OH)2D3

Dietary restriction

Lack of sun exposure

Reduced hydroxylation of the kidney

Intrinsic renal damage or hyperphosphatemia

Decreased interstitial calcium and phosphorus absorption

Reduced skeletal sensitivity to PTH and inhibition and synthesis and release of pre-pro PTH in response to calcium receptor protein stimulation

ADRENAL GLANDS

Adrenal medulla

Adrenal cortex

Elevated circulating catecholamine's

Plasma cortisol halflife is prolonged .

Plasma cortisol increases with ACTH stimulation

ADRENAL GLAND
Medulla Epinephrine neurotransmitter for the systematic nervous system Nor-epinephrine Cortex Aldosterone-increases sodium absorption, potassium losss by the kidney Cortisol-metabolism of nutrients, regulates blood glucose levels, affects growth and and decreases effects of stress

PANCREAS
Insulin lowers blood gucose by facilitating glucose transport across cell membranes of muscle, liver and adipose tissue Glucagon- increases blood gucose concentration by stiimulation of glycogenesis and glyconeogenesis Somatostatin delays intestinal absorption of glucose

PANCREAS

Impaired renal metabolism of peptide hormones results in altered clearance kinetics of insulin, glucagon and adipokines. These changes in peripheral metabolism are associated with peripheral hormone resistance and excessive circulating free fatty acids and triglycerides and a normal fasting blood glucose because of elevated plasma insulin levels. Hyperinsulimea stimulates very low density lipoprotein synthesis and insulin resistance impairs lipoprotein lipase activity and increase serum triglycerides.

PARATHYROID REGULATES SERUM CALCIUM Hyper parathyroidism

Vitamin D deficiency Reduction in serum ionized calcium Elevation in serum phosphorus value

Hypocalcemia
Osteitis firbosa cystica Extra skeletal manifestation of disordered calcium/phosphorus metabolism

Phosphate retention and hyperphosphatemia

Reduced intestinal calcium absorption Skeletal resistance to PTH
Calcium deposition in the media of various arteries Perathritis and myopathy pruritus Anemia and bone marrow fibrosis

SEX HORMONE
Testes Androgendevelopment of male sex organ and secondary sex characteristics Ovaries estrogendevelopment of female sex organ and secondary sex characteristics progesterone influences menstrual cycle; stimulates growth of uterine wall; maintains preganancy

SEX HORMONE

Testes Decreased libido seminal fluid volume is small and both sperm numbers and motility are decreased Impotence infertility serum testosterone levels are reduced---decreased leydig cell testosterone production Decreased libido

Ovaries

Menstruation (amenorrhea, menorrhea, metromenorrhagia) Infertility

plasma estradiol levels are normal, suggesting relatively intact ovarian function