1. The Endocrine System 2. Endocrine Disorders Disease states that result from excess or insufficiency of hormone Clinical challenge is determination of the origin of excess or insufficiency, i.e., Hypothalamus (tertiary), Pituitary (secondary) or target gland (primary) 3. Endocrine Disorders (Other than diabetes) Thyroid Adrenal Parathyroid Pituitary gland Gonadal Gout (uric acid) 4. Hypothalamus ACTH = adrenocorticotropic hormone LH = lutenizing hormone FSH = follicle-stimulating hormone AVP = arginine vasopressin CRH = corticotropin-releasing hormone GHRH = growth hormone-releasing hormone GnRH = gonadotropin-releasing hormone GH = growth hormone TSH = thyroid-stimulating hormone PRL = prolactin SRIF = somatotropin releaseinhibiting factor (somatostatin) TRH = thyrotropin-releasing hormone; VIP = vasoactive intestinal polypeptide. DA = dopamine Goldman: Cecil Medicine, 23rd ed. 2007 5. Hormone Target Gland Growth hormone (GH) Multiple Prolactin (PRL) Breast Adrenocorticotropic hormone (ACTH) Adrenal Thyroid-stimulating hormone (TSH) Thyroid Luteinizing hormone (LH) Gonad Follicle-stimulating hormone (FSH) Gonad Anterior Pituitary Hormones 6. Anterior Pituitary Hormones TSH, ACTH, FSH, and LH hormones are tropic hormones that simulate other endocrine glands TSH-Thyroid ACTH- Adrenal Cortex FSH, LH- Gonads 7. Posterior Pituitary Hormones Vasopressin(ADH)- kidney, baroreceptors (plasma osmolality, water retention, thirst) Oxytocin- breast, uterus (no known function in males) Both are synthesized in specialized neurons in the hypothalamus (neurohypophyseal neurons) 8. Too big, Too tall or Too short Prof. Tariq Waseem 9. CASE SCENARIO 1 A 50 yr old male presented in OPD with C/O off & on headache, poor concentration and fatigue. He has gained weight, he sweats a lot. He also has difficulty in churning the food bolus in mouth and food particles are stuck in his unusually widened teeth spaces. His skin has coarsened and has developed multiple skin tags. His friends report that he has a heavy, doughy and sweaty handshake and often does not notice people sitting on either sides of his desk. 10. O/E BP 160/100. Displaced cardiac apex in 6th i.c. space. Hepatosplenomegaly. BSR 240mg/dl Glycosuria ++ 11. What is the diagnosis? What is the best test to diagnose this condition? List three further investigations to confirm the diagnosis. 12. GROWTH HORMONE Single chain 191 amino acid anabolic polypeptide synthesized by somatotropic cells of anterior pituitary gland. Fasting serum values