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 gland Antidiuretic hormone Causes kidneys to retain water and,
(vasopressin) 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-stimulating including the production of sperm and
hormone 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 secretion
hormone of hormones by the thyroid gland
Parathyroid Parathyroid hormone Controls bone formation and the
glands excretion of calcium and phosphorus
Thyroid gland Thyroid hormone Regulates the rate at which the body
functions (metabolic rate)
Calcitonin In people, function is unclear; in other
species, regulates calcium balance
Adrenal glands Aldosterone Helps regulate salt and water 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
DehydroepiandrosteroneHas effects on bone, mood, and the
(DHEA) 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 tract Cholecystokinin Controls gallbladder 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 muscle
tissue
Leptin Controls appetite
Placenta Chorionic gonadotropin Stimulates ovaries to continue to release
progesterone during early pregnancy
Estrogen and Keep uterus receptive to fetus and
progesterone 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.

What Is Diabetes Insipidus?

by Gary L. Robertson, M.D., Northwestern University, Chicago, Illinois, USA
*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
 – A serum osmolarity lower than the urine osmolarity indicates the
inappropriate excretion of concentrated urine in the presence of very
dilute serum

– Dilutional hyponatraemia is indicated by serum sodium < 134mEq/l,

serum osmolarity less than 280mOsm/kg & specific gravity > 1.005

– other Labs include decreased BUN, creatinine

Causes

• The causes of SIADH are as follows:

• Increased hypothalamic production

– Infections - Meningitis, encephalitis, abscess

– Vascular - Thrombosis, subarachnoid or subdural hemorrhage

– Neoplasm

– Other - HIV, Guillain-Barré syndrome, acute intermittent porphyria,

autonomic neuropathy, post–pituitary surgery, multiple sclerosis,
psychosis

– Drugs

• Chemotherapeutic - Cyclophosphamide, vincristine, vinblastine

• Antipsychotic - Thiothixene, thioridazine, haloperidol

• Antidepressants - Monoamine oxidase inhibitors, tricyclic

antidepressants, serotonin reuptake inhibitors

• Miscellaneous – Bromocriptine

– Pulmonary diseases , Pneumonia , Tuberculosis, Acute respiratory

failure ,Positive pressure ventilation, Asthma & Atelectasis

– Postoperative complications

– Idiopathic

Treatment

• If symptoms are mild & serum sodium >125 meq:

 – treatment may be fluid restriction of 800-1000ml/day

– This restriction should result in a gradual daily reduction in weight,

progressive rise in serum sodium concentration and osmolality, and
symptomatic improvement

• If fluid restriction alone does not improve the symptoms

– 3-5% saline solution (hypertonic) is administered IV & diuretic therapy

may be indicated to promote diuresis