Medical and Rehabilitation Innovations Neuroendocrine Screening and Hormone Replacement Therapy in Trauma Related Acquired Brain Injury

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Medical and Rehabilitation Innovations Neuroendocrine Screening and Hormone Replacement Therapy in Trauma Related Acquired Brain Injury"

Transcription

1 Medical and Rehabilitation Innovations Neuroendocrine Screening and Hormone Replacement Therapy in Trauma Related Acquired Brain Injury

2 BACKGROUND Trauma related acquired brain injury (ABI) is known to cause a number of secondary effects to the brain including neuroendocrine dysfunctions. Pituitary hormonal disruptions after ABI have been well described in medical literature but with variable prevalence rates of deficiency ranging from 25% to 69% depending upon the definitions and laboratory screening used. A review article in 2007 noted prevalence of anterior hypopituitarism following ABI being 27.5% and posterior hypopituitarism being 26% in the acute phase, while in the longer term survivors of ABI had a prevalence of 6.9%. 1 Interestingly, there is a lack of consensus around the criteria defining pituitary deficiency in ABI patients, as well as best practice recommendations regarding neuroendocrine hormone replacement therapies. It is also important to note that there is no clear delineation as to what degree of endocrine changes in ABI is adaptive and functional versus maladaptive and detrimental during the recovery period. Furthermore, the generally accepted threshold for normal cutoff values for endocrine laboratory tests are based upon a healthy, mainly middle aged, normal weight population. 1 The debate remains about whether screening and treating neuroendocrine dysfunctions in ABI leads to measurable improvements in cognitive, behavioral and physical functions that enable optimal neurological and neurobehavioral recovery. Although a number of studies have looked at the incidence and prevalence of neuroendocrine dysfunctions following ABI, the number of Class I research studies looking at functional outcome benefits from hormonal replacement therapies in ABI have been very minimal, 2 especially with gonadal and growth hormones. Hence, it is unclear whether hormone replacement is as beneficial for ABI patients as it is for those patients from other non-traumatic causes of hypopituitarism. LITERATURE SUMMARY The following summarizes the current conclusions from the medical literature to date. 1. Studies suggest that acute disturbances of hypothalamic-pituitary-gonadal (HPG) axis are noted soon after ABI, but the majority recover normal HPG axis function within one year from injury. Deficiencies were more likely with LH/FSH; followed by growth hormone (GH); then adrenal insufficiency with low ACTH; and the least common being TSH due to less common pituitary-thyroid axis disturbance. Diabetes Insipidus (DI) was not associated with the presence of anterior hypopituitarism. 1,3 2. Opiates and cytokines from inflammatory cascade induced by ABI also lower testosterone levels 3 ; while other commonly prescribed medications, including phenytoin, carbamazepine, heparin, NSAIDs, and dopamine agonists affect thyroid function. 3. Provocative testing was more sensitive and specific in identifying GH deficiency and ACTH deficiency. TSH tends to fall following injury and rise with recovery, and measuring thyroid hormone levels during the acute period after ABI has not proven useful. 3 2 Paradigm Outcomes, Proprietary

3 4. In the acute phase of ABI, the diagnosis of adrenal insufficiency and diabetes insipidus should not be missed because it is life threatening and requires replacement therapy. In the ICU setting, replacement with thyroid hormone or GH therapy has not been clearly beneficial, while at 3 months post-injury, thyroid deficits should be treated. 2,3 5. Syndrome of Panhypopituitarism is associated with hypothermia, hypotension, hypoglycemia and hyponatremia. Providers should remain vigilant for symptoms of this rare but life threatening syndrome and screen and treat it acutely. 6. Replacement of other neuroendocrine deficits can restore normal growth hormone response to GH provocative testing A study of GH replacement therapy on ABI patients post one year of injury showed no difference between treated and placebo groups on most of the neuropsychological and functional measures. Some differential improvement was noted with finger tapping with dominant hand, WAIS III processing speed index, Wisconsin card sorting test, and California verbal learning test at 6 months and 12 months of GH replacement therapy. Interestingly, this study did not show improvements with the Community Integration Questionnaire (CIQ), a quality of life measure. The study intimated some potential benefit of GH replacement therapy, but acknowledged the limitation of the small sample size. 4 PARADIGM OUTCOMES POSITION Neuroendocrine dysfunctions are commonly associated with ABI and the endocrine changes that occur during the acute period seem to progress and recover during a one year time frame. To ensure identification of those ABI patients with chronic hypopituitarism that can impact the overall functional recovery of patients, Paradigm Outcomes supports the following neuroendocrine screening and treatment procedures specifically for our ABI patients. Neuroendocrine Screening Procedure 1. Candidate Criteria for screening (any presence of the following) a. Moderate and severe ABI patients by GCS criteria (score of 3-12) b. ABI patients with basilar skull fracture, facial fractures, diffuse brain swelling or edema, significantly elevated ICP, prolonged period of hypotension and/or hypoxia within 24 hours post injury c. MRI or CT Abnormalities in the area of Sella Turcica (location of Pituitary gland) d. Clinical symptoms consistent with chronic hypopituitarism 2. Acute period screening (within 30 days post injury) a. Cortisol level in am (within first 7days post-injury) b. Urine diuresis monitoring c. Serum Sodium and Osmolality & Urine Osmolality (if DI or SIADH suspected) 3. Post-acute period screening a. 3-6 months post-injury i. Serum Cortisol in am ii. Cosyntropin stimulation test (if acute period cortisol level < 12 mcg/dl) 3 Paradigm Outcomes, Proprietary

4 iii. TSH, free T3, free T4 iv. Insulin like growth factor (IGF-1) v. If clinically symptomatic: 1. Follicle stimulating hormone (FSH), Luteinizing hormone (LH) 2. Testosterone (male) or Estradiol (female) 3. Prolactin vi. If in vegetative state (VS), would defer steps iv-v b. 12 months post-injury i. Serum Cortisol in am (if abnormal level during prior testing) ii. Urinary free cortisol (if abnormal serum cortisol level during acute period) iii. Insulin like growth factor (IGF-1) iv. Glucagon Stimulation Testing (GTT) v. If clinically symptomatic or previously with low levels: 1. Follicle stimulating hormone (FSH), Luteinizing hormone (LH) 2. Testosterone (male) or Estradiol (female) 3. Prolactin 4. TSH, free T3, free T4 vi. If in a vegetative state, would defer steps iii-v Neuroendocrine Hormone Replacement Therapy General approach: Hormone replacement therapy (HRT) must be instituted for Diabetes Insipidus (DI) and Secondary Adrenal Insufficiency from ABI. Acute Panhypopituitarism requires hormonal replacement therapy for DI, Secondary Adrenal Insufficiency and hypothyroidism. Chronic Panhypopituitarism and multiple endocrine deficits at one year post ABI, HRT be continued for DI and Secondary Adrenal Insufficiency. Replacement therapy to be implemented for hypothyroidism. In Chronic Panhypopituitarism and multiple endocrine deficits at one year post ABI, consider benefits of hypogonadism therapy and GH replacement as related to given patient s clinical symptoms (consultation with an endocrinologist required). Case-by-case approach: Isolated hypogonadism and growth hormone deficiency at one year post ABI requires the consultation of an endocrinologist to determine the potential functional outcome improvement. Prior to initiation of HRT for hypogonadism and GH deficiency, the physical medicine and rehabilitation specialist and endocrinology specialist must collaborate to determine the appropriate outcome measure, as well as a therapy plan that combines HRT with rehabilitation modalities customized for each individual. The Paradigm Medical Director will review the treating physician s letter of medical necessity to ensure the appropriate consideration is given to contraindications, 4 Paradigm Outcomes, Proprietary

5 Summary outcome measures, therapy plan, and regularly scheduled follow-up timelines for monitoring treatment effectiveness. Neuroendocrine dysfunctions are common following ABI with higher risk of developing chronic hypopituitarism. Since symptoms of pituitary deficiencies and ABI sequelae can overlap, chronic hypopituitarism may be underdiagnosed in ABI patients. Help: Diabetes Insipidus and Secondary Adrenal Insufficiency are life threatening and require screening and immediate hormone replacement therapy during both acute and post-acute periods of TBI. Syndrome of Panhypopituitarism requires HRT for DI, adrenal insufficiency and hypothyroidism. Treatment of ABI induced secondary hypothyroidism during post-acute period is considered appropriate and beneficial. Hope: Extrapolating from published studies of non-abi associated endocrinopathies related to the benefits of HRT in growth hormone deficiency and gonadotropin deficiency, there are hopes that ABI induced pituitary deficiencies may benefit from aforementioned HRT leading to incremental cognitive, neurobehavioral and physical gains that can enhance the quality of life for ABI patients. Hype: GH and hypogonadism HRT will expedite and facilitate functional neurological and neurobehavioral recovery of ABI patients. ENDNOTES References 1. Schneider et al. Hypothalamopituitary Dysfunction Following Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage: A Systemic Review. JAMA. 2007; 208(12) E. Ghigo et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury. Brain Injury. 2005; 19 (9): Rothman et al. The Neuroendocrine Effects of Traumatic Brain Injury. J. Neuropsychiatry Clinical Neurosciences. 2007; 19: High et al. Effect of Growth Hormone Replacement therapy on Cognition after Traumatic Brain injury. Journal of Neurotrauma : Acknowledgements Special thanks Nancy Mann, MD, Brent Masel, MD, Elizabeth Sandel, MD, Alan Weintraub, MD, and Ross Zafonte, DO, for contributing to this paper, as well as the facilitators Chris Anderson, Laurie Anderson, Michael Choo, MD, and Steven Moskowitz, MD. 5 Paradigm Outcomes, Proprietary

6 2014. Paradigm Management Services, LLC ( Paradigm ). No part of this publication may be reproduced, transmitted, transcribed, shared, disseminated, summarized, stored in a retrieval system, adapted, or translated into any language in any form by any means without the written permission of Paradigm. Trademarks, service marks, products names, company names or logos of Paradigm are protected by trademark and other laws of the United States, as well as international conventions and the laws of other countries. 6 Paradigm Outcomes, Proprietary

PITUITARY: JUST THE BASICS PART 2 THE PATIENT

PITUITARY: JUST THE BASICS PART 2 THE PATIENT PITUITARY: JUST THE BASICS PART 2 THE PATIENT DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and

More information

9. Neuroendocrine Disorders Post ABI

9. Neuroendocrine Disorders Post ABI 9. Neuroendocrine Disorders Post ABI 9.1 History and Epidemiology On behalf of the ERABI Research Group Neuroendocrine disorders, primarily hypopituitarism, were first diagnosed by the German researcher

More information

Medical and Rehabilitation Innovations Hyperbaric Oxygen Therapy for Traumatic Brain Injury

Medical and Rehabilitation Innovations Hyperbaric Oxygen Therapy for Traumatic Brain Injury Medical and Rehabilitation Innovations Hyperbaric Oxygen Therapy for Traumatic Brain Injury BACKGROUND Traumatic Brain Injuries (TBI) have become a national interest over the recent years due to a growing

More information

JACK L. SNITZER, DO INTERNAL MEDICINE BOARD REVIEW COURSE 2018 PITUITARY

JACK L. SNITZER, DO INTERNAL MEDICINE BOARD REVIEW COURSE 2018 PITUITARY JACK L. SNITZER, DO INTERNAL MEDICINE BOARD REVIEW COURSE 2018 PITUITARY JACK L. SNITZER, D.O. Peninsula Regional Endocrinology 1415 S. Division Street Salisbury, MD 21804 Phone:410-572-8848 Fax:410-572-6890

More information

9 - Neuroendocrine Disorders Following Acquired Brain Injury

9 - Neuroendocrine Disorders Following Acquired Brain Injury 9 - Neuroendocrine Disorders Following Acquired Brain Injury Genevieve Sirois MD, Jo-Anne Aubut BA, Lilia Golverk MD, Robert Teasell MD FRCPC, T. Arnold Bayley, MD, FRCPC, Mark Bayley MD, FRCPC ERABI Parkwood

More information

Pathophysiology of Pituitary Gland Disorders. PHCL 415 Hadeel Alkofide May 2010

Pathophysiology of Pituitary Gland Disorders. PHCL 415 Hadeel Alkofide May 2010 Pathophysiology of Pituitary Gland Disorders PHCL 415 Hadeel Alkofide May 2010 1 Learning Objectives Understand the physiology of pituitary gland Understand acromegaly & describe its clinical features

More information

HYPOPITUITARISM. Partial or complete loss of production of one or more of the pituitary gland hormones. Diagnosis Male & Female

HYPOPITUITARISM. Partial or complete loss of production of one or more of the pituitary gland hormones. Diagnosis Male & Female HYPOPITUITARISM Partial or complete loss of production of one or more of the pituitary gland hormones. Diagnosis Male & Female About Hypopituitarism Hypopituitarism refers to decreased secretion of pituitary

More information

Pathology of pituitary gland. By: Shifaa Qa qa

Pathology of pituitary gland. By: Shifaa Qa qa Pathology of pituitary gland By: Shifaa Qa qa Sella turcica Adenohypophysis (80%): - epithelial cells - acidophil, basophil, chromophobe - Somatotrophs, Mammosomatotrophs, Corticotrophs, Thyrotrophs, Gonadotrophs

More information

Endocrine part two. Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy

Endocrine part two. Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy Endocrine part two Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy Cushing's disease: increased secretion of adrenocorticotropic

More information

International Journal of Pharma and Bio Sciences

International Journal of Pharma and Bio Sciences Case Report Medicine International Journal of Pharma and Bio Sciences ISSN 0975-6299 PITUITARY APOPLEXY A RARE CAUSE OF HYPONATREMIA DR. SAKTHI SELVA KUMAR *1, DR.M.V.BHARGAVI 2 AND DR.S.PALANIANDAVAN

More information

HYPOTHALAMO PITUITARY GONADAL AXIS

HYPOTHALAMO PITUITARY GONADAL AXIS HYPOTHALAMO PITUITARY GONADAL AXIS Physiology of the HPG axis Endogenous opioids and the HPG axis (exerciseinduced menstrual disturbances) Effects of the immune system on the HPG axis (cytokines: interleukins

More information

PATIENT INFORMATION HYPOPITUITARISM YOUR QUESTIONS ANSWERED

PATIENT INFORMATION HYPOPITUITARISM YOUR QUESTIONS ANSWERED PATIENT INFORMATION HYPOPITUITARISM YOUR QUESTIONS ANSWERED Contents What is hypopituitarism? 1 What causes hypopituitarism? 2 What are the symptoms and signs of hypopituitarism? 4 How is hypopituitarism

More information

Traumatic Brain Injury and Hypopituitarism

Traumatic Brain Injury and Hypopituitarism Mini-Review Article TheScientificWorldJOURNAL (2005) 5, 777 781 ISSN 1537-744X; DOI 10.1100/tsw.2005.100 Traumatic Brain Injury and Hypopituitarism Gianluca Aimaretti and Ezio Ghigo* Division of Endocrinology

More information

CHAPTER 41: Animal Hormones

CHAPTER 41: Animal Hormones CHAPTER 41: Animal Hormones 1. List a few similarities and differences comparing: a. endocrine system b. nervous system 2. What is the difference between endocrine and exocrine glands? 3. What is the difference

More information

Children s Hospital & Research Center Oakland. Endocrinology

Children s Hospital & Research Center Oakland. Endocrinology Children s Hospital & Research Center Oakland Endocrinology 5.22 GOAL: Prevention, Counseling and Screening (Endocrine). Understand the role of the pediatrician in preventing endocrine PC, MK, dysfunction,

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: somatostatin_analogs 7/2016 7/2017 7/2018 7/2017 Description of Procedure or Service Somatostatin, a hypothalamic

More information

Reproductive Health and Pituitary Disease

Reproductive Health and Pituitary Disease Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives

More information

Anatomy and Physiology. The Endocrine System

Anatomy and Physiology. The Endocrine System Anatomy and Physiology The Endocrine System The endocrine system includes anything that secretes hormones directly into body fluids. Endocrine glands include: the thyroid, parathyroid, adrenal, kidney,

More information

Endocrine System. Chapter 18. Introduction. How Hormones Work. How Hormones Work. The Hypothalamus & Endocrine Regulation

Endocrine System. Chapter 18. Introduction. How Hormones Work. How Hormones Work. The Hypothalamus & Endocrine Regulation Introduction Endocrine System Chapter 18 The endocrine system consists of cells, tissues, & organs that secrete into the blood Hormone an organic substance secreted by a cell that has an effect on the

More information

Imaging pituitary gland tumors

Imaging pituitary gland tumors November 2005 Imaging pituitary gland tumors Neel Varshney,, Harvard Medical School Year IV Two categories of presenting signs of a pituitary mass Functional tumors present with symptoms due to excess

More information

The Endocrine System Dr. Gary Mumaugh

The Endocrine System Dr. Gary Mumaugh The Endocrine System Dr. Gary Mumaugh Endocrine System Endocrine system the body s second great controlling system which influences metabolic activities of cells by means of hormones Endocrine glands pituitary,

More information

Art labeling Activity: Figure 16.1

Art labeling Activity: Figure 16.1 ANP 1105D Winter 2013 Assignment 6 part I: The Endocrine Sy... Assignment 6 part I: The Endocrine System, Chapter 16 Due: 11:59pm on Monday, March 4, 2013 Note: To understand how points are awarded, read

More information

Endocrine System. The Endocrine Glands

Endocrine System. The Endocrine Glands Endocrine System Working together with the nervous system, the endocrine system helps maintain homeostasis in the body. Where the nervous system uses electric signals, the endocrine system uses chemical

More information

Chapter 18: Endocrine Glands

Chapter 18: Endocrine Glands Chapter 18: Endocrine Glands I. Functions of the Endocrine System A. List and describe the eight major functions of the endocrine system: 1. 2. 3. 4. 5. 6. 7. 8. Page 1 of 19 C II. Pituitary Gland and

More information

The Neuroendocrine Effects of Traumatic Brain Injury

The Neuroendocrine Effects of Traumatic Brain Injury SPECIAL ARTICLES The Neuroendocrine Effects of Traumatic Brain Injury Micol S. Rothman, M.D. David B. Arciniegas, M.D. Christopher M. Filley, M.D. Margaret E. Wierman, M.D. Neuroendocrine dysfunction after

More information

John Sutton, DO, FACOI, FACE, CCD. Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989

John Sutton, DO, FACOI, FACE, CCD. Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989 John Sutton, DO, FACOI, FACE, CCD Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989 Gonadal Physiology and Disease 3 No Disclosures Gonadal Axis Hypothalamic-pituitary-gonadal Feedback mechanisms

More information

Pituitary for the General Practitioner. Marilyn Lee Consultant physician and endocrinologist

Pituitary for the General Practitioner. Marilyn Lee Consultant physician and endocrinologist Pituitary for the General Practitioner Marilyn Lee Consultant physician and endocrinologist Pituitary tumours Anterior/posterior pituitary Extension of adenoma upwards/downwards/sideways Producing too

More information

Table of Contents. What Is Hypopituitarism? What Causes Hypopituitarism? What It Means to You... 4

Table of Contents. What Is Hypopituitarism? What Causes Hypopituitarism? What It Means to You... 4 Hypopituitarism Table of Contents What Is Hypopituitarism?... 2 What Causes Hypopituitarism?... 4 What It Means to You... 4 I. Thyroid-Stimulating Hormone (TSH) Deficiency... 4 II. Adrenocorticotrophic

More information

ENDOCRINE SYSTEM. Endocrine

ENDOCRINE SYSTEM. Endocrine ENDOCRINE SYSTEM Endocrine Function Help regulate internal functions Use chemical messengers Recall: Endocrine vs. Exocrine glands Nervous System vs Endocrine System Target Specificity Lock n Key action

More information

Chapter 8.2 The Endocrine System

Chapter 8.2 The Endocrine System Major Endocrine Organs Hypothalamus Pineal Gland Pituitary Gland Thyroid Gland Thymus Gland Adrenal Glands Pancreas Ovaries (Female) Testis (Male) Chapter 8.2 The Endocrine System The endocrine system

More information

The Endocrine System

The Endocrine System The Endocrine System What is the system? 1. Made up of glands that produce and secrete hormones (chemical messengers) 2. Regulation of growth, metabolism, sexual development 3. Responses to stress and

More information

Human Anatomy and Physiology - Problem Drill 16: The Endocrine System

Human Anatomy and Physiology - Problem Drill 16: The Endocrine System Human Anatomy and Physiology - Problem Drill 16: The Endocrine System Question No. 1 of 10 The endocrine system is made up of a number of organs and glands. Which one of the following is not an organ or

More information

Endocrine System. Endocrine vs. Exocrine. Bio 250 Human Anatomy & Physiology

Endocrine System. Endocrine vs. Exocrine. Bio 250 Human Anatomy & Physiology Endocrine System Bio 250 Human Anatomy & Physiology Endocrine vs. Exocrine Endocrine glands secrete their products called hormones into body fluids (the internal environment) Exocrine glands secrete their

More information

Endocrine System. Modified by M. Myers

Endocrine System. Modified by M. Myers Endocrine System Modified by M. Myers 1 The Endocrine System 2 Endocrine Glands The endocrine system is made of glands & tissues that secrete hormones. Hormones are chemicals messengers influencing a.

More information

Non-Functioning Tumours and Pituitary Hormone Testing. Miguel Debono Consultant in Endocrinology

Non-Functioning Tumours and Pituitary Hormone Testing. Miguel Debono Consultant in Endocrinology Non-Functioning Tumours and Pituitary Hormone Testing Miguel Debono Consultant in Endocrinology Agenda Pituitary masses Non functioning pituitary adenomas Testing pituitary function Pituitary Hormone Replacement

More information

Pharmacology of Hypothalamic Hormones

Pharmacology of Hypothalamic Hormones Pharmacology of Hypothalamic Hormones Pharmacology of Hypothalamic Hormones The neuroendocrine system, which is controlled by the pituitary and hypothalamus, coordinates body functions by transmitting

More information

Urgent and Emergent Pituitary Conditions

Urgent and Emergent Pituitary Conditions Urgent and Emergent Pituitary Conditions PANKAJ A. GORE, MD DIRECTOR, BRAIN AND SKULL BASE T UMOR SURGERY PROVIDENCE B R AIN AND S PINE I NSTITUTE Urgent and Emergent Pituitary Conditions Neurosurgical

More information

Humatrope*, Norditropin*, Genotropin, Nutropin, Nutropin AQ, Omnitrope, Saizen

Humatrope*, Norditropin*, Genotropin, Nutropin, Nutropin AQ, Omnitrope, Saizen Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.08.11 Subject: Growth Hormone Adult Page: 1 of 6 Last Review Date: September 15, 2016 Growth Hormone

More information

The Endocrine System. The Endocrine System

The Endocrine System. The Endocrine System The Endocrine System Like nervous system, endocrine system provides communication and control. Messages are relayed from one cell to another via chemical messengers (hormones). Unlike nervous system which

More information

Chemical Regulation. Chapter 26. Testosterone and Male Aggression: Is There a Link? THE NATURE OF CHEMICAL REGULATION

Chemical Regulation. Chapter 26. Testosterone and Male Aggression: Is There a Link? THE NATURE OF CHEMICAL REGULATION Chapter 6 Chemical Regulation PowerPoint Lectures for Biology: Concepts and Connections, Fifth Edition Campbell, Reece, Taylor, and Simon Testosterone and Male Aggression: Is There a Link? Among male animals,

More information

The Endocrine System/Hormones

The Endocrine System/Hormones The Endocrine System/Hormones Controls many body functions exerts control by releasing special chemical substances into the blood called hormones Hormones affect other endocrine glands or body systems

More information

Endocrine system. Coordination & regulation Glands Hormones

Endocrine system. Coordination & regulation Glands Hormones Endocrine system Coordination & regulation Glands Hormones Endocrine system structures Anatomy - Dispersed system of glands that communicate with each other & all body cells via hormones. Endocrine glands:

More information

Growth and DMD Endocrine aspects of care

Growth and DMD Endocrine aspects of care Growth and DMD Endocrine aspects of care Meilan Rutter, MB,BCh, FRACP Division of Endocrinology Cincinnati Children s Hospital Medical Center July 2007 Where are we now? Inactive Reactive Proactive CCHMC

More information

Endocrine System. Chemical Control

Endocrine System. Chemical Control Endocrine System Chemical Control Endocrine System - the system that secretes hormones in the body - hormones can last for minutes or for hours - a major gland, once called the master gland, is the pituitary

More information

Homeostasis Through Chemistry. The Endocrine System Topic 6.6

Homeostasis Through Chemistry. The Endocrine System Topic 6.6 Homeostasis Through Chemistry The Endocrine System Topic 6.6 Comparing NS & ES Animals have two systems of internal communication and regulation The nervous system Response time: Fast, quick Signals: electrical

More information

See the latest estimates for new cases of pituitary tumors in the US and what research is currently being done.

See the latest estimates for new cases of pituitary tumors in the US and what research is currently being done. About Pituitary Tumors Overview and Types If you have been diagnosed with a pituitary tumor or worried about it, you likely have a lot of questions. Learning some basics is a good place to start. What

More information

Chapter 20. Endocrine System Chemical signals coordinate body functions Chemical signals coordinate body functions. !

Chapter 20. Endocrine System Chemical signals coordinate body functions Chemical signals coordinate body functions. ! 26.1 Chemical signals coordinate body functions Chapter 20 Endocrine System! Hormones Chemical signals Secreted by endocrine glands Usually carried in the blood Cause specific changes in target cells Secretory

More information

The Endocrine System 7/6/2015. Outline. Function of the Endocrine System

The Endocrine System 7/6/2015. Outline. Function of the Endocrine System The Endocrine System Biology 105 Lecture 13 Chapter 10 Outline I. Function of endocrine system II. Hormones and neurotransmitters III. Types of hormones and their actions IV. Endocrine glands/organs and

More information

Balancing Hormone Function in Women By Meghna Thacker, NMD

Balancing Hormone Function in Women By Meghna Thacker, NMD Balancing Hormone Function in Women By Meghna Thacker, NMD Hormone function is central to health and well being in both men as well as women. A problem encountered with any one endocrine gland can lead

More information

Chapter 20 Endocrine System

Chapter 20 Endocrine System Chapter 20 Endocrine System The endocrine system consists of glands and tissues that secrete Hormones are chemicals that affect other glands or tissues, many times far away from the site of hormone production

More information

Endocrine System. Chapter 20. Endocrine Glands and Hormones. The Endocrine System. Endocrine glands

Endocrine System. Chapter 20. Endocrine Glands and Hormones. The Endocrine System. Endocrine glands Chapter 20 Endocrine System Endocrine Glands and Hormones The endocrine system consists of glands and tissues that secrete hormones Hormones are chemicals that affect other glands or tissues, many times

More information

Aetna Better Health of Virginia

Aetna Better Health of Virginia Genotropin Nutropin Serostim Zomacton Humatrope Omnitrope Zorbtive somatropin Norditropin Saizen General Criteria for Approval: Omnitrope vial formulation is the preferred Growth Hormone product; consideration

More information

Lab Exercise Endocrine System

Lab Exercise Endocrine System Lab Exercise Endocrine System Name Date Materials: Human torso model Compound light microscope Prepared slides of the pituitary gland, pineal gland, thyroid gland, parathyroid glands, thymus gland, adrenal

More information

The Endocrine response to Stress. Dr. Sajeda Al-Chalabi Assistant Professor Head of Dept. Of Physiology

The Endocrine response to Stress. Dr. Sajeda Al-Chalabi Assistant Professor Head of Dept. Of Physiology The Endocrine response to Stress Dr. Sajeda Al-Chalabi Assistant Professor Head of Dept. Of Physiology The Physiology of Stress A series of neural and chemical reactions meant for physical survival

More information

Growth hormone therapy for short stature in adolescents the experience in the University Medical Unit, National Hospital of Sri Lanka

Growth hormone therapy for short stature in adolescents the experience in the University Medical Unit, National Hospital of Sri Lanka Growth hormone therapy for short stature in adolescents Growth hormone therapy for short stature in adolescents the experience in the University Medical Unit, National Hospital of Sri Lanka K K K Gamage,

More information

in Primary Care (Part 2) Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University

in Primary Care (Part 2) Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University Common Endocrine Problems Seen in Primary Care (Part 2) Lecture #34 Jonathan R. Anolik, MD, FACP, FACE Lewis Katz School of Medicine at Temple University None Conflict of Interest Topics to be Covered

More information

Endocrine system. Coordination & regulation Glands Hormones

Endocrine system. Coordination & regulation Glands Hormones Endocrine system Coordination & regulation Glands Hormones Endocrine system structures Anatomy - Dispersed system of glands that communicate with each other & all body cells via hormones. Endocrine glands:

More information

Endocrine System Worksheet

Endocrine System Worksheet Endocrine System Worksheet Name Section A: Endocrine vs. Nervous Systems The endocrine and nervous systems function to regulate body activities. Since both systems are involved in regulation, how does

More information

Overview of Reproductive Endocrinology

Overview of Reproductive Endocrinology Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,

More information

Traumatic Brain Injury-Related Hypopituitarism: A Review and Recommendations for Screening Combat Veterans

Traumatic Brain Injury-Related Hypopituitarism: A Review and Recommendations for Screening Combat Veterans MILITARY MEDICINE, 175, 8:574, 2010 Traumatic Brain Injury-Related Hypopituitarism: A Review and Recommendations for Screening Combat Veterans CPT(P) Arthur F. Guerrero, MC USA ; MAJ Abel Alfonso, MC USA

More information

BIO 116 Practice Assignment 1 The Endocrine System and Blood This is not a required assignment but it is recommended.

BIO 116 Practice Assignment 1 The Endocrine System and Blood This is not a required assignment but it is recommended. BIO 116 Practice Assignment 1 The Endocrine System and Blood This is not a required assignment but it is recommended. 1. Match the following glands of the endocrine system with the appropriate label 1.

More information

Biochemistry and Disorders of Hormones of the Hypothalamic and pituitary gland (hypothalamus and pituitary axis)

Biochemistry and Disorders of Hormones of the Hypothalamic and pituitary gland (hypothalamus and pituitary axis) Biochemistry and Disorders of Hormones of the Hypothalamic and pituitary gland (hypothalamus and pituitary axis) Objectives: 1. Describe the structure and function of the hypothalamus 2. List the hormones

More information

I. Endocrine System & Hormones Figure 1: Human Endocrine System

I. Endocrine System & Hormones Figure 1: Human Endocrine System I. Endocrine System & Hormones Figure 1: Human Endocrine System Endocrine System: a) Endocrine glands are ductless since they lack specific vessels for the transport of hormones throughout the body. Instead,

More information

Glands of the Endocrine System

Glands of the Endocrine System Glands of the Endocrine System Key Questions What are the functions of the major endocrine glands? How are endocrine glands controlled? Vocabulary pituitary gland releasing hormone corticosteroid epinephrine

More information

Growth hormone therapy in a girl with Turner syndrome showing a large increase over the initially predicted ht of 4 5

Growth hormone therapy in a girl with Turner syndrome showing a large increase over the initially predicted ht of 4 5 Disorders of Growth and Puberty: How to Recognize the Normal Variants vs Patients Who Need to be Evaluated Paul Kaplowitz, M.D Pediatric Endocrinology. VCU School of Medicine Interpretation of Growth Charts

More information

Reproductive System (Hormone Function) Physiology Department Medical School, University of Sumatera Utara

Reproductive System (Hormone Function) Physiology Department Medical School, University of Sumatera Utara Reproductive System (Hormone Function) Physiology Department Medical School, University of Sumatera Utara 1 Endocrine Control: Three Levels of Integration Hormones of the hypothalamic-anterior pituitary

More information

Endocrine Control. Chapter 35

Endocrine Control. Chapter 35 Endocrine Control Chapter 35 Impacts, Issues Hormones in Balance Many chemicals we release into the environment (such as the herbicide atrazine) have disruptive hormonal effects 35.1 Introducing the Vertebrate

More information

lactotrophs 120 min- FSH 60 min- LH Hypothalamus GnRH pituitary Estradiol +/- Progesterone _ FSH L H Ovary Uterus Ovulation Antral follicle >2mm

lactotrophs 120 min- FSH 60 min- LH Hypothalamus GnRH pituitary Estradiol +/- Progesterone _ FSH L H Ovary Uterus Ovulation Antral follicle >2mm lactotrophs Hypothalamus GnRH 120 min- 60 min- LH Progesterone _ pituitary L H + Ovary + Estradiol +/- Uterus Antral follicle >2mm Ovulation Preovulatory follicles atresia Follicular phase Luteal phase

More information

CCRN/PCCN Review Course May 30, 2013

CCRN/PCCN Review Course May 30, 2013 A & P Review CCRN/PCCN Review Course May 30, 2013 Endocrine Anterior pituitary Growth hormone: long bone growth Thyroid stimulating hormone: growth, thyroid secretion Adrenocorticotropic hormone: growth,

More information

Traumatic Brain Injury

Traumatic Brain Injury Traumatic Brain Injury Mark J. Harris M.D. Associate Professor University of Utah Salt Lake City USA Overview In US HI responsible for 33% trauma deaths. Closed HI 80% Missile / Penetrating HI 20% Glasgow

More information

The Endocrine System

The Endocrine System The Endocrine System Glands are modified epithelium which produces certain secretions. TYPES OF GLANDS: Exocrine Gland/Duct Gland Secretions of these Glands are carried to the site of action through fine

More information

BACKGROUND AND KEY TERMS RELATED TO THIS EXERCISE

BACKGROUND AND KEY TERMS RELATED TO THIS EXERCISE Downloaded from advan.physiology.org on April 15, 2012 LABORATORY EXERCISE BACKGROUND AND KEY TERMS RELATED TO THIS EXERCISE Questions are integrated throughout the text to serve as a source of discussion

More information

Exercise Physiology: Theory and Application to Fitness and Performance By Scott Powers & Edward Howley

Exercise Physiology: Theory and Application to Fitness and Performance By Scott Powers & Edward Howley Exercise Physiology: Theory and Application to Fitness and Performance By Scott Powers & Edward Howley Ch 5 Cell Signaling and the Hormonal Responses to Exercise Summary Created by Dan Hechler Class Lecture

More information

ENDOCRINOLOGY Cross setion of discipline. Zdeněk Fryšák, III. interní klinika, nefrologie, revmatologie a endokrinologie FN a LF Olomouc

ENDOCRINOLOGY Cross setion of discipline. Zdeněk Fryšák, III. interní klinika, nefrologie, revmatologie a endokrinologie FN a LF Olomouc ENDOCRINOLOGY Cross setion of discipline Zdeněk Fryšák, III. interní klinika, nefrologie, revmatologie a endokrinologie FN a LF Olomouc Coordination of systems involve Nervous System» Rapid response» Short

More information

BIOLOGY 2402 Anatomy and Physiology Lecture. Chapter 18 ENDOCRINE GLANDS

BIOLOGY 2402 Anatomy and Physiology Lecture. Chapter 18 ENDOCRINE GLANDS BIOLOGY 2402 Anatomy and Physiology Lecture Chapter 18 ENDOCRINE GLANDS 1 ENDOCRINE GLANDS Homeostasis depends on the precise regulation of the organs and organ systems of the body. Together the nervous

More information

Module 2 Endocrine System

Module 2 Endocrine System Module 2 Endocrine System Student Name: 1 Lesson 1 Lesson 2 Lesson 3 Lesson 4 Lesson 5 Total Marks Total Possible Marks 10 8 14 21 16 69 Your Mark Teacher Comments: 2 (10 marks) Lesson 1: Structure and

More information

LESSON ASSIGNMENT. After completing this lesson, you should be able to:

LESSON ASSIGNMENT. After completing this lesson, you should be able to: LESSON ASSIGNMENT LESSON 11 The Human Endocrine System. LESSON ASSIGNMENT Paragraphs 11-1 through 11-18. LESSON OBJECTIVES After completing this lesson, you should be able to: 11-1. Given a hormone, identify

More information

Endocrine Glands System. Agha Zohaib Khan

Endocrine Glands System. Agha Zohaib Khan Endocrine Glands System Agha Zohaib Khan Introduction Endocrine means secreting internally. Indeed, the endocrine system is made up of glands whose secretions enter the blood stream. Hence these glands

More information

Endocrine pharmacology (3)

Endocrine pharmacology (3) بسم رلا هللا Endocrine pharmacology (3) Natural hormone characterized by short of action : a lot of them ineffective orally ( for example ), but when we give it from outside it enters the body exactly

More information

GUNA -ACTH GUNA -BETA-ENDORFIN GUNA -BETA-ESTRADIOL ADRENOCORTICOTROPIC HORMONE

GUNA -ACTH GUNA -BETA-ENDORFIN GUNA -BETA-ESTRADIOL ADRENOCORTICOTROPIC HORMONE GUNA -ACTH Stimulation of the adrenal cortex hormones as follows: Glucocorticoids: hydrocortisone, corticosterone, cortisol Mineralcorticoids: aldosterone, 11-Deoxycorticosterone Sex hormones Asthenia

More information

Diagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine.

Diagnosis and Treatment of Osteoporosis. Department of Endocrinology and Metabolism Ajou University School of Medicine. Diagnosis and Treatment of Osteoporosis Department of Endocrinology and Metabolism Ajou University School of Medicine Yoon-Sok CHUNG WCIM, COEX, Seoul, 27Oct2014 Case 1 71-year old woman Back pain Emergency

More information

HYPONATRAEMIA: NUH GUIDELINE FOR INITIAL ASSESSMENT AND MANAGEMENT.

HYPONATRAEMIA: NUH GUIDELINE FOR INITIAL ASSESSMENT AND MANAGEMENT. HYPONATRAEMIA: NUH GUIDELINE FOR INITIAL ASSESSMENT AND MANAGEMENT. HYPONATRAEMIA: SODIUM < 130 MMOL/L SIGNIFICANT. Symptoms/signs usually only occur when sodium < 125 mmol/l. Acute hyponatraemia is less

More information

Testosterone and other male hormones seem to be related to aggressive behavior in some species

Testosterone and other male hormones seem to be related to aggressive behavior in some species Testosterone and Male Aggression Testosterone and other male hormones seem to be related to aggressive behavior in some species In the fish species Oreochromis mossambicus, elevated levels have been found

More information

Receptors Functions and Signal Transduction L1- L2

Receptors Functions and Signal Transduction L1- L2 Receptors Functions and Signal Transduction L1- L2 Faisal I. Mohammed, MD, PhD University of Jordan 1 Introduction to Physiology (0501110) Spring 2013 Subject Receptors: types and adaptation - Membrane

More information

Assessing Adrenal Function in Ill, Hospitalized Patients. Bruce Redmon, MD Division of Endocrinology, Diabetes and Metabolism

Assessing Adrenal Function in Ill, Hospitalized Patients. Bruce Redmon, MD Division of Endocrinology, Diabetes and Metabolism Assessing Adrenal Function in Ill, Hospitalized Patients Bruce Redmon, MD Division of Endocrinology, Diabetes and Metabolism Disclosures Very surprised when I received an email two weeks ago disclosing

More information

13 Common Endocrine INTRODUCTION CHANGES IN GH/IGF-1 AXIS

13 Common Endocrine INTRODUCTION CHANGES IN GH/IGF-1 AXIS 13 Common Endocrine Abnormalities in ICU Abstract: With sophisticated mechanical devices and monitoring systems, mortality and morbidity in the critically ill patients in the intensive care units (ICU)

More information

Name. Endocrinology. d.) What gland in the brain is a major organizing center of hormone release?

Name. Endocrinology. d.) What gland in the brain is a major organizing center of hormone release? Endocrinology Background Information: The endocrine system functions to maintain homeostasis within many of the longterm, ongoing processes that occur in the body. Some examples of these processes include

More information

Endocrine System. A system that consists of glands that transmit chemical messengers throughout the body.

Endocrine System. A system that consists of glands that transmit chemical messengers throughout the body. Endocrine System A system that consists of glands that transmit chemical messengers throughout the body. HORMONES: chemical that circulates throughout the blood stream and influence the activity of distant

More information

The Endocrine System

The Endocrine System The Endocrine System Overview of the Endocrine System System of ductless glands that secrete hormones Hormones are messenger molecules Circulate in the blood Act on distant target cells Target cells respond

More information

the ENDOCRINE SYSTEM these hormones all over the body.

the ENDOCRINE SYSTEM these hormones all over the body. the ENDOCRINE SYSTEM Hormones are chemical messengers. They bind to specific target cells with receptors, regulate metabolism and the sleep cycle, and contribute to growth and development. The endocrine

More information