nlme endocrine
DESCRIPTION
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National License: Infectious disease
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NL: Endocrine system..
Endocrine Circulation Blood vessels Target cell hormone 2
1) Steroid hormone Sex hormone target nucleus receptor cytoplasm (cytoplasmic receptor) steroid hormone lipid cell membrane cytoplasmic receptor nuclear receptor DNA transcription protein estrogen receptor nucleus protein cell breast tissue proliferation mammillary gland
2) Peptide hormone Insulin, Glucagon hormone anterior pituitary cell membrane receptor cell membrane hormone receptor secondary messenger phosphorylation activate enzyme
Hormone Axis Hypothalamus-Pituitary axis Target organ axis Adrenal axis Thyroid axis function Hypothalamus
Hypothalamus Releasing Inhibiting peptide Anterior pituitary hormone Hypothalamus hormone axon Posterior pituitary ADH Vasopressin ( Supra-optic nucleus) Oxytocin ( Paraventricular nucleus)
Releasing Inhibiting peptide Hypothalamus Hypothalamo-hypophyseal portal system anterior pituitary hormone Hypothalamus Pituitary hormone Portal system Hormone
Pituitary gland structure function hypophyseal fossa sella turcica neurosecretory cell hypothalamus axon hormone paraventricular nucleus supraoptic nucleus hypothalamus posterior pituitary gland ADH Oxytocin releasing inhibiting factors hormone anterior pituitary gland factor portal system
Pituitary gland 2 Adenohypophysis Neurohypophysis hormone hypothalamus glandular structure hormone hormone cell specific hormone
Somatotroph Growth hormone (GH)
Lactotroph Prolactin
Thyrotroph Thyroid stimulating hormone (TSH)
BasophilGonadotroph FSH LH
Corticotroph ACTH ( MSH)
Cell Hyperactivity hormone tumor somatotroph GH effect GH acromegaly gigantism
Lactotroph prolactin dopamine prolactin lactotroph dopamine hypothalamus pituitary stalk hypothalamus irritate inflammation stalk dopamine inhibit prolactin hyperprolactinemia dopamine antagonist
thyrotroph clinical hyperthyroidism hypothyroidism
Pituitary gland sella turcica Sphenoid sinus sphenoid sinusitis tumor sphenoid Infection sphenoid sinus Pituitary gland
Pituitary gland Optic chiasma pituitary Optic chiasma Visual field defect Bitemporal hemianopia
histology cell posterior pituitary cell neuroectoderm anterior pituitary cell gland Rathkes pouch remnant oral ectoderm anterior tumor embryo CraniopharyngiomaHypopituitarism
Hypopituitarism pituitary gland 1. Tumor Normal functioning cells cell (Necrosis ) common cause of hypopituitarism
2. (postsurgical) (cranial radiation)
3. Head injury 4. Hypothalamic dysfunction craniopharyngioma suprasellar tumor extend sella turcica pituitary pituitary necrosis 5. Sheehans syndrome postpartum bleeding Pituitary gland bleeding hypovolemia shock Pituitary gland ischemic infarction cell Pituitary gland Pituitary massive blood loss vital organs Pituitary gland structure cell dysfunction necrosis Sheehans syndrome hormone deficit hypopituitarism hormone 1. TSH Basal metabolic rate body temperature 2. prolactin lactation breast atrophy 3. ACTH adrenal insufficiency stress glucocorticoid stress adrenal crisis adrenal shock
4. Gonadotrophin amenorrhea,loss of libido,infertility
5. growth hormone
epiphyseal plate ( ) muscle mass Hyperpituitarism
Hyperprolactinemia
Most common hyperpituitarism hyperprolactinemia prolactinoma hormone prolactin lactotroph dopamine prolactin dopamine hypothalamus stalk portal system anterior pituitary hypothalamus head injury prolactin ( hypothalamus higher center cerebral cortex )
dopamine Antipsychotic Haloperidol , Antidepressant Tricyclic antidepressant ,H2 blocker cimetidine dopamine dopamine lactotroph prolactin : prolactin sex hormone hypogonadism amenorrhea, oligomenorrhea, infertility (Delayed secondary sexual characteristic) Clinical galactorrhea breast tissue (Gynecomastia) Hirsutism (), Acne () Osteoporosis osteopenia prolactin estrogen estrogen : decrease of libido (), impotence, infertility ( hypogonadism ) sexual intercourse problem prolactinoma late presentation mass effect bitemporal hemianopia hyperprolactinemia physiological condition rule out hyperprolactinemia
1. Pregnancy amenorrhea sexual intercourse urine pregnancy test estrogen Lactotroph prolactin 2. Post-partum stage Hormone cycle [ prolactin 3-4 - Lecture .]
3. Stress stress dopamine Higher center Cerebral cortex Hypothalamus inhibit dopamine galactorrhea () amenorrhea exclude pregnancy medication sexual intercourse urine pregnancy test antipsychotic, antidepressant, H2 blocker renal failure hypothyroidism hyperprolactinemia TRH hypothalamus dopamine hyperprolactinemia exclude Pregnancy, Medication, Renal failure, Hypothyroidism mass effect visual field defect prolactin level ( 150 ng/ml) pituitary adenoma ( prolactinoma ) MRI 10 mm Microprolactinoma 10 mm Macroprolactinoma
Prolactinoma microprolactinoma tumor function hyperprolactinemia galactorrhea prolactinoma prolactin level prolactin Growth hormone
Hypothalamus GHRH anterior pituitary GH IGF-1 (Insulin growth factor 1) organ somatic growth GH 1-5 GH
inhibit GH somatostatin hormone inhibit hormone pancreas pituitary gland
IGF-1 Insulin-like growth factor binding protein target organ membrane receptor signal stromal cell growth
GH tumor cell GH Growth factor cell Growth hormone membrane receptor Secondary messenger nucleus cell proliferation
GH epiphyseal plate Gigantism ( ) epiphyseal plate longitudinal horizontal
GH Insulin resistance Atherosclerosis Hypertension Cardiomegaly
GH Hypertension (Arthrosis) Insulin resistance DM Polyuria Sinus () supra-orbital ridge prominence visual field defect stalk hyperprolactinemia ( stalk dopamine prolactin )
Acromegaly macroadenoma macroadenoma mass effect hyperfunction ( prolactinoma hyperfunction mass effect microadenoma )
tissue bone nerve neuropathy most common Carpal tunnel syndrome thenar muscle atrophy median nerve ( )Thyroid disease
T3 T4 Bioactivity T3 Half life T4 T3 (Conversion) tissue
Thyroid hormone iodine thyroid follicular cell iodide trapping Tyrosine molecule thyroglobulin iodide oxidation Peroxidase Monoiodotyrosine (MIT) Diiodotyrosine (DIT) (coupling) T3 (MIT+DIT) T4 (DIT+DIT) colloid thyroid follicle release
TSH pituitary thyroid hormone autoregulation thyroid iodine uptake hormone
Thyroid hormone hypothalamus TRH anterior pituitary thyrotroph TSH thyroid follicular cell thyroid hormone (T3 T4) target cell
Bone target organ thyroid hormone Bone growth thyroid hormone (congenital hypothyroidism - cretinism) growth thyroid hormone IQ mental retardation screening detect congenital hypothyroidism TSH Primary hypothyroidism TSH
Thyroid hormone Hyperthyroid thyroid Levothyroxine hormone replacement hormone thyroid hormone Osteoclast resorption Osteopenia Osteoporosis Hyperthyroidism
1. Graves disease : autoimmune thyroid stimulating immunoglobulin receptor hyperfunction thyroid TSH diffuse thyroid goiter ( autoantibodies cell ) hyperthyroidism ( autoimmune disease ) Iodine uptake 2. Toxic multinodular goiter : thyroid (multinodular) hyperthyroidism thyroid iodine thyroid hormone TSH follicular cell cell fibrosis cell necrosis fibrosis healing process nodule fibrosis hyperfunction Toxic multinodular goiter3. Toxic adenoma : hyperfunction tumor thyroid hormone TSH Normal follicular cell hyperfunction normal cell TSH ( negative feedback thyroid hormone )4. Transient painless thyroiditis Subacute painful thyroiditis : thyroid Infection Hashimotos thyroiditis release thyroid hormone follicular cell hyperthyroidism Iodine uptake
Hyperthyroidism toxic adenoma toxic multinodular goiter diffuse Graves disease thyroiditis ( thyroiditis Infection )
Radioactive iodine uptake Iodine uptake Graves disease, toxic multinodular goiter toxic adenoma hyperfunction Iodine uptake thyroiditis
Hyperthyroidism system GI, CVS, Neuromuscular Nervous system
1. Cardiovascular system
Thyroid hormone sympathetic overactivity (palpitation) tachycardia arrhythmia atrial fibrillation arrhythmia tachyarrhythmia thyroid function Heart failure
- Edema: Heart failure matrix substance Pretibial area ( Pretibial myxedema)
- Catecholamine sensitivity cardiac output Vascular resistance hypertrophy Left ventricle Atrial fibrillation
2. Neuromuscular system
- Muscle weakness: myopathy muscle atrophy muscle contraction
- Hypokalemia: thyroxine sympathetic Na+-K+ ATPase K+ shift cell Na+ K+
- Thyrotoxic periodic paralysis: acute muscle weakness thyroxine myopathy Na+-K+ ATPase Hypokalemia muscle contraction
3. Nervous system
- Neuropsychitis sympathetic overactivity agitation
- ( Focus Parasympathetic)
4. GI system ( .. CM II)
- diarrhea thyroid hormone GI motility Thyroiditis
Thyroiditis Infection Trauma Hashimotos thyroiditis lymphocyte antibody thyroid cell hyperthyroidism follicular cell thyroid hormone release hormone normal hypothyroidism ( follicular cell ) histopathology lymphocyte infiltration germinal center lymphoma
Hashimotos thyroiditis antilysosomal antibody (80% antibody thyroid peroxidase enzyme) hormone supplement (Levothyroxine)
Subacute painless thyroiditis antithyroid drug -blocker Thyroxicosis Eltroxine thyroid replacement
Thyroid crisis
Thyroid hormone crisis sympathetic overactivity agitation () Tachycardia heart failure GI dysfunction diarrhea jaundice
case
67 2 Schizophrenia (Chlorpromazine) 2 () 1 3 vital sign body temperature Pulse rate Hypothyroidism
hypothyroidism general appearance pulse rate Body temperature mucopoly-saccharide Myoedema reflex relax phase
Hypothyroid Periorbital edema 1 3 lateral mucopolysaccharide (macroglossia) thyroid metabolism Tyrosine Carotemia mucopolysaccharide carpal tunnel bilateral carpal tunnel syndrome
Hypothyroid Thyroid function test TSH ( 0.2-3.2), T3 (80-200), Free T4 (0.78-2.1) case TSH >100, T3 19, FT4 0.04 TSH T3 FT4 Primary hypothyroidism Thyroid gland
TSH 0.01 secondary hypothyroidism pituitary gland postpartum bleeding tumor pituitary gland hormone
Primary hypothyroidism most common Chronic autoimmune thyroiditis Hashimotos thyroiditis 131I radiation Graves disease 131I cell hyperfunction hypothyroidism transient thyroiditis
Antithyroid antibodies Antithyroglobulin Antithyroid peroxidase titer 102400 positive
Myxedema coma
hypothyroid Thyroid hormone (Decreased mental status), hypothermia (), hypotension, bradycardia electrolyte imbalance hyponatremia SIADH hypoglycemia
Tumor of thyroid gland
Benign tumor thyroid Follicular adenoma Malignant 5 Most common Papillary carcinoma Follicular carcinoma, Medullary carcinoma, Anaplastic carcinoma Lymphoma Follicular adenoma: Function Follicular carcinoma: follicular adenoma histopathology tumor invade capsule Follicular carcinoma evidence Metastasis hemogenous route Bone metastasis Pulmonary metastasis Papillary carcinoma: lymphatic route thyroid cervical lymph node papillary carcinoma of thyroid gland Medullary carcinoma: neoplasia parafollicular (C) cell calcitonin serotonin Carcinoid syndrome MEN II
Carcinoid syndrome: Serotonin Flushing secretion diarrhea Metabolite Serotonin HIAA Paraneoplastic ACTH Cushings syndrome ]
Anaplastic carcinoma: Prognosis (Hard consistency) Lymphoma: Hashimotos thyroiditis Adrenal gland
Anatomy and Histology of adrenal gland
Adrenal gland upper pole 2 histology 2 cortex medulla ( Chromaffin cell adrenaline Noradrenaline)
Adrenal cortex 3
1) Zona glomerulosa mineralcorticoid Aldosterone Na+ K+ H+ distal tubule aldosterone Renin-Angiotensin system Aldosterone Hyperaldosteronism
2) Zona fasiculata cholesterol Glucocorticoids ACTH Cushings syndrome
3) Zona reticularis sex hormone menopause sex hormone gonad ( adrenal gland androgen)
Hypothalamus-pituitary-adrenal axis stress Hypothalamus CRH anterior pituitary ACTH ACTH Adrenal cortex Zona fasiculata glucocorticoid steroid hormone immune function candida Cushings syndrome Oral thrush (oral candidiasis) glucocorticoid physiological function feedback CRH
Mineralcorticoids Renin-Angiotensin system potassium
Adrenal cortex cholesterol SER Adrenal steroid hormone pathway cortex
Zona reticularis sex hormone tumor androgen (Hirsutism) Virilization
Tumor chromaffin cell adrenal medulla Pheochromacytoma tumor chromaffin cell Paraganglioma neuroblastoma
Adrenal gland endocrine hypertension hypertension endocrine disease Adrenal gland 2 hyperaldosteronism Pheochromocytoma
Hyperaldosteronism
Hyperaldosteronism aldosterone hypertension with hypokalemia most common Aldosterone-producing adenoma adrenal gland Conns syndrome hypertension hypokalemia proximal muscle weakness nephrogenic DI (hypokalemia ADH renal tubule polyuria ) bilateral adrenal hyperplasia rare Adrenal carcinoma serum aldosterone renin
Secondary Hyperaldosteronism renin renal artery stenosis blood flow juxtaglomerular apparatus renin Aldosterone serum aldosterone renin
Aldosterone-producing adenoma (Conns syndrome)
Conns syndrome most common cause primary hyperaldosteronism benign tumor 2 cm Aldosterone hypertension with hypokalemia BP atherosclerosis
Aldosterone Na+ K+ HT Na+ retention cardiac output BP hypertension K+ K+ aldosterone H+ metabolic alkalosis
Primary aldosteronism most common Conns syndrome hypertension with hypokalemia and metabolic alkalosis
Pheochromocytoma
Tumor adrenal medulla catecholamine sympathetic overactivity (palpitation) tachycardia flushing catecholamine Paroxysm ( ) adrenal medulla tumor chromaffin cell extra-adrenal sympathetic ganglion Rules of 10 10% ; 10% ganglion adrenal gland; 10% ; 10% malignancy; 10% familial disease
Pheochromocytoma Paroxysm hypertension metabolite catecholamine VMA metanephrin catecholamine amino acid Tyrosine tyrosine hydroxylase , DOPA decarbosylase Noradrenaline MAO COMT metabolite VMA urine VMA imaging
Clinical triad Pheochromocytoma1. Paroxysmal throbbing headache
2. Sweating
3. palpitation
hyperglycemia sympathetic overactivity
Pheochromocytoma familial disease MEN II (Multiple endocrine neoplasia type 2) VHL gene ( von Hippel-Lindau disease) Neurofibromatosis 1 (NF-1) Pheochromocytoma (VHL gene renal cell carcinoma )
antihypertensive of choice Conns syndrome K+-sparing diuretics spironolactone Aldosterone
Cushings syndrome
cortisol
Cortisol bone calcium calcium excretion osteoclast activity on steroid Cushings disease hypocalcemia PTH osteoclast vicious cycle osteoporosis
Signs & Symptoms Cushings syndrome buffalo hump moon face muscle weakness abdominal striae emotion psychosis, depression
pituitary gland sella turica cortisol salt-water retention hypertension insulin-resistance Cushings syndrome DM fat distribution truncal obesity extremities muscle atrophy cortisol proteolysis protein Cortisol fibroblast collagen glycosaminoglycan bleeding immune function cortisol WBCs lymphoid organ infection hypersensitivity phospholipase A2
(moon face) purplish striae steroid acne ( Cushings syndrome phase ) Salt-water retention, buffalo hump, moon face, cardiac hypertrophy polyuria, polydypsia DM
Cushings syndrome 2 exogenous endogenous
1) Exogenous Cushings syndrome steroid hormone Prednisolone ( steroid )2) Endogenous Cushings syndrome cortisol 2 ACTH dependent pituitary microadenoma, ectopic ACTH tumor adrenal gland ACTH small cell carcinoma of lung pancreatic tumor paraneoplastic syndrome ** ectopic ACTH skin pigmentation ACTH independent adrenal adenoma cortisol ACTH ( Ectopic function Eutopic )
Adrenal insufficiency
hypofunction adrenal gland primary secondary
1) Primary adrenal insufficiency adrenal gland autoimmune adrenalitis Addisons disease, enzyme , Adrenal hemorrhage, Adrenal infarction Hyperpigmentation ACTH structure MSH Melanocyte melanin pigment Hyperkalemia aldosterone Conns syndrome Metabolic acidosis hypotension
Cortisol lung surfactant adrenal insufficiency neonatal respiratory distress syndrome
2) Secondary adrenal insufficiency [ pituitary gland] Sheehans syndrome, Mass effect pituitary tumor, Craniophayngioma, empty-sella syndrome pituitary gland ACTH (vitiligo)
Orthostatic hypotension hypoglycemia hyponatremia SIADH lymphocytie lymphocytosis cortisol PMN predominanat PMN dysfunction cortisol lymphocyte
Polyglandular autoimmune syndrome (PGA)
PGA autoimmune disease involve endocrine gland 2 type
PGA type I Autosomal recessive hypoparathyroidism mucocutaneous candidiasis
PGA type II 20-60 DM type 1 ( autoimmune disease islets of Langerhans)Sex hormones
sex-related Y chromosome testis testosterone testosterone active form dihydrotestosterone 5-reductase dihydrotestosterone Androgen receptor male phenotype testis Anti-Mullerian hormone regression Mllerian duct Ambiguous sex sex hormone
Sex hormone hypothalamic-pituitary-ovarian axis FSH LH anterior pituitary gland GnRH hypothalamus
FSH follicles ovary LH secondary sexual characteristics LH epididymis anabolism FSH spermatogenesis
Estrogen Osteoblastic activity estrogen ( menopause) osteoclast bone resorption osteoporosis
Testosterone ( Side effect )Congenital adrenal hyperplasia
Adrenal steroid hormone enzyme 3-hydroxysteroid dehydrogenase 21-hydroxylase (21-OH) 11-hydroxylase (11-OH) enzyme -21-hydroxylase deficiency (21-OHD) : (90%) cortisol Aldosterone hypotension, hyperkalemia adrenal insufficiency stress hypoglycemia testosterone metabolite shift testosterone testosterone female virilization muscle mass -11-hydroxylase deficiency (11-OHD) : (5%) 21-OHD Deoxycorticosterone (DOC) metabolite Aldosterone hypertension estrogen clinical Primary adrenal insufficiency (hyperpigmentation) hypoglycemia stress virilization
21-OHD glucocorticoid minerocorticoid androgen hyperkalemia aldosterone Alkalosis BP metabolite 17-OHP metabolite 21-hydroxylase 11-OHD cortisol mineralocorticoid DOC BP Na+ K+ Adrenal gland hyperfunction Conns syndrome, Adrenal cushings syndrome Pheochromocytoma
hypofunction adrenal insufficiency Addisons disease Congenital adrenal hyperplasia (21-OHD 11-OHD BP) 3 hyperthyroidism, DM, pheochromocytoma
endocrine hypertension acromegaly, hyperthyroid, adrenal Cushings syndrome, Conns syndrome, adrenal hyperplasia, DM, pheochromocytomaParathyroid gland
Parathyroid gland calcium phosphate metabolism Parathyroid hormone (PTH) calcium phosphate osteoclast bone osteoclast activity PTH calcium phosphate fracture hypoparathyroidism calcium phosphate
Calcium absorb hormone calcium vitamin D PTH calcium ( GI vitamin D ) PTH
phosphate 1) cell lysis 2) phosphate vitamin D PTH
Vitamin D phosphate calcium phosphate PTH phosphate calcium phosphate
Hyperparathyroidism
1. PTH osteoclast osteopenia skull salt and pepper skull ( skull) long bone cyst osteitis fibrosa cystica
2. Calcium peptic ulcer
3. Calcium pancreatic enzyme pancreatitis
4. Calcium nephron nephrocalcinosis calcium phosphate stone renal failure
5. Calcium calcification metastatic calcification
6. Calcium nephrogenic DI ADH renal tubule hypokalemia hypercalcemia
DI 2 Central DI hypothalamus ADH
Nephrogenic DI ADH
Hyperparathyroidism
1. Primary hyperparathyroidism
- Most common adenoma
- 5% hyperplasia 4
- 2% carcinoma
2. Secondary hyperparathyroidism calcium - chronic renal failure hydroxyl vitamin D ( vitamin D hydroxyl ) inactive vitamin D- malabsorption syndrome calcium Capillaria philippinensis Crohns disease -Vitamin D deficiency
3. Tertiary hyperparathyroidism parathyroid gland autonomous nodule PTH
chronic renal failure calcium phosphate () parathyroid gland PTH PTH parathyroid gland autonomous nodule calcium phosphate
electrolyte primary calcium phosphate secondary tertiary calcium phosphate ( )
Humoral hypercalcemia of malignancy
Malignant tumor small cell type Parathyroid hormone-related peptide (PTHrP) PTH hypercalcemia paraneoplastic syndrome paraneoplasm
MEN syndromes (Multiple endocrine neoplasia)
MEN syndromes endocrine glands Autosomal dominant genetic familial history
MEN I (Wermer syndrome) mutation MEN I gene 11 clinical syndrome 3P ( Para-Pan-Pit)
1. Parathyroid adenoma hypercalcemia
2. Pancreatic islet cell tumor most common Insulinoma (-cell tumor) hypoglycemia
3. Pituitary adenoma Prolactinoma , acromegaly Cushings disease
MEN IIA (Sipples disease) point mutation RET oncogene 10 Medullary carcinoma of Thyroid gland, Parathyroid adenoma hyperplasia Pheochromocytoma ( Med-Par-Phe)
MEN IIB (Gorlins syndrome) RET oncogene tyrosine kinase domain medullary carcinoma of Thyroid gland, Pheochromocytoma MEN IIA Mucosal neuroma Ganglioneuroma of gut
Practice Endocrine disease 1.
Prolactinoma
Galactorrhea MRI pituitary gland Prolactinoma functional pituitary tumor pathologic hyperprolactinemia Prolactin 2.
Addisons disease
Hyperpigmentation gum, oral mucosa, ACTH Primary adrenal insufficiency blood electrolyte hyperkalemia Addisons disease (hypoglycemia, orthostatic hypotension, loss of libido, hyperpigmentation)
adrenal gland ACTH ACTH ACTH MSH 3.
Cushing syndrome Clinical Cushings syndrome (Cushinoid appearance) Phase Purplish striae collagen structure (fibroblast activity ) vascular tissue 4.
general appearance Reflex Pathological finding Pheochromocytoma tumor adrenal cortex
5.
3-4 Na+ Myxedema general appearance 1/3 bradycardia, body temperature , , , suggest Hypothyroidism
- Primary: Hashimotos thyroiditis, Postsurgical or postradiation
- Secondary: Hypopituitarism Sheehans, empthy sella syndrome, craniopharyngioma hormone
6.
Addisons disease hypopigmentation vitiligo autoimmune disease
7.
Gross pathology adrenal cortical adenoma
8.
Grave disease pretibial myxedema specific sign Graves disease
9.
MRI Acromegaly carpal tunnel syndrome endocrine disease acromegaly MRI Tumor
10.
Skin lesion endocrine disease 37.19 acanthosis nigricans skin hyperpigmentation insulin resistance DM, Cushings syndrome, acromegaly
11.
Graves disease
starring eye exophthalmos substance retrobulbar space12.
Grave disease pretibial myxedema clinical endocrine 3 1. Hyperthyroid metabolism2. Pheochromocytoma sympathetic activity
3. DM
13.
Grave disease starring eye exophthalmos diffuse thyroid enlargement myedema
14.
Bradycardia Hypothyriod
mucopolysaccharide 15.
Addisons disease (Primary adrenal insufficiency)
hyperpigmentation postural hypotension cortisol potassium mineralocorticoid
Primary adrenal insufficiency acute primary adrenal insufficiency meningococcemia adrenal gland adrenal insufficiency adrenal hemorrhage Waterhouse-Friderichsen syndrome16.
Cushing syndrome
Purplish striae sign specific Cushing syndrome obesity 17.
Addisons disease
18.
Addisons disease
19.
Acromegaly nasolabial fold tumor pituitary
Acidophil
Thyroid hormone (T3) nuclear receptor
Neurohypophysis
Adenohypophysis
Overview of Endocrine system
Hormone negative feedback hormone pituitary hypothalamus
Hormone Central + Peripheral