THE ENDOCRINE SYSTEM

1. THE ENDOCRINE SYSTEM Purpose: Communication Nature: Slow, not specific Regulates: growth, metabolism, reproduction, autonomic functions

2. hormone Cell A Cell A Cell A Cell B hormone receptor blood DEFINITIONS HORMONE Cell B PARACRINE AGENT AUTOCRINE AGENT

7. Regulation of thyroid hormone release

11. Fukushima Daiichi nuclear power plant From: thepoliticalcarnival.net From: http://www.guardian.co.uk/world/2011/mar/14/fukushima-nuclear-power-plant-japan Radioactive iodine Risk of thyroid cancer

12. TSH causes: • Uptake of iodine • Synthesis of thyroglobulin • Iodination of thyroglobulin • Uptake of colloid into thyroid cell • Secretion of T3/T4 from thyroid cell • Increase in the size and number of thyroid cells

14. T3 Cell membrane T3 cytoplasm Nuclear membrane gene T3 receptor

15. EFFECTS OF THYROID HORMONES • Increased O2 consumption/metabolic rate • -Increased size of mitocondria • - Increased expression of respiratory enzymes • - Increase Na+/K+ ATPase • - Increased proteins for growth and maturation • Increased expression of b-adrenergic receptors • Required for brain development

17. Iodine Deficiency

18. IODINE REQUIREMENTS (mg/kg/day) Infants (10-12 mo) 15 Children (1-6 yr) 6 School children (6-12 yr) 4 Adults (12+ yr) 2 Pregnant and 3.5 lactating women

19. DIETARY SOURCES OF IODINE (ug/g) Fish (fresh water) 17-40 Fish (marine) 163-3180 Shellfish 308-1300 Meat 27-97 Milk 35-56 Eggs 93 Grain 22-72 Fruits 10-29 Legumes 23-36 Vegetables 12-201

20. IODINE DEFICIENCY • Leading cause of brain damage worldwide (13% of world • population) • Another 39% at risk • 130 developing countries affected • particularly problematic in pregnant women (iodine • required for fetal development) • even mild cases with no symptoms can result in a • decrement of 15 IQ points

21. How do you know if someone is iodine deficient?

22. How do you know if someone is iodine deficient? • Increased thyroid size • Increased serum TSH levels

25. Regulation of thyroid hormone release

26. Insufficient dietary iodine  Inability of thyroid to make T3/T4  Reduced serum T3/T4  Less T3/T4 inhibition of anterior pituitary TSH synthesis  Increased serum TSH  Increased thyroid growth (goiter)  Increases efficiency of the thyroid for T3/T4 production

27. CONSEQUENCES OF IODINE DEFICIENCY Fetus Abortions/stillbirths Congenital abnormalities Increased perinatal mortality Neurological deficits (cretinism) Mental and growth retardation Psychomotor defects Neonates Goiter Hypothyroidism Children Goiter Hypothyroidism Impaired mental function Retarded growth Adults Goiter Hypothyroidism Impaired mental function

29. A Public Health Story Early 1900’s goiter was highly prevalent in the Great Lakes and Northwest regions of the US 1924: Michigan department of Health does survey in 4 counties. 39% of children have goiter. Begins campaign for iodized salt. 1928: Same counties resurveyed. Goiter down by 75% 1951: Goiter prevalence less than 0.5% 1993: Universal Salt Iodization Program started (WHO). Global rates of goiter, cretinism and mental retardation are declining rapidly.

30. Why salt? • Cheap (0.05 US$ per person per year) • Widely available • Consumed throughout the year

31. Hyperthyroidism – Grave’s Disease • most common cause of hyperthyroidism • autoimmune disorder • Antibodies that stimulate TSH receptor • increased T3/T4 levels • goiter (enlargement of the thyroid)

32. Regulation of thyroid hormone release Antibodies that stimulate TSH receptor

33. Grave’s Disease - Symptoms • Hypermetabolicstate • Increased core body temperature • Increased sweating • Increased heart rate • Increased ventilation • Increased O2 consumption • Weight loss in absence of dieting • Excess sympathetic nervous activity • Psychological symptoms • Overactivity of muscles retracting eyelids: increased staring, decreased blinking • Exopthalmus (protruding eyes) • Increased gut motility (diarrhea)

35. Grave’s Disease - Treatment • Destroy gland • Surgery • Radioactive Iodine • Block T3/T4 synthesis • Thiouricil: inhibits peroxidation of thyroglobulin • Lithium (blocks TSH signal transduction pathway)

36. Hypothyroidism • inadequate production of thyroid hormone • Primary • Ablation of thyroid by surgery/radioisotopes • Hashimoto’s thyroiditis • Autoimmune • idiopathic • Secondary • Lack of TSH

37. Hypothyroidism – Symptoms (adult onset) • Decreased metabolic state • Cold intolerance, fatigue, hypothermia, weight gain • Decreased sympathetic activation • bradycardia • Slowing of intellectual and motor activity • Forgetfulness, apathy, even dementia • Decreased gut motility (constipation) • Myxedema

38. Myxedema • Accumulation of mucopolysaccharides and fluid in tissues • Facial puffiness • Edema • Hoarseness • Joint stiffness • Nerve compressions/parathesias • Pleural, cardiac, and peritoneal effusions

41. Hypothyroidism – Symptoms (childhood onset) • Cretinism (lack of T3/T4 in childhood) • impaired development of skeletal, nervous system • mental retardation • historically, dietary; iodine supplementation eliminates

42. Disorders of growth hormone

46. Growth hormone is secreted in a pulsatile fashion From: Am J PhysiolEndorinolMetab 282:943-51, 2002

47. Effects of growth hormone • Bone growth • Protein synthesis • Anti-insulin effects • Results in: • Decreased adiposity • Increased lean body mass • Increased organ size and mass • Increased plasma glucose concentrations

48. plasma glucose •  • Hypothalamus • GHRH secretion •  • Anterior Pituitary • GH secretion •  • Liver Adipocytes Most cells • Gluconeogenesis  lipolysis  glucose uptake •  • plasma glucose • fatty acids

49. Lengthening occurs at epiphyseal plates • At puberty, epiphyseal plates close • After puberty, bones can get wider, but • not longer

50. at: www.orthopediatrics.com/.../elbow_panners.html