ENDOCRINOLOGY

Maria Ruth B. Pineda, RMT, MSMT

2 Physiologic Regulatory Systems

Endocrine system Nervous system
Neuroendocrine System

Types of Glands
Endocrine Exocrine

Endocrine System
consists of ductless glands, which secrete hormone directly into the circulatory system

Major Glands of Endocrine System

Pituitary Gland Thyroid Gland Parathyroid Gland Adrenal Gland Pancreas Reproductive Glands (ovaries & testes) Thymus Gland Pineal Gland

Hormones
from a Greek word hormon meaning to set in motion intercellular chemical signal transported to act on tissues at another site of the body to influence their activity

Functions of Hormones:
regulate the chemical composition and volume of the ECF help regulate metabolism and energy balance help regulate contraction of smooth and cardiac muscles and secretion of glands help maintain activities of immune system

Functions of Hormones:
plays a role in the smooth sequential integration of growth and development contribute to the basic processes of reproduction help maintain homeostasis

Types of Hormones
Circulating hormones/Endocrines: Local Hormones
Paracrines Autocrines

Functional Types of Hormones

Releasing Hormones:
promote secretion of Ant. Pituitary hormones

Inhibitory Hormones:
suppress the secretion of a particular hormone

Tropic Hormones:
stimulate growth & activity of other endocrine glands

Effector Hormones:
targets non endocrine cells

Types of Hormones according to Structure

Steroids Biogenic Amines Peptides and Proteins Glycoproteins Eicosanoids

Steroids
lipids derived from cholesterol transported to blood stream through attachment to transport protein

Biogenic Amines (AA)

tyrosine
Thyroid hormones Adrenal hormones

Peptides and Proteins

synthesized by rough ER hypothalamic releasing and inhibiting hormone

Glycoproteins
AA derivatives with CHO groups

Eicosanoids
Fatty acids with 20 carbon atom fatty acid (arachidonic fatty acid)

Mechanism of Hormone Action

Hormone
Received by neurons Coordinated with neuroendocrine system

Receptor

Sensory input from environment

Hypothalamus

H-receptor complex

Metabolic activities/synthesis

Hypothalamic hormones

1st target: Ant.Pituitary gland

Thyrotropin, FSH, LH

2nd target: a. thyroid T3, T4 to muscles & liver b. Ovaries & testes
Estrogen, progesterone, testosterone to reproductive organs

Post. Pituitary Gland responsible for blood glucose Islet cells of pancreas Insulin & glucagon to liver & muscles

Hypothalamus
collection of specialized cells located at the central part of the brain main link between the endocrine & nervous system control the pituitary gland by production of chemicals that stimulate or suppress hormone secretion of pituitary

Hypothalamus

Hormones:
TRH GnRH GH-IH GH:RH CRH PIF

PITUITARY GLAND

Pituitary Gland (hypophysis)

small egg shaped gland located at the base of the brain beneath the hypothalamus master gland divided into 2 lobes: anterior & posterior

Anterior Pituitary Gland

regulates the activity of thyroid, adrenals, and reproductive glands GH, PRL, TSH, FSH, LH, ACTH also secretes ENDORPHINS

Anterior Pituitary Gland

Hormones:
GH: growth of bone and soft tissues PRL: for lactation TSH: release of thyroid hormones FSH: growth of the follicle and initial wave of spermatogenesis LH: ovulation and final follicular growth and production of testosterone ACTH: release of cortisol

Anterior Pituitary Gland

Growth Hormone
stimulates AA transport and nucleic acid & CHON synthesis exerts major effects on cartilage and growth of long bones increases hepatic glucose effect in excess and exerts anti-insulin effect in muscles increases lipolysis elevating levels of plasma free FA

Anterior Pituitary Gland

Prolactin (PRL)
controls the initiation and maintenance of lactation requires priming by estrogens, progestins, corticosteroids, thyroid hormones, and insulin

Anterior Pituitary Gland

Thyroid Stimulating Hormone (TSH)

increases size of thyroid follicular cells increases uptake of iodide by thyroid cells from the ECF increases release of thyroxine from the thyroid colloid follicles stimulates biosynthesis of thyroxine differentiates pituitary hypothyroidism from primary hypothyroidism

Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH)/(ICSH)

gonadotropic hormones FSH: growth and maturity of ovarian follicles, estrogen secretion, promotes endometrial changes (1st: proliferative phase of mens), spermatogenesis LH: ovulation and secretion of androgens and progesterone, initiates secretory phase of mens (2nd), formation of corpus luteum and development of testicular cells

Anterior Pituitary Gland

Anterior Pituitary Gland

Adrenocorticotropic Hormone (ACTH)

acts primarily on the adrenal cortex, to stimulate growth and secretion of corticosteroids follows circadian rhythm elevated during times of stress

Anterior Pituitary Gland

Types of cells
Acidophils: GH, PRL Basophils: TSH, FSH, LH, ACTH chromophobes

Hormones:

Posterior Pituitary Gland

Oxytocin or pitocin: for contraction of uterus and ejection of milk primed with estrogen ADH or arginine vasopressin or pitressin: permeability of kidney tubules

DISEASES ASSOCIATED WITH HORMONES OF THE PITUITARY GLAND

Dwarfism

Pituitary Gland

hyposecretion of GH during growth years types:

Achrondroplasia Hypoachondroplasia Spondyloepiphyseal Dysplasia Diastrophic dysplasia

Pituitary Gland

Gigantism
hypersecretion of GH during childhood

Pituitary Gland

Acromegaly
hypersecretion of GH during adulthood

Galactorrhea
inappropriate production of breast milk due to hypersecretion of PRL symptoms: irregular menstruation, menopausal symptoms, milk discharges, difficulty in getting erection, breast tenderness and enlargement

Pituitary Gland

Pituitary Gland

Amenorrhea
absence of menstrual cycle in females due to hypersecretion of PRL

Pituitary Gland

Impotence
inability to attain penile erection in males due to hypersecretion of PRL

Pituitary Gland

Infertility
lack of FSH and LH in both male and female inability to conceive after 1 year of unprotected intercourse

Pituitary Gland and Adrenal Gland

Cushings disease
hypersecretion of ACTH leads to bilateral adrenal hyperplasia and cortisol overproduction Obesity!!!

Pituitary and Adrenal Gland

Addisons disease
secondary (ACTH) or tertiary (CRH) adrenal insufficiency hyposecretion of glucocorticoids and aldosterone

Polyuria
deficient ADH production or action
Hypothalamic DI Nephrogenic DI Psychogenic or primary polydypsia

Pituitary Gland

Syndrome of Inappropriate ADH Secretion (SIADH)

Pituitary Gland

autonomous sustained production of AVP in the absence of known stimuli for its release malignancy, CNS diseases, pulmonary disorders drug therapies

Laboratory Measurement of Some Hormones Secreted by the Pituitary Gland

Growth Hormone Immunoassay

uses specific GH antibody draw specimens every 20-30 minutes over a 1224 hours period Insulin tolerance test: to produce hypoglycemia and provoke GH release
Basal: 2-5 ng/mL or ug/L Insulin tolerance: >10 ng/mL Arginine/L-dopa: >7.5 ng/mL

hGH-EASIA
solid phase Enzyme Amplified Sensitivity Immunoassay Mab 1-hGH-Mab-HRP absorbance is measured after colorimetric reaction
Day: <0.2-10 uIU/mL Night: 30 uIU/mL

Prolactin Immunoassay
homologous competitive binding immunoassay/sandwich technique uses two or more antibodies directed at different parts of the PRL molecule hook effect
Adult male: 3-14.7 ng/mL or ug/L Adult female: 3.8-23 ng/mL or ug/L Pregnancy, 3rd tri: 95-473 ng/mL

ACTH Immunoassay
measures the amount of adrenocorticotropic hormone (ACTH) in blood like chemiluminescence and ELISA using ACTH antisera related test: cortisol reacts with intact ACTH and ACTH fragments
Adults: 5-80 pg/mL (X 0.22= pmol/L) Specimen: P, EDTA

ACTH Stimulation Test

cosyntropin test or tetracosactide test small amount of synthetic ACTH is injected, and the amount of cortisol or Aldosterone is measured distinguish whether the cause is adrenal (low cortisol and aldosterone production) or pituitary (low ACTH production) Fasting (8 hrs)

LH
LH Ovulation Dipstrip Urine Test
coloured bands will appear on the test card to indicate whether or not the LH surge is occurring presence of two purple bands of similar color and intensity indicate an increase in LH is detected - test approximately the same time each day - reduce liquid intake two hours before testing

LH Immunoassay (EIA/IRMA)
Mab1-LH-Mab2HRP
measured using chromogenic reaction Absorbance proportional to LH concentration

Mab1-LH-Mab2125I

Fertility test (male)

Semen analysis Testosterone Prolactin Luteinizing Hormone ( LH) Follicle Stimulating Hormone ( FSH): Estradiol ( Day 3): 300-1100 ng/dl 7-18 ng/ml 2-18 mIU/ml

2-18 mIU/ml <50 pg/ml

Fertility test (female)

Phase of Cycle
Hormone Follicular Day of LH Surge

FSH < 10 mIU/ml > 15 mIU/ml LH < 7 mIU/ml > 15 mIU/ml PRL < 25 ng/ml FSH: measures your ovarian reserve (ovarian function) low levels of FSH & LH: hypogonadotropic hypogonadism high LH with a normal FSH level: PCOD (polycystic ovarian disease) high prolactin: hyperprolactinemia

Fertility test (female)

Hormone Estradiol Progesterone Follicular Day of LH Surge < 50 pg/ml > 100 pg/ml < 1.5 ng/ml > 15 ng/ml

estradiol: rises as follicle matures mature follicles: > 200-300 pg/ml of estradiol; for monitoring superovulation P >15 ng/ml about 7 days after ovulation: corpus luteum is functioning normally low Day 21 P suggests the cycles was anovulatory

Serum FSH Measurement (IRMA)

measures the amount of follicle stimulating hormone (FSH) in blood Mab1-serum-Mab2125I used to assess and manage disorders of the endocrine glands, including suspected infertility related tests: LH, PRL, testosterone, estradiol

Normal Values for serum FSH

Female, menstruating:
Follicular phase: 1.4-9.9 mIU/mL (IU/L) Ovulatory phase: 0.2-17.2 mIU/mL (IU/L) Luteal phase: 1.1-9.2 mIU/mL (IU/L)

Postmenopausal: 19.3-100.6 IU/L Male: 1-15.4 mIU/mL (IU/L)

ADH Measurement
measures the amount of antidiuretic hormone, or vasopressin, in blood Related tests: sodium and osmolality
270-280 mOsm/kg: <1.5 pg/mL (<1.4 pmol/L)

280-285 mOsm/kg: <2.5 pg/mL (<2.3 pmol/L) 285-290 mOsm/kg: 1-5 pg/mL (0.9-4.6 pmol/L) 290-295 mOsm/kg: 2-7 pg/mL (1.9-6.5 pmol/L) 295-300 mOsm/kg: 4-12 pg/mL (3.7-11.1 pmol/L)

THYROID GLAND

Thyroid Gland
located in front of the lower neck bow tie or butterfly like Follicles: structural units of thyroid Colloid: homogenous viscous fluid consisting mainly of a glycoprotein iodine complex called thyroglobin secretes T3 and T4 and calcitonin

Thyroid Gland

Types of cells:
Follicular cells: T3 and T4
calorigenesis & O2 consumption CNS activity and brain development Cardiovascular stimulation, bone and tissue growth and development GI regulation and sexual maturation

Perifollicular cells: calcitonin

regulation of calcium

Thyroid Gland

T3 and T4
Hormone Bound ( Albumin, Prealbumin, Globulin) T3 99.8% Free

0.2%

T4

99.98%

0.02%

DISEASES ASSOCIATED WITH HORMONES OF THE THYROID GLAND

Thyroid Gland

Cretinism
hyposecretion of thyroid hormones during fetal life or infancy Iodine deficiency

Thyroid Gland

Myxedema
hypothyroidism during the adult years

Thyroid Gland

Hashimotos disease
acquired hypothyroidism in later childhood due to development of autoantibodies to thyroid tissue components

Thyroid Gland

Goiter
an enlarged thyroid gland which is a symptom of many thyroid disorders

Graves Disease

Thyroid Gland and Pituitary Gland

hyperthyroidism which is an autoimmune disorder hypersecretion of thyroid stimulating immunoglobulins (TSIs)

Laboratory Measurement of Some Hormones Secreted by the Thyroid Gland

Serum Free Triiodothyronine

measures the amount of free triiodothyronine (T3) in blood used to evaluate and manage disorders of the thyroid gland related tests: TSH, FT4
Adults: 1.4-4.4 pg/mL (0.22-6.78 pmol/L) N>37 weeks (cord blood): 15-391 pg/dL (0.2-6 pmol/L) Pregnancy, 1st: 211-383 pg/dL (3.2-5.9 pmol/L) Pregnancy, 2nd: 196-338 pg/dL (3-5.2 pmol/L) Pregnancy, 3rd: 196-338 pg/dL (3-5.2 pmol/L)

FT3 and FT4

Direct Equilibrium Dialysis

uses undiluted serum dialyzed for 16-18 hours at 37C dialysate is then analyzed directly using RIA
2-128 ng/L (2.6 to 165 pmol/L)

FT3 and FT4

Ultracentrifugation
serum is adjusted to pH of 7.4 incubated for 20 minutes at 37C ultracentrifuge for 30 minutes at 37C and 2000 rpm ultrafiltrate is analyzed by immunoassay less time consuming than dialysis

Triiodothyronine Measurement
measures the level of total T3 in blood used to evaluate and manage thyroid dysfunction, including hyperthyroidism related tests: FT4, T3 uptake
Adults: 60-181 ng/dL (0.92-2.78 nmol/L) Pregnancy (last 5 mos): 116-247 ng/dL (1.79-3.8 nmol/L)

Serum Total T4 Competitive Immunoassay

measures the total amount of thyroxine/T4 (both free and CHON bound)in blood uses barbital buffers (vs TBPA) and 8-anilino-1naphthalene-sulfonic acid (vs TBG)
Adults: 4.5-10.9 g/dL (58-140 nmol/L)

TSH Immunoassay
measures the amount of thyroid stimulating hormone (TSH) in blood using chemiluminescence w/ low detection limit related tests: T3 and T4
Adults: 0.5-4.7 units/L Pregnancy (1st): 0.3-4.5 units/L Pregnancy (2nd): 0.5-4.6 L Pregnancy (3rd): 0.8-5.2 L

Anti-TSH Receptor Autoantibody

for diagnosis of Graves disease detects autoantibodies that interfere with the binding of TSH to TSH receptor serum + TSH receptor + I125 labelled TSH tracer amount of free tracer is measured
lower than 9 U/L

Thyrotropin Releasing Hormone (TRH) Stimulation Test

injection of TRH and measurement of the output of TSH used in the diagnosis of combined pituitarythyroid disorders differentiates 2 hypothyroidism and 3 hypothyroidism

Other Laboratory Tests:

RAI uptake:

Thyroid Gland

based on the ability of the thyroid to concenrate, convert and release I2

TBI:
based on the thyroid hormone transport system indirectly measuring the amount of TBG

Thyroid Gland

Other Laboratory Tests:

PBI:
based on thyroid hormone concentration representing the organic fraction of blood iodine that precipitates with serum proteins

BMR:
based on metabolic response measuring the O2 consumption in the resting fasting state

PARATHYROID GLAND

Parathyroid Gland
four tiny glands attached to the thyroid releases PTH
actions directed to bone, kidney and intestines controls calcium and phosphate metabolism with the help of calcitonin

Parathyroid Gland

Types of cells:
Chief cells

Oxyphil cells

DISEASE ASSOCIATED WITH HORMONES OF THE PARATHYROID GLAND

Parathyroid Gland

Clinical significance of PTH

Tetany: hypoparathyroidism and deficiency of calcium abnormally high PTH values may indicate primary, secondary, or tertiary hyperparathyroidism, chronic renal failure, malabsorption syndrome, and vitamin D deficiency

Laboratory method for PTH:

PTH level measurement:
overnight fasting
Intact PTH: 10-65 pg/mL PTH N-terminal (includes intact PTH): 8-24 pg/mL PTH C-terminal (includes C-terminal, intact PTH, and midmolecule): 50-330 pg/mL

related tests: Calcium, Phosphorus and Creatinine

ADRENAL GLAND

Adrenal Gland
a triangular gland on top of the kidney Adrenal cortex
regulates salt & water balance, responds to stress, metabolism, immune system, & sexual development & function

Adrenal medulla
consists of Chromaffin cells produces catecholamines from tyrosine

Hormones:
Outer zone (zona glomerulosa):
mineralocorticoids (aldosterone)

Adrenal cortex

Middle zone (zona fasciculata):

glucocorticoids (cortisol and cortisone), regulate CHO, CHON, and fat metabolism

Inner zone (zona reticularis):

sex hormones

Adrenal cortex

Mineralocorticoids (aldosterone)
responsible for fluid and electrolyte balance sodium reabsorption and water retention maintain osmolality

Adrenal cortex

Glucocorticoids (cortisol & cortisone)

enhances glucose production from CHONs, acting as insulin antagonist (cortisol) only hormone to inhibit the anterior pituitary secretion of ACTH by negative feedback (cortisone): reacts with stress stimulate lipolysis, provide resistance to stress and depress immune responses urinary metabolite: 17-hydroxycorticosteroids

Adrenal cortex

Sex hormones/Androgenic steroids

Estrogen, progesterone, dehydroepiandrosterone (DHEA), androstenedione, and testosterone Male: development of sexual characteristics, usually insignificant Female: influence female sex drive, pubic hair, axillary hair growth

Adrenal medulla

Hormones
Epinephrine (70%) Norepinephrine (30%) Dopamine
mobilize energy stores and prepare the body for muscular activity and stressful conditions (increase heart rate and BP, and increase blood sugar)

Urinary metabolite: vanillyl mandelic acid (VMA)

DISEASES ASSOCIATED WITH HORMONES OF THE ADRENAL GLAND

Adrenal Gland

Hyperaldosteronism
hypersecretion of aldosterone 1: due to an adenoma, hyperplasia, adrenal carcinoma, glucocorticoid suppressible aldosteronism
greatly affects electrolyte balance

2: stimulus outside the adrenal gland

Adrenal Gland

Hypoaldosteronism
deficient aldosterone production seen in Addisons disease, kidney disease-2 (hyporeninemic hypoaldosteronism), enzyme defects, acquired due to heparin therapy or surgery

Pituitary Gland and Adrenal Gland

Cushings syndrome
hypersecretion of cortisol due to primary adrenal disease like adenoma features: truncal obesity, moon face, hypertension, hirsutism

Pituitary and Adrenal Gland

Addisons disease
primary adrenal insufficiency due to progressive dysfunction or destruction of the gland symptoms: fatigue, weakness, weight loss, GI disturbances, postprandial hypoglycemia hyposecretion of adrenal hormones

Congenital Adrenal Hyperplasia (Adrenogenital Syndrome)

Adrenal Gland

congenital absence or deficiency of one or more of the biosynthetic enzymes needed in cortisol biosynthesis hyperplasia: ACTH stimulation because of low levels of cortisol ambiguous genitalia for girls, and precocious puberty for boys

Adrenal Gland and Gonads

Virilism or hirtuism
elevated plasma testosterone in women as a result of ovarian or adrenal tumor (virilizing adenoma)

Adrenal Gland and Gonads

Gynecomastia
excessive growth (benign) of the male mammary glands due to an adrenal tumor (feminizing adenoma) which secretes feminizing hormone (estrogen)

Adrenal Gland

Pheochromocytoma
tumor of the adrenal medulla that is a cause of hypertension

Adrenal Gland

Neuroblastoma
fatal malignant condition in children in which cancer of the nervous system causes excess production of norepinephrine

Laboratory Measurement of Some Hormones Secreted by the Adrenal Gland

Aldosterone Measurement
measures the amount of aldosterone in blood related tests: sodium and potassium test is done in the morning position affects the result: seat upright alcohol intake
supine, normal-Na diet: 2-9 ng/dL (55-250 pmol/L) upright, normal-Na diet: 2 to 5x supine value supine, low-Na diet: 2 to 5x supine value

Urine Free Cortisol Measurement (UFC)

measures the amount of cortisol in urine 24-hour urine collection avoid drinking alcohol before and during the urine collection normal:<2% of cortisol is seen in urine >120 g/day is diagnostic
RIA (adults): 20-70 g/day (55-193 nmol/24 hrs) HPLC (adults): 50 g/day (138 nmol/24 hrs)

Serum Cortisol Measurement

amount of cortisol in blood used to help diagnose adrenal gland dysfunction caused by conditions such as Addison's disease and Cushing's syndrome related test: ACTH pregnancy (FE) 8 AM to noon: 5-25 g/dL (138-690 nmol/L)
8 PM to 8 AM: 0-10 g/dL (0-276 nmol/L)

Dexamethasone Suppression Test

1 mg at midnight serum cortisol is measured the following day (8:00 AM) suppressed to <5 g/dL or 140 nmol/L

ACTH Stimulation test

Cosyntropin test evaluates the hyposecretion of adrenal gland exogenous ACTH is administered cortisol should be increased by twofold to threefold within 60 minutes

Adrenal antibody test

detects antiadrenal antibodies, which attack the body's own adrenal gland, in blood used to diagnose and monitor patients suspected to have autoimmune adrenocortical insufficiency related test: ACTH
Adults: Negative at 1:10 dilution

PANCREAS

Pancreas
lying immediately beneath the stomach both an exocrine and an endocrine gland

Pancreas

Types of tissues:
Acini
Islets of Langerhans

Pancreas

Hormones
Glucagon: glycogenolysis and gluconeogenesis Insulin: glycogenesis, glycolysis, lipogenesis Somatostatin

DISEASES ASSOCIATED WITH HORMONES OF THE PANCREAS

Pancreas

Diabetes mellitus
deficiency of insulin or defects in insulin receptors

Pancreas

Hyperinsulinism
hypersecretion of insulin may be due to a tumor, insulinoma

Pancreas

Glucagonoma
hypersecretion of glucagon by a tumor

Pancreas

Somatostatinoma
hypersecretion of somatostatin by a tumor

Laboratory Measurement of some hormones secreted by the Pancreas

Insulin C-peptide Measurement

measures the level of a by-product of the hormone insulin called C-peptide in blood used to know how much insulin is being produced in the body fasting specimen
Adults: 0.5 - 2.0 ng/mL (0.17 - 0.66 nmol/L)

Anti-Insulin Antibody Test (RIA)

measures the amount of antibodies to insulin used when insulin resistance in diabetes is suspected determination of the binding of 125I-Tyr-Al4insulin to the serum fraction precipitated by PEG related test: Insulin C-peptide
<8.2% binding

Glucagon Immunoassay (RIA)

glucagon competes with 125I tracer for binding sites amount of 125I is measured and is inversely proportional to the concentration of glucagon
Fasting: 60-200 pg/mL

Gonads
main source of sex hormones Testes: androgens (testosterone)
sexual development (muscle enlargement, growth of body hair, voice changes, male sexual drive)

Ovaries: located in the pelvis

secrete estrogen and progesterone and relaxin
for sexual development (breast enlargement, distribution of fats), menstruation, pregnancy

Diseases associated with Hormones secreted by Gonads

Female Pseudohermaphroditism
genetically female but whose phenotypic characteristics are, to varying degrees, male exposure to androgens before the 12th week of gestation

Precocious Puberty
development of secondary sexual characteristics in girls < 8 yrs old and boys < 9 years old premature hair and breast development

Kallmann Syndrome
most common form of hypogonadotropic hypogonadism due to deficiency of GnRH both seen in males and females

Testicular Feminization Syndrome

Androgen insensitivity syndrome defect in androgen action males w/ female habitus & develop breast tissue blind vagina with rudimentary testes

Laboratory Measurement of some hormones secreted by the Gonads

Estrone Measurement
measures the amount of estrone in blood note pregnancy and menstruation
Prepubertal children 1-10 yrs:<56 pmol/L Adult males: 55-240 pmol/L Adult females (menstrual phase):
Early follicular phase: 55-555 pmol/L Luteal phase: 55-740 pmol/L

Pregnant: increases 10-fold from 24th to 41st wk

Progesterone RIA
Mab1-Progesterone-Mab2125I
Male: 0.6-2.11 ng/mL Female:
Follicular: 0.70-1.78 ng/mL Ovulatory: 0.79-3.95 ng/mL Luteal: 4.57-17.56 ng/mL Menopause: 0.43-2.13 ng/mL

Serum Estradiol Measurement

used for conditions such as amenorrhea, early puberty or hypogonadism related tests: FSH, LH, testosterone, PRL
Postmenopausal: <59 pg/mL (217 pmol/L) Menstruating Adult Female
Follicular phase: <20-145 pg/mL (184-532 pmol/L) Midcycle peak: 112-443 pg/mL (411-1,626 pmol/L) Luteal phase: <20-241 pg/mL (184-885 pmol/L)

Adult Male: <20 pg/mL (184 pmol/L)

Total Testosterone EIA

measure the total amount of testosterone uses salicylates or sulfactants, pH alterations, temperature changes, and competing steroids related tests: FSH, LH, PRL, free testosterone
Adult M (morning): 9.36-37.1 nmol/L Adult F (morning): 0.21-2.98 nmol/L Pregnant: 3 to 4 times normal Postmenopausal: 0.28-1.22 nmol/L

RIA (125I)

Thymus Gland
lies in the upper part of the thoracic cavity important in the immune system, especially early in life secretes thymosin
helps in the development of WBCs (T cells)

Pineal Gland/Body
small pinecone shaped located in the middle of the brain secretes melatonin
decreases the secretion of LH and FSH by decreasing the release of hypothalamic releasing hormone (inhibits functions of reproductive system) plays an important role in the onset of puberty regulates sleep and wake cycle

SUMMARY of Glands and Hormones

Gland Anterior Pituitary Gland Posterior Pituitary Gland Thyroid Gland Parathyroid Gland Hormones GH, TSH, ACTH, MSH, LH/ICSH, FSH, PRL ADH, Oxytocin T3, T4, Calcitonin PTH

Adrenal Gland

Epinephrine, norepinephrine, dopamine, mineralocorticoids, glucocorticoids, adrenal androgens

Insulin, glucagon, somatostatin Testosterone, estrogens, progesterone Thymosin Melatonin

Pancreas Reproductive Gland Thymus Gland Pineal Gland

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