Hormones I: Quick Reference

What hormones have the source as the Zona glomerulosa?

• Aldosterone

• Cortisol

What is the main action of Aldosterone?

• Na+, Cl-, H2O retention

• K+ and H+ excretion

• ↑ BP

What is the main action of cortisol?

• ↑ blood glucose

• stress response

• immunosuppression

What is the source of DHEA-S / androgens

• Zona reticularis

What is the main action of DHEA-S / androgens

• weak androgens

• sex-steroid precursors

• hirsutism screen

What is he source of epinephrine / norepinephrine?

• adrenal medulla

what is the main action of epinephrine / norepinephrine?

• fight of flight

• ↑ HR, BP, glucose

What is the source of Dopamine?

• Medulla / hypothalamus

What is the main action of Dopamine?

• reward, movement, inhibits prolactin

What is the source of Serotonin?

• Enterochromaffin cells

What is the main action of Serotonin

• mood, sleep, GI, vasoconstriction

What hormones is the anterior pituitary the source?

• ACTH

• FSH / LH

What is the main action of ACTH?

• stimulates cortisol

What is the main action of FSH/LH?

• FSH - grows the follicle / supports spermatogenesis

• LH - triggers ovulation / testosterone

What is the main action of Inhibin?

• selectively inhibits FSH release

What is the source of Inhibin?

• sertoli cells (males)

• granulosa cells (female)

What is the source of Testosterone?

• Leydig cells (testis)

What is the main action of testosterone?

• male secondary characteristics

• negative feedback on LH

What is the source of estrogen?

• ovarian follicle, placenta

What is the source of progesterone?

• corpus luteum, placenta in pregnancy

What is the main action of estrogen?

• follicular phase rise triggers LH surge

What is the main action of progesterone?

• rises after ovulation

• suppresses LH in luteal phase

What is the source of Estriol?

• fetal adrenal + fetal liver + placenta

What is the main action of Estradiol?

• marker of fetoplacental well-being

What is the source of hCG?

• trophoblast / placenta

what is the main action of hCG?

• maintains corpus luteum, pregnancy test, tumor marker

What is the source of ADH / oxytocin?

• hypothalamus → posterior pituitary

What is the main action of ADH / oxytocin?

• water retention / uterine contraction

What condition does this indicate:

Cortisol: ↑

ACTH: ↓

ACTH-independent

• Primary Hypercortisolism (adrenal tumor)

What condition does this indicate:

Cortisol: ↑

ACTH: ↑

High-dose dexamethasone suppresses (> 50%)

• Crushing disease (pituitary adenoma)

What condition does this indicate:

Cortisol: ↑

ACTH: ↑

No suppression at any dose, no CRH response, normal imaging

• Ectopic ACTH

  • small cell lung carcinoma

What condition does this indicate:

Cortisol: ↓

ACTH: ↑

Aldosterone also ↓ → low Na+, high K+

• Addison disease (primary insufficency)

What condition does this indicate:

Cortisol: ↓

ACTH: ↓

aldosterone normal

electrolytes closer to normal

• Secondary insufficiency (pituitary)

What condition does this indicate:

Cortisol: ↓

ACTH: ↑

enzyme deficiency

aldosterone ↓

androgens ↑

• Congenital adrenal hyperplasia

What disease patterns are associated with the cortisol axis?

• Primary hypercortisolism

• Cushing disease

• Ectopic ACTH

• Addison disease

• Secondary insufficiency

• Congenital adrenal hyperplasia

what diseases are associated with the gonadal axis pattern?

• Primary hypogonadism

• Secondary / tertiary hypogonadism

• Menopause

• GnRH-dependent precocious puberty

• GnRH-independent precocious puberty

What disease is this?

• Sex steroid ↓

• FSH/LH ↑

• level of defect: gonad

• Primary (hypergonadotropic) hypogonadism

  • Klinefelter 47, XXY

What disease is this?

• Sex steroid ↓

• FSH/LH ↓

• level of defect: pituitary / hypothalamus

• Secondary / tertiary (hypogonadotropic) hypogonadism

  • Kallmann

What disease is this?

• Sex steroid : estrogen ↓, inhibin ↓

• FSH/LH ↑

• level of defect: ovary

• Menopause

What disease is this?

• Sex steroid : ↑

• FSH/LH ↑

• level of defect: early activation of whole axis

• GnRH-dependent precocious puberty

What disease is this?

• Sex steroid : ↑

• FSH/LH ↓

• level of defect: peripheral steroid source

• GnRH-independent precocious puberty

What are examples of Amine metabolites and tumors

• VMA, metanephrines

• HVA

• 5-HIAA

What does VMA, metanephrines point to?

• Pheochromocytoma and paraganglioma

• also neuroblastoma

What are the parent hormones of VMA, metanephrines?

• epinephrine

• norepinephrine

What are the parent hormones of HVA?

• dopamine

What does HVA point to?

• Neuroblastoma

What are the parent hormones of 5-HIAA?

• Serotonin

What does 5-HIAA point to?

• Carcinoid tumor

  • fast overnight before collection

What is the important order of dysfunctions?

• Primary: target gland

• Secondary: pituitary

• Tertiary: hypothalamus

What is the parent of ALL steroid hormones, including androgens and estrogens?

• cholesterol

What is the cortisol axis?

• CRH (41aa) → ACTH (39aa) → cortisol

• with negative feedback at both upper levels

Explain Diurnal Cortisol.

• highest at 8 am

• lowest late evening (11 pm)

• paired specimens at 8 am and 4 pm

Explain the difference between Crushing syndrome and disease

• Cushing syndrome

  • any cause

• Cushing disease

  • pituitary adenoma specifically

what is the most sensitive screen for hypercortisolism?

• urinary free cortisol

  • confirmed using midnight salivary cortisol

What does high-dose dexamethasone supress?

• Crushing disease

• NEVER suppresses ectopic ACTH

What are qualities of Addison disease?

• ↓ cortisol

• ↑ ACTH

• ↓ Aldosterone

  • low sodium, high potassium

  • low glucose

What are qualities of Conn Syndrome?

• hypertension

• low potassium

• alkilosis

What is the ACTH stimulation test?

• what definitely demonstrates primary adrenal insufficiency

  • an impaired cortisol response to ACTH

What is ectopic?

• hormone from a tissue that normally does NOT make it

  • ACTH from small cell lung carcinoma

  • hCG from lung tumor

What is the rate limiting enzyme of catecholamine synthesis?

• Tryosine hydroxylase

What makes metanephrines?

• COMT

  • VMA is the final metabolite

What is the best test for pheochromocytoma?

• urinary metanephrines

What does Norepinephrine do?

• raises heart rate and blood pressure

• constricts peripheral vessels

What does DHEA-S do?

• adrenal androgen

• screens for hirsutism and virilization

• no diurnal rhythm

• measured on serum

What is associated with anterior pituitary?

• Adenohypophysis

What is associated with posterior pituitary?

• neurohypophysis

• stores and releases ADH and oxytocin

What hormones are non-tropic?

• GH

• prolactin

• MSH

What hormones are tropic?

• ACTH

• TSH

• FSH

• LH

what hormone inhibits FSH?

• Inhibin

What is the Prolactin-inhibiting hormone?

• dopamine

What triggers an LH surge?

• estrogen

What releases the ovum?

• LH