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Is Ketoacidosis Hyposecretion Or Hypersecretion

Chapter 14

Chapter 14

hormones affect although hormones travel throughout the body in blood and lymph, they only go to the target tissues or organs that have specific receptors for the hormone adenohypophysis hormones adrenocorticotropic hormone, follicle-stimulating hormone, growth hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone FSH ovaries- stimulates egg production and increases secretion of estrogen; testes- stimulates sperm production (follicle-stimulating hormone) TH function increases the rate of oxygen consumption and, thus, the rate at which carbohydrates, proteins, and fats are metabolized; also influences growth hormone and plays an important role in maintaining blood pressure calcitonin disorders the most significant effects are exerted in childhood when bones are growing and changing dramatically in mass, size, and shape; and also a hypocalcemic agent in adults sex hormones help maintain secondary sex characteristics, such as the development of the breasts in females and distribution of body hair in adults; includes androgens, estrogens, and progestins dysfunction not caused by a deficiency in the secretion of the adrenal medulla hormones because they merely intensify activities set into motion by the sympathetic nervous system insulin clears glucose molecules from the body by promoting their storage in tissues as carbohydrates when blood glucose levels are high (hyperglycemia), thereby lowering the blood glucose level and enabling the cells to use glucose for energy treatment for hyperthyroidism may involve drug therapy to block the production of thyroid hormones or surgical removal of all or part of the thyroid gland; administer a sufficient amount of radioactive iodine to destroy the thyroid secretory cells Addison disease clinical manifestations incl Continue reading >>

8.01 Identify The General Functions Of The Endocrine System.

8.01 Identify The General Functions Of The Endocrine System.

The endocrine system is responsible for coordinating and regulating body cells, tissues, organs, and systems to maintain homeostasis by secreting chemicals known as hormones. Unlike the nervous system, the effects of the endocrine system are sustained and work for longer periods of time. The endocrine system works primarily on negative feedback mechanisms. 8.02 Describe a “hormone†and how it functions in the body. Hormones are chemical messengers released by one tissue (gland) and transported by the bloodstream to reach the target tissues. The target tissue is where the effect of the hormone actually occurs. Over 50 different hormones 8.02 Describe a “hormone†and how it functions in the body. Regulates chemical and volume of the body’s internal environment Regulates metabolism and energy balance Regulates contraction of cardiac and smooth muscle Regulates certain activities of the immune system Maintains homeostasis despite emergency environmental interruptions infection - trauma - starvation dehydration - hemorrhage emotional stress - temperature extremes Plays a role in normal growth and sequential development Contributes to the process of reproduction 8.03 Describe the locations, secretions, and functions of the major endocrine glands. Hypothalamus Pituitary Thyroid Parathyroid Thymus Pancreas Adrenals Gonads Testes Ovaries Pineal Thalamus Kidneys Liver Stomach Lungs Heart Small Intestine Skin Placenta 8.03 Hypothalamus Coordinates the Endocrine System activities to maintain Homeostasis A small portion of the diencephalon located below the thalamus partially protected by the sella turcica of the sphenoid bone One of the main regulators of homeostasis in the body production and secretion of hormones that control other Endocrine Glands Lack Continue reading >>

Hyperglucagonemia

Hyperglucagonemia

Background Hyperglucagonemia is a state of excess glucagon secretion. In healthy individuals, insulin has a suppressive effect on alpha-cell function and on glucagon secretion. The most common cause of hyperglucagonemia is an absence or deficiency of the restraining influence of insulin on glucagon production. Although rare, hyperglucagonemia can be caused by an autonomous secretion of glucagon by a tumor of pancreatic alpha cells (glucagonoma syndrome). In 1942, Becker and colleagues described the first case report of what, in retrospect, appears to have been a classic presentation of glucagonoma syndrome. The patient presented with diabetes mellitus, weight loss, severe depression, and an unusual erythematous migratory skin rash associated with a malignant tumor of the pancreas of an unknown cell type. The patient later died, following an acute thrombosis of the left iliac vein. In 1965, glucagon was positively identified by radioimmunoassay (RIA) in the tumor and plasma of a patient who presented with symptoms similar to those of the patient from 1942. The patient also had a tumor of the pancreas, with metastasis to the liver. In 1974, in a review of a series of 9 patients who had necrolytic migratory erythema (NME), normochromic normocytic anemia, and diabetes mellitus, with markedly elevated glucagon levels (among other features), Mallinson and colleagues suggested that these findings constituted glucagonoma syndrome. [1, 2, 3, 4, 5, 6, 7, 8] Continue reading >>

Hyper And Hypo Function Of The Pancreas

Hyper And Hypo Function Of The Pancreas

Transcript of Hyper and Hypo Function of the Pancreas Hyper and Hypo Function of the Pancreas Hypoglycemia, Hyperglycemia, Diabetes. Pancreas α - alpha cells - glucagon (increases the glucose in the blood β - beta cells - insulin (decreases the glucose in the blood) γ - gamma cells - PP (pancreatic polypeptide) Δ - delta cells - somatostatin (regulates/stops the α and β cells) There are four main types of cells that can be classified by their secretion. Hyper and Hypo function Hyper function - high secretion of hormones by some cell types. Hypo function - low secretion of hormones by some cell types. There are some conditions that might occur if the pancreas is not working properly. Hypoglycemia Hypoglycemia - abnormal diminished content of glucose in the blood. What it can cause: mild dysphoria seizures unconsciousness neuroglycopenia death Hyperglycemia Hyperglycemia - higher than normal blood glucose level. Chronic hyperglycemia can lead to: neurological damage cardiovascular damage damage of the retina damage of the feet and legs kidney damage diabetic neuropathy Diabetes Diabetes Mellitus Diabetes mellitus (DM) is a metabolic disease in which a person has high blood sugar. Complications : diabetic ketoacidosis (DKA) fatty acids ketone bodies acetoacetic acid acetone Type 1 It results from the body's failure to produce insulin. a) "juvenile diabetes" usually appears in childhood; b) "Brittle" diabetes (unstable diabetes). Symptoms: vomiting dehydration confusion deep gasping breathing coma hyperosmolar hyperglycemic state (HHS) results: dehydration, increases of osmolarity, coma, death. It can be accomplished by some other serious cases. Type 2 It is characterized by insulin resistance which can be combined with relatively reduced insulin secretion. Early stag Continue reading >>

Endocrine Disease

Endocrine Disease

Endocrine diseases are disorders of the endocrine system. The branch of medicine associated with endocrine disorders is known as endocrinology. Types of disease[edit] Broadly speaking, endocrine disorders may be subdivided into three groups:[1] Endocrine gland hyposecretion (leading to hormone deficiency) Endocrine gland hypersecretion (leading to hormone excess) Tumours (benign or malignant) of endocrine glands Endocrine disorders are often quite complex, involving a mixed picture of hyposecretion and hypersecretion because of the feedback mechanisms involved in the endocrine system. For example, most forms of hyperthyroidism are associated with an excess of thyroid hormone and a low level of thyroid stimulating hormone.[2] List of diseases[edit] Glucose homeostasis disorders[edit] Diabetes Type 1 Diabetes Type 2 Diabetes Gestational Diabetes Mature Onset Diabetes of the Young Hypoglycemia Idiopathic hypoglycemia Insulinoma Glucagonoma Thyroid disorders[edit] Goiter Hyperthyroidism Graves-Basedow disease Toxic multinodular goitre Hypothyroidism Thyroiditis Hashimoto's thyroiditis Thyroid cancer Thyroid hormone resistance Calcium homeostasis disorders and Metabolic bone disease[edit] Parathyroid gland disorders Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism Hypoparathyroidism Pseudohypoparathyroidism Osteoporosis Osteitis deformans (Paget's disease of bone) Rickets and osteomalacia Pituitary gland disorders[edit] Posterior pituitary[edit] Diabetes insipidus Anterior pituitary[edit] Hypopituitarism (or Panhypopituitarism) Pituitary tumors Pituitary adenomas Prolactinoma (or Hyperprolactinemia) Acromegaly, gigantism, dwarfism Cushing's disease Sex hormone disorders[edit] Disorders of sex development or intersex disorders Hermaphrodi Continue reading >>

44 What Is A Goiter Explain How Goiters Can Develop

44 What Is A Goiter Explain How Goiters Can Develop

Unformatted text preview: 44) What is a goiter? Explain how goiters can develop in both hyposecretion and hypersecretion disorders. In these hyposecretion and hypersecretion disorders, would you expect the levels of other regulatory hormones involved in control of thyroid hormone secretion to be high or low? Why? Answer: Difficulty: Medium Learning Objective 1: 18.7 Describe the location, histology, hormones, and functions of the thyroid gland. Section Reference 1: 18.7 Thyroid Gland Solution: A goiter is an enlarged thyroid gland. Hyposecretion goiters are usually due to insufficient iodide in the diet. Resulting low levels of thyroid hormones cause increased TRH and TSH until adequate thyroid activity is restored. Graves' disease causes hyperthyroidism by producing an antibody that mimics TSH. Thyroid enlargement occurs, and production of thyroid hormones increases. TRH and natural TSH remain low due to negative feedback, but TSH- mimicking antibody stimulates increased thyroid hormone production and secretion. 45) Compare the metabolic changes that occur during starvation with those that occur in diabetes mellitus. Answer: Difficulty: Hard Learning Objective 1: 18.10 Describe the location, histology, hormones, and functions of the pancreatic islets. Section Reference 1: 18.10 Pancreatic Islets Solution: A starving person is lacking energy-providing nutrient sources, and so, must use structural components of the body as energy sources. The diabetic consumes adequate nutrients, but due to the lack of insulin, is unable to move glucose into cells, and so, cannot use the glucose as an energy source. In both cases, energy generation becomes dependent on non-glucose sources, such as fatty acids and amino acids. Mobilization and metabolism of fats and proteins for energy pr Continue reading >>

Endocrine System

Endocrine System

Introduction The endocrine system consists of glands, specialized cell clusters, and hormones, which are chemical transmitters secreted by the glands in response to stimulation. ES & CNS regulates and integrates the body’s metabolic activities and maintains homeostasis. Hypothalamus: is the heart of the endocrine system It helps control some endocrine glands by neural and hormonal pathways. On the path to the posterior pituitary gland Neural stimulation of the posterior pituitary gland in turn causes the secretion of two effector hormones— antidiuretic hormone (ADH) and oxytocin. Please release me Hypothalamic hormones stimulate the anterior pituitary gland to release four types of trophic (gland-stimulating) hormones: adrenocorticotropic hormone (ACTH) thyroid-stimulating hormone (TSH) luteinizing hormone (LH) follicle-stimulating hormone (FSH). The secretion of trophic hormones stimulates their respective target glands. Hypothalamic hormones also control the release of effector hormones from the pituitary gland. Examples are growth hormone (GH) and prolactin. Getting feedback A negative feedback system regulates the endocrine system by inhibiting hormone overproduction. A patient with a possible endocrine disorder needs careful assessment to identify the cause of the dysfunction. Dysfunction may result from defects: • in the gland • in the release of trophic or effector hormones • in hormone transport • of the target tissue. How do you end up with an endocrine disorder? Endocrine disorders may be caused by: • hypersecretion or hyposecretion of hormones • hyporesponsiveness of hormone receptors • inflammation of glands • gland tumors. Dysfunctional Hypersecretion or hyposecretion may originate in the hypotha Continue reading >>

Human Anatomy & Physiology Ninth Edition

Human Anatomy & Physiology Ninth Edition

PowerPoint® Lecture Slides prepared by Barbara Heard, Atlantic Cape Community College © 2013 Pearson Education, Inc. © Annie Leibovitz/Contact Press Images C H A P T E R 16 © 2013 Pearson Education, Inc. Endocrine System: Overview Acts with nervous system to coordinate and integrate activity of body cells Influences metabolic activities via hormones transported in blood Response slower but longer lasting than nervous system Endocrinology Study of hormones and endocrine organs © 2013 Pearson Education, Inc. © 2013 Pearson Education, Inc. Endocrine System: Overview Controls and integrates Reproduction Growth and development Maintenance of electrolyte, water, and nutrient balance of blood Regulation of cellular metabolism and energy balance Mobilization of body defenses © 2013 Pearson Education, Inc. © 2013 Pearson Education, Inc. Endocrine System: Overview Exocrine glands Nonhormonal substances (sweat, saliva) Have ducts to carry secretion to membrane surface Endocrine glands Produce hormones Lack ducts © 2013 Pearson Education, Inc. © 2013 Pearson Education, Inc. Endocrine System: Overview Endocrine glands: pituitary, thyroid, parathyroid, adrenal, and pineal glands Hypothalamus is neuroendocrine organ Some have exocrine and endocrine functions Pancreas, gonads, placenta Other tissues and organs that produce hormones Adipose cells, thymus, and cells in walls of small intestine, stomach, kidneys, and heart © 2013 Pearson Education, Inc. © 2013 Pearson Education, Inc. Figure 16.1 Location of selected endocrine organs of the body. Pineal gland Hypothalamus Pituitary gland Thyroid gland Parathyroid glands (on dorsal aspect of thyroid gland) Thymus Adrenal glands Pancreas Gonads • Testis (male) • Ovary (female) © 2013 Pearson Continue reading >>

Med Term Quiz4

Med Term Quiz4

Home > Preview Hormone produced by pancreatic alpha cells that increases the blood glucose level by stimulating the liver to change stored glycogen (a starch form of sugar) to glucose Relative constancy or balance in the internal environment of the body, maintained by processes of feedback and adjustment in response to external or internal changes Hormone produced by pancreatic beta cells that acts to remove sugar (glucose) from the blood by promoting its storage in tissues as carbohydrates (glycogen) * Ovaries - in females, stimulates egg production; increases secretion of estrogen * Hyposecretion causes failure of sexual maturation * Testes - in males, stimulates sperm production * Hypersecretion has no known significant effects * Bone, cartilage, liver, muscle, and other tissues - stimulates somatic growth; increases use of fats for energy * Hyposecretion in children causes pituitary dwarfism * Hypersecretion in children causes gigantism; hypersecretion in adults causes acromegaly * Ovaries - in females, promotes ovulation; stimulates production of estrogen and prgesterone * Testes - in males, promotes secretion of testosterone * Hyposecretion causes failure of sexual maturation * Hypersecretion has no known significant effects * Hyposecretion in nursing mothers causes poor lactation * Regulates calcium levels in the blood in conjunction with parathyroid hormone * Secreted when calcium levels in the blood are high in order to maintain homeostasis * The most significant effects are exerted in childhood when bones are growing and changing dramatically in mass, size, and shape * At best, calcitonin is a weak hypocalcemic agent in adults * Increases energy production from all food types * Increases rate of protein synthesis * Hyposecretion in infants causes cretinism; hy Continue reading >>

12 Endocrine

12 Endocrine

A B diabetes insipidus condition caused by insufficient production of antidiuretic hormone or failure of the kidneys to respond to the hormone cretinism congenital hypothyroidism which can cause arrested physical and mental development myxedema severe adult hypothyroidism due to atrophy of the thyroid gland; causes edema with a mucus-like material, dry puffy skin and atherosclerosis thyrotoxicosis severe, potentially life-threatening hyperthyroidism that can lead to congestive heart failure and pulmonary edema Cushing syndrome (hypercortisolism) caused by prolonged exposure to excessive cortisol due to overproduction of the hormone or taking glucocorticoid medication for extended periods of time; moon-shaped face addison disease deficiency of cortisol and aldosterone, most likely due to autoimmune adrenalitis hyperglycemia abnormally high levels of sugar in the blood hypoglycemia abnormally low levels of sugar in the blood; may be due to hyperinsulinism gestational diabetes diabetes that occurs during pregnancy; but usually disappears after delivery thyroid scan visualization of the thyroid by scanning for radiation after the administration of radioactive iodine antithyroid drugs medications that relieve symptoms of hyperthyroidism chemical thyroidectomy administration of radioactive iodine to destroy thyroid cells hypersecretion excessive production and secretion of a hormone hyposecretion deficient production and secretion of a hormone hypothyroidism underactivity of the thyroid; fatigue, sluggishness, weight gain, fluid retention, low body temperature, constipation, slow heart rate acromegaly enlargement of the extremities caused by hypersecretion of growth hormone after puberty gigantism abnormal overgrowth of body tissues caused by hypersecretion of growth hormone Continue reading >>

Regulation Of Hormone Secretion

Regulation Of Hormone Secretion

Homeostasis & Controls Successful compensation Homeostasis reestablished Failure to compensate Pathophysiology Illness Death Figure 1-5: Homeostasis Sensing and signaling: a biological need is sensed, the endocrine system sends out a signal to a target cell whose action addresses the biological need. Key features of this stimulus response system are: ·       receipt of stimulus ·       synthesis and secretion of hormone ·       delivery of hormone to target cell ·       evoking target cell response ·       degradation of hormone Target tissue response will generally be determined by two factors: Plasma Concentrations Normally, the greater the concentration, the greater the response (up to receptor saturation). • The number of cell membrane receptors More receptors obviously result in a greater response. Control of Endocrine Activity Concentration of hormone in blood and extracellular fluid. Almost inevitably, disease results when hormone concentrations are either too high or too low, and precise control over circulating concentrations of hormones is therefore crucial. Control of hormone concentration: Synthesis and secretion of hormones are the most highly regulated aspect of endocrine control. Such control is mediated by positive and negative feedback circuits. Negative Feedback Negative feedback is the primary mechanism through which your endocrine system maintains homeostasis Secretion of a specific hormone is turned on or off by specific physiological changes (similar to a thermostat) EXAMPLE: plasma glucose levels and insulin response Receptor numbers are usually increased when hormone secretion is low and decreased when hormone secretion is high. Also, some hormonal response Continue reading >>

Chapter 18. Dysfunction Initially Described Excessive – Hypersecretion Insufficient - Hyposecretion Today Abnormal Receptor Function Altered Intracellular.

Chapter 18. Dysfunction Initially Described Excessive – Hypersecretion Insufficient - Hyposecretion Today Abnormal Receptor Function Altered Intracellular.

Presentation on theme: "Chapter 18. Dysfunction Initially described Excessive – hypersecretion Insufficient - hyposecretion Today Abnormal receptor function Altered intracellular."— Presentation transcript: 2 Dysfunction Initially described Excessive – hypersecretion Insufficient - hyposecretion Today Abnormal receptor function Altered intracellular response Circulating inhibitors * water-soluble hormones (not steroids – lipid- soluble) 4 Alterations of the Hypothalamic – Pituitary System “ interruption of the pituitary stalk ” Destructive lesions Rupture after head injury Surgical transaction Stem tumor 6 Diseases of the Posterior Pituitary Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) Hypersecretion of ADH Ectopically produced (small cell carcinoma) Brain injury or infection (pulmonary disease) Psychiatric/drugs Water intoxication ( ↓ Na +, hypo- osmolality) 7 Diseases of the Posterior Pituitary Diabetes insipidus Insufficiency of ADH Polyuria and polydipsia Partial or total inability to concentrate urine Neurogenic Insufficient amounts of ADH Nephrogenic Inadequate response to ADH Psychogenic 9 Diseases of the Anterior Pituitary Hypopituitarism – “spectrum” Pituitary infarction Sheehan syndrome ( pituitary necrosis) Hemorrhage Shock Other: head trauma, infections and tumors 14 Diseases of the Anterior Pituitary Hyperpituitarism Commonly caused by a benign slow- growing pituitary adenoma Manifestation Headache and fatigue Visual changes Hyposecretion of neighboring anterior pituitary hormones 15 Diseases of the Anterior Pituitary Hypersecretion of growth hormone (GH) Acromegaly Hypersecretion of GH during adulthood Gigantism Hypersecretion of GH in children and adolescents 21 Diseases of the Anterior Pituitary Hypersecretion o Continue reading >>

Endocrine System Diseases And Disorders - Advanced

Endocrine System Diseases And Disorders - Advanced

How tall can a person become? This may be an exaggeration, but the world's tallest person, Robert Pershing Wadlow, stood almost nine feet tall when he died at the age of 22. Is growing that tall due to a problem with the endocrine system? Diseases of the endocrine system are common and include diseases such as diabetes, thyroid disease, and obesity. An endocrine disease is usually characterized by hyposecretion or hypersecretion of hormones and an inappropriate response to hormone signaling by cells. Cancer can occur in endocrine glands, such as the thyroid, and some hormones are involved in signaling distant cancer cells to multiply. For example, the estrogen receptor has been shown to be involved in certain types of breast cancers. Hyposecretion Hyposecretion is the production of no hormone or too little of a hormone. It can be caused by the destruction of hormone-secreting cells, such as in Type 1 diabetes, or by a deficiency in a nutrient that is important for hormone synthesis. Hyposecretion can be treated with hormone-replacement therapies. Type 1 diabetes is an autoimmune disease that results in the destruction of the insulin-producing beta cells of the pancreas. A person with Type 1 diabetes needs insulin replacement therapy, usually by injection or an insulin pump, in order to stay alive. An insulin pump is shown in Figure below. [Figure2] Diabetes insipidus is characterized by the excretion of large amounts of very dilute urine, even if liquid intake is reduced. It is caused either by an inability of the kidneys to concentrate urine due to a lack of antidiuretic hormone (ADH), also called vasopressin, or by an insensitivity of the kidneys to that hormone. Blood glucose levels are not affected in diabetes insipidus. Growth hormone deficiency is caused by a lack Continue reading >>

Glossary Of Ch 16: Endocrine (cont)

Glossary Of Ch 16: Endocrine (cont)

Circulating insulin lowers blood sugar levels by enhancing membrane transport of glucose into body cells especially (1) muscle and fat cells After glucose enters a target cell, the insulin binding triggers what enzymatic activites? (3) (1)catalyze the oxidation of glucose from ATP production (2)join glucose molecules together to form glycogen (3)convert glucose to fat What happens when insulin levels increase to much (hypersecretion)? the person begins to feel nauseated which precpipiates to fight or flight response What is lipidemia? is when there is a high level of fatty acids in the blood bc the body cannot use sugar as fuel when will ketoacidopsis result? when ketones begin to accumulate in the blood, it causes a pH drops which triggers the ketoacidosis When ketones begin to accumulate in the blood, the pH drops which triggers (1) How does the nervous system repond to ketoacidosis? by initaiating rapid deep breathing to blow off the carbon dioxide from the blood and increase the blood pH The nervous system responds to (1) by initaiting rapid deep breathing to blow off the carbon dioxide from the blood and increase the blood pH Hypoglycemia triggers the release of hyperglycemic hormones which cause (1) anxiety, nervousness, tremors, and weakness What are estrogen responsble for? maturation of the reproductive organs and the appearance of the secoundary sex characteristics What do estrogen and progesterone do together? they promote breast development and cyclic changes in the uterine mucosa What does the testisterone do during puberty? (1)initiates the maturation of the male reproductive organs and the appearnce of the secoundary sex charateristics and sex drive Continue reading >>

Endocrine System Diseases

Endocrine System Diseases

1. Endocrine System Diseases Introduction to Human Diseases: Chapter 14 2. Endocrine System Terminology • Endocrine • Exocrine • Hormone • Target organ • Hypersecretion • Hyposecretion 3. Pituitary Gland Diseases • Hyperpituitarism – Hypersecretion of growth hormone (GH) by the pituitary • Gigantism – GH hypersecretion during puberty and growth years • Person is very tall, proportioned normally • Acromegaly – GH hypersecretion during adulthood – Disfiguring overgrowth of bones & soft tissues 4. Hyperpituitarism • Other aspects: – Gigantism: • Fairly abrupt onset • Non-life threatening • Growth up to 6 inches/yr – Agromegaly: • Gradual onset • Decreases life expectancy • Headache, sinus problems, skin changes, paresthesias, joint pain, visual disorders 5. Hypopituitarism • Deficiency of any or all of the pituitary hormones • Usually involve GH and gonadotropin – LH, FSH, Prolactin, Oxytocin • Less commonly involved: – ACTH and TSH • Panhypopituitarism: – All hormones are deficient 6. Hypopituitarism • S/S: varies with hormone deficiency and age of disease onset – In childhood: S/S are dwarfism and delayed development of 2ndary sexual characteristics – In adults: S/S are amenorrhea, infertility, lowering of testosterone levels, libidy, hair loss. – ACTH & TSH deficiency: general S/S: fatigue, pallor, anorexia, poor stress response 7. Hypopituitarism: • Treatment: hormone replacement 8. Diabetes Insipidus • Hyposecretion of vasopressin – ADH (antidiuretic hormone) • S/S: extreme polyuria, thirst, very dilute urine produced, leads to dehydration • Etiology: anything that destroys the pituitary or idiopathic • Treatment: fluid replacement, hormone replacement (tablet, nasal spray) 9. Thyroid Glan Continue reading >>

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