CHAPTER 21

Endocrine System
Learning Objectives
1. Define key terms and abbreviations relating to the endocrine system.
2. Describe the function of the endocrine system.
3. Identify the glands of the endocrine system and name at least one hormone produced
by each of the endocrine glands.
4. Discuss how the endocrine system adjusts with the hormonal changes of puberty,
pregnancy, and menopause.
5. Describe at least three methods used to assess the function of the endocrine system.
6. Describe at least five disorders of the endocrine system.
7. Discuss issues and innovations relating to the endocrine system.
KEY TERMS
Basal metabolic rate
(BAY-sal met-uh-BOL-ik rayt) Minimal energy expended for respiration, circulation,
peristalsis, muscle tone, body temperature, and glandular activity of the body at rest
Endocrine
(EN-do-krin) Glands that secrete internally into blood or lymph
Exophthalmos
(ek-sof-THAL-mus) Abnormal protrusion of eyeball
Gonadotropin
(go-NAD-o-trope-in) Any hormone that stimulates the reproductive organs
Hormone
(HORE-mone) Chemical substance produced in the body that has specific regulatory
effect on the activity of a specific organ
Hyperglycemia
(hi-per-glie-SEE-mee-uh) Abnormally high sugar content in the blood
Hypoglycemia
(hi-po-glie-SEE-mee-uh) Abnormally low sugar content in the blood
Immunoassay
(im-yoo-no-AS-say) Quantitative determination of antigenic substances by examination of
blood
Polydipsia
(pol-ee-DIP-see-uh) Excessive thirst persisting for long periods
Polyphagia
(pol-ee-FAY-jee-ah) Excessive hunger
Polyuria
(pol-ee-YOO-ree-uh) Passage of a large volume of urine in a given time
Prostaglandin
(pros-tah-GLAN-din) Lipid molecule that has hormone-like effect; tissue hormone
Puberty
(PYOO-ber-tee) Period during which the secondary sexual characteristics begin to develop
and the capability of sexual reproduction is attained
Endocrine System Terminology∗

An adenoma may be benign or cancerous, like this adenocarcinoma of the

intestines. (From Cooke RA, Stewart B: Colour atlas of anatomical pathology, ed
3, Sydney, 2004, Churchill Livingstone.)
Term Definition Prefix Root Suffix

Acromegaly Enlargement of the extremities acro megaly

Adenoma Tumor of a gland aden oma

Adenomalacia Softening of a gland aden/o malacia

Adrenalectomy Removal of the adrenal gland adrenal ectomy

Endocrine To secrete inside endo crine

Hyperglycemia Too much sugar in the blood hyper glyc emia

Pancreatitis Inflammation of the pancreas pancreat itis

Polyphagia Excessive hunger poly phagia

Polyuria Excessive excretion of urine poly uria

Thyroidectomy Removal of the thyroid thyroid ectomy

∗ A transition syllable or vowel may be added to or deleted from the word parts to make
the combining form.
Abbreviations of the Endocrine System

Abbreviation Meaning

ADH Antidiuretic hormone

ANS Autonomic nervous system

BMR Basal metabolic rate

DM Diabetes mellitus

FSH Follicle stimulating hormone

GH Growth hormone

SIADH Syndrome of inappropriate antidiuretic hormone

STH Somatotropic hormone

TH Thyroid hormone
 Abbreviation Meaning

TSH Thyroid-stimulating hormone

Structure and Function of the Endocrine System

The primary function of the endocrine system is to produce hormones that monitor and coordinate
body activities (Fig. 21-1). Chemical agents related to the endocrine system can be divided into
four groups based on their method of signaling:
▪ Autocrine—the cell synthesizes a chemical and responds to it
▪ Paracrine—chemicals diffuse into an area and interact with nearby cells

FIGURE 21-1 The endocrine system. (From Patton KT: The human body in health and
disease, ed 6, St Louis, 2014, Mosby.)
▪ Intracrine—acts inside a cell to regulate intracellular events
▪ Endocrine—chemicals secreted into the blood and tissue fluids to other cells
Hormones are chemical messengers secreted by the endocrine glands. Each type of hormone
moves through the blood to its own target cells, which react specifically to it. The endocrine glands
secrete hormones directly into the bloodstream. Hormones may be proteins, glycoproteins,
polypeptides, amino-acid derivatives, or lipids.
Hormones may be divided into two classes on the basis of their composition and the way they
influence their target organs:
▪ Nonsteroid hormones are proteins that work as “first-messengers.” They act on cells of the target
organ to cause them to produce or release a second messenger molecule.
▪ Steroid hormones influence the target organ independently.
Hormones may also be divided into categories on the basis of their function:
▪ Tropic hormones target other endocrine structures to increase their growth and secretions.
▪ Sex hormones influence reproductive changes.
▪ Anabolic hormones stimulate the process of building tissues.
Hormones direct many body processes, including growth, metabolism, and reproductive
functions (Table 21-1). Hormones regulate the body’s reaction to stress and maintain the internal
environment (homeostasis). The importance of hormones in the body can be demonstrated by the
numerous and diverse disorders that occur when the amount of hormone produced is either too
great (hypersecretion) or too little (hyposecretion). The quantity of hormones in the blood is
monitored through a negative feedback mechanism, which stimulates more secretion when needed
(Fig. 21-2). Additionally, the autonomic nervous system controls and stimulates the secretion of
the hormones of the adrenal gland.

TABLE 21-1
Endocrine Glands and Hormones∗

Gland Hormone Function

Pituitary Somatotropin (or growth Promotes tissue growth and development

hormone [GH])

Hypothalamus Thyrotropin Releasing Affects pituitary to affect thyroid gland

Hormone (TRH) activity

Pineal Melatonin Supports the biological clock

Thyroid Thyroxine (TH) Regulates the metabolic rate

Parathyroid Parathyroid hormone (PTH) Regulates calcium and phosphates in the

bloodstream and bones
Gland Hormone Function

Thymus Thymosin Stimulates development of T cells

Adrenal Epinephrine Regulates autonomic nervous system

response

Pancreatic islets Insulin Regulates blood sugar

Ovaries Estrogen Regulates female sexual characteristics

Testes Testosterone Regulates male sexual characteristics

∗Most of the endocrine glands secrete more than one hormone with functions not listed
here.

FIGURE 21-2 The triggered factor for the negative feedback mechanism of hormone
control may be the concentration of a hormone or other substance such as calcium in
the blood.
 Glands and Their Hormones
Hypothalamus
The hypothalamus is a structure located above the pituitary gland that translates nervous system
impulses into endocrine system messages. Although the hypothalamus releases tropic hormones
into the blood, the anterior pituitary is affected more quickly because the blood vessels are in a
direct line. The hypothalamus also produces hormones that have an effect on body tissues. The
growth hormone–releasing hormone is an example of a tropic hormone that causes the anterior
pituitary to secrete growth hormone. The hypothalamic–pituitary–adrenal axis is a series of
secretions and feedback that control the “fight-flight” reaction to stress. Two hormones produced
in the hypothalamus that are then secreted by the posterior pituitary are oxytocin (OT) and
antidiuretic hormone (ADH).

FIGURE 21-3 Effects of hormones from the pituitary gland. (From Applegate E: The
anatomy and physiology learning system, ed 4, St Louis, 2011, Saunders.)

Pituitary
The pituitary gland (hypophysis) has been called the “master” gland because the hormones that it
produces regulate the secretion of other glands (Fig. 21-3). It is located at the base of the brain and
is divided into two parts: the anterior and posterior.

Brain Byte
Although the pituitary gland is called the “master” gland because its hormones control other
glands, the hypothalamus releases chemicals that stimulate the release of pituitary hormones.
The anterior pituitary (adenohypophysis) gland produces seven hormones:
▪ Thyroid-stimulating hormone (TSH) stimulates the growth and secretion of the thyroid gland.
▪ Adrenocorticotrophic hormone (ACTH) stimulates the growth and secretion of the adrenal cortex.
▪ Follicle-stimulating hormone (FSH) stimulates the growth of the ovarian follicle, production of
estrogen in females, and production of sperm in males.
▪ Luteinizing hormone (LH) stimulates ovulation and the formation of the corpus luteum in the
menstrual cycle.
▪ In males the LH, called interstitial cell-stimulating hormone, stimulates the secretion of
testosterone.
▪ Lactogenic hormone (prolactin) stimulates the secretion of milk and influences maternal behavior.
▪ Somatotropic hormone, also called the growth hormone, accelerates the growth of the body.
The posterior pituitary (neurohypophysis) secretes two hormones:
▪ ADH, or vasopressin, maintains water balance by increasing the reabsorption of water by the
kidneys.
▪ Oxytocin (Pitocin) promotes the ejection of milk and stimulates uterine contractions during
pregnancy.

Brain Byte
Endocrine disruptors are chemicals that mimic a natural hormone and trigger overproduction or
underproduction of hormones.

Pineal Body
The pea-sized pineal body is a gland located deep within the brain. It produces the hormone
melatonin. Melatonin regulates the release of substances in the hypothalamus of the brain that
influence secretion of the pituitary gonadotropins, or sex hormones. It is believed that melatonin
inhibits the activity of the ovaries and LH secretion. Thus it influences the menstrual cycle and
onset of puberty. Melatonin is also believed to be involved in the regulation of the “biological
clock,” or the body’s physiologic reaction to changes in light and dark.

Thyroid
The thyroid, a butterfly-shaped gland with two lobes, is located in the neck. The thyroid produces
hormones that regulate body metabolism. They are called thyroxine and tri-iodothyronine. Iodine
is required for production of both of these hormones. Calcitonin, another hormone produced by
the thyroid, decreases the amount of calcium in the blood.

Parathyroid
The parathyroids are actually four tiny glands attached to the back of the thyroid gland. They
secrete parathyroid hormone, which also affects the amount of calcium in the blood. This hormone
increases the blood’s calcium level by breaking the bonds of calcium and phosphorus compounds
in the bones. It also increases the rate of phosphorus excretion by the kidneys.

Thymus
The thymus is a butterfly-shaped gland located above the heart. It produces the hormone thymosin,
which stimulates the lymphoid organs to produce T lymphocytes or antibodies in newborns and
young children. The thymus gland provides additional immunity until it disintegrates and is
replaced with fatty tissue at the time of puberty.

Pancreas
The pancreas, located behind the stomach, produces the hormones insulin and glucagon. Insulin
regulates the transportation of sugar, fatty acids, and amino acids into the cells. It also participates
in protein synthesis. The action of glucagon opposes that of insulin by increasing the blood sugar
level. The pancreas is the only gland that has both endocrine and exocrine functions. Chapter
19 provides more information about the exocrine function of the pancreas.

Adrenal Glands
The adrenal glands are located above the kidneys. Each gland can actually be divided into two
layers, called the adrenal cortex and adrenal medulla. The adrenal cortex produces about 30
hormones, including glucocorticoids, mineralocorticoids, and androgens. Three of the most
important hormones of the cortex are cortisol, aldosterone, and androgen. Glucocorticoids produce
an anti inflammatory response, metabolize food, and make new cells. Mineralocorticoids control
the body’s fluid level and electrolyte balance by influencing the rate of excretion of mineral salts
(sodium and potassium) by the kidneys. Androgenic hormones stimulate the development of male
sexual characteristics, including increased body size, and affect the buildup of protein tissues
(anabolism).
The adrenal medulla produces epinephrine (adrenaline) and norepinephrine. Epinephrine
initiates the “fight or flight” reaction to stress. Along with norepinephine, increases heart rate,
blood pressure, and blood sugar, and it decreases the blood flow to the internal organs.

Gonads
The gonads are the primary sexual glands. In the female the ovaries produce estrogen and
progesterone. The ovaries are located in the lower abdomen beside the uterus. Estrogen and
progesterone stimulate breast development, hair placement, and menstruation. Estrogen also
initiates ovulation. Progesterone assists in the normal development of pregnancy.
In the male the primary sexual organs are the testes, located in the external scrotal sac. The testes
produce the hormone testosterone. Testosterone stimulates secondary characteristics of the male,
including a lowered voice, body hair growth, and muscular development.

Prostaglandins
Prostaglandins are fatty hormones that are produced by tissues throughout the body that influence
the tissues surrounding the area. Prostaglandins are known to decrease blood pressure, cause fever,
increase hydrochloric acid secretion in the stomach, increase uterine contraction during pregnancy,
and influence intestinal peristalsis. These “tissue hormones” are broken down quickly in the body.

Hormonal Changes of Puberty

Puberty is the time during which the body matures sexually. Hormones of the pituitary gland direct
the changes that occur during puberty. These stimulate the gonads to secrete the hormones that
cause the testes and ovaries to mature. In males the testes enlarge. In females the menstrual cycle
(menarche) begins. Both acquire the ability to reproduce. Chapter 24 provides more information
about the reproductive system.
The adrenal gland secretes the hormones that begin the development of secondary sexual
characteristics, those body features that are different in males and females but do not directly affect
reproduction. In the male the voice deepens and facial hair begins to grow. In the female the breasts
enlarge and fatty tissue is deposited around the hips. In both males and females, height and weight
increase. Emotional changes, which have been attributed to hormonal changes, may also occur
during this growing time.

Hormonal Changes of Pregnancy

 With the onset of pregnancy, many hormonal changes occur that influence the appearance and
function of the woman’s body. The placenta, or interfacing organ between the fetal and maternal
circulation, produces a hormone called human chorionic gonadotropin (HCG), which stimulates
the development and secretions of the ovaries to maintain the uterine lining. HCG can be detected
in the urine and is used for pregnancy testing.

Brain Byte
In 2012 the ADA reported that 29.1% of Americans have diabetes costing $245 billion annually.
The increased estrogen and progesterone from the ovaries are maintained until the placenta
begins to produce these hormones for the duration of the pregnancy. Progesterone increases the
mobility of the pelvic and lower bones of the back to allow the birthing process and may result in
backache. Dilation of the ureters and renal pelvis may lead to an increase in urinary frequency.
Progesterone also decreases the mobility and tone of the gastrointestinal tract and causes relaxation
of the pyloric sphincter. It may cause heartburn and constipation.
During pregnancy the pituitary and thyroid glands increase in size, resulting in a higher
metabolic rate. The adrenal gland secretions increase, especially aldosterone. An increase in the
plasma level of insulin may be due to an increase in lipids or fats in the blood. Additionally, the
destruction of insulin is faster during pregnancy, which may lead to a condition called “gestational”
diabetes in which the woman’s pancreas cannot produce enough insulin. The changes in the
hormonal levels during early pregnancy may also be responsible for the nausea and vomiting called
“morning sickness.”

Hormonal Changes of Menopause

Menopause, or climacteric, is the term used to describe the time during which the female stops
menses. Menopause occurs after a decrease in secretion of the gonadotropins FSH and LH. This
change leads to a decrease in the secretion of the hormone estrogen by the ovaries. Hot flashes,
periods of feeling extreme heat, are the only universal symptoms of menopause. Estrogen
replacement therapy may be given after menopause in some instances.

Assessment Techniques
Hormonal disorders except diabetes mellitus (types 1 and 2) and thyroid disease are rare. Thyroid
function may be assessed by using basal metabolic rate and protein-bound iodine studies.
However, results of both of these tests can be affected by many other factors. Several other
methods used for assessment of the endocrine disorders include immunoassay, radioiodine uptake
studies, and glucose tolerance testing.
▪ Basal metabolic rate is the amount of energy necessary to maintain the functions of a resting
body, including circulation, respiration, digestion, and cell metabolism. The basal metabolic rate
is measured by a test called indirect calorimetry, which measures the amount of oxygen
consumed.
▪ Protein-bound iodine is a blood test to measure the amount of proteins attached to thyroxine. Test
results may be influenced by cough syrups, iodine used in tests, diuretics, steroids, and
pregnancy.
▪ Immunoassay is a chemical test in which a blood specimen is mixed with a specific agent. The
number of antigens formed indicates the presence of certain hormones.
▪ Radioiodine uptake involves drinking radioactive iodine and measuring the iodine absorbed by
the thyroid with a Geiger counter. The rate that the thyroid removes the iodine from the blood
indicates how well it is functioning.
▪ The glucose tolerance test assesses the function of the pancreas, using urine and blood specimens.
Glucose is given and specimens are compared over time. This measures the efficiency of the
insulin production of the pancreas.

Disorders of the Endocrine System

Acromegaly (ak-ro-MEG-uh-lee) is an enlargement of the bones of the hands, feet, and jaws (Fig.
21-4). It results from an increased secretion of somatotropic (so-mah-to-TROP-ik) hormone,
usually caused by a pituitary tumor. Heavy perspiration, oily skin, excess body hair, high blood
pressure, and other symptoms may also result. Treatment includes surgical removal of the tumor
or radiation to destroy gland tissue.

Addison (AD-ih-sun) disease is caused by hyposecretion of the hormones produced by the

cortex of the adrenal gland. The person with Addison disease experiences excessive skin
pigmentation, decreased blood sugar, and decreased blood pressure, which result in muscle
weakness, fatigue, gastrointestinal disturbances, and dehydration. Treatment includes
administration of cortisone, a decrease in sodium intake, and monitoring the level of potassium
and sodium in the blood.

Cretinism (KREE-tin-izm) is a condition resulting from a congenital deficiency of thyroid

secretion, or hypothyroidism (hi-poe-THI-royd-izm). The basal metabolic rate and mental and
physical growth are decreased. Early indications of hypothyroidism include jaundice, excessive
drowsiness, and a hoarse cry. Hypothyroidism can be treated by oral administration of thyroxine,
and early treatment can minimize mental and physical damage.

Cushing (KOOSH-ing) syndrome is a disorder that causes hyperactivity of the adrenal glands,
which has been triggered by oversecretion of the pituitary hormone ACTH. The person with
Cushing syndrome has a redistribution of fat, giving a distinctive “moon face” and “buffalo hump”
appearance (Fig. 21-5). Sexual dystrophy, increased blood pressure, unusual hair growth
(hirsutism), and easy bruising also result. Treatment depends on the cause of the hormone
imbalance. If the cause is a tumor, surgical removal, radiation, and medication to control cortisol
may be used.
FIGURE 21-4 Acromegaly is characterized by enlargement of the bones of the hands,
feet, and jaws with an increase in the soft tissue covering them. (Courtesy Henry M.
Seidel, MD.)

Diabetes insipidus (die-uh-BEE-tez in-SIP-i-dus) results from an acquired or inherited decrease

in the pituitary hormone ADH. The main sign is an increase in urine production (polyuria) that
leads to an intense thirst (polydipsia), weakness, constipation, and dry skin. Treatment is related
to the cause and may include giving ADH by injection or nasal spray.

Case Study 21-1

You are helping admit a patient to the hospital for fatigue and weight loss. He has lost 64 lb in 2
years even though he is eating more. He also complains of being thirsty and irritable all the time.
What should you do?
Answers to Case Studies
are available on the Evolve website: http://evolve.elsevier.com/Gerdin/Careers
Diabetes mellitus (die-uh-BEE-tez mel-LIE-tus) is a complex disorder of carbohydrate, fat, and
protein metabolism resulting from insufficient insulin production by the pancreas. Its cause is
unknown. The person with diabetes mellitus experiences unusual thirst (polydipsia), increased
urine output (polyuria), and unusual hunger (polyphagia) (Table 21-2). Hyperglycemia may
result, which is a greater-than-normal amount of glucose in the blood, causing nausea, headache,
coma, and, if untreated, eventual death.
Two main types of diabetes mellitus exist. Type 1 can occur at any age and results when the
pancreas does not produce insulin. Treatment includes injection of insulin to meet this need. Type
2 diabetes is linked with obesity. The pancreas does not produce enough insulin to meet the need
of the body. Treatment may include oral hypoglycemic medication and weight loss. Having a
blood glucose level that is higher than normal but not high enough to be classified as diabetes is
called prediabetes. The Centers for Disease Control and Prevention (CDC) estimated that 79
million Americans aged 20 years or older were prediabetic in 2010.
FIGURE 21-5 Cushing syndrome. (Swartz M: Textbook of physical diagnosis, ed 7,
2015, Saunders.)

TABLE 21-2
Signs and Symptoms of Diabetes Mellitus

Hyperglycemia Hypoglycemia

Increased thirst Weakness

Increased urination Trembling

Weight loss Drowsiness

Increased appetite Headache

Hyperglycemia Hypoglycemia

Nausea Confusion

Vomiting Dizziness

Fatigue Double vision

Ketoacidosis Insulin shock

Brain Byte
According to the CDC, people with prediabetes can reduce the onset of type 2 diabetes by 58%
with lifestyle changes, including a 5% to 7% weight loss and at least 150 minutes of physical
activity per week.

Case Study 21-2

Your friend who has diabetes tells you she is feeling faint and needs something to eat quickly.
What should you do?
Answers to Case Studies
are available on the Evolve website: http://evolve.elsevier.com/Gerdin/Careers
Dwarfism (DWARF-izm) is usually characterized by a normal trunk and head with shortened
extremities. It results from hyposecretion of the growth hormone of the pituitary gland, which has
been caused by a tumor, infection, genetic factors, or trauma (Fig. 21-6). If discovered in the
development years, dwarfism can be treated with injections of a somatotropic hormone (growth
hormone) for 5 years or longer. Treatment may also include surgery to correct the direction of
bone growth or lengthen the limbs. Dwarfism does not affect intelligence.
FIGURE 21-6 Dwarfism results from low levels of pituitary growth hormone during the
early years and is the opposite of the condition of gigantism. (Courtesy Ewing
Galloway.)

Gigantism (ji-GAN-tizm), or giantism (see Fig. 21-6), is an excessive growth of the long bones
caused by hypersecretion of the somatotropic hormone. Treatment may include medication,
radiation, and surgery.
Graves (grayvz) disease is caused by hyperthyroidism (hi-per-THIE-royd-izm) or
thyrotoxicosis (thie-ro-tok-sih-KO-sis). The person with Graves disease experiences nervousness,
rapid pulse, weight loss, irritability, sensitivity to heat, increased basal metabolic rate and blood
sugar; and sometimes exophthalmos, or protruding eyeballs. Treatment includes removal of part
or all of the thyroid, radioactive iodine therapy, and administration of drugs to decrease the
thyroxine level. Adults older than 40 years can be given radioactive iodine to destroy thyroid
tissue.
Hyperparathyroidism (hi-per-pare-ah-THIE-roid-izm) causes hypercalcemia (hi-per-kal-SEE-
mee-uh), an increased calcium blood level. It can cause kidney stone formation. The calcium is
taken from the bones, which can lead to fractures and deformities. This condition is often caused
by an adenoma (ad-uh-NO-mah), a glandular tumor, and treatment requires its removal.
Hypoglycemia (hi-po-glie-SEE-mee-uh) results from increased insulin production by the
pancreas. The low blood sugar causes fatigue, tremors, cold sweats, headache, and weight
disturbances. Treatment is based on the cause and may include a diet that is low in carbohydrates
and high in protein.
Hypoparathyroidism (hi-po-par-uh-THIE-roid-izm) is a decreased secretion of parathyroid
hormone that causes tetany. Blood calcium levels are decreased, interrupting function of the
nerves. The sufferer experiences a convulsive twitching. Death may result if the respiratory
muscles are affected. Treatment is giving oral supplements of vitamin D, calcium, and
parathormone.
 Hypothyroidism (hi-po-THIE-royd-izm) results from an insufficient production of thyroxine. It
may be caused by an autoimmune disorder, iodine deficiency, or malfunction of the pituitary gland
or hypothalamus. Hypothyroidism is most often caused by Hashimoto disease (thyroiditis).
Hashimoto disease is an autoimmune disorder in which the body attacks the thyroid gland. The
thyroid enlarges to compensate for the deficiency, resulting in goiter (GOY-ter) (Fig. 21-7). This
leads to increase in fat tissue and sluggishness. Myxedema (mik-seh-DEE-muh) is the most severe
form of hypothyroidism. The person with myxedema experiences edema, obesity, lethargy,
decreased heart rate, decreased intelligence, sensitivity to cold, and coarse skin. Treatment
includes administration of oral thyroid extract.

Case Study 21-3

You are helping to admit a patient to the hospital for chronic tiredness and difficulty concentrating.
She also complains of weight gain and constipation. She tells you she is chilly and needs another
blanket. What should you do?
Answers to Case Studies
are available on the Evolve website: http://evolve.elsevier.com/Gerdin/Careers
Syndrome of inappropriate antidiuretic hormone (SIADH) involves water intoxication and the
dilution of intracellular and extracellular body tissues. Antidiuretic hormone production is
increased in the pituitary gland. SIADH can lead to convulsions and death. Some of the causes
include medications, post-operative stress, hormones, or CNS or pulmonary disorders. Treatment
is based on the cause and includes management of the serum sodium level.

Virilism (VIR-i-lizm) results from increased secretion in the adrenal glands. Adrenal virilism
may be present at birth due to congenital adrenal hyperplasia. It may also develop later in life due
to a tumor. The female may develop male sexual characteristics, including facial hair, broad
shoulders, and small breasts. Treatment focuses on the cause of hypersecretion by the gland.

FIGURE 21-7 Simple goiter is a painless enlargement of the thyroid gland that may
result from inadequate iodine intake in the diet. (From Swartz MH: Textbook of physical
diagnosis, ed 7, St Louis, 2014, Saunders.)
Issues and Innovations
Diabetes
According to the CDC, more than 29 million people, or 9.3% of the U.S. population, have diabetes.
Of those, 8.1 million or 27.8% are undiagnosed. Another 86 million adults have prediabetes. Based
on a 2014 National Diabetes Statistics Report, 1.7 million people aged 20 and older were newly
diagnosed with diabetes in 2012. Diabetic retinopathy is the leading cause of blindness in
American adults over the age of 40 (Fig. 21-8). It remains the seventh leading cause of death in
the United States. It is considered to be epidemic in China, India, and many emerging countries.

FIGURE 21-8 Complications of diabetes mellitus. (From Damjanov I: Pathology for the
health professions, ed 4, St Louis, 2012, Saunders.)

Exubera, a new form of insulin that can be taken with an inhaler, was approved by the U.S. Food
and Drug Administration (FDA) and became available in 2006. Exubera could be used by patients
who have either type 1 or type 2 diabetes. Pfizer discontinued the production of Exubera in 2007
due to poor sales, patent issues, and a possible association with lung cancer. In 2014 a new
inhalable insulin product called Afreeza was approved by the FDA for general sale.
 Generex Biotechnology Corporation developed an insulin medication that can be sprayed into
the buccal mucosa or mouth. Generex Oral-lyn was approved by the FDA for experimental use in
2009.
Transplantation of a donor pancreas has a 95% rate of survival for at least one year. Another
method of treatment creates an artificial pancreas by implanting bioengineered tissue that contains
islet cells into the pancreas. Investigation is in progress to transfer the insulin gene into another
organ such as the liver, intestine, or stomach.
In 2002 Florida became the first state to offer screening for diabetes mellitus to all newborns.
The newborns will be monitored throughout their lifetime. The purpose of this program is to
identify newborns with genetic risk for developing type 1 diabetes and refer them to clinical trials
and research designed to end the disease.
Another clinical trial uses infusion of cord stem cells into children with type 1 diabetes. Using
the children’s own cells, the researchers are comparing this treatment with standard insulin
injection. Preliminary results indicate that infusion of cord blood stem cells is safe and may slow
the progression of type 1 diabetes in children.

Steroid Abuse
Abuse of hormones continues to be a problem, especially by athletes hoping for better
performance. In a 2013 National Institute of Drug Abuse survey, 1.1% of 8th grade students, 1.3%
of 10th grade students, and 2.1% of 12th grade students admitted they had tried steroids.
Performance-enhancing or “ergogenic” steroids are commonly abused. These include
somatotropin, or growth hormone, and androgenic anabolic steroids such as testosterone. The
benefit, if any, from use of these hormones in sports training is far less than the health risk imposed.
The effects of even a short use of these steroids can be long lasting or permanent.
Synthetic growth hormone was developed to treat children with a deficiency of this pituitary
hormone. Some athletes believe that supplementing exercise with growth hormone will improve
performance, but such improvement has not been shown scientifically. It is known that an
oversupply of the hormone in adults leads to physical changes of acromegaly.
Androgenic anabolic steroids, including synthetic drugs similar to the hormone testosterone,
have been banned by most major sports organizations. Muscle growth can be increased with use
of anabolic steroids, but the risks and complications far exceed the benefits. Effects on men include
early baldness, stunted growth, changes in liver structure, liver tumors, decreased sperm
production, testicular atrophy, enlarged breasts, and increased risk of cardiovascular disease.
Effects on women include menstrual irregularities, complete loss of menstrual cycle (amenorrhea),
abnormal hair placement (hirsutism), baldness, and irreversible deepening of the voice. Bad breath,
severe acne, headache, dizziness, hypertension, mood swings, and aggressiveness (“roid rages”)
are commonplace in both sexes.

Case Study 21-4

You notice that one of your friends has more facial hair and is adding muscle weight and seems
aggressive most of the time. What should you do?
Answers to Case Studies
are available on the Evolve website: http://evolve.elsevier.com/Gerdin/Careers
In 1988 anabolic steroids were classified as a controlled substance by federal law. Possession
and selling of illegal steroids has both federal and state criminal penalties and is a felony.
Conviction for the selling of steroids results in up to 7 years in prison.
 Summary
▪ The function of the endocrine system is to produce hormones that monitor and coordinate body
activities.
▪ Endocrine system structures include the pineal, hypothalamus, thyroid, pituitary, and thymus
glands, as well as others.
▪ The hormone produced by the thyroid gland (thyroxine) regulates body metabolism.
▪ Methods used to assess the endocrine system include basal metabolic rate, protein-bound iodine
blood tests, and radioactive uptake.
▪ Disorders of the endocrine system include acromegaly, cretinism, Cushing syndrome, diabetes
insipidus, and diabetes mellitus.

Review Questions
1. Describe the functions of the endocrine system.
2. Describe the location and function of each of the following parts of the endocrine system:

Adrenal medulla Pituitary

Pineal body Prostaglandin

3. Describe three tests used to assess the function of the endocrine system.
4. Describe three changes that occur during puberty as a result of hormonal changes.
5. Describe three changes that occur during pregnancy as a result of hormonal changes.
6. List five side effects and risks of using androgenic anabolic hormones.
7. Use the following terms in one or more sentences that correctly relate their meaning:
endocrine, hormone, hyperglycemia, polyphagia, and polyuria.

Critical Thinking
1. Investigate and compare the cost of at least three tests used to diagnose disorders of the endocrine
system.
2. Investigate the function of at least five common medications used in treatment of the endocrine
system.
3. List at least five occupations involved in the health care of endocrine system disorders.
4. Compare the difference between the conditions of being a dwarf or midget.
5. Investigate and describe the function of the following exocrine glands: lacrimal, mammary,
salivary, and sudoriferous.
6. Use the Internet to prepare an oral, written, or slide presentation using a computer program such
as Google Docs or Prezi that describes the incidence of steroid abuse in sports and the methods
used to combat this problem. Create a pamphlet that describes the issue.
7. Use the Internet to prepare an oral, written, or slide presentation using a computer program such
as Google Docs or Prezi that describes a recent development or treatment method relating to the
endocrine system.
8. Use the Internet to prepare an oral, written, or slide presentation using a computer program such
as Google Docs or Prezi that describes CDC success stories for diabetes prevention in Alaska,
North Dakota, or Texas.
9. Use the Internet to prepare an oral, written, or slide presentation using a computer program such
as Google Docs or Prezi that compares and provides examples of autocrine, paracrine, intracrine,
and endocrine agents.

Explore the Web

Diabetes Success Stories
CDC
http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm

CDC
http://www.cdc.gov/diabetes/

IDF Diabetes Atlas

http://www.idf.org/diabetesatlas/

Steroid Abuse
National Institute on Drug Abuse
http://www.drugabuse.gov/students.html

U.S. Department of Justice

http://www.deadiversion.usdoj.gov/pubs/brochures/steroids/professionals