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Download MBBS 1st Year Physiology Endocrinology Physiology Notes Notes

Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 1st Year (First Year) Physiology Endocrinology Physiology Notes Handwritten Notes

This post was last modified on 11 August 2021

MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities


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HORMONES

HORMONE RECEPTORS:

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TSH

Protein Hormones

Catecholamines

Thyroid Hormones

Steroid Hormones

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Cytoplasmic receptors

MODE OF ACTION OF STEROID HORMONES:

Hormone + Receptor

TR complex

DNA

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HR complex

PremRNA

mRNA

Ribosomes

Protein

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Response

MODE OF ACTION OF PROTEIN HORMONES & CATECHOLAMINES

ECE

Cytoplasm

CAMP

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ATP

Protein Kinase A

Response.

Adrenal Gland

Thyroid gland

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TH, ADH

Mineralocorticoids

Glucagon, Catecholamines

Hypophysis/Pituitary Gland

Adenohypophysis

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Ant. Pituitary

Master Gland

Ectodermal

Develops from Rathke's pouch

Neuromypophysis

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Post Pituitary.

Neuroectodermal in origin

Developed from ventricle

Pars distalis

Pars intermedia

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Pars tuberalis

Pars nervosa.

Hormones of Ant. Pituitary

Somatotrophs/Somanotropes

Lactotrophs/Lactotropes

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Corticotrophs - ACTH & B-lipotropin

Thyrotrophs - TSH

Gonadotrophs - FSH, LH

Classical Tropic Hormones - ACTH, TSH, FSH, LH

Ant. Pituitary

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Chromophobes - taken no stain; secrete no hormone

Chromophils - take stain; secrete hormone

Regulation of Ant. Pituitary Secretion

Hypothalamus controls ant. pituitary by secreting releasing & inhibiting hormones which are called neurohormones. These hormones are transported to ant. pituitary through hypothalamic portal vessels.

Hormones of Hypothalamus: (all are peptide hormones except Dopamine)

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  1. Growth Hormone Releasing Hormone (GHRH)
  2. Corticotropic Releasing Hormones (CRH)
  3. Thyrotropin Releasing Hormone (TRH)
  4. Gonadotrophin Releasing Hormone (GnRH)
  5. Growth Hormone Inhibiting Hormone (Somatostatin)
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  7. Prolactin Inhibiting Hormone (Dopamine)

Regulation of GH Secretion

Hypoglycemia, fasting, starvation

Exercise, stress, trauma.

Hypothalamus

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GHIH/Somatostatin

GHRH

GHRP

Anterior Pituitary

GH

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Liver

Other tissues.

Somatomedin

Action of GH:-

GH acts on bones, growth & protein metabolism through somatomedin secreted by liver.

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Somatomedin: substance through which GH acts.

Types

IGF-I/Somatomedin C

IGF-II

Related to insulin except there is C-chain extension of A-chain & domain

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Acts on bones & protein metabolism

Insulin Like IGF

Role in fetus growth

Duration of Action:

GH

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IGF-I/Somatomedin C

Loose binding with plasma protein. Released from plasma protein rapidly

Binds with plasma protein strongly

Released slowly from plasma protein

Action lasts for short duration

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Action continuesly for long duration

Mode of Action of Somatomedin C/IGF-I

Via 2nd messenger cAMP

GH Receptor/GHS [Growth Hormone Secretagogue]

GH + GHS (transmembrane receptor) - cytokine family

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Mainly liver cells

HR complex

Intracellular Enzyme Pathways

Somatomedin secretion.

Hormones of Post. Pituitary

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  1. ADH/Vasopressin
  2. Oxytocin.

Neurohypophysis doesn't secrete any hormones

ADH & Oxytocin - synthesized in hypothalamus.

Hypothalamo-hypophyseal tract (axonic flow)

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Post pituitary.

Stored at Nerve endings.

When myelinated from Hypothalamus reach post pituitary, hormones are released from Nerve endings.

Neurohormones

Neurophysin winding protein which transport ADH & Oxytocin from Hypo post pituitary via hypothalamo-hypophyseal tract.

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Neurophysin I/Oxytocin Neurophysin

Winding protein for oxytocin.

Neurophysin II/ADH Neurophysin.

Winding protein for ADH/Vasopressin.

Secreted by supraoptic nuclei of hypothalamus (mainly)

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Paraventricular nucleus (in small qty)

Actions:

ADH

+Vasopressin V2 Receptor

ADH-Receptor complex

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Gs

GTP

AC

ATP

cAMP

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PKA

AQ-2

Increase reabsorption of plasma volume

ADH + V1R, Vasoconstriction

Peripheral Resistance

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Vasoconstriction

Plasma osmolality

ADH/Vasopressin

Aquaporin-3, 7- always open

Aquaporin-2

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Glomerulus

PCT

Loop of Henle

DCT

Renal Tubules

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Principal Cell

Normally bound to water keeps it off

Bound to ATP turns it on

Diabetes insipidus

(Polyuria, polydipsia)

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Oxytocin

Endometrium

Myometrium

Perimetrium

Hyposecretion

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Uterine Inertia

Postpartum Haemorrhage.

Less common in ant. Pituitary.

Hypersecretion

Pitocin (synthetic oxytocin)

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Given during labor

Stretching of cervix of Uterus.

Ca storage

Ca++

DAG

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PL-C

Increase intracellular [Ca++]

Increase contraction

Milk Let

Ejection of Milk

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Love & Trust

THPT Axis

Paraventricular nucleus

Oxytocin

TRH

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Ant. Pituitary

Portal system

Hypothalamus

Thyroid Hormone

Follicular Cells

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Simple cuboidal epithelial cell

Tyrosine

Steps of Thyroid hormone synthesis

TRH stimulate thyrotrophs from hypothalamus (Peptide hormone)

Ant. Pituitary release TSH.

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TSH + Follicular cells to synthesize Thyroglobulin

Iodide trapping

Oxidation of Iodide TPO

Organification of Tyrosine + Thyroglobulin

Coupling of DIT & MIT

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Storage-known

Endocytosis of Thyroglobulin with T3 & T4

Lysosomal Enzymes cleave T3 & T4 out of Thyroglobulin

Exocytosis of T3 & T4 into blood plasma.

Release of Thyroid

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Follicular cells send extensions- Pseudopods around thyroglobulin mediated by PSEUDOPODS

Thyroglobulin comes into pinocytic vesicle

Mode of Action of Thyroid Hormone

T3, T4

Glucose

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Glycogen

Liver

Blood

Glycogenolysis

Hyperglycemia

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Gluconeogenesis

Increase LDL uptake

LDL had cholesterol

T3, T4

TBG

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Thyroid Hormone through lipid bilayer

Cellular ATP

Increase O2 usage

TBMR

Increase Heat production

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Increase no of mitochondria

Hypertrophy

Heart:

Non contractile

Myocardium

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B-Adrenergic Receptor

Norepinephrine

Increase contractility

Increase CO

Increase HR/BP

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5' Deiodinase

Retinoic Acid

Transcription Factor

Hormone response Element

Protein into membrane

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Skin.

Stratum corneum

S. Lucidum

S. Granulosum

S. Spinosum

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S. Basale

Blood vessels

Sweat glands

Sweat

Smooth muscle

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GIT

Glands

Increase metabolism

Increase secretion

Transport of Thyroid Hormones

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By 3 types of proteins:

  1. Thyroxine-Binding Globulin (TBG)
  2. Thyroxine binding Prealbumin (TRPA)
  3. Albumin

Glycoprotein

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Of Transthyretin (TTR)

Great affinity for Thyroxine

Transports most of hormone

Transports 1/3 of T4

Transports 1/3 of TH.

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Regulation of secretion of TH. (Negative feedback control)

  1. Decrease TBMR
  2. Leptin from adipose tissue
  3. Alpha-melanocyte stimulating hormone from pituitary
  4. Increase I2 intake.
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  6. Stress.
  7. Somatostatin-PIH
  8. Dopamine

Hypothalamus

TRH

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Ant. Pituitary

TSH

Secretion receptor

Thyroid gland

(T3, T4)

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Mode of Action:

In larger cells (cells of liver, muscle & kidney), most of T4 is deiodinated to form T3

True intracellular hormone is T3, rather than T4

Bound with plasma protein

Found freely in plasma.

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Increase binding affinity for thyroid hormone receptor.

TH acts by activating the genes & using the genetic transcription.

Sequence of Events:

T3- enter the nucleus

Binds with Thyroid Hormone Receptor (TR)

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Contained to DNA strand

Always bound to another receptor (RXR Retinoic acid

THR complex formed

RNA polymerase & phosphoprotein kinase

Initiates transcription

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Large no. of mRNA is formed.

Synthesis of Nuclear Proteins.

Functions of Thyroid Hormones

  1. Increase BMR
  2. Stimulate growth in children.
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Increase O2 consumption of tissues.

TBMR

Increase heat production.

Calorigenic Action

Protein Metabolism: Increase synthesis of protein

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Decrease catabolism of protein

Using the translation of RNA

Using the transcription of DNA TORNA

Using the Activity & No. of mitochondria: Increase ATP Product

Using the Activity of cellular enzymes like

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Alpha-glyceral po4 dehydrogenase & oxidative enzymes

Carbohydrate Metabolism:

Accelerate Gluconeogenesis

Increase Glycogenolysis.

Increase Glucose absorption from GIT tract.

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Fat Metabolism:

Thyroxine decreases fat storage by mobilizing it from adipose tissues. Mobilized fat is converted into free FA & transported by blood

The free FA in blood.

CVS: Increase HR - acts directly on heart

Increase force of contraction.

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Increase blood vessels

Increase metabolic rate

Increase qty of metabolites production

Vasodilation

Increase Arterial BP: - Increase rate & force of contraction

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Increase CO

Increase BP

Mean Press - unaltered

Systolic BP-Increase

Diastolic BP-Decrease

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Pulse A. Pressure

CNS:- Thyroxine-essential for development & maintainance of normal functioning of CNS.

CNS development: Thyroxine-important for brain development during fetal life & in few yrs of post natal life.

On normal function of CNS:-

Thyroxine-stimulating factor for CNS, especially brain

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Increase blood flow to brain

Normal functioning of brain needs the mu of T4.

Hypersecretion of T4- excess stimulation of CNS.

Excess worries.

Hypothyroidism

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Myxedema-adults

Cretinism-children.

Myxedema: general edematous appearance

Causes:

  1. disease of thyroid gland.
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  3. genetic disorder
  4. I2 deficiency.
  5. deficiency of TSH/RH

Common Cause: Hashimoto's Thyroiditis - late middle aged

Autoimmune antibodies lead to destruction of gland.

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Symptoms: edematous appearance throughout the body

  1. swelling of face
  2. Bagginess under eyes.
  3. Non pitting type of edema i.e when pressed, it does not make pits.

Accumulation of [hyaluronic Acid

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Chondroitin SO4

Atherosclerosis: hardening of wall of arteries

Accumulation of fats deposited & Increase plasma level of cholesterol.

Produces Arteriosclerosis

Thickening & stiffening of arterial wall

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Anemia (RBCs)

Decrease body wet.

Constipation.

Menorrhagia & polymenorrhea.

Cretinism

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Hypothyroidism in children, stunted growth

Causes:-

  1. Congenital absence of thyroid gland.
  2. genetic disorder
  3. lack of I2 in diet
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Symptoms:

New born baby appears normal as the lining of birth (T3, T4 might have was supplied from mothers

Few weeks after birth, baby starts developing signs

Sluggish movement

Croaking sound while crying.

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Unless treated immediately, the baby will be mentally retarded permanently

Skeletal growth more affected then soft tissue

Stunted growth + bloated body.

Tongue- so big that hangs with dripping of saliva

Loud croak + swallowing

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Breathing

Cretin

Mental retardation.

Body is disproportionate

Reproductive function affected.

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Pituitary Dwarf

CNS- normal.

Body parts- proportionate

May be normal

Goiter - enlargement of thyroid gland.

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Toxic Goiter

Goiter in hyperthyroidism

Enlargement of thyroid gland with Increase in TH (due to thyroid tumor)

Non Toxic Goiter

Enlargement of thyroid gland without Increase in hormone secretion.

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(Hypothyroid goiter).

Based on causes

Endemic Colloid Goiter

I2 deficiency goiter.

Non toxic goiter due to I2 deficiency

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Intake < 50mg/day

Lack of I2 no hormone formation.

By feedback mechanism

Hypothalamus

TRH Increase

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Ant. Pituitary

TSH Increase

Thyroid cells to secrete Thyroglobulin into Thyroid follicles.

As there is no hormone to be cleaved, Thyroglobulin remains as it is & is accumulated in follicles of gland Increase in size of gland.

Idiopathic Non Toxic Goiter

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(unknown cause).

Enlargement without I2 deficiency

Cause: may be due to

  1. thyroiditis
  2. deficiency of enzymes.
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Ex- Peroxidase, TPO iodinase,

5-deiodinase.

Required for TH synthesis

Some food stuffs contains goitrogens, TH inhibitors

Ex- turnip, cabbage, soyabea

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Becomes active during I2 intake.

Hyperthyroidism.

Grave's Disease: autoimmune disease.

Most common cause of hyperthyroidism

Normally, TSH combine with surface receptors of thyroid cells

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Synthesis & secretion of th

B lymphocytes (plasma cells) produces autoimmune Abs

Thyroid stimulating Abs (TSAbs)

Lar wer TSH

Binds with membrane receptor of TSH

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cAMP system of thyroid follicular cells

Hypersecretion of th.

TS Abs- lasts for long time upto 12ms.

TSH- lasts for an hr

[TSA]=0 Increase in plasma.

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Adrenal Gland

Life saving gland/

Essential endocrine gland.

Adrenal Cortex

Outer portion

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80% of gland.

Adrenal Medulla

Central portion

20%

Zona Glomerulosa

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Zona Fasciculata

Zona Reticularis.

All adrenocortical hormones are steroids in nature.

Name corticosteroids

Cytoplasmic receptor

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Mineralocorticoids

Glucocorticoids

Sex hormones

Zona Glomerulosa

Synthesis

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Paraventricular Nuclei

Corticotropin Releasing Hormone

ACTH

Lungs

ACE

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Angiotensin II

Angiotensin I

Zona Glomerulosa

Zona Fasciculate

Zona Reticularis

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Adrenal medulla

Renin

JG cells

Decrease BP

ANP

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Atrial Natriuretic Peptide

Increase TBP

Functions of Mineralocorticoid:

Transport

Transcortin

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Corticosteroid - Albumin Binding Globulin

94% Transport.

Aldosterone & circulates on its own.

It has to wind to transport protein as it is an steroid

Synthesis of Aldosterone

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Mechanism of Action:

Aldosterone Increase Increase activity of (ENals)

Insertion of these channels inca om from cytoplasm

Gene for (sgk) serdem & glucocorticoid regulated kinase.

Increase activity of ENac activity

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Activates genes for other proteins.

Synthesis of Aldosterone

Cholesterol

Cholesterol desmolase

Pregnenolone

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3-B hydroxysteroid dehydrogenase

Progesterone

21-B-hydroxylase

11 deoxy corn costerone

11-B hydroxylate

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Glucocorticoid

Mineralocorticoids/ Corticosterone

18-A-hydroxylase &

Aldosterone

18-R-dihydroxy dehydrogenase

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Conn's Syndrome

Increase hyperaldosteronit

Prolonged excess secretion of aldosterone from adrenal cortex due a de non to tamom of 2. glomerula

Features:

  1. Increase to Not absorption & its exchange with H+ & K+ in DCT
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  3. Hyponatremia Increase Net Increase TECly & Increase B.P
  4. Mexuesion in urine Hypokalemia.
  5. musculer weakness.
  6. Metabolic alkalosis free Ca++ Tetany.
  7. Hypokalemic neuropathy (renal tubules demy) polyuria, polydipsia, Decrease conc. ability of Kidney.
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Aldosterone escape.

5- desence of intravascular vol.

Functions of Mineralocorticoids.

Aldosterone

Colife saving hormone.

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(Na) death within 2 days 2 weeks.

Na

acts on OCT & collecting auch (Peeler)

Increase Na EnaL, Increase No absorption

ECF

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Hypernatriuria

Na absorbed from renal tubules

simultaneously no vallo absorbed.

TECF volume

Increase Na absorption Increase (Na+)

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n2o absorbed simultaneously

BP-

TECF YOU & Twood you

TRA

Aldosterone

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Escape

K+:-

Increase K+ excretion through renal neuveres

Hypokalemia.

n+:-

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Increase Na reabsorption from renal tubules

(Note annet pes)

tuinler unerion of(n+]

+(n+) in ECF

Aldosterone maintain Acid we baan.

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Adosterom

Increase Hyposecretion

Acidosis.

Alkalosis

Conn's Syndrome

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Aldosterone Escape - 2° effect of excess Mineralocorti

Escape of kidney from salt-retaining effects of excess administration/secretion of Aldosterone.

Increase Aldosterone level

ENGU.

Increase duorption of Na & Ho from renel tubules

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TECF volume

Increase arterial B.P.

Pelcretion of AND BNP & CNP

(C-type namuretic peptide) from cardiac muscle.

Exuena of Na+

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Excursion of Not Increase wo through urine

Decrease ECF volume

LIVER

Angiotensinogen

Increase [K+]-Hyperkalemia.

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Decrease [Na+)-Hyponatremia

Decrease ECFAMA

Decrease BP

Renin

TGAK

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Angiotensin-I

Angiotensin

ACE lungs.

Angiotensin II

Adrenal Cortex

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2 Glomerulosa

Increase small art

Increase discharge of

Decrease [K+]

Increase [Ng+]

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TECE YOU

Excretion of K+

Retention of Nat

Retention of no

Increase

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Kidneys

Increase

Aldosterone

Zona Fasciculata

Stimule

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Hypoglycemia

Long term,

Chronic

Stress

eg: Trauma

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Starvation

Cornires.

Paraventricular Nucleos

Corticotropin elleaning nomine

Corticotroper (ACTH)

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Cortisol

Glycogenoty is (Indirectly)

Gluconeogenisic

Glycogeners (Direct (w)

Protein caracolin

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depresses immune systu

Adipose Tissue

Adipocytes

Tram transtornh

corncom usia

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Just lunding Glolentin

Liver

Glyure

Glucose

Glycogen

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GLYLOGENER

MUA CREA

Prettin

catalection

AA

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Ra

Smooth Muicer Ce

Increase rensinuity et

Alpha Adrenergic retentor for NORER

Vasoconstriction

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TR-

This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities

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