ENDOCRINOLOGY Flashcards
(302 cards)
1
Q
- the study of hormones & their actions
A
ENDOCRINOLOGY
2
Q
- tissues that release their secretory products into extracellular & interstitial fluids
A
ENDOCRINE GLANDS
3
Q
- a finely integrated system whereby the hypothalamus, pituitary & target glands continually communicate through feedback inhibition & stimulation, to control all aspects of metabolism, growth and reproduction (Henry)
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ENDOCRINE SYSTEM
4
Q
- secretory products transported in the bloodstream from their place of synthesis to a distant location where they exert their action
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HORMONES
5
Q
Some hormones also act in close proximity to their
A
site of release
6
Q
What are hormones? Substances secreted by an endocrine gland and transported in the blood that…
A
1) Control rates of certain chemical reactions
2) Transport substances across cell membranes
3) Help regulate water and electrolyte balance
4) Play a role in reproduction
7
Q
1) Control rates of certain chemical reactions ex
A
Thyroid hormones
8
Q
2) Transport substances across cell membranes
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Insulin
9
Q
3) Help regulate water and electrolyte balance
A
Aldosterone
ADH
10
Q
4) Play a role in reproduction ex
A
Estrogen (F)
Testosterone (M)
Follicle-stimulating hormone (M & F)
11
Q
Three general classes of hormones
A
- STEROIDS
- POLYPEPTIDES & PROTEINS
- HORMONES DERIVED FROM AMINO ACIDS
12
Q
Water-insoluble
A
- STEROIDS
13
Q
Water-soluble
A
- POLYPEPTIDES & PROTEINS
- HORMONES DERIVED FROM AMINO ACIDS
14
Q
Hydrophilic
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- POLYPEPTIDES & PROTEINS
- HORMONES DERIVED FROM AMINO ACIDS
15
Q
Hydrophobic
A
- STEROIDS
16
Q
Most are proteinbound
A
- STEROIDS
17
Q
Most are free
A
- POLYPEPTIDES & PROTEINS
18
Q
Some are free (50%)
The rest are bound
A
- HORMONES DERIVED FROM AMINO ACIDS
19
Q
- STEROIDS Half-life:
A
60 - 100 mins
20
Q
- POLYPEPTIDES & PROTEINS Half-life:
A
vary from 5 to 60 mins.
21
Q
- HORMONES DERIVED FROM AMINO ACIDS
Thyroxine - proteinbound (Half-life: ?)
Epinephrine - not protein-bound (Halflife: ?.)
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almost 1 week
<1 min
22
Q
Nuclear receptor
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23
Q
Cell membrane receptor
A
24
Q
STEROIDS aka
A
Steroid hormones
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HORMONES DERIVED FROM AMINO ACIDS aka
Non-steroid hormones
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generally hydrophobic
STEROIDS
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Many circulate in plasma bound to high-affinity proteins
STEROIDS
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Small % are free for biologic activity
STEROIDS
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Formed from cholesterol
Steroid Hormones
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Can-pass through cell membranes.
Steroid Hormones
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Receptors for steroid hormones are located in the
target cell's nucleus
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The H-R complex binds with the DNA and activates specific genes that, in turn, direct the synthesis of specific proteins.
Steroid Hormones
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water-soluble (Hydrophilic)
POLYPEPTIDES & PROTEINS
HORMONES DERIVED FROM AMINO ACIDS
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Circulate unbound in plasma (freely)
POLYPEPTIDES & PROTEINS
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Initiate their response by binding to cell membrane receptor
POLYPEPTIDES & PROTEINS
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Either free or protein-bound
HORMONES DERIVED FROM AMINO ACIDS
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Half-lives vary
HORMONES DERIVED FROM AMINO ACIDS
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Initiate their response by binding to cell membrane receptor ex
Insulin
PTH
Adrenocorticotropic hormone
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HORMONES DERIVED FROM AMINO ACIDS ex
Thyroxine
Epinephrine
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Hormones possess a high degree of
structural specificity
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between hormone and receptor
1:1
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Slight alteration in molecular composition may bring significant
changes in
physiological activity
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FUNCTIONS OF HORMONES
THREE GENERAL ASPECTS:
I. REGULATORY FUNCTION
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• Maintain constancy of chemical composition of ECF & ICF
I. REGULATORY FUNCTION
II. MORPHOGENESIS
III. INTEGRATIVE ACTION
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Other regulatory functions:
• Responses to demands of:
o Starvation
o Infection
o Trauma
o Psychological stress
o Process of sexual reproduction
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• Control the growth & development of an organism
II. MORPHOGENESIS
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• Control the growth & development of an organism ex
o Testosterone
o Estradiol
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o GH: influences devt of male and female characs
o Testosterone
o Estradiol
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• Most complex & the least understood
III. INTEGRATIVE ACTION
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• Several endocrine hormones may be important for regulating a single function
III. INTEGRATIVE ACTION
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Types of Hormone Action according to Tietz
1. Endocrine
2. Neuroendocrine
3. Neurocrine
4. Neurotransmission
5. Paracrine
6. Exocrine
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hormone synthesized in one location & released into plasma
1. Endocrine
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Binds to specific receptors in cells at a distant site to elicit characteristic response
1. Endocrine
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Hormone action (gardner-shoback)
1. PARACRINE
2. AUTOCRINE
3. INTRACRINE
4. JUXTACRINE
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Endocrine ex
TSH
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Neurocrine ex
Norepinephrine
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Paracrine ex
Somatostatin
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Exocrine ex
Gastrin
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hormone synthesized in nerve ending & released into EC space
Neuroendocrine
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Interacts w/ receptors of cells at distant site
Neuroendocrine
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hormone synthesized in neurons & released into EC space
Neurocrine
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Binds to receptor in nearby cell & affects its function
Neurocrine
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hormone synthesized in neurons & released from nerve endings
Neurotransmission
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Crosses synapse & binds to specific receptors in another neuron
Neurotransmission
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hormone synthesized in endocrine cells & released into EC space
Paracrine
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Binds to specific receptor of nearby cell & affects its function
Paracrine
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hormone synthesized in endocrine cells & released into lumen of gut
Exocrine
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- acts on neighboring cells
PARACRINE
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counterpart ex: Somatostatin
PARACRINE
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– hormone acts on receptors found on the same cell; “self”
AUTOCRINE
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- related to autocrine; hormone will not be released by the cell
INTRACRINE
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- hormone bound on one cell but interacts w/ a receptor on a diff cell
JUXTACRINE
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The biological response to a hormone is initiated by the binding of the hormone to
target cell receptors
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- provides the target cell with a mechanism for recognizing & concentrating the hormone
RECEPTOR
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- activates the target cell to begin the chain of events that constitutes the biological effect(s) of that hormone
H - R complex
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CHARACTERISTICS OF THE H- RCOMPLEX
1. Highly specific
2. An equilibrium system
3. It has high affinity
4. It is saturable
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• The degree of biological response of a target fissue is
directly proportional to the # of H-R complexes
4. It is saturable
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• Maximal response is obtained when all sites are filled
4. It is saturable
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Main function of the Endocrine System:
Secretion of hormones to be released in the circulation
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3 WAYS TO CONTROL OF HORMONAL SECRETIONS
1. Releasing (trophic) hormones from the HYPOTHALAMUS control secretions of the anterior pituitary.
2. The NERVOUS SYSTEM influences certain endocrine glands directly.
3. FREE-STANDING GLANDS: respond directly to changes in fluid composition.
81
1. Releasing (trophic) hormones from the [?] control secretions of the anterior pituitary.
HYPOTHALAMUS
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2. The [?]influences certain endocrine glands directly.
NERVOUS SYSTEM
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3. [?]: respond directly to changes in fluid composition
FREE-STANDING GLANDS
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Releasing (trophic) hormones from the HYPOTHALAMUS control secretions of the anterior pituitary ex
Tyrotrophin-releasing hormone
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FREE-STANDING GLANDS ex
Parathyroid gland secreted by the Parathyroid hormone
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An increase in one hormone would result in the increase of a second hormone
Positive feedback
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more commonly observed
Positive feedback
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An increase in one hormone causes a decrease in the second hormone
Negative feedback
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• First endocrine gland
HYPOTHALAMUS
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HYPOTHALAMUS
Located [?]
behind the frontal lobe and below the thalamus
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Regulates anterior pituitary hormonal secretion
HYPOTHALAMUS
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HYPOTHALAMUS 7 hormones :
3 regulatory hormones
2 pairs of regulatory and inhibitory hormones
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TRH (thyrotrophin-releasing hormone)
HYPOTHALAMIC HORMONE
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TSH (Thyroid-stimulating hormone)
ANT. PITUITARY HORMONE
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CRH (corticotrophin-releasing hormone)
HYPOTHALAMIC HORMONE
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ACTH (Adrenocorticotropic hormone)
ANT. PITUITARY HORMONE
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GnRH (gonadotrophin-releasing hormone)
HYPOTHALAMIC HORMONE
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LH (Luteinizing hormone) and FSH (Follicle-stimulating hormone)
ANT. PITUITARY HORMONE
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GHRH (growth hormonereleasing hormone)
HYPOTHALAMIC HORMONE
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GH (growth hormone)
ANT. PITUITARY HORMONE
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Somatostatin (GHRH counterpart)
HYPOTHALAMIC HORMONE
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Suppress GH
Somatostatin
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Suppress PRL
PIF
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PRF (prolactin-releasing factor)
HYPOTHALAMIC HORMONE
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PRL
ANT. PITUITARY HORMONE
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PIF (prolactininhibiting factor)
HYPOTHALAMIC HORMONE
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3 important regulatory hormones:
• TRH • CRH • GnRH
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GHRH counterpart
Somatostatin
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Dopamine
PIF
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PRF counterpart
PIF
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prolactin
PRL
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PIF counterpart
PRL
113
HYPOTHALAMIC HORMONE
114
Regulates TSH secretion
TRH
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TRH-secreting neurons are located in the
medial portions of the PVN
116
Known as a tripeptide (consists of 3 amino acids)
TRH
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TRH Innervated by axons that release:
Norepinephrine
Leptin
‘Neuropeptide Y
Somatostatin
118
Secretion is influenced by energy state and temperature
TRH
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• Stimulates secretion of ACTH and other products of its precursor molecule
CRH
120
CRH-secreting neurons are found in the
anterior portion of the PVN (paraventricular nucleus)
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• Stimulates LH and FSH secretion
GnRH
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GnRH Neurons are primarily located primarily in the
preoptic area of the hypothalamus
123
Neuron carriers are said to be unusual
GnRH
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GnRH Stimulated by:
GALP (galanin-like peptide)
Kisspeptine
Norepinephrine
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GnRH Inhibited by:
GABA (gamma-aminobutyric acid)
Endorphine
CRH
126
• Stimulates GH secretion by somatotrophs
GHRH
127
• GHRH Neurons are located in the
arcuate nuclei of the medial basal hypothalamus
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• GHRH Stimulated by:
1. Dopamine
2. Galanine
3. Brain stem neurons
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• GHRH Suppressed by:
SRIH (somatostatin release-inhibiting hormone)
130
• Suppress secretion of GH and TRH (thyrotrophin-releasing hormone)
Somatostatin
131
Somatostatin Neurons are located in the
periventricular region
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• Shows the relationship between the hypothalamus, pituitary gland, and the target organ
Hypothalamic Pituitary Organ Axis (HPO Axis)
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TSH
Thyroid
T4 (triodothyroni ne) and T3 (thyroxine)
TRH
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ACTH
Adrenal Cortex
Cortisol
CRH
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LH, FSH
Ovaries or Testes
Estrogen, Testosterone
GnRH
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Pituitary gland a.k.a
hypophysis or master gland
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Pituitary gland a.k.a Located within the
sella turcica
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Pituitary gland
Connected to the median eminence of the hypothalamus by the
infundibular stalk
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HORMONE-SYNTHESIZING & SECRETING CELLS OF THE ANTERIOR PITUITARY GLAND:
1. Somatotrophs
2. Lactotrophs
3. Thyrotrophs
4. Gonadotrophs
5. Corticotrophs
140
- secrete GH
Somatotrophs
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Responds to GH-releasing hormone
Somatotrophs
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Inhibited by GH-inhibiting hormone
Somatotrophs
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- secrete prolactin (PRL)
Lactotrophs
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Responds to thyrotrophin-releasing hormone, prolactinreleasing hormone, and dopamine
Lactotrophs
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- secrete thyroid-stimulating hormone (TSH)
Thyrotrophs
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Responds to thyrotrophin-releasing hormone
Thyrotrophs
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- secrete a- and B-subunits of FSH & LH
Gonadotrophs
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Responds to gonadotrophin-releasing hormone
Gonadotrophs
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- secrete pro-opiomelanocortin (POMC)
Corticotrophs
150
Responds to corticotrophin-releasing hormone
Corticotrophs
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pro-opiomelanocortin: precursor to ACTH
Corticotrophs
152
Main Target Organs of the Anterior Pituitary tropic hormones:
• Thyroid gland
• Adrenal cortex
• Gonads
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Most abundant hormone in the anterior pituitary gland
Human Growth Hormone
154
Marked structural resemblance to PRL & hCS
Human Growth Hormone
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(?): helps during pregnancy
placental hormone chorionic somatomammotropin (hCS)
156
Human Growth Hormone
Concentration varies with[?]
exercise sleep and stressional status
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Human Growth Hormone Peak levels occur [?] after the onset of sleep
1 - 4 hrs
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Locations of Receptors of the Human Growth Hormone
1. Liver
2. Bones
3. Adipose tissue
4. Muscle
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Human Growth Hormone
Promote growth of [?] by stimulating protein synthesis
cartilage, bone & many soft tissues
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Human Growth Hormone
Growth-promoting effects mediated by IGF-1 (aka [?])
Somatomedin C
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Stimulation:
Deep sleep
a-Adrenergic
Fasting
Acetylcholine
Sex steroids
Stress
Amino acids
Hypoglycemia
Ghrelin
Opiods
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Suppression:
Obesity
B-Adrenergic
Glucocorticoids
High FFA
Hyperglycemia
Hypothyroidism
Elevated IGF-1
163
Inhibition:
Undernutrition
Acute illness
Chronic illness
GH receptor deficiency
GHR antibodies
IGF-I receptor deficiency (genetic)
164
Insulin like activity in other tissues
igfS
165
Enhances synthesis of collagen and proteoglycans
igfS
166
Affects positively calcium, magnesium and potassium homeostasis
igfS
167
Concentration rise during childhood
igfS
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Achieve peak conc. During puberty
igfS
169
GH affects the bone and cartilage directly through [?]
IGFs
170
Increase in growth of soft tissue and skeleton is accompanied by changes in[?]
electrolyte metabolism
171
Increase intestinal absorption of [?]
calcium
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Decreased urinary excretion of [?]
sodium and potassium
173
Increases [?]
blood glucose
174
Insulin [?]
antagonist
175
GH Reference values:
• Children : generally higher than adults
• Males: 4.2 +/ - 1.2 mg/dL
• Females : 5.1 +/ - 1.0 mg/dL
176
[?] induce growth in similar manner
GH and Insulin
177
Their respective effects on glucose homeostasis oppose each other
GH and Insulin
178
Conditions associated with abnormal release of hormone: Acromegaly
• Pathologic or autonomous
• Caused by pituitary tumor
• Increase width of bone rather than length (hand, feet and jaw)
• Generalized organomegaly and coarsening of facial features
• hyperglycemia
179
Diagnosis for acromegaly
Randomly collected [?]
IGF-1
180
Tests for acromegaly
• Screening test
• Oral glucose tolerance test
181
• Confirmatory test
Oral glucose tolerance test
182
Oral glucose tolerance test
Obtain baseline blood sample for
glucose and GH
183
Oral glucose tolerance test
Administering [?] of glucose orally, obtain blood for glucose and GH every [?] over the next [?]
75 g
30 mins
2 hours
184
Oral glucose tolerance test
Normal response: suppression of GH to [?] at anytime of the day
< 1 ng/mL
185
GH deficiency/ primary dwarfism
Children: idiopathic GH deficiency
Adults : pituitary adenoma
186
Gold standard test
INSULIN TOLERANCE TEST
187
Failure of blood sugar level to decrease in response to insulin
INSULIN TOLERANCE TEST
188
• Synthesized in thyrotrophs
Thyroid stimulating hormone
189
• Composed of two non-covalently linked alpha & beta sub-units
Thyroid stimulating hormone
190
a-unit is identical to [?]
FSH, LH & hCG
191
B-unit attaches to
thyroid receptors
192
B-unit attaches to thyroid receptors & stimulate:
Stimulates growth and vasculature of the thyroid gland
Uptake and organification of iodine
Promotes release of stored thyroid hormones
193
Thyroid Stimulating Hormone Test
Immunoradiometric assay (IRMA)
194
Ultrasensitive
Immunoradiometric assay (IRMA)
195
best thyroid function test
Immunoradiometric assay (IRMA)
196
Differentiate hypo vs hyperthyroidism
Thyroid Stimulating Hormone
Immunoradiometric assay (IRMA)
197
• detectable in the serum of thyrotoxic patients which imitates the biologic action of TSH
LATS (long acting thyroid stimulating substance)
198
Produced by thyroid gland
T3, T4: controls rate of reaction
TSH
Thyroid hormones
199
Produced by pancreas in response to high of glucose plasma level
Insulin
200
Transports glucose extracellular to intracellular
Insulin
201
Promotes reabsorption of water and electrolyte balance
Aldosterone
ADH
202
Water-fearing; Formed from cholesterol - insoluble to water
STEROIDS
203
Location: nucleus; Differentiate one type of hormone to another
Steroid Hormones
204
H-R complex
Hormone-receptor complex
205
Receptor in the cell membrane
Steroid Hormones
206
End result: Formation of a specific protein
Steroid Hormones
207
Steroid is hydrophobic - passively enters the cell (passive diffusion)
steroid hormones
208
Traverse the cell cytoplasm and directly enter the cell nucleus where the receptor is located
steroid hormones
209
o Yellow: hormone
o Purple: receptor
steroid hormones
210
Formation of the Hormone-receptor complex affecting the DNA
steroid hormones
211
Activates specific genes that direct synthesis of specific proteins
steroid hormones
212
Less complicated (direct impact on DNA)
steroid hormones
213
steroid hormones
End result:
Formation of a specific protein
214
Small circle:
nonsteroid hormones
215
Hormones derived from protein or amino acid
nonsteroid hormones
216
Soluble
nonsteroid hormones
217
Receptor in the cell membrane
nonsteroid hormones
218
Binding forms H-R complex; Cascade of biological activity takes place
nonsteroid hormones
219
nonsteroid hormones
H-R complex activates [?] connected to the receptor
G protein activates [?]
Adenylate Cyclase moves 2 phosphates from [?] (substrate) to produce [?] (product)
G protein
Adenylate Cyclase
ATP; Cyclic Adenosine Monophosphate
220
- secondary messenger that affects biological processes; activates inactive form
Cyclic Adenosine Monophosphate (cAMP)
221
More complicated (there are still enzymes to be activated)
nonsteroid hormones
222
nonsteroid hormones
End result:
Cellular change
223
Maintain constancy of chemical composition of ECF & ICF
Thru regulation of [?]
salt, water, proteins, fats, and carbohydrates
224
Receptors found on distant sites
Endocrine
225
TSH
Produced by anterior pituitary gland or base of the brain
Released in the plasma to reach the thyroid
Endocrine
226
has a significant effect of the cardiac muscle cells
Norepinephrine
227
secreted by nerve endings and receptor is nearby its site of origin
Norepinephrine
228
produced by the pancreas
Somatostatin
229
action on a different cell of the pancreas
Somatostatin
230
secreted by the delta cell of the islet of the pancreas
Somatostatin
231
action on the beta cell and alpha cell
Somatostatin
232
Outside the circulation
Exocrine
233
Secretion of gastric juice; Mucosal cells; Helps in the metabolism of food
Gastrin
234
Allows the target tissues to recognize many mol to w/c it is exposed to
It has high affinity
235
Stimulates pituitary gland to release thyroidstimulating hormone
Tyrotrophin-releasing hormone
236
Made of [?] serving as building blocks of communication
neurons
237
Certain stimuli directs neurons to send signals to the brain (?)
hypothalamus
238
Acts on the bones and kidneys to regulate serumcalcium concentration
Parathyroid gland secreted by the Parathyroid hormone
239
Releasing hormone:
Hypothalamus
240
Tropic hormone:
Pituitary gland
241
Effector hormone:
Gland
242
more commonly observed
Positive feedback
243
– part of the brain involved in the storage of longterm memory
Hippocampus
244
Hippocampus sends signal to the hypothalamus to release
corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP)
245
corticotropin-releasing hormone (CRH) acts on the anterior pituitary gland to secrete
adrenocorticotropic hormone (ACTH)
246
adrenocorticotropic hormone (ACTH) stimulates
glucocorticoids (cortisol)
247
– stress hormone; stimulates the body to make use of the remaining energy; effect is stress eating
cortisol
248
Excessive levels of glucocorticoids in the blood or cortisol in the plasma will send signal to the anterior pituitary gland to stop ACTH production and hypothalamus to stop CRH production
Negative feedback
249
Responds to levels of chemicals in the circulation
FREE-STANDING GLANDS
250
FREE-STANDING GLANDS ex
Parathyroid hormone (PTH)
251
Decreased level of calcium trigger the free-standing gland (PT gland) to release [?]
PTH
252
[?] acts on bones and kidneys to release calcium
PTH
253
Once corrected, it will signal the free-standing gland to stop [?] production
PTH
254
Trophic/releasing hormones; effect on the anterior pituitary gland
HYPOTHALAMIC HORMONE
255
: triggers ovulation
LH
256
: regulates devt of growth and puberty
FSH
257
: regulates puberty and reproduction
Kisspeptine
258
Pituitary gland
Located in the
base portion of the skull
259
: depression that encloses the pituitary gland
Sella turcica
260
Sella turcica structure
Turkish saddle (seat of a bike)
261
: sac-like structure
Pituitary gland
262
: tube-like structure that connects the hypothalamus and pituitary gland
Infundibular/Pituitary stalk
263
Two distinct regions of the pituitary gland:
Anterior portion and Posterior portion
264
Pituitary gland
Secretes [?] different peptides and protein hormones
9
265
Anterior pituitary gland aka
adenohypophysis
266
Surrounded by a capillary network that extends from hypothalamus down to the infundibulum and the pituitary gland
Anterior pituitary gland (adenohypophysis)
267
Synthesizes and secretes seven hormones
Anterior pituitary gland (adenohypophysis)
268
Contains different types of cells; Each cells synthesizes and secretes specific hormones upon the stimulation of trophic hormones from the hypothalamus
Anterior pituitary gland (adenohypophysis)
269
Two types of chromophils:
Pink: acidoohilic
Blue/purple: basophilic
270
Pink: acidoohilic
1. Somatotrophs
2. Lactotrophs
271
Blue/purple: basophilic
1. Corticotrophs
2. Thyrotrophs
3. Gonadothrophs
272
Conc of human GH rises [?] after a meal and a physical activity
3 hrs
273
is a stimulant for GH secretion
Stress
274
Peak of GH secretion happens during the
deepest sleep
275
Primary receptor of human GH is found in the
liver
276
Liver secretes a group of polypeptide hormone called
Insulin-Growth Factor 1 (IGF-1)
277
Secretion of human GH is stimulated by [?] from the hypothalamus, which is inhibited by somatostatin hormone growth inhibiting hormone
GHRH
278
Pituitary gland again release [?], traveling to the circulation, then reach its target receptor (primary: liver)
GH
279
Liver is triggered to secrete
IGF-1
280
[?] directly affects the long bones and muscle by helping in its growth and devt
IGF-1
281
Other receptors are found in [?], triggering catabolism or lipolysis
adipose tissues
282
: decreases blood sugar by carrying glucose in the plasma inside the cells
Insulin-like GF
283
Gives rigidity and support to to skin
collagen and proteoglycans
284
igfS
Achieve peak conc. During puberty
13 to 15 yrs old
285
One effect of igfS is
bone resorption
286
Bones and osteoblasts releases their contents/electrolytes
bone resorption
287
Insulin antagonist
Side effect: stimulates [?] (prod of glucose from noncarbohydrate sources) and [?] (lysis of glycogen)
glucogeneolysis
glycogeneolysis
288
: disorder of IGF-1 which causes excessive growth of the hands, feet, jaw, and internal organs in adulthood
Acromegaly
289
Growth is straight; childhood
Acromegaly
290
: abnormally high linear growth due to the excessive action of IGF-1 before the closure of the epiphyseal growth plates in childhood
Gigantism
291
Growth upwards; childhood
Gigantism
292
shows a pituitary tumor in 90% of acromegalic patients
MRI
293
The best confirmatory test for acromegaly is the
oral glucose suppression test
294
In [?], glucose does not suppress growth hormone
acromegaly
295
Decreases from the baseline; Failure to decrease is diagnostic of acromegaly; Collection: 5x
Oral glucose tolerance test
296
Damage to the pituitary gland or the hypothalamus
idiopathic GH deficiency
297
Tumor or cancer
pituitary adenoma
298
: psychosocial dwarfism (due to stressful environment)
Secondary dwarfism
299
Administration of insulin via IV following an overnight fasting
INSULIN TOLERANCE TEST
300
Collection of blood sample every 15, 30, 60,.. minutes
INSULIN TOLERANCE TEST
301
Goof indicator of GH deficiency/ primary dwarfism
INSULIN TOLERANCE TEST
302
Ag and Ab + radioisotope; Measurement of radioactivity
Immunoradiometric assay (IRMA)
