Endocrine
Endocrine
Endocrine
HYPOPITUITARISM
Etiology
Q
Sheehan syndrome Apoplexy RT Infiltration
• Post partum pituitary • Haemorrhage in the • More sensitive: • 3 main examples:
Q
necrosis pituitary Hypothalamus > – Sarcoidosis,
• Cause: Severe post partum • Cause: 90% due to pituitary – Hemochromatosis,
haemorrhage pituitary macro adenoma • If radiation is >12-18 – Langerhans cell
• History of multiple blood • Other causes: DIC, gy: GH affected first, histiocytosis
transfusion during delivery / Malignant hypotension, mainly somatotropes • Mainly damage anterior
labour trauma, coagulopathy • If radiation is >30 pituitary
• Mother presents with • Clinical features: gy: lead to multiple • Patients presents with
lactation failure nausea, vomiting, intense pituitary hormone central DI, polyuria,
• Deficiency of GH, headache because of deficiency polydypsia
prolactin, TSH (central raised ICP, diplopia • History of childhood • Sarcoidosis can lead to
hypothyroidism) due to 6th CN damage, brain tumor central & Nephrogenic
• Investigation: MRI → empty visual field defect, DI
Q
Other causes
• Drugs
– D2 receptor blockers: Anti emetic →
metaclopramide, domperidone
– Anti psychotic: haloperidol, risperidone
– Amine depletors: tetrabenazine, verapamil
Classification based on size & functional
status • CKD
If decreased, then rule if GH increases, then it • If the value is detectable / increased, then it is
known as hook effect
Out GH excess confirms GH excess
• Non functioning macro adenoma can compress • Hyperosmolar hyponatremia (decrease serum
osmolality)
the pituitary stalk which can produce
hyperprolactinemia • Increased urine osmolality
• Trans sphenoidal surgery also does the stalk Treatment
transection
• Check if severe symptoms (coma, seizures)
• Leads to classic triphasic response present, give 3% NaCl → if no severe symptoms,
do standard SIADH management
Q
Differential diagnosis
• Cerebral salt wasting syndrome
– Defect of CNS → increased release of BNP,
increased urinary sodium & osmolality
– Total body salt decreases → patient will be
Hypovolemic
Conditions S. Na+ Baseline Post H2O Post dDAVP Pituitary MRI Baseline AVP
UOSM deprivation
PP N/↓ ↓ ↑ Same N N/↑
CDI N/↑ ↓ Same ↑ Stalk thickening ↓↓
NDI N/↑ ↓ Same Same N N/↑
• Causes of NDI
is mitochondrial transmitted disease
DI - Diabetes insipidus – Congenital
CNS causes
* For Making Notes
49
Medicine
MEN SYNDROMES
MEN 1
Features MEN 2A (Sipple) MEN 2B MEN 4
(Wermer)
Inheritance AD, Chromosome 11 AD, chromosome 10 AD, Chromosome 10 AD
RET gene (proto onco Q
MEN 1 (menin Q RET gene
gene)
Mutations protein – tumor • Codon: 918 (worst CDK N1B
Q • Codon Mutations: 634,
suppressor protein) mutation)
88
Present, cause
PHPT + - +
hypercalcemia
present, MC is
Pituitary adenoma - - +
prolactinoma
present, non
functioning >
Pancreatic NENs gastrinoma - - +
• Most common
cause of death
present, most
common cause
MTC - +
of death, most
aggressive
Present, Bilateral &
Pheochromocytoma - Present, Bilateral & benign
benign
Familial medullary thyroid
Angiofibroma, Reproductive organ
cancer, Hirschsprung Mucosal neuroma,
Others lipoma, foregut tumors: Testicular
disease, cutaneous lichen marfanoid habitus
Carcinoid tumor
amyloidosis
≥ 2 major features
present or 1 major
2 major manifestations
feature with FDR
Diagnosis or FDR with proven RET Same as MEN 2A
with MEN 1 or
mutation
positive MEN 1
gene mutation
In 634, 883 mutation:
do Total thyroidectomy In 918 Mutation: do
Treatment before 5 years of age in Total thyroidectomy
case of intermediate to within 1 year of age
high risk of Mutations
DIABETES MELLITUS -
DIAGNOSIS
APS (AUTOIMMUNE
Normal Pre-diabetes DM
POLYGLANDULAR SYNDROME)
FPG (mg/dl) < 100 100 – 125 ≥ 126
• Features:
– Osmotic symptoms: polyuria, polydipsia
• Ectodermal dystrophy
– Catabolic symptoms: weight loss
APS Type 2 – Age of onset: juvenile
• Female > male • Treatment
• Polygenic inheritance – Insulin
• Triad
• In DKA, plasma ketone is detected best by VEGF: for diabetic retinal edema
Beta hydroxy butyrate level → >30 mmol /L
Diabetic neuropathy
• In HHS, beta hydroxy butyrate is <1.5 mmol / L
• Distal symmetric polyneuropathy
• Treatment
– Length dependent atonal neuropathy
– DKA
– Earliest site involved: feet
FLIP : Fluid (in 1st 3 hours → 2-3 L or
10-20 ml / kg/ hr of NS 0.09% → After – Painful but 70% painless, burning, numbness
3 hours shift the fluid to 0.45% NaCl), – Treatment for painful form: SNRI, tricyclic
Insulin, potassium
Q
antidepressants, calcium channel blockers
If capillary blood glucose value is <200- • Diabetic autonomic neuropathy
250 mg/dl → add Dextrose 5% solution
to prevent Hypoglycemia – GI (bladder & bowel problems: constipation,
diabetic diarrhea, gastroparesis), GU
– Use FDII regime (erectile dysfunction), CVS (Tachycardia)
If S. Potassium: problems
• Biopsy: Kimmelstiel Wilson lesion also known as – Beta hydroxy butyrate <2.7 → not insulin
nodular glomerulosclerosis mediated
• Treatment: <2.7
– ACE inhibitors or ARB blockers
– Finerenone: non steroidal MRA if insulin value <3 → cause is IGF 2
>3
When to start screening for diabetes
• Type 2 diabetes: at the time of diagnosis C peptide <0.2 → exogenous insulin abuse
• Type 1 diabetes: after 5 years of diagnosis, >0.2
then start screening
• Retinopathy: do fundus examination Rule out sulphonylurea abuse → if positive,
• Nephropathy: do EGFR + urine albumin: it is an induced cause
creatinine If -ve
• Neuropathy: do 10 gm mono filament testing
+ deep tendon reflexes + pain & temperature Do Imaging
assessment
• Check for Type 2 diabetes:
• If screening is normal → do annual screening
– MRI of pancreas → mass lesion present →
METABOLIC SYNDROME due to insulin
• Criteria
Q
– If MRI is normal, do Ab testing because
insulin auto Ab can cause Hypoglycemia
I. Central obesity - check by waist → do SACST (selective arterial calcium
circumference stimulation test to diagnose Nesidioblastosis
Males ≥ 102 cm, females ≥ 88 cm (benign beta cell hyperplasia) - can be
Idiopathic (known as NIPHS – non insulinoma
In Asian males ≥ 90, females ≥ 80
pancreatogenous Hypoglycemia syndrome)
II. Impaired fasting glucose, Impaired glucose or occur after gastric bypass)
tolerance, frank Type 2 diabetes
Whipple’s traid
Q
III. Hypertension •
Symptoms of Hypoglycemia
IV. Triglyceride ≥150 mg/dl
– Low HDL: males <40, females <50
• If any 3 of these 5 Criterias are present, it is
diagnosed as Metabolic syndrome
APPROACH TO HYPOGLYCEMIA
• Check for diabetes
– Present: Most common cause is drugs - Documentation of Complete resolution
insulin, sulphonylurea, pioglitazone
Q
Hypoglycemia of symptoms with
glucose
– Absent: Do 72 hour fast (CBG <45 – take
blood sample – end the fast)
A.1° insufficiency
• Problem with adrenal gland
• Low cortisol production → increased ACTH
• Most common cause in India - infectious,
leprosy, in western world – Autoimmune
adrenalitis
Q
• Problem with Pituitary gland • Most common site is Adrenal gland (in medulla)
• Low level of ACTH → low S. Cortisol • Most common extra Adrenal site is Para Aortic
region near the organ of zuckerkandl
Q
• Lead to Risk of Adrenal crisis
• Low Adrenal Androgen • Genetic syndromes associated:
• Aldosterone level normal – MEN 2A, 2B
• No salt wasting → euvolemic hyponatremia – VHL
• No hyperkalemia, no Metabolic acidosis
– NF-1
• Investigation of choice: ACTH stimulation test
– TMEN 127
• Non sun exposed area are quite specific for this
disease features (gingiva, nails, nipples) – SDH
Abnormal imaging, mass present → • In 17-OH & 3-BHS deficiency, there will be
Pheochromocytoma decreased Testicular Androgen
For metastatic & multifocal disease • 21-OH deficiency is also known as non classic
congenital Adrenal hyperplasia
• Nuclear imaging: I123 MIBG, PET scan, Ga68
(DOTATOC / DOTATATE scan) – Post puberty → PCOS-like presentation
→ hyperandrogenism features, oligo /
• Preparation: reduce BP → target <160 /90
amenorrhea
* For Making Notes
58
Cerebellum Quick Revision Notes
• Thyroglobulin
– Low level - Source is exogenous - Factitious
hyperthyroidism
Q
Thyroid Storm
Dermopathy (pre tibial myxedema)
• Most common cause is inadequate preparation
Acropachy (bone disease - rare)
of gland for surgery
• Clinical features
– Undetectable TSH, detectable T3, T4
– Increased HR
– Increased systolic BP
• Treatment
– Beta blockers (esmolol, metaprolol, propranolol),
• Investigation
CCB (verapamil, diltiazem), anti thyroid
– IOC: MRI of orbit drugs (PTU), lugol’s iodine/potassium iodine,
dexamethsone, plasma exchange
• Treatment
Myxoedema coma Q
THYROIDITIS
Chronic Subacute Subacute
Features Acute suppurative Riedal’s
lymphocytic lymphocytic granulomatous
Autoimmune,
Etiology HLA DR 3, Autoimmune Viral Infection -
DR5, B8
Pain - - ++ ++ -
Fever /
- - ++ ++ -
malaise
1° Hypothyroid to
TFT Thyrotoxicosis N TFT N TFT
hyperthyroid euthyroid
Persistence Yes Variable No No Yes
Lymphocytic Lymphocytic Giant cells & Fibrosis +
Pathology Abscess
infiltration infiltration granulomas seen inflammation
Beta blockers,
Antibiotics, incision Immuno suppressent
Treatment Levothyroxine NSAIDS,
& drainage (tamoxifen), surgery
corticosteroids
• Presence of germinal centres indicate chronicity. • Hashimoto patients are at increased risk of PTC
& Thyroid lymphoma
• Presence of Hurthle cells is common in
Hashimoto’s (but not specific).
• Other:
– Loop diuretics only in case of hyper volemic
state
Milk alkalosis AKI
– Dexamethasone in case of vit D excess
Hypercalcemic crisis – Denosumab → subcutaneously, safe in renal
failure
• Clinical features
– Dialysis
– Severe polyuria
Hypocalcemic disorders
Disorders Ca PO4 PTH ALP Comments
Q
Cause: Autoimmune , APS 1, post thyroid surgery – have
1° Hypoparathyroidism ↓ ↑ ↓↓ N Transient hyperparathyroidism, post parathyroidectomy
(rare), Wilson disease, Hemochromatosis
• Rickets, osteomalacia, cod fish vertebrae, looser’s zone
In diet↓ / pseudo fractures
Vit D deficiency ↓ ↑ N /↑
In CKD↑ • Elevated ALP in CKD → renal osteo dystrophy → rueger
jersey
• IA, Ib , Ic, II → IA & Ic have skeletal defect called as
Albright hereditary osteo dystrophy
PHP (GNAS gene #) ↓ ↑ ↑↑ N
• Features: Short stature, round face, brachydactyly
Q
(knuckle Dimple sign)
PPHP (GNAS gene #) N N N N Albright hereditary osteo dystrophy
• High bone turnover
• X-ray: cystic & blastic lesion
• Abnormal bone remodelling
• If symptoms present: bone pain (tibia)
PDB N N N ↑↑
• MC neurological symptoms: headache
• CN affected commonly: 8th CN
• Increased risk of osteosarcoma (giant cell tumor of bone)
• Treatment in Symptomatic patient: Bisphosphonates
Osteoporosis N N N * ForNMaking
BoneNotes
metric problem, trabecular bone affected
62
Cerebellum Quick Revision Notes
• Bazedoxifene - with Conjugated estrogen Short: look FSH → if low - central causes
Oxytocin Hyperthyroidism
– Main function is to contract the uterus 1. Thyroid Peroxidase Inhibitors (Thioamides)
• DOC for augmentation of labour Carbimazole (Prodrug)
Propyl Thio Uracil (PTU)
• DOC for postpartum hemorrhage Methimazole (Active)
– Other function is ejection of milk → Crosses placenta easily → Less crossing of Placenta
β cells Insulin ↓ Blood Sugar Diabetes mellitus Afreeza → Short acting insulin → So, should be
Amylin given before every meal
INSULIN
ORAL ANTI DIABETICS DRUGS
Indications
1. Insulin Secretagogues (Act by ↑ Insulin secretion)Q
1. All patients of type 1 DM
– These drugs secrete insulin and thus can cause
2. Uncontrolled patients of type 2 DM
hypoglycemia
3. Diabetes in pregnancy
Sulfonylureas Meglitinides
4. Diabetic Ketoacidosis
1st Generation Nateglinide
Routes of Administration Repaglinide
Chlorpropamide
1. Sub - cutaneous route:
Tolbutamide
– MC route (because self-administration is 2nd Generation
possible with this route)
Glipizide
– All insulin preparations can be given by Gliclazide
subcutaneous route. Glibenclamide
– Site of administration
Drugs ending with “IDE” can cause - hypoglycemiaQ
• Entire abdomen except area around umbilicus
(thickness of skin is not uniform, so insulin
absorption is affected)
43
Pharmacology
2. Drugs Acting by Other Mechanisms C. Acarbose
→ Act by inhibiting the intestinal absorption of
A. Metformin carbohydrates (blood sugar decreases)
Adverse effects → Does not cause hypoglycemia
1. Megaloblastic Anemia → Flatulence → MC side effect
2. Lactic acidosis → C/I in lnflammatory bowel diseaseQ
Risk of lactic acidosis further ↑, if there isQ • Ulcerative colitis
B. Glitazones
E.g. Troglitazone
Rosiglitazone
Pioglitazone
Mechanism
Act by stimulating PPAR-ꝩ → Reversal of Insulin Resistance
Adverse Effects A. GLP analogues:
→ Given subcutaneously (Cannot be given orally since
1. Hepatotoxic
these are peptides)
→ Max. hepatoxicity → Troglitazone [withdrawn]Q
GLP-1 analogues : Used for type 2 DMQ
→ Rosiglitazone and Pioglitazone require LFT
– Exenatide
monitoringQ
– Liraglutide
2. Na+ and water Retention → Avoid in CHF and HTNQ
3. Predispose to osteoporotic fractures. GLP-2 analog : Used for short bowel syndromeQ
CLASSIFICATION OF DRUGS
Glucocorticoids Mineralocorticoids
Short Acting (<12 hours) Aldosterone
Cortisone Fludrocortisone
→ SGLT-2 inhibitors stop the reabsorption of glucose Hydrocortisone DOCA
in PT resulting in glucosuria.
Intermediate Acting (12-36 hours)
Drugs areQ Prednisone
– Canagliflozin Prednisolone
– Dapagliflozin Triamcinolone
– Ertugliflozin Dexamethasone
Betamethasone
– Most common side effect of SGLT-2 Inhibitors
Paramethasone
is Urinary Tract infections
– SLGT-2 inhibitors provide cardiovascular benefits.
Special PointsQ
These are approved for treatment of CHF.
Property Drug
3. Amylin Analogs:
Maximum G activity Dexamethasone
→ Amylin is secreted form b - cells of pancreas. Maximum M activity Aldosterone
→ Function of amylin is to ↓ blood sugar. G with max M activity Hydrocortisone
Uses of Corticosteroids
Antenatal Replacement Other Uses
Dexa / Acute Adrenal Inflammation
Betamethasone insufficiency / Auto immune
for fetal Addisonian crisis diseases
lung maturity [by IV] Transplantation
(Glucocorticoids Anticancer therapy
increase Chronic Adrenal Asthma
surfactant lnsufficiency /
production) Addison’s disease
[by oral]
Betamethasone → IM 12 mg
24 mg 48 hrs.
every 24 hrs. x 2 DosesQ
Dexamethasone → IM 6 mg OSTEOPOROSIS
24 mg 48 hrs
every 12 hrs. x 4 Doses
Drugs used in Osteoporosis
Hypothalamo-Pitutary-Adrenal Axis [HPA Axis]
Previous Years Questions Q6. A 28 year old female with Graves’ disease was taking
medication for hyperthyroidism during pregnancy.
Q1. A patient was operated for prostate carcinoma and She delivered a child with congenital anomaly ‘aplasia
during surgery local metastasis was noted. Which of the cutis congenita’. Most likely drug implicated for this
following drug this patient should receive? teratogenic effect is?
A. Leuprolide B. Desmopressin A. Carbimazole B. Levo-thyroxine
C. Octreotide D. Tamsulosin C. Methylthiouracil D. Liothyronine
Q2. Tolvaptan is used for: Q7. Drug of choice for hyperthyroidism in third
trimester of pregnancy is
A. SIADH
B. Central Diabetes Insipidus A. Carbimazole B. Propylthyouracil
C. Von Willebrand Disease C. Sodium iodide D. Radioactive iodine
D. Catecholamine resistant Shock
Q 8. A 30 year old female presented with weight gain
and cold intolerance. On investigations Value of T3 is
Q3. A patient presents with pituitary tumor that
70 ng/dl (reference value 100-200 ng/dl),T4 is 3 mcg/
overproduces growth hormone. surgical removal of the
dl (reference value 5-12 mcg/dl) and TSH is 20 mIU/L
tumor was incomplete. What is the first line treatment
(reference value 0.5-5 mIU/L). Which of the following
of this patient?
statement is correct regarding the management of this
A. Leuprolide B. Octreotide patient?
C. Nafarelin D. Goserelin A. Measure T3, T4 and TSH after one month
Q4. A 40 year old male presents with protrusion of chin, B. Start L-thyroxine (T4) treatment 100 mcg once
daily
excessive sweating, impaired glucose tolerance and
enlargement of hands and feet? Which of the following C. Start L-thyroxine (T4) treatment 25 mcg daily and
drugs is a growth hormone receptor antagonist used to gradually increase
treat this condition? D. Start daily L-thyroxine (T4) 100 mcg with Liothy-
ronine (T3) 5 mcg
A. Pegvisomant B. Octreotide
C. Cabergoline D. Olcegepant
Q 9. What is the Drug of choice for Hyperthyroidism in
Q5. A female presented with galactorrhea. Her urine first trimester of Pregnancy?
pregnancy test was negative. MRI of head revealed A. Lugol’s iodine B. Methimazole
a large pituitary tumor. Patient refused to undergo
C. Propylthiouracil D. Carbimazole
surgery for the tumor. Which of the following is the
best drug for the treatment of this patient? Q 10. Which of the following drug is given pre-operatively
A. Octreotide B. Bromocriptine to decrease the risk of intraoperative bleeding in a
hyperthyroid patient planned for thyroidectomy?
C. Promethazine D. Clozapine
A. Potassium iodide B. Propranolol
C. Propylthiouracil D. Methimazole
Answers
1. - A 3. - B 5. - B 7. - A 9. - C
2. - A 4. - A 6. - A 8. - C 10. - A
49
Pharmacology
Q 11. A 70 year old patient has diabetes mellitus and Q 16. Which of the following drug is given to mother
hypertension. He presents with late stage chronic delivering premature baby for fetal lung maturation?
kidney disease. Which of the following anti-diabetic
A. Aspirin
drugs require least dose modification in renal disease?
B. Dexamethasone
A. Sitagliptin B. Vildagliptin
C. Magnesium sulfate
C. Linagliptin D. Saxagliptin
D. Depot medroxy progesterone acetate
Q 12. A 50 year old patient of type 2 diabetes mellitus
was controlled on oral hypoglycemic drugs. This patient Q 17. A patient presented with the following features
presented to hospital with profuse sweating and after chronic intake of a drug for several years. Which
dizziness. There was presence of hypoglycemia. Which is the likely drug person has consumed?
among the following drugs can result in hypoglycemia in A. Paracetamol B. Prednisolone
this patient?
C. Phenytoin D. Metformin
A. Metformin B. Voglibose
C. Vildagliptin D. Glipizide
D. It is amylin analogue and decrease glucagon Q 18. What is the prenatal dose of dexamethasone
given for lung maturation in premature infants ?
Q 15. To minimize the risk of HPA axis suppression, A. 6 mg 2 doses 12 hours apart
what is the correct method of administration of
B. 12 mg 2 doses 24 hours apart
prednisolone?
C. 6 mg 4 doses 12 hours apart
A. Give at night just before bedtime
D. 6 mg 4 doses 24 hours apart
B. Divide in three doses and give small doses 8 hourly
C. Give on alternate day
D. Replace with betamethasone
Answers
11. - C 13. - B 15. - C 17. - B
12. - D 14. - A 16. - B 18. - C
50
Cerebellum Quick Revision Notes
Q 19. Which of the following is not used in treatment of Q 21. A 22 year old female presents 8 hours after
polycystic ovarian disease? sexual assault. It is the 13th day of her menstrual cycle.
Which emergency contraceptive should be prescribed
A. Letrozole
to her?
B. Clomiphene citrate
A. Levonorgestrel 1.5 g single tablet
C. Ulipristal
B. Injection DMPA
D. Combined oral contraceptives
C. OCP from day 1 of next cycle
Q 20. Combined oral contraceptive pills act by all of the D. Misoprostol
following mechanisms except?
Q 22. Which of the following is not used as emergency
A. Inhibit implantation by bringing change in the uterus
contraceptive?
B. Inhibit ovulation
A. Danazol
C. Makes cervical mucus thick and hostile
B. Levonorgestrel
D. Increase gonadotropin secretion
C. Mifepristone
D. IUCD
Answers
19. - C 21. - A
20. - D 22. - A
Physiology Revision 7 07 53
Nearby
cell Autocrine signalling Gap Junctions
Most of the anterior pituitary hormones will have negative feedback except LH
surge (Increase in estrogen causes increase in LH levels).
Hypothalamic Releasing factors :
Hypothalamic hormones Anterior pituitary hormones
Thyrotropin-releasing hormone (TRH) Thyroid stimulating Hormone (TSH)
Adreno corticotrophin Releasing
Corticotropin-releasing hormone (CRH)
Hormone (ACTH)
Gonadotropin-releasing hormone Follicle Stimulating Hormone (FSH),
(GnRH) Luteinizing Hormone (LH)
Growth hormone-releasing hormone
Growth Hormone
(GHRH)
Physiology Revision • 1.0 • Marrow 6.5 • 2023
54 07 Physiology
Hypothalamus -
GHRH Somatostatin
+ -
+ Somatotrophs in anterior -
Ghrelin
pituitary
Growth Hormone
Liver
Indirect Actions:
Hypothalamus
Insulin receptor
Cell membrane
Tyrosine kinase
Hyperglycemic hormones :
Hormones antagonizing action of insulin hyperglycemia.
a.k.a counter regulatory hormones :
• Cortisol
• Growth hormone
• Glucagon
• Epinephrine
• Thyroid hormone
Zona glomerulosa :
Secrete Aldosterone
Zona fasciculata :
Secrete cortisol
Zona reticularis :
Secrete sex steroids
Adrenal medulla
Secrete
Catecholamines
Aldosterone
Actions : Collecting duct
Aldosterone acts on principal cell of Blood
Distal convoluted tubule vessel
I-cell
• Reabsorption of sodium : Through
Epithelial Na channels (ENac) in luminal H+-K+
Exchanger
surface Aldost H+
Na
• Reabsorption of water MR
Urine
Al
• Excretion of potassium ions in urine : Complex
HCo3-
Through Renal Outer Medullary K+
HCo3--Cl-
channels (ROMK channel). Exchanger
Aldosterone escape :
Normally increase in aldosterone causes sodium reabsorption.
To prevent indefinite reabsorption of sodium, Atrial natriuretic peptide (ANP) is
secreted to promote sodium excretion
Hence the sodium excreted despite the presence of aldosterone.
Physiology Revision • 1.0 • Marrow 6.5 • 2023
Physiology Revision 7 07 61
Effect Mechanism
On carbohydrate
“Hyperglycemic hormone” gluconeogenesis
metabolism
• Catabolic to proteins present in the muscle
On protein
• Anabolic in liver : synthesis of plasma proteins
metabolism
from liver
On fat metabolism Lipolytic
On immune system Universal anti-inflammatory agent
• Cortisol the blood levels of : Eosinophils, Lympho-
cytes, Basophils
On blood cells
• Cortisol the blood levels of : Neutrophils,Platelets,
RBCs
• Alters mood and behaviour
On nervous system
• appetite
On kidney • glomerular filtration rate and calcium excretion
On bone bone resorption by activity of osteoclasts
On connective Inhibits fibroblast proliferation and collagen formation
tissues (Delay wound healing)
Hypercalcemia Hypocalcemia
Absorption of calcium :
• Calcium absorption occurs mainly in duodenum.
• Absorption of calcium is facilitated by gastric acid, protein rich diet.
• Absorption of calcium is inhibited by phytates and oxalates (Form complexes
with calcium).