Endocrine system and syndromes

Last Review Date: July 1, 2018

WHAT IS THE ENDOCRINE SYSTEM?

The endocrine system is made up of various glands located throughout the body. Together with the nervous system, it controls and
regulates all bodily functions. While the nervous system uses nerve impulses as a means of control, the endocrine system uses chemical
messenger molecules called hormones. These hormones are released by the endocrine glands into the blood stream, where they seek
out specific target tissues. The targets have receptors that accept the hormones like fitting a key to a lock. Some of the hormones’
targets are other glands – they are secreted by one gland and travel to another, where they stimulate the production and secretion of
another hormone that then takes action. An example of this is the hypothalamus gland (see table on Tests page) that releases
thyrotropin-releasing hormone (TRH). This hormone stimulates the pituitary gland to release thyrotropin (more commonly known as TSH
or thyroid-stimulating hormone). TSH in turn stimulates the thyroid gland to produce thyroid hormones thyroxine (T4) and
triiodothyronine (T3), which help to regulate the rate of metabolism.

To learn more about specific endocrine glands, the hormones they produce, and the disorders associated with their improper function,
see the table of endocrine glands on the Tests page.

All of the endocrine glands are normally carefully controlled with the use of feedback systems. For example, the amount of thyroid
hormone in the bloodstream acts as a regulating factor on the hypothalamus and pituitary, telling them to release more TRH and TSH
respectively when thyroid hormone concentrations in the blood decrease. In some cases, such as thyroid hormone, the body strives to

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keep a relatively constant amount in the blood.

Some hormones have a daily or monthly pattern of release. For example, cortisol (produced by the adrenal glands) concentrations are
high in the morning and lower late in the evening, while both follicle-stimulating hormone (FSH) and luteinising hormone (LH) (produced
by the pituitary gland) increase and decrease with and regulate a woman’s monthly menstrual cycle. Other hormones are generally
present in very small quantities in the blood and are released in specific situations, such as the release of adrenaline (epinephrine) from
the adrenal glands in response to stress.

WHAT CAN GO WRONG?

Hormones affect systems all over the body. They control the development of male and female sexual characteristics, fertility, growth, the
rate at which the body uses energy, its ability to digest food, to utilise glucose, to respond to stress, to maintain fluid/water balance and
to maintain a proper blood pressure. Endocrine abnormalities usually result in the production of either too much of a specific hormone or
too little. Some of the conditions that cause dysfunction have been given names, such as Cushing’s syndrome (associated with excess
cortisol) because when they occur they cause a typical set of symptoms and complications.

Endocrine gland dysfunction may be due to either a problem with the gland itself, a problem “upstream” in the feedback system, and/or
due to a lack of response by the target tissues. There may be decreased hormone production related to trauma, disease, infection,
crowding of the hormone-producing cells by a tumour, or due to an inherited gene mutation that affects the quantity, quality, or use of a
hormone. Decreased production may also be due to failure of the “upstream” gland to produce its hormone(s). Increased production may
also be related to a problem upstream (such as the pituitary producing too much ACTH, leading to the production of too much cortisol),
hyperplasia or tumour of the hormone-producing cells, lack of tissue response, medication use or an inherited condition.

Tumours are generally small and usually benign. Most of them are located inside the affected gland and produce a single type of
hormone. Rarely they may be cancerous and also rarely they may be located elsewhere in the body. A tumour may cause symptoms
because of the excess hormone it is producing, because its growth crowds out and decreases the production of other hormones in the
gland, or because its physical size presses against surrounding nerves and structures.

Most inherited conditions are rare and are usually related to deficient or dysfunctional production of a single hormone or to the hormone
production of a particular gland (for example, congenital hypothyroidism). However, there are genetically-caused conditions that affect
the glands themselves. Two that have been identified as affecting several endocrine glands are MEN-1 and MEN-2 (multiple endocrine
neoplasia, types 1 and 2). These conditions are related to alterations in specific genes, and they increase the lifetime risk that those
affected will develop tumours in one or more of their endocrine glands.

TESTS

Table of Endocrine Glands

 EXAMPLES OF DISORDERS
ENDOCRINE LOCATION/ HORMONES GLAND GLAND/ HORMONE
ASSOCIATED WITH
GLAND DESCRIPTION PRODUCES FUNCTION
IMPROPER FUNCTION

Growth hormone-releasing
hormone (GHRH
Communicates with
Thyrotropin-releasing hormone both nervous and
Precocious puberty (early GnRH
(TRH)
endocrine systems; 

production);

Corticotropin-releasing hormone Stimulates GH, TSH,

Kallman syndrome (inadequate
(CRH)
ACTH, LH/FSH or
GnRH production);

Gonadotropin-releasing hormone inhibits prolactin

Thyroid diseases
(GnRH)
hormone production in
Lower middle of
Hypothalamus Prolactin Inhibitory Factor (PIF, the pituitary
the brain
dopamine)

Uterine contraction
Oxytocin  
during labour

Arginine vasopressin (AVP), also

called antidiuretic hormone (ADH)- Diabetes insipidus (inadequate
Water balance
produced by the hypothalamus; AVP production)
stored and secreted by the pituitary

Hypopituitarism

syndrome

Prolactin Milk production Galactorrhoea (milk production

not during pregnancy due to high
prolactin)

Stimulates childhood Acromegaly or Gigantism (excess

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growth, cell production, GH)

Below Growth hormone (GH) helps maintain muscle Growth Hormone

hypothalamus, and bone mass in Deficiency (GHD)

Pituitary
behind sinus adults
cavity
ACTH Cushing's syndrome (excess
Stimulates cortisol
ACTH)

Stimulates thyroid Hyperthyroidism

TSH
hormone Hypothyroidism

Regulation of Loss of menstrual period

LH, FSH testosterone and Loss of sex drive

oestrogen, fertility Infertility

Butterfly- T4 (thyroxine)
Helps regulate the rate Thyroid diseases (including hypo
shaped; lies flat T3 (triiodothyronine) of metabolism & hyperthyroidism)
Thyroid against
windpipe in the Helps regulate bone
Calcitonin  
throat status, blood calcium

4 tiny glands
located behind, Hyperparathyroidism

Regulates blood
Parathyroid next to, or Parathyroid hormone (PTH) Hypoparathyroidism

calcium
below the  
thyroid

Blood pressure
Adrenaline

regulation, stress Phaeochromocytoma 

Noradrenaline
reaction

2 triangular Aldosterone Salt & water balance Conn’s syndrome

Adrenal organs, on top
of each kidney Cushing’s syndrome

Cortisol Stress reaction

Addison’s disease

Body hair development Cancer

DHEA-S
at puberty Adrenal hyperplasia
 EXAMPLES OF DISORDERS
ENDOCRINE LOCATION/ HORMONES GLAND GLAND/ HORMONE
ASSOCIATED WITH
GLAND DESCRIPTION PRODUCES FUNCTION
IMPROPER FUNCTION

Ovaries 
2 located in the Oestrogen
Female sexual Polycystic ovary syndrome
(females only) pelvis Progesterone characteristics (PCOS)

Testes 
2 located in the Male sexual
Testosterone Hypogonadism
(males only) groin characteristics

Large, gourd-
Insulin

shaped gland, Diabetes mellitus

Pancreas Glucagon
Glucose regulation
located behind Zollinger-Ellison syndrome
Somatostatin
the stomach

Not well understood;

Lower side of Helps control sleep

Pineal Melatonin  
the brain patterns, affects
reproduction

This table includes a listing of endocrine glands, the hormones they produce, and the diseases and conditions associated with their
improper function.

The goal with endocrine gland testing is to identify the hormone(s) that are being over- or under-produced, to determine which gland(s)
are involved, and to determine the cause. This may involve measuring hormone levels and their metabolites in the blood and/or urine. It
may also involve stimulation or suppression testing to evaluate hormone production and/or its “upstream” hormone stimulation (to find
out if it is the gland itself that is dysfunctional or if it is due to dysfunction by the gland preceding it). If a tumour is suspected, then
imaging scans may be used to help locate the tumour. If symptoms are suspected to be due to an inherited condition, then genetic
testing may be recommended. Patients often see an endocrinologist (an endocrine gland specialist) to help them determine the

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appropriate testing and treatment. Related testing on this site includes:

Laboratory tests

ACTH (Adrenocorticotropic hormone)

Aldosterone

Calcitonin

Calcium

Catecholamines, plasma and urine

Cortisol

DHEAS (dehydroepiandrosterone sulphate)

Electrolytes

FSH (Follicle-stimulating hormone)

GH (Growth hormone)

hCG (Human chorionic gonadotropin)

IGF-1 (Insulin-like growth factor – 1)

LH (Lutenising hormone)

Metanephrines, plasma free

Metanephrines, urine

Oestrogen

Progesterone

Prolactin

PTH (Parathyroid hormone)

Free T3 (triiodothyronine)

Free T4 (thyroxine)

Testosterone

TSH (Thyroid-stimulating hormone)

Non-laboratory tests
 Magnetic resonance imaging (MRI)

Computed tomography (CT)

Ultrasound

Radioisotope scans

TREATMENT
Treatment of endocrine gland-related conditions depends on the cause. If the problem is due to a drug therapy, then the patient may be
able to be weaned off the medication (never abruptly stop taking a medication without consulting with your doctor). If it is due to
hyperplasia, then the action of the hormone may be able to be blocked. If is due to a tumour, then the tumour may be able to be surgically
removed. Often this will resolve the problem or decrease it to the point that it can be successfully controlled.

In some cases, after a gland has been removed to resolve the problem, the patient may need to take replacement medications, such as
thyroid hormone. Replacement is also often used when a patient’s gland has been damaged or is otherwise not capable of producing a
sufficient quantity of one or more hormones. When patients have a gene mutation associated with MEN-1 or MEN-2, careful lifetime
monitoring will be necessary. Treatment of all endocrine-related conditions should be tailored to the individual. Patients should work with
their doctor to determine the right course of action for them.

RELATED PAGES
On this site

Tests: ACTH, aldosterone, cortisol, calcitonin, calcium, catecholamines, plasma and urine, DHEAS, electrolytes, FSH, GH, hCG, IGF-1, LH,
metanephrines, plasma free and urine, oestrogen, progesterone, prolactin, PTH, free T3, free T4, testosterone, TSH

Conditions: Adrenal insufficiency & Addison’s disease, Cushing’s syndrome, Conn’s syndrome

Elsewhere on the web

MedlinePlus Medical Encyclopedia: Endocrine Glands

Nemours Foundation: Endocrine System, KidsHealth for Parents

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EndocrineWeb.com

Healthdirect Australia: Endocrine diseases