A Synopsis of Endocrinology and Metabolism by David G. Ferriman

By David G. Ferriman

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There are gaps in our present knowledge. Sodium loss leads to an increased production in order to conserve this ion. Changes in extracellular fluid volume also act as trigger mechanisms for regulation of aldosterone by way of renin production (Fig. 7). RENIN Catalyst liberated from a-protein ANGIOTENSIN Enzyme in blood ANGIOTENSIN II Stimulates output of ALDOSTERONE Fig. —Renin-angiotensin-aldosterone control mechanism. ADRENAL A S S E S S M E N T 1. — a. Disturbance of electrolytes, acid-base balance, and carbohydrate metabolism are suggestive of various disorders which are dealt with under their appropriate headings.

2. Raised serum cholesterol. 3. Low T3 resin uptake. Low P B I except in forms associated with abnormal iodinated proteins. HYPOTHYROIDISM 33 2. —Childhood. The dividing line between infantile and juvenile hypothyroidism can be blurred. In some cases the underlying disorder has clearly arisen after some years, in others it has been present at birth but for some time the production of thyroxine has been sufficient to meet needs. In others hypothyroidism may have been present from infancy but manifestations have been mild and the diagnosis has not been made until later.

B. — i. —Weight-loss is usual. Two factors are involved—increased catabolism and increased appetite. The increased appetite sometimes outweighs the increased catabolism, and occasionally patients present with weight gain. Sweating with warm moist skin. Lassitude and easy fatigability. ii. —Nervousness, hyperexcitability, and tremor. These features tend to be prominent in younger patients, but are often minimal in older subjects, iii. —Palpitations, tachycardia, and dyspnoea. These features tend to be prominent in older subjects.

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