1. ENDOCRINE SERIES AKSHAT JAIN MD FAAP MOUNT SINAI SCHOOL OF MEDICINE New York

2. Hypothalamus and Pituitary Axis

4. Hypothalamus and pituitary gland

6. Hypothalamus and posterior pituitary Secrete oxytocin and vasopressin directly into capillaries in the posterior lobe

8. Hypothalamus and anterior pituitary

9. Regulation of Hypothalamus Reituclar activating substance Thalamus neocortex Limbic system Optical system Heat regulation (temperature) Energy regulation (hunger, BMI) Autonomic regulation (blood pressure etc) Water balance (blood volume, intake--thirst, output—urine volume) Metabolic rate, stress response, growth, reproduction, lactation) Sleep/wake pain Emotion, fright, rage, smell vision Anterior pituitary hormones posterior pituitary hormones

11. Hypothalamic releasing hormones Hypothalamic releasing hormone Effect on pituitary Corticotropin releasing hormone (CRH) Stimulates ACTH secretion Thyrotropin releasing hormone (TRH) Stimulates TSH and Prolactin secretion Growth hormone releasing hormone (GHRH) Stimulates GH secretion Somatostatin Inhibits GH (and other hormone) secretion Gonadotropin releasing hormone (GnRH) a.k.a LHRH Stimulates LH and FSH secretion Prolactin releasing hormone (PRH) Stimulates PRL secretion Prolactin inhibiting hormone (dopamine) Inhibits PRL secretion

13. Anterior pituitary cells and hormones Breasts PRL 10-15% Lactotroph All tissues, liver, gonads GH 40-50% Somatotroph Gonads LH, FSH 10-15% Gonadotroph Thyroid gland TSH 3-5% Thyrotroph Adrenal gland Adipocytes Melanocytes ACTH 15-20% Corticotroph Target Product Pituitary population Cell type

14. Anterior pituitary hormones

15. SHORT STATURE and GROWTH HORMONE

21. ICP Model Infancy Childhood Puberty Nutrition Thyroxin GH Sex Steroids

24. Concept of GROWTH VELOCITY Boys: 10 to 14 cm (4 to 6 in) Girls: 8 to 12 cm (3 to 5 in) Pubertal growth spurt 5 to 5.5 cm (2 to 2.2 in) Prepubertal nadir 6 to 7 cm (2 to 3 in) Fourth year 10 to 14 cm (4 to 6 in) Second year 23 to 27 cm (9 to 11 in) First year 60 to 100 cm (24 to 40 in) In utero Growth velocity per year Life stage

30. Familial Short Stature

31. Familial short stature Most parents with short stature have short children. These children have a Normal growth velocity and their growth curves run parallel to the normal growth curves. A Short as adults, with a similar height to their parents.

39. Abnormal Growth Findings Suggesting the Need for Referral Bone age: advanced or delayed by more than two standard deviations Multiple syndromic or dysmorphic features: abnormal facies, midline defects, body disproportions Genetic potential: projected height varies from midparental height by more than 5 cm (2 in) Growth velocity: decreased or accelerated growth velocity for age Height: growth less than the 3rd percentile or greater than the 95th percentile for height

40. SHOX