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FDM Training Program: Mod 7 * FDMT561A Introduction to Functional Endocrinology

Wayne L. Sodano, D.C., D.A.B.C.I. & Ron Grisanti, D.C., D.A.B.C.O., M.S.

©Sequoia Education Systems, Inc.

http://www.FunctionalMedicineUniversity.com1

Functional Diagnostic Medicine Training Program

Module 7 * FDMT561A

Introduction to Functional Endocrinology

Wayne L. Sodano, D.C., D.A.B.C.I.

&

Ron Grisanti, D.C., D.A.B.C.O., M.S.

Stress

Immune SystemGastrointestinal System

Limbic System

Endocrine System

Hypothalamus

Pituitary

©2010AllRightsReservedCSDesigns

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19239.htm





Hypothalamic Function and Influence

• Homeostasis

• Hunger thirst, response to pain, level of pleasure,

sexual satisfaction, anger, aggressive behavior

• Control over the pituitary

• Control of the autonomic nervous system

• Circadian rhythms

• Appetite

Reprinted with permission: BioHealth Diagnostics

http://www.biodia.com/TechnicalCharts/HPA-HPTAxesChart.pdf

Physiological Aspects of Cortisol and DHEA

Reprinted with permission: BioHealth Diagnostics http://www.biodia.com/TechnicalCharts/HPA-HPTAxesChart.pdf





Steroidal Hormone Principle Pathways

Reprinted with permission: BioHealth Diagnostics http://www.biodia.com/TechnicalCharts/HPA-HPTAxesChart.pdf

Case History

Case Study : 02/08/2006

Chief complaint: “ All joints hurt” (Patient questions possibility of MS? RA?

Autoimmune Disease?)

• Started Synthroid .05 mg: 2/7/2006

• Cancerous colon polyp removed 7/23/2004

• Herpes simplex (chronic breakouts)

• Carpal Tunnel Syndrome

• Positive TPO (Thyroid Antibody)

Patient: Female 48 years-old

Occupation: School bus driver

Previous Occupation: Worked with/around motor vehicles; family

business. Pumped own fuel daily.





Review of Systems & Past History

• Enlarged thyroid

• Bruising easily and dry skin

• Weight gain, weakness, sleeping disturbances, hot flashes,

low sex drive, low blood pressure, MVP, depression/mood

swings

• Endometriosis/uterine fibroids

• Hysterectomy 12/26/2000; left ovary, adhesions and

appendix 12/7/2001

Menstrual History

• Age 14: Menarche; irregular cycles 26-48 days

• Age 17: Began BCP; regular periods for 8 years; no health problems

• 1984: First yeast infection

• 1984: Married; stopped BCP – irregular periods began with heavy bleeding and clotting

• Age 33: Bleeding on/off during first pregnancy-delivered 2 weeks early-breast fed 3 months-stopped due to bleeding nipples

• Age 36: 2nd pregnancy no bleeding – breast fed 19 months –no problems

• Ages 38-39: Menstrual cycles better

• Age 40: Began with heavy bleeding/clotting

• Age 43: Fibrocystic breast disease

• Age 46: Began treatment with medical doctor.

Physical Exam

• Ht: 5’ 4”

• Wt: 140 lbs

• Pulse: 68 b/m

• Resp: 16

• Temp: 98.2

• BP: 110/64 R 116/70 L

• Neuro/Ortho: WNL

• Abd: left lower quadrant: significant tenderness

• Hair: Thin: pulls out easily

• Skin: Dry scalp

• Tongue: White coating, scalloped





Blood tests

ordered by

primary

care

physician

prior to

initial visit

Thyroglobulin AB…………………………………………………………………….39 IU/mL (less than 20)

Health Symptom Assessment Questionnaire

There are three general classes of hormones:

1. Steroids (e.g. estrogens) These hormones are synthesized from cholesterol and are not stored.

2. Amino acid derivatives (e.g. epinephrine, thyroid hormones)

3. Peptide hormones (e.g. insulin)- Amino acid and peptide hormones are stored in secretory vessels until they are needed.

(The eicosanoids are also considered hormones and are derived from fatty acids)





The Endocrine Glands

• Hypothalamus

• Pineal

• Anterior Pituitary

• Posterior Pituitary

• Thyroid

• Parathyroid

• Adrenal Cortex

• Adrenal Medulla

• Pancreas

• Testes

• Ovaries

• Placenta

• Kidney (skin and liver are also

part of the metabolism of

vitamin D)

• Heart

• Stomach

• Small intestines

• Adipocytes

• Thymus

• Eicosanoids “local hormones”

• Liver

Chemical Messengers

• Neurotransmitters

• Endocrine hormones

• Neuroendocrine hormones

• Paracrines

• Autocrines

• Cytokines

Step 1 L-methylfolate assists in the production of a nutrient called

tetrahydrobiopterin (BH4), which is a critical cofactor for the

production of monoamines.

Step 2 BH4 activates the rate limiting enzymes for the synthesis of

monoamines. (tyrosine hydroxylase and tryptophan

hydroxylase)

Step 3 Tyrosine + (BH4 + tyrosine hydroxylase)→ Dopamine and

Norepinephrine

Tryptophan + (BH4 + tryptophan hydroxylase) → Serotonin





Hormone Concentration in Circulating Blood

Feedback Control of Hormone Secretion

(Regulation)

• Negative feedback

• Positive feedback

• Cyclical Variations of Hormone Release

Hormone Carriers in the Blood





Clearance of Hormones from the Blood

Concentration of hormones

– Rate of secretion into the blood

– Rate of clearance from the blood- “metabolic clearance

rate” (protein-bound hormones are cleared at much

slower rate.)

Clearance rate

– Metabolic destruction by the tissues

– Binding with the tissues

– Excretion by the liver into the bile

– Excretion by the kidneys into the urine

Target Cells, Hormone Receptors and Principle

Mechanism of Hormone Action

Target Cells, Hormone Receptors and Principle

Mechanism of Hormone Action

• Cell surface receptors

• Intracellular receptors

©2010 CS Designs





Cell Surface Receptors

Intracellular Receptors

Extracellular fluid

mRNA

Target cell

Nuclear envelope

Lipophilic hormone

Diffusion

Cytoplasmic

receptor

Nucleus

Nuclear

receptor

Hormone

Receptor

complex

DNA

Hormone

response

element

mRNA

Nuclear pore

Ribosome

Proteins

©2010AllRightsReserved CSDesigns





Endocrine Disrupting Chemical

(Hormone Disruptors)

http://e.hormone.tulane.edu/learning/docking-

receptor-binding.html#EndocrineDisruption









Summary

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