Endocrine Pathology: Treading Water in a Shark Tank of Uncertain Malignant Potential

      A wonderful thing about endocrine-related diseases is that most of them make sense. Unlike the complicated molalities of the Loop of Henle or the mapping of the complex and vaguely specific geography of the brain, we can logically contemplate the mechanism of action of central to end-organ feedback of hormone regulation. If the body physiologically requires more calcium, calcium sensors tell the parathyroid to facilitate increased calcium absorption and secretion. To maintain homeostasis in body temperature and metabolism, thyrotropin-releasing hormone does a well-rehearsed dance with thyroid-stimulating hormone (TSH; or thyrotropin), which, in turn, greets the transmembrane TSH receptor in the thyroid to facilitate iodine uptake via the sodium iodide symporter and the production of thyroid hormone by thyrocytes. From thyroglobulin stores within thyroid follicles, there is secretion of thyroid hormone in its active form of triiodo-l-thyronine as well as in its primary form of thyroxine to be activated by cells in the body's periphery, resulting in intracellular modification of gene and protein expression via complexes associated with thyroid hormone receptor isoforms, and subsequently feeding back centrally to cool down additional secretion in times of plenty. For as much as we understand about endocrine physiology, a great deal is left to be discovered about endocrine pathophysiology, much of which centers around endocrine neoplasia.
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