Navigating the Complexity of the Endocrine System

By Beverly Araujo, Rachel Densmore, Annalise Speer, Lindsey Duff, Lacy M. Cleveland

Abstract

In this interrupted case study, students learn about “Eva,” a twenty-eight-year-old experiencing an array of endocrine-related issues and misdiagnoses. The case provides students with the opportunity to review the hypothalamic-pituitary axis and to dive deeply into the hypothalamic-pituitary-adrenal (HPA) axis. Students examine the short- and long-feedback loops associated with cortisol regulation, along with its circadian rhythm. Students are exposed to various causes of hyper- and hyposecretion of cortisol and challenged to explore how clinicians use hormone panels and suppression tests to distinguish between primary, secondary, and tertiary disorders. The case was designed for an undergraduate anatomy and physiology or pathophysiology course.

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Date Posted

07/07/2025

Overview

Objectives

Identify the hormones associated with the hypothalamic-pituitary axis signaling pathway.
Describe the signaling and feedback loop of the hypothalamic-pituitary-adrenal (HPA) axis.
Compare and contrast the symptoms, risk factors, and causes of the diseases associated with the HPA axis.
Compare and contrast hormone panels for HPA diseases of primary and secondary hyper- and hyposecretion.
Evaluate a dexamethasone suppression test to distinguish between various causes of hypercortisolism.
Consider the impacts and necessity of surgery as a primary treatment for hypercortisolism and hormone therapy as adjuvant treatment.

Keywords

Hypothalamic-pituitary-adrenal axis; HPA axis; Cushing; hypersecretion; hyposecretion; DEXA suppression test; cortisol; anterior pituitary; ACTH; CRH

Subject Headings

Medicine (General)

Nursing

Physiology

EDUCATIONAL LEVEL

Undergraduate lower division

FORMAT

PDF

TOPICAL AREAS

N/A

LANGUAGE

English

TYPE/METHODS

Interrupted, Directed, Discussion

Teaching Notes & Answer Key

Teaching Notes

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Answer Key

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Materials & Media

Supplemental Materials

Videos

Dexamethasone Suppression Test: Explained Clearly
This video reviews the hypothalamic-pituitary-adrenal axis and how the dexamethasone suppression test is used to determine the cause of hypercortisolism. Running time: 3:52 min. Produced by AJMonics, 2022.