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- Identify the normal range of plasma glucose concentrations and the hormonal regulation of its metabolism, storage, and mobilization.
- Identify the specific roles of insulin, glucagon, glucocorticoids, catecholamines, growth hormone, and thyroid hormone in the regulation of energy substrate utilization, storage, and mobilization.
- Describe the hormonal regulation of energy substrate metabolism during the fed and fasted states and understand the consequences of its dysregulation.
- Identify the mechanisms involved in the maintenance of long-term energy balance.
- Identify the normal range of dietary sodium intake, its body distribution, and routes of excretion. Explain the roles of antidiuretic hormone, aldosterone, angiotensin, and atrial natriuretic hormone in the regulation of sodium balance.
- Identify the normal range of dietary potassium intake, its body distribution, and routes of excretion. Explain the hormonal regulation of plasma potassium concentration, distribution, and balance in the acute and chronic settings.
- Identify the normal range of dietary calcium intake, its body distribution, and routes of excretion. Explain the hormonal regulation of plasma calcium concentration through bone resorption, renal excretion, and intestinal absorption.
- Identify the normal range of dietary phosphate intake, its body distribution, and routes of excretion. Explain the hormonal regulation of plasma phosphate concentration through exchange with bone, renal excretion, and dietary intake and absorption.
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In the first chapter, several of the key functions of the endocrine system that maintain homeostasis were outlined. Subsequent chapters described the specific physiologic effects of individual hormones, the mechanisms that regulate their production and release, and the consequences of isolated excess or deficiency. The presentation of this material would not be complete without an attempt to integrate some of these actions into the overall regulation of specific functions. Although a complete description of the integrative control of physiologic function is beyond the scope of this book, this chapter integrates many of the concepts already presented. It describes how the different arms of the neuroendocrine system interact to regulate and maintain basic functions, which include energy substrate balance, blood volume and blood pressure, and preservation of bone mineral density (BMD). Finally, it presents an integrated discussion of the neuroendocrine mechanisms involved in mediating the stress response.
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Two distinct phases directly related to the ingestion of a meal alternate throughout the day in the regulation of energy metabolism. The fed state reflects overall anabolic metabolism, during which energy is stored in the form of energy-rich compounds (adenosine triphosphate [ATP], phosphocreatinine), glycogen, fat, and proteins. The fasted or catabolic phase is the period during which endogenous energy sources are utilized.
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The anabolic and catabolic phases alternate to preserve adequate glucose supply to the brain as well as sufficient energy to maintain body functions, such as thermoregulation (maintaining a constant core temperature), food digestion, and physical activity. The 2 hormones at the core of maintaining this balance are insulin and glucagon (see Chapter 7); in particular, their ratio plays a critical role in the dynamic regulation of substrate metabolism (summarized in Table 10–1). ...