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Chemical Coordination and Integration

Chemical Coordination and IntegrationNEET Zoology · Class 11 · NCERT Chapter 19

Introduction

The nervous system gives fast, short-lived signals. The endocrine system gives slower, longer-lasting signals using chemical messengers called hormones. Together, both systems coordinate the activity of every organ in your body.

Expect 2 to 3 NEET questions every year from this chapter. The questions almost always test one of three things: which gland makes which hormone, what each hormone does, and which disorder is caused by which deficiency or excess.

What is a Hormone?

A hormone is a chemical messenger that is:

  • Secreted in very small amounts by an endocrine (ductless) gland.
  • Carried by the blood to distant target cells.
  • Acts on the target cell by binding to a specific receptor.

Endocrine glands have no ducts. They release hormones directly into the bloodstream. Examples: pituitary, thyroid, adrenal. Exocrine glands have ducts (sweat glands, salivary glands, pancreatic acini that release digestive enzymes). Some glands are both, like the pancreas.

Hypothalamus
Pituitary
Pineal
Thyroid
Parathyroid
Thymus
Adrenal
Pancreas (islets)
Gonads (testes/ovaries)

Pituitary

Location

In the sella turcica at the base of the brain; attached to the hypothalamus.

Hormones

Anterior: GH, TSH, ACTH, FSH, LH, prolactin, MSH. Posterior: stores ADH and oxytocin.

Function

Called the "master gland". Its hormones control thyroid, adrenal cortex, gonads, and growth.

NEET disorder fact

GH deficiency = dwarfism (child); GH excess = gigantism (child) or acromegaly (adult).

Hypothalamus

The hypothalamus is the central command for the endocrine system. It sits at the base of the brain, just above the pituitary, and links the nervous system to the endocrine system.

  • Secretes releasing hormones (GnRH, TRH, CRH, GHRH, PRH) and inhibiting hormones (GHIH/somatostatin, PIH/dopamine) that travel to the anterior pituitary and either push or block release of pituitary hormones.
  • Also makes oxytocin and ADH (vasopressin), which travel down to the posterior pituitary for storage and release.

Pituitary Gland

Sits in a bony cavity called the sella turcica at the base of the brain, attached to the hypothalamus by a stalk called the infundibulum. Has two clear lobes:

Anterior Pituitary (Adenohypophysis)

Makes and releases six major hormones plus MSH. All of them are peptide hormones.

  • Growth Hormone (GH): stimulates growth of long bones in childhood, protein synthesis, and cell division. Excess in children causes gigantism; in adults causes acromegaly. Deficiency in children causes dwarfism.
  • Thyroid Stimulating Hormone (TSH): stimulates the thyroid to produce T3 and T4.
  • Adrenocorticotropic Hormone (ACTH): stimulates the adrenal cortex to release glucocorticoids (mainly cortisol).
  • Follicle Stimulating Hormone (FSH): in females, stimulates growth of ovarian follicles; in males, supports spermatogenesis via Sertoli cells.
  • Luteinizing Hormone (LH): in females, the LH surge triggers ovulation and maintains the corpus luteum; in males, stimulates Leydig cells to produce testosterone.
  • Prolactin: stimulates milk production in the mammary glands during pregnancy and lactation.
  • Melanocyte Stimulating Hormone (MSH): acts on melanocytes to control pigmentation.

Posterior Pituitary (Neurohypophysis)

Does NOT make any hormones. Only stores and releases two hormones produced by the hypothalamus:

  • ADH (Vasopressin): acts on the distal convoluted tubule and collecting duct of the kidney. Increases water reabsorption, reducing urine volume. Deficiency causes diabetes insipidus.
  • Oxytocin: causes contraction of the uterus during childbirth (the foetal ejection reflex) and milk ejection (let-down reflex) during lactation.

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Pineal Gland

Small endocrine gland near the back of the brain. Secretes melatonin, which regulates the 24-hour circadian rhythm of the body, especially the sleep-wake cycle. Melatonin levels rise at night. It also influences pigmentation and the immune response.

Thyroid Gland

Butterfly-shaped gland in the front of the neck with two lobes connected by an isthmus. Made of follicles filled with colloid. The follicular cells produce thyroid hormones; the parafollicular cells (C-cells) produce calcitonin.

  • Thyroxine (T4) and Triiodothyronine (T3): both contain iodine. Control basal metabolic rate (BMR), body temperature, growth, and red blood cell formation. Together they are the main "metabolic" hormones.
  • Calcitonin (Thyrocalcitonin): from C-cells. Lowers blood calcium by depositing calcium into bone and reducing kidney reabsorption.

Parathyroid Gland

Four small glands embedded on the back of the thyroid. Secrete parathyroid hormone (PTH), which is the most important hormone in calcium homeostasis.

  • PTH raises blood calcium (it is a "hypercalcemic" hormone).
  • How: by mobilising calcium from bone, increasing intestinal absorption (via vitamin D activation), and increasing reabsorption from kidney.
  • Acts in opposition to calcitonin.

Thymus

Lobed organ located in the chest between the lungs, on top of the heart. Large in young children and shrinks with age. Secretes a group of peptide hormones called thymosins, which drive the maturation and differentiation of T lymphocytes. Thymus is the primary lymphoid organ for T-cell development. It also stimulates humoral immune responses.

Adrenal Gland

Two glands, each sitting on top of a kidney. Each adrenal has two distinct parts that work differently and have different embryonic origins:

Adrenal Cortex (outer)

Secretes steroid hormones called corticoids. Three groups:

  • Glucocorticoids (mainly cortisol): raise blood glucose by gluconeogenesis, break down proteins and lipids. Anti-inflammatory and immunosuppressive.
  • Mineralocorticoids (mainly aldosterone): act on the kidney to reabsorb sodium (and water) and excrete potassium. Raises blood pressure.
  • Small amounts of sex steroids (androgens, estrogens).

Adrenal Medulla (inner)

Secretes the catecholamines: adrenaline (epinephrine) and noradrenaline (norepinephrine). These are the emergency hormones, often called "fight or flight" hormones. They raise heart rate, blood pressure, blood glucose, and dilate the bronchioles.

Pancreas

The pancreas has both exocrine and endocrine parts. Its endocrine part is made of small clusters of cells called the islets of Langerhans. These contain at least four cell types:

  • Beta cells (about 70%): secrete insulin. Insulin lowers blood glucose by promoting glucose uptake into liver, muscle and fat cells, and stimulating glycogen synthesis (glycogenesis) and fat storage (lipogenesis).
  • Alpha cells (about 20%): secrete glucagon. Glucagon raises blood glucose by breaking down liver glycogen (glycogenolysis) and synthesising new glucose (gluconeogenesis).
  • Delta cells: secrete somatostatin (inhibits insulin and glucagon).

Insulin and glucagon act in opposition. After a meal, insulin dominates (blood sugar high). During fasting, glucagon dominates (blood sugar low).

Gonads (Testes and Ovaries)

The gonads produce both gametes and hormones.

  • Testis (Leydig cells): produce testosterone under LH stimulation. Drives spermatogenesis and male secondary sexual characters (beard, deeper voice, muscle growth).
  • Ovary (theca and granulosa cells, then corpus luteum): estrogen grows the uterine lining and gives female secondary sexual characters; progesterone (from corpus luteum) maintains the uterine lining for possible pregnancy. Inhibin and relaxin are also produced.

Hormones from Heart, Kidney and GI Tract

  • Atrial Natriuretic Factor (ANF): from the wall of the atrium of the heart. Released when blood pressure rises. ANF causes the kidneys to excrete more sodium and water, which lowers blood pressure.
  • Erythropoietin (EPO): from the juxtaglomerular cells of the kidney. Released when blood oxygen is low. Stimulates red blood cell production in the bone marrow.
  • Renin: also from the kidney. Triggers the renin-angiotensin pathway which eventually raises blood pressure.
  • Gastrointestinal hormones:
    • Gastrin (from stomach): stimulates HCl and pepsinogen secretion.
    • Secretin (from duodenum): stimulates the pancreas to release bicarbonate.
    • Cholecystokinin (CCK): from duodenum. Stimulates the pancreas to release digestive enzymes and the gallbladder to release bile.
    • GIP (Gastric Inhibitory Peptide): inhibits gastric secretion and motility.
All
Pituitary
Thyroid
Parathyroid
Adrenal
Pancreas
Gonads
Other

Growth Hormone (GH)

Pituitary
Peptide

Gland

Anterior pituitary

Target

Long bones, liver, muscle

Action

Stimulates growth of long bones, protein synthesis, cell division.

NEET fact: Excess in childhood = gigantism; in adult = acromegaly. Deficiency in childhood = dwarfism.

TSH

Pituitary
Glycoprotein

Gland

Anterior pituitary

Target

Thyroid

Action

Stimulates the thyroid to release T3 and T4.

NEET fact: In iodine deficiency, TSH rises high while trying to push the thyroid harder, causing goiter.

ACTH

Pituitary
Peptide

Gland

Anterior pituitary

Target

Adrenal cortex

Action

Stimulates the adrenal cortex to release glucocorticoids (mainly cortisol).

FSH

Pituitary
Glycoprotein

Gland

Anterior pituitary

Target

Sertoli cells (male); ovarian follicle (female)

Action

Supports spermatogenesis; stimulates ovarian follicle growth and estrogen secretion.

LH

Pituitary
Glycoprotein

Gland

Anterior pituitary

Target

Leydig cells (male); ovary (female)

Action

Stimulates testosterone production; triggers ovulation and maintains corpus luteum.

NEET fact: LH surge around day 13-14 of the menstrual cycle triggers ovulation.

Prolactin

Pituitary
Peptide

Gland

Anterior pituitary

Target

Mammary glands

Action

Stimulates milk synthesis during pregnancy and lactation.

MSH

Pituitary
Peptide

Gland

Anterior pituitary

Target

Melanocytes (skin)

Action

Controls pigmentation by stimulating melanin production.

ADH (Vasopressin)

Pituitary
Peptide

Gland

Posterior pituitary (made by hypothalamus)

Target

Distal tubule and collecting duct of kidney

Action

Increases water reabsorption, reducing urine volume.

NEET fact: Deficiency causes diabetes insipidus (15+ litres of dilute urine per day).

Oxytocin

Pituitary
Peptide

Gland

Posterior pituitary (made by hypothalamus)

Target

Uterus and mammary glands

Action

Contracts uterine smooth muscle during childbirth (parturition); milk ejection during lactation.

Thyroxine (T4) and T3

Thyroid
Amine

Gland

Thyroid (follicular cells)

Target

Almost every cell

Action

Control basal metabolic rate, body temperature, growth and RBC formation. Need iodine to be made.

Calcitonin

Thyroid
Peptide

Gland

Thyroid (parafollicular C-cells)

Target

Bone and kidney

Action

LOWERS blood calcium by depositing it into bone and reducing kidney reabsorption.

Parathyroid Hormone (PTH)

Parathyroid
Peptide

Gland

Parathyroid (4 small glands)

Target

Bone, kidney, intestine (via vitamin D)

Action

RAISES blood calcium. Mobilises calcium from bone; increases intestinal absorption and kidney reabsorption.

NEET fact: PTH and calcitonin act in opposition. PTH is the hypercalcemic hormone.

Cortisol

Adrenal
Steroid

Gland

Adrenal cortex (zona fasciculata)

Target

Liver, muscle, immune cells, almost all tissues

Action

Raises blood glucose by gluconeogenesis; breaks down protein and fat; anti-inflammatory and immunosuppressive.

NEET fact: Deficiency = Addison disease. Excess = Cushing syndrome.

Aldosterone

Adrenal
Steroid

Gland

Adrenal cortex (zona glomerulosa)

Target

Kidney distal tubule

Action

Reabsorbs sodium and water; excretes potassium. Raises blood pressure.

Adrenaline + Noradrenaline

Adrenal
Amine

Gland

Adrenal medulla

Target

Heart, blood vessels, muscles, liver

Action

Fight or flight emergency response: raise heart rate, blood pressure, blood glucose; dilate bronchioles.

Insulin

Pancreas
Peptide

Gland

Pancreas (beta cells of islets)

Target

Liver, muscle, fat cells

Action

LOWERS blood glucose. Promotes uptake (via GLUT4), glycogen synthesis, fat storage.

NEET fact: Deficiency or resistance = diabetes mellitus.

Glucagon

Pancreas
Peptide

Gland

Pancreas (alpha cells of islets)

Target

Liver

Action

RAISES blood glucose by glycogenolysis (breakdown of glycogen) and gluconeogenesis.

Testosterone

Gonads
Steroid

Gland

Testis (Leydig cells)

Target

Reproductive organs, skeletal muscle, bone, brain

Action

Supports spermatogenesis; male secondary sexual characters; muscle and bone growth.

Estrogen

Gonads
Steroid

Gland

Ovary (granulosa cells of follicle, also placenta)

Target

Uterus, mammary glands, bone, brain

Action

Grows the uterine lining (follicular phase); female secondary sexual characters; bone health.

Progesterone

Gonads
Steroid

Gland

Ovary (corpus luteum, also placenta)

Target

Uterus, mammary glands

Action

Maintains uterine lining for implantation; prepares mammary glands for lactation; sustains pregnancy.

Melatonin

Other
Amine

Gland

Pineal gland

Target

Brain

Action

Regulates the 24-hour circadian rhythm and sleep-wake cycle. Levels rise at night.

Thymosins

Other
Peptide

Gland

Thymus

Target

T lymphocytes (in thymus)

Action

Drive maturation and differentiation of T cells.

Atrial Natriuretic Factor (ANF)

Other
Peptide

Gland

Atrium wall of heart

Target

Kidney and blood vessels

Action

Released when blood pressure rises. Excretes sodium and water; dilates blood vessels. LOWERS blood pressure.

Erythropoietin (EPO)

Other
Glycoprotein

Gland

Kidney (juxtaglomerular cells)

Target

Bone marrow

Action

Stimulates red blood cell production when blood oxygen is low.

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Mechanism of Hormone Action

How a hormone affects its target depends on whether the hormone is water-soluble or fat-soluble:

Peptide hormones (water-soluble)

Examples: insulin, GH, ADH, oxytocin, glucagon, all anterior pituitary hormones.

  • Cannot cross the cell membrane (too big, charged).
  • Bind to a receptor on the cell surface.
  • Activate second messengers inside the cell, mainly cyclic AMP (cAMP), IP3, and calcium ions.
  • Action is fast (seconds to minutes) but short-lived.

Steroid hormones (fat-soluble)

Examples: cortisol, aldosterone, testosterone, estrogen, progesterone. Thyroid hormones T3 and T4 also behave this way although they are not strictly steroids.

  • Easily cross the cell membrane.
  • Bind to receptors inside the cell (in the cytoplasm or nucleus).
  • The hormone-receptor complex enters the nucleus and activates specific genes.
  • Action is slow (hours) but long-lasting.

Endocrine Disorders

All disorders
Hyposecretion (too little)
Hypersecretion (too much)
Diabetes insipidus
Diabetes mellitus
Goiter
Cretinism
Myxoedema
Dwarfism
Addison disease
Graves disease (exophthalmic goiter)
Gigantism
Acromegaly
Cushing syndrome

Diabetes insipidus

Hyposecretion

Hormone

ADH (vasopressin)

Gland

Posterior pituitary

Cause

Deficiency of ADH from the posterior pituitary. Kidneys cannot reabsorb water in the collecting duct.

Symptoms

Passing very large volumes of dilute urine (sometimes 15+ litres per day). Extreme thirst.

Treatment

Synthetic ADH (desmopressin).

NEET fact

Blood glucose is normal. Do not confuse with diabetes mellitus.

Disorders from too little hormone (hyposecretion)

  • Diabetes insipidus (ADH deficiency): kidneys cannot reabsorb water. Symptoms: very large volume of dilute urine (polyuria), extreme thirst (polydipsia). Blood sugar is normal.
  • Diabetes mellitus (insulin deficiency or resistance): blood glucose rises. Symptoms: polyuria, polydipsia, polyphagia (extreme hunger), weight loss, glucose in urine.
  • Goiter (iodine deficiency): thyroid swells trying to make hormone without iodine. Most common cause of an enlarged thyroid worldwide. Fix: iodised salt.
  • Cretinism (thyroid hormone deficiency from birth or early childhood): stunted growth, mental retardation, poor learning, coarse dry skin.
  • Myxoedema (adult hypothyroidism): low metabolic rate, weight gain, sluggishness, cold intolerance, dry skin.
  • Dwarfism (GH deficiency in childhood): short stature with normal body proportions.
  • Addison disease (cortisol and aldosterone deficiency): weakness, low blood pressure, weight loss, salt craving, brown skin pigmentation.

Disorders from too much hormone (hypersecretion)

  • Graves disease (exophthalmic goiter): autoimmune hyperthyroidism. Enlarged thyroid plus protruding eyeballs (exophthalmos), weight loss, heat intolerance, rapid heart rate.
  • Gigantism (GH excess in childhood, before growth plates close): very tall stature.
  • Acromegaly (GH excess in adulthood, after growth plates close): abnormal growth of jaw, hands and feet; coarsened features.
  • Cushing syndrome (cortisol excess): moon face, buffalo hump, weight gain mainly around the trunk, thin skin, easy bruising, weakness, high blood sugar.

Worked NEET Problems

1

NEET-style problem · Pituitary Hormones

Question

Match the following pituitary hormones with their actions: (A) FSH (B) LH (C) ACTH (D) TSH. Options: (1) Stimulates thyroid (2) Stimulates Sertoli cells / ovarian follicle growth (3) Stimulates Leydig cells / triggers ovulation (4) Stimulates adrenal cortex.

Solution

A-2: FSH stimulates Sertoli cells (males) and ovarian follicle growth (females).

B-3: LH stimulates Leydig cells (males) and triggers ovulation (females).

C-4: ACTH stimulates the adrenal cortex to release cortisol.

D-1: TSH stimulates the thyroid to release T3 and T4.

2

NEET-style problem · Calcium Regulation

Question

Compare and contrast the actions of calcitonin and parathyroid hormone (PTH).

Solution

Both hormones regulate blood calcium, but they act in opposite directions.

Calcitonin is from the C-cells (parafollicular cells) of the thyroid. It LOWERS blood calcium by depositing calcium into bone and reducing reabsorption in the kidney.

PTH is from the parathyroid glands. It RAISES blood calcium by mobilising calcium from bone, increasing absorption in the intestine (via vitamin D activation), and increasing reabsorption in the kidney.

When blood calcium is high, calcitonin rises. When blood calcium is low, PTH rises.

3

NEET-style problem · Pancreas

Question

After a heavy meal, what happens to insulin and glucagon, and how do they regulate blood glucose?

Solution

After a meal, blood glucose rises. The beta cells of the pancreatic islets sense this and release insulin. The alpha cells reduce glucagon release.

Insulin acts on the liver, muscle and fat. It promotes glucose uptake (via GLUT4 in muscle and fat), glycogen synthesis (glycogenesis) in liver and muscle, and fat storage (lipogenesis).

Result: blood glucose drops back to normal.

During fasting, the opposite happens. Insulin drops, glucagon rises, the liver breaks down glycogen (glycogenolysis) and makes new glucose (gluconeogenesis) to keep blood sugar from going too low.

4

NEET-style problem · Disorders

Question

A patient passes about 15 litres of dilute urine every day and feels extreme thirst, but her blood glucose is normal. What is the likely diagnosis and which hormone is involved?

Solution

Diagnosis: Diabetes insipidus.

Hormone involved: ADH (vasopressin) deficiency from the posterior pituitary.

Without ADH, the kidneys cannot reabsorb water in the collecting duct, so very large volumes of dilute urine are passed. The patient drinks more to compensate. Note that blood glucose is NORMAL, which rules out diabetes mellitus.

5

NEET-style problem · Mechanism

Question

Insulin and cortisol both control blood glucose, but their mechanisms of action are very different. Explain why.

Solution

Insulin is a peptide hormone. It cannot cross the cell membrane. It binds to a receptor on the cell surface and activates second messengers (cAMP, IP3). Action is fast (seconds to minutes) but short-lived. Insulin lowers blood glucose immediately.

Cortisol is a steroid hormone. It is lipid-soluble and easily crosses the cell membrane. It binds to a receptor in the cytoplasm or nucleus. The hormone-receptor complex enters the nucleus and turns on genes that produce enzymes for gluconeogenesis. Action is slow (hours) but long-lasting. Cortisol raises blood glucose over many hours.

Summary Cheat Sheet

  • Anterior pituitary: makes GH, TSH, ACTH, FSH, LH, prolactin, MSH.
  • Posterior pituitary: only stores and releases ADH and oxytocin (made by hypothalamus).
  • Thyroid: T3 + T4 (need iodine) for metabolism; calcitonin (C-cells) LOWERS calcium.
  • Parathyroid: PTH RAISES calcium. PTH and calcitonin oppose each other.
  • Adrenal cortex: glucocorticoids (cortisol), mineralocorticoids (aldosterone), small sex hormones.
  • Adrenal medulla: adrenaline + noradrenaline (fight or flight).
  • Pancreas islets: beta = insulin (lowers glucose), alpha = glucagon (raises glucose).
  • Testis: Leydig cells make testosterone (under LH). Ovary: estrogen + progesterone.
  • Pineal: melatonin (sleep cycle). Thymus: thymosins (T-cell maturation).
  • Heart: ANF (lowers blood pressure). Kidney: erythropoietin (RBC), renin.
  • GI hormones: gastrin (stomach acid), secretin (bicarbonate), CCK (enzymes + bile), GIP (inhibits).
  • Peptide hormone: binds surface receptor, uses cAMP. Fast and short.
  • Steroid hormone: binds nuclear receptor, activates genes. Slow and long.
  • Diabetes insipidus: ADH deficiency. Diabetes mellitus: insulin deficiency.
  • Goiter: iodine deficiency. Cretinism: thyroid deficiency in infancy.
  • Graves disease: hyperthyroid + exophthalmos. Myxoedema: adult hypothyroid.
  • Dwarfism: GH deficiency (child). Gigantism: GH excess (child). Acromegaly: GH excess (adult).
  • Addison disease: cortisol deficiency. Cushing syndrome: cortisol excess.

Next: use the interactive learning widgets to explore the human endocrine gland map, drill the hormone reference table, and review every major endocrine disorder, or work through the 30+ NEET PYQs with full solutions. To time yourself, take the free 10-question mock test.

Frequently asked questions

How many questions come from Chemical Coordination in NEET 2027?

You can expect 2 to 3 questions from Chemical Coordination in NEET 2027. The most reliable scoring topics are: anterior vs posterior pituitary hormones, the cause of common endocrine disorders (diabetes mellitus, diabetes insipidus, goiter, cretinism, Addison disease), insulin vs glucagon, and the difference between peptide and steroid hormone action.

What is the difference between the anterior and posterior pituitary?

The anterior pituitary (adenohypophysis) makes and releases its own hormones: Growth Hormone (GH), TSH, ACTH, FSH, LH, prolactin and MSH. The posterior pituitary (neurohypophysis) does NOT make hormones; it only stores and releases two hormones that are made by the hypothalamus: ADH (vasopressin) and oxytocin. This difference is a NEET-favorite.

What is the difference between diabetes insipidus and diabetes mellitus?

Diabetes insipidus is caused by ADH (vasopressin) deficiency from the posterior pituitary. Without ADH, the kidneys cannot concentrate urine. Symptoms: very large volumes of dilute urine, extreme thirst. Blood sugar is normal. Diabetes mellitus is caused by insulin deficiency or resistance from the pancreas. Without insulin, blood glucose rises. Symptoms: high blood sugar, glucose in urine, weight loss, polyuria. The two are completely different disorders.

Which hormones control blood calcium?

Two hormones working in opposite directions. Calcitonin (from thyroid C-cells) lowers blood calcium by promoting calcium deposition in bone. Parathyroid hormone (PTH, from parathyroid glands) raises blood calcium by mobilising calcium from bone and increasing intestinal absorption (with the help of vitamin D). PTH is the "hypercalcemic" hormone.

What is the difference between peptide and steroid hormones in their mechanism of action?

Peptide hormones (insulin, growth hormone, ADH) cannot cross the cell membrane because they are water-soluble and large. They bind to receptors on the cell surface and activate second messengers like cAMP. Their action is fast but short. Steroid hormones (cortisol, aldosterone, testosterone, estrogen) and thyroid hormones are lipid-soluble. They cross the cell membrane and bind to intracellular receptors. The hormone-receptor complex enters the nucleus and turns on specific genes. Their action is slow but long lasting.

Which gland is called the "master gland" of the body?

The pituitary gland is often called the master gland because its hormones control most other endocrine glands. TSH controls the thyroid, ACTH controls the adrenal cortex, and FSH and LH control the gonads. However, the pituitary itself is controlled by the hypothalamus, so some textbooks call the hypothalamus the master.

What causes goiter and how is it related to iodine?

Goiter is the swelling of the thyroid gland. The most common cause is iodine deficiency. Iodine is needed to make thyroid hormones (T3 and T4). Without iodine, the thyroid cannot make enough hormone, so the pituitary releases more TSH to push the thyroid harder. The thyroid grows bigger trying to make hormone, but still cannot. This swelling is goiter. The fix is iodised salt. In children, severe iodine deficiency in the womb causes cretinism (stunted growth, mental retardation).

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