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IMF-023-02-0001-en	How can a hormone value be abnormal without gland hypersecretion, or normal despite disease?	Concentration integrates secretion, pulsatility, binding, distribution, conversion, degradation and clearance, and effect depends on receptor abundance and sensitivity, so normal levels can coexist with resistance.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0002-en	Why is endocrine physiology tissue-specific as well as systemic?	Local enzymes alter hormone action within tissues: deiodinases activate or inactivate thyroid hormone, 11-beta hydroxysteroid dehydrogenase controls cortisol access to mineralocorticoid receptors, and aromatase makes oestrogens from androgens.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0003-en	When is a trophic hormone within the reference range still abnormal, and when does a non-suppressed one need confirmation?	It is pathological when the target is clearly deficient. With a high target, a non-suppressed trophic value raises assay interference, resistance or autonomous central secretion, confirmed before imaging.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0004-en	Why is endocrine testing during severe acute illness often better deferred?	Secretion, binding, conversion and clearance all change, so feedback patterns become unreliable and transient non-thyroidal or stress patterns can provoke unnecessary treatment.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0005-en	Why can a random growth hormone value not diagnose deficiency?	Growth hormone is secreted in pulses and may be nearly undetectable between them.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0006-en	How can high-dose biotin mislead thyroid and trophic-hormone testing, and why ask specifically about it?	It can give falsely high results in some competitive assays and falsely low results in sandwich assays, imitating thyrotoxicosis or hiding trophic-hormone elevation; patients may not count vitamins as medicines.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0007-en	Why should a very large pituitary mass with only mild prolactin elevation prompt sample dilution?	In the hook effect, an extremely high analyte saturates the assay antibodies and yields a falsely modest result, which dilution corrects.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0008-en	Why can a synthetic adrenocorticotropic hormone test be falsely reassuring in central deficiency?	It asks whether the adrenal cortex can produce cortisol, and in early central deficiency adrenal responsiveness may be retained temporarily.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0009-en	What is the logic of dexamethasone suppression testing?	Dexamethasone should suppress normal adrenocorticotropic drive, whereas autonomous cortisol secretion escapes suppression, so the test assesses autonomy.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0010-en	Why does upward pituitary expansion reduce the temporal visual fields specifically?	The pituitary sits beneath the optic chiasm, and upward expansion compresses the crossing nasal retinal fibres, which serve the temporal fields.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0011-en	In suspected pituitary apoplexy with crisis features, why is glucocorticoid given before investigation is complete?	Acute adrenocorticotropic loss makes cortisol deficiency immediately dangerous, so empirical glucocorticoid is given, taking samples first only if this causes no delay.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0012-en	By what mechanism can thyroid hormone given first precipitate adrenal crisis in combined pituitary failure?	Thyroid replacement increases metabolic demand and cortisol clearance, so giving it before cortisol is secured can precipitate crisis.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0013-en	Why do fertility goals change treatment of pituitary gonadal deficiency?	Sex-steroid replacement does not reproduce gonadotropin-driven gamete production, so it cannot restore fertility.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending
IMF-023-02-0014-en	Why can treating cortisol deficiency cause sudden polyuria and rising sodium?	Cortisol deficiency increases vasopressin and impairs water excretion, so replacing cortisol can unmask previously hidden diabetes insipidus.	Integrated Medical Foundations; chapter 23, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e9a519a3249013cc2cfefbd93d4aed9f9bd6f8eac9b79a57b641533cf18b03d4; editorial review pending	imf lang::en chapter::023 module::023-02 review::pending