endocrinology(内分泌总论)-课件

endocrinology(内分泌总论)-课件1endocrinology(内分泌总论)-课件2Classical endocrine glandsPineal（松果体）（松果体）Pituitary（垂体）（垂体）Thyroid（甲状腺）（甲状腺）Parathyroid（甲状旁腺）（甲状旁腺）Adrenal（肾上腺）（肾上腺）Islets（胰岛）（胰岛）gonads（性腺）（性腺）Classical endocrine glandsPine3endocrinology(内分泌总论)-课件4 Endocrineendo-crineendo-a combining form meaning“within,”used in the formation of compound words:endocardial;endocrinologycrine:paracrine autocrine exocrine Endoc5endocrinology(内分泌总论)-课件6endocrinology(内分泌总论)-课件7EndocrinologyWith development,the definition and scope of investigative and clinical endocrinology continues to expand.For example:heart,kidney,adipose tissueEndocrinologyWith development,8Components of the endocrine and metabolic systemsArchitectural and functional properties of endocrine and metabolic systemComponents of the endocrine an9Endocrine systemEndocrine system consists of two main parts:Endocrine glandsSporadic endocrine tissues and cells in non-endocrine organEndocrine systemEndocrine syst10endocrinology(内分泌总论)-课件11Hypothalamus-pituitary-target glandHypothalamus-pituitary-target 12Hypothalamus-pituitaryHypothalamus-pituitary13endocrinology(内分泌总论)-课件14anterior pituitary releases six hormones:ACTH、TSH、FSH、LH、PRL、GHposterior pituitary releases two hormones that are actually produced in the hypothalamus:1.antidiuretic hormone(ADH)acts on the kidneys to conserve water and also promotes constriction of blood vessels.2.oxytocin stimulates uterine contractions and promotes milk“letdown”in the breasts during lactation.anterior pituitary releases si15HORMONETARGET FUNCTIONThyroid(TSH)Stimulating Thyroid glandTH synthesis&releaseGrowth(GH)Many tissuesgrowthAdrenocortico-Tropin(ACTH)Adrenal cortexCortisol release(androgens)Prolactin(Prl)BreastMilk productionFollicle(FSH)GonadsEgg/sperm prod.Luteinizing(LH)GonadsSex hormonesHORMONETARGET FUNCTIONThyroid 16An excess of growth hormone in children causes giantism.In adults it causes acromegaly.dwarfism(lack of growth hormone).Excess ACTH overstimulates the adrenal cortex,resulting in Cushing disease.An excess of growth hormone in17Increased prolactin causes milk secretion,or galactorrhea,in both males and females.A specific lack of ADH from the posterior pituitary results in diabetes insipidus(polyuria and polydipsia).Increased prolactin causes mil18HormonesPituitaryPituitaryTSH，ACTH，GH，PRL，LH，FSHPeripheral glandPeripheral glandThyroidThyroid：T3，T4ParathyroidParathyroid：PTHAdrenalAdrenal：cortisolcortisol、aldosteronealdosteroneGonadsGonads：T，DHT，E，PLiverLiver：IGFkidneykidney：1，25(OH)2D3isletsislets：insulin,glucagoninsulin,glucagon（胰高血糖素）（胰高血糖素）HormonesPituitary19endocrinology(内分泌总论)-课件20endocrinology(内分泌总论)-课件21Apart from these glands,there are many tissues and cells sparsely distributed in non-endocrine organs,such as the atrium of the heart,the liver,the kidney,the gastrointestinal tract and the adipose tissues.Apart from these glands,there22Classification of hormoneHormones are customarily divided into three groups:Proteins and peptides:insulin （蛋白质和肽类激素）（蛋白质和肽类激素）Steroids:cortisol （类固醇激素）（类固醇激素）Amino acid analogues:T3,T4 （氨基酸类激素）（氨基酸类激素）Classification of hormoneHormo23SteroidsTissues which produce steroid hormones include ovary/testis,adrenal cortex,placenta and skin(vitamin D).All steroid hormones are based on the precursor molecule cholesterol.SteroidsTissues which produce 24Regulation of hormone levelsSpontaneous,or basal,hormone releaseFeedback inhibition by hormones of their synthesis and/or releaseStimulation or inhibition of hormone release by substances that may or may not be regulated by the same hormonesRegulation of hormone levelsSp25Establishment of circadian rhythms for hormone release by systems such as the brainBrain mediated stimulation or inhibition of hormone release in response to anxiety anticipation of a specific activity,or other sensory inputs.Establishment of circadian rhy26Hypothalamus-pituitary-adrenal axisThe hypothalamus produces CRH,which travels down the portal vessels through the hypothalamic stalk to the anterior pituitary,where it stimulates ACTH release.ACTH then travels to the adrenal gland,where it stimulates the release of cortisol.Hypothalamus-pituitary-adrenal27Cortisol in turn inhibits both CRH and ACTH release（feedback inhibition）.The brain establishes circadian rhythms and can trigger increased CRH release in response to stress.Cortisol in turn inhibits both28CRHCRHACTHACTHcortisolCRHACTHcortisol29endocrinology(内分泌总论)-课件30endocrinology(内分泌总论)-课件31Mechanisms of hormone actionPeptide and catecholamine hormones and prostaglandins bind to receptors on the cell surface.Steroid and thyroid hormones act for the most part by binding to intracellular receptors.Mechanisms of hormone actionPe32binding to receptors on the cell surfacebinding to intracellular receptorsbinding to receptors on the ce33hormones bind to receptors on the cell surfacePeptide and catecholamine hormones and prostaglandins bind to receptors on the cell surface,where the hormone-receptor interactions affect intracellular mediators,or second messengers.hormones bind to receptors on 34Second messengers cAMP:Glucagon,ACTH,PTHProtein kinase activityInsulinCalcium Alpha-adrenergic agonists,AT II phospholipidsADH,GnRH,TRH.Second messengers cAMP:35hormones bind to receptors on the cell surface hormones bind to receptors on 36binding to intracellular receptorsbinding to intracellular recep37intracellular receptorsintracellular receptors38Disorders of the endocrine Disorders of the endocrine and metabolic systemand metabolic systemDisorders of the endocrine and39Most recognizable disorders of the endocrine system are due to an excess or a deficiency of particular hormones,whether caused by abnormalities of endocrine glands,ectopic production of hormones,abnormal conversion of prohormones to their active forms,or iatrogenic factors.Most recognizable disorders of40Hypofunction of endocrine glandsEndocrine glands may be injured or destroyed by neoplasia,infections,hemorrhage,autoimmune disorders,and other causes.Hypofunction of endocrine glan41Hormone deficiency secondary to extraglandular disordersImpaired conversion of a prohormone to a hormone occurs in chronic renal failure,in which there is defective conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol.Hormone deficiency secondary t42Hyporesponsiveness to hormonesHormone levels may be normal or even elevated in the presence of manifestations of endocrine deficiency.Hyporesponsiveness to hormones43Hormone exess syndromeHyperfunction of endocrine glandsEctopic hormone productionHormone administrationTissue hypersensitivityHormone exess syndromeHyperfun44Hyperfuction of endocrine glandsThe most common cause of hormone excess syndromes is hyperfunction of endocrine glands secondary to tumors of the glands or hyperplasia of several causes.Hyperfuction of endocrine glan45endocrinology(内分泌总论)-课件46Metabolic disordersDiabetes mellitusHypoglycemiaHyperuricemia and goutDisorders of lipid metabolismNutritional/vitamin deficienciesMetabolic disordersDiabetes me47Symptoms and signs of endocrine and metabolic diseasesHormones affect the function of all tissues and organ systems.Consequently,the symptoms and signs of endocrine disease are extremely diverse.They may vary from generalized,such as fatigue,to localized,such as weakness of the extraocular muscles.Symptoms and signs of endocrin48Generalized symptomesWeakness and fatigueMental changesUnintended weight lossWeight gainAbnormal body temperatureGeneralized symptomesWeakness 49Hypersecretion of Adrenal CortexHypersecretion of Adrenal Cort50SymptomesOphthalmic abnormalitiesAbnormal skin pigmentationHirsutismGynecomastiaGalactorrheaAbnormal appetiteDiarrheaSymptomesOphthalmic abnormalit51endocrinology(内分泌总论)-课件52SymptomesAnemiaTachycardia and bradycardiaPolyuriaAmenorrhea or oligomenorrheaInfertilityBone pain and pathologic fractureSymptomesAnemia53Hyposecretion of THHyposecretion of TH54GH=pituitary dwarfismGH=pituitary dwarfism55Physical and laboratory examination and diagnosisPhysical and laboratory examin56History and physical examinationMany syndromes of hormonal excess or deficiency display manifestations that are readily apparent at the time of initial presentation,e.g.,severe thyrotoxicosis and cushings syndrome.In other instances,the clinial presentation is more subtle and the physician must rely on laboratory testing to establish a diagnosis.History and physical examinati57Laboratory testingThe level of free rather than total hormone is usually the best index of the effective hormone concentration in plasma.A measurement of the 24-h urine free cortisol usually provides a reasonable estimate of the integrated levels of free plasma hormone.Laboratory testingThe level of58正常人正常人2400 0800 16002400 0800 1600库欣病患者库欣病患者2400 0800 16002400 0800 1600正常人和库欣患者的血正常人和库欣患者的血F昼夜节律昼夜节律正常人2400 0800 59Clinical interpretationThe clinicians must remember that in both mormal subjects and patients with endocrine and other diseases,hormone levels are extensively regulated.For instance,plasma insulin levels should be evaluated in relation to the plasma glucose concentration,and PTH levels should be considered in relation to serum calcium levels.Clinical interpretationThe cli60Clinical interpretationSince cortisol production integrated over a 24-h period is increased in cushings syndrome,the 24-h urinary free cortisol provides a more accurate index of cortisol hypersecretion.Clinical interpretationSince c61Clinical interpretationSometimes the significance of hormone levels can be evaluated only by the simultaneous measurement of more than one hormone.For instance,with progressive damage to the thyroid hormones,secretion of TSH increases in a compensatory fashion so that normal plasma levels of the thyroid hormones may be maintained.Clinical interpretationSometim62GD的自身免疫发病机制的自身免疫发病机制GD的自身免疫发病机制63Clinical interpretationPlasma estrogens are low in ovarian failure.If ovarial failure is due to disease of the ovary,plasma gonadotropins will be elevated.If ovarian failure is secondary to pituitary or hypothalamic disease,plasma gonadotropin levels will be normal or decreased.Clinical interpretationPlasma 64Dynamic testingProvocative testing assesses the ability of a gland to respond to stimuli as an index of its reserve capacity.Insulin induced hypoglycemia is used to assess the secretory ability of cells that produce growth hormone.Dynamic testingProvocative tes65Tests that provide indirect informationDiagnosis of diabetes mellitus and assessment of therapy depend on measurement of plasma glucose rather than insulin levels.It is helpful to follow the serum calcium levels in hyperparathyroidism and the serum potassium levels in primary aldosteronism.Tests that provide indirect in66Tests that provide indirect informationFor instance,serum sodium is almost always greater than 139mEq/liter in patients with an aldosterone producing adenoma,plasma cholesterol tends to be high in hypothyroidism and low in hyperthyroidism.Tests that provide indirect in67endocrinology(内分泌总论)-课件68Treatment of endocrine and metabolic diseaseFor endocrine deficiency syndromes,hormones are generally administered to counter the deficiency.Treatment of endocrine and met69Vitamin D is given instead of PTH to treat hypoparathyroidism,since it can increase the extracellular Ca+.Vitamin D is given instead of 70In cases in which hormone resistance is present,steps are taken when possible to alleviate this,such as through diet restriction in type 2 diabetes.In cases in which hormone resi71In hormone-excess syndromes,a variety of approaches are used.Hyperfuctioning tumors are removed or destroyed with radiotherapy when possible,and sometimes hyperplastic glands are removed.In hormone-excess syndromes,a72In other cases drugs are given to block hormone production and release,such as methimazole/propylthiouracil for thyrotoxicosis and cabergoline/bromocriptine for prolactin-producing adenomas.In other cases drugs are given73Antagonists such as spironolactone can some times be useful in primary aldosteronism due to hyperplasia.Antagonists such as spironolac74