endocrinology(內(nèi)分泌總論)課件1endocrinology(內(nèi)分泌總論)課件2ClassicalendocrineglandsPineal（松果體）Pituitary（垂體）Thyroid（甲狀腺）Parathyroid（甲狀旁腺）Adrenal（腎上腺）Islets（胰島）gonads（性腺）ClassicalendocrineglandsPine3endocrinology(內(nèi)分泌總論)課件4Endocrine

endo-crine

endo-acombiningformmeaning“within,”usedintheformationofcompoundwords:endocardial;endocrinology

crine:paracrineautocrineexocrine

Endoc5endocrinology(內(nèi)分泌總論)課件6endocrinology(內(nèi)分泌總論)課件7EndocrinologyWithdevelopment,thedefinitionandscopeofinvestigativeandclinicalendocrinologycontinuestoexpand.Forexample:heart,kidney,adiposetissueEndocrinologyWithdevelopment,8ComponentsoftheendocrineandmetabolicsystemsArchitecturalandfunctionalpropertiesofendocrineandmetabolicsystemComponentsoftheendocrinean9EndocrinesystemEndocrinesystemconsistsoftwomainparts:EndocrineglandsSporadicendocrinetissuesandcellsinnon-endocrineorganEndocrinesystemEndocrinesyst10endocrinology(內(nèi)分泌總論)課件11Hypothalamus-pituitary-targetglandHypothalamus-pituitary-target12Hypothalamus-pituitary

Hypothalamus-pituitary

13endocrinology(內(nèi)分泌總論)課件14anteriorpituitaryreleasessixhormones:ACTH、TSH、FSH、LH、PRL、GHposteriorpituitaryreleasestwohormonesthatareactuallyproducedinthehypothalamus:antidiuretichormone(ADH)actsonthekidneystoconservewaterandalsopromotesconstrictionofbloodvessels.oxytocinstimulatesuterinecontractionsandpromotesmilk“l(fā)etdown”inthebreastsduringlactation.anteriorpituitaryreleasessi15HORMONETARGETFUNCTIONThyroid(TSH)StimulatingThyroidglandTHsynthesis&releaseGrowth(GH)ManytissuesgrowthAdrenocortico-Tropin(ACTH)AdrenalcortexCortisolrelease(androgens)Prolactin(Prl)BreastMilkproductionFollicle(FSH)GonadsEgg/spermprod.Luteinizing(LH)GonadsSexhormonesHORMONETARGETFUNCTIONThyroid16Anexcessofgrowthhormoneinchildrencausesgiantism.Inadultsitcausesacromegaly.dwarfism(lackofgrowthhormone).ExcessACTHoverstimulatestheadrenalcortex,resultinginCushingdisease.Anexcessofgrowthhormonein17Increasedprolactincausesmilksecretion,orgalactorrhea,inbothmalesandfemales.AspecificlackofADHfromtheposteriorpituitaryresultsindiabetesinsipidus(polyuriaandpolydipsia).Increasedprolactincausesmil18Hormones

PituitaryTSH，ACTH，GH，PRL，LH，F(xiàn)SHPeripheralglandThyroid：T3，T4Parathyroid：PTHAdrenal：cortisol、aldosteroneGonads：T，DHT，E，PLiver：IGFkidney：1，25(OH)2D3islets：insulin,glucagon（胰高血糖素）Hormones

Pituitary19endocrinology(內(nèi)分泌總論)課件20endocrinology(內(nèi)分泌總論)課件21Apartfromtheseglands,therearemanytissuesandcellssparselydistributedinnon-endocrineorgans,suchastheatriumoftheheart,theliver,thekidney,thegastrointestinaltractandtheadiposetissues.Apartfromtheseglands,there22ClassificationofhormoneHormonesarecustomarilydividedintothreegroups:Proteinsandpeptides:insulin（蛋白質(zhì)和肽類激素）Steroids:cortisol（類固醇激素）Aminoacidanalogues:T3,T4（氨基酸類激素）ClassificationofhormoneHormo23SteroidsTissueswhichproducesteroidhormonesincludeovary/testis,adrenalcortex,placentaandskin(vitaminD).Allsteroidhormonesarebasedontheprecursormoleculecholesterol.SteroidsTissueswhichproduce24RegulationofhormonelevelsSpontaneous,orbasal,hormonereleaseFeedbackinhibitionbyhormonesoftheirsynthesisand/orreleaseStimulationorinhibitionofhormonereleasebysubstancesthatmayormaynotberegulatedbythesamehormonesRegulationofhormonelevelsSp25EstablishmentofcircadianrhythmsforhormonereleasebysystemssuchasthebrainBrainmediatedstimulationorinhibitionofhormonereleaseinresponsetoanxietyanticipationofaspecificactivity,orothersensoryinputs.Establishmentofcircadianrhy26Hypothalamus-pituitary-adrenalaxisThehypothalamusproducesCRH,whichtravelsdowntheportalvesselsthroughthehypothalamicstalktotheanteriorpituitary,whereitstimulatesACTHrelease.ACTHthentravelstotheadrenalgland,whereitstimulatesthereleaseofcortisol.Hypothalamus-pituitary-adrenal27CortisolinturninhibitsbothCRHandACTHrelease（feedbackinhibition）.ThebrainestablishescircadianrhythmsandcantriggerincreasedCRHreleaseinresponsetostress.Cortisolinturninhibitsboth28CRHACTHcortisolCRHACTHcortisol29endocrinology(內(nèi)分泌總論)課件30endocrinology(內(nèi)分泌總論)課件31MechanismsofhormoneactionPeptideandcatecholaminehormonesandprostaglandinsbindtoreceptorsonthecellsurface.Steroidandthyroidhormonesactforthemostpartbybindingtointracellularreceptors.MechanismsofhormoneactionPe32bindingtoreceptorsonthecellsurfacebindingtointracellularreceptorsbindingtoreceptorsonthece33hormonesbindtoreceptorsonthecellsurfacePeptideandcatecholaminehormonesandprostaglandinsbindtoreceptorsonthecellsurface,wherethehormone-receptorinteractionsaffectintracellularmediators,orsecondmessengers.hormonesbindtoreceptorson34Secondmessengers

cAMP:Glucagon,ACTH,PTHProteinkinaseactivityInsulinCalciumAlpha-adrenergicagonists,ATIIphospholipidsADH,GnRH,TRH.SecondmessengerscAMP:35hormonesbindtoreceptorsonthecellsurface

hormonesbindtoreceptorson36bindingtointracellularreceptorsbindingtointracellularrecep37intracellularreceptorsintracellularreceptors38DisordersoftheendocrineandmetabolicsystemDisordersoftheendocrineand39Mostrecognizabledisordersoftheendocrinesystemareduetoanexcessoradeficiencyofparticularhormones,whethercausedbyabnormalitiesofendocrineglands,ectopicproductionofhormones,abnormalconversionofprohormonestotheiractiveforms,oriatrogenicfactors.Mostrecognizabledisordersof40HypofunctionofendocrineglandsEndocrineglandsmaybeinjuredordestroyedbyneoplasia,infections,hemorrhage,autoimmunedisorders,andothercauses.Hypofunctionofendocrineglan41HormonedeficiencysecondarytoextraglandulardisordersImpairedconversionofaprohormonetoahormoneoccursinchronicrenalfailure,inwhichthereisdefectiveconversionof25-hydroxycholecalciferolto1,25-dihydroxycholecalciferol.Hormonedeficiencysecondaryt42HyporesponsivenesstohormonesHormonelevelsmaybenormalorevenelevatedinthepresenceofmanifestationsofendocrinedeficiency.Hyporesponsivenesstohormones43HormoneexesssyndromeHyperfunctionofendocrineglandsEctopichormoneproductionHormoneadministrationTissuehypersensitivityHormoneexesssyndromeHyperfun44HyperfuctionofendocrineglandsThemostcommoncauseofhormoneexcesssyndromesishyperfunctionofendocrineglandssecondarytotumorsoftheglandsorhyperplasiaofseveralcauses.Hyperfuctionofendocrineglan45endocrinology(內(nèi)分泌總論)課件46MetabolicdisordersDiabetesmellitusHypoglycemiaHyperuricemiaandgoutDisordersoflipidmetabolismNutritional/vitamindeficienciesMetabolicdisordersDiabetesme47SymptomsandsignsofendocrineandmetabolicdiseasesHormonesaffectthefunctionofalltissuesandorgansystems.Consequently,thesymptomsandsignsofendocrinediseaseareextremelydiverse.Theymayvaryfromgeneralized,suchasfatigue,tolocalized,suchasweaknessoftheextraocularmuscles.Symptomsandsignsofendocrin48GeneralizedsymptomesWeaknessandfatigueMentalchangesUnintendedweightlossWeightgainAbnormalbodytemperatureGeneralizedsymptomesWeakness49HypersecretionofAdrenalCortexHypersecretionofAdrenalCort50SymptomesOphthalmicabnormalitiesAbnormalskinpigmentationHirsutismGynecomastiaGalactorrheaAbnormalappetiteDiarrheaSymptomesOphthalmicabnormalit51endocrinology(內(nèi)分泌總論)課件52SymptomesAnemiaTachycardiaandbradycardiaPolyuriaAmenorrheaoroligomenorrheaInfertilityBonepainandpathologicfractureSymptomesAnemia53HyposecretionofTHHyposecretionofTH54GH=pituitarydwarfismGH=pituitarydwarfism55PhysicalandlaboratoryexaminationanddiagnosisPhysicalandlaboratoryexamin56HistoryandphysicalexaminationManysyndromesofhormonalexcessordeficiencydisplaymanifestationsthatarereadilyapparentatthetimeofinitialpresentation,e.g.,severethyrotoxicosisandcushing’ssyndrome.Inotherinstances,theclinialpresentationismoresubtleandthephysicianmustrelyonlaboratorytestingtoestablishadiagnosis.Historyandphysicalexaminati57LaboratorytestingTheleveloffreeratherthantotalhormoneisusuallythebestindexoftheeffectivehormoneconcentrationinplasma.Ameasurementofthe24-hurinefreecortisolusuallyprovidesareasonableestimateoftheintegratedlevelsoffreeplasmahormone.LaboratorytestingThelevelof58正常人240008001600庫欣病患者240008001600正常人和庫欣患者的血F晝夜節(jié)律正常人2400080059ClinicalinterpretationThecliniciansmustrememberthatinbothmormalsubjectsandpatientswithendocrineandotherdiseases,hormonelevelsareextensivelyregulated.Forinstance,plasmainsulinlevelsshouldbeevaluatedinrelationtotheplasmaglucoseconcentration,andPTHlevelsshouldbeconsideredinrelationtoserumcalciumlevels.ClinicalinterpretationThecli60ClinicalinterpretationSincecortisolproductionintegratedovera24-hperiodisincreasedincushing’ssyndrome,the24-hurinaryfreecortisolprovidesamoreaccurateindexofcortisolhypersecretion.ClinicalinterpretationSincec61ClinicalinterpretationSometimesthesignificanceofhormonelevelscanbeevaluatedonlybythesimultaneousmeasurementofmorethanonehormone.Forinstance,withprogressivedamagetothethyroidhormones,secretionofTSHincreasesinacompensatoryfashionsothatnormalplasmalevelsofthethyroidhormonesmaybemaintained.ClinicalinterpretationSometim62GD的自身免疫發(fā)病機制GD的自身免疫發(fā)病機制63ClinicalinterpretationPlasmaestrogensarelowinovarianfailure.Ifovarialfailureisduetodiseaseoftheovary,plasmagonadotropinswillbeelevated.Ifovarianfailureissecondarytopituitaryorhypothalamicdisease,plasmagonadotropinlevelswillbenormalordecreased.ClinicalinterpretationPlasma64DynamictestingProvocativetestingassessestheabilityofaglandtorespondtostimuliasanindexofitsreservecapacity.Insulininducedhypoglycemiaisusedtoassessthesecretoryabilityofcellsthatproducegrowthhormone.DynamictestingProvocativetes65TeststhatprovideindirectinformationDiagnosisofdiabetesmellitusandassessmentoftherapydependonmeasurementofplasmaglucoseratherthaninsulinlevels.Itishelpfultofollowtheserumcalciumlevelsinhyperparathyroidismandtheserumpotassiumlevelsinprimaryaldosteronism.Teststhatprovideindirectin66TeststhatprovideindirectinformationForinstance,serumsodiumisalmostalwaysgreaterthan139mEq/literinpatientswithanaldosteroneproducingadenoma,plasmacholesteroltendstobehighinhypothyroidismandlowinhyperthyroidism.Teststhatprovideindirectin67endocrinology(內(nèi)分泌總論)課件68TreatmentofendocrineandmetabolicdiseaseForendocrinedeficiencysyndromes,hormonesaregenerallyadministeredtocounterthedeficiency.Treatmentofendocrineandmet69VitaminDisgiveninsteadofPTHtotreathypoparathyroidism,sinceitcanincreasetheextracellularCa+.VitaminDisgiveninsteadof70Incasesinwhichhormoneresistanceispresent,stepsaretakenwhenpossibletoalleviatethis,suchasthroughdietrestrictionintype2diabetes.Incasesinwhichhormoneresi71Inhormone-excesssyndromes,avarietyofapproachesareused.Hyperfuctioningtumorsareremovedordestroyedwithradiotherapywhenpossible,andsometimeshyperplasticglandsareremoved.Inhormone-excesssyndromes,a72Inothercasesdrugsaregiventoblockhormoneproductionandrelease,suchasmethimazole/propylthiouracilforthyrotoxicosisandcabergoline/bromocriptineforprolactin-producingadenomas.Inothercasesdrugsaregiven73Antagonistssuchasspironolactonecansometimesbeusefulinprimaryaldosteronismduetohyperplasia.Antagonistssuchasspironolac74endocrinology(內(nèi)分泌總論)課件75endocrinology(內(nèi)分泌總論)課件76ClassicalendocrineglandsPineal（松果體）Pituitary（垂體）Thyroid（甲狀腺）Parathyroid（甲狀旁腺）Adrenal（腎上腺）Islets（胰島）gonads（性腺）ClassicalendocrineglandsPine77endocrinology(內(nèi)分泌總論)課件78Endocrine

endo-crine

endo-acombiningformmeaning“within,”usedintheformationofcompoundwords:endocardial;endocrinology

crine:paracrineautocrineexocrine

Endoc79endocrinology(內(nèi)分泌總論)課件80endocrinology(內(nèi)分泌總論)課件81EndocrinologyWithdevelopment,thedefinitionandscopeofinvestigativeandclinicalendocrinologycontinuestoexpand.Forexample:heart,kidney,adiposetissueEndocrinologyWithdevelopment,82ComponentsoftheendocrineandmetabolicsystemsArchitecturalandfunctionalpropertiesofendocrineandmetabolicsystemComponentsoftheendocrinean83EndocrinesystemEndocrinesystemconsistsoftwomainparts:EndocrineglandsSporadicendocrinetissuesandcellsinnon-endocrineorganEndocrinesystemEndocrinesyst84endocrinology(內(nèi)分泌總論)課件85Hypothalamus-pituitary-targetglandHypothalamus-pituitary-target86Hypothalamus-pituitary

Hypothalamus-pituitary

87endocrinology(內(nèi)分泌總論)課件88anteriorpituitaryreleasessixhormones:ACTH、TSH、FSH、LH、PRL、GHposteriorpituitaryreleasestwohormonesthatareactuallyproducedinthehypothalamus:antidiuretichormone(ADH)actsonthekidneystoconservewaterandalsopromotesconstrictionofbloodvessels.oxytocinstimulatesuterinecontractionsandpromotesmilk“l(fā)etdown”inthebreastsduringlactation.anteriorpituitaryreleasessi89HORMONETARGETFUNCTIONThyroid(TSH)StimulatingThyroidglandTHsynthesis&releaseGrowth(GH)ManytissuesgrowthAdrenocortico-Tropin(ACTH)AdrenalcortexCortisolrelease(androgens)Prolactin(Prl)BreastMilkproductionFollicle(FSH)GonadsEgg/spermprod.Luteinizing(LH)GonadsSexhormonesHORMONETARGETFUNCTIONThyroid90Anexcessofgrowthhormoneinchildrencausesgiantism.Inadultsitcausesacromegaly.dwarfism(lackofgrowthhormone).ExcessACTHoverstimulatestheadrenalcortex,resultinginCushingdisease.Anexcessofgrowthhormonein91Increasedprolactincausesmilksecretion,orgalactorrhea,inbothmalesandfemales.AspecificlackofADHfromtheposteriorpituitaryresultsindiabetesinsipidus(polyuriaandpolydipsia).Increasedprolactincausesmil92Hormones

PituitaryTSH，ACTH，GH，PRL，LH，F(xiàn)SHPeripheralglandThyroid：T3，T4Parathyroid：PTHAdrenal：cortisol、aldosteroneGonads：T，DHT，E，PLiver：IGFkidney：1，25(OH)2D3islets：insulin,glucagon（胰高血糖素）Hormones

Pituitary93endocrinology(內(nèi)分泌總論)課件94endocrinology(內(nèi)分泌總論)課件95Apartfromtheseglands,therearemanytissuesandcellssparselydistributedinnon-endocrineorgans,suchastheatriumoftheheart,theliver,thekidney,thegastrointestinaltractandtheadiposetissues.Apartfromtheseglands,there96ClassificationofhormoneHormonesarecustomarilydividedintothreegroups:Proteinsandpeptides:insulin（蛋白質(zhì)和肽類激素）Steroids:cortisol（類固醇激素）Aminoacidanalogues:T3,T4（氨基酸類激素）ClassificationofhormoneHormo97SteroidsTissueswhichproducesteroidhormonesincludeovary/testis,adrenalcortex,placentaandskin(vitaminD).Allsteroidhormonesarebasedontheprecursormoleculecholesterol.SteroidsTissueswhichproduce98RegulationofhormonelevelsSpontaneous,orbasal,hormonereleaseFeedbackinhibitionbyhormonesoftheirsynthesisand/orreleaseStimulationorinhibitionofhormonereleasebysubstancesthatmayormaynotberegulatedbythesamehormonesRegulationofhormonelevelsSp99EstablishmentofcircadianrhythmsforhormonereleasebysystemssuchasthebrainBrainmediatedstimulationorinhibitionofhormonereleaseinresponsetoanxietyanticipationofaspecificactivity,orothersensoryinputs.Establishmentofcircadianrhy100Hypothalamus-pituitary-adrenalaxisThehypothalamusproducesCRH,whichtravelsdowntheportalvesselsthroughthehypothalamicstalktotheanteriorpituitary,whereitstimulatesACTHrelease.ACTHthentravelstotheadrenalgland,whereitstimulatesthereleaseofcortisol.Hypothalamus-pituitary-adrenal101CortisolinturninhibitsbothCRHandACTHrelease（feedbackinhibition）.ThebrainestablishescircadianrhythmsandcantriggerincreasedCRHreleaseinresponsetostress.Cortisolinturninhibitsboth102CRHACTHcortisolCRHACTHcortisol103endocrinology(內(nèi)分泌總論)課件104endocrinology(內(nèi)分泌總論)課件105MechanismsofhormoneactionPeptideandcatecholaminehormonesandprostaglandinsbindtoreceptorsonthecellsurface.Steroidandthyroidhormonesactforthemostpartbybindingtointracellularreceptors.MechanismsofhormoneactionPe106bindingtoreceptorsonthecellsurfacebindingtointracellularreceptorsbindingtoreceptorsonthece107hormonesbindtoreceptorsonthecellsurfacePeptideandcatecholaminehormonesandprostaglandinsbindtoreceptorsonthecellsurface,wherethehormone-receptorinteractionsaffectintracellularmediators,orsecondmessengers.hormonesbindtoreceptorson108Secondmessengers

cAMP:Glucagon,ACTH,PTHProteinkinaseactivityInsulinCalciumAlpha-adrenergicagonists,ATIIphospholipidsADH,GnRH,TRH.SecondmessengerscAMP:109hormonesbindtoreceptorsonthecellsurface

hormonesbindtoreceptorson110bindingtointracellularreceptorsbindingtointracellularrecep111intracellularreceptorsintracellularreceptors112DisordersoftheendocrineandmetabolicsystemDisordersoftheendocrineand113Mostrecognizabledisordersoftheendocrinesystemareduetoanexcessoradeficiencyofparticularhormones,whethercausedbyabnormalitiesofendocrineglands,ectopicproductionofhormones,abnormalconversionofprohormonestotheiractiveforms,oriatrogenicfactors.Mostrecognizabledisordersof114HypofunctionofendocrineglandsEndocrineglandsmaybeinjuredordestroyedbyneoplasia,infections,hemorrhage,autoimmunedisorders,andothercauses.Hypofunctionofendocrineglan115HormonedeficiencysecondarytoextraglandulardisordersImpairedconversionofaprohormonetoahormoneoccursinchronicrenalfailure,inwhichthereisdefectiveconversionof25-hydroxycholecalciferolto1,25-dihydroxycholecalciferol.Hormonedeficiencysecondaryt116HyporesponsivenesstohormonesHormonelevelsmaybenormalorevenelevatedinthepresenceofmanifestationsofendocrinedeficiency.Hyporesponsivenesstohormones117HormoneexesssyndromeHyperfunctionofendocrineglandsEctopichormoneproductionHormoneadministrationTissuehypersensitivityHormoneexesssyndromeHyperfun118HyperfuctionofendocrineglandsThemostcommoncauseofhormoneexcesssyndromesishyperfunctionofendocrineglandssecondarytotumorsoftheglandsorhyperplasiaofseveralcauses.Hyperfuctionofendocrineglan119endocrinology(內(nèi)分泌總論)課件120MetabolicdisordersDiabetesmellitusHypoglycemiaHyperuricemiaandgoutDisordersoflipidmetabolismNutritional/vitamindeficienciesMetabolicdisordersDiabetesme121SymptomsandsignsofendocrineandmetabolicdiseasesHormonesaffectthefunctionofalltissuesandorgansystems.Consequently,thesymptomsandsignsofendocrinediseaseareextremelydiverse.Theymayvaryfromgeneralized,suchasfatigue,tolocalized,suchasweaknessoftheextraocularmuscles.Symptomsandsignsofendocrin122GeneralizedsymptomesWeaknessandfatigueMentalchangesUnintendedweightlossWeightgainAbnormalbodytemperatureGeneralizedsymptomesWeakness123HypersecretionofAdrenalCortexHypersecretionofAdrenalCort124SymptomesOphthalmicabnormalitiesAbnormalskinpigmentationHirsutismGynecomastiaGalactorrheaAbnormalappetiteDiarrheaSymptomesOphthalmicabnormalit125endocrinology(內(nèi)分泌總論)課件126SymptomesAnemiaTachycardiaandbradycardiaPolyuriaAmenorrheaoroligomenorrheaInfertilityBonepainandpathologicfractureSymptomesAnemia127HyposecretionofTHHyposecretionofTH128GH=pituitarydwarfismGH=pituitarydwarfism129PhysicalandlaboratoryexaminationanddiagnosisPhysicalandlaboratoryexamin130HistoryandphysicalexaminationManysyndromesofhormonalexcessordeficiencydisplaymanifestationsthatarereadilyapparentatthetimeofinitialpresentation,e.g.,severethyrotoxicosisandcushing’ssyndrome.Inotherinstances,theclinialpresentationismoresubtleandthephysicianmustrelyonlaboratorytestingtoestablishadiagnosis.Historyandphysicalexaminati131LaboratorytestingTheleveloffreeratherthantotalhormoneisusuallythebestindexoftheeffectivehormoneconcentrationinplasma.Ameasurementofthe24-hurinefreecortisolusuallyprovidesareasonableestimateoftheintegratedlevelsoffreeplasmahormone.LaboratorytestingThelevelof132正常人240008001600庫欣病患者240008001600正常人和庫欣患者的血F晝夜節(jié)律正常人24000800133ClinicalinterpretationThecliniciansmustrememberthatinbothmormalsubjectsandpatientswithendocrineandotherdiseases,hormonelevelsareextensivelyregulated.Forinstance,plasmainsulinlevelsshouldbeevaluatedinrelationtotheplasmaglucoseconcentration,andPTHlevelsshouldbeconsideredinrelationtoserumcalciumlevels.ClinicalinterpretationThecli134ClinicalinterpretationSincecortisolproductionintegratedovera24-hperiodisincreasedincushing’ssyndrome,the24-hurinaryfreecortisolprovidesamoreaccurateindexofcortisolhypersecretion.ClinicalinterpretationSincec135ClinicalinterpretationSometimesthesignificanceofhormonelevelscanbeevaluatedonlybythesimultaneousmeasurementofmorethanonehormone.Forinstance,withprogressivedamagetothethyroidhormones,secretionof