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Principle of Endocrine & Metabolic Diseases

Principle of Endocrine & Metabolic Diseases. Shan Zhongyan 单忠艳 The Endocrionology Department. Contents. Endocrine system and Hormones Diagnosis of Endocrine Diseases Treatment of Endocrine Diseases Progress. Endocrine system & Hormones. (1) Endocrine system & function

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Principle of Endocrine & Metabolic Diseases

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  1. Principle of Endocrine & Metabolic Diseases Shan Zhongyan 单忠艳 The Endocrionology Department

  2. Contents Endocrine system and Hormones Diagnosis of Endocrine Diseases Treatment of Endocrine Diseases Progress

  3. Endocrine system & Hormones (1) Endocrine system & function (2) Hormone & function (3) Regulation of hormone (4) Mechanism of hormone action

  4. Endocrine system Glands + Cells Hormones

  5. Endocrine System & Hormones Organ Hypothalamus Pituitary CRH ACTH TRH TSH GnRH(LRH) FSH, LH GHRH, GHRIH GH PIF, PRIF PRL ADH ADH Hormones

  6. Endocrine System & Hormones Organ Hormone Parathyroid PTH Thyroid TH(T3,T4) , Cacitonine Pancreas Insulin, Glucagon, SS Adrenal gland Glucocorticoid, Aldosterone, Testosterone Catecholamine Ovary Estrogen, Progesterone Testis Testosterone

  7. Endocrine Cells & Hormones Cells Hormone APUD cells Peptide or Catecholemine Adipocytes Leptin Endothelium cells Peptides

  8. Hormone Classification Peptides or Proteins: GH Amine: Catecholamines Amino Acid Analogs: TH Steroids: Cortisol, VitD

  9. Hormone Secretion Endocrine: Paracrine: Autocrine: Intracrine:

  10. Hormone Secretion Rhythms • Pulsatile or cyclic secretion: likes a wave Insulin, PRL, TSH change from min. to hr. • FSH, LH, E, and P change in wks • T4 change in season • Circadian variability • ACTH and cortisol : 8am/4pm/midnight • Sleep-associated rhythms • GH，Prolectin

  11. Hormone Regulation • Endocrine and Nervous system • Endocrine and Endocrine • Endocrine and Immune system • Endocrine and Metabolism

  12. Hypothalamus-pituitary-target glands Feedback Regulation Nerve impulse & Cytokines Advanced never center Hypothalamus Pituitary Target Glands

  13. TH Secretion Regulation Hypothalamus TRH Pituitary TSH TH Thyroid

  14. Hypothalamus CRH Pituitary ACTH Cortisol Adrenal Cortisol Secretion Regulation

  15. Gonadal Hormone Secretion Regulation Hypothalamus GnRH Pituitary FSH, LH E2, P Gonads

  16. Interaction of Hormones One hormone, Multiple actions One function, Multiple hormones Self-review Hormone • Other regulation system • Mechanism of action • Hormone receptors

  17. 2. Diagnosis of Endocrine Diseases (1) Symptoms--- Fantastico (2) Signs--- Inspection (3) Lab Tests--- Function (4) Causes or Localization

  18. Symptoms & Signs Symptoms & signs Diseases Weight gain Hypothalamic syn. Cushing syn. Hypothyroidism, Insulinoma Weight loss Adrenal insufficiency, Hyperthyroidsm, DM, Hypopituitarism, Pheochromocytoma Short stature Idiopathic GH deficiency (Dwarfism), Turner’s syn. Tall stature Pituitary giganism, Sexual precocity

  19. Symptoms & Signs Symptoms & signs Diseases Polyuria Diabetes insipidus, Diabetes mellitus, Hypercalcemia, Hypokalemia HyperpigmentationAddison’s syn. Nelson’s syn. Hypopigmentation Panhypopituitarism Acne Androgen excess, PCOS, Cushing syn. Striae Cushing syn.

  20. Symptoms & Signs Symptoms & signs Diseases Decreased body hair Hypothyroidism, Hypopituitarism Hirsutism Androgen excess states, Cushing syn. Amenorrhea Adrenal insufficiency, Cushing syn. Hyperprolactinemic states, PCOS, Hypopituitarism, Ovarian failure Galactorrhea Hyperprolactinemic states, Prolactinomas, Hypothyroidism

  21. Symptoms & Signs Symptoms & signs Diseases Proptosis Graves’ disease, Obital tumor Hypokalemia Primary aldosteronism, Paralysis Renin-secreting tumors Cushing syn. Acanthosis nigricans Obesity, PCOS, Acromegaly, Severe insulin resistance, Cushing syn. Bone pain Osteoporosis, Hypercalcemia, Hyperparathyroidism

  22. Laboratory Tests • The level of hormone: TH, GH, Insulin • The effect of hormones: BG, Ca • Basal condition or to some provocative stimulus • Blood or urine samples

  23. Laboratory Tests • Basal levels: FT3, FT4, TT3, TT4 • Hormone’s rhythm: ACTH-Cortisol • Provocative (functional) tests • Stimulation test: on hypofunction disease • eg. TRH, ACTH, OGIRT • Suppression test:on hyperfunction disease. • eg. dexmethasone suppression test • on Cushing syndrome.

  24. Localization & Cause Diagnosis • Localization • Imaging studies: MRI , CT, ECT, B ultrasound • Cause diagnosis • Immunoassay: IAA, ICA, GAD, TPOAb, TgAb • Genetic analysis: DNA analysis • Biopsy procedures: Fine-needle biopsy

  25. 3. Treatment of Endocrine Diseases (1) To causes (2) To Excess of hormone (3) To Deficiency of hormone (4) To resistance to hormone

  26. Cause of Endocrine Hyperfunction • Tumor: ACTH-producing tumor • Hyperplasia: Adrenal hyperplasia • Autoimmune stimulation: GD • Ectopic endocrine syndrome • Drugs

  27. Cause of Endocrine Hypofunction • Destruction of the gland • Autoimmune disease • Schmidt’s syn.(hypothyridism, Addison) • Neoplasms, infection or hemorrhage. • Extraglandular disorders • Congenital defects in hormone biosynthesis • Receptor Deficiency • Drugs

  28. Defects in Sensitivity to Hormone • Type 2 diabetes mellitus • Pseudohypoparathyroidism • Some hypothyroidism • Nephrogenic diabetes insipidus • Rickets (vitamin D insensitivity)

  29. Treatment to Hyperfunction • Remove tumors • Pharmacology block hormone production • Control sequelae of hyperfunction • Immunotherapy • Radiothyrapy

  30. Treatment to Hypofunction • Replacement with hormone in a physiologic • manner: insulin • Replacement with hormone mimics: Vitamin D • Replacement with cations: Ca, P • Immunotherapy • Transplantation

  31. Changes of Hormone

  32. Changes of Hormone

  33. The End

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