In the name of God

1. In the name of God

2. هورمون ها • اهداف آموزشی هورمونها • تعریف هورمون • 2- ساختمان ، بافت مترشح و بافت هدف را یاد بگبرد • 3-نحوه انتقال هورمونها را بداند • 4-متابولیسم • -5ختلال ناشی از افزایش و کاهش ترشح هر کدام از هورمونها را بداند. • 8-تستهای ازمایشگاهی هورمون ها • هورمونهای پپتیدی • هومونهای استروییدی • هومونهای مشتق از اسید آمینه

3. Hypothalamuses-pituitary axis • Hypothalamose • -pituitary stalk ADH, OX Pituitary hormones

4. Posterior Pituitary (neurohypophysis) • Cell bodies in SON (ADH) & PVN (Oxytocin) of hypothalamus • Consists of neural endings with • associated blood vessels • Acts as storage area, secretory • granules travel down axon • Connects to hypothalamus via • hypothalamic-hypophyseal tract • Processes extend through infundibulum and end in Post. Pit

5. Primary positive signal Fig. 4-10A Page 117

6. Pituitary hormones hypothalamus-Pituitary axis Prolactin GH Prolaction Structure function .

7. Regulation of prolactin

8. Laboratory tests • Variation secretion • TRH stimulate production • Normal level in women (up to 20ng/ml/12ng/ml • Prolactin Excess In women:Milk production(galactorrhea), amenorrhes) In Men:Infertility, and impotence,Rarely breast enlargment(Gynecomastia) >200ng/ml: Pituitary tumores 100-200ng/ml: tumors 20-100: diurnal variation,medications,stress,…

9. Prolactin levels

10. Growth hormones • Structure • Function -Indirect -Direct

11. Regulation

12. Prolactin levels • Marked diurnal Variation

13. Laboratory data • GH Levels (single mea. Unless 1 h sleep) • RESPONSE TO Physiologic and pharmacologic changesS • STIMULATORS:Exersise,Insulu Hypogly.GHRH(1mg/kg,clonidine(4mg/kg),l-dopa(0.5g)argenine(0.5g/kg) • IGF-I and binding proteins • IGF-1 best marker),<5 year very low • Inhibition:liver disease,acute illoness,malnutreitient

14. Laboratory evaluation • GH over production • Pituitary tumore (gigantism,acromegaly) • Other effects:thickening, In.sweating,oilness of skin,hypertention,joint paint,hyperglecia • GH deficiency

15. Sampling • Transfering • Blood increase • Blood decrease

19. Evolution of Adrenal function • Introduction • Hypothalamic-pituitary-glucocorticosteroid Axis • Biosynthesis • Glococorticoids • Mineral corticoids • Sex Hormones • Regulations

22. Direct tests of the hypothalamic –pituitary –adrenal Axis • Cortisol,ACTH(stress) • Cortisol(not specific), Synthetic stroids,CBG change. (↓Liver disease, malnutrition, ↑Est, pregnancy.) Urine Free cortisol Plasma cortisol exceeds protein binding capacity, ref.(20-90µg/day) Corticosteroid intermediates Evaluation for suspected congenital adrenal hyperplasia or carcinoma(17-hydroxysteriods, ). Adrenal Androgen production DHEA_S (plasma, urine), Testesteron (gonads),Weak androgens(from gonads and adrenal(measured)

23. Dynamic tests of the hypothalamic-pituitary-adrenal Axis • Dexamethasone suppression tests (DST) • 1-Overnight DST(1 mg Dexa.). • 2-Low doseDST(0.5 mg/6 h/2d) • 3-high dose(2mg/6h/2d) • Stimulatory stimulation • 1- Cortrosyn stimulation(250 µg/0,30,60 min. after injection),7µg to 18-20 µg, normal,1µgphysiological dose? • 2-Metyrapone Test(inhibites last step in cortisol synthesis) • 3-Insulin hypoglycemia(Insulin,0.05-0.1 u/kg) • 4- corticotropin –releasing hor. stimulation

24. Abnormalities of Glu. production • Suspected Cushing syndrome (excess Glu. Obesity, hypertention,virilization,hyperglycemia(hypokalemia and metabolic alkalosis may?) Diagnosis of Cushing syndrome UFC or Overnight DS Adrenal insufficiency Mineral cor. (dehydration, hyponatremia, hyperkalemia, non-anion gap metyabolic acidosis.) Glu. Deficeincy(weight loss, vometing, weakness) Primary insufficiency(addison disease). Pigmentation skin(POMC) Secondary adrenal insuficiency(pituitary). Neither min nor excess ACTH is present(Hyperglecimia) Diagnosing adrenal insufficiency Cortisol measument(18-20µg ruling out) Trea. Administration dexametasine, cotrosyn)

25. Congenital adrenal hyperplasia • 21-hydroylase deficiency • 11-hydroxylase deficiency

26. Laboratory tests of mineral and metabolism Plasma calcium Total and active form (PH,complexing anion) Adjusted Ca(mg/dl)=totalCa(mg/dL)+0.8x(4-Albumin(g/dL) Free Calcium?

27. Phosphate • Variation(Throuhgout the day and after meals↓) • Single assay? • Renal failure? • Monoclonal gammopathies • Magnesium • Plasma equilibrates with cell magnesium

28. PTH • Mid-molecule or C-terminal assay measure long-lived,inactive metabolite • Renal failure? • PTH assay? • Vitamin D assay • 25-Hydroxyvitamin D assay proportion to deficiency or toxicity • 1,25 Dihydroxyvitamin D(suspected ectopic) • PTHr • Urinary Mineral Excretion

29. Hypercalcemia • Artifactual(protein bound)hypercalcemia • Primary hyperparathyroidism • Hypercalcemia of Malignancy • Uncommon causes of hypercalcemia

30. Hypocalcemia • Artfactual • Chronic Renal failure • Uncommon causes (hypoPTH,Hypomagnesemia)

31. Hyperphosphatemia • Renal failure • Uncommon causes(HypoPTH,Vitamin D Toxicity,hyperthyroidism,Cell lysis sydromes)

32. hypophosphatemia • Osteoporosis • Vitamin D defiemcy • Paget,s disease • Renal Osteodystrophy

33. Metabolic Bone disease