ENDOCRINOLOGY

1

• ENDOCRINOLOGY
• by
• Dr. Anwar Maruf, M.Kes., drh

2

• HORMONE CLASSIFICATIONS
• a.   Extent of Effect
• 1.    Local Hormone
• 2.   General Hormone
• b. Chemical structure
• 1.   Steroid ( Cholesterol)
•         Adrenal Cortex Cortisol and
  Aldosterone
•         Ovary Estrogen and
  Progesterone
•        Testis Testosterone
• 2.    Tyrosine Amino Acid Derivate
•         Thyroid Thyroxine and
  Triiodothyronine
•         Adrenal Medulla Epinephrine
  and
• Nor-
  Epinephrine
• 3. Peptide/Protein
•  

3
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4

•      
• C. Action of Mechanism ? Solubility
• 1.    Hydrophylic (water soluble) Most
  of the hormones
• 2.    Hydrophobic (water insolube)
  Steroid and Thyroid
• 
  Hormones
•  
• HORMONE FUNCTIONS
• Controlling the Activity Level of Target Tissue
  by
• 1.    Changing Chemical Reactions within
  Cells
• 2.  Changing Cell Membrane Permeability
  against Specific
• Agents
•  
• HOMEOSTASIS

5

• HORMONE ACTION MECHANISM
• 1.    Through Cyclic AMP ? Most of the
  hormones
•  
• Membrane Cytoplasma
• R
  ATP
• HORMONE E Adenylcyclase
• C
• E
  Cyclic AMP (cAMP)
• P
  Second Messenger
• T Enzyme Activation
• O
  
• R
  PHYSIOLOGICAL EFFECT
•  
•         Fast Reaction
•  

6

• 2. Activating gene from cells, affecting the
  formation of specific protein
•  
• Steroid Hormone
• 
  Cytoplasma
• Receptor-bound Steroid Hormone
• (Specific Receptor within Cell) 
• 
  Nucleus
• Specific Gene Activation 
• Creating m-RNA
• Cytoplasma 
• Ribosome 
• Creating New Protein
•         Long Reaction

7

• ATP
• Adenylcyclase
• Cyclic AMP (Active)
• Phosphodiesterase
  Caffeine
•  
• 5-AMP (Non Active)
• HORMONE MEASUREMENT
• 1.   Bioassay
• 2.   RIA (Radio Immuno Assay)
• 3.   ELISA (Enzyme Linked Immunosorbent
  Assay)

8

•  
• HIPOTHALAMUS
•  
• HIPOPHYSIS
•  
•  
• Anterior H. Pars Intermedialis
  Posterior H.
• Adenohypofisis
  Rudimentary
  Neurohipophysis
• Except Animals

9

• HIPOTHALAMUS
•  
• Hormone Secretion Secretion
• RH (Releasing Hormone)
• IH (Inhibitory Hormone)
•  
• Hypothalamico Hypothalamic
  Hypophyseal
• Hypophysial Tract
  Portal Vessels
•  
•  
• Posterior Hypophysis Anterior Hypophysis
•  
• Hormone Preserved Hormon Production
•  

10

• NEGATIVE FEEDBECK MECHANISM
• Hypothalamus
• IH
  RH
• Adenohyphophysis
• _ Tropic Hormone
  
• Target Gland
•  
• Target Gland Hormone
•  
• POSITIVE FEEDBACK MECHANISM
• Estrogen ? LH ?

11

• HORMON SECRETION
•  
• a. Posterior Hypophysis
• 1.    Antidiuretic Hormone (ADH)
• 2.    Oxcytocin
• b. Anterior Hypophysis
• 1.    Growth Hormone (GH)
• 2.    Adrenocorticotropic Hormone (ACTH,
  Adrenocorticotropin)
• 3.    Thyroid Stimulating Hormone (TSH,
  Thyrotropin)
• 4.    Prolactin (LTH Luteotropic Hormone)
• 5.    Follicle Stimulating Hormone (FSH)
• 6.    Luteinizing Hormone (LH)
  Gonadotropic Hormone 

12

• c.   Pars Intermedialis
•         Melanocyte Stimulating
  Hormone (MSH)
• ? in fish, reptiles, and
  amphibian
•         Human has no MSH

13
SETELAH LULUS, LALU APA ?
14
Apa yang sebenarnya saya inginkan? Seperti apakah
saya 5 tahun dari sekarang? 10 tahun dari
sekarang? Definisikan SUKSES yang ingin Anda
capai
15

• ANTIDIURETIC HORMONE
• (ADH, VASOPRESIN)
•  
• a.     Secretion Hypothalamus
• Posterior Hypophysis ? Site of
  Storage
•  
• b.    Effect
•    Reducing Urine Volume
•   ADH controls water and regulates body fluid
  osmotic
• pressure
•   ADH in Moderate and High Concentration has
• Pressor Effect ? VASOPRESIN
•  

16

• Hypertonic Extracellular Fluid
•  
• Water Secreted from Supraoptic Nuclei
• (OSMORECEPTOR)
•  Shrinked Stimulated 
• Stimulating Posterior Hypophysis 
• ADH Secretion
• Increasing the Permeability of Distal Tubule,
  Collecting Tubule and Collecting Ducts to Water 
• Water Reabsorption ?
• Urine ?
•  

17

• Low Blood Pressure (Bleeding)
•  
• Low Atrial Pressure
  Baroreceptor
• - Sinus Caroticus
• Stretch Receptor - Aorta
• in Atrium Relaxation - Pulmonary
  Area
•  
•  
• ADH Secretion?
•  
• Vasoconstriction
•  
• Blood Pressure ?
•  

18

• Stimulating and Inhibiting Factors of ADH
  Secretion
•         Trauma
•         Illness
•         Anxiety ADH ?
•         Drugs ( Morphine, Nicotine,
  Tranquilizer)
•  
•         Alcohol ? ADH ?
• Alcohol
•  
• ADH Secretion?
  Arteriol Afferent Dilatation
•  
• GFR (glomerulo
  filtration rate) ?
• Diuresis
• DIABETES (Diuresis 15
  times/day)
•  

19

• OXYTOCIN
•  
•  
• FUNCTIONS 1. Human milk secretion
• (Milk Ejection
  Milk Letdown)
• 2. Uterine contraction
  Partus
• 
  Ovum Fertilization
•  
• Mammary Gland Alveoli ? Myoepithelium ?
•  
• Contraction
•  
• Oxytocin
•  

20

• INFANT STIMULATION/SUCKLING TO THE
  PAPILLA/MAMMARY AREOLA
• Medulla Spinalis
•   
• 
  HYPOTHALAMUS Emosi
•   
• Posterior Hypophysis
  Anterior Hypophysis
•  
• Oxytocin ?
  Prolactin ? Milk
  production ?
•  
•  
• Myoepithelial Cells
  GnRH ?
• Contraction
•  
• MILK EJECTION FSH
  LH ?
•  
• 0,5-1 minutes after stimulation
  OVULATION
• ? 1.5 l/day
• 
  BIRTH CONTROL

21

• GRAVIDITY
•  
•         Uterus Receptor Oxytocin ? ? More
  Sensitive
•         Gravid End Oxytocin Secretion ?
•      Stimulation/IrRitation/Stretching in
  Uterine Cervix,
• Uterus and Vagina ? Oxytocin ? ?
  SMOOTH PARTUS
•       Hypophysectomy ? PROLONGED PARTUS

22

• STIMULATION/IRRITATION/STRETCHING
• (UTERINE CERVIX, UTERUS, VAGINA) 
• Medulla Spinalis
•  
•   Hyphothalamus
  Emotion
•  
• Posterior Hypophysis
•   Oxytosin ?
•   
• PARTUS SUCKING PUMP
  
• 1.    Infant
• 2.      Placenta FASTER SPERMATOZOA
• 3.    Stop Bleeding
  ARRIVAL AT FALLOPIAN TUBE
•  
• 
  FERTILIZATION
•  
•  

23

• Langkah-langkah apa yang harus Anda lakukan untuk
  mencapai keinginan-keinginan tersebut?

24
OPINI

• Apapun yang kita mau, harus disadar resource
  kita terbatas. Jadi, kita harus me-manage
  bagaimana mengatur waktu, tenaga, uang dan segala
  macam. Tapi, menentukan tujuan ke mana kita
  pergi, adalah hal pertama yang harus dilakukan.

Palgunadi T. Setyawan Mantan Dirut PT Astra
International Alumnus Teknik Mesin ITB 57
25

• GROWTH HORMONE (GH)
•  
• SYNONIMES Somatotropic Hormone
• Somatotropin
• SECRETED BY
• Anterior pituitary somatotropes/acidophi
  l cells
• 30-40
• STRUCTURE
• GH Polypeptide, 191 amino acids
• IGF-I Polypeptide, 70 amino acids
• FUNCTION Stimulating the growth of all tissues
  in the body
• Cell count Hyperplasia
• Cell size Hypertrophy

26

• In early growth Whole organs of the body
•  
• Adult Post epiphysial closure
• Bone growth ceases
• Soft
  tissues keep growing
• GROWTH AFFECTING HORMONES
• 1.    Growth hormone
• 2.   Thyroid hormone Thyroxin
• 3.    Sex hormone Androgen
  Testosteron
• 
  Estrogen
• 4.    Insulin
• 5.    Glucocorticoid Cortisol
• Genetic and Nutrition

27

• FAST GROWTH PERIOD
• Infants Growth hormone
• Thyroxin
• Adolescences Androgen 1. Testis
• 2. Ovary
• 
  3.  Adrenal Cortex
• Estrogen

28

• GH Secretion Stimulator Hypoglycemia
• Amino Acid (Arginine, Lecithen)
• Exercise
• Fasting
• Sleeping
• GH Secretion Inhibitor Increased Blood
  Glucose
• Somatostatin
• Cortisol
• GH Secretion Children to Adults
• Increasad/Decreased Secretion depend
  on
• Nutrition, Hypoglycemia,
  Exercise, etc.

29

• GH SECRETION REGULATION
• Stimulus
  Inhibitors
•  
• Reduced glucose
  Somatostatin
• Reduced free fattu acid Increased
  glucose
• Increased amino acid Increased free
  fatty acid
• (arginin)
• Fasting Somatomedin
• Calorie loss in a long time GH
• Sleeping ?-Adrenergic agonists
• Exercise Cortisol
• Puberty Senescence
• Estrogen
• Androgen Obesity
• Dopamine
• Acetylcholin Pregnancy
• Serotonin
• ?-Adrenergic agonists

30

• GH SECRETION REGULATION PATHWAY
•  
• Stimulus/Inhibitor
•  
• HYPOTHALAMUS
• 
  GHRH ? Somatostatin ?
• 
  
  
• ANTERIOR PITUITARY
• GH ?
• _
• Liver and other tissues
•  
• IGF-I/Somatomedin ?
•  
•  
• Growth ?
  Protein synthesis ?
  Gluconeogenesis ?
• 
  Lypolisis ?

31

• SOMATOMEDIN C /Insulin-Like Growth Factor I
  (IGF-I)
•  
• GH ? Bone and cartilage growth
•  
• Indirectly
•  
• GH
•  
• Liver/Kidney
•  
• IGF-I/Somatomedin C
•  
• Bone and Cartilage Growth
• Closed epiphysis (Puberty) - Bone stops to
  lengthen
• - Bone thickening keeps in progress

32

• GH METABOLIC EFFECTS
• 1. Increased protein synthesis
• 2. Reduced use of carbohydrate as energy source
• 3. Increased fat mobilization
• Protein Metabolism
•  
• A.a transport through cell membrane into the
  cell ?
•             More activated ribosome within the
  cell
• Intranuclear RNA formation ?
•  
• Increased protein synthesis
• Reduced protein and a.a. catabolism

33

• Lipid metabolism
• Increased lipid mobilization (energy source)
• Lipid tissue ----- Increased fatty acid release
•  
• Increased Acetyl Co A
• Energy
• Lipid mobilization
•  
• High amount of hepatic acetoacetic acid
  production
•  
• Ketosis

34

• Carbohydrate metabolism
•  
• 1.    Reduced glucose use of energy
• Unclear mechanism, possibly
• Increased fatty acid mobilization
•  
• Increased fatty acid
  Energy source
•  
• Feedback
•  
• Glycolysis inhibition

35

• 2.    Increased glycogen deposition
• Less use of glucose and glycogen as the source
  of energy
•  
• Glucose Glycogen
• into the cell
•  
• 3. Reduced cellular glucose uptake, blood
  glucose ?
• First, glucose uptake into the cells
  increases Glycogen ?
• Then, glycogen becomes
  saturated
•  
• Reduced glucose uptake
•  
• Increased blood glucose level (50-100 of
  normal)

36

• GH causes the reduction of glucose use as
  energy, so that GH has DIABETOGENIC effect
•  
• GH
•  
• 
  Glucose enters the cell Glycogen
•  
• Glycogen saturated cell
•  
• Reduced glucose uptake by the cell
•  
• Increased blood glucose level
•  
• Enhancing beta pancreatic cells/Islets of
  Langerhans
•  
• Increased insulin secretion
•  
• Increased glucose uptake into the cell
•  

37

• Results in damaged beta cells
•  
• Reduced insulin production capability
•  
• Diabetes mellitus
• GH GROWTH EFFECTS
• Requiring - Carbohydrate
• - Insulin
• Insulin ----- a.a ch transport
  into the cells
• Carbohydrate
• Required for
  Energy of growth
•  
• If pancreas removed
• Diet without carbohydrate GH fails
  to affect
• growth

38

• ANTERIOR HYPOPHYSIS HORMONE
• Increasing blood glucose level
• -         GH
• -         ACTH
• -         TSH Have
  Diabetogenic Effect
• -         Prolactin PITUITARY
  DIABETES
•  
• GH CONCENTRATION
• In the past GH was thought to disappear
  post-puberty ---- WRONG
• Facts GH secretion in children adults almost
  similar
• GH secretion is pulsatile
• Children 5 milimicrogram/milimeter
• Adults 3 milimicrogram/milimeter
• GH concentration may increase to 50 mmcg/ml in
• the loss of - Protein
• - Carbohydrate

39

• In acute condition hypoglycemia
  
• In chronic condition protein deficiency
• GH secretion strong stimulator
• GH SECRETION ABNORMALITIES
• I. Panhypopituitarism
• Reduced secretion of all hormones from
  anterior hypophysis
• May occur - Congenital
• - Suddenly/slowly
• 1.    DWARFISM/CRETINISM
•        during childhood
•      proportional growth, but
  the degree
• children of 10 y like
  those of 4-5 y
• children of 20 y like those
  of 7-10 y

40

• Theoretically, the followings may
  also be found
• - Thyroid deficiency
• - Adrenocortical deficiency
• Small body --- few needs
• Deficiency syndromes are
  subtle
•          Inhibited sexual development during
  adulthood
•         Only 1/3 have sexual function
• 2.    PANHYPOPITUITARISM IN ADULTS
• Causes - Tumor --- suppresses
  Anterior hypo. --- function ?
• - Thrombosis in
  hypophysis (often in
• post partus
  shock)
• Effects
• - Hypothyroidism
•        - Adrenal
  cortex secretion ?
• 
  -  Gonadotropic hormone secretion ? --- sexual
  hormone ?
• - Therapy
  satisfactory with hormone substitution

41

• II.  Increased GH secretion
• 1.    GIANTISM/GIGANTISM in childern
• Cause acidophil cell activity ? or
  tumor
• Effect Hyperglycemia
• ?
  cell Islets of Langerhans
• GH Stimulation? degeneration
•  
• Diabetes Mellitus
•  
• because Epiphyseal Height unclosed
• More severe tumor ---- Damaged Ant.
  Hypo. ---
• Panhypopituitarism
•  

42

• 2.    ACROMEGALY in adults
• Cause acidophil cell tumor emerges
  in adulthood
• (the epiphysis has
  closed)
•  
• Effects Not tall, but bone thickens
  
• Small bones in arms
  and legs
• Membranous bones
• Soft tissues keeps
  growing
• body organ enlarge
•         Tongue
•         Liver
•         Kidney
•         etc

43
MANAJEMEN WAKTU
44
Jika Anda hidup 60 tahun, maka Tidur 8 jam
sehari ? totalnya 20 tahun seumur hidup Menonton
TV 2 jam sehari ? totalnya 5 tahun seumur
hidup Makan (3 kali) 2 jam sehari ? totalnya 5
tahun seumur hidup Terjebak macet 3 jam sehari ?
totalnya 7.5 tahun seumur hidup BERAPA WAKTU
YANG TERSISA UNTUK BERKARYA ?
45
TOP SECRET THEYLL PUSH YOU TO THE LIMIT !
Pada awal-awal, Anda hanya diberi beban tidak
seberapa. Lama-kelamaan, pekerjaan yang
diberikan akan lebih banyak dari waktu yang
tersedia. Kunci Manajemen Waktu !
46

• PROLACTIN
•  
• 1. Effect on Mammary Gland
• Lactation Process
•         Mammary Gland Growth and
  Differentiation
•         Lactogenesis Human Milk
  Production
•         Galactopoisis Lactation Maintenance
• In Pregnancy
• Progesterone Lactogenesis
• Progesterone ? Prolactin ?
  Lactogenesis
• None
• Estrogen ? Human Milk
  Production
• Not Inhibiting Prolactin

47

• The End of Pregnancy
• Progesteron ? ? Estrogen ?
  Milk not Ejected
•  
• Prolactin secretion
• Partus ? Prolactin ? ? and ? ? DEPENDS ON
• 1.    Lactation frequency
• 2.    Touch of mammary papillae
• 3.    Visual
• 4.    Auditive
• Hyperprolactinemia ? Lactation ? ?
  Amenorrhoea
• KB ? Positive Estrogen-LH Feedback
  Mechanism

48

• 2. Effect on the Testis
• Improving Spermatogenesis
• ICSH Receptor Sensitiveness ? ? Androgen ?
  
• 
  Spermatogenesis ?

49

• THYROID STIMULATING HORMONE/TSH
• Hypothalamus
• TSH-RH
• Anterior Hypophysis
  
  
  
• 
  (cold
  temperature)
• TSH
  Needs of Energy ?
• Thyroid Gland
  Energy Fulfilled
•  
• Thyroxin
  Rate of Metabolism ? ?
•  

50

• ADRENOCORTICOTROPIC HORMONE/ACTH
•  
• Hypothalamus
• ACTH-RH
• Anterior Hypophysis
• ACTH
• Adrenal Cortex
  Stressor (individual)
•  
• Corticosteroid
  Anti stress

51

• FOLLICLE STIMULATING HORMONE/FSH
• LUTEINIZING HORMONE/LH
•  
•  
• Hypothalamus
• FSH-RH, LH-RH
• Anterior Hypophysis
• FSH, LH
• 
  Testis Spermatogenesis
• 
  Ovarium Follicle growth

52

• ADRENOCORTICAL
• (ADRENAL/SUPRARENAL)
•  
• 1.    Adrenal Medulla
• Sympathetic stimulation ? Epinephrine
• 
  Nor Epinephrine
•  
• 2.    Adrenal Cortex
•   Zona Glomerulosa ?
  Mineralocorticoid
•  Zona Fasciculata
  Glucocorticoid and Androgen
•  Zona Reticulosa
  
• 
  Musculinizing Effect
• Small amount
  of Progesterone Estrogen

53

• MINERALOCORTICOID
• (ALDOSTERON)
• EFFECT
• 1.    In the Kidney Ion Exchange
• 
  Aldosteron
•   Na Reabsorption
•  
•  Reabsorption Hypernatremia Reabsorption
  Secretion Secretion
• Water ? Anion (Cl-) H ?
  K ?
• Polydipsia
  Alcalosis Hypokalemia
• Extracellular vol. ?
  
  
• Paralis Blood
  vol.
•  
• Blood Pressure ? DIURESIS

54

• 2.    In Sweat Gland, Salivary Gland,
  Intestine
•  
• Aldosterone ? ? Absorbsi Na ? (menahan air)
  ? Diare
•  
• Aldosterone ?
•         Extracellular K ion ?
•         Na Ion ?
•         Angiotensinogen II ?
•  
• Aldosterone ?
• ACTH ? Permissive
  Effect

55

• GLUCOCORTICOID
• (CORTISOL, CORTICOSTERONE, DESOXYCORTICOSTERONE)
•  
• Anti Stress
•  
• EFFECTS
• 1.    Carbohydrate Metabolism
•   Amino acid mobilization from
  extrahepatic tissue (muscle)
• ? Amino acid in the plasma ?
•   Transpor A.a transport into
  hepatsic cells ? ?
• Gluconeogenesis ?
•   Glucose use by the cells ? ?
  Blood glucose ?
• ADRENAL DIABETES

56

• 2. Protein Metabolism
•     Protein Synthesis ?
•     Protein Catabolism ? ? Blood
  amino acid ?
•    Amino acid transport into hepatic
  cells ?
• ? Preservation
• cellular protein ? EXCLUDING that in
  hepatic cells
• 3. Lipid Metabolism
•         Lipid metabolism ? ? Fatty in the
  plasma ? ?
• Energy
•         Requiring GH and ACTH
•  

57

• 4.Others
• Stress ? ACTH ? ? Cortisol
• Anti Inflammation
• Anti Alergy
• CIRCADIAN RHYTHM ACTH-RH, ACTH, CORTISOL
• 1.    In the morning ? High
• 2.    Afternoon/evening ? Low

58

• ABNORMAL
• 1.    Hypoadrenalism (ADDISONS DISEASE)
•     Failure in Adrenal Cortex
•     Aldosterone ? ? Na Reabsorption ? ?
  Extracellular NA ? ? Blood volume ?
• ? SHOCK
•     Cortisol ? ? Gluconeogenesis
  ? ? Energy ?
•      Stress ? Death
• 2.    Hyper Adrenalism (CUSHING DISEASE)
•         Adrenal Hypersecretion
•         Cortisol ?
•         Androgene ? ?
  Musculinizing effect ? and Acne
•         Lipid mobilization ? ?
  BUFFALO TORSO
•         Steroid ? ? Oedema Face ?
  MOON FACE
•         Protein Catabolism ??
  Protein Tissue ? ? Weak ? OSTEOPOROSIS
•         Blood glucose ?? ADRENAL
  DIABETES

59
MENINGKATKAN MOTIVASI
60
CONTOH PENYEBAB KURANG MOTIVASI

• Merasa beban terlalu berat
• Telah berulang kali gagal
• Mengalami konflik berat yang menghilangkan
  konsentrasi
• Jenuh
• Lingkungan yang permisif
• Terpengaruh lingkungan / teman

61
TIPS MEMOTIVASI DIRI
Beri hadiah pada diri
Bagi tugas yang besar
Gunakan aturan 5 menit
Tetapkan sasaran tiap kegiatan
Cari bantuan bila perlu
62

• Miliki motivator internal eksternal
• Evaluasi tanggung jawab
• Jangan menghindar
• Buat skala prioritas

MEMBANGKITKAN KEMBALI MOTIVASI
63

• PANCREATIC GLAND
• Consists of
• ACCINI digestive enzymes secretion
• ISLETS OF LANGERHANS
• ALPHA CELLS glucagon secretion
• BETA CELLS insulin secretion
• DELTA CELLS somatostatin secretion
• F CELLS

64

• GLUCOSE TRANSPORT Facilitated diffusion
• G C C G
• GC GC
• Insulin

65

• Glucose Transport
• Without insulin ? ¼ of normal
• With insulin ? 5 times of normal
• Insulin effective in SKELETAL MUSCLE and ADIPOSE
  TISSUE
• Insulin does not enhance glucose transpor in
• 1. Brain cells
• 2. Red blood cells
• 3. Intestinal mucosa
  Simple Diffusion
• 4. Renal tubular epithelium

66

• The Importance of Glucose Level Regulation
• Energy obtained from glucosa, lipid and protein
• Glucose is the only nutrient for
• Brain
• Retina glucose
  level should never be low
• Germinal epithelium
• If glucose level is high
• Extracellular osmotic pressure ? ? Water out
  of cell ? DEHYDRATION
• Glucose in renal tubule ? ? 1. Glucose
  wasting in urine
• 2. Osmotic diuretic ? high loss of
  fluid
• Normal Blood Glucose Level
• Fasting 80-90 mg
• 1 h post prandial 120-140 mg
• 2 h post prandial ?120 mg

67

• INSULIN METABOLIC EFFECTS
• Carbohydrate Metabolism
• Glucose transport ?
• Glycogen ?
• Glucose metabolism ?
• 
  Burnt
• Glucose Glucose
• Glycogen
• Insulin

68

• 2. Lipid Metabolism
• Glucose
• Insulin
• Glucose Synthesis
• Lipoprotein
• Glycolysis
• Alpha Glycerophosphat Fatty Acid
• Triglyceride
• Glycerol Fatty Acid

69

• TRIGLYCERIDE SYNTHESIS WITHIN ADIPOSE TISSUE
• Glucose Glucose-6-phosphate
• Pyruvic acid Lipoprotein
• ?-glycerol Acetyl CoA
  Liporotein
• phosphate lipase
• Fatty
  acids Fatty Acids
• Triglyceride Glycerol
• ADIPOSE
  TISSUE
• PLASMA PLASMA

70

• Insulin ?
• 
  FATTY
  ACID
• Fatty Acid ?
• synthesized oxidation
• by the liver
• Cholesterol Acetyl Co A
• Triglyceride
• Phospholipid
  Energy Aceto-acetic acid
• Atheroscerosis
  ?-(OH)-butyric acid Aceton
• KETOBODIES

71

• 3. Protein Metabolism
• Sufficient insulin
• Amino Acid Active Transport into the Cells ?
• Protein synthesis ?
• Growth ?
• (having potential effect with GH)
• N balance ()

72

• Insufficient Insulin
• Amino Acid Transport into the Cells ?
• Protein Synthesis ?
  Plasma amino acid ?
• Liver AA
  Degradation
• 
  Energy Urea Excretion ?
• Gluconeogenesis

73

• Pemecahan Protein breakdown not balances with new
  protein synthesis
• Protein wasting
• Both may cause
• 1. Autoatrophy
• 2. Fatigue
• 3. Disordered organ function
• Protein wasting
• 
  BODY WEIGHT ?
• Lipolysis

74

• PARATHYROID GLAND
• 2 glands around thyroid gland
• Function Regulating blood Ca level
• Blood Ca 10 mg (5 mEq/L)

75

• HYPOCALCEMIA
• Extracellular Ca
• Nerve cells more excitable
• (Permiability ?)
• Potential of spontaneous action
• TETANY

76

• HYPERCALCEMIA
• Reflex ?
• Constipation
• Appetite ?
• Suppressed Nerve System
• ABNORMAL
• HYPOPARATHYROID
• parathormone level ?
• EFFECT
• a. Calcium ? TETANY

77

• Laryngeal muscle most sensitive ?
  Spasm/Obstruction of respiratory tract
• FATAL
• b. Phosphate ? (normal 4 mg) ?12 mg
• 2. HIPERPARATIROID
• Kadar parathormone ? ? Calcium ?
• Phosphate ?
• Causes 1. Tumor
• 2. Female, more frequent due to
  Lactation and Pregnancy
• Plasma Ca ?
• Stimulating parathyroid tissue
• (if prolonged,
  hypertrophy)

78

• 3. RICKETTSIA
• In children
• Ca and Phosphate deficiency in extracellular
  fluid
• Cause Vitamin D deficiency
• 7-dehydrocholesterol (pro-vitamin D)
• Ultra violet ?
• Vitamin D
• Digestive tract
• Ca Absorption ? and Phosphate ?

79

• Rickettsia Physiological Effects
• Parathyroid Tissue Hyperplasia
• Bone Strength ?
• Tetany
• Treatment
• Vitamin D and Calcium Phosphate
• If Vitamin D only
• Absorption ? in digestive tract but Ca
  absorption is absent
• Bone reabsorption ? but bone is loss
• Bone formation ? so that blood Ca ?

80

• If Ca and Phosphate only
• Ca Phosphate
• without vit. D
• Ca Absorption ? Phosphate Absorption?
• Plasma Ca ?
• Bone formation

81

• THYROID GLAND
• Secretion 1. Thyroxin tetraiodothyronin (T4)
  
• 2. Triiodothyronin (T3)
• Iodine requirement 50 mg/year
• 1 mg/week
• Iodine deficiency ? MENTAL RETARDATION
• Goitrogenic Area area where the land contains
  no iodine.
• e.g. montainous area

82

• THYROID HORMONE SYNTHESIS
• Iodine in food ? entering plasma in the form of
  iodide (J)
• J I I
  Peroxydase I2
• Thyreoglobulin Thyreoglobulin
• Thyroxine
  Thyreoglobulin Thyroxine
• Lysosomal Protease
  (Coupling MIT, DIT)
• Plasma Thyroid cells
  Intrafollicle

83

• METABOLIC EFFECTS
• Stimulating metabolism in general except in
  brain, retina, lymph, testis and lung
• Carbohydrate metabolism, protein and lipid
  increase
• Enhanced bone growth
• ABNORMAL
• Hyperthyroid
• Cause 1. LATS (long acting thyroid
  stimulation)
• Antibody (TSH like)?Thyroid ?Thyroxin ?
• 2. Thyroid gland adenoma
• Symptoms Heat intolerance, exophthalmos,
  sweating,
• fatigue, unable to sleep,
  BW ?

84

• 2. Hypothyroid
• Goitrogenesis The process of thyroid gland
• enlargement due to
  coloid retention
• and water within
  follicle or tumor.
• Cause
• a. Iodine deficiency
• (Iodine def./endemic goiter/goitrogenic area)

85

• Hypothalamus
• TSH-RH
• Anterior Hypophysis
• TSH
• Thyroid Tissue
• Thyroglobulin ?
  ? Enlargement gland cells
• Thyroxin (T2, T4) ? ? due to
  Iodine absence
• Negative Feed Back
• TSH
  ?? ? Thyroid gland enlarges due to
• 
  numerous follicles
  Thyreoglobulin
• and enlarged gland cells

86

• b. Idiopathic Non-toxic Goitercolloid
• Normal amount of thyroid hormone secretion,
• but inhibited due to mild thyroiditis
• c. Thiocyanate (Antithyroid)
• Inhibiting iodine pump
• d. Thiocarbamide (Antithyroid)
• Inhibiting iodination

87
MENJAGA KESEHATAN PENAMPILAN
88
MENJAGA PENAMPILAN

• Pada 3 30 detik pertama berjumpa, orang akan
  berpersepsi tentang
• Status sosioekonomik Anda
• Tingkat keterpelajaran
• Menyenangkan atau tidakkah Anda

89
TIPS BERPENAMPILAN

• Tarik perhatian, jangan alihkan
• Kenakan pakaian yang tepat
• Pilih sepatu yang sesuai
• Rambut yang rapi
• Asesoris yang tepat
• Pancarkan percaya diri

90

• ANDROGEN HORMONE
• LH (Luteinizing Hormone)
  ACTH
• ICSH ( Interstitial Cell Stimulating Hormone)
• Sel Leydig Interstitial Cells Adrenal Cortex
• (Pars Reticularis)
• Androgen Hormone
• Peak secretion in age of 20 years and decreases
  thereafter

91

• FUNCTION
• Male sexuality characteristics
• a. Primary ? Sexual organ development
• b. Secondary Hair - Coarse
• - Typical distribution
• Skin - More coarse
• - Sweat ?
• - Lipid ?
• - Darker
• Voice
• Thyroid cartilage
• Hip

92

• Age more than 45 years ? ANDROPOUSE (male)
• ? MENOPAUSE (female)
• Symptoms
• Depression
• Hypertension
• Headache
• Psyhcological

93

• ESTROGEN
• Secretion
• Ovary
• Adrenal Cortex
• Functions
• Primary sexual characteristics
• a. Uterus - Sensitive to mechanic and oxytocin
  stimulation
• - Endometrial proliferation
• b. Tuba Fallopii - Sensitive to mechanic and
  oxytocin stimulation
• - Endometrial proliferation
• - More numerous and more active cilia
• c. Vagina cornification

94

• 2. Secondary sexual characteristics
• Mammary
• Hip
• Voice
• Lipid
• Epyphyseal line closes faster

95

• PROGESTERONE
• Secretion
• Placenta
• Corpus Luteum
• Functions
• Uterus - Increased gland and blood vessel
• - Secretory phase
• - Less sensitive to mechanic and
  oxytocin
• stimulation ? ANTI
  ABORTUS
• 2. Fallopian Tube similar effect to that in the
  uterus
• 3. Catabolism ?