Principle of Endocrine

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Principle of Endocrine Metabolic Diseases
Shan Zhongyan ??? The Endocrionology
Department
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Contents

1. Endocrine system and Hormones
2. Diagnosis of Endocrine Diseases
3. Treatment of Endocrine Diseases
4. Progress

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1. Endocrine system Hormones

(1) Endocrine system function (2) Hormone
function (3) Regulation of hormone (4) Mechanism
of hormone action
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Endocrine system
Glands Cells
Hormones
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Endocrine System Hormones
Organ
Hypothalamus Pituitary CRH
ACTH TRH
TSH GnRH(LRH)
FSH, LH GHRH, GHRIH GH
PIF, PRIF PRL
ADH ADH
Hormones
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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
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Endocrine Cells Hormones
Cells Hormone APUD
cells Peptide or
Catecholemine Adipocytes
Leptin Endothelium cells
Peptides
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Hormone

• Classification
• Peptides or Proteins GH
• Amine Catecholamines
• Amino Acid Analogs TH
• Steroids Cortisol, VitD

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Hormone

• Secretion
• Endocrine
• Paracrine
• Autocrine
• Intracrine

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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

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Hormone

• Regulation
• Endocrine and Nervous system
• Endocrine and Endocrine
• Endocrine and Immune system
• Endocrine and Metabolism

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Hypothalamus-pituitary-target glands Feedback
Regulation

Nerve impulse Cytokines
Advanced never center
Hypothalamus
Pituitary
Target Glands
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TH Secretion Regulation
Hypothalamus
TRH
Pituitary
TSH
TH
Thyroid
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Cortisol Secretion Regulation
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Gonadal Hormone Secretion Regulation
Hypothalamus
GnRH
Pituitary
FSH, LH
E2, P
Gonads
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Interaction of Hormones
One hormone, Multiple actions One function,
Multiple hormones

• Self-review
• Hormone
• Other regulation system
• Mechanism of action
• Hormone receptors

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2. Diagnosis of Endocrine Diseases
(1) Symptoms--- Fantastico (2) Signs---
Inspection (3) Lab Tests--- Function (4) Causes
or Localization
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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),
Turners syn. Tall stature
Pituitary giganism, Sexual precocity
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Symptoms Signs
Symptoms signs
Diseases Polyuria Diabetes
insipidus, Diabetes mellitus,
Hypercalcemia, Hypokalemia
Hyperpigmentation Addisons syn. Nelsons
syn. Hypopigmentation Panhypopituitarism Acne
Androgen excess,
PCOS, Cushing syn. Striae
Cushing syn.
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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

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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
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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

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Laboratory Tests

• Basal levels FT3, FT4, TT3, TT4
• Hormones rhythm ACTH-Cortisol
• Provocative (functional) tests
• Stimulation test on hypofunction disease
• eg. TRH, ACTH,
  OGIRT
• Suppression teston hyperfunction disease.
• eg. dexmethasone
  suppression test
• on Cushing
  syndrome.

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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

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

• Tumor ACTH-producing tumor
• Hyperplasia Adrenal hyperplasia
• Autoimmune stimulation GD
• Ectopic endocrine syndrome
• Drugs

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Cause of Endocrine Hypofunction

• Destruction of the gland
• Autoimmune disease
• Schmidts syn.(hypothyridism,
  Addison)
• Neoplasms, infection or hemorrhage.
• Extraglandular disorders
• Congenital defects in hormone biosynthesis
• Receptor Deficiency
• Drugs

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Defects in Sensitivity to Hormone

1. Type 2 diabetes mellitus
2. Pseudohypoparathyroidism
3. Some hypothyroidism
4. Nephrogenic diabetes insipidus
5. Rickets (vitamin D insensitivity)

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Treatment to Hyperfunction

1. Remove tumors
2. Pharmacology block hormone production
3. Control sequelae of hyperfunction
4. Immunotherapy
5. Radiothyrapy

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Treatment to Hypofunction

• Replacement with hormone in a physiologic
• manner insulin
• Replacement with hormone mimics Vitamin D
• Replacement with cations Ca, P
• Immunotherapy
• Transplantation

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Changes of Hormone
Hypothalamus Pituitary Target Diseases
CRH ? ACTH? CS?
? ? ?
? ? ?
TSH ? TH?
? ?
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Changes of Hormone
Hypothalamus Pituitary Target Diseases
CRH ? ACTH? CS? Addisons Disease
? ? ? Cushings Disease
? ? ? Adrenal hyperfunction
TSH ? TH? Hyperthyroidism
? ? Hypothyroidism
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The End