Download Principle of Endocrine & Metabolic Diseases

Principle of Endocrine &
Metabolic Diseases
Shan Zhongyan
单忠艳
The Endocrionology
Department
Contents
1. Endocrine system and Hormones
2. Diagnosis of Endocrine Diseases
3. Treatment of Endocrine Diseases
4. Progress
1. Endocrine system & Hormones
(1) Endocrine system & function
(2) Hormone & function
(3) Regulation of hormone
(4) Mechanism of hormone action
Endocrine
system
Glands
+
Cells
Hormones
Endocrine System & Hormones
Organ
Hypothalamus
Pituitary
Hormones
CRH
ACTH
TRH
TSH
GnRH(LRH)
FSH, LH
GHRH, GHRIH
GH
PIF, PRIF
PRL
ADH
ADH
Endocrine System & Hormones
Organ
Hormone
Parathyroid
PTH
Thyroid
TH(T3,T4) ,
Pancreas
Insulin, Glucagon, SS
Adrenal gland
Glucocorticoid, Aldosterone, Testosterone
Cacitonine
Catecholamine
Ovary
Estrogen, Progesterone
Testis
Testosterone
Endocrine Cells & Hormones
Cells
Hormone
APUD cells
Peptide or
Catecholemine
Adipocytes
Leptin
Endothelium cells
Peptides
Hormone
Classification
① Peptides or Proteins: GH
② Amine: Catecholamines
③ Amino Acid Analogs: TH
④ Steroids: Cortisol, VitD
Hormone
Secretion
① Endocrine:
② Paracrine:
③ Autocrine:
④ Intracrine:
Hormone
Secretion Rhythms
① 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
② Circadian variability
ACTH and cortisol : 8am/4pm/midnight
③ Sleep-associated rhythms
GH，Prolectin
Hormone
Regulation
① Endocrine and Nervous system
② Endocrine and Endocrine
③ Endocrine and Immune system
④ Endocrine and Metabolism
Hypothalamus-pituitary-target
glands Feedback Regulation
Nerve impulse & Cytokines
Advanced never center
Hypothalamus
Pituitary
Target Glands
TH Secretion Regulation
Hypothalamus
TRH
Pituitary
TH
TSH
Thyroid
Cortisol Secretion Regulation
Hypothalamus
CRH
Pituitary
Cortisol
ACTH
Adrenal
Gonadal Hormone Secretion Regulation
Hypothalamus
GnRH
Pituitary
E2, P
FSH, LH
Gonads
Interaction of Hormones
One hormone, Multiple actions
One function, Multiple hormones
Self-review
Hormone
 Other regulation system
 Mechanism of action
 Hormone receptors
2. Diagnosis of Endocrine Diseases
(1) Symptoms--- Fantastico
(2) Signs--- Inspection
(3) Lab Tests--- Function
(4) Causes or Localization
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
Symptoms & Signs
Symptoms & signs
Polyuria
Diseases
Diabetes insipidus, Diabetes mellitus,
Hypercalcemia, Hypokalemia
Hyperpigmentation Addison’s syn. Nelson’s syn.
Hypopigmentation
Panhypopituitarism
Acne
Androgen excess, PCOS, Cushing syn.
Striae
Cushing syn.
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
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
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
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.
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
3. Treatment of Endocrine Diseases
(1) To causes
(2) To Excess of hormone
(3) To Deficiency of hormone
(4) To resistance to hormone
Cause of Endocrine Hyperfunction
① Tumor: ACTH-producing tumor
② Hyperplasia: Adrenal hyperplasia
③ Autoimmune stimulation: GD
④ Ectopic endocrine syndrome
⑤ Drugs
Cause of Endocrine Hypofunction
① Destruction of the gland
Autoimmune disease
Schmidt’s syn.(hypothyridism, Addison)
Neoplasms, infection or hemorrhage.
② Extraglandular disorders
③ Congenital defects in hormone biosynthesis
④ Receptor Deficiency
⑤ Drugs
Defects in Sensitivity to Hormone
① Type 2 diabetes mellitus
② Pseudohypoparathyroidism
③ Some hypothyroidism
④ Nephrogenic diabetes insipidus
⑤ Rickets (vitamin D insensitivity)
Treatment to Hyperfunction
① Remove tumors
② Pharmacology block hormone production
③ Control sequelae of hyperfunction
④ Immunotherapy
⑤ Radiothyrapy
Treatment to Hypofunction
① Replacement with hormone in a physiologic
manner: insulin
① Replacement with hormone mimics: Vitamin D
② Replacement with cations: Ca, P
③ Immunotherapy
④ Transplantation
Changes of Hormone
Hypothalamus
Pituitary
Target
CRH ↑
ACTH↑
CS↓
↑
↑
↑
↓
↓
↑
TSH ↓
TH↑
↑
↓
Diseases
Changes of Hormone
Hypothalamus
Pituitary
Target
Diseases
CRH ↑
ACTH↑
CS↓
Addison’s Disease
↑
↑
↑
Cushing’s Disease
↓
↓
↑
Adrenal hyperfunction
TSH ↓
TH↑
↑
↓
Hyperthyroidism
Hypothyroidism
The
End