內(nèi)科學 內(nèi)分泌和代謝性疾病總論 英文教學課件2018

1、endocrine & metabolic diseasesthe department of endocrinology and metabolismkey points1. to know endocrine system and hormones2. to grasp the principle of diagnosis and treatment of endocrine diseasescontents1. endocrine system and hormones2. diagnosis of endocrine diseases3. treatment of endocr

2、ine diseases4. progress contents1. endocrine system and function(1) endocrine glands and cells(2) hormone & function (3) regulation of hormone(4) mechanism of hormone action(5) metabolism of hormone endocrine systemglands+ cells（apud）hormonescrh、gnrh、trh ghrh, ghrih pif, prif,adhacth,tshfsh, lh,

3、 ghprl,adhth (t3,t4) cacitoninepthinsulin,c-pss,glucagon estrogen progesteroneglucocorticoid aldosterone testosteronecatecholaminetestosteroneendocrine cells & hormonesleptin, adiponectin, resistin, visfatin et aladipocytesendothelium cellsno，endothelinapud cells (amine precursor uptake and deca

4、rboxylation)peptide or catecholemine hormone classification peptides or proteins: gh,insulin amine or amino acid analogs: th catecholamines,e, ne steroids: cortisol, t, e,vitd fatty acid derivatives: prostaglandin hormone secretionneuroendocrine:endocrineparacrineautocrineintrarine neurocrine: solin

5、ocrine:pulsatile and rhythms secretion pulsatile or cyclic secretion: likes a wavel t4 change in seasonl fsh, lh, e, and p change in wksl insulin, prl, gnrh from min. to hr. hormone rhythms secretion diurnal rhythm acth and cortisol : 8am/4pm/midnight sleep-associated rhythms gh，prolectinone hormone

6、, multiple functionsone function, multiple hormones antagonism of hormoneshormone action & interaction eg. hyperglycemia vs hypoglycemia hormone regulation nervous-endocrine-immune system nervous-endocrine-metabolism endocrine and endocrinehypothalamus-pituitary-target glands feedback regulation

7、 nerve impulse & cytokineshypothalamuspituitarytarget glandsnever centera b c dth secretion regulation axis trh thhypothalamus pituitarythyroidtshcortisol secretion regulation axisacth crhcortisolhypothalamus pituitaryadrenalgonadal hormone secretion regulation axisfsh, lhgnrhe2, p, thypothalamu

8、s pituitarygonadsother hormone regulation axisp renin-angiotensin-aldosterone system (raa)p energy-metabolic regulation system p pth- cacitonine -1,25(oh)2d3 hormone receptor membrane receptor(4 types): peptides or proteins nuclear and cytoplasmic receptor steroids, th, vitdcontents1. endocrine syst

9、em and hormones2. diagnosis of endocrine diseases3. treatment of endocrine diseases2. endocrine diseasesclassification(1) hyperfunction(2) hypofunction (3) abnormal response to hormone: sensitive or resistant (4) tumor: secrete hormones or destroy glandsdiagnosis of endocrine diseases(1) function (2

10、) location (anatomy)(3) causessymptoms & signssymptoms & signs diseasesweight gain hypothalamic syn. cushing syn. hypothyroidism, insulinoma weight loss adrenal insufficiency, hyperthyroidsm, dm, hypopituitarism, pheochromocytomashort stature idiopathic gh deficiency (dwarfism), turners syn.

11、tall stature pituitary giganism, klinefelter syn.symptoms & signssymptoms & signs diseasespolyuria diabetes insipidus, diabetes mellitus, hypercalcemia, hypokalemia hyperpigmentation addisons syn. nelsons syn.hypopigmentation panhypopituitarismacne androgen excess, pcos, cushing syn.striae c

12、ushing syn.symptoms & signssymptoms & signs diseasesdecreased body hair hypothyroidism, hypopituitarism hirsutism androgen excess states, cushing syn. amenorrhea adrenal insufficiency, cushing syn. hyperprolactinemic states, pcos, hypopituitarism, ovarian failure galactorrhea hyperprolactine

13、mic states, prolactinomas, hypothyroidism symptoms & signssymptoms & signs diseasesproptosis graves disease, obital tumor hypokalemia primary aldosteronism, paralysis renin-secreting tumors cushing syn.acanthosis nigricans obesity, pcos, acromegaly, severe insulin resistance, cushing syn. bo

14、ne pain osteoporosis, hypercalcemia, hyperparathyroidismsymptoms & signssymptoms & signs the level of hormone (blood or urine or salivary) serum prl, gh, acth, tsh, fsh, lh, insulin, t3, t4, pth, t, e2, p, aldo urine cortisol, salivary cortisol basal levels: ft3, ft4, tsh hormones rhythm: ac

15、th-cortisol(8/15/24) biochemical index: bg, ca,k,na,plaboratory tests dynamic (functional) tests stimulation test: on hypofunction disease eg. trh, acth, ogirt suppression test: on hyperfunction disease. eg. dexmethasone suppression test on cushings syndrome. laboratory testslocalization of disorder

16、s localization imaging studies: mri , ct, ect, b ultrasound samples for measurement of hormone via cathetercause of disorders cause diagnosis chemistry analysis: urine iodine immunoassay: iaa, ica, gad, tpoab, tgab genetic analysis: dna analysis, chromosome pathology: fine-needle biopsy, operation s

17、amplediagnosis of endocrine diseases(1) symptoms- strange (2) signs- inspection(3) lab tests- function(4) causes or localization3. treatment of endocrine diseases(1) to causes (2) correct metabolic abnormity(3) special treatmentcauses of hypofunctiondestruction of the gland: autoimmune, tumor, infec

18、tion, surgery, radiation, hemorrhage.extraglandular disorders:renal congenital defects in hormone biosynthesisreceptor deficiencydrugsdefects in sensitivity to hormone type 2 diabetes mellitus pseudohypoparathyroidism some hypothyroidism nephrogenic diabetes insipidus rickets (vitamin d insensitivity) treatment to hypofunction replacement with hormone in a physiologic manner: insulin,th repla