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7/27/2019 01. Introduction Prof Ieva
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The term endocrine denotes internal
secretion of biologically active substance
called hormone
The term exocrine denotes secretion
outside the body e.g through sweatglands or ducts that lead into the GI tract.
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There is a tight coupling between the
basic science of endocrinology and
clinical medicine
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The endocrine and nervous systems
are the major controllers
of the flow of information
between
different cells and tissues
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Traditional definition
The endocrine system releases
chemical mediators termed hormonesinto the circulation for actionaway from their sites of origin.
This definition becomes blurred
because the recoqnition thatthe circulating hormones can also havelocal effects in the cells in which they are synthetized ( autocrine)or
in adjacent cells after diffusion (paracrine)oracts inside the cell without being released (intracrine)
e.g insulin (inhibits its own release)
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Hormone Released Transported
Target
bind to receptors
on the cell surface intracellular (nuclear)
e.g Insulin Steroid
GH Thyroid hormones
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RECEPTORS BIFUNCTIONAL
1. Recognition
2. Signal activation
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Hormone antagonism
Certain hormones antagonize the effects of
other hormones.
It is necessary to know the value of each
hormone to interpret the clinical phenomenon
N Testosteron
Estrogen
N Estrogen
Testosteron
GYNECOMASTIA
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The function of hormones
There are 4 domain :
Reproduction Growth and development
Maintenance of the internal environment
Energy production, utilization and storage
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CHEMICAL COMPOSITIONOF HORMONES
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MECHANISM OF HORMONE ACTION
Hormone receptors
Cell surface receptors
Nuclear receptors
Hormone effects on receptor activity
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CLASSESOF HORMONE ACTION
Classification of hormone action by receptor type
Glucocorticoid CH regulating activities
Mineralocorticoid Salt regulating activity
Classification of hormone action by ligand typeAgonist
Partial agonist-partial antagonist
Antagonist
Inactive compounds
Mixed agonist-antagonist
Ligands with Reserve Pharmacology
Mechanisms of ligand action
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MODULATIONOF HORMONE LEVELS
Hormone synthesis
Regulation of hormone production
There are a number of patterns of regulation
of hormone release:1. The hypothalamic-pituitary-target gland2. Free standing endocrine glands (parathyroid,
islet cells )3. Pulsatile release etc
Hormone transport in the circulation
BoundFree
Transport of hormones across the membrane
Metabolism & elimination of hormones
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DISORDERSOF THE ENDOCRINE SYSTEM
Arise from :
Excess of hormones
Deficiency of hormones
Resistance to hormones
Specific tumorsIatrogenic syndromes
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Hypofunction
Destruction of the gland:
Auto immune diseaseType 1 diabetesHypothyroidismAdrenal insufficiency
IschaemiaTumorInflammationHaemorrhage
Extraglandular disorders
Damage to tissues thatconvert hormonr precursor to active form
e.gRenal disease
Defective conversion of25(OH)D3 1,25 (OH) D3
abnormalities in Ca & phosphate balance
Defects in hormone biosynthesis
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Endocrine hyperfunction
Results usually from :
Tumors
Hyperplasia
Autoimmune stimulation
Ectopic production of hormones by tumors
Defects in sensitivity to hormonesSyndromes of hormone excess due toadministration of exogenous hormone
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Glands that produce hormones are scattered allover the bodys tissue but glands that areconsidered to be the principal glands are
- the hypophysis (pituary)
- the thyroid gland- the parathyroid glands- the adrenasls- isletsof Langerhans- the gonads
Many other (new) hormones are beingdiscovered
Principal glands
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APPROACHTO THE PATIENTWITH ENDOCRINE DISEASE
Evidence-based endocrinology
History & physical examination
Laboratory studies
-
Measurement of hormonal levels: basal level- Plasma & urine analysis- Free hormone ;evels- Immune assays- Biopsy
Screening for endocrine diseases
Clinical interpretation of laboratory test
Treatment of endocrine diseases
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Laboratory testing of Endocrine Function
It is worthwhile to review ; anda considerable judgmentis required,
because of :
Pulsatile hormone secretionDiurnal variation
Cyclic variation
Age
Sleep entrainmentHormone antagonism
Dynamic testing
Hormone and metabolite interaction
Protein binding
Laboratory error
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Cases to be discussed as to trigger the studentsto learn the endocrine-metabolism system are :
Disorders of :
* The hypophysis
* Tahe thyroid gland
* The calcium metabolism
(concerning the parathyroid gland)
* The adrenals
* The islets of Langerhans* The gonads
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