Non Classical (Unique) Actions ofNon Classical (Unique) Actions of

HormonesHormones

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Hormone Action

Nuclear Non Nuclear

Genomic Non Genomic Cytosolic

Non Cytosolic

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Hormone ActionsHormone Actions

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Complex( 1st Messenger)

Receptors on Cell Membrane

2nd Messenger RNA

Nuclear RNA

Signal Transduction

Nuclear DNA Transcription

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Non Genomic - Non Classical

By activation Protein Coupled Receptors

Activation of Signal Transducing Kinases

Eg : MAPK – Mitogen Activated Protein Kinases

Protein Transgression - Activation of Cytokines and Growth Factors to translate the Cell – Cell language of Hormone action (Hormonisation of the Milieu Interieur)

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Differences with

Gender Difference - Male, Female Difference of Estradiol,Testosterone, DHT, Androstenedione- Actions

Age Difference - Prepubertal

PreAdolescent

Post Pubertal & Fertility period

Peri & Post Menopausal

Geriatric Age

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In Critical Care Medicines

Where Homeostasis is Turbulantly altered by

Substrate Changes of – Inflammatory

Cascade of Cytokines, Interferones, Prostaglandins & Prostacyclines & other Kinins of Cell Adhsion & Cell Apoptosis

Relevance in the use of Recombnint Growth Hormone (RGH), Anti Thrombin III, Factor VII, Novo Seven in Criticare to Modulate Catabolic ,Protein loss &Healing towards - HEALING !

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We have used the Non Classical Actions of following Hormones in Clinical Medicine

- In Osteopenia,

- Arthropathies (Degenerative &

Immunomodulated Types

Eg :: Osteoarthritis

Rheumatoid Arthritis,

Psoriatic Arthritis

Actions on Endothelium

Osteoid Cells

Osteoid Seam

Vascular & Neuronal Tissues

T Lymphocyties & Monocytes

Estrogen

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Progesterone

- used in Sperm activation before AIH,ECSEI

- Sensitising the Estrogen Receptors for benefits of pain Relieving effects on Bone

- Recurrent Tropical Infections like Malaria Typhoid etc - in cases of severe Epilepsy in Females

On Sperm

Anti Inflammatory Effects

Arthritis

Boosting Immune System

Anti Epileptic – Neuro Sedative effects

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Acute Care Medicine

Case of Multiple Organ Failure

- in Road Traffic Accident (RTA) with Serve Head Injury

- in Cerebro Vascular Accidents (CVA) with complications of DM, CAD

- in Post Traumatic Neurological Damage with Quadri & Para Paresis (Cervical & Lumbar Disc Fractures

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Morbid Obesity-Hypothalamic Obesities with Respiratory insufficiency & Parasomnias (Sleep Disorders)

-Treated with RGH & Anti Obesity Measures

Degenerative Diseases of Skin With Acute Phase Reactions

Two Females of Pemphigus 30 & 34 Yrs Three Cases of Psoriasis with Arthritis – Males (20 to 50 Yrs)Treated with RGH & Gonadal Steroids .

- Like Pemphigus, Psoriasis, Exfoliative Dermatitis

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- Used in Clinical Medicine – Specially T3 (Triodothyronine) in cases of Obesity - Growth problems (Childhood Obesity , Constitutional growth delay, Childhood Behaviour Problems like Enuresis, Strammering and Reading and Writing Defects in Dyslexia

- Used in Oncology as Promoters of Cell Apoptosis in Cencer Theropy

- Given Pre and Post Operatively in Major Surgeries like Total Hip and Knee replacements (3 Cases ) – Coupled with Viscosupplementation (with Hyaluronidase)

Thyroid Hormones (Non Classical Effects of )

Anti Estrogen

Estrogen, Progesterone & RGH

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RGH Use in Acute & Chronic Degenerative Conditions

( Actions of Anti Catabolic, Prohealing , Anti Degenerative Protiein Sparing )

1. Rheumotoid & Degenarative Arthritis with High Morbidisation and

Immbilisation (Knee and Hip Joints) – 3 Cases of Female Patients(40 to

55 Yrs of Peri & Post Menopausal Arthritis treated with RGH & HRT - 3

Cases of Hip and Shoulder and Knee Arthritis in Young (16 , 22, 26 Yrs)

– 2 Male and 1 Female

2. Debilitating Lumbar & Cervical Dorsalgias (6 Cases of Post Menopausal Male and Female cases treated with RGH and HRT

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MOF Cases (Multiple Organ Failure)

In CVA Cases Complicated with DM , CAD and Neuroipathies

(Somatosensory and Autonomic)

1 Case of Cushing Syndrome 22 Yrs old Male in Persistent

Hyperkalemia and Hyperglycimia who developed MOF in

Hospital & Treated with RGH and Supportive Criticare

SurvivedWith normalisation of Cortisolemia & Hyperkalemia

and Hyperglycimia (MOF came as a blessing in this guys to

Downregulate his Hyperactive Adrenals !!)

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Reported (Hitherto ) Failure of RGH Benefits in Criticalcare Most Likely to be – Dose Related (Very High Doses were used ? And Improper selection of cases )

Failure in our cases was Positively Attribuble to the development of DIC & Platelet , Thrombopathies

Becase we have had very Encouraging Results with RGH in Creticare With use of 2 to 5 units 12 Hourly

Propably the on going trials with Factor VII (NOVO Seven) will add to the Positive results and RGH + Amtithrombin III + NOVO Seven seem to be future Blockbuster criticare package towards decreasing Mortality in Critical Care patients.

We have Subciquintly got over this problem by the concurrent use ofAntithrombin III,

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