内分泌总论PPT课件

内分泌和代谢疾病Endocrine and Metabolic Diseases,Department of Endocrine First Affiliated Hospital of Dalian Medial University,第七篇,1,总 论General Introduction,第七篇第一章,2,概念 Definition,内分泌系统（Endocrine System） 由固有的内分泌腺和某些脏器的内分泌组织和细胞以及它们所分泌的激素组成的一个体液调节系统。内分泌和外分泌（Endocrine and Exocrine）,3,内分泌和外分泌Endocrine and Exocrine,内分泌Endocrine,外分泌Exocrine,4,内分泌系统的组成Composition of Endocrine System,垂体前叶、垂体后叶、松果体、甲状腺、甲状旁腺、肾上腺（皮质和髓质）、性腺（睾丸和卵巢）。 胸腺、胎盘,人体内分泌腺（Endocrine Glands）,内分泌组织和细胞（Endocrine Tissues and Cells）,大脑、胃肠道、心脏、胰岛、肾脏、脂肪等。,5,内分泌学的发展史History of Endocrinology,腺体内分泌学Organic Endocrinology,组织内分泌学Histological Endocrinology,分子内分泌学Moleculer Endocrinology,6,激素分类Classification of Hormone,肽类激素（Peptide Hormones）,类固醇激素（Steroid Hormones）,氨基酸类激素（Amino Acid Hormones）,胰岛素(insulin)、甲状旁腺激素(Parathyroid hormone, PTH)、阿片-黑素-促皮质素原(proopiomelanocortin, POMC)、 各种垂体激素(GH, TSH, ACTH, LH, FSH, PRL),儿茶酚胺(Catecholamines)、褪黑素(Melatonin),糖皮质激素(Cortisol, Cor)、盐皮质激素(Aldosterone)、雄激素(Testosterone, T)、雌激素(Estrogen, E)、 孕激素(Progesterone, P)和维生素D(Vitamin D),胺类激素（Amine Hormones）,甲状腺激素(Thyroid hormones, TH),自学,7,激素的分泌方式Fashions of hormonal secreting,内分泌 旁分泌 自分泌 神经内分泌 胞内分泌Endocrine Paracrine Autocrine Neurocrine Intracrine,激素（Hormone）,8,激素的作用机制Mechanism of hormonal action,细胞膜受体(Membrane Receptors),核受体和细胞质受体(Nuclear Receptors),9,内分泌系统的调节Regulation of endocrine system,内分泌系统的反馈调节 Negative feedback regulation下丘脑-垂体-靶腺轴的反馈调节RAAS的反馈调节神经-内分泌相互调节 Neuro-endocrine regulation神经对内分泌的调节（下丘脑与垂体前后叶）内分泌对神经系统的影响（甲状腺与CNS）免疫系统与内分泌功能 Immune system and endocrine function,10,下丘脑-垂体前叶Hypothalamus-anterior pituitary,神经内分泌性神经元,下丘脑-垂体门静脉,垂体前叶Anterior pituitary,动脉血流入,静脉血流出,垂体后叶Posterior pituitary,下丘脑Hypothalamus,11,下丘脑、垂体、靶腺激素Hypothalamus-pituitary-target glands,ADH/AVP ADH/AVP KidneyGHRH GH Liver,Muscle, Bone CRH ACTH CorTRH TSH THGnRH FSH E2、P (F) LH T (M)GIF（DA） PRL Breast,Hypothalamus,Target glands,Pituitary,12,下丘脑-垂体-靶腺轴,13,负反馈调节（以甲状腺为例） Negative feedback regulation (HPT axis),生理作用,TRH,TSH,（+）,（+）,T4T3,下丘脑Hypothalamas,垂体Pituitary,甲状腺Thyroid,负反馈抑制Negative feedback inhibition,（）,（）,14,E2 P,TRH,TSH,（+）,T4T3,Hypothalamus,Pituitary,Thyroid,负反馈调节Negative feedback regulation,Adrenal,Gonads,ACTH,LHFSH,CRH,GnRH,（+）,Cor,T,（）,（）,15,RAAS的负反馈调节Negative feedback regulation of RAAS,H2O Na+ UK+BK+,Renin,ACE,测定血浆肾素活性（PRA）、AII和ALD水平判断是原发性还是继发性ALD增多,A,AI,AII,ALD,16,Neurosecretory neurons,Paraventricular nucleus,Supraoptic nucleus,Hypothalamic-pituitary stalk,动脉血流入,静脉血流出,Posterior pituitary,Anterior pituitary,Hypothalamus,下丘脑-垂体后叶Hypothalamus-posterior pituitary,17,血浆渗透压Plasma osmolality,AVP,AVP,+,+,下丘脑Hypothalamas,垂体后叶Posterior pituitary,肾脏Kidney,下丘脑-垂体后叶-肾脏的反馈调节Feedback regulation of hypothalamus-posterior pituitary-kidney,中枢性尿崩症Pituitary diabetes insipidus,肾性尿崩症Nephrogenic diabetes insipidus,AQP,18,正反馈调节Positive feedback regulation,月经周期Menstrual cycle负反馈正反馈,19,激素的分泌节律Hormonal rhythms,生物节律（Biological rhythms）昼夜节律（Circadian rhythms）血液、尿液激素浓度的昼夜变化,20,血浆GH的昼夜节律变化Circadian rhythm of plasma GH,正常人24小时血浆GH浓度变化,Time,06:00,10:00,14:00,18:00,22:00,02:00,06:00,20,10,GH (pmol/min),0,21,早餐,胰岛素分泌随饮食的变化,胰岛素浓度的变化,午餐,晚餐,22,内分泌系统疾病病因分类Causes of endocrine diseases,内分泌腺肿瘤；多内分泌腺瘤；激素受体突变；异位内分泌综合征；激素代谢异常；自身免疫；医源性内分泌紊乱,功能亢进 (Hyperfunction),功能减低 (Hypofunction),激素敏感性缺陷 (Hormone resistance),内分泌腺破坏；内分泌腺激素合成缺陷；基因突变；内分泌腺以外的疾病,膜或核受体和（或）受体后信号转导缺陷,23,内分泌代谢疾病的诊断原则Diagnostic principles of endocrine diseases,功能诊断 (Functional diagnosis)病理（定位）诊断 (Locational diagnosis)病因诊断 (Etiological diagnosis),24,临床表现(Clinical manifestations)典型的症状(Symptoms)典型的体征(Sings)实验室检查(Laboratory testing),功能诊断,体形异常性腺功能异常皮肤表现特殊面容痛风及骨代谢异常,25,皮肤表现 (Features of skin),26,面容 (Facial features),27,嘌呤及骨代谢异常Abnormalities of metabolism,28,临床表现 (Clinical manifestations)实验室检查 (Laboratory testing),功能诊断 (Functional diagnosis),代谢紊乱证据激素分泌情况测定垂体-靶腺的激素水平采血时间24h尿动态功能测定兴奋试验抑制试验,29,内分泌代谢疾病的诊断原则 Diagnostic principles of endocrine diseases,影像学检查放射性核素检查细胞学检查静脉导管检查,功能诊断 (Functional diagnosis)病理（定位）诊断 (Locational diagnosis)病因诊断 (Etiological diagnosis),30,内分泌代谢疾病的诊断原则 Diagnostic principles of endocrine diseases,HLA鉴定,白细胞染色体检查,自身抗体检测,功能诊断 (Functional diagnosis)病理（定位）诊断 (Locational diagnosis)病因诊断 (Etiological diagnosis),31,诊断（以甲状腺疾病为例）Diagnosis (e.g. Thyroid diseases),功能诊断 functional diagnosis,病理诊断 pathological diagnosis,病因诊断 etiological diagnosis,甲减 hypothyroidism,甲状腺性甲减 thyroidal hypothyroidism,慢性淋巴细胞性甲状腺炎 chronic lymphocytic thyroiditis,T3T4,TSH细胞学,细胞学抗体,32,内分泌疾病的防治原则Prevention and treatment for endocrine diseases,手术切除(Surgical resection)机能亢进的肿瘤或增生放疗(Radiotherapy)、核素治疗(Nuclide therapy)药物治疗（抑制激素合成与释放的药物）,功能亢进(Hyperfunction),功能减退(Hypofunction),替代治疗(Replacement therapy)内分泌腺或组织移植 (Transplantation),病因治疗(Etilogical treatment),预防(Prevention),补碘缺碘性甲状腺肿加强围生期医疗保健希恩综合征,肿瘤切除、免疫调节、基因治疗等,33,Questions,内分泌疾病诊断原则？ Diagnostic principles of