机体平衡精品教学（汕大医附一院）15、内分泌系统疾病总论

ENDOCRINOLOGY&METABOLISMShantou Univ. Med. Coll.Dr. Shaoda LinENDOCRINOLGYAll physiologic processes is controlled by two systems: The nervous systemexerts point-to-point control through nerves by electric or chemical pathways, which is specific, precise and fast. The endocrine systembroadcasts chemical messages by secretion into blood and extracellular fluid. The effect is diffuse, slow and lasts long.ENDOCRINOLOGY is the study of chemical communication systems that provide the means to control a huge number of physiologic processes by the molecular agent which we call HORMONE.THE ENDOCRINE SYSTEMCONSTITUTION Hormone producing tissuesLarge endocrine glands as single organsEndocrine tissues and cells distributed in non- endocrine organs Hormones the message carriers sended into the blood flow and extracellular fluid Hormone receptor the message receiver presents in hormone target cells内分泌系统的结构与功能特点内分泌系统的结构与功能特点 内分泌腺和激素分泌细胞 激素分泌细胞的结构特点 激素 内分泌调节轴与调节系统 激素作用机制 营养素代谢内分泌腺和激素分泌细胞内分泌腺和激素分泌细胞 内分泌腺 弥散性神经 -内分泌细胞系统 组织的激素分泌细胞Pineal GlandThyroid and Parathyroid GlandsHeartAdrenal GlandsKidneyOvaryPlacental HormonesTestesPancreasStomach, Duodenum and JejunumPituitary Gland and HypothalamusThymus Gland内分泌腺内分泌腺弥散性神经弥散性神经 -内分泌细胞系统内分泌细胞系统Autonomic Control Centers in the BrainHypothalamus-Pituitary Axis组织的激素分泌细胞组织的激素分泌细胞激素分泌细胞的结构特点激素分泌细胞的结构特点 合成肽类激素的细胞 内质网和高尔基体丰富 胞浆内有膜分泌颗粒 细胞排列成索状或团块状 合成类固醇类激素的细胞 滑面内质网丰富 胞浆内脂质小滴 细胞弥散性分布激素激素 激素分类 激素合成与储存CLASSIFICATION (structural)Peptides Consist of at least 3 amino acids. Amines Derived from single amino acids.Steroids Derived from cholesterol. Eicosanoids Derived from arachidonic acidHORMONE DEFINITIONChemical messenger that is synthesized in endocrine cells, secreted into blood and extracellular fluid and stimulates physiological responses in target cells. NUMBEROver 100 different hormones are known so far. Its no doubt that more are waiting for you to discover. ACTIONThe actions among hormones are quite complicated, added to numerous number of hormones, which indicates that the endocrine regulation network is extremely sophisticated.Adrenal (suprarenal)Cortex (endocrine) Mineralocorticoids (aldosterone) Glucocorticoids (cortisone)Gonadocorticoids (testosterone, estrogens)Medulla (neurosecretory) Catecholamines (epinephrineadrenaline)Pancreas (Pancreatic islets of Langerhans) Alpha cells (A) GlucagonBeta cells (B) InsulinDelta cells (D) SomatostatinPP cells (F) Pancreatic polypeptideOvaries Estrogens, ProgesteroneTestis Testosterone, InhibinPlacenta Human chorionic gonadotropin (HCG)Estrogens, Progesterone, Placental lactogenGI (gastrointestinal) Mucosa Gastrin, Secretin, Pancreatic polypeptideEnteroglucagon, Histamine, 5-HT, SomatostatinGastric inhibitory polypeptide(GIP)Vasoactive intestinal peptide(VIP)Cholecystokinin, Neurotensin, Ghrelin, MotilinHeart Atrial natriuretic hormone (ANH)Kidney Erythropoietin(EPO), CacitriolPineal MelatoninAdipose tissues Leptin, ResistinOther Vitamin D3, ProstaglandinMoreHORMONES KNOWN IN HUMAN BODYHypothalamusTRH(thyrotropin-releasing hormone) GnRH(gonadotropin-releasing hormone)GHRH(growth hormone-releasing hormone)CRH(corticotropin-releasing hormone) Somatostatin, Dopamine PituitaryAnterior pituitary (adrenohypophysis)Pr (prolactin)GH (growth hormone)ACTH (adrenocorticotropic hormone)TSH (thyroid-stimulating hormone)LH (luteinizing hormone)FSH (follicle-stimulating hormone)LPH(Lipotrophic hormone)MSH(melanocyte stimulating hormone)Posterior pituitary (neurohypophysis) Oxytocin ADH (antidiuretic hormone)ThyroidFollicular cells T3 (triiodothyronine),T4 (tetraiodothyronine)Parafollicular cells CalcitoninParathyroid Parathyroid hormone (PTH)Thymus ThymosinSTORAGE Peptides: Stored as precursors in secretory granules Thyroxin: Stored in extracellular gland follicles Other amines: Stored in intracellular granules Steriods: Release immediately after synthesized and stored in blood binding to plasma proteinsThyroid follicles Secretory granules in neurohypothysis激素的分泌方式激素的分泌方式TRANSPORT Hydrophilic hormones Catecholamines and peptides can be dissolved and circulate freely in blood and interstitial fluid. Hydrophobic hormones Steroids and thyroid hormone must bind to transport proteins for transport. Bound hormone Binding form can prolong half-life to weeks and be protected from enzymes and kidney filtration Unbound hormone Only unbinding form can leave capillary to reach target cell ELIMINATION Broken down by enzymes in plasma or interstitial fluid Take up and degraded by liver and kidney Excreted in bile or urine激素分泌节律激素分泌节律 生物节律 血液激素浓度的昼夜变化 尿液成分浓度的昼夜变化Rhythmicity of Endocrine SystemEpisodic secretion: Hypothalamic Regulatory PeptideDiurnal rhythm: ACTH, GH, TSH, Melatonin, etc.Monthly rhythm: Menstrual Cycle GHNocturnal Release Rhythm of ACTH, GH 050100ACTH(ng/ml)ACTH激素合成也分泌的调节途径激素合成也分泌的调节途径 内分泌调节 旁分泌 /自分泌调节Hypothalamus-Pituitary AxisPosteriorPituitaryAnteriorPituitaryOxytocinADHGrowth HormoneProlactinMelanocyte-Stimulating HormoneReleasingHormonesReleasing-InhibitingHormonesTRHCRHGnRHTSHACTHLH、 FSHGonads ThyroidAdrenalCortexSex Hormones Glucocorticoid TyroxinHypothalamusHPG axis HPA axis HPT axisDiffuse Endocrine System This concept is to emphasize that clusters of cells that secrete hormones exist in some non-endocrine organs. All cells involved in this system produce amines or peptides, and they are called APUD cells. (amine precursor uptake and decarboxylation cell). Organs involved in this system include heart, kidney, gastrointestina