内科学 内分泌总论-高鑫

1、高 鑫 Gao Xin Department of EndocrinologyZhongshan Hospital,Fudan UniversityGao.xinzs-Principles of Endocrinology1Three stages of endocrinology development内分泌学发展三阶段腺体内分泌学 Organic Endocrinology组织内分泌学 Histological Endocrinology分子内分泌学 Moleculer Endocrinology2Principles of Endocrinology Basic of endocrino

2、logy_ Structure and function of Endocrinology System1. Endocrine glands and cells 2. Hormone secretion cell 3. Definition of hormone: classificationSynthesis and Elimination Diurnalrhythms Variation 4.Correlation with neural and immune system 5. Regulation of endocrine systems Axis ragulation Regula

3、tion between hormones 6. Mechanisms of Hormone Action Hormones with Cell Surface Receptors:4 types Hormones with Intracellular ReceptorsDownstream Signaling Pathways7. Nutriment metabolism Clinical endocrinology Characteristic of endocrine systems: Principles of Diagnosis :Function, Localization, Pa

4、thological diagnosis Principles of prevention and treatment 3Principles of Endocrinology一、内分泌学基础-内分泌系统结构与功能一、内分泌腺和激素分泌细胞 二、激素分泌细胞的结构特点三、激素定义：分类激素的合成与贮存 激素分泌方式激素转运 激素降解与转换激素的分泌节律 血浆激素组分的不均一性 激素合成与分泌的调节途径激素与神经系统及免疫系统的相互联系 四、内分泌调节轴与调节系统 内分泌调节轴 激素间的相互调节与影响 五、激素作用机制主要作用于核转录因子的激素 主要与靶细胞表面受体结合的激素 ：激素-膜受体相互

5、作用 ；膜受体结构： 一般将膜受体分为四类激素信号的受体后转导通路 六、营养素代谢 二、临床内分泌 内分泌系统疾病特点： 诊断原则：诊断包括功能诊断、定位诊断诊断和病因诊断（解剖诊断） 治疗原则治原则：4Principles of Endocrinology Basic of endocrinology_ Structure and function of Endocrinology System1. Endocrine glands and cells 2. Hormone secretion cell 3. Definition of hormone: classificationSynt

6、hesis and Elimination Diurnalrhythms Variation 4.Correlation with neural and immune system 5. Regulation of endocrine systems Axis ragulation Regulation between hormones 6. Mechanisms of Hormone Action Hormones with Cell Surface Receptors:4 types Hormones with Intracellular ReceptorsDownstream Signa

7、ling Pathways7. Nutriment metabolism Clinical endocrinology Characteristic of endocrine systems: Principles of Diagnosis :Function, Localization, Pathological diagnosis Principles of prevention and treatment 5Endocrine SystemEndocrine glandsHormones and their regulation systemMetabolic Process代谢过程Or

8、gans Function器官功能Growth and development生长发育Reproductionand aging生殖衰老 Diffused nerve and endocrine Cells in other tissueNervous System 6Endocrine SystemEndocrine glandsHormones and their regulation systemMetabolic Process代谢过程Organs Function器官功能Growth and development生长发育Reproductionand aging生殖衰老 Diffu

9、sed nerve and endocrine Cells in other tissueNervous System 7Principles of EndocrinologyEndocrine glands8Endocrine SystemEndocrine glandsHormones and their regulation systemMetabolic Process代谢过程Organs Function器官功能Growth and development生长发育Reproductionand aging生殖衰老 Diffused nerve and endocrine Cells

10、in other tissueNervous System 9 Diffused nerve and endocrine Cells in other tissuePrinciples of Endocrinology10Principles of EndocrinologyBasic of Endocrinology is the study of: (1) hormones (2) their receptors (3) and the intracellular signalling pathwaysClinical endocrinology is the study of endoc

11、rine diseases (1) hormone overproduction; (2) hormone underproduction; (3) altered tissue responses to hormones; (4) tumors of endocrine glands. 11Principles of EndocrinologyDefinition of hormoneHormones are chemical messengers secreted into blood or extracellular fluid by one cell that affect the f

12、unctioning of other cells. What exactly are hormones? 121314Principles of Endocrinology15Principles of Endocrinology16Principles of Endocrinology17Principles of EndocrinologyHormones classificationMost commonly, hormones are categorized into four structural groups: Peptides and proteins : ACTH,LH, F

13、SH, PHT, TSH, Insulin ,Glucagon, IGFs Steroids : cortisone, aldosterone, 1,25(OH)2 D3 , androgen, estrogen Amino acid derivatives: catecholamine , noradrenalin,adrenalin Fatty acid derivatives: prostaglandings, Retinol18Regulation of endocrine systems19Regulation of endocrine systems2021Anterior Pit

14、uitary Hormones22Mechanisms of Hormones Action and intracellular signalling pathways 与膜受体结合 G蛋白偶联 发挥生物效应 （肽类激素、生物胺、前列腺素） 与膜受体结合 受体自身磷酸化 发挥生物学效应 （酪氨酸激酶） （生长因子家族、Insulin , IGFs)与核受体结合 与DNA特异序列结合 功能蛋白转录 （甾体类激素）23Mechanisms of Hormones Action and intracellular signalling pathways24G-protein coupled 7 me

15、mbrane spanning receptor25G-protein coupled 7 membrane spanning receptor26Mechanisms of Insulin Action and intracellular signalling pathways27Mechanisms of Nuclear Receptor Action2829Three stages of endocrinology development内分泌学发展三阶段腺体内分泌学 Organic Endocrinology组织内分泌学 Histological Endocrinology分子内分泌学

16、 Moleculer Endocrinology30Principles of EndocrinologyTed Ryder-one of the first patients of type 1 diabetes treated by insulin in 192231Principles of EndocrinologyJ.J.R. Macleod (1876-1935)Frederick G.Banting(1891-1941)James B.Collip(1892-1965)Charles H Best(1899-1978)The Nobel prize in 1923 to Bant

17、ing FG for his contribution to discovery of insulin32Coris: 发现了磷酸化酶的可逆磷酸化 （无活性的磷酸化酶b/有活性的磷酸化酶a之间的互变） 获得1951年诺贝尔奖。Sutherland: 成功分离和确定的腺苷酸环化酶和磷酸二酯酶 （cAMP合成与分解的两个关键酶） 提出了激素作用的第二信使学说 获得1971年诺贝尔生理医学奖。Krebs & Fisher: 于60年代末发现蛋白激酶A(PKA) （依赖cAMP , 刺激多种底物蛋白磷酸化) 阐明了PKA启动的磷酸化和去磷酸化途径。 获得1992年诺贝尔生理医学奖。 Mechanism

18、s of Hormones Action and intracellular signalling pathways33Principles of Endocrinology Basic of endocrinology_ Structure and function of Endocrinology System1. Endocrine glands and cells 2. Hormone secretion cell 3. Definition of hormone: classificationSynthesis and Elimination Diurnalrhythms Varia

19、tion 4.Correlation with neural and immune system 5. Regulation of endocrine systems Axis ragulation Regulation between hormones 6. Mechanisms of Hormone Action Hormones with Cell Surface Receptors:4 types Hormones with Intracellular ReceptorsDownstream Signaling Pathways7. Nutriment metabolism Clini

20、cal endocrinology Characteristic of endocrine diseases: Principles of Diagnosis :Function, Localization, Pathological diagnosis Principles of prevention and treatment Expectation34 Characteristics of endocrine Diseases Principles of Diagnosis : Function, Localization, Pathological diagnosis Principl

21、es of prevention and treatment Clinical endocrinology35 Characteristics of endocrine Diseases Principles of Diagnosis : Function, Localization, Pathological diagnosis Principles of prevention and treatment Clinical endocrinology36Classification of endocrin diseases按病变器官分类按功能分类：亢进、减退、正常；按病变部位分类：原发性、继

22、发性、三发性激素分泌缺陷受体基因缺陷-激素抵抗37Acromegaly肢端肥大症 Dwarfism侏儒症Characteristics of endocrine diseases38Hyperthyroidism Graves DiaeaseHyperthyroidism Graves DiaeaseCharacteristics of endocrine diseases39Characteristics of endocrine diseases40“Pear” obesity“Apple obesity”Fat distrophyCharacteristics of endocrine diseases41 Characteristics of endocrine Diseases Principles of Diagnosis : Function, Localization, Pathological diagnosis Principles of prevention and treatment Clinical endocrinology42内分泌疾病的诊断原则三大原则： 功能诊断 定位诊断 病因/病理诊断43功能诊断症状、体征实验室资料：代谢紊乱的证据；