生殖内分泌学【-】课件

生殖內分泌學蔡永杰醫師財團法人奇美醫院生殖醫學中心生殖內分泌學蔡永杰醫師1內分泌學概論外分泌腺(有管腺)汗腺、乳腺、唾液腺。內分泌腺(無管腺)下視丘、腦下腺、甲狀腺、副甲狀腺、腎上腺、性腺、松果腺、胰臟、胸腺。內分泌學概論外分泌腺(有管腺)2人體的內分泌腺人體的內分泌腺3分泌的種類分泌的種類4分泌的種類Autocrine:amodeofhormoneactioninwhichahormonebindstoreceptorsonandaffectsthefunctionofthecelltypethatproducedit.Paracrine:atypeofhormonefunctioninwhichhormonesynthesizedinandreleasedfromendocrinecells

bindstoitsreceptorinnearbycellsofadifferenttypeandaffectstheirfunction.Endocrine:appliedtoorgansandstructuresthatreleasetheirproductsintothebloodorlymph,andtosubstances(hormones)thatexertspecificeffectsonotherorgans.分泌的種類Autocrine:amodeofhormo5荷爾蒙的種類固醇類(steroid)三個六碳環與一個五碳環Cortisol,testosterone,progesterone,estrogenPolypeptides&醣蛋白類(glycoprotein)Polypeptides：ADH,insulin,oxytocinglycoprotein：TSHAminesEpinephrine,norepinephrine,T3,T4荷爾蒙的種類固醇類(steroid)6荷爾蒙的種類荷爾蒙的種類7Endocrine的作用機轉ReceptorvsTargetcellEndocrine的作用機轉ReceptorvsTar8Endocrine的作用機轉固醇類激素

脂溶性Receptor在細胞質內Estrogen-receptorcomplexEstrogen-receptorcomplex/DNADNA→RNARNA→ProteinProtein→reactionPolypeptides激素水溶性Receptor在細胞核內T4→T3→T3-bindingproteinT3/DNADNA→RNARNA→ProteinProtein→reactionEndocrine的作用機轉固醇類激素Polypepti9Endocrine的作用機轉Endocrine的作用機轉10Endocrine的作用機轉Endocrine的作用機轉11Endocrine的作用機轉Amines類激素

水溶性Receptor在細胞膜內Primarymessenger→secondarymessengercAMP(環單磷酸腺甘酸)cGMP(環單磷酸鳥甘酸)CalciumIP3(肌醇三磷酸)DAG(二乙硫甘油脂)secondarymessenger→ProteinkinaseAProteinkinaseA→reactionEndocrine的作用機轉Amines類激素12Endocrine的作用機轉Endocrine的作用機轉13Endocrine的作用機轉cAMP(環單磷酸腺甘酸)H+R→ATPcAMP→activatedPKAcGMP(環單磷酸鳥甘酸)H+R→GTPcGMP→activatedPKACalciumH+R→calciumchannelopen→Ca+++calmodulin(調鈣蛋白)IP3(肌醇三磷酸)H+R→G-protein→phospholipaseC(PLC)→PIP2IP3+DAGDAG(二乙硫甘油脂)Endocrine的作用機轉cAMP(環單磷酸腺甘酸)14Endocrine的回饋控制負回饋作用(大部份)GnRH→FSH,LHTRH→TSHCRH→ACTHSS→GH正回饋作用(少部份)OxytocinEndocrine的回饋控制負回饋作用(大部份)15生殖内分泌学【-】课件16生殖内分泌学【-】课件17下視丘與腦下垂體下視丘與腦下垂體18下視丘位於大腦正中底部、腦下腺上方、緊臨視丘區的下方圍繞第三腦室。可分泌調節激素經由門脈系統進入腦下腺。下視丘位於大腦正中底部、腦下腺上方、緊臨視丘區的下方圍繞第三19生殖内分泌学【-】课件20下視丘

GnRH(性腺刺激素釋放激素)→FSH,LHTRH(甲狀腺刺激素釋放激素)→TSHCRH(腎上腺皮質素刺激素釋放激素)→ACTHGHRH(生長激素刺激素釋放激素)→GHPRH(泌乳刺激素釋放激素)PIH泌乳刺激素抑制激素)MRF(黑色素刺激素釋放因子)MIF(黑色素刺激素抑制因子)下視丘

GnRH(性腺刺激素釋放激素)→FSH,LH21GnRHGnRH的神經元位於中底下視丘(MBH)的弓狀神經核與前下視丘的視神經前區GnRHGnRH的神經元位於中底下視丘(MBH)的弓狀神經核22GnRHGnRHisasmallpeptidewith10aminoacidswithsomevariationintheaminoacidsequenceamongvariousmammals.GnRHGnRHisasmallpeptidewi23生殖内分泌学【-】课件24GnRH半生期2-4分鐘膜動式分泌濾泡前期90分鐘濾泡後期60分鐘黃體前期100分鐘黃體後期200分鐘GnRH半生期2-4分鐘25下視丘-腦下腺-卵巢

Thehypothalamus-pituitary-ovarian(H-P-O)axis下視丘-腦下腺-卵巢

Thehypothalamus-26生殖内分泌学【-】课件27生殖内分泌学【-】课件28下視丘與腦下垂體

解剖與功能上的相關性下視丘與腦下垂體

解剖與功能上的相關性29腦下腺腦下腺又稱腦下垂體約1.3公分位於蝶鞍內。以腦下垂體柄(漏斗)與下視丘相連。分三部份前葉75%(腦下腺腺體部)、來自為外胚層。中間部、可分泌黑色素細胞刺激素後葉25%(腦下腺神經部neurohypophysis),含有下視丘的神經軸突末端腦下腺腦下腺又稱腦下垂體約1.3公分位於蝶鞍內。以腦下垂體柄30生殖内分泌学【-】课件31腦下腺腦下腺前葉的細胞嗜酸性細胞GH、PRL嗜鹼性細胞TSH、FSH、LH無顆粒性細胞ACTH腦下腺腦下腺前葉的細胞32濾泡刺激素

(follicle-stimulatinghormone；FSH)和黃體生成素合稱性腺刺激素♂：刺激睪丸製造精子與支持細胞分泌抑制素♀：刺激濾泡的發育與動情素的分泌濾泡刺激素

(follicle-stimulatingh33FSH/LH在男性的作用FSH/LH在男性的作用34FSH/LH在女性的作用FSH/LH在女性的作用35黃體刺激素

(Luteinizinghormone；LH)和濾泡刺激素合稱性腺刺激素♀：刺激卵巢的排卵作用、刺激黃體的生成並分泌黃體激素。♂：刺激睪丸的間質細胞生成與分泌睪固酮(testosterone)。黃體刺激素

(Luteinizinghormone；LH36泌乳激素(Prolactin)加強黃體生成素的作用。促進乳腺的發育與分泌乳汁。平常:濃度低排卵後：濃度上升月經時：濃度下降剛生產後：濃度下降哺乳時：濃度上升泌乳激素(Prolactin)加強黃體生成素的作用。37催產激素(Oxytocin)刺激子宮平滑肌的收縮促進乳腺管平滑肌上皮的收縮將乳汁排出催產激素(Oxytocin)刺激子宮平滑肌的收縮38催產激素(Oxytocin)的作用催產激素(Oxytocin)的作用39RBl5ZJtd)RBl5ZJtd)QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YIrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Oxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFp8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg0TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Lue-SCm6#Kue-VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SCl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SCl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SCl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SCl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SCl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YIrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SCl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YIrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SCm5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)QAk4YIsc(QAk4YIsc(QDn7!Lvf+TDn7!Lvf+TDn7#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtc(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-SBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJtc(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4YHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mwf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn7#Kue-SCm6#Kue-VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1UEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mvf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn6#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJsc(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGq9%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1UEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mvf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn6#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJsc(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pyi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGq9%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1UEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Mvf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDn6#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue-RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZJsc(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAk4XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Pyi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGq9%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh1UEo8$MAj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WFp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDm6#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZIsc(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb&Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDm6#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5ZIsc(QAk4YIsc(QAk4YIsc(QAk4YIsc(QAj3XHrb*Pzj3XHrb*Pzj3XHrb*Pzj3XHrb*Oyi2WGqa&Oyi2WGqa&Oyi2WGqa&Oyi2WGp9%Nxh1VFp9%Nxh1VFp9%Nxh1VFp9%Nxh0UEo8$Mwg0UEo8$Mwg0UEo8$Mwg0UEo8$Lvf+TDn7!Lvf+TDn7!Lvf+TDn7!Lvf+TDm6#Kue-SCm6#Kue-SCm6#Kue-SCm6#Kue)RBl5ZJtd)RBl5ZJtd)RBl5ZJtd)RBl5Z