Principle of Endocrine & Metabolic Diseases

Shan Zhongyan 单忠艳The Endocrionology Dep

artment

Contents

1. Endocrine system and Hormones

2. Diagnosis of Endocrine Diseases

3. Treatment of Endocrine Diseases

4. Progress

1. Endocrine system & Hormones

(1) Endocrine system & function

(2) Hormone & function

(3) Regulation of hormone

(4) Mechanism of hormone action

Endocrine system

Glands

+ Cells

Hormones

Hypothalamus Pituitary

CRH ACTH

TRH TSH

GnRH(LRH) FSH, LH

GHRH, GHRIH GH

PIF, PRIF PRL

ADH ADH

Endocrine System & Hormones

Hormones

Organ

Organ Hormone

Parathyroid PTH

Thyroid TH(T3,T4) , Cacitonine

Pancreas Insulin, Glucagon, SS

Adrenal gland Glucocorticoid, Aldosterone, Testosterone

Catecholamine

Ovary Estrogen, Progesterone

Testis Testosterone

Endocrine System & Hormones

Cells Hormone

APUD cells Peptide or

Catecholemine

Adipocytes Leptin

Endothelium cells Peptides

Endocrine Cells & Hormones

Hormone

Classification

① Peptides or Proteins: GH

② Amine: Catecholamines

③ Amino Acid Analogs: TH

④ Steroids: Cortisol, VitD

Hormone

Secretion

① Endocrine:

② Paracrine:

③ Autocrine:

④ Intracrine:

Hormone

Secretion Rhythms① Pulsatile or cyclic secretion: likes a wave

Insulin, PRL, TSH change from min. to hr. FSH, LH, E, and P change in wks T4 change in season

② Circadian variability ACTH and cortisol : 8am/4pm/midnight

③ Sleep-associated rhythms GH， Prolectin

Hormone

Regulation

① Endocrine and Nervous system

② Endocrine and Endocrine

③ Endocrine and Immune system

④ Endocrine and Metabolism

Hypothalamus-pituitary-target glands Feedback Regulation

Nerve impulse & Cytokines

Advanced never center

Hypothalamus

Pituitary

Target Glands

TRH

TH

Hypothalamus

Pituitary

Thyroid

TH Secretion Regulation

TSH

ACTH

CRH

Cortisol

Hypothalamus

Pituitary

Adrenal

Cortisol Secretion Regulation

FSH, LH

GnRH

E2, P

Hypothalamus

Pituitary

Gonads

Gonadal Hormone Secretion Regulation

One hormone, Multiple actions

One function, Multiple hormones

Interaction of Hormones

Self-review

Hormone

Other regulation system

Mechanism of action

Hormone receptors

2. Diagnosis of Endocrine Diseases

(1) Symptoms--- Fantastico

(2) Signs--- Inspection

(3) Lab Tests--- Function

(4) Causes or Localization

Symptoms & signs Diseases

Weight gain Hypothalamic syn. Cushing syn.

Hypothyroidism, Insulinoma

Weight loss Adrenal insufficiency, Hyperthyroidsm,

DM, Hypopituitarism, Pheochromocytoma

Short stature Idiopathic GH deficiency (Dwarfism),

Turner’s syn.

Tall stature Pituitary giganism, Sexual precocity

Symptoms & Signs

Symptoms & signs Diseases

Polyuria Diabetes insipidus, Diabetes mellitus,

Hypercalcemia, Hypokalemia

Hyperpigmentation Addison’s syn. Nelson’s syn.

Hypopigmentation Panhypopituitarism

Acne Androgen excess, PCOS, Cushing syn.

Striae Cushing syn.

Symptoms & Signs

Symptoms & signs Diseases

Decreased body hair Hypothyroidism, Hypopituitarism

Hirsutism Androgen excess states, Cushing syn.

Amenorrhea Adrenal insufficiency, Cushing syn. Hyperprolactinemic states, PCOS, Hypopituitarism, Ovarian failure

Galactorrhea Hyperprolactinemic states, Prolactinomas, Hypothyroidism

Symptoms & Signs

Symptoms & signs Diseases

Proptosis Graves’ disease, Obital tumor

Hypokalemia Primary aldosteronism,

Paralysis Renin-secreting tumors Cushing syn.

Acanthosis nigricans Obesity, PCOS, Acromegaly,

Severe insulin resistance, Cushing syn.

Bone pain Osteoporosis, Hypercalcemia, Hyperparathyroidism

Symptoms & Signs

The level of hormone: TH, GH, Insulin

The effect of hormones: BG, Ca

Basal condition or to some provocative stimulus

Blood or urine samples

Laboratory Tests

Basal levels: FT3, FT4, TT3, TT4

Hormone’s rhythm: ACTH-Cortisol

Provocative (functional) tests

Stimulation test: on hypofunction disease

eg. TRH, ACTH, OGIRT

Suppression test:on hyperfunction disease.

eg. dexmethasone suppression test

on Cushing syndrome.

Laboratory Tests

Localization & Cause Diagnosis

Localization

Imaging studies: MRI , CT, ECT, B ultrasound

Cause diagnosis

Immunoassay: IAA, ICA, GAD, TPOAb, TgAb

Genetic analysis: DNA analysis

Biopsy procedures: Fine-needle biopsy

3. Treatment of Endocrine Diseases

(1) To causes

(2) To Excess of hormone

(3) To Deficiency of hormone

(4) To resistance to hormone

Cause of Endocrine Hyperfunction

① Tumor: ACTH-producing tumor

② Hyperplasia: Adrenal hyperplasia

③ Autoimmune stimulation: GD

④ Ectopic endocrine syndrome

⑤ Drugs

Cause of Endocrine Hypofunction

① Destruction of the gland

Autoimmune disease Schmidt’s syn.(hypothyridism, Addison) Neoplasms, infection or hemorrhage.

② Extraglandular disorders

③ Congenital defects in hormone biosynthesis

④ Receptor Deficiency

⑤ Drugs

Defects in Sensitivity to Hormone

① Type 2 diabetes mellitus

② Pseudohypoparathyroidism

③ Some hypothyroidism

④ Nephrogenic diabetes insipidus

⑤ Rickets (vitamin D insensitivity)

Treatment to Hyperfunction

① Remove tumors

② Pharmacology block hormone production

③ Control sequelae of hyperfunction

④ Immunotherapy

⑤ Radiothyrapy

Treatment to Hypofunction

① Replacement with hormone in a physiologic

manner: insulin

① Replacement with hormone mimics: Vitamin D

② Replacement with cations: Ca, P

③ Immunotherapy

④ Transplantation

Hypothalamus Pituitary Target Diseases

CRH ↑ ACTH↑ CS↓

↑ ↑ ↑

↓ ↓ ↑

TSH ↓ TH↑

↑ ↓

Changes of Hormone

Hypothalamus Pituitary Target Diseases

CRH ↑ ACTH↑ CS↓ Addison’s Disease

↑ ↑ ↑ Cushing’s Disease

↓ ↓ ↑ Adrenal hyperfunction

TSH ↓ TH↑ Hyperthyroidism

↑ ↓ Hypothyroidism

Changes of Hormone

The End