Introduction To Endocrinology For Clinical Students

INTRODUCTION TO ENDOCRINOLOGY FOR CLINICAL STUDENTS
2007
OUTLINE
Definition of endocrinology Chemical messengers Structure of the endocrine system Structure of the endocrine system : endocrine organs Hormones: operands of the endocrine system Communication in the endocrine system Functions of the endocrine system Some endocrine concepts and principles Pathogenesis of endocrine disease or endocrinopathies Endocrine diagnosis or evaluation Principles of endocrine treatment
The Specialism or Subspecialty of Endocrinology Endocrinology Metabolism Diabetes mellitus Nutrition Biochemistry
DEFINITION
Endocrinology
Study of communication Control within living organisms Chemical messengers
synthesized in whole or in part by the organism
METABOLISM
Part of the science and practice of endocrinology Study of the biochemical control of mechanisms IN living organisms Includes Gene expression, biosynthetic pathways and their enzymatic catalysis The modification, transformation and degradation of biological substances The biochemical mediation of the actions and interactions of substances The means for obtaining, storing and mobilizing energy
SYSTEM OPERANDS
CHEMICAL MESSENGERS: 1st Or 2nd Messengers Hormones Mediate intracellular and intercellular communications
Structure of ES
ENDOCRINE ORGANS Non-organic continuity cf CVS or NS Components Most organs or tissues possess
Diffuse ES: skin, GIT, ND Discrete ES: Ant Pituitary, Thyroid etc
endocrine function
Cf Heart, Kidney, Fat cells
HORMONES
HORMONES: Operands of the ES Classes Of Hormones Amino acids and Derivatives Tryptophan serotonin and melatonin Tyrosine Dopamine, NA, Adr, T3, T4 L-glutamic acid GABA Histidine Histamine
CLASSES OF HORMONES Polypeptides (<150 amino acids) Proteins and Glycoproteins
GnRH, TRH, Somatostatin, PTH, Insulin, ACTH, Nerve Growth factors

FSH, LH, TSH, GH (Somatotrophin)
Steroids (Derived from cholesterol)
Fatty Acid Derivatives
Progesterone, androgens, oestrogens, corticosteroids, vitamin D and its metabolites Prostaglandins, leukotrienes, thromboxane
COMMUNICATION IN THE ENDOCRINE SYSTEM

COMMUNICATION IN THE ENDOCRINE SYSTEM
Autocrine: cell to self, self-regulation Paracrine: cell to its neighbour cell, direct or interstitial Lumocrine or Solinocrine: Gastrin, VIP, serotonin, secretion etc Neurocrine: specialized autocrine communication
Haemocrine: Traditional endocrine communication Multiple communication mechanisms
Synaptic or non-synaptic (neurosecretion)- ADH, Oxytocin
FUNCTIONS OF THE ES
FUNCTIONS OF THE ES: FOUR MAIN DOMAINS

Reproduction: Control of all phases of, sexual bebaviour etc Growth and Development For normal growth and development regulation Required limitation of growth Regulated by multiple hormone actions: somatomedin systemIGF Maintenance of Internal Melieu Regulation of all major homoeostatic systems Energy Production, Utilisation and Storage Insulin vs Counter-regulatory hormones
FUNCTIONS OF THE ES Collaborative Function:
Within the ES: One hormone, several functions One function, several hormones Extra ES Inter-system Collaboration and interaction Nervous system The immune system
SOME ENDOCRINE CONCEPTS AND PRINCIPLES

SOME ENDOCRINE CONCEPTS AND PRINCIPLES
Hormone synthesis:
transcription and translation Prohormones
Hormone Storage Hormone Release: role of calcium Hormone Transport:
Concept of free hormones Carrier proteins for bound hormones [H]x[P]/[HP] [H]x[P]/[HP] = K
AND PRINCIPLES
Mechanisms of Hormone Action
The Hormone Receptor Concept The Lock and Key Principle Plasma membrane vs Cytosolic receptors
Control of hormone secretion: Feedback Mechanisms: Negative FB classic example Positive feedback: classic example
PATHOGENSIS OF ENDOCRINE DISEASE OR ENDOCRINOPATHIES

Organ hypofunctionHormone under production Organ hyperfunction Hormone excess in circulation Structurally abnormal hormone : damaged key Resistance to hormonal action: lock problem Abnormal hormone transport Multiple mechanisms
ENDOCRINE DIAGNOSIS AND EVALUATION
ENDOCRINE DIAGNOSIS
Clinical Aspects
Clinical endocrine signs and symptoms* Anthropometric measurements* Charts: growth, pubertal staging. Tanner Visual tests: acuity and perimetry Psychometry Cervical Mucus assessment Orchidometry*
ENDOCRINE DIAGNOSIS 2:
Basal Hormone measurement Serial hormone determination Biorhythm determination Paired hormone measurements Transport protein evaluation Dynamic Tests Suppression or inhibition tests: Hypofunction? Stimulation or provocation tests: Hyperfunction?
Body Fluid Hormone Determination
DIAGNOSIS : Laboratory
Techniques:
Chemical techniques; spectrophotometry / colorimetry

Bioassays and receptor assays Immunoassays Principles of : Ag, Ab, Labels, Signal reader The History of RIA The history of EIA Cf of RIA vs ELISA
*Nobel Laureate
DIAGNOSIS : Microscopic
Diagnosis
Histology of tissues, biopsies Cytology

Vaginal cytology
*SFA: collection, transport, etc
Chromosomal Studies
Buccal smear for Barr Bodies : Xn-1 in interphase or non-dividing cell
Blood Smear: Karyotyping - culture lymphocytes, terminate in metaphase with colchicine Examples of abnormalities:
Monosomy X (45 X or X0): Turners 47XXY : Klinefelters syndrome Mosaics Drum sticks (x chromosomes) Barr bodies
EVALUATION:
Metabolic and Immunological tests:
EVALUATION
Target organ dependent Examples:Thyroid, & Endocrine pancreas Serological, lymphocytes Examples : in Thyroiditis
ENDOCRINE EVALUATION:
Imaging Studies
Photography:

Radiology, USS etc
family background, age of onset, dx progress etc Plain radiographs: Skull, hands, Contrast radiology Venous sampling CT scan Ultrasound MRI
Radionuclide Imaging
Thyroid, Adrenal
Isotopes: Technitium pertechnetate Iodine-123, iodine-131
Bones
Laparascopy
Amenorrhoea. Hirsutism. Intersex. Precocious puberty
PRINCIPLES OF ENDOCRINE TREATMENT

Confirm diagnosis Re-establish eumetabolism Hypofunction/ deficiency: replacement therapy Hyperfunction or hormone excess : suppression or extirpation Drugs, radiotherapy and/or surgery Monitor therapy Patient self management Long-term treatment , often life long Rewarding results

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INTRODUCTION TO ENDOCRINOLOGY FOR CLINICAL STUDENTS

Cf Heart, Kidney, Fat cells

CLASSES OF HORMONES Polypeptides (<150 amino acids) Proteins and Glycoproteins

GnRH, TRH, Somatostatin, PTH, Insulin, ACTH, Nerve Growth factors

Steroids (Derived from cholesterol)

Fatty Acid Derivatives

COMMUNICATION IN THE ENDOCRINE SYSTEM

Haemocrine: Traditional endocrine communication Multiple communication mechanisms

Synaptic or non-synaptic (neurosecretion)- ADH, Oxytocin

FUNCTIONS OF THE ES: FOUR MAIN DOMAINS

FUNCTIONS OF THE ES Collaborative Function:

SOME ENDOCRINE CONCEPTS AND PRINCIPLES

Hormone Storage Hormone Release: role of calcium Hormone Transport:

PATHOGENSIS OF ENDOCRINE DISEASE OR ENDOCRINOPATHIES

ENDOCRINE DIAGNOSIS AND EVALUATION

Body Fluid Hormone Determination

Chemical techniques; spectrophotometry / colorimetry

Histology of tissues, biopsies Cytology

*SFA: collection, transport, etc

Metabolic and Immunological tests:

Radiology, USS etc

Amenorrhoea. Hirsutism. Intersex. Precocious puberty

PRINCIPLES OF ENDOCRINE TREATMENT

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