内分泌总论动画全保留获奖作品上传课件.ppt

www.drsun.haoDF.com,EndocrineandMetabolicDiseases,Contents,2,内分泌系统疾病总论THEPRINCIPLESOFENDOCRINOLOGY,郑州大学一附院内分泌科孙良阁,www.drsun.haoDF.com,www.drsun.haoDF.com,人体三大调节系统Threesystemsofextracellularcommunicationcontrolallphysiologicprocesses,神经系统Nervoussystem,内分泌系统Endocrinesystem,免疫系统Immunesystem,www.drsun.haoDF.com,Contents,A、Basicconcepts(Review)B、TheClassificationofEndocrinediseasesC、ThediagnosticroutineofEndocrinediseasesD、ThemanagementsofEndocrinediseases,基本概念,www.drsun.haoDF.com,A、Basicconcepts,Endocrinesystem(内分泌系统),Function(内分泌系统的功能),Hormone(激素),Regulationandaccommodation(内分泌系统活动调节),返回,www.drsun.haoDF.com,A、Basicconcepts,Endocrinesystem(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulationandaccommodation(内分泌系统活动调节),返回,www.drsun.haoDF.com,Endocrinesystem,Endocrinesystem,Endocrineglands,Endocrinetissuesandcells,Bodyfluidregulatedsystem,StartlingEH:19021905,Lancet1905;2:339341神经与内分泌独立控制胰腺分泌及胃肠功能；Hormone=hormon(压力、逼迫)、hormao(运动),Penole:Endocrine=Endo(内部)+Krine(分泌),内分泌系统,内分泌腺,内分泌组织/细胞,体液调节系统,www.drsun.haoDF.com,Endocrineglands,垂体甲状腺甲状旁腺肾上腺（髓质、皮质）.性腺,胰岛胸腺,www.drsun.haoDF.com,EndocrineTissues/Cells,www.drsun.haoDF.com,Traditional(Classical)Endocrinology,www.drsun.haoDF.com,ModernEndocrinology,Targetcell,Endocrinecell,内分泌,邻分泌,自分泌,Endocrine,Paracrine,Autocrine,Intracrine,www.drsun.haoDF.com,几乎所有细胞均是内分泌细胞!,返回,AreTheyEndocrineCells?,Fatcell,EndothelialCell,www.drsun.haoDF.com,A、Basicconcepts,Endocrinesystem(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulationandaccommodation(内分泌系统活动调节),返回,www.drsun.haoDF.com,在神经系统的控制及物质代谢的反馈调节下分泌激素，从而调节人体的多种代谢过程、生理功能及生命过程，维持内环境的稳定，以适应人体内外的各种变化,代谢过程：糖、脂、蛋白、能量代谢、水电解质平衡、维生素代谢等,生理功能：各系统器官的功能,生命过程：生长发育，生、老、病、死,www.drsun.haoDF.com,Hormones,Metabolism:carbohydrate,lipid,Protein,energy,Electrolyte,etc.代谢,Reproduction,GrowthandDevelopment,etc.生命过程,Physiology:Respiratory,Circulatory,Digestive,Hematogenic,Etc.生理,MaintenanceofinternalEnvironment内环境稳定,www.drsun.haoDF.com,A、Basicconcepts,Endocrinesystem(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulationandaccommodation(内分泌系统活动调节),返回,www.drsun.haoDF.com,激素(Hormone),Hormone,agroupofchemicalmessengersmanufacturedbyendocrineglands,regulatethefunctionofallvitalorgans.,定义：由内分泌细胞合成、分泌及释放入血的生物活性物质(chemicalmessengers)。内分泌(Endocrine):活性物质分泌入血作用于靶细胞旁分泌或邻分泌(Paracrine)：活性物质经细胞外液或邻近传递的影响靶细胞功能自分泌(Autocrine)：内分泌细胞分泌的物质可直接作用于细胞本身功能胞内分泌(Intracrine):在细胞浆合成的激素直接作用于细胞核影响细胞基因的表达,www.drsun.haoDF.com,www.drsun.haoDF.com,激素分类（1）按化学结构分类Categoriesofchemicalstructure,肽类激素(Peptidesandproteins)：下丘脑激素、垂体激素、甲状旁腺激素、胰岛激素(Insulin,Glucogan)等氨基酸激素(aminoacids)：甲状腺激素(iodothyronines:三碘甲腺原氨酸T3，四碘甲腺原氨酸甲状腺素T4)胺类激素(amine)：肾上腺素、去甲肾上腺素、多巴胺，5-羟色胺等类固醇激素(steroidderivatives)：肾上腺皮质激素、性腺激素,VitD类,www.drsun.haoDF.com,（2）按作用分子机制分类,亲水性激素：由多肽类（含氮）激素所组成主要通过与靶细胞上受体结合而发挥生物学作用亲脂类激素：包括类固醇激素（肾上腺皮质激素、性激素、活性VitD)和氨基酸衍生物(甲状腺激素）分子量小，可通过双脂层细胞膜和核膜进入细胞内和核内，与细胞内或核内受体结合，影响及调控靶基因转录,www.drsun.haoDF.com,Synthesis-Release-Transport-Receptors-Secondarymessengers-Physiologicaleffect,激素作用机制MechanismsofHormoneaction,PMRCPR,激素合成、运输受体结合、第二信使、生物活性,www.drsun.haoDF.com,细胞膜受体,www.drsun.haoDF.com,www.drsun.haoDF.com,www.drsun.haoDF.com,细胞核受体,www.drsun.haoDF.com,激素的特点,作用于特异性受体,以ug,ng,fg,pg计量,协同作用(synergisticaction)拮抗作用(antagonisticaction)允许作用(permissibleaction),MS,S,MIN,H,Day,是生理调节物质,作用的特异性,不产生新功能，使原有的功能增强或减弱,血液浓度很低，活性很大,分泌呈节律性,激素之间相互作用,不同激素作用时限不同,激素的分泌及灭活呈动态平衡,www.drsun.haoDF.com,皮质醇的节律性分泌,www.drsun.haoDF.com,性激素的节律性分泌,www.drsun.haoDF.com,A、Basicconcepts,Endocrinesystem(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulationandaccommodation(内分泌系统活动调节),返回,www.drsun.haoDF.com,内分泌系统活动的调节,1、神经系统与内分泌系统的调节2、内分泌系统的反馈调节3、免疫系统与内分泌系统的调节,www.drsun.haoDF.com,1、Nervousendocrineregulation神经-内分泌系统的调节,Targetgland,CNS,Hypothalamus,Pituitary,Targetorgan/cell,Physicalactionsandmetibolism,www.drsun.haoDF.com,神经介质对内分泌的调节作用,去甲肾上腺素多种内分泌过程多巴胺调节GH、PRL分泌5-HT调节ACTH-肾上腺皮质乙酰胆碱多种内分泌功能组胺促进儿茶酚胺的释放-氨基丁酸，调整多项内分泌功能，保持大脑清醒状态,www.drsun.haoDF.com,www.drsun.haoDF.com,www.drsun.haoDF.com,2、Feedbacksystem(内分泌系统的反馈调节),下丘脑垂体靶腺轴调节下丘脑垂体靶器官轴激素相互之间的调节代谢产物与激素之间代谢产物之间的调节,www.drsun.haoDF.com,Hypothalamus-pituitary-targetglands(下丘脑垂体靶腺轴),包括三条轴线：下丘脑垂体甲状腺轴（TRHTSHT3、T4）下丘脑垂体肾上腺皮质轴（CRHACTHCortisol）下丘脑垂体性腺轴LRHFSH、LHT（M）；E，P（F）,www.drsun.haoDF.com,Feed-backregulations,（1）负反馈调节（Negative),TRH-TSH-T3+T4,CRH-ACTH-COrtisol,www.drsun.haoDF.com,（2）负、正反馈调节（Negative+Positivefeed-backregulation）,www.drsun.haoDF.com,下丘脑垂体靶器官(hypothalamus-pituitary-targetorgans),GRH、GIH-GH-Somatomedin(生长介素)-Epiphysis(骨骺)-Growth(生长)PIH-PRL-Breast(乳房)-Develop(发育),www.drsun.haoDF.com,Feed-backHormoneMetabolicproduction,insulin,www.drsun.haoDF.com,Feed-backHormoneMetabolicproduction,血钙/磷,CT,PTH,www.drsun.haoDF.com,3、Endocrineandimmuneregulation内分泌与免疫系统的调节,Endocrinesystem,Nervoussystem,Immunesystem,神经介质肽类激素抗体共同受体,www.drsun.haoDF.com,Contents,A、Basicconcepts(Review)B、TheClassificationofEndocrinediseasesC、ThediagnosticroutineofEndocrinediseasesD、ThemagementsofEndocrinediseases,返回,内分泌疾病的分类,www.drsun.haoDF.com,B、TheCategoriesofEndocrinediseases,Endocrinedisorders,Hormonedeficiency,Hormoneoverproduction,Productionofabnormalhormone,Disordersofhormonereceptors,Abnormalofhormonetransportormetabolism,Multiplehormoneabnormalities,Tumorsthatproducehormones,www.drsun.haoDF.com,内分泌功能减退症内分泌功能亢进症激素变异症（激素分子病）激素受体病变激素代谢转化异常多激素异常综合症伴瘤（癌）综合症,B、TheCategoriesofEndocrinediseases,www.drsun.haoDF.com,Hormonedeficiencysyndromes,PrimarydeficiencyHypofunctionofEndocrineGlands,E.g.:PrimaryHypothyroidism,T3,T4Hypo-,TSHHyper-,SecondarydeficiencyHypofunctionsecondarytohypothalamusandpituitary,E.g.:SeconaryHypothyroidsium,T3,T4Hypo-,TSHHypo-,www.drsun.haoDF.com,Hormoneexcesssyndrome,PrimaryoverproductionHyperfunctionofendocrineglands,SecondaryoverproductionHyperfuntionsecondarytohypothala-musandpituitary,E.g.:PrimaryHyperthyroidism,T3,T4Hyper-,TSHHypo-,E.g.:SeconaryHyperthyroidsium,T3,T4Hyper-,TSHHyper-,www.drsun.haoDF.com,B、TheClassificationofEndocrinediseases,功能亢进根据病理功能功能减退原发性根据发生部位受体反应性异常异源性、医源性功能异常,功能正常,继发性,www.drsun.haoDF.com,功能减退的分类,原发性减退：内分泌腺本身功能减退所致：如原发性甲减,T3，T4,TSH,继发性减退：下丘脑或垂体功能减退所致的靶腺功能减退：如继发性甲减,TSH,T3、T4,www.drsun.haoDF.com,功能减退的病因,内分泌腺体破坏内分泌激素合成缺陷内分泌腺以外的疾病(激素进一步活化受损),www.drsun.haoDF.com,激素敏感性缺陷,激素抵抗症：受体或受体后缺陷，功能减退激素过敏感症：功能亢进,www.drsun.haoDF.com,功能亢进的分类,原发亢进：由于腺体本身功能亢进所致的异常；如原发性甲亢,T3，T4,TSH,继发亢进：由于下丘脑或垂体功能亢进所致的靶腺功能亢进。如继发性甲亢,TSH,T3、T4,原发亢进：由于腺体本身功能亢进所致的异常；如原发性甲亢,www.drsun.haoDF.com,功能亢进原因,内分泌腺肿瘤及垂体肿瘤多发性内分泌腺瘤异源性内分泌综合症(ecotopicHormoneProductionbytumors)灭活功能减弱医源性,www.drsun.haoDF.com,Contents,A、Basicconcepts(Review)B、TheClassificationofEndocrinediseasesC、ThediagnosticroutineofEndocrinediseasesD、ThemagementsofEndocrinediseases,返回,内分泌疾病的诊断,www.drsun.haoDF.com,C、ThediagnosticroutineofEndocrinediseases,一、功能诊断（functionaldiagnosis),二、病理诊断（pathologicaldiagnosis),三、病因诊断(Etiologicaldiagnosis),返回,www.drsun.haoDF.com,一、功能诊断(functionaldiagnosis)1、病史、症状、体征：体型、生活规律变化2、代谢紊乱的证据：各种生化指标3、激素及其代谢物的浓度4、动态功能测定：兴奋试验，抑制试验,C、ThediagnosticroutineofEndocrinediseases(1),返回,www.drsun.haoDF.com,www.drsun.haoDF.com,www.drsun.haoDF.com,www.drsun.haoDF.com,www.drsun.haoDF.com,www.drsun.haoDF.com,河南名星,www.drsun.haoDF.com,生化异常,血钾异常血钙、磷异常血、尿酸碱度异常血糖异常脂代谢异常,www.drsun.haoDF.com,C、ThediagnosticroutineofEndocrinediseases(2),二、病理诊断(pathphysiologicaldiagnosis)1、放射学检查：X线片、CT、MRI2、放射性核素检查3、超声波检查4、静脉导管检查5、细胞学检查6、组织活检,返回,www.drsun.haoDF.com,www.drsun.haoDF.com,131I-MIBG,www.drsun.haoDF.com,C、ThediagnosticroutineofEndocrinediseases(3),三、病因诊断(Etiologicaldiagnosis)1、自身抗体检查2、染色体检查3、HLA鉴定4、某些特异物质的测定,返回,www.drsun.haoDF.com,www.drsun.haoDF.com,Downssyndrome,www.drsun.haoDF.com,Klinfelterssyndrome,www.drsun.