In the name of God

هورمون ها اهداف آموزشی هورمونها تعریف هورمون 2- ساختمان ، بافت مترشح و بافت هدف را یاد بگبرد 3-نحوه انتقال هورمونها را بداند 4-متابولیسم -5ختلال ناشی از افزایش و کاهش ترشح هر کدام از هورمونها را بداند. 8-تستهای ازمایشگاهی هورمون ها هورمونهای پپتیدی هومونهای استروییدی هومونهای مشتق از اسید آمینه

Hypothalamuses-pituitary axis Hypothalamose -pituitary stalk ADH, OX Pituitary hormones

Posterior Pituitary (neurohypophysis) Cell bodies in SON (ADH) & PVN (Oxytocin) of hypothalamus Consists of neural endings with associated blood vessels Acts as storage area, secretory granules travel down axon Connects to hypothalamus via hypothalamic-hypophyseal tract Processes extend through infundibulum and end in Post. Pit

Primary positive signal Fig. 4-10A Page 117

Pituitary hormones hypothalamus-Pituitary axis . Prolactin GH Prolaction Structure function .

Regulation of prolactin

Laboratory tests Variation secretion TRH stimulate production Normal level in women (up to 20ng/ml/12ng/ml Prolactin Excess In women:Milk production(galactorrhea), amenorrhes) In Men:Infertility, and impotence,Rarely breast enlargment(Gynecomastia) >200ng/ml: Pituitary tumores 100-200ng/ml: tumors 20-100: diurnal variation,medications,stress,…

Prolactin levels

Growth hormones Structure Function -Indirect -Direct

Regulation

Prolactin levels Marked diurnal Variation

Laboratory data GH Levels (single mea. Unless 1 h sleep) RESPONSE TO Physiologic and pharmacologic changesS STIMULATORS:Exersise,Insulu Hypogly.GHRH(1mg/kg,clonidine(4mg/kg),l-dopa(0.5g)argenine(0.5g/kg) IGF-I and binding proteins IGF-1 best marker),<5 year very low Inhibition:liver disease,acute illoness,malnutreitient

Laboratory evaluation GH over production Pituitary tumore (gigantism,acromegaly) Other effects:thickening, In.sweating,oilness of skin,hypertention,joint paint,hyperglecia GH deficiency

Sampling Transfering Blood increase Blood decrease

Evolution of Adrenal function Introduction Hypothalamic-pituitary-glucocorticosteroid Axis Biosynthesis Glococorticoids Mineral corticoids Sex Hormones Regulations

Direct tests of the hypothalamic –pituitary –adrenal Axis Cortisol,ACTH(stress) Cortisol(not specific), Synthetic stroids,CBG change. (↓Liver disease, malnutrition, ↑Est, pregnancy.) Urine Free cortisol Plasma cortisol exceeds protein binding capacity, ref.(20-90µg/day) Corticosteroid intermediates Evaluation for suspected congenital adrenal hyperplasia or carcinoma(17-hydroxysteriods, ). Adrenal Androgen production DHEA_S (plasma, urine), Testesteron (gonads),Weak androgens(from gonads and adrenal(measured)

Dynamic tests of the hypothalamic-pituitary-adrenal Axis Dexamethasone suppression tests (DST) 1-Overnight DST(1 mg Dexa.). 2-Low doseDST(0.5 mg/6 h/2d) 3-high dose(2mg/6h/2d) Stimulatory stimulation 1- Cortrosyn stimulation(250 µg/0,30,60 min. after injection),7µg to 18-20 µg, normal,1µg physiological dose? 2-Metyrapone Test(inhibites last step in cortisol synthesis) 3-Insulin hypoglycemia(Insulin,0.05-0.1 u/kg) 4- corticotropin –releasing hor. stimulation

Abnormalities of Glu. production Suspected Cushing syndrome (excess Glu. Obesity, hypertention,virilization,hyperglycemia(hypokalemia and metabolic alkalosis may?) Diagnosis of Cushing syndrome UFC or Overnight DS Adrenal insufficiency Mineral cor. (dehydration, hyponatremia, hyperkalemia, non-anion gap metyabolic acidosis.) Glu. Deficeincy(weight loss, vometing, weakness) Primary insufficiency(addison disease). Pigmentation skin(POMC) Secondary adrenal insuficiency(pituitary). Neither min nor excess ACTH is present(Hyperglecimia) Diagnosing adrenal insufficiency Cortisol measument(18-20µg ruling out) Trea. Administration dexametasine, cotrosyn)

Congenital adrenal hyperplasia 21-hydroylase deficiency 11-hydroxylase deficiency

Laboratory tests of mineral and metabolism Plasma calcium Total and active form (PH,complexing anion) Adjusted Ca(mg/dl)=totalCa(mg/dL)+0.8x(4-Albumin(g/dL) Free Calcium?

Phosphate Variation(Throuhgout the day and after meals↓) Single assay? Renal failure? Monoclonal gammopathies Magnesium Plasma equilibrates with cell magnesium

PTH Mid-molecule or C-terminal assay measure long-lived,inactive metabolite Renal failure? PTH assay? Vitamin D assay 25-Hydroxyvitamin D assay proportion to deficiency or toxicity 1,25 Dihydroxyvitamin D(suspected ectopic) PTHr Urinary Mineral Excretion

Hypercalcemia Artifactual(protein bound)hypercalcemia Primary hyperparathyroidism Hypercalcemia of Malignancy Uncommon causes of hypercalcemia

Hypocalcemia Artfactual Chronic Renal failure Uncommon causes (hypoPTH,Hypomagnesemia)

Hyperphosphatemia Renal failure Uncommon causes(HypoPTH,Vitamin D Toxicity,hyperthyroidism,Cell lysis sydromes)

hypophosphatemia Osteoporosis Vitamin D defiemcy Paget,s disease Renal Osteodystrophy

Metabolic Bone disease