1. Ieva B. Akbar Department of Physiology Faculty Of Medicine – Universitas Islam Bandung

2. I. INTRODUCTION Neuroendocrinology –The interaction between the central nervous system (CNS) and endocrine systems in the control of homeostasis –The control of pituitary hormone secretion by the hypothalamus –The fundamental role of the hypothalamus in controlling anterior pituitary function.

3. The Endocrine System

4. Pituitary Gland Anatomy

5. Synthesis, storage and release of posterior pituitary hormone

6. Hypothalamic and pituitary hormones

7. Hormones of the hypothalamic anterior pituitary pathway

8. A complex endocrine pathway

9. II. NEURAL CONTROL OF GLANDULAR SECRETION a.Neurosecretion The release of any neuronal secretory product from a neuron Neurons that secrete substances directly into the blood stream to act as hormones Neurons have basic ability to respons and integrate input from multiple neurons through specific receptors Three types of hypothalamic neurosecretory cells

11. b.The autonomic nervous system contribution to endocrine control The neurons system controls or modifies or both, the function of basic endocrine and exocrine glands Anterior pituitary : releasing hormone Pancreas, Adrenal, Pineal salivary (endocrine & exocrine) : regulated through direct innervation from autonomic neurons system

13. Blood Various effector organs Epinephrine Brain HeartNE Postganglionic sympathetic neuron Sympathetic ganglia Sympathetic ganglia Medulla Adrenal glands Preganglionic sympathetic neuron

14. III. HYPOTHALAMIC- PITUITARY UNIT a.Anatomy of the hypothalamic-pituitary unit Adenohypophysis Pars distalis Pars intermedia Pars tuberalis Neurohypophysis b.The median eminence and hypophyseotropic neuronal system Lies in the center of tuber cinereum

15. A. Human hypothalamic Pituitary unit B. Midsaggital nuclear Magnetic resonance scan of the brain of a normal woman

16. IV. CIRCUMVENTRICULAR ORGAN a.Median eminence The median eminence and neurohypophysis contain the secretory axons that control pituitary function

17. Hypothalamic magnocellular neurons and the posterior pituitary gland

18. b.Organum vasculosum of the lamina terminalis and the subfornical organ Are located at the front wall of the third ventricle, the lamina terminalis Involved in the maintenance of many processes : fluid and electrolyte balance, blood pressure, reproduction, thermaregulation

20. c. Area postrema d. Subcommissural organ

21. V. HYPOPHYSEOTROPIC HORMONES AND NEUROENDOCRINE AXES a.Feedback concepts in neuroendocrinology b.Endocrine rhythms c.Thyrotropin-releasing hormone -Chemistry and evolution -Clinical applications -Regulating of thyrotropin release -Feedback control : Pituitary-Thyroid Axis -Neural control : Circadian rhythm, Temperature, Starvation, Infection and inflammation

23. d. Corticotropin-releasing hormone - Chemistry and evolution - Effect on the pituitary and mechanism of action - Clinical applications - Feedback control - Neural control - Other factors influencing secretion of corticotropin : Circadian rhythm, corticotropin release-inhibiting factor

24. e. Growth hormone-releasing hormone Chemistry and evolution

25. - Growth hormone-releasing hormone receptor - Effect on the pituitary and mechanism of action - Extrapituitary functions - Clinical applications

26. Neuroendocrine regulation of growth hormone secretion

27. - Neural control

28. - Factors influencing secretion of growth hormone : Human growth hormone rhythms, external and metabolic signals

29. f. Somatostatin - Chemistry and evolution - Somatostatin receptors - Effect on target tissues and mechanism of action - Clinical applications of somatostatin analogues

30. g. Prolactin-regulating factors - Dopamine

31. - Prolactin-releasing factors - Intrapituitary regulation of prolactin secretion - Neuroendocrine regulation of prolactin secretion - Feedback control - Neural control - Factors influencing secretion

32. h. Gonadotropin-releasing hormone and control of the reproductive axis - Chemistry and evolution - Anatomic distribution - Embryonic development - Action at the pituitary : receptor, pulsatic gonadotropin-releasing hormone stimulation - Regulating systems - Feedback regulation - Regulation by inhibins and activins - Regulation of the ovarian cycle - Early development and puberty - Reproductive function and stress

33. i. Leptin and the brain-gut-adipose axis

34. - Chemistry and evolution of leptin - Effects of leptin on the hypothalamus and neuroendocrine axes - Mechanism of action - Clinical applications - Feedback control

36. j. Neuroendocrine-immune interactions - Cytokines signal the central nervous system - Interaction of cytokines with the circumventricular organs - Interaction of cytokines at the barriers of the brain - Entry of cytokines into the brain - Interaction of cytokines with peripheral nerves - Cell groups throughout the brain responsive to cytokines

37. A model of the central nervous system circuitry mediating the activation of the PVN or PVH and HPA axis by immune system stimulation

38. VI. NEUROENDOCRINE DISEASE a.Pituitary isolation syndrome b.Hypophyseotropic hormone deficiency c.Hypophyseotropic hormone hypersecretion d.Neuroendicrine disorders of gonadotropin regulation -Precocious puberty -Idiopathic sexual precocity -Neurogenic precocious puberty -Hypothyroidism -Tumors of the pineal gland -Approach to the patient with precocious puberty -Management of sexual precocity -Psychogenic amenorrhea -Neurogenic hypogonadism in males

39. e. Neurogenic disorders of prolactin regulation f.Neurogenic disorders of growth hormone decretion -Hypothalamic growth failure -Maternal deprivation syndrome and psychosocial dwarfism -Neurogenic hypersecretion of growth hormone -Diencephalic cachexia -Syndrome of inappropriate growth hormone hypersecretion

40. g. Neurogenic disorders of cortricotropin regulation h. Genetic obesity disorders involving hypothalamic circuits i. Nonendocrine manifestations of hypothalamic disease