1. In the name of God

2. 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

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

4. 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

5. Primary positive signal
Fig. 4-10A
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6. Pituitary hormones hypothalamus-Pituitary axis . Prolactin GH
Prolaction
Structure
function .

7. Regulation of prolactin

8. 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
ng/ml: tumors
20-100: diurnal variation,medications,stress,…

9. Prolactin levels

10. Growth hormones
Structure
Function
-Indirect
-Direct

11. Regulation

12. Prolactin levels
Marked diurnal Variation

13. 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

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

15. Sampling
Transfering
Blood increase
Blood decrease

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

22. 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)

23. 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 µg, normal,1µg physiological dose?
2-Metyrapone Test(inhibites last step in cortisol synthesis)
3-Insulin hypoglycemia(Insulin, u/kg)
4- corticotropin –releasing hor. stimulation

24. 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)

25. Congenital adrenal hyperplasia
21-hydroylase deficiency
11-hydroxylase deficiency

26. 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?

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

28. 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

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

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

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

32. hypophosphatemia Osteoporosis Vitamin D defiemcy Paget,s disease
Renal Osteodystrophy

33. Metabolic Bone disease