内分泌总论专业知识讲座课件.ppt

内分泌系统疾病总论THE PRINCIPLES OF ENDOCRINOLOGY,郑州大学一附院内分泌科孙良阁,1,内分泌系统疾病总论THE PRINCIPLES OF EN,2,2,人体三大调节系统 Three systems of extra cellular communication control all physiologic processes,神经系统Nervous system,内分泌系统 Endocrine system,免疫系统Immune system,3,人体三大调节系统 Three systems of ext,Contents,A、Basic concepts(Review)B、The Classification of Endocrine diseases C、The diagnostic routine of Endocrine diseases D、The managements of Endocrine diseases,基本概念,4,Contents A、Basic concepts(Re,A、Basic concepts,Endocrine system(内分泌系统),Function(内分泌系统的功能),Hormone(激素),Regulation and accommodation(内分泌系统活动调节),返回,5,A、Basic conceptsEndocrine syst,A、Basic concepts,Endocrine system(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulation and accommodation(内分泌系统活动调节),返回,6,A、Basic concepts Endocrine sys,Endocrine system,Endocrine system,Endocrine glands,Endocrine tissues and cells,Body fluid regulated system,Startling EH:19021905,Lancet 1905;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,7,Endocrine systemEndocrine Endo,Endocrine glands,垂体甲状腺甲状旁腺肾上腺（髓质、皮质）.性腺,胰岛胸腺,8,Endocrine glandsgonadsPituitar,Endocrine Tissues/Cells,9,Endocrine Tissues/Cells9,Traditional(Classical)Endocrinology,10,Traditional(Classical)Endoc,Modern Endocrinology,Target cell,Endocrine cell,内分泌,邻分泌,自分泌,胞内分泌,Endocrine,Paracrine,Autocrine,Intracrine,11,Modern Endocrinology Target ce,几乎所有细胞均是内分泌细胞!,返回,Are They Endocrine Cells?,Fat cell,Endothelial Cell,12,几乎所有细胞均是内分泌细胞!返回Are They Endoc,A、Basic concepts,Endocrine system(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulation and accommodation(内分泌系统活动调节),返回,13,A、Basic concepts Endocrine,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,14,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,Hormones,Metabolism:carbohydrate,lipid,Protein,energy,Electrolyte,etc.代谢,Reproduction,Growth and Development,etc.生命过程,Physiology:Respiratory,Circulatory,Digestive,Hematogenic,Etc.生理,Maintenance of internal Environment内环境稳定,15,HormonesMetabolism:Reproductio,A、Basic concepts,Endocrine system(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulation and accommodation(内分泌系统活动调节),返回,16,A、Basic concepts Endocrine sys,激素(Hormone),Hormone,a group of chemical messengers manufactured by endocrine glands,regulate the function of all vital organs.,定义：由内分泌细胞合成、分泌及释放入血的生物活性物质(chemical messengers)。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,17,激素(Hormone)Hormone,a group of,18,Endocrine cellTarget cellTarge,激素分类（1）按化学结构分类Categories of chemical structure,肽类激素(Peptides and proteins)：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(steroid derivatives)：肾上腺皮质激素、性腺激素,Vit D 类,19,激素分类（1）按化学结构分类Categories of c,（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,20,（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,Synthesis-Release-Transport-Receptors-Secondary messengers-Physiological effect,激素作用机制Mechanisms of Hormone action,PMRCPR,激素合成、运输受体结合、第二信使、生物活性,21,Synthesis-Release-Transport-Re,细胞膜受体,22,细胞膜受体22,23,23,24,24,细胞核受体,25,细胞核受体25,激素的特点,作用于特异性受体,以ug,ng,fg,pg计量,协同作用(synergistic action)拮抗作用(antagonistic action)允许作用(permissible action),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,26,激素的特点作用于特异性受体 以ug,ng,fg,pg计,皮质醇的节律性分泌,27,皮质醇的节律性分泌27,性激素的节律性分泌,28,性激素的节律性分泌28,A、Basic concepts,Endocrine system(内分泌系统)Function(内分泌系统的功能)Hormone(激素)Regulation and accommodation(内分泌系统活动调节),返回,29,A、Basic conceptsEndocrine syst,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,30,内分泌系统活动的调节 30,1、Nervous endocrine regulation神经-内分泌系统的调节,Target gland,CNS,Hypothalamus,Pituitary,Target organ/cell,Physical actions and metibolism,31,1、Nervous endocrine regulatio,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,32,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,33,33,34,34,2、Feed back system(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,35,2、Feed back system(内分泌系统的反馈调,Hypothalamus-pituitary-target glands(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）,36,Hypothalamus-pituitary-target,Feed-back regulations,（1）负反馈调节（Negative),TRH-TSH-T3+T4,CRH-ACTH-COrtisol,37,Feed-back regulations（1）负反馈调节（,（2）负、正反馈调节（Negative+Positive feed-back regulation）,38,（2）负、正反馈调节（Negative+Positiv,下丘脑垂体靶器官(hypothalamus-pituitary-target organs),GRH、GIH-GH-Somatomedin(生长介素)-Epiphysis(骨骺)-Growth(生长)PIH-PRL-Breast(乳房)-Develop(发育),39,下丘脑垂体靶器官(hypothalamus-pitui,Feed-backHormoneMetabolic production,insulin,40,Feed-backHormoneMetabolic pr,Feed-backHormoneMetabolic production,血钙/磷,CT,PTH,41,Feed-backHormoneMetabolic pr,3、Endocrine and immune regulation内分泌与免疫系统的调节,Endocrine system,Nervous system,Immune system,神经介质肽类激素抗体共 同 受 体,42,3、Endocrine and immune regulat,Contents,A、Basic concepts(Review)B、The Classification of Endocrine diseasesC、The diagnostic routine of Endocrine diseasesD、The magements of Endocrine diseases,返回,内分泌疾病的分类,43,ContentsA、Basic concepts(Revi,B、The Categories of Endocrine diseases,Endocrine disorders,Hormone deficiency,Hormone overproduction,Production of abnormal hormone,Disorders of hormone receptors,Abnormal of hormone transport or metabolism,Multiple hormone abnormalities,Tumors that produce hormones,44,B、The Categories of,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、The Categories of Endocrine diseases,45,内分泌功能减退症B、The Categories of,Hormone deficiency syndromes,Primary deficiency Hypofunction of Endocrine Glands,E.g.:Primary Hypothyroidism,T3,T4 Hypo-,TSH Hyper-,Secondary deficiency Hypofunction secondary to hypothalamus and pituitary,E.g.:Seconary Hypothyroidsium,T3,T4 Hypo-,TSH Hypo-,46,Hormone deficiency syndromes,Hormone excess syndrome,Primary overproduction Hyperfunction of endocrine glands,Secondary overproductionHyperfuntion secondary to hypothala-mus and pituitary,E.g.:Primary Hyperthyroidism,T3,T4 Hyper-,TSH Hypo-,E.g.:Seconary Hyperthyroidsium,T3,T4 Hyper-,TSH Hyper-,47,Hormone excess syndrome Prim,B、The Classification of Endocrine diseases,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,48,B、The Classification of,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、T4,49,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,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),50,功能减退的病因内分泌腺体破坏50,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,51,激素敏感性缺陷激素抵抗症：受体或受体后缺陷，功能减退51,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,52,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,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(ecotopic Hormone Production by tumors)灭活功能减弱 医源性,53,功能亢进原因 内分泌腺肿瘤及垂体肿瘤 53,Contents,A、Basic concepts(Review)B、The Classification of Endocrine diseases C、The diagnostic routine of Endocrine diseases D、The magements of Endocrine diseases,返回,内分泌疾病的诊断,54,Contents A、Basic concepts(Re,C、The diagnostic routine of Endocrine diseases,一、功能诊断（functional diagnosis),二、病理诊断（pathological diagnosis),三、病因诊断(Etiological diagnosis),返回,55,C、The diagnostic routine of,一、功能诊断(functional diagnosis)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、The diagnostic routine of Endocrine diseases(1),返回,56,一、功能诊断(functional diagnosis)C,57,57,58,58,59,59,60,60,61,61,河南名星,62,河南名星62,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,63,生化异常血钾异常63,C、The diagnostic routine of Endocrine diseases(2),二、病理诊断(pathphysiological diagnosis)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,64,C、The diagnostic routine,65,65,131I-MIBG,66,131I-MIBG66,C、The diagnostic routine of Endocrine diseases(3),三、病因诊断(Etiological diagnosis)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,67,C、The diagnostic routine,68,68,Downs syndrome,69,Downs syndrome69,Klinfelters syndrome,70,Klinfelters syndrome70,HLA测定,71,HLA测定71,Contents,A、Basic concepts(Review)B、The Classification of Endocrine diseases C、The diagnostic routine of Endocrine diseases D、The magements of Endocrine diseases,返回,内分泌疾病的治疗,72,Contents A、Basic concepts(Re,D、The magements of Endocrine diseases,(一)可防可治，防治结合 病因清楚(地方性甲状腺肿,Sheehan 病)病因不明但功能状态清楚：针对功能进 行调整(二)恢复功能状态(Restore)功能亢进 功能减退,73,D、The magements of Endocr,功能亢进症的治疗The magements of hormone overproduction,1、手术切除功能亢进的腺瘤或 增生组织(Surgery)2、放射性治疗(Radiation)3、药物治疗：破坏腺体、抑制 激素的合成及分泌、拮抗激素作用(pharmacological therapy),74,功能亢进症的治疗The magements of hor,功能减退症的治疗The magements of subnormal hormone production,1、内分泌器官的移植、细胞移植、干细胞移植(transplantation of endocrine organs)2、缺乏激素的替代治疗、增敏治疗(replacement)3、调整生化异常(restore),75,功能减退症的治疗The magements of sub,See you!,contents,76,See you!contents76,本课件获教育厅多媒体教育大奖赛一等奖（2005年）,并参加 教育部全国多媒体教育大奖赛展评,注：此作品原件为2003年（2000级）系统内科讲稿(当时使用Microsoft office 2000制作)制作者：孙良阁,77,本课件获教育厅多媒体教育大奖赛一等奖（2005年）,并参,