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CLINICALENDOCRINOLOGY&METABOLISM—INTRODUCTIONANDGENERALCONCEPTS(总论)InstituteofMetabolism&EndocrinologyEryuanLiao(廖二元)A.Therapidityandextensivenessofadvancesinendocrinologyhavemadeitincreasinglydifficultforthestudentsandphysicianstotakefulladvantageofinformationavailablefortheunderstanding,diagnosis,andtreatmentofclinicaldisorders,notonlyofdiseasesinendocrinology,butalsoofthatinallclinicalspecialties.B.Whateasytohandleisthatthegeneralknowledgeandtheprinciplesofendocrinologyandmetabolism.C.Forinterest,beinterestedintheinterestingmedicalbranch.D.MainsubjectsI.RegulationsystemsofextracellularcommunicationII.Endocrineglandandhormone-secretingcellsIII.HormonesIV.HormonesecretionrhythmsV.HormonesynthasesanditsregulationVI.EndocrineregulationaxesVII.MechanismsofhormoneactionVIII.NutrientmetabolismIX.SystemicexaminationX.LaboratoryandspecialexaminationsXI.TherapeuticprinciplesI.RegulationSystemsofExtra-CellularCommunicationnervoussystemendocrinesystemimmunesystemII.EndocrineGlandandHormone-SecretingCells（激素分泌细胞）A.Endocrineglanda.hypothalamus&posteriorpituitaryb.pinealgland(松果体)c.anteriorandintermedialpituitaryd.thyroide.parathyroidf.endocrinepancreas(内分泌胰腺)g.adrenalcortexandmedullah.sexualgland(testisorovary)i.others:thymus(胸腺)，placentaB.Diffuseneuro-endocrinecellsAPUD(amineprecursoruptakeanddecarboxylation)cellsinGI,pancreas,adrenalmedulla,etc.)C.Hormone-secretingcellsintissuesatrium,endothelium,fibroblast,lipocytes,lymphocytesD.Structureofhormone-secretingcellspeptide/proteinhormone-secretingcells:hormone-containinggranules(激素颗粒)steroidhormone-secretingcells:lipiddroplet(脂质小滴)A.Classificationa.aspeptide/proteinb.asderivativesofaminoacid(catecholamine,5-HT,melatonin,T3/T4)c.asderivatesofcholesterol(cortisol,aldosterone,estrogen,androgen,progesterone,1,25-(OH)2D3)B.Storagehormonegranulesthyroglobulin(甲状腺球蛋白)III.HormonesC.Typesofhormonesecretionendocrine(内分泌)paracrine(旁分泌)autocrine(自分泌)intracrine(胞内分泌)neurocrine(神经分泌)juxtacrine(并邻分泌)solinocrine(腔分泌)amphicrine(双重分泌)solublehormone+bindingprotein:insulin,GH.IGF.Glucagon-likepeptideinsolublehormone+bindingprotein:T3,T4,sexsteroids,cortisol,vitaminD.D.Hormonetransportationhalf-life:peptidesandprotein:minutessteroids:variable,hrsdegradationinliver,kedney,othertissues,orinhormone-secretingcells.E.Hormonedegradationandhalf-lifeA:Biologicalrhythms（生物节律）milliseconds:nerveimpulse,membraneelectrolytes.minutes:neurotransmittershours:LH,TRH,testosterone,cortisol,GH,prolactin,TSH,etcdays:FSHpeaksweeks:menorrheamonths:T4,1,25-(OH)2D3,pregnancyIV.SecretionRhythmsB.Circadianrhythms(昼夜节律)biological“clock”inhypothalamus(melatonin),butlostinCushingdiseaseandpsychosisC.24-hrchangesofserumandurinehormone(metabolicproducts)D.Heterogeneityofserumhormoneshormone,pro-hormone(激素原),prepro-hormone(前激素原)monomer,dimer,trimertetramer,etc.fragementofpeptides.A.Endocrineregulationactivehormonemoleculehormone-bindingproteinhormonereceptoronmembraneincytoplasmainnucleolus(nucleoplasm)post-receptortransduction(cascadereaction)tropic-hormone(促激素)feedbackcycletargetcellreactionV.HormoneSynthasesandItsRegulationB.Paracrine/autocrineregulationexistalmostinalltissues.“point-line”(点-线式)regulationnetworkA.HormoneregulationA:ultra-shortfeedback(超短反馈)B:shortfeedback(短反馈)C:positivefeedback(正反馈)D:longnegativefeedback(负反馈):stimulating;:inhibitoryAnerveimpulses/cytokinesCNShypothalamuspituitaryglandtargetglandDBVI.EndocrineRegulationAxesB.Regulationaxes(调节轴)a.hypothalamus-pituitary-thyroid(adrenalcortex,sexualgland)b.GIH/GHRH-GH/GHBP-IGFs/IGFBPS-IGFBP/IGFBPasec.renin-AT-ALDinvolvedinrenin,AT,ALD,ANP,AVP,AM(adrenomedullin,肾上腺髓质素)d.axisofendocrinepancreas-energymetabolismandbodyweightinvolvedininsulin,glucagon,glucagon-likepeptide-1,somatostatin,leptin,etc.e.PTH-CT-1,25-(OH)2D3involvedinPTH,CT,1,25-(OH)2D3,serumCa2+,Pi3-f.AVP-AVPreceptor-AQP(aquaporin,水孔蛋白)V1receptor:relatedtoregulationofBPV2receptor:relatedtoH2OreabsorptionA.Actedastranscription-regulatoryfactorssteroidhormonebindinwithreceptor(cytoplasmornucleoplasm)H-Rcomplex+DNAbindingdomaingeneexpressionproteinVII.MechanismsofHormoneActionB.Actedatcellsurfacea.peptidehormone+membraneRpostreceptorcascadereactionb.typesofmembraneR–G-proteincoupledreceptor(transmenbrane7times)involvedinPTH,AT,glucagon,LH,FSH,TSH,AVP,CT,HCG,etc.–receptorkinases(transmembrane1time),withtyrosinekinase(activity),involvedininsulin,IGF,EGF,etc.–receptor-linkedkinases,involvedinGH,PRL,leptin–receptorsofligand-gatedionchannels(transmembrane4or6times),involvedin5-HT,GABA,etc.a.metabolism,anabolismandcatabolismb.metabolicdiseases(relatedtoenzymes,hormones,orionchannels,etc).c.macroelementandmicroelement(tracedelement)d.micronutrient(Fe,F,Zn,Cu,Mn,I,Cr,Co,etc)e.vitaminsVIII.NutrientMetabolismA.Generalconcepts:A.Symptomandsignsa.bodyheight(geneticfactors,GH,TH,sexhormones,IGF-1,nutrition,systemicdiseases)b.obesityandweighloss(geneticconstitution,nutrition,systemicdisease,GH,TH,insulin,leptin,cortisol,sexhormones)c.polydipsiaandpolyuria(DM,ALD,hyperparathyroidism,DI)IX.SystemicExaminationd.hypert