INTRODUCTION TO ENDOCRINOLOGY FOR CLINICAL STUDENTS Outline Definition of endocrinology Chemical messengers Structure of the endocrine system Structure

ture of the endocrine system : endocrine organs Hormones: operands of the endocrine system Communication in the endocrine system Functions of the endocrine system Some endocrine concepts and principles Pathogenesis of endocrine disease or endocrinopathies Endocrine diagnosis or evaluation Principles of endocrine treatment

The Specialism or Subspecialty of Endocrinology Endocrinology Metabolism Diabetes mellitus Nutrition Biochemistry Physiology

Endocrinology
Study of communication Control within living organisms Chemical messengers synthesized in whole or in part by the organism

Metabolism Part of the science and practice of endocrinology

Study of the biochemical control of mechanisms that occur within living organisms Includes i. Gene expression, biosynthetic pathways and their enzymatic catalysis ii. The modification, transformation and degradation of biological substances iii. The biochemical mediation of the actions and interactions of substances iv. The means for obtaining, storing and mobilizing energy CHEMICAL MESSENGERS: 1st Or 2nd Messengers Hormones Mediate intracellular and intercellular communication STRUCTURE OF THE ENDOCRINE SYSTEM ENDOCRINE ORGANS Non-organic continuity cf CVS or NS Components o Diffuse ES: skin, GIT, ND o Discrete ES: Ant Pituitary, Thyroid etc Most organs or tissues possess endocrine function Cf Heart, Kidney, Fat cells

HORMONES: Operands of the ES Classes Of Hormones Amino acids and Derivatives Tryptophan serotonin and melatonin Tyrosine Dopamine, NA, Adr, T3, T4 L-glutamic acid GABA Histidine Histamine CLASSES OF HORMONES Polypeptides (<150 amino acids) GnRH, TRH, Somatostatin, PTH, Insulin, ACTH, Nerve Growth factors Proteins and Glycoproteins FSH, LH, TSH, GH (Somatotrophin) Steroids (Derived from cholesterol) Progesterone, androgens, oestrogens, corticosteroids, vitamin D and its metabolites Fatty Acid Derivatives Prostaglandins, leukotrienes, thromboxane

COMMUNICATION IN THE ENDOCRINE SYSTEM o Autocrine: cell to self, self-regulation o Paracrine: cell to its neighbour cell, direct or interstitial o Lumocrine or Solinocrine: Gastrin, VIP, serotonin, secretion etc o Neurocrine: specialized autocrine communication Synaptic or non-synaptic (neurosecretion)- ADH, Oxytocin o Haemocrine: Traditional endocrine communication o Multiple communication mechanisms FUNCTIONS OF THE ES

FUNCTIONS OF THE ES: FOUR MAIN DOMAINS Reproduction: Control of all phases of, sexual bebaviour etc Growth and Development For normal growth and development regulation Required limitation of growth Regulated by multiple hormone actions: somatomedin systemIGF Maintenance of Internal Melieu Regulation of all major homoeostatic systems Energy Production, Utilisation and Storage Insulin vs Counter-regulatory hormones

FUNCTIONS OF THE ES Collaborative Function: Within the ES: One hormone, several functions One function, several hormones Extra ES Inter-system Collaboration and interaction Nervous system The immune system

SOME ENDOCRINE CONCEPTS AND PRINCIPLES o Hormone synthesis: transcription and translation Prohormones o Hormone Storage o Hormone Release: role of calcium o Hormone Transport: Concept of free hormones Carrier proteins for bound hormones o [H]x[P]/[HP] [H]x[P]/[HP] = K

SOME ENDOCRINE CONCEPTS AND PRINCIPLES Mechanisms of Hormone Action The Hormone Receptor Concept The Lock and Key Principle Plasma membrane receptors vs Cytosolic receptors Control of hormone secretion: Feedback Mechanisms: Negative FB classic example Positive feedback: classic example

SOME ENDOCRINE CONCEPTS AND PRINCIPLES Biorhythms- Biological Clocks Pulsatile secretions: min-to min, ultradian: examples Hour to days: Circadian or diurnal rhythms, the clock gene: examples ------------------: Ovulatory menstrual cycles

PATHOGENSIS OF ENDOCRINE DISEASE OR ENDOCRINOPATHIES Organ hypofunctionHormone under production Organ hyperfunction Hormone excess in circulation Structurally abnormal hormone : damaged key Resistance to hormonal action: lock problem

Abnormal hormone transport Multiple mechanisms

ENDOCRINE DIAGNOSIS AND EVALUATION ENDOCRINE DIAGNOSIS Clinical Aspects Clinical endocrine signs and symptoms Anthropometric measurements Charts: growth, pubertal staging. Tanner Visual tests: acuity and perimetry Psychometry Cervical Mucus assessment Orchidometry ENDOCRINE DIAGNOSIS 2: Body Fluid Hormone Determination Basal Hormone measurement Serial hormone determination Biorhythm determination Paired hormone measurements Transport protein evaluation Dynamic Tests Suppression or inhibition tests: Hypofunction? Stimulation or provocation tests: Hyperfunction? ENDOCRINE DIAGNOSIS : Laboratory Techniques: Chemical techniques; spectrophotometry / colorimetry Bioassays and receptor assays Immunoassays o Principle of : o Ag, Ab, Labels, Signal reader o The History of RIA o The history of EIA Cf of RIA vs ELISA *Nobel Laureate ENDOCRINE DIAGNOSIS : Microscopic Diagnosis Histology of tissues, biopsies Cytology o Vaginal cytology *SFA: collection, transport, etc

ENDOCRINE EVALUATION: Chromosomal Studies Buccal smear for Barr Bodies : Xn-1 in interphase or non-dividing cell Blood Smear: Drum sticks (x chromosomes) Barr bodies Karyotyping - culture lymphocytes, terminate in metaphase with o colchicine Examples of abnormalities: o Monosomy X (45 X or X0): Turners o 47XXY : Klinefelters syndrome o Mosaics . ENDOCRINE EVALUATION Metabolic and Immunological tests: Target organ dependent Examples: Thyroid, Endocrine pancreas Serological, lymphocytes o Examples : in Thyroiditis ENDOCRINE EVALUATION: Imaging Studies Photography: family background, age of onset, dx progress etc Radiology, USS etc Plain radiographs: Skull, hands, Contrast radiology Venous sampling CT scan Ultrasound MRI ENDOCRINE EVALUATION: Radionuclide Imaging Thyroid, Adrenal Isotopes: Technitium pertechnetate o Iodine-123, iodine-131

ENDOCRINE EVALUATION: Laparascopy Amenorrhoea. Hirsutism. Intersex. Precocious puberty

PRINCIPLES OF ENDOCRINE TREATMENT Confirm diagnosis Re-establish eumetabolism Hypofunction/ deficiency: replacement therapy Hyperfunction or hormone excess : suppression or extirpation Drugs, radiotherapy and/or surgery Monitor therapy Patient self management Long-term treatment , often life long Rewarding results