The

term

endocrine

denotes

internal

secretion of biologically active substance

called hormone

The

term

exocrine

denotes

secretion

outside the body e.g

through sweat

glands or ducts that lead into the GI tract.

There is a tight coupling between the

basic science of endocrinology and

clinical medicine

The endocrine and nervous systems

are the major controllers

of the flow of information

between different cells and tissues

Traditional definition
The endocrine system releases chemical mediators termed hormones into the circulation for action away from their sites of origin. This definition becomes blurred

because the recoqnition that the circulating hormones can also have local effects in the cells in which they are synthetized ( autocrine) or in adjacent cells after diffusion (paracrine) or acts inside the cell without being released (intracrine) e.g insulin (inhibits its own release)

Hormone

Released

Transported

Target
bind to receptors

on the cell surface

intracellular (nuclear)

e.g

Insulin GH

Steroid Thyroid hormones

RECEPTORS

BIFUNCTIONAL

1. Recognition

2. Signal activation

Interaction of hormones One hormone, multiple actions e.g testosterone One function, multiple hormones e.g maintenance of plasma glucose

Hormone antagonism
Certain hormones antagonize the effects of other hormones. It is necessary to know the value of each hormone to interpret the clinical phenomenon
N Testosteron Estrogen

GYNECOMASTIA
N Estrogen Testosteron

The function of hormones

There are 4 domain :

Reproduction
Growth and development

Maintenance of the internal environment

Energy production, utilization and storage

CHEMICAL COMPOSITION OF HORMONES

MECHANISM OF HORMONE ACTION

Hormone receptors Cell surface receptors Nuclear receptors Hormone effects on receptor activity

CLASSES OF HORMONE ACTION

Classification of hormone action by receptor type Glucocorticoid Mineralocorticoid CH regulating activities Salt regulating activity

Classification of hormone action by ligand type Agonist Partial agonist-partial antagonist Antagonist Inactive compounds Mixed agonist-antagonist Ligands with Reserve Pharmacology Mechanisms of ligand action

MODULATION OF HORMONE LEVELS

Hormone synthesis Regulation of hormone production

There are a number of patterns of regulation of hormone release: 1. The hypothalamic-pituitary-target gland 2. Free standing endocrine glands (parathyroid, islet cells ) 3. Pulsatile release etc

Hormone transport in the circulation Bound Free Transport of hormones across the membrane Metabolism & elimination of hormones

DISORDERS OF THE ENDOCRINE SYSTEM

Arise from :
Excess of hormones

Deficiency of hormones
Resistance to hormones

Specific tumors
Iatrogenic syndromes

Hypofunction
Destruction
of the gland:

Auto immune disease Type 1 diabetes Hypothyroidism Adrenal insufficiency Ischaemia Tumor Inflammation Haemorrhage

Extraglandular disorders
Damage to tissues that convert hormonr precursor to active form

e.g Renal disease

Defective conversion of 25(OH)D3 1,25 (OH) D3 abnormalities in Ca & phosphate balance

Defects in hormone biosynthesis

Endocrine hyperfunction
Results usually from :
Tumors

Hyperplasia
Autoimmune stimulation Ectopic production of hormones by tumors

Defects in sensitivity to hormones Syndromes of hormone excess due to administration of exogenous hormone

Principal glands Glands that produce hormones are scattered all over the bodys tissue but glands that are considered to be the principal glands are the hypophysis (pituary) the thyroid gland the parathyroid glands the adrenasls islets of Langerhans the gonads (new) hormones are being

Many other discovered

APPROACH TO THE PATIENT WITH ENDOCRINE DISEASE

Evidence-based endocrinology

History & physical examination

Laboratory studies
-

Measurement of hormonal levels: basal level Plasma & urine analysis Free hormone ;evels Immune assays Biopsy

Screening for endocrine diseases Clinical interpretation of laboratory test Treatment of endocrine diseases

Laboratory testing of Endocrine Function

It is worthwhile to review ; and a considerable judgment is required, because of : Pulsatile hormone secretion Diurnal variation Cyclic variation Age Sleep entrainment Hormone antagonism Dynamic testing Hormone and metabolite interaction Protein binding Laboratory error

Cases to be discussed as to trigger the students to learn the endocrine-metabolism system are :
Disorders of :

* The hypophysis * Tahe thyroid gland * The calcium metabolism (concerning the parathyroid gland) * The adrenals * The islets of Langerhans * The gonads