內科學 內分泌總論-高鑫

1、高 鑫 Gao Xin Department of EndocrinologyZhongshan Hospital,Fudan UniversityGao.xinzs-Principles of Endocrinology1Three stages of endocrinology development內分泌學發(fā)展三階段腺體內分泌學 Organic Endocrinology組織內分泌學 Histological Endocrinology分子內分泌學 Moleculer Endocrinology2Principles of Endocrinology Basic of endocrino

2、logy_ Structure and function of Endocrinology System1. Endocrine glands and cells 2. Hormone secretion cell 3. Definition of hormone: classificationSynthesis and Elimination Diurnalrhythms Variation 4.Correlation with neural and immune system 5. Regulation of endocrine systems Axis ragulation Regula

3、tion between hormones 6. Mechanisms of Hormone Action Hormones with Cell Surface Receptors:4 types Hormones with Intracellular ReceptorsDownstream Signaling Pathways7. Nutriment metabolism Clinical endocrinology Characteristic of endocrine systems: Principles of Diagnosis :Function, Localization, Pa

4、thological diagnosis Principles of prevention and treatment 3Principles of Endocrinology一、內分泌學基礎-內分泌系統(tǒng)結構與功能一、內分泌腺和激素分泌細胞 二、激素分泌細胞的結構特點三、激素定義：分類激素的合成與貯存 激素分泌方式激素轉運 激素降解與轉換激素的分泌節(jié)律 血漿激素組分的不均一性 激素合成與分泌的調節(jié)途徑激素與神經系統(tǒng)及免疫系統(tǒng)的相互聯(lián)系 四、內分泌調節(jié)軸與調節(jié)系統(tǒng) 內分泌調節(jié)軸 激素間的相互調節(jié)與影響 五、激素作用機制主要作用于核轉錄因子的激素 主要與靶細胞表面受體結合的激素 ：激素-膜受體相互

5、作用 ；膜受體結構： 一般將膜受體分為四類激素信號的受體后轉導通路 六、營養(yǎng)素代謝 二、臨床內分泌 內分泌系統(tǒng)疾病特點： 診斷原則：診斷包括功能診斷、定位診斷診斷和病因診斷（解剖診斷） 治療原則治原則：4Principles of Endocrinology Basic of endocrinology_ Structure and function of Endocrinology System1. Endocrine glands and cells 2. Hormone secretion cell 3. Definition of hormone: classificationSynt

6、hesis and Elimination Diurnalrhythms Variation 4.Correlation with neural and immune system 5. Regulation of endocrine systems Axis ragulation Regulation between hormones 6. Mechanisms of Hormone Action Hormones with Cell Surface Receptors:4 types Hormones with Intracellular ReceptorsDownstream Signa

7、ling Pathways7. Nutriment metabolism Clinical endocrinology Characteristic of endocrine systems: Principles of Diagnosis :Function, Localization, Pathological diagnosis Principles of prevention and treatment 5Endocrine SystemEndocrine glandsHormones and their regulation systemMetabolic Process代謝過程Or

8、gans Function器官功能Growth and development生長發(fā)育Reproductionand aging生殖衰老 Diffused nerve and endocrine Cells in other tissueNervous System 6Endocrine SystemEndocrine glandsHormones and their regulation systemMetabolic Process代謝過程Organs Function器官功能Growth and development生長發(fā)育Reproductionand aging生殖衰老 Diffu

9、sed nerve and endocrine Cells in other tissueNervous System 7Principles of EndocrinologyEndocrine glands8Endocrine SystemEndocrine glandsHormones and their regulation systemMetabolic Process代謝過程Organs Function器官功能Growth and development生長發(fā)育Reproductionand aging生殖衰老 Diffused nerve and endocrine Cells

10、in other tissueNervous System 9 Diffused nerve and endocrine Cells in other tissuePrinciples of Endocrinology10Principles of EndocrinologyBasic of Endocrinology is the study of: (1) hormones (2) their receptors (3) and the intracellular signalling pathwaysClinical endocrinology is the study of endoc

11、rine diseases (1) hormone overproduction; (2) hormone underproduction; (3) altered tissue responses to hormones; (4) tumors of endocrine glands. 11Principles of EndocrinologyDefinition of hormoneHormones are chemical messengers secreted into blood or extracellular fluid by one cell that affect the f

12、unctioning of other cells. What exactly are hormones? 121314Principles of Endocrinology15Principles of Endocrinology16Principles of Endocrinology17Principles of EndocrinologyHormones classificationMost commonly, hormones are categorized into four structural groups: Peptides and proteins : ACTH,LH, F

13、SH, PHT, TSH, Insulin ,Glucagon, IGFs Steroids : cortisone, aldosterone, 1,25(OH)2 D3 , androgen, estrogen Amino acid derivatives: catecholamine , noradrenalin,adrenalin Fatty acid derivatives: prostaglandings, Retinol18Regulation of endocrine systems19Regulation of endocrine systems2021Anterior Pit

14、uitary Hormones22Mechanisms of Hormones Action and intracellular signalling pathways 與膜受體結合 G蛋白偶聯(lián) 發(fā)揮生物效應 （肽類激素、生物胺、前列腺素） 與膜受體結合 受體自身磷酸化 發(fā)揮生物學效應 （酪氨酸激酶） （生長因子家族、Insulin , IGFs)與核受體結合 與DNA特異序列結合 功能蛋白轉錄 （甾體類激素）23Mechanisms of Hormones Action and intracellular signalling pathways24G-protein coupled 7 me

15、mbrane spanning receptor25G-protein coupled 7 membrane spanning receptor26Mechanisms of Insulin Action and intracellular signalling pathways27Mechanisms of Nuclear Receptor Action2829Three stages of endocrinology development內分泌學發(fā)展三階段腺體內分泌學 Organic Endocrinology組織內分泌學 Histological Endocrinology分子內分泌學

16、 Moleculer Endocrinology30Principles of EndocrinologyTed Ryder-one of the first patients of type 1 diabetes treated by insulin in 192231Principles of EndocrinologyJ.J.R. Macleod (1876-1935)Frederick G.Banting(1891-1941)James B.Collip(1892-1965)Charles H Best(1899-1978)The Nobel prize in 1923 to Bant

17、ing FG for his contribution to discovery of insulin32Coris: 發(fā)現(xiàn)了磷酸化酶的可逆磷酸化 （無活性的磷酸化酶b/有活性的磷酸化酶a之間的互變） 獲得1951年諾貝爾獎。Sutherland: 成功分離和確定的腺苷酸環(huán)化酶和磷酸二酯酶 （cAMP合成與分解的兩個關鍵酶） 提出了激素作用的第二信使學說 獲得1971年諾貝爾生理醫(yī)學獎。Krebs & Fisher: 于60年代末發(fā)現(xiàn)蛋白激酶A(PKA) （依賴cAMP , 刺激多種底物蛋白磷酸化) 闡明了PKA啟動的磷酸化和去磷酸化途徑。 獲得1992年諾貝爾生理醫(yī)學獎。 Mechanism

18、s of Hormones Action and intracellular signalling pathways33Principles of Endocrinology Basic of endocrinology_ Structure and function of Endocrinology System1. Endocrine glands and cells 2. Hormone secretion cell 3. Definition of hormone: classificationSynthesis and Elimination Diurnalrhythms Varia

19、tion 4.Correlation with neural and immune system 5. Regulation of endocrine systems Axis ragulation Regulation between hormones 6. Mechanisms of Hormone Action Hormones with Cell Surface Receptors:4 types Hormones with Intracellular ReceptorsDownstream Signaling Pathways7. Nutriment metabolism Clini

20、cal endocrinology Characteristic of endocrine diseases: Principles of Diagnosis :Function, Localization, Pathological diagnosis Principles of prevention and treatment Expectation34 Characteristics of endocrine Diseases Principles of Diagnosis : Function, Localization, Pathological diagnosis Principl

21、es of prevention and treatment Clinical endocrinology35 Characteristics of endocrine Diseases Principles of Diagnosis : Function, Localization, Pathological diagnosis Principles of prevention and treatment Clinical endocrinology36Classification of endocrin diseases按病變器官分類按功能分類：亢進、減退、正常；按病變部位分類：原發(fā)性、繼

22、發(fā)性、三發(fā)性激素分泌缺陷受體基因缺陷-激素抵抗37Acromegaly肢端肥大癥 Dwarfism侏儒癥Characteristics of endocrine diseases38Hyperthyroidism Graves DiaeaseHyperthyroidism Graves DiaeaseCharacteristics of endocrine diseases39Characteristics of endocrine diseases40“Pear” obesity“Apple obesity”Fat distrophyCharacteristics of endocrine diseases41 Characteristics of endocrine Diseases Principles of Diagnosis : Function, Localization, Pathological diagnosis Principles of prevention and treatment Clinical endocrinology42內分泌疾病的診斷原則三大原則： 功能診斷 定位診斷 病因/病理診斷43功能診斷癥狀、體征實驗室資料：代謝紊亂的證據(jù)；