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OVERVIEW OF ENDOCRINOLOGY Cecilia A. Jimeno, M.D. UPCM Dept of Pharmacology UP-PGH Section of Endocrinology, Diabetes & Metabolism
Objectives ,[object Object],[object Object],[object Object],[object Object]
Endocrinology is a  fascinating specialty of medicine! ,[object Object],[object Object]
Diabetes Mellitus Type 2: A worldwide epidemic Nature 414:782-787  (2001) 2000: 151 million 2010: 221 million Increase: 46%
Obesity is usually measured as  Body Mass Index (BMI) BMI = Weight (kg) Height (m 2 ) World Health Organization, 1998 Classification  BMI (kg/m 2 )  Risk co-morbidities Normal range  18.5  24.9 Average Overweight    25 Pre-obese  25  29.9 Increased Obese class I  30.0  34.9 Moderate Obese class II  35.0  39.9 Severe Obese class III    40.0  Very severe
FNRI 1987 to 1999 Food and Nutrition Research Institute (FNRI) Survey 1987-1999 Prevalence of OVERWEIGHT & OBESITY  among Filipino Adults 3.2% 16.9% 1999 2.6% 14.0% 1993 1.7% 11.8% 1987 BMI > 30 BMI 25-29.9 Study Year
(WHO vs. Asia Pacific), FNRI 1999  20.1% 23.3% 1999 (AP) 3.2% 16.9% 1999 (WHO) Obese Overweight Study Year Prevalence of  OVERWEIGHT & OBESITY  among Filipino Adults Food and Nutrition Research Institute (FNRI) Survey 1987-1999
Pituitary Gigantism ,[object Object],[object Object]
And who will forget these pts with hyperthyroidism due to Graves’ disease?
Sheehan’s Syndrome
Turner’s syndrome
Definitions & Scope of Endocrinology ,[object Object],[object Object],[object Object]
Definitions & Scope of Endocrinology ,[object Object],[object Object]
Endocrine vs Exocrine
What are Hormones? ,[object Object]
Mechanisms to maintain Homeostasis (Integrative Regulation) ,[object Object],[object Object],[object Object]
Types of cell-to-cell communication (by hormones) ,[object Object],[object Object],[object Object]
Types of c-c comm; sites of hormone action
Comparison of Determinants of  Endocrine (A) & Paracrine (B) Signaling
Comparison of Determinants of  Endocrine (A) & Paracrine (B) Signaling
Endocrine System & Biologic Activities of Complex Organisms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Four Primary Arenas of Hormone Action Hormones Growth & Development Reproduction Maintenance of Internal Environment Energy Production, Utilization & Storage
Maintenance of internal environment (homeostasis) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Basic Attributes of the  Endocrine System ,[object Object],[object Object],[object Object],[object Object],[object Object]
Endocrine Glands ,[object Object],[object Object],[object Object]
Basic Attributes of the Endocrine System:  Glands ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Basic Attributes of the  Endocrine System ,[object Object],[object Object],[object Object],[object Object],[object Object]
Characteristics of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Steps in Hormone Action ,[object Object],[object Object],[object Object],[object Object]
Chemical Nature of hormones ,[object Object],[object Object],[object Object]
Peptide Hormones ,[object Object],[object Object]
Peptide Hormones ,[object Object],[object Object],[object Object]
Peptide Hormone ,[object Object],[object Object],[object Object],[object Object],[object Object]
Structure of Insulin
Glucagon:  Insulin’s counter-regulatory hormone
Pro-opiomelanocortin (POMC) Pro-ACTH B- LPH N-POC ACTH JP  - MSH  - MSH CLIP  -LP H  -End
Pro-hormones exist for ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Peptide Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object]
Patterns of Hormone Biosynthesis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Steroid hormones ,[object Object],[object Object],[object Object]
Steroid hormones ,[object Object],[object Object],[object Object],[object Object],[object Object]
Protein Binding of Cortisol Cortisol Transcortin (80%) Albumin (10%) Receptor DNA/mRNA Endoplasmic  Reticulum Glucocorticoid response Ribosomes Glucocorticoid response Free Cortisol (5 -8%) (Macrocortin/lipomodulin)
Steroid hormones ,[object Object],[object Object],[object Object]
Chemical Nature of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Steps in Hormone action ,[object Object],[object Object],[object Object],[object Object]
Transport of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Steps in Hormone action ,[object Object],[object Object],[object Object],[object Object]
Hormone to cell interactions ,[object Object],[object Object],[object Object]
Target Cells as Active Participants ,[object Object],[object Object],[object Object]
Lipid-soluble Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object]
Water-soluble Hormones ,[object Object],[object Object],[object Object]
[object Object],Water-soluble Hormones
INSULIN SIGNALING MECHANISMS
 
Interaction of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interaction of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Interaction of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interaction of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Glucose Regulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Implications ,[object Object],[object Object]
Types of Hormone Interactions ,[object Object],[object Object],[object Object]
Interaction of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Hormone synergism- recruitment of multiple hormones for coordinated response
Interaction of Hormones ,[object Object],[object Object],[object Object]
Interaction of Hormones ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interaction of Hormones ,[object Object],[object Object],[object Object],[object Object]
Hormonal regulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hormonal regulation ,[object Object],[object Object],[object Object]
Peripheral feedback mechanism & a million-fold amplifying cascade of hormonal signals
Model for regulation of anterior pituitary hormone secretion by three tiers of control
Pituitary-thyroid axis Hypothalamus TRH
Feedback Systems ,[object Object],[object Object]
Control of Hormone Secretion ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rhythms of Feedback Systems ,[object Object],[object Object],[object Object],[object Object]
Hormone Measurement ,[object Object],[object Object],[object Object],[object Object],[object Object]
Endocrine Diseases ,[object Object],[object Object],[object Object],[object Object]
Patterns of Endocrine Pathology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PROHORMONE HORMONE RECEPTOR EFFECTOR RESPONSE GLAND Degraded Degraded
PROHORMONE HORMONE RECEPTOR EFFECTOR RESPONSE GLAND Degraded Degraded HYPOFUNCTION Destruction Block BLOCK stimulation Antibodies Antagonists DEFECT Tissue damage
Defects which may cause DM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PROHORMONE HORMONE RECEPTOR EFFECTOR RESPONSE GLAND Degraded Degraded HYPERFUNCTION Tumor, hyperplasia Ectopic production Iatrogenic BLOCK Antibodies Tissue damage STIMULATION
Hormone Overproduction ,[object Object],[object Object]
[object Object],[object Object],Causes of Mineralocorticoid Hypertension  GCC-REMEDIABLE HYPER-ALDOSTERONISM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hormone Overproduction ,[object Object]
Graves’ disease?
Hormone Overproduction ,[object Object],[object Object]
Acromegaly
Acromegaly
Cushing’s Syndrome
 
 
 
Cushing’s disease
Cushing’s Syndrome
 
Hormone Underproduction ,[object Object],[object Object]
 
Altered Tissue Responses ,[object Object],[object Object]
Therapeutic Strategies ,[object Object],[object Object],[object Object]
Therapeutic Strategies ,[object Object],[object Object]

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Overview 2009

Editor's Notes

  1. 3 Xenical Slide Kit August 1998 Section 1 3 Slide 3: Obesity is usually measured as body mass index (BMI) The most common measure of obesity is the body mass index (BMI). BMI is the ratio of body weight (kg) divided by height (m 2 ). Both weight and height can be measured very simply in the clinic and the BMI determined by calculation of the formula. Using BMI, it is possible to determine obesity by reference to internationally accepted “Grades”, commencing with “normal” (Grade 0) for individuals with a BMI <25 kg/m 2 and rising to “severely obese” at Grade 3 (BMI >40 kg/m 2 ).
  2. Prevalence of Overweight / Obesity in Adult Filipinos Applying the NIH / WHO guidelines to the results of the surveys conducted by the Food and Nutrition Research Institute of the Philippines from 1987 to 1999, one can see that the prevalence of overweight has increased in a 12 year period from 12% to 17%. Likewise, prevalence of obesity has almost doubled from 1.7% to 3.2%.
  3. Prevalence of Overweight / Obesity in Adult Filipinos (WHO vs.. AP) However, when the Asia-Pacific guidelines is used instead as it is more appropriate for our population, then one can appreciate the magnitude of the health problem we are currently facing. With the lower cutoff BMIs for obesity (>25) and overweight (>23), about 20% of adult Filipinos are considered obese, and an additional 23% are considered overweight. This means that 43% of adult Filipinos, or roughly 17 million, are either overweight or obese.
  4. Some neurotransmitters are also hormones (e..g dopamine, catecholamines) while some hormones are also neurotransmitters