⑤ 내분비 Pituitary hormones and their control by hypothalamus

Chapter 75 Pituitary hormones and their control
by the hypothalamus
Endocrinology
경북대학교 의학전문대학원
생리학교실 홍 장 원

1. Pituitary gland and relation to hypothalamus
<RcR R a)PUN NPaR V aVP S VabVaN f T N Q
9 a( VabVaN f T N Q
u ? v I w 9; x F NPaV y >I z B
F a( VabVaN f T N Q
u 9< v Eefa PV
9 a( VabVaN f T ( P aNV QVSSR R a PR aUNa f aUR VgR (
F aR V VabVaN f U R N R f aUR VgRQ Of PR O QVR
V aUR Uf aUN N b
2. Hypothalamus controls pituitary secretion
f aUN N VP f Uf VN aN O Q cR R S 9 a(
VabVaN f T N Q
f aUN N VP R RN V T)V UVOVa f ( N R RP RaRQ V a aUR
RQVN R V R PR(
f aUN N VP R RN V T)V UVOVa f P a N a( VabVaN f
RP RaV
u H v ;H w ? H x ? A y ? H z FA
I RPVSVP N RN V aUR f aUN N b P a RP RaV S
RPVSVP f aUN N VP R RN V T N Q V UVOVa f U R
3. Physiological functions of Growth Hormone
? aR T daU S N f O Qf aV bR
? UN RcR N RaNO VP RSSRPa
u ? aR aRV QR VaV V aV bR
p NN a N a l q a N NaV l r a N P V aV l
s aRV PNaNO V m
v ? R UN PR SNa baV VgNaV S R R Tf  
p Ra TR VP RSSRPa
w ? QRP RN R PN O UfQ NaR baV VgNaV  
p V b V %? 5 T daU aV T RSSRPa S ?
Chapter 75 Pituitary hormones and their control by the hypothalamus
x ? aV b NaR PN aV NTR)O R T daU
y ? N Q Na RQV
HRTb NaV S ? 5 b NaV R& T bP R)SRRQV T
H R S f U)? H )? A
4. Posterior Pituitary Gland and hypothalamus
FUf V TVPN >b PaV S 9<
HRTb NaV S 9< QbPaV
u A P RN RQ ;> E k 9< l
v d O Q c b R) R b R k 9< l
aV b NaR 9< RP RaV
Eefa PVP U R
u Eefa PV PNb R P a NPaV S aUR
RT N a baR b
v Eefa PV NVQ V V RWRPaV Of aUR O RN a
5. Hypothyroidism
F R R aNaV N Q QVNT V 5 QRSVP( (
BNO V cR aVTNaV 5 a UVP m& N TRa m
RNa R a5 QRSVP( (
6. Anterior Pituitary tumor syndrome
cN bNaV S R N N R
CNT RaVP HR N PR V NTV T
E aUN TVP RcNb NaV
BNO( V cR aVTNaV Sb PaV N NQR N8
FVa( NQR N N Q Uf R RP RaV f Q R
u ?VTN aV v 9P RTN f
e( S Uf aUN N VP& VabVaN f& R N N R
u Ib TVPN v HNQVNaV w CRQVPN
7. Deficiencies of AVP secretion and action
<VNORaR A V VQb

Hypothalamus
① TRH (thyrotropin-releasing hormone)5
aV b NaR TSH N Q NPaV RP RaV
② CRH (corticotrpin-releasing hormone); PNb R
ACTH R RN R
③ GHRH (growth-hormone-releasing hormone)5
PNb R GH R RN R
④ GHIH (growth-hormone-inhibitory hormone)5
V UVOVa GH R RN R
⑤ GnRH (gonadotropin-releasing hormone)5
PNb R LH/FSH R RN R
⑥ Dopamin or prolactin-inhibiting factor; V UVOVa
prolactin R RN R
Anterior pituitary
① GH (growth hormone)5 aRV f aUR V &
cR N T daU
② TSH5 aV b NaR f aUR V S thyroid hormone
③ ACTH5 aV b NaR f aUR V S adrenocortical
hormone
④ Prolactin5 aR QRcR R a S SR N R
O RN a) RP RaV S V
⑤ FSH5 PNb R T daU S S VP R V cN VR N Q
R Nab NaV V R a V PR S aR aR
⑥ LH; aV b NaR aR a aR R f aUR V V BRfQVT
PR S aR aR 5 cb NaV & P b baRb
S NaV & R a TR ) TR aR R f (
Posterior pituitary
① ADH (antidiuretic hormone, vasopressin)5
V P RN R dNaR RNO aV Of VQ Rf& PNb R
cN P a VPaV & V P RN R :F
② Oxytocin5 V b NaR V RWRPaV S O RN a
N Q baR V R P a NPaV
1. Pituitary gland and its relation to the hypothalamus

FVabVaN f T N Q Uf Uf V & + P (/ +T (
R N ab PVPN & Uf aUN N b VabVaN f Uf Uf RN aN → (
→ N aR V VabVaN f NQR Uf Uf V aR V VabVaN f Rb Uf Uf V →
“
N V aR RQVN (

→ anterior pituitary는 Ranthke’s pouch R O f VP V cNTV NaV S aUR
UN f TRN R VaUR Vb & posterior pituitary Uf aUN N b neural tissue
의 outgrowth에서 유래 (
& ant. pituitary는 epitheloid한 특성을 지니며 (adenohypophysis)& post. pituitary는
neural tissue의 특성을 지닌다 (neurohypophysis).

9 aR V VabVaN f T N Q i N aR T N Qj→ 
( Uf aUN N b  
R Q P V R T N Q (
- Anterior pituitary gland에서 분비되는 호르몬
ⓐ GH R aV R O Qf T daU aR( aRV  
S NaV & PR b aV VPNaV & QVSSR R aVNaV
ⓑ ACTH (adrenocorticotropin) NQ R P aVPN  
U R k RaNO V
ⓒ TSH (thyroid-stimulating hormone)  
-) . NaR S RP RaV k 
a V a NPR b N PUR VPN RNPaV NaR
ⓓ PRL (prolactin) N N f T ( QRcR R a  
V QbPaV
ⓔ FSH (follicle-stimulating H.)/LH (luteinizing H.)  
cN f aR aR T daU

- Posterior pituitary gland에서는 분비되는 호르몬
ⓐ Antidiuretic hormone (vasopressin) b V R → dNaR ReP RaV NaR
O Qf S bVQ dNaR P PR a NaV ( cR R P a VPaV (
ⓑ Oxytocin bP V T V R→ O RN a T N Q V Re R (
baR V R P a NPaV QR VcR f (

① Anterior pituitary gland contains several different cell types that synthesize H
N aR V VabVaN f T N Q / (
u I Na a R - . ?
v ; aVP a R , 9;
w Uf a R I x ? NQ a R >I )B y BNPa a R FHB
Na a R NPa a R a T NPVQ UV & P aVP a R)aUf a R)
T NQ a R ON UV

② Posterior pituitary hormones are synthesized by cell bodies in the hypothalamus
aR V VabVaN f U R PR O Qf a( VabVaN f T N Q
& NT PR b N Rb → hypothalamus의 supraoptic/paraventricular nuclei
에 존재 (
a( VabVaN f U R Uf aUN N b a( VabVaN f T N Q→ R cR SVOR
a N aRQ (

FVabVaN f ( Uf aUN N b U R& R c b VT N (
- Post. Pituitary의 secretion은 hypothalamus에서 originate하는 nerve signal에 의해
- Ant. Pituitary의 secretion은 hypothalamic releasing/inhibitory hormones (factor)에 의해 조
절되며, hypothalamic-hypophysial portal vessel을 통해 전달 (
f aUN N b R c b f aR VT N (
f aUN N b V aR N dR ORV T S aUR O Qf V S NaV PR aR

① Hypothalamic-Hypophysial portal blood vessel of Ant. pituitary gland
9 a( FVabVaN f T UVTU f cN Pb N T N Q
IV b → k RQVN R V R PR→ dR Uf aUN N b
PN V N f ORQ→ k Uf aUN N VP Uf Uf VN aN O Q cR R → (
② Hypothalamic releasing/inhibitory H. are secreted into the median eminence.
f aUN N b RPVN VgRQ Rb hypothalamic releasing/inhibitory hormone을
secrete (
Rb Uf aUN N b  
VTV NaR median eminence와 tuber cinereum 
→ R cR SVOR k Hypothalamic releasing 
/inhibitory hormone을 분비 k hypothalamic- 
hypophysial portal system 으로 흡수 k 
ant. pituitary gl.의 sinus로 이동.
bOR PV R Rb

③ Hypothalamic releasing/inhibitory H controls ant. pituitary secretion
R RN V T)V UVOVa f ( N a( VabVaN f ( (
R RN V T ( NPaV V UVOVa f (
- Hypothalamus에서 hypothalamic-hypophyseal portal system으로 분비되는 호르몬
ⓐ TRH (Thyrotropin-releasing H.); release of TSH (thyroid-stimulating H.)
ⓑ CRH (corticotropin-releasing H.); release of adrenocorticotropin
ⓒ GHRH (growth H.-releasing H.); release of GH, GHIH (growth hormone-inhibitory
hormone, somatostatin)
ⓓ GnRH (gonadotropin-releasing H.); release 
gonadotropin H. (LH/FSH)
ⓔ PIH (prolactin inhibitory H.); inhibit PRL secretion
④ Specific areas in the Hypothalamus control 
secretion of specific Hypothalamic releasing 
and inhibitory hormones
Uf aUN N VP ( RQVN R V R PR 
R cR R QV T RP RaRQ
R cR PR O Qf Uf aUN N b  
ON N O NV
RPVSVP PV (

Growth H을 제외한 ant. pituitary H.은 target gland를 자극한다  
R(T( aUf VQ T (& NQ R N P aRe& cN VR & aR aR & N N f T (
GH는 이들과는 달리 일정한 target organ 없이 우리 몸의 대부분의 조직에 작용한다.
① GH promotes growth of many body tissues
? & Na a VP (& Na a V
+3+ N(N(& CM( ,,& /
T daU (
세포의 크기의 증가, mitosis의 증가, 세포들의 development와 differentiation
>VT( 1/ /5 ? V WRPa Na (

② GH has several metabolic effects

? T daU RaNO VP RSSRPa (
- GH는 대부분의 세포에서 protein synthesis의 rate를 증가시키고,
- adipose tissue에서 fatty acid이 mobilization을 일으켜서 혈중 free fatty acid를 증가시키며,
- 에너지로 fatty acid의 사용을 증가시키며, glucose utilization을 감소시킨다.
→ GH는 body protein을 증가시키고, fat store를 사용하며, glucose/carbohydrate를 보존한다.

Basic Metabolism
Glucose-6-P
ATP→ADP glucose-6
phosphatase
1,6-
bisphosphatase
ATP→ADP
(2) NAD→NADH
(2) ADP→ATP
(2) ADP→ATP
ATP→ADP
GTP→ADP
(2) ATP → ADP
(2) NADH→NAD
Glycolysis
Gluconeogenesis
Glucose
Fructose-6-P
Fructose-1,6-bisP
Dihydroxyacetone-PDihydroxyacetone-P
Glyceraldehyde-3-P
1,2-bisphosphoglycerate
3-phosphoglycerate
Phosphoenolpyruvate
Oxaloacetate
Pyruvate
Glycogenesis
Glycogenolysis
Glucose-6P
Glucose-1P
UDP-glucose
Glycogen
Glucose
NAD→NADH
NAD→NADH
NAD→NADH
GDP→ GTPQ→QH2
NAD→NADH
ATP→ADP
Kreb’s
Cycle
Acetyl-CoA
Citrate
Aconitate
D-Isocitrate
α-ketoglutarate
Succinyl-CoA
Succinate
Fumarate
Malate
Oxaloacetate
Pyruvate
Acetoacetate
Acetoacetyl-CoA
β-Hydroxybutyrate
Acetyl-CoA
Triglyceride
Carnitine
transport
β-oxidation
Acyl-CoA
2,3, Enoyl-CoA
3-Hydroxyacyl-CoA
3-Ketoacyl-CoA
CoAShortened
acyl-CoA
Free Fatty acid
Glycerol
HMG-CoA
Acetoacetate
β-Hydroxybutyrate
Acetone
KetogenesisLipolysis
Acetyl-CoA
Manoyl-coA
Fattyacid
synthesis
Lipogenesis
Amino
acids
Amino
acids

Basic Metabolism
Glucose Amino acids
Amino acids
Gluconeo 
genesis
Triglyceride
Lipolysis
Lipogenesis
Amino acids
Amino acids
Protein
Protein
Catabolism
Protein
Synthesis
PyruvateGlycolysis
Protein
Catabolism
Protein
Protein
Synthesis
Glucose
Glycogen
Glycogenesis
Glycogenolysis
Fattyacidsynthesis
TCA cycle
(Energy)
Pyruvate
metabolism
Acetyl-CoA
TCA cycle
(Energy)
β-oxidation
Acetyl-CoA
Glycolysis
Glucose
Glucose
Glucose-6-P
Pyruvate
Acetyl-CoA
TCA cycle
(Energy)
Glucose
Glucose
Glycogenesis
Glucose-6-P
Pyruvate
Acetyl-CoA
Glycolysis
Glycogen
Glycogenolysis
TCA cycle
(Energy)
Free Fatty acid
Monoglyceride
Triglyceride
Fatty
acid
Fatty
acid
β-oxidation
Lipogenesis
Fatty acid
Triglyceride
Glucose concentration의 tight control이 필요한 이유
① Brain의 주된 energy source가 glucose
② High glucose concentration은 complication을 일으킨다.
Glucose-6-P
Glycolysis
Gluconeo 
genesis
Glycerol
Fatty acidGlucose

Postprandial
Pyruvate
Amino acids
Amino acids
Glucose
Glucose-6-P
Glycogen
Glycerol
Triglyceride
Glycolysis
Gluconeo 
genesis
Lipolysis
Lipogenesis
Amino acids
Amino acids
Protein
Protein
Catabolism
Protein
Synthesis
Glycolysis
Free Fatty acid
Monoglyceride
β-oxidation
Protein
Protein
Catabolism
Protein
Synthesis
Glucose
Glucose
Glucose
Fatty acid
Glycogenesis
Glycogenolysis
Pyruvate
metabolism
Glucose
Glucose-6-P
Pyruvate
Acetyl-CoA
Fattyacidsynthesis
Glycolysis
Glycogenesis
Glucose-6-P
Pyruvate
Glycolysis
Glycogen
Glycogenolysis
Lipogenesis
Fatty acidTCA cycle
(Energy)
Acetyl-CoA
TCA cycle
(Energy)
Acetyl-CoA
TCA cycle
(Energy)
TCA cycle
(Energy)
Fatty
acid
Fatty
acidTriglyceride
β-oxidation
InsulinFood stuff Glucose
Triglyceride
Acetyl-CoA
Glucose Glucose

Fasting
Glucose
Pyruvate
Amino acids
Amino acids
Glucose
Glucose-6-P
Glycogen
Glycerol
Triglyceride
Glycolysis
Gluconeo 
genesis
Lipolysis
Lipogenesis
Amino acids
Amino acids
Protein
Protein
Catabolism
Protein
Synthesis
Glycolysis
VLDL LDL
Phospholipid
Cholesterol
β-oxidation
Ketogenesis
Protein
Protein
Catabolism
Protein
Synthesis
Glucose
Glucose
Glucose
Insulin
Fatty acid
Glycogenesis
Glycogenolysis
Pyruvate
metabolism
Glucose
Glucose
Glucose-6-P
Pyruvate
Acetyl-CoA
Fattyacidsynthesis
Glycolysis
Glycogenesis
Glucose-6-P
Pyruvate
Acetyl-CoA
Glycolysis
Glycogen
Glycogenolysis
Lipogenesis
Triglyceride
Fatty acidTCA cycle
(Energy)
TCA cycle
(Energy)
Acetyl-CoA
TCA cycle
(Energy)
TCA cycle
(Energy)
Fatty
acid
Fatty
acidTriglyceride
Food stuff Glucose
β-oxidation
Gluconeo 
genesis
Ketone
body
Acetyl-CoA

ⓐ GH promotes protein deposition in tissues
p UN PR R a S N V NPVQ a N a aU bTU PR R O N R
q UN PR R a S HD9 a N NaV a PNb R aRV f aUR V Of VO R
r A P RN RQ bP RN a N P V aV S <D9 a S HD9
t <RP RN RQ PNaNO V S aRV N Q N V NPVQ
Amino acids
Transcription
DNA
mRNA
Ribosome
Amino acids Protein
Growth Hormone
Protein Synthesis
AA uptake
Protein catabolism
Translation

N V NPVQ b aN R & aRV f aUR V & aRV O RN Q d
㉠ Enhancement of amino acid transport through cell membrane
? N V NPVQ a N a (
” N V NPVQ P PR a NaV & aRV f aUR V
A b V NN a N a
㉡ Enhancement of RNA translation to cause protein synthesis by ribosome
? VO R HD9 a N NaV aRV
Amino acids
Transcription
DNA
mRNA
Ribosome
Amino acids Protein
Growth Hormone
Protein Synthesis
AA uptake
Protein catabolism
Translation

㉢ Increased nuclear transcription of DNA to form RNA
F TRQ R V Q ,. .2 U ? bP Rb <D9 a N P V aV
HD9 k aRV f aUR V
㉤ Decreased catabolism of protein and amino acid
? aRV f aUR V aRV O RN Q d (
? NQV R aV bR→ SNaaf NPVQ OV VgR →
→ aRV O RN Q d (
Amino acids
Transcription
DNA
mRNA
Ribosome
Amino acids Protein
Growth Hormone
Protein Synthesis
AA uptake
Protein catabolism
Translation

ⓑ GH enhances fat utilization for Energy
Adipose tissue에서 fatty acid의 release를 유도 k O Qf S bVQ S RR SNaaf NPVQ
P PR a NaV (
fatty acid를 acetyl-CoA로의 conversion을 증가 k 에너지로 사용
GH에 의해서 carbohydrate/protein 대신 fat을 에너지로 쓰게 된다(
fat utilization과 protein anabolic effect는 lean body mass를 증가 (
•Ketogenic effect of excessive GH
RePR VcR ? adipose tissue에서 fat mobilization↑ k liver에서 acetic acid
(Ketone body)의 생성↑ → ketosis
9QV R aV bR SNa RePR VcR OV VgNaV fatty liver (
Fatty acid Acetyl-CoAFatty acid
Glycerol
Triglyceride
Lipolysis β-oxidation
TCA cycle
(Energy)
Fatty acid
Acetyl-CoA
Ketone
body
Ketone
body
Ketogenesis
Free FA
VLDL LDL
Phospholipid
Cholesterol

ⓒ GH decreases carbohydrate utilization
? skeletal muscle과 fat에서 glucose uptake를 억제 & liver에서 glucose
production을 증가 k insulin secretion의 보상성 증가
insulin의 역할 T bP R b aN R )b aV VgNaV & VcR T bP R TR R V
과 정반대5 GH ↑인 경우는 type II DM 환자와 동일한 metabolic disturbance 5
diabetogenic, insulin resistance를 증가
? V b V R V aN PR & ? O Q SNaaf NPVQ
P PR a NaV → O Q SNaaf NPVQ P PR a NaV
VcR ) R RaN b P R V b V R VaVcVaf
Glycerol
Triglyceride
TCA cycle
(Energy)
Fatty acid
Acetyl-CoA
Ketone
body
Ketone
body
Ketogenesis
Glucose
Glucose
Gluconeo 
genesis Insulin
Glucose
Free FA
VLDL LDL
Phospholipid
Cholesterol

ⓒ GH decreases carbohydrate utilization
㉠ GH의 성장효과에는 insulin과 carbohydrate가 필요하다.
N P RN PN O UfQ NaR QVRa ?
T daU k V b V )PN O UfQ NaR ? T daU aV T
RSSRPa 5 & ? & V b V
Glycerol
Triglyceride
TCA cycle
(Energy)
Fatty acid
Acetyl-CoA
Ketone
body
Ketone
body
Ketogenesis
Glucose
Glucose
Gluconeo 
genesis Insulin
Glucose
Amino acids
Amino acids
Transcription
mRNA
Ribosome
Protein Synthesis
Translation
Free FA
VLDL LDL
Phospholipid
Cholesterol

ⓓ GH stimulates cartilage and bone growth
GH는 skeletal frame의 증가를 가져온다(
? k PU Q PfaVP& aR TR VP PR aRV QR VaV k R QbPaV NaR &
PU Q PfaR aR TR VP PR → P cR V k Rd O R QR VaV
? k aR P N a NPaVcVaf R aV
GH에 의한 deposition > resorption이므로 결과적으로 bone의 thickness가 증가

ⓓ GH stimulates cartilage and bone growth
? O R T daU
? aV b NaV T O R epiphyseal cartilage에서 length의 growth
k → PN aV NTR QR VaV k P cR V V a Rd O R k UNSa
R TNaV → R V Uf V k R V Uf RN PN aV NTR
→ & UNSa R V Uf V O Qf Sb V
T O R (

ⓔ GH exerts much of its effect through intermediate substance “somatomedins”
I Na RQV & V b V V R T daU SNPa
? → PN aV NTR PU Q PfaR → &
PU Q PfaR R N TR R a ( ” V aNPa N V N ?
PU Q PfaR VSR NaV T daU (
이는 GH가 liver에서 somatomedin이라 불리우는 small peptide의 분비를 증가시키고, 이러
한 somatomedin은 bone growth를 증가시키기 때문.
Na RQV V b V T daU V b V V R T daU
SNPa A?> (
㉠ Short duration of action of GH but prolonged action of somatomedin C
? N N aRV NaaNPU ( aV bR→ →
& UN S VSR , ( somatomedin C는 carrier protein에 강
하게 부착되므로 half-life가 20시간에 다다르며 growth H의 growth-promoting effect
를 강화시켜준다.
Growth
Hormone
Somatomedin Chondrocyte proliferation,
growth

③ Regulation of GH
GH는 pulsatile pattern으로 분비 (
? aN cNaV & Uf T fPR VN) d P PR a NaV S SNaaf NPVQ&
ReR PV R& RePVaR R a& a Nb N& TU R V a NPU RN 5
O Q T bP R RcR ) RaNO V
? +(0 - T) 5 0 T)
F TRQ aN cNaV & aRV )PN O UfQ NaR /
T) ( N ba VaV ?

④ Role of the hypothalamus, GHRH, GHIH (somatostatin) in the GH secretion
- GHRH (growth H. releasing hormone), GHIH (growth H. inhibitory hormone,
somatostatin); polypeptides
Feeding instinct를 조절하는 부위가 GH secretion을 조절 (
GHRH Uf aUN N b ventromedial nucleus ( blood glucose
concentration을 sensing →& Uf R T fPR VP aNaR NaVRaf Uf T fPR VP
P QVaV Ub TR (
GHIH (somatostatin) hypothalamus의 주변부에서 생성 (
GHRH GHIH
GH
Ventromedial
Nucleus
Hypothalamus의
주변부

④ Role of the hypothalamus, GHRH, GHIH (somatostatin) in the GH secretion
Emotion, stress, trauma k Uf aUN N VP VT N k ?
GH의 조절은 대게 somatostatin보다는 GHRH에 의해 (
? H VabVaN f T N Q T daU U R QbPV T PR
cAMP level을 증가 → PN PVb V k ? RP Ra f cR VP R R O N R Sb V
k ? R RN R& T aR → ? a N P V aV f aUR V (
- GH를 동물에 주사하면 GH secretion이 감소한다; direct negative feedback
GHRH GHIH
GH
Ventromedial
Nucleus
Hypothalamus의
주변부

- Neurohypophysis. pituicyte라 불리우는 glial-like cell로 구성되어 있다.
VabVPfaR & b N aVP) N NcR a VPb N bP RV
aR V N R cR SVOR aR V N R cR R QV T “ ↓ (
nerve fiber들은 pituitary stalk (hypophysial stalk)를 통해 neurohypophysis로 들어오며,
두가지 post. pituitary H.를 분비한다 (antidiuretic hormone (ADH), vasopressin, arginine
vasopressin (AVP); oxytocin)
VabVaN f aN VabVaN f T N Q Uf aUN N b
( paraventricular nucleus (oxytoxin), supraoptic nucleus (ADH)에
서 만들어져서 axon을 따라 neurophysin이라고 하는 carrier protein을 통해 이동되어서 분비되기
때문에, stalk이 잘리더라도 생성에는 큰 문제가 없기 때문 (
9< efa PV N V NPVQ  
“ UR f N NV R N TV V R V RbPV  
RbPV → (

① Physiological Function of antidiuretic hormones
ADH (AVP); kidney에서 water의 excretion을 억제한다 (이뇨, antidiuresis)
1 T → VQ Rf ↑ +2 o N N SV a NaV ( 2
eV N abOb R DN% RNO O & . / R Rh RNO O (
AVP는 collecting tubule에서 이러한 water의 reabsorption ( 9LF P RPaV T
QbPa V PV N PR L, RPR a ?F;H OV QV T k P9CF RcR V P RN R k
a N PNaV S N bN V 9GF , a R O N R k 9GF dNaR R→
V P RN RQ R RNOV Vaf a dNaR
- 결과적으로 ADH에 의한 water reabsorption → 혈중 osmolarity를 감소

② Regulation of antidiuretic hormone production
ⓐ Increased extracellular fluid Osmolarity stimulates ADH secretion
- 혈중의 osmolarity가 증가 → supraoptic paraventricular nuclei의 ADH neuron의 자극 →
post. pituitary gland에서 ADH의 분비
- 반대로 혈중 osmolarity의 감소 → ADH 분비가 멈춘다.
N Vaf Uf aUN N b RPR a QVSVRQ
Rb NTN b cN Pb b & - Q cR a VP R (
Rea NPR b N S bVQ P PR a NaV  
k RPR a PR S bVQ  
k k Uf aUN N b  
9< RP RaV R cR VT N ( 
→ Rea NPR b N S bVQ QV baR  
k → → dNaR k  
k 9< RP RaV (

② Regulation of antidiuretic hormone production
ⓑ Low blood volume/pressure simulate ADH secretion (vasoconstrictor effect)
높은 농도의 ADH (AVP)는 arteriole의 constriction을 일으켜서 arterial pressure를 높이는
효과 ( vasopressin이라 명명됨
- blood pressure의 인지는 carotid, aortic, pulmonary region에 존재하는 baroreceptor를
통해서 이루어진다.
O Q c b R k a RaPU RPR a k 9< RP RaV
O Q c b R k R NeNaV S ON RPR a k O NV 9<
RP RaV

③ Oxytocic hormone
ⓐ Oxytocin causes contraction of the pregnant uterus
Eefa PV RT N a baR b P a NPaV 5 QR VcR f ’
Uf Uf RPa VgRQ N V N Qb NaV S NO ’ &
NO efa PV & RT N a N V N PR cVe
efa eV (

③ Oxytocic hormone
ⓑ Oxytocin aids in milk ejection by the breasts
Eefa PV NPaNaV (
IbP V T aV b b aUR V R k VT N a N V V aU bTU R f  
R cR a efa PV Rb V aUR N NcR a VPb N ) b N aVP bP RV k  
R RN R S efa PV S a( VabVaN f  
T N Q( k PN VRQ V aUR O Q a aUR  
O RN a k PNb R P a NPaV S f R VaUR VN PR  
S V T NaaVPR d b b QV T aUR N cR V  
S N N f T N Q k V ORTV a S d

5. Hypopituitarism
- 충분하지 못한 ant. pituitary hormone → panhypopituitarism
V UR VaRQ QV QR ab VabVaN f T N Q P R V &
PN VabVaN f)Uf aUN N VP a Nb N)V S N NaV )cN Pb N QN NTR (

5. Hypopituitarism
① Presentation and diagnosis
Uf VabVaN V (
- GH deficiency; growth disorder in children
Gonadotropin deficiency5 R a bN QV QR & V SR aV Vaf& 
QRP RN RQ RebN Sb PaV & S RP QN f RebN  
PUN NPaR V aVP
TSH deficiency5 T daU RaN QNaV & Uf aUf VQV
ACTH deficiency5 Uf P aVP V & P R cRQ V R N  
P aVP VQ
Prolactin deficiency5 SNV b R S NPaNaV
Post. pituitary에 lesion 9< m k fb VN&  
fQV VN

5. Hypopituitarism
① Presentation and diagnosis
Dwarfism;
QdN SV NPU Q N VN QdN SV 1 (
- Ant. pituitary secretion의 감소 (panhypopituitarism)
( dwarfism은 대부분 puberty로 넘어가지 못하며, gonadotropic hormone의 감소로
adult sexual function을 보이지 못한다( +)- ?
R QbPaV (
4 NPU Q N VN
→ 4 N Uf VabVaN V

5. Hypopituitarism
② Laboratory investigation
BNO SV QV T respective pituitary trophic hormone의 감소 target hormone의 감소
를 확인 (
R(T(& I m)S RR aUf eV R m
R a S VabVaN f bSSVPVR Pf5 H aR a 7 VabVaN f I k -) .
③ Treatment
U N R NPR R a aUR N f V P bQV T T bP P aVP VQ&  
aUf VQ U R& Re aR VQ& T daU U R& cN R V
aN TRa U R ae(
FVabVaN f
Uf Sb PaV
f aUN N b
Uf Sb PaV
N TRa TN
Uf R Sb PaV
FVabVaN f
f R Sb PaV
f aUN N b
Uf R Sb PaV
f aUN N b ↑ ↓ ↓ ↓ ↑
FVabVaN f T N Q ↓ ↓ ↓ ↑ ↑
N TRa TN ↓ ↓ ↑ ↑ ↑

5. Hypopituitarism
③ Treatment
T daU U R → & dR N V N T daU
U R Ub N (
T daU U R Ub N VabVaN f T N Q & ”
RP OV N a <D9 aRPU Tf ( ; V
→ (
Fb R T daU U R QRSVPVR Pf QdN S T daU U R →
(

f aUN N VP& VabVaN f& aUR R N N R
① Evaluation of sellar masses
NQR N R N R V P V VPN N VSR aNaV
FVabVaN f NQR N b N R N QV RPaV → ReaR Q (
→ NQR N
- 호르몬은 tumor의 분화 정도, tumor 성장에 따라 눌리는 주변 구조물에 따라서 증가/감소
Adenoma의
종류에 따른
호르몬 분비
(pituitary H)
Tumor 성장에 따른
주변 구조물의 defect

② Magnetic Resonance imaging
CHA Uf aUN N b & VabVaN f aN & VabVaN f aV bR b N R N PV aR “ &
PNcR b V b & UR VQ V b & aVP PUVN “

② Magnetic Resonance imaging

③ Opthalmologic evaulation
Re N QV T VabVaN f N k aVP PUVN P R V k cV bN SVR Q aR a N VN
QRSRPa V cV bN SVR Q & OVaR N UR VN VN& O V Q R (
;N cR b V b V c cR k aUN RTVN  
dVaU)dVaU ba a V & QV VN & SNPVN b O R

④ Laboratory Investigation
FVabVaN f NQR N VTV U R )
& VabVaN f NQR N (
+). b b RPaRQ VP NQR N 6+ & VabVaN f
V NTV T VabVaN f R V QRaRPa +
→ R RN R U R (

⑤ Pituitary adenoma and hypersecretion syndrome
•Gigantism
NPVQ UV VP& T daU U R QbPV T PR NPaVcR ab
Bone을 포함한 대부분의 조직이 빠르게 자라며, 키가 매우 큰 특징 (
Hyperglycemia를 보이게 되는 경우가 많으며, 결국 diabetes mellitus→ (
치료를 하지 않을 경우 대부분의 경우 panhypopituitarism → (
” TVTN aV pituitary tumor에 의하며, 종양이 
성장하면서 gland 자체가 파괴 k VP b TVPN  
R cN )V NQVNaV

⑤ Pituitary adenoma and hypersecretion syndrome
•Gigantism
•Acromegaly
O R aUVP & Sa aV bR T daU URR NQ & )
& & Uf R UVQ V & U d& EV f V &
& eV N b P R dRN R & 9PN aU V VT VPN &
& cV PR RTN f& PN QV RTN f
; N f URN a QV RN R& PN QV f NaUf dVaU N UfaU VN & RSa cR a VPb N
Uf R a Uf& QRP RN RQ QVN a VP Sb PaV & Uf R aR V & b R NV dNf O a bPaV
dVaU RR N RN& QVNORaR R Vab

⑥ Treatment of hypothalamic, pituitary, and other sellar masses
u N UR VQN b TR f5 NQR Na b N Q N VabVaN f aV bR cV bN QV aV PaV
N QV RPa (
v HNQVNaV
w CRQVPN 5 QR R Q ab af R

7. Deficiencies of AVP secretion and action
① Diabetes Insipidus
9< <VNORaR V V VQb <A& (
,.U b V R c b R 7 / n) T& N Vaf 6 - E )o
V N f S R bR Pf& Pab VN& fQV VN5 fQV VN P V VPN VT S QRUfQ NaV
(
ⓐ Etiology
F V N f QRSVPVR Pf S 9< VabVaN f <A& Rb TR VP <A& PR a N <A 5  
NTR R V )V RcR VO R QR a bPaV S Rb Uf Uf V & TR RaVP& a Nb N
DR U TR VP <A5 Q bT V QbPRQ& TR RaVP
IRP QN f QRSVPVR Pf S 9< 5 V N f fQV VN
ⓑ Pathophysiology
: Qf dNaR m& N N N Vaf l& N N QVb l k aV b NaR aUV a N Q N
P R Na f V P RN R V dNaR V aN R5 Uf R Na R VN)P V VPN VT S
QRUfQ NaV
ⓒ Treatment
f aURaVP 9LF

⑤ 내분비 Pituitary hormones and their control by hypothalamus

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⑤ 내분비 Pituitary hormones and their control by hypothalamus