INTRODUCTION TO ENDOCRINOLOGY FOR CLINICAL STUDENTS A.E. OHWOVORIOLE DEPT OF MEDICINE.

UNIVERSITY OF LAGOS NIGERIA OUTLINE Definition of endocrinology Chemical messengers Structure of the endocrine system Structure 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 DEFINITION Endocrinology Study of communication Control within living organisms Chemical messengers synthesized in whole or in part by the organism METABOLISM SYSTEM OPERANDS CHEMICAL MESSENGERS: 1st Or 2nd Messengers Hormones Mediate intracellular and intercellular communications Structure of ES ENDOCRINE ORGANS Non-organic continuity cf CVS or NS Components Diffuse ES: skin, GIT, ND Discrete ES: Ant Pituitary, Thyroid etc Most organs or tissues possess endocrine function Cf Heart, Kidney, Fat cells HORMONES 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 metaboli tes Fatty Acid Derivatives Prostaglandins, leukotrienes, thromboxane

COMMUNICATION IN THE ENDOCRINE SYSTEM COMMUNICATION IN THE ENDOCRINE SYSTEM Autocrine: cell to self, self-regulation Paracrine: cell to its neighbour cell , direct or interstitial Lumocrine or Solinocrine: Gastrin, VIP, serotonin, secretion etc Neurocrine: specialized autocrine communication Synaptic or non-synaptic (neurosecretion)- ADH, Oxytocin Haemocrine: Traditional endocrine communication Multiple communication mechanisms FUNCTIONS OF THE ES FUNCTIONS OF THE ES: FOUR MAIN DOMAINS FUNCTIONS OF THE ES Collaborative Function: SOME ENDOCRINE CONCEPTS AND PRINCIPLES SOME ENDOCRINE CONCEPTS AND PRINCIPLES Hormone synthesis: transcription and translation Prohormones Hormone Storage Hormone Release: role of calcium Hormone Transport: Concept of free hormones Carrier proteins for bound hormones [H]x[P]/[HP] [H]x[P]/[HP] = K ENDOCRINE CONCEPTS AND PRINCIPLES PATHOGENSIS OF ENDOCRINE DISEASE OR ENDOCRINOPATHIES Organ hypofunction Hormone 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 Principles of : Ag, Ab, Labels, Signal reader The History of RIA

The history of EIA Cf of RIA vs ELISA *Nobel Laureate ENDOCRINE DIAGNOSIS : Microscopic Diagnosis Histology of tissues, biopsies Cytology 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 colchicine Examples of abnormalities: Monosomy X (45 X or X0): Turner s 47XXY : Klinefelter s syndrome Mosaics . ENDOCRINE EVALUATIONMetabolic and Immunological tests: 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 Iodine-123, iodine-131 Bones 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