Download - Endokrin 1 Kuliah XX
Pemeriksaan Laboratorium Gangguan Sistim Endokrin
Dr. D.A.A.MandagiBagian Patologi Klinik
FK UNSRAT
TIU / TIK
TIU : Mengenal beberapa pemeriksaan laboratorium pada gangguan endokrin.
TIK :1. Dapat mengenali beberapa pemeriksaan
laboratorium pada gangguan endokrin.2. Dapat mengenali metoda pemeriksaan laboratorium
pada gangguan endokrin.3. Dapat mengenali faktor pra-analitik pemeriksaan
laboratorium pada gangguan endokrin.
Cell Signaling
• Endocrine Signaling• Neuroendocrine Signaling • Autocrine Signaling• Paracrine Signaling• Juxtacrine Signaling
ENDOCRINE GLANDS
• Hypothalamus• Pituitary / Hypophysis• Thyroid• Parathyroid• Pancreas• Adrenal• Ovary• Testes
Hormone Classification
1) Proteins / Polypeptides2) Steroids3) Amino Acids Derivatives
Hypothalamus(Neuroendocrine)
Hormone Action Site Action
TRH Anterior Pituitary TSH (PRL) ReleaseGnRH Anterior Pituitary FSH / LH ReleaseCRH Anterior Pituitary ACTH Release
GHRH Anterior Pituitary GH ReleaseGHIH Anterior Pituitary Inhibition of many hormonesADH ---- ----
Oxytocin ---- ----
Hypothalamus(Neuroendocrine)
• TRH• GnRH• CRH• GHRH• GHIH (Somatostatin =
SS)• ADH / Vasopressin• Oxytocin
Anterior PituitaryAdeno-Hypophysis
Hormone Action Site Action
TSH Thyroid Formation / Secretion of Thyroid Hormones
FSH Ovary Follicle Growth, Estrogen Secretion, OvulationTestes Spermatogenesis, Develop. Tubul. Seminiferi
LH Ovary Ovulation, Corpus Luteum, Progesteron Sec.Testes Androgen Secretion, Stim. Interstitial Tissue
PRL Mammary Glands Proliferation of M. Glands, Milk Secretion
GH Liver Production of IGF-1 (Promoting Growth)Liver / Peripherals Anabolic / Anti-Insulin
ACTH Adrenal Cortex Stimulation of Adrenocortical Steroids Formation and Secretion
Alfa-MSH Skin Darkning of Skin
Anterior PituitaryAdeno-Hypophysis
• TSH / TSHs• FSH• LH• PRL• GH / Somatotropin
– IGF-1– ITT / OGTT
• ACTH / Corticotropin• Alfa-MSH
Posterior PituitaryNeuro-Hypophysis
Hormone Action Site Action
ADH / Vasopressin
Arteriole Blood Pressure Elevation
Renal Tubules Water ReabsorptionOxytocin Smooth Muscles
(Uterus / Mammary)Contraction; Action in Parturition; Sperm Transport; Ejection of Milk
Posterior PituitaryNeuro-Hypophysis
• ADH / Vasopressin– Osmolality
• Direct (Measured)• Indirect (Calculated)
– Water Deprivation Test– Arginine Vasopressin
• Oxytocin
Thyroid / Parathyroid
Hormone Action Site Action
T4 / T3 General Body Tissue Stimulation of Oxygen Consumption and Metabolic Rate
Calcitonin Skeleton Decreased Bone ResorptionPTH Kidney Increased Ca Reabsorption / Decreased
PO4 ReabsorptionSkeleton Increased Bone Resorption
Thyroid / Parathyroid
• THYROID :– T4 / Thyroxine– T3 / Triidothyronine– fT4– fT3– Calcitonin
• PARATHYROID :– PTH
PancreasIslets of Langerhans
Hormone Action Site Action
Insulin Liver, Fat, Muscle Regulation of CBH Metabolism; Lipogenesis
Glucagon Liver GlycogenolysisSomatostatin
(GHIH)Pancreas Inhibition of Secretion of Insulin /
Glucagon.
PancreasIslets of Langerhans
• Insulin• Glucagon• Somatostatin
Adrenal Cortex
Hormone Action Site Action
Aldosterone Kidney Salt and Water Balance
Cortisol Many Metabolism of CBH, Fat, Protein; Antiinflammatory Effect.
“DHEA(S)” Hormone Precursor Converted to Estrogen / Testosterone
Adrenal Cortex
• Mineralocorticoids– Aldosterone
• Glucocorticoids– Cortisol
• Androgens– DHEA / DHEAS– Testosterone / Estrogen
Adrenal Medulla
Hormone Action Site Action
Norepinephrine; Epinephrine
Sympathetic Receptor
Stimulation of Sympathetic Nervous System.
Epinephrine Liver, Muscle GlycogenolysisAdipose Tissue Lipolysis
Adrenal Medulla
• Epinephrine• Norepinephrine
OvariumFollicle / Corpus Luteum
Hormone Action Site Action
Estrogen Female Accessory Sex Organ
Development of Secondary Sex Charcteristic
Bone Control of Skeletal MaturationProgesterone Female Accessory
Reproductive Structure
Preparation of the Uterus for Ovum Implantation; Maintenance of Pregnancy
“HCG” Ovary Prolongation of Corpus Luteal Function
OvariumFollicle / Corpus Luteum
• Progesterone• Estrogens
– Estradiol
Testes
Hormone Action Site Action
Testosterone Male Accessory Sex Organ
Development of Secondary Sex Characteristic, Maturation and Normal Function
Testes
• Androgens– Testosterone
• Estradiol
Analytical Methods
• Bioassay• Receptor based• Immunoassay• Instrumental
Preanalytical Factors
• Uncontrollable• Controllable
Preanalytical FactorsUncontrollable
• Biological– Age, Sex, Race
• Environmental– Altitude, Ambient Temprature, Place of residence
• Long-term Cyclical Influences– Seasonal, Mentruation
• Underlying Medical Conditions– Obesity, Blindness, Pregnancy, Stress, Fever, Shock /
Trauma, Transfusion, Infusion
Preanalytical FactorsControllable
• Physiological variables– Posture, Prolonged bed rest, exercise / physical
training, Circadian variation, Travel• Diet
– Food ingestion, Ingestion of specific foods and beverages, Vegetarian, Malnutrition, Fasting / Starvation
• Lifestyle– Smoking, Alcohol
• Drugs, Herbal, Recreational drugs
Kepustakaan1. Michael Kleerekoper : Hormones; in : Tietz Textbook of Clinical Chemistry
and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1019 – 1031
2. Helena A.Gruber et.al.: Chapter 24: Evaluarion of Endocrine Function; in : Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed., Copyright © 2006 W. B. Saunders Company
3. Laurence M.Demers : Pituitary Function; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1967 – 1991
4. Laurence M.Demers : The Adrenal Cortex; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 2003 – 2036
5. Laurence N.Demers : The Thyroid : Pathophysiology and Thyroid Function Testing; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 2053 – 2084
6. David B.Endres : Hormone Regulating Mineral Metabolism; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1912 – 1918.
7. Donald S.Young et.al.: Preanalytical Variables and Biological Variation; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 449 – 474