study guide block endocrine semester v
TRANSCRIPT
Content
PAGE Study Guide Endocrine System, Metabolism and Disorders
Endocrinology is an expanding science with new concepts and ideas appearing in the literature almost daily. The term endocrine denotes internal secretion of biologically active substances. Basically, the endocrine system uses hormones to convey information between different tissues. Hormones are released by endocrine glands and transported through the bloodstream to tissues where bind to specific receptor molecules and regulate the target tissues function. In addition to this traditional views, hormones can also act locally by binding to receptors that are expressed by cells that are close to the site of release, remain in the membranes of the one cell, acts on receptors located in the same cell, or can act inside the cell without being released. The action is called paracrine, juxtacrine, autocrine, or intracrine.
In this block, we will learn about the basic of hormone synthesis, release and action, continue with discussing of each endocrine organs and their hormones and diseases including pituitary organ and disorders, diabetes mellitus, lipid metabolism, energy balance: obesity and metabolic syndrome, thyroid and parathyroid gland and disorders, adrenal gland and disorders, and also congenital hypothyroid and ambiguous genital.
This block will take 16 meeting to be completed, each meeting consist of introductory lecture continued by individual learning, single group discussion and self assessment, ending with plenary session. In each topic there will be a list of tasks to discuss which some of them are based on a case that commonly find in clinical practice. There will also a simple clinical problem that you need to discuss and respond, each part will be given a cut of clinical information for you to be responded.
Evaluation in this block will be formative and summative. The formative evaluation is directive and will take as checklist and peer assessment, while summative will be conducted at the end of this block.
We believe that the basic of endocrinology that you will learn in this block will impulse you to learn more about it to help you dealing with endocrine problems in patients.
Good luck,
Planner team
ListPage no.
1.Cover
2.Preface2
3.List of Contents3
4.Planners Team4
5.Facilitators5
6.Seven General Core Competency6
7.Curriculum Block: The endocrine system, metabolism, and disorders7
8.General Learning Outcome10
9.Time Table 11
10.Meeting of student representatives14
11.Assessment method14
12.Content outline15
13.Learning Tasks19
14.Problem Based Learning31
15.Clinical skills32
16.References38
17.Standard of medical competence39
18.Block evaluation form40
19. Paper (article review) format43
20.Article review assessment form45
21Final examination question plan46
No.NAMEDEPARTEMENTPHONE
1.Dr. dr. Made Ratna Saraswati, SpPD-KEMD (Head)Internal Medicine08123814688
2.Dr. dr. Desak Made Wihandani, M.Kes (Secretary)Biochemistry081338776244
3.Dr. IGN Mayun, PHKHistology08155715359
4.Prof.Dr.dr. Ketut Suastika,SpPD-KEMDInternal Medicine0811380916
5.Prof.Dr.dr. AAG Budiartha,SpPD-KEMDInternal Medicine0811398205
6.Dr. dr. Wira Gotera,SpPD-KEMDInternal Medicine08155736480
7.Dr. Pande Dwipayana, SpPDInternal Medicine08123657130
8. Dr. Made Arimbawa, SpAPediatric081338596115
9.Dr. I Wayan Bikin Suryawan, SpAPediatris081338465525
10.Dr. I Wayan Surudarma, M.SiBiochemistry081338486589
11.Dr. IA Dewi Wiryanthi, M.BiomedBiochemistry081239990399
Regular Class
NONAMEGROUPDEPTPHONEROOM
1dr. Ni Nyoman Mahartini, Sp.PKA1Clinical
Pathology 0813371655773rd floor R.3.01
2dr Ni Nyoman Metriani Nesa, M.Sc.,Sp.AA2Pediatric0813370721413rd floor R.3.02
3dr. I Dewa Ayu Inten Dwi Primayanti, M.Biomed.A3Fisiology0813377612993rd floor R.3.03
4dr. I Wayan Surudarma, M.SiA4Biochemistry 0813384865893rd floor R.3.04
5dr. I Wayan Niryana, Sp.BS, M. Kes.A5Surgery081792019583rd floor R.3.05
6Dr.dr. Susy Purnawati, MKKA6Fisiology081239898913rd floor R.3.06
7dr. Anak Agung Ayu Yuli Gayatri, Sp.PDA7Interna 081238039853rd floor R.3.07
8dr. I Gede Ngurah Harry Wijaya Surya, Sp.OGA8Obgyn08143869353rd floor R.3.08
9Dr. dr. Made Sudarmaja, M.KesA9Parasitology081239539453rd floor R.3.20
10dr. I Wayan Juli Sumadi, Sp.PAA10Anatomy Pathology0822374077783rd floor R.3.21
11dr. Anak Agung Mas Putrawati Triningrat, Sp.M (K)A11Opthalmology081238469953rd floor R.3.22
12dr. I Gusti Ngurah Pramesemara , M.BiomedA12Andrology0813386050873rd floor R.3.23
English ClassNONAMEGROUPDEPTPHONEROOM
1Dr. dr. A.A. Ayu Putri laksmidewi, Sp.S(K)B1Neurology 08113888183rd floor R.3.01
2dr. Ni Made Renny Anggreni Rena , Sp.PDB2Interna 0818036516563rd floor R.3.02
3dr. I G A Dewi Ratnayanti , M.BiomedB3Histology 0851045503443rd floor R.3.03
4dr. I Ketut Mariadi, Sp.PDB4Interna081238537003rd floor R.3.04
5dr. Ida Bagus Alit, Sp.F, DFMB5Forensic0819166134593rd floor R.3.05
6Dr. dr. Made Ratna Saraswati, Sp.PD-KEMD-FINASIMB6Interna081238146883rd floor R.3.06
7dr. Anak Agung Wiradewi Lestari , Sp PKB7Clinical Pathology081552379373rd floor R.3.07
8dr. Putu Budhiastra, Sp.M(K)B8Opthalmology0852382389993rd floor R.3.08
9dr. Ida Ayu Kusuma Wardani, Sp.KJ, MARSB9Psychiatry081238138313rd floor R.3.20
10dr. Sri Laksminingsih Sp. RadA10Radiology081647455613rd floor R.3.21
11dr. Tjok. Istri Anom Saturti, Sp.PDA11Interna0819162537773rd floor R.3.22
12dr. I Made Suka Adnyana, Sp.BP-REB12Surgery0812362889753rd floor R.3.23
1. Patient careDemonstrate capability to provide comprehensive patient care that is compassionate, appropriate, and effective for the management of health problems, promotion of health and prevention of disease in the primary health care settings.
2. Medical knowledge base
Mastery of a core medical knowledge which includes the biomedical sciences, behavioral sciences, epidemiology and statistics, clinical sciences, the social aspect of medicine and the principles of medical ethics, and apply them
3. Clinical skill
Demonstrate capability to effectively apply clinical skills and interpret the findings in the investigation of patient.
4. Communication
Demonstrate capability to communicate effectively and interpersonally to establish rapport with the patient, family, community at large, and professional associates, that results in effective information exchange, the creation of a therapeutically and ethically sound relationship.
5. Information management
Demonstrate capability to manager information which includes information access, retrieval, interpretation, appraisal, and application to patients specific problem, and maintaining records of his or her practice for analysis and improvement
6. Professionalism Demonstrate a commitment to carrying out professional responsibilities and to personal probity, adherence to ethical principles, sensitivity to a diverse patient population, and commitment to carrying out continual self-evaluation of his or her professional standard and competence
7. Community based and health system- based practice
Demonstrate awareness and responsiveness to larger context and system of health care, and ability to effectively use system resources for optimal patient care
Learning OutcomeLearning ObjectivesEducati-onal strategyLearning ResourcesStudent assessment
1. Comprehend the hormone action1.1. Describe the transport of hormone in the blood
1.2. Describe the control of hormone secretion
1.3. List the endocrine disease
1.4. Mention the therapeutic strategies in endocrine disordersIntro.lec
IL
SGD
PlenoRefferencesMCQ
2. Summarize the pituitary gland function and provide initial management and/or refer patient with pituitary disorders
2.1. Recognize the anatomy of pituitary
2.2. Summarize the pituitary hormone axis
2.3. Recognize the type of pituitary tumor and differential diagnosis of pituitary tumor
2.4. Interpret the endocrine tests of hypothalamic-pituitary function
2.5. Describe the clinical features of pituitary adenoma
2.6. Summarize the course and the condition associated with pituitary adenoma, including prolactinoma, acromegaly, gigantisme, growth hormone deficiency.
2.7. Summarize the normal physiologic hormone function of posterior pituitary
2.8. Describe the clinical features of diabetes insipidus Intro.lec
IL
SGD
SE
PlenoMCQ
3. Summarize the insulin action, provide initial management and/or refer patient with diabetes mellitus (DM) 3.1 Recognize the characteristics of pancreas and the secretory product associated with each cell type
3.1. Understand major stimuli and inhibitors of insulin secretion. Summarize the cellular mechanism involved in glucose-induced insulin secretion
3.2. Understand major biologic actions of insulin and the target organs. Able indicate which metabolic pathways of fuel metabolism are affected by insulin
3.3. Explain how the blood glucose control by insulin
3.4. Recognize the major biologic actions of glucagon and the target organs, indicate which metabolic pathway of fuel metabolism are affected by glucagons
3.5. Summarize the pathophysiologic basis for the major symptoms of diabetes mellitus
3.6. Mention the diagnostic criteria of prediabetes and diabetes
3.7. Describe the clinical features of type 1 and type 2 diabetes and other types of diabetes
3.8. Summarize the pathogenesis of beta cell dysfunction and insulin resistance (glucose toxicity and lipotoxicity of the beta cell)
3.9. Recognize the acute and chronic complication of diabetes
3.10. Plan the prevention of type 2 diabetes
3.11. Plan the strategy of therapy in diabetes
3.12. Recognize the drugs use in treatment of diabetes (insulin secretogogues, insulin sensitiziser, thiazolidinediones, alfa glucosidase inhibitor)
3.13. Summarize the acute and chronic complication of diabetes
3.14. Plan the management of hypoglycemia and acute hyperglycemiaIntro.lec
IL
SGD
Pleno
PBL
MCQ
4. Summarize and select the appropriate drug in patient with lipid metabolism disorders4.1. Summarize the lipid transport and the role of plasma lipoprotein
4.2. Recognize the disorders of lipoprotein metabolism
4.3. Summarize the mechanism of action of drugs in lipid disorder
4.4. Describe the prevention of lipid disorder
4.5. Plan a rational drugs treatment regimen based on a set of baseline serum lipid valuesIntro.lec
IL
SGD
Pleno
CBLMCQ
5. Summarize the energy balanced and heat metabolism, and provide management in patient with obesity and metabolic syndrome5.1. Summarize the mechanism of heat production and body heat loss
5.2. Summarize the energy metabolism
5.3. Define the criteria obesity
5.4. Describe the pathogenesis of obesity
5.5. Recognize the complication of obesity
5.6. Define the criteria of metabolic syndrome
5.7. Describe the pathogenesis of metabolic syndromeIntro.lec
IL
SGD
Pleno
CBLMCQ
6. Provide initial management and/or refer patient with thyroid disorders6.1. Summarize the organization of the thyroid and secretory cells present in thyroid
6.2. Recognize the function of a thyroid follicle cells and follow the different process involved in this function with particular emphasis on the location of each action within the cell or follicle
6.3. Summarize the biosyntesis, transport, and autoregulation of thyroid hormone
6.4. Explain the thyroid hormone action
6.5. Recognize the disorder of thyroid gland, including problem of over/undersecretion and thyroid nodule
6.6. Describe the clinical features (symptoms, signs, and laboratory findings) and the management of Graves disease
6.7. Describe the clinical features and management of hypothyroidismIntro.lec
IL
SGD
Pleno
CBLMCQ
7. Summarize the mineral metabolism (calcium and phosphate) and parathyroid hormone functions7.1. Summarize the mineral metabolism, including calcium and phosphate and the rule of hormones
7.2. Describe the secretion and action of PTH
7.3. Summarize the rule of PTH, Ca, vit D, and calcitonin. Intro.lec
IL
SGD
Pleno
8. Provide initial management and/or refer patient with adrenal disorders8.1. Summarize the regulation of synthesis and secretion of cortisol, aldosterone, and the weak androgen DHEA.
8.2. Summarize the major actions of glucocorticoid on metabolism, inflammation, permissive effects and the stress concept..
8.3. Summarize the mechanisms of action for mineralocorticoids
8.4. Summarize the pathophysiology and clinical features of cushing syndrome
8.5. Recognize the diagnostic test for cushing syndromeIntro.lec
IL
SGD
Pleno
9. Provide initial management and/or refer patient with congenital hypothyroid and ambiguous genital
9.1. Recognize clinically, laboratory and provide initial management, and refer patient with abnormalities in sexual determination and differentiation Intro.lec
IL
SGD
Pleno
MCQ
Note: Intro. Lec = Introductory lecture
IL= Individual learning
SGD= Single group discussion
Pleno= Plenary lecture
PBL= Problem based learning
Mastery of Basic Knowledge with Its Clinical and Practical Implication1. Comprehend the hormone action
2. Summarize the pituitary gland function, provide initial management, and/or refer patient with pituitary disorders
3. Summarize, provide initial management, and/or refer patient with diabetes mellitus
4. Summarize and select the appropriate drugs in patient with lipid metabolism disorders
5. Summarize the energy balanced and heat metabolism, and provide management in patient with obesity and metabolic syndrome
6. Provide initial management and/or refer patient with thyroid disorders
7. Summarize the mineral metabolism (calcium and phosphate) and parathyroid hormone function
8. Provide initial management and/or refer patient with adrenal disorders
9. Provide initial management and/or refer patient with congenital hypothyroid and ambiguous genital
Skills1. History taking
2. Physical examination of metabolic syndrome (waist circumference, body mass index), thyroid nodule
3. Interpreting the laboratory result of blood sugar, A1C, lipid profile, hormone level
4. Communication with patient, family and community
5. Assessing data base, extracting relevant information
Personal behaviorAwareness to:1. Lifestyle as a risk factors of diabetes mellitus and metabolic syndrome
2. Early treatment and proper management of metabolic disease to prevent chronic complication of diabetes mellitus, metabolic syndrome, and other hormonal disorder.
Community aspect: 1. Risk assessment and disease screening of diabetes mellitus and metabolic syndrome
2. Cost effectiveness of prevention, screening, and treatment of the disease
3. Utilization of health system facilities
4. Health prevention and health promotion
DayDateTopicLearning situationEnglish ClassRegular Class
PIC
1Monday, Oct, 26, 2015Introduction
(The hormone action)Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Suastika/Ratna
2Tue, Oct, 27, 2015Histology and Anatomy of the endocrine system
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-09.45
09.45-10.30
10.30-12.30
12.30-14.00
14.00-15.00
15.00-16.00Yuliana
Mayun
3Wed, Oct, 28, 2015The pituitary gland and disordersIntro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0008.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00Ratna
4Thursday, Oct, 29, 2015Carbohydrate metabolism Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Dewi Wiryanthini
5Friday, Oct, 30, 2015Insulin secretion, insulin action.
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Suastika/Ratna
6Monday, Nop, 02, 2015Pathogenesis and diagnosis of diabetes Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Suastika/Ratna
7Tue, Nop,03, 2015Management of
Diabetes
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Suastika/Pande
8Wed, Nop, 04, 2015PBL 1
Clinical skills 1: Insulin injectionSGD
Pleno
SP
Clinical Skills08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.0011.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00Budhiarta
Pande
95 NopManagement of Diabetes in ChildrenIntro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Bikin/Arimbawa
10Thursday, Nop, 05, 2015Acute and chronic complication of diabetesIntro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Budhiarta
11Monday, Nov, 09, 2015PBL2
Clinical skill 2:
self monitoring blood glucoseSGD
Pleno
SP
Clinical Skills08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.0011.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00Wiragotera
Pande
12Tue,
Nov, 10, 2015Lipid metabolism Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Surudarma
13Wed, Nov, 11, 2015Lipid metabolism and disorderIntro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Suastika/Pande
14Thursday, Nov, 12, 2015The energy balance
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Adiputra
15Friday, Nov, 13, 2015PBL3
Clinical skills 3: Diabetic Foot ExaminationSGD
Pleno
SP
Clinical Skills08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.0011.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00Suastika/Ratna
Pande
16Monday, Nov, 16, 2015Obesity and metabolic syndrome
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Budhiarta
17Tue, Nov, 17, 2015Iodine metabolism, and thyroid hormon functionIntro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Wihandani
18Wed, Nov, 18, 2015Calcium, phosphate, and vitamin D metabolism, PTH functionIntro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Sutadarma
19Thursday, Nov, 19, 2015The thyroid and parathyroid hormone disordersIntro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Wira Gotera
20Friday, Nov, 20, 2015The Adrenal gland and adrenal hormone function
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Ratna
21Monday, Nov, 23, 2015Cushing syndrome
Adrenal CrisisIntro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Ratna
22Tue, Nov, 24, 2015Congenital hypothyroid and disorder of sex development (DSD)
Intro. Lect
IL & L task
SGD
SP
Pleno08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.0009.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00Bikin/
Arimbawa
23Wed, Nov, 25, 2015PBL3
Clinical skills 4: Thyroid Nodule ExaminationSGD
Pleno
SP
Clinical Skills08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.0011.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00Suastika/Ratna
Pande
24Thursday, Nov, 26, 2015PBL 4
Clinical Skills 5:
Lab result interpretation
(case studies)SGD
Pleno
SP
Clinical Skills08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.0011.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00Suastika/Ratna
Pande
25Friday. Nov, 27, 2015Student project presentation
Pleno
08.00-13.00
08.00-13.00
Lecturers and Fasilitators
26Monday, Nov, 30, 2015Evaluation
Team
Meeting of the student representatives
One student from each group discussion will invited to discuss the block activities with members of the block planners every Saturday, in block-coordinators room.
Meeting of the facilitators
The meeting between block planners and facilitators will take every Saturday after meeting of the student representatives, in block-coordinators room.
Assessment in this thema consists of:
SGD
: 5%
Paper (review article): 15%
Final examinations: 80%.
Final exam will be carried out on (Monday, 29th November 2015). There will be 100 questions consisting mostly of Multiple Choice Questions (MCQ) and some other types of questions. The minimal passing score for the assessment is 70.
The requirement for taking the final exam:
- join 75% of total student activities
- uniform: white shirt, black trouser/skirt, shoes
- bring student ID card with photo
- be present 15 minute before examination starting time
Other than the examination score, your performance and attitude during group discussions will be considered in the calculation of your average final score.
1. The hormone action
The endocrine system uses hormones to convey information between different tissues. Hormones derive from the major classes of biologic molecules, this can be proteins (including glycoproteins), peptides or peptide derivatives, amino acid analogs, or lipids. Endocrine hormones are part of a large complement of small intercellular signaling molecules.
The system of internal hormone secretion is subject to complex regulatory mechanisms that govern receptor activity and hormone synthesis, release, transport, metabolism, and delivery to the target cells. Hormones bind specifically to hormone receptors and translate the signal into biologic activity. The receptors can be expressed on the cell surface or within the cell.
Hormone response is regulated by hormone concentration. This in turn is governed by hormone production, efficiency of delivery and metabolism. The classic disorders of the endocrine system arise from state of excess or deficiency of hormones, however resistance to hormones also play a role. Disorders of the endocrine system will discuss in each part of the gland.
2. Pituitary gland (and hypothalamus)
The pituitary gland lies on the base of the skull in a portion of the sphenoid bone called the sella tursica. The hypothalamus and pituitary gland form a unit which exerts control over the function of several endocrine glands: thyroid, adrenal, and gonads, as well as a wide range physiologic activities. This unit constitutes a paradigm of neuroendocrinology: brain-endocrine interactions.
The hypothalamic hormones can be divided into those secreted into hyppophysial portal blood vessels and those secreted by the neurohypophysis directly into the general circulation. The hypophysiotropic hormones regulate the secretion of anterior pituitary hormones, include growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), corticotrophin-releasing hormone (CRH), and gonadotropoin-releasing hormone (GnRH). The six major anterior pituitary hormones are adrenocorticotropic hormone (ACTH), growth hormone (GH), prolactin (PRL), TSH, LH, and FSH. The posterior pituitary hormones are antidiuretic hormone (ADH) and oxytocin.
Hypothalamic and pituitary lesions present with a variety of manifestations, including pituitary hyper- and hyposecretion, sellar enlargement, and visual loss.
PRL hypersecretion is the most common endocrine abnormality due to hypothalamic-pituitary disorders, and PRL is the hormone most commonly secreted in excess by pituitary adenoma. GH-secreting adenomas are second in frequency to prolactinoma and cause the classic syndromes of acromegaly and gigantism.
The major effect of ADH is to increase the water permeability of the luminal membrane of the collecting duct in the kidney. Diabetes insipidus is a disorder resulting from deficient ADH action and is characterized by the passage of amounts of very dilute urine.
3. Pancreas and Diabetes mellitus
The pancreas is made up of two functionally different organs: exocrine and endocrine. The major product of exocrine pancreas is the digestive enzims. The endocrine pancreas consists of 0.7-1 million small endocrine glands the islets of Langerhans scattered within the glandular substance of the exocrine pancreas. The product of endocrine pancreas are: insulin, glucagon, somatostatin, and pancreatic polypeptide.
Clinical diabetes mellitus is a syndrome of disordered metabolism with inappropriate hyperglycemia due either to absolute deficiency of insulin secretion or a reduction in the biologic effectiveness of insulin (insulin resistance), or both. Type 1 diabetes is the severe form of diabetes mellitus and is associated with ketosis in the untreated state. While type 2 diabetes previously classified as non-insulin-dependent-diabetes (NIDDM) afflict patient with insulin resistance who generally have relative insulin deficiency. There are also other types of diabetes. Patient with diabetes needs a proper diet, exercise, and also pharmacologic agent, such as insulin or oral anti diabetes. Oral anti diabetes fall into three categories: 1) drugs that stimulate insulin secretion, 2) drug that alter the insulin action, 3) drug that principally affect absorption of glucose.
In most patient with diabetes, a number of pathologic changes occur at variable intervals during the course of the disease. There are also acute complications either cause by hypoglycemia or hyperglycemia.
4. Lipid metabolism and disorders
The clinical importance of dislipidemia is mainly from the role of lipoprotein in atherosclerosis. Because lipid are relatively insoluble in water, they are transported in association with proteins. The simplest complexes are those formed between unesterified or free, fatty acids (FFA) and albumin, which serve to carry the FFA from peripheral adipocytes to other tissue. Cholesterol in the atheroma originates in circulating lipoprotein. Atherogenic lipoproteins include low-density (LDL), intermediate density (IDL), very low density (VLDL), and Lp(a) species.
Initial treatment in all forms of hyperlipidemia is an appropriate diet. Patient with severe hypercholesterolemia will require drug therapy. The increased risk of acute pancreatitis associated with hypertriglyceridemia is another indication for intervention.
5. Energy balance and metabolism disorder, obesity and metabolic syndrome
The energy balance equation is dynamic and this may explain why there is a long-term relative stability of body weight and fat stores. The three determinants of body fat stores are intake, expenditure, and nutrient partitioning, each under complex control.
Obesity is a disorder of body composition defined by relative or absolute excess of body fat and characterized by several remarkable features. It is difficult to certain the relationship between obesity and disease, because it is confounded by many metabolic and hormonal that either contribute to or derive from excess adiposity. Obesity and abdominal obesity are closely associated with dyslipidemia, hypertension, insulin resistance, and diabetes. The abdominal adipose tissue has several features of interest in connection with the metabolic syndrome. This is the reason of The ATP III definition of the metabolic syndrome lists the waist circumference as a diagnostic factor of the metabolic syndrome.6. Thyroid gland
Thyroid gland is the largest organ specialized for endocrine function in the human body. The major function of thyroid gland is to secrete a sufficient amount of thyroid hormones, which promote normal growth and development, regulate a number of homeostatic function including energy and heat production.
Patient with thyroid disease will usually complain of thyroid enlargement (diffuse or nodular), symptoms of thyroid deficiency (hypothyroidism), symptoms of thyroid hormone excess (hyperthyroidism), or complication of specific form of Graves disease. Thyrotoxic crisis (thyroid storm) is one of an acute state that requires vigorous management.
7. Mineral metabolism and parathyroid gland
Four parathyroid glands located adjacent to the thyroid gland. The two superior glands are usually found near the posterior aspect of the thyroid capsul, and the inferior glands are located most often located near the inferior thyroid margin. The parathyroid gland composed of epithelial cell and stromal fat. The epithelial cell consist of chief cell and oxyphil cell, both contain of parathyroid hormone (PTH). The function of PTH is to regulate serum calcium levels by concerted effects on three target organs: bone, intestinal mucosa, and kidney.
8. Adrenal gland and disorders
The adrenal cortex produces many steroid hormones, the most important are cortisol, aldosterone, and the adrenal androgen. Disorders of the adrenal glands lead to a classic endocrinopathies such as Cushings syndrome, Addisons disease, hyperaldosteronism and the syndrome of congenital adrenal hyperplasia.
The adrenal medulla is a specialized part of the symphathetic nervous system that secretes catecholamines. Pheochromacytoma is tumors that arise from the adrenal medulla, may present at any age. Screening for pheochromacytoma should be considered for such patients with severe hypertension and also for hypertensive patients with suspicious symptoms, e.g., headache, palpitation, sweating episodes, or unexplained bouts of abdominal or chest pains.
9. Congenital hypothyroid and ambiguous genital
Congenital hypothyroidism (CH) occurs in babies who are born without the ability to produce adequate amounts of thyroid hormone. Thyroid hormone is important for normal function of all of the body's organs and is essential for normal brain development. CH affects about one in every 3,500 babies. The most common cause of primary CH is dysgenesis (various abnormalities in the formation of the thyroid gland). If detected early a child will develop normally. Treatment is thyroid medication daily. Deficiency of thyroid hormone may result in mental and growth retardation. If CH is not diagnosed and treated early in life, most infants will still appear clinically normal before 3 months of age, by which time some brain damage has usually occurred.
Symptoms or signs, when present, may include prolonged neonatal jaundice, constipation, lethargy and poor muscle tone, poor feeding, a large tongue, coarse facies, wide fontanelle, distended abdomen and umbilical hernia. Ideally a neonatal screening (TSH screening) for CH should be routinely done in all children as treatment of affected infants within 45 days of birth leads to normal mental development. The TSH should be done 3 to 5 days after birth and patients with TSH levels more than 20-25 mU/L should be assessed further.
Once clinically suspected or a positive neonatal screening test; the diagnosis is confirmed by serum T4 and TSH levels. The TSH will be elevated (>10 mcU/ml) and T4 will be low (