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Introduction to endocrinology & endocrine function tests.

Dr. Mahmudul Huque Endocrinologist Department of Medicine Holy Family Red Crescent Medical College

Introduction to endocrinology & endocrine function tests.

Hormones: Signaling bio-molecules - Proteins, steroids or amines, regulates subcelluler events: in conjunction with N/S regulate organs.
   

Axis: 1. Hypothalamus Detail target organs

Pituitary

7 In number

endo. Gland

2. Direct metabolic signals Nature: Mode of action: Nuclear




pancreas & PTH

Classification of endocrine diseases hormone excess / Deficiency / Hypersensitivity / Resistance / Tumour example: Thyroid Gland

Hormonal mechanism of action


Signaling bio-molecules - Proteins, steroids or amines, regulates subcelluler events: in conjunction with N/S regulate organs. 1. Lipophilic hormones intra cellular receptors 2. Hydrophilic hormones extra cellular receptors

1. HRC

HRE ( element) DNA (derepression) for example: All steroid hormones

Protein synthesis

2.

2nd messengers: CAMP Releasing hormones PTH. Calcitonin CGMP ANP by DNA or other effect Ca ++1 Phosphatidyt inositol GnRH, TRH catecols. Unknown Insulin, GH, PRL

Endocrine function tests


Basal hormone measurement
Only florid or advanced cases. Normal range is wide. False (+) and False (-ve)

Steps of hormone assessment in preclinical stage with greater accuracy

1. Serial hormone measurement.


Diurnal variation Nocturnal surge / Excludes

(2) Paired measurement


   

Axis Based

e.g. TSH, FT4 / PTH, calcium LH, testosterone / ACTH, Cortisol Glucose / Insulin Appropriate in detecting Deficiency, ectopic, resistance,

 

Dynamic tests
For subtle lesions
Suppression / Stimulation of endogenous Hormone production Stimulation tests to see hypo-function Stimulatory agent Tropic hormone

Target gland stimulation

Organs Adrenal Gonads Hypothalamo/ Pituitary

Stimulus ACTH / Upright postums HCG Hypoglycemia L - DOPA, Exercise / Clonidine

Measured Response Cortisol / Renin, Aldosterone Testosterone GH, ACTH GH Trophics T4 T3 uptake

Pituitary Thyroid

TRH, GnRH, CRF TSH

Pancreas

Glucose

Insulin

Suppression tests
To sec hyper function & negative feedback control.
Administered a hormone or regulatory substance & suppression of endogenous hormone production is assessed.

Commonly used suppression tests


Glands Adrenal Agents Dexmclhasomc Saline Thyroid Hypothalamic pituitary Pancreas T4 / T3 Glucose Fasting Measured Response Cortisol Renin / Advsterne TSH, Radioiodine uptake GH, ACTH Glucose / Insulin

Endocrine investigation sheet


History Wt HT Arm span Upper segment Lower segment of body Testicular volume, SPL Hair distribution / Breast staging Pigmentation / Striae General & Neruous sygleis in detcil Primary and secondary, disorders

Thank You All