Endocrinology Diagram. Endocrinology Department and Endocrine System for Endocrinologist.

What is Endocrine System Study and medical branch?

Endocrine system medical branch or Endocrinology is the study of endocrine system studied and dealt in endocrine department of a medical school or hospital.

 

How do we define endocrinology?

Endocrinology Definition: (endocrine – ology) is a biological and medicinal stream dealing with the endocrine system,  its diseases and secretions known as Hormones. Its scope includes growth and differentiation, integration of developmental events proliferation, psychological or behavioral activities of metabolism, tissue function, digestion excretion, stress, mood, movement, sleep, respiration, reproduction, growth and development  and sensory perceptions caused by hormonal activities. This departmental specialization entails behavioral endocrinology & comparative endocrinology.

 

SECTION 1

What is the meaning of endocrinology?

Endocrinology Meaning – General Introduction: The endocrine system is a cell or delicate group (ie endocrine glands) developed from embryonic mesoderm and endoderm. They secrete trace chemical substances ‘hormones’ to reach target cells through the blood circulation, combine with corresponding receptors, and affect their metabolic processes to exert their extensive systemic effects.

The endocrine system cooperates with the nervous system developed and differentiated by the ectoderm to maintain the balance of the internal environment of the body. In order to maintain a stable balance, the endocrine system has a complete set of mutual constraints, mutual influences and more complex positive and negative feedback systems. When the external conditions have different changes, working with the nervous system to keep the internal environment still stable is a necessary condition for maintaining life and maintaining the continuity of race. Excessive or lack of a hormone caused by the malfunction of any one endocrine cell can cause corresponding pathophysiological changes.

 

Anatomy and Physiology

Organs whose main function is synthesis and secretion of hormones are called endocrine glands, such as pituitary, pineal gland, thyroid, adrenal gland, islet, gonadal and so on. Many organs are not endocrine glands. But tissues or cells that contain endocrine functions, such as brain (endorphin, gastrin, release factors, etc.), liver (angiotensinogen, 25-hydroxylated osteosteroids, etc.), kidney (renin, prostaglandin, 1 , 25 hydroxy osteosteroids, etc.).

The same hormone can be synthesized in different tissues or organs, such as somatostatin (hypothalamus, islets, gastrointestinal, etc.), and peptide growth factors (nervous system, endothelial cells, platelets, etc.). The nervous system is closely related to the physiological aspects of the endocrine system. For example, the middle part of the hypothalamus is neuroendocrine tissue, which can synthesize antidiuretic hormones and oxytocins and store them along the axons in the posterior pituitary.

Ayapeptides act on both the nervous system (belonging to neurotransmitters) and the pituitary (belonging to hormonal properties in endocrinology). The two affect and coordinate each other in maintaining the stability of the body environment. For example, in the mechanism of maintaining blood sugar stability, there are endocrine hormones such as insulin, glucagon, growth hormone, somatostatin and adrenal corticosteroids. There is also involvement of the nervous system such as the sympathetic and parasympathetic nerves. Therefore, in endocrinology, only when the nervous system and the endocrine system are normal can the internal environment of the body be maintained in an optimal state.

 

Hormonal Regulation

In order to maintain the balance between the main hormones in the body, there is a complex system under the action of the central nervous system. Hormones are usually released at a relatively constant rate (such as thyroxine) or a certain rhythm (such as cortisol, sex hormones). Physiological or pathological factors can affect the basal secretion of hormones. Hormone levels are also monitored and regulated by sensors. The feedback regulation system is an important self-regulation mechanism in the endocrine system. The information of the central nervous system passes through the hypothalamus, the pituitary reaches the peripheral glands. The target cells exert physiological effects, any of which is positive or negative. Control of feedback regulation.

Hormone transport peptide hormones are mainly in free form in circulation. Sterol hormones and thyroid hormones (except aldosterone) both bind to specific plasma proteins with high affinity, and only a small amount (about 1-10%) is biological. The free state of live salamander. This control of the ratio of binding to free can assist in regulating glandular function, which can regulate both biological activity and half-life.

Endocrinology states Hormones and Receptors Hormones need to bind to specific receptors to initiate their physiological activities. Different hormones can have different processes. Peptide hormones and catecholamines bind to cell surface receptors and exert their biological effects by affecting genes. Insulin binds to cell surface receptors and enters cells to form pancreatin-receptor complexes. It is then combined with the second receptor to produce a biological effect. The binding of hormones and receptors is specific, and is reversible, in line with the law of quality and action.

 

Classification

According to different pathogenesis, including abnormal endocrine glands, abnormal secretion of hormones, abnormal conversion from pre-hormones, abnormal response of target cells to hormones, etc. Endocrine system diseases can be classified as follows:

I. Hormone deficiency diseases

(1) Endocrine gland hypofunction can be caused by trauma, tumor destruction, infection, bleeding, autoimmune damage, etc., namely primary hypoendocrine gland function, hypothalamic or pituitary hormone deficiency.  This is manifested as target organs (such as Thyroid, adrenal cortex, gonads) are low, that is, secondary endocrine glands are dysfunction, congenital endocrine glands are often dysfunction of hormone synthesis. Sometimes the structure of synthetic hormones is abnormal, lack of biological activity, such as in rare diabetes, blood insulin levels are higher than normal. But their amino acid arrangement is disordered and has no biological activity. Disorders of congenital hormone synthesis can be partial or complete.

(2) Hormone deficiency secondary to factors outside the glands, such as obstacles in the conversion of prohormones to hormones, accelerated hormone degradation, and the appearance of antagonistic substances, such as corresponding antibodies.

(3) The hormone response is low, and in some of the endocrine glands with dysfunction, blood hormone levels are normal or even high. This may be due to the appearance of anti-receptor antibodies, blocking the receptor and reducing the chance of hormone binding to the receptor. It may also be caused by abnormal structure or reduced number of receptors. For example, pseudohypoparathyroidism, plasma parathyroid hormone is significantly increased, but clinical hypoparathyroidism is significantly low. It may not be sensitive to posterior vasopressin in kidney disease and insensitive to pancreatic hypertension glucoside in liver disease.

 

Hyperhormone Syndrome

(1) Excessive endocrine glands function: glandular hyperplasia or functional adenoma may be caused by various reasons. These functional adenomas (including functional adenomas) are well differentiated. Glandular hyperplasia is mostly caused by hyperfunction of the upper glands, the so-called secondary hyperendocrine syndrome.

(2) Tumors that produce ectopic hormones: Due to tumor cells’ ability to secrete hormones or similar compounds with hormonal activity, they cause corresponding clinical manifestations. Can be composed of single genes (ACTH, growth hormone, prolactin, parathyroid hormone, calcitonin, gastrin, erythropoietin, etc.) and double genes (such as chorionic gonadotropin, luteinizing hormone, cytokinin) Etc.) caused by abnormalities. Although a variety of ectodermal tumor cells can produce such abnormal biologically active substances, they are mainly cells that have uptake of amine precursors and decarboxylation (APUD). More common in lung oat cell carcinoma, carcinoid, thymoma and so on.

(3) Iatrogenic tadpoles can cause iatrogenic excess hormone syndrome when treating diseases with hormones or their derivatives in excess of physiological doses.

(4) High sensitivity is rare in target tissues. For example, the sensitivity of catecholamine receptors in some tissues of hyperthyroidism is increased, and those with atrial fibrillation often have abnormal changes in the heart.

(5) Autoimmune diseases: Some autoimmune antibodies bind to the receptor and have a hormone-like effect. The most common such as irritating antibodies in Graves disease can cause hyperthyroidism, and rare insulin receptor antibodies. Clinical manifestations similar to hyperinsulinemia can occur.

(6) The state of high hormone secretion secondary to systemic diseases is caused by excessive physiological or pathological stimulation of normal endocrine glands. For example, liver cirrhosis with ascites, congestive heart failure and nephrotic syndrome increase in aldosterone, parathyroid hormone increase in uremia and so on.

 

Endocrine Gland Syndrome in Endocrinology

Schmidt’s syndrome is a disorder of two or more glands with hypofunction that may be related to immune disorders and can include islets, thyroid, adrenal glands, parathyroid glands and gonads. Hyperthyroidism due to hyperplasia, adenoma and adenocarcinoma is called multiple endocrine adenoma disease. Generally divided into 3 types. MEN type I (Wermer syndrome) includes parathyroid, islets, pituitary, adrenal corte, and hyperthyroidism. MEN type II (Sipple syndrome) includes pheochromocytoma (possibly bilateral and extra-adrenal), medullary thyroid carcinoma and parathyroid hyperplasia.

MEN type III, including medullary thyroid carcinoma, pheochromocytoma, and neuroma. These 3 types are mostly family crickets and the etiology mechanism is unknown.

Endocrine gland disease without hormone disorders

Including non-functional tumors, cancer, cysts, inflammation, etc.

The general clinical narrow sense endocrine diseases are classified as follows:

I. Hypothalamus

(A) Functionality

(2) Organic (hypothalamic syndrome caused by tumor, inflammation, trauma, surgery, radiation, etc.).

 

II. Pituitary Disease

(I) Adenoid pituitary disease

1. Hyperthyroidism, giant disease, acromegaly, hyperprolactinemia, and prolactinoma, etc., Cushing’s disease and pituitary hyperthyroidism.

2. Hypofunction, pituitary dwarfism, adult hypohypophysis.

(II) Pituitary tumors

(III) Pituitary disease

1. Diabetes insipidus

2. Inappropriate pituitary antidiuretic hormone secretion

(IV) Hollow bubble saddle

 

III. Thyroid Disease

(A) Autoimmune thyroid disease

  1. Hyperthyroidism
  2. Hypothyroidism
  3. Simple goiter (including endemic goiter)
  4. Thyroiditis
  5. Thyroid tumors and nodules
  6. Congenital ectopic and deformity of thyroid

 

IV. Parathyroid Disease

  1. Hyperparathyroidism
  2. Hypoparathyroidism
  3. Pseudo and pseudo hypoparathyroidism

 

V. Adrenal Disease

(I) Cortical diseases

1. Adrenal insufficiency

(1) Chronic (Addison’s disease and selective aldosterone deficiency)

(2) Acute (small renal gland crisis)

2. Adrenal hyperfunction

(1) Cortisol syndrome (Cushing syndrome)

(2) primary aldosteronism

(3) Adrenal syndrome (congenital adrenal hyperplasia)

(4) Mixed type

(5) medulla disease pheochromocytoma

(6) gastrointestinal islet disease

 

(A) Diabetes

(B) Insulinoma (functional islet beta cell tumor)

(C) glucagon tumor

(D) Gastrinoma (ZoIIinger-EIIison syndrome)

(E) Diastolic Intestinal Peptide Tumors (Watery Diarrhea, Hypokalemia, and Gastric Acid Syndrome)

(F) somatostatin tumor

(G) Carcinoid tumors and carcinoid syndromes

 

VII. Ovarian disease

(A) premenstrual tension

(B) Menopause syndrome (menopause syndrome)

(C) premature ovarian failure

(D) polycystic ovary

(E) Others (Amenorrhea and menstrual disorders are classified as gynecological endocrine diseases)

 

VI. Testicular Disease

(A) hypogonadism in men

(B) premature male aging

 

XI. Endocrine diseases of the kidney

(A) Batter syndrome

(B) Reninoma

 

X. Heterologous endocrine syndrome caused by non-endocrine tumors

 

XI. Multiple endocrine diseases

 

Principle of Endocrine Disease Diagnosis in Endocrinology

A complete diagnosis of endocrine diseases should include the following three aspects:

i. Functional diagnosis

ii. pathological diagnosis (localization and qualitative)

iii. etiology diagnosis.

A detailed medical history and comprehensive physical examination often provide important clues to remind doctors to consider a diagnosis or need to rule out endocrine disease. To diagnose as early as possible and strive for the best prognosis, pay attention to the following points:

1. The determination of hormone concentration can be measured by radioimmunoassay, enzyme-linked immunoassay and other methods to determine the concentration of hormones in body fluids, the reliability of which determines the purity and characteristics of the antibody, the quality of the collected samples, such as the measurement of insulin concentration in blood also includes proinsulin. In the determination of blood C-peptide, undissociated C-peptide is also included, which affects the reliability of the measurement result. Resolution can only be improved when using monoclonal antibody detection methods. In addition, care must be taken to distinguish free (mostly biologically active) hormones from conjugated (mostly non-biologically active) hormones in body fluids in order to correctly evaluate the measurement results.

2. Observation of Hormonal Dynamics Determine the normal rhythm of hormone secretion, such as ACTH, the diurnal fluctuation of cortisol, the luteinizing hormone and the monthly rhythm of cytokinin. The disappearance of normal rhythm is mostly an early manifestation of glandular dysfunction.

3. Hormone regulation function tests: Including excitability test (checking the response to stimulating hormone) and inhibition test (checking feedback inhibition function), it has great significance in identifying physiological changes and pathological changes, and clarifying the nature of pathological changes.

4. Receptor measurement: Measurement of the quantity and quality of various target cell receptors, such as the measurement of red blood cell insulin receptors, the determination of blood cell nuclear T3 receptors and the like. It is mainly used in patients with inconsistent clinical manifestations of hormonal water disease. The rhythm of receptor changes also has important clinical significance.

5. Target cell function test: Only the response of target cells can reflect the abnormal function of endocrine glands in clinical, so measuring the function of target cells can objectively evaluate the effect of hormones. For example, platelet potassium-sodium ATPase activity is significantly increased during hyperthyroidism, myocardial isovolumic contraction period is shortened and basal metabolic rate is increased.

6. Localization examination: It is mainly imaging examination to identify endocrine gland tumors and early detection of distant metastases of cancer.

7. Pathological examination: To determine the nature of the lesion, for example, thyroid needle biopsy has certain value in determining Hashimoto’s disease and thyroid cancer.

 

Treatment Principles of Endocrine Diseases

First, those who are hormone-deficient should supplement the corresponding hormones at physiological doses. When it is difficult to supplement the hormones or take other measures to maintain the stability of the internal environment, such as parathyroid insufficiency, they can be treated with calcium supplements and vitamin C. Adrenal insufficiency can be supplemented with a high-sodium diet.

Second, too many hormones should be cured as much as possible but not in every case. Methods are as follows:

i. Surgical resection leads to hyperfunctional tumors or hyperplasia.

ii. Drug treatment inhibits the synthesis and release of hormones, such as thiourea drugs for hyperthyroidism, bromocriptine and regurgitation for prolactinoma and acromegaly and cyprotin is used to treat Kexing disease.

iii. Inhibition of gonadotropin synthesis and secretion by target hormone feedback, such as thyroid hormone inhibition of thyroid stimulating hormone, cortisol inhibition of adrenocorticotropic hormone, estrogen or androgen inhibition of gonadotropin and so on.

iv. For patients who cannot be treated with chemotherapy, such as adrenocortical carcinoma with dichlorobenzodiazepine (O, P-DDO) and islet β-cell carcinoma with streptozotocin.

v. use some hormones to regulate or correct metabolic abnormalities, such as testosterone equivalent hormone treatment of increased cortisol, negative oxygen balance and so on.

vi. Radiation therapy inhibits its secretory function.

Etiological treatment: For example, exophthalmos can be treated with immunological control agents. Chronic adrenal insufficiency caused by adrenal cortex tuberculosis should be treated with anti-tuberculosis.

 

Advancement in Modern Endocrinology

In terms of thyroid, it was initially recognized that diffuse goiter with hyperthyroidism (Greaves’ disease), chronic lymphocytic thyroiditis (Hashimoto’s disease), etc. are all diseases-autoimmune thyroid disease. The two can co-exist or transform each other. Hypothyroidism and transient normal thyroid function in the disease are manifestations in different processes of the disease. In the diagnosis, using mouse thyroid cell lines to measure various antibody titers and changes in the course of the disease tends to become hot, which is very helpful for the diagnosis, the degree of remission, the indication for withdrawal and the chance of relapse.

In terms of diabetes, many in-depth discussions have been made on the mechanism and prevention of comorbidities. It is believed that saccharification, the relative increase in polyol bypass metabolism and abnormal changes in thromboxane, prostaglandin, etc. main reason. It is also clarified that chronic long-term comorbidities caused by these factors are the key to determine the prognosis of elderly diabetic patients. Many treatment options such as continuous subcutaneous insulin injection with an insulin pump, continuous use of artificial islets, long-term use of pansentin, and so on are all promising signs. But their efficacy should be further observed.

In terms of endocrine gland, tissue or cell transplantation, many beneficial scientific explorations have been carried out in the past ten years, such as islet transplantation such as microcapsule method, antigen blocking method or islet β cell transplantation, which have been successful in experimental animals. Others have also explored transplantation in areas with weak immune responses, such as the ventricle and arachnoid space, which have also proved promising. Other gland transplants have also been explored, but they are far from practical.

Although the treatment of endocrine system diseases has made great progress, there are still many problems to be solved. The first is prevention. The incidence of diabetes is very high, and it is increasing with the improvement of life. However, there is no effective prevention and treatment measures. In terms of treatment, there are also many problems that need to be urgently solved. Most endocrine diseases lack a cure. For example, the treatment methods adopted by diabetes are not completely effective in preventing the occurrence of chronic comorbidities, and there is no lack of means to reverse the chronic comorbidities that have occurred. Better prolong the disease-free survival time of patients. Many basic research results. For example, the physiological and rational significance of various active peptides lacks in-depth discussion, let alone clinical application.

With the general improvement of people’s living standards, the requirements for the diagnosis and treatment of andrological diseases with high incidence are getting higher and higher. But in the vast areas of the world, including many large cities, there is still a blank spot. There is lack of understanding. These are urgently needed for a large number of medical staff to conduct research.

 

 

 

 

 

 

 

 

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