基因,蛋白,免疫 课程之免疫学.ppt

* Feedback Mechanisms Pituitary hormones (to blood) (TSH, LH, FSH, ACTH) Target Glands TSH ? Thyroid ? T3, T4 ACTH ? adrenal ? cortisol FSH testes ? testosterone LH ovaries ? oestradiol ? progesterone ? ? Growth hormone prolactin ? No discrete target gland -ve Brain Hypothalamus Increased Serum Ca2+ PTH -ve Hypothyroidism sluggishness mental dullness feel cold slow speech hoarse, croaking voice weight gain sparse brittle hair constipation dry skin Slow reflexes reduced heart rate Cretin, aged 38 years. Mental age of 4 years and less than 4 feet in height (120 cm). Deep croaking voice, coarse dry skin and hair Endocrinology from past years Hyperthyroidism goitre and eye-signs (Graves’ Disease) warm, and sweating increased body temperature weight loss restlessness Irritability nervousness muscular weakness rapid heart rate Laboratory Investigation TSH Thyroid hormones TBII (binding reagent TSH receptor Up to hundreds Note elevated levels in hypothyroidism Estimation of the thyroid hormones themselves is also important Other Investigations requiring immunoassay of pituitary and steroid hormones Investigation of infertility (male and female) LH, FSH, prolactin – commonly used assays Oestrogens and progesterone SHBG testosterone Cushing’s Syndrome and Addison’s Disease (pituitary-adrenal cortex) ACTH and cortisol Other needs for steroid hormone assays - adrenal and ovarian tumours (androstenedione, DHEA-sulphate) - congenital adrenal hyperplasia (17α-hydroxyprogesterone) etc Peptide hormone analysis of less value in Diabetes, except in research Assay of parathyroid hormone important in investigation of Primary parathyroid disease Secondary hyperparathyroidsm, especially in renal disease Calcitonin assay is important in the diagnosis, monitoring and family screening in medullary thyroid carcinoma 25-hydroxyvitamin D assay is also important in the investig