内科学 内分泌和代谢性疾病总论 英文课件2018.ppt

Dynamic (functional) tests Stimulation test: on hypofunction disease eg. TRH, ACTH, OGIRT Suppression test: on hyperfunction disease. eg. dexmethasone suppression test on Cushing’s syndrome. Laboratory Tests Localization of Disorders Localization Imaging studies: MRI , CT, ECT, B ultrasound Samples for measurement of hormone via catheter Cause of Disorders Cause diagnosis Chemistry analysis: urine iodine Immunoassay: IAA, ICA, GAD, TPOAb, TgAb Genetic analysis: DNA analysis, chromosome Pathology: Fine-needle biopsy, operation sample Diagnosis of Endocrine Diseases (1) Symptoms--- Strange (2) Signs--- Inspection (3) Lab Tests--- Function (4) Causes or Localization 3. Treatment of Endocrine Diseases (1) To causes (2) Correct metabolic abnormity (3) Special treatment Causes of Hypofunction Destruction of the gland: autoimmune, tumor, infection, surgery, radiation, hemorrhage. Extraglandular disorders:renal Congenital defects in hormone biosynthesis Receptor Deficiency Drugs Defects in Sensitivity to Hormone Type 2 diabetes mellitus Pseudohypoparathyroidism Some hypothyroidism Nephrogenic diabetes insipidus Rickets (vitamin D insensitivity) Treatment to Hypofunction Replacement with hormone in a physiologic manner: insulin,TH Replacement with hormone mimics: Vitamin D Replacement with cations: Ca, P Immunotherapy Transplantation Causes of Hyperfunction Tumor: ACTH-producing tumor Hyperplasia: Adrenal hyperplasia Autoimmune stimulation: GD Ectopic endocrine syndrome Drugs Treatment to Hyperfunction Remove tumors (surgery, X-ray, γ-knife) Pharmacology block hormone production Control sequelae of hyperfunction Immunotherapy Radioactive therapy Intervention therapy Hypothalamus Pituitary Target Diseases CRH ↑ ACTH↑ CS↓ ↑ ↑ ↑