藥學共筆
Advertisement
Endocrine

[[內分泌系統]]

Ad
Langzh-800px-ACTH Negative Feedback

許多內分泌系統中的荷爾蒙都是由負反饋系統所控制,例如腎上腺分泌的糖皮質激素就是如此。下視丘分泌促肾上腺皮质素释放素(CRH),CRH會使腦下垂體分泌促腎上腺皮質素(ACTH),而ACTH會使腎上腺分泌糖皮質激素,如皮質醇。糖皮質激素不但會使身體有對應的反應外,也會使下視丘和腦下垂體的分泌減少,因此只要糖皮質激素已經到達一定的量,就不會再繼續分泌。[1]

主條目:內分泌系統Central nervous system中樞神經系統CNS

神經系統下視丘接受身體的神經訊息傳入,藉由賀爾蒙控制腦下腺而影響周邊內分泌腺體

Hypothalamus下視丘

分泌hypophysiotropic hormone

(促腦下腺素)

腦下腺控制賀爾蒙

下視丘賀爾蒙(Hypothalamic Hormones)

~tropin Releasing hormone

釋放激素RH

Inhibiting hormone

抑制激素IH

H寫F亦可


Hormone1

Pituitary gland腦下腺(hypophysis腦下垂體)前葉

分泌腦下腺前葉賀爾蒙(anterior Pituitary Hormones)

分成basophil cell嗜鹼性細胞, chromophobe cell嫌色细胞, acidophil cell嗜酸性細胞,

~troph分泌Hormone2 ~tropin 促(腺體)素
~tropic Hormone
X gland stimulating Hormone

XSH   X腺刺激激素

對Hormone1有負回饋機制

Peripheral gland周邊腺體


分泌Hormone3




對Hormone1和Hormone2有負回饋機制

Target目標器官
Thyrotropin releasing hormone

促甲狀腺素釋放激素TRH

basophil cell嗜鹼性細胞,
thyrotroph分泌 thyrotropin 促甲狀腺素
thyrotropic Hormone
Thyroid-stimulating Hormone

TSH   甲狀腺刺激激素

Thyroid gland分泌

Thyroxine(t4)

Triiodothyronine(t3)

Target目標器官
Gonadorelin

=Gonadotropin releasing hormone

促性腺(素)釋放激素GnRH

Ex. LH-RH

gonadotroph分泌 gonadotropin 促性腺素
gonadotropic Hormone
FSH: follicle-stimulating Hormone

濾泡刺激激素

LH: luteinizing hormone黃體生成素,在男性又稱作間質細胞刺激激素ICSH(interstitial cell stimulating hormone)
hCG 效果同LH,懷孕時取代LH
Gonads性腺 Ovaries卵巢
Testis睪丸

Testosterone睪固酮

Progesterone黃體素(助孕酮)

Estrogen動情素

Target目標器官
Corticotropin releasing hormone

促腎上腺皮質(素)釋放激素CRH

chromophobe cell嫌色细胞,
corticotroph分泌 corticotropin

corticotropic Hormone

adrenocorticotropic hormone

促腎上腺皮質素ACTH

Melanocyte-stimulating Hormone

MSH   黑色素細胞刺激激素

Adrenocortex腎上腺皮質 Cortisol皮質醇

葡萄糖皮質類固醇

MSH Melanocye黑色素細胞(分泌melanin黑色素)
Target目標器官
ACTH和MSH來自同preprohormone
Growth hormone releasing hormone生長激素釋放激素GHRH

Growth hormone inhibiting hormone 生長激素抑制激素GHIH=somatostatin 體抑素

acidophil cell嗜酸性細胞,
somatotroph分泌 somatotropin
somatotropic Hormone
(Human) growth hormone (人類)生長激素(h)GH
Liver to secrete somatomedin (insulin-like growth factor類胰島素生長因子, IGF-1), IGF-2 Target目標器官
Prolactin inhibiting factor/hormone泌乳素抑制因子PIF/PIH

=dopamine多巴胺DA

lactotroph分泌 Lactotropin=prolactin泌乳素PRL
Target目標器官
其他地方相同原理的調節系統
胃腸道中有攝食的葡萄糖glc Intestine secrete GIP(glucose-dependent insulinotropic peptide葡萄糖依賴性促胰島素胜肽) Pancreas beta-cell secrete insulin胰臟的beta細胞分泌胰島素 Target目標器官:

葡萄糖進入其他器官和靜止的肌肉

RAAS renin腎素酵素 血管收縮素/血管張力素Angiotensin I變成angiotensin II Adrenocortex腎上腺皮質分泌aldosterone醛固酮/留鹽激素礦物性皮質類固醇 Target目標器官

腎、大腸、汗腺

三級神經元third-order neuron Ex. brain 二級神經元second-order neuron Ex. Spinal cord 一級神經元first-order neuron Ex. Nerve Target目標器官
CNS ENS 胃腸道

下視丘分泌激素(posterior pituitary hormone)儲存在腦下腺後葉(神經垂體):

分泌oxytoxin催產素ADH抗利尿激素(Anti-diuretic hormone (also called vasopressin血管加壓素))

acidophil cell的應用[]

pituitary gland的somatotroph和lactotroph同樣為acidophil cell

所以青春期的時候,GH作用在乳房,連男生也會有乳頭敏感的現象

另外長得像dopamine的麥角生物鹼,可以作用在somatotroph抑制somatotrophin的分泌而治療巨人症

下視丘賀爾蒙[]

產生釋放激素,調控腦垂線激素的分泌

生長激素釋素 (GHRH)[]

.

生長激素抑素[]

.

促腎上腺皮質素釋素 (CRH)[]

.

甲狀腺促素釋素 (TRH)[]

.

促性腺素釋素 (GnRH)[]

.

腦垂腺(前葉)賀爾蒙[]

生長激素 (GH)[]

促進生長發育 巨人症 侏儒症

促甲狀腺素 (TSH)[]

促進甲狀腺分泌


促腎上腺皮質素 (ACTH)[]

促進腎上腺皮質分泌


促濾泡成熟素 (FSH)[]

與生殖有關的激素


黃體成長素 (LH)[]

.

Hypothalamic-pituitary-adrenal axis (HPA axis)下視丘-腦下腺前葉-腎上腺軸[]

.

Hypothalamic–pituitary–gonadal axis (HPG axis)下視丘-腦下腺前葉-性腺軸[]

.

Hypothalamic–pituitary–thyroid axis (HPT axis)下視丘-腦下腺前葉-甲狀腺軸[]

.

各賀爾蒙的臨床適應症[]

Somatotropin GH deficiency p.646
Prader-Willi syndrome

Turner syndrome

Chronic renal failure in pediatric patient

Small-for-gestational-age condition at birth in which the child has fail to catch up by age 2

p. 647
Idiopathic short stature p.647

Non-hormone-deficient short stature

Servere catabolic state Ex. Wasting in AIDS patients p.647
Patient of short bowel syndrome depending on TPN p.647
Anti-aging X p.647
Banned drug of Olympic p.647
Antiobesity drug X p.648
Bovine milk production p.649
IGF-1 mecasermin IGF-1 deficiency not responsive to GH
Somatostatin

and Octreotide

and lanreotide(long-acting)

Small pituitary adenoma
GH receptor antagonist

Pegvisomant

D2 agonist

bromocriptine

Transphenoidal surgery or radiation Large pituitary adenomas
Octrotide p.650 Hormone-secreting tumors:(因somatostatin可-(-)→各種secretion cell的分泌)

Acromegaly

The carcinoid syndrome

Gastrinoma

Glucagonoma

…etc.

Gonadotropin

女和男不孕症主流藥

?隱睪症
平時 FSH+LH
排卵時 給大量LH
Ovulation induction p.651

FSH→hCG→progesterone

Male infertility p.652
Native GnRH Gonadorelin: acetate of synthetic hGnRH
GnRH analogue
goserelin(Zoladex)
Histrelin
Leuprolide(Lupron)
Nafarelin
Triptorelin
GnRH
?
一次大量給 作用劑
持續緩慢給 阻斷
stimulation Female infertility gonadorelin p.653
male infertility gonadorelin p.654
Diagonosis of LH responsiveness p.654
supression Controlled ovarian hyperstimulation p.654
Leuprolide (SC) (Lupron)
Nafarelin (nasal)
Endometriosis子宮內膜異位 p.654
Leuprolide(Lupron)
Goserelin(Zoladex)
Nafarelin
Uterine leiomyomata肌瘤 p.654

(Uterine fibroids)

Leuprolide(Lupron)
Goserelin(Zoladex)
Nafarelin
Prostate cancer p.654
Leuprolide(Lupron)
Goserelin(Zoladex)
Histrelin Coadministrate bicalutamide to avoid tumor flares
Triptorelin
Central precocious puberty p.654
Leuprolide(Lupron)
Nafarelin
Advanced breast and ovarian cancer
Thining of the endometrial lining in preparation for an endometrial ablation procedure in woman with dysfunctional uterine bleeding.
Amenorrhea and infertility in women with polycystic ovary disease
GnRH antagonist
Ganirelix
Cetrorelix
Abarelix
degarelix
Suppression of gonadotropin production p.655
Ganirelix
Cetrorelix
Advanced prostate cancer p.655
Abarelix
degarelix
Menotropin

hMG (human menopausal gonadotropin)

Extract of postmenopausal women urine contain substance with
LH
FSH

Property

FSH Urofollitropin, uFSH: FSH extract of postmenopausal women urine
rFSH(recombinant FSH) Follitropin α
Follitropin β
Follitropin α AA sequence is identical to FSH, differ in carbohydrate side chain, shorter t1/2, equel or more potent, more expensive
Follitropin β
LH Lutropin α: used in combination with follitropin α for stimulation of follicular development in infertile women with profound LH deficiency.
hCG(IM): produced by human placenta and excreted into the urine.
rhCG(SC)(choriogonadotropin α): the only gonadotropin preparation dosing based on weight but unit of activity.
D2 agonist
S1. Ergot alkaloids
Bromocriptine
Cabergoline
S2. Nonergot
Ropinirole

(Parkinson)

Pramipexole

(Parkinson)

Quinagoline
Hyperprolactinemia


Acromegaly(1/3)

Oxytocin
Oxytocin antagonist:

atosiban

Preterm labor難產
Vasopressin

Desmopressin (DDAVP, 1-desamino-8-D-arginine vasopressin)

Pituitary diabetes insipidus(尿崩症)
Desmopressin (DDAVP, 1-desamino-8-D-arginine vasopressin) Nocturnal enuresis夜尿

Hemophilia A and von Willebrand’s disease (factor VIII)

Vasopressin V1 agonist: vasopressor

V2 agonist: reduce diuresis→acute CHF

Hyponatremia(因其為借水而非Na的?)

Desmopressin (DDAVP, 1-desamino-8-D-arginine vasopressin) Select V2 agonist: reduce diuresis, Nocturnal enuresis夜尿,

Hemophilia A and von Willebrand’s disease (factor VIII)

Long-acting

Vasopressin antagonist:

Conivaptan

Tolvaptan

Conivaptan: ,  antagonist: hyponatremia(IV)

Tolvaptan:  antagonist

  1. Raven, PH; Johnson, GB. Biology, Fifth Edition, Boston: Hill Companies, Inc. 1999. page 1058.
Advertisement