
[[內分泌系統]]


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
神經系統的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
(促腦下腺素)
H寫F亦可
|
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,
對Hormone1有負回饋機制 |
Peripheral gland周邊腺體
對Hormone1和Hormone2有負回饋機制 |
Target目標器官 | ||||||||||
Thyrotropin releasing hormone | basophil cell嗜鹼性細胞, |
|
Thyroid gland分泌
Thyroxine(t4) Triiodothyronine(t3) |
Target目標器官 | |||||||||
Gonadorelin
=Gonadotropin releasing hormone Ex. LH-RH |
|
|
Target目標器官 | ||||||||||
Corticotropin releasing hormone | chromophobe cell嫌色细胞, |
|
|
Target目標器官
| |||||||||
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, |
|
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 |
|
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催產素和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
| |||||||||||||||
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
|
Ovulation induction p.651
FSH→hCG→progesterone | |||||||||||||||
Male infertility p.652 | ||||||||||||||||
Native GnRH | Gonadorelin: acetate of synthetic hGnRH | |||||||||||||||
GnRH analogue |
| |||||||||||||||
GnRH
|
stimulation | Female infertility gonadorelin p.653 | ||||||||||||||
male infertility gonadorelin p.654 | ||||||||||||||||
Diagonosis of LH responsiveness p.654 | ||||||||||||||||
supression | Controlled ovarian hyperstimulation p.654
| |||||||||||||||
Endometriosis子宮內膜異位 p.654
| ||||||||||||||||
Uterine leiomyomata肌瘤 p.654
(Uterine fibroids)
| ||||||||||||||||
Prostate cancer p.654
| ||||||||||||||||
Central precocious puberty p.654
| ||||||||||||||||
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
|
Suppression of gonadotropin production p.655
| |||||||||||||||
Advanced prostate cancer p.655
| ||||||||||||||||
Menotropin
hMG (human menopausal gonadotropin) |
Extract of postmenopausal women urine contain substance with
Property | |||||||||||||||
FSH | Urofollitropin, uFSH: FSH extract of postmenopausal women urine | |||||||||||||||
| ||||||||||||||||
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
|
Hyperprolactinemia
| |||||||||||||||
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 |
- ↑ Raven, PH; Johnson, GB. Biology, Fifth Edition, Boston: Hill Companies, Inc. 1999. page 1058.