1、What is glands?HormoneEndocrine cells Duct Sweat glandExocrine glandsrelease their secretions into a duct that carries them to the outside the bodyRelease their hormones directlyinto the bloodsream Endocrine glands Endocrine GlandsThyroid GlandThyroid hormones(甲状腺激素)Regulating metabolism（调节代谢）Disord
2、ers of thyroid glandHyperthyroidism甲亢Hypothyroidism甲减Cretinism呆小症Adrenal GlandAdrenal gland 肾上腺sitting atop顶上 the kidneysSecreting catecholamines儿茶酚胺,mineralocorticoids盐皮质激素,glucocorticoids糖皮质激素 and sex hormonesParathyroid Hormone（PTH）Parathyroid hormones甲状旁腺激素Calcium balance钙平衡PancreasPancreas胰腺Exo
3、crine glandsecreting digestive juice分泌消化液Endocrine glandreleasing hormones释放激素insulin胰岛素localized in the islet胰岛 cellsrootmeaningexamplecrin（o）-secretiveendocrinology内分泌学 hypercrine内分泌机能亢进 crinogenic促内分泌secret（o）-secretive分泌的 secretin 促胰液素酶 secretoinhibitory 抑制分泌的hormon（o）-hormonehormonal激素的 hormono
4、genesis激素生成 hormonology激素学pitui-pituitarypituicyte垂体细胞 pituitectomy垂体切除术 hyperpituitarism垂体机能亢进hypophy-hypophyseal垂体的 neurohypophysis神经垂体 hypophysectomy 垂体切除术thyr（o）-thyroidthyroiditis甲状腺炎 thyroidectomy甲状腺切除术 hypothyroidism甲状腺功能减退症adren（o）-adrenaladrenitis肾上腺炎 adrenolytic抗肾上腺的 adrenopathy肾上腺疾病gluc（o
5、）-glucoseglucagon胰高血糖素 glucogenesis葡萄糖生成 glucolysis糖酵解 The Root and Word Buildingrootmeaningexamplepineal（o）-pinealparapineal松果体旁的 pinealoma松果体瘤 pinealocyte松果体细胞gonad（o）-gonadhypergonadism性腺机能亢进 gonadopathy性腺病 gonadotropic促性腺的test（o）-testistestopathy睾丸病 testitis睾丸炎 testectomy睾丸切除术pancreat（o）-pancrea
6、s pancreatic胰腺的 pancreatin胰腺素 pancreatogram胰腺造影calc（i）-calciumcalcipenia钙质减少 hypercalcemia高钙血症 calciuria尿钙cortic（o）-cortexcorticosteroid皮质类固醇 corticotropic促肾上腺皮质的 corticoadrenal肾上腺皮质的ster/osterol steroid类固醇 steroidogenic生成类固醇的 sterolytic可分解类固醇的 insulin/oinsulininsulinase胰岛素酶 insuloma胰岛细胞瘤 hyperinsul
7、inism胰岛功能亢进ovari/oovary ovariotomy卵巢切开术 ovaritis卵巢炎 ovariopathy卵巢病 andr（o）-male andrology男科学 androgen雄性激素 hyperandrogenism雄激素过多症 Background of the Endocrine System About Hormones These endocrine organs or tissues can secrete some substances which is called hormones,which get into the blood circulati
8、on and regulate the activities of the organs in the body.Classification of Hormone Protein and polypeptide(多肽)hormones(hormones secreted by pituitary（垂体）hypothalamus（下丘脑）and parathyroid（甲状旁腺）;insulin,glucagon（胰高血糖素）etc.)Amino acid（氨基酸）hormones （T3 T4 etc.）Amine（胺）hormones (NE,DA,5-HT,melatonin褪黑素)St
9、eroid（类固醇）hormones(adrenal cortex hormones;T,DHT,estrogen,Vit D3 etc.)Some Hormones Calcitonin 降钙素Corticosteriod 皮质内固醇激素Glucocorticoid 糖皮质激素Cortisol 可的松Mineralocorticoid 盐皮质激素Aldosterone 醛固酮Epinephrine 肾上腺素Norepinephrine 去甲肾上腺素 Moradrenaline Estradiol 雌二醇Progesterone 孕激素Malatonin 褪黑激素 Mechanism of H
10、ormones signal molecule（信号分子）act through extracellular surface receptor（细胞表面受体）or intracellular receptor（细胞内受体）to regulate body functions.Feedback Control of Hormones Secretion负反馈正反馈下丘脑垂体前叶 Pathology Hyperfunction of glandsendocrine tumorsectopic endocrine syndrome(异位内分泌综合征)autoimmunity（自身免疫）Hypofun
11、ction of glands(endocrine disrupting（内分泌腺破坏）Endocrine gland hormone synthesis defect（内分泌腺激素合成缺陷）)The receptor lack sensitivity to hormonesHyper-高于，超过，上Hypo-在下，次，次于缺乏激素敏感性 Diagnosis and Examinations Complete the function of endocrine system diseases diagnosis should include three aspects:1.Functional
12、 diagnosis 功能诊断 2.Pathological diagnosis 病理诊断3.Etiological diagnosis 病因诊断 Functional diagnosis 1.Clinical Manifestation Typical signs and symptoms has important reference value to the diagnosis of endocrine disease.For example：amenorrhea,Oligomenorrhea,sexuality and sexual function change,Hair chang
13、e,growth disorder or excessive,Weight loss or increase,headache,decreased visual acuity,the spirit of excitement or depression,weakness,skin pigment changes，purple lines,anemia,gastrointestinal symptoms(loss of appetite,vomiting,abdominal pain,constipation,diarrhea),etc.闭经月经过少参考价值皮肤色素改变食欲呕吐便秘腹泻2.Lab
14、oratory tests and data analysis（1）Evidence of metabolic disorder：measure the basic condition of the blood glucose,blood lipid spectrum,serum sodium,potassium（钾）,calcium，ect.（2）Hormone secretion：Generally,to determine hormone levels of basic condition of pituitary and target gland,can help to underst
15、and its function and pathogenic site.(3)Determination of dynamic capabilities：include Inhibition test and Excitation test,actually evaluating hormone levels,we should consider of age,gender,nutritional status,whether in a stress state and take blood time and so on,and combine with the clinical statu
16、s in order to make every effort to correct.Pathological Diagnosis 1.Imageological examination the X-ray plain film、CT、MRI、type-B ultrasonic，which belongs to the noninvasive endocrine gland test,can identify the hypothalamus-pituitary,thyroid,gonad disease,adrenal tumors,islet cell tumor(胰岛细胞),etc.2.
17、Radionuclide examination thyroid scintiscan(123I),Adrenal cortical scanning with131 I-cholesterol,131I-MIBG scanning for the diagnosis of pheochromocytoma（嗜铬细胞瘤）.3.Cytological examination Pathological biopsy needle puncture cells（针吸活检）,immune cells in chemical technology,semen,hormone receptor testi
18、ng.4.Vein catheterization Selective determination of venous catheter（静脉导管）in the different parts take blood hormone in order to make clear pituitary,thyroid,adrenal,islet lesion site.Phe/o 微暗的，褐Chrom/o 色素，颜色Cyt/o 细胞 Etiological Diagnosis1.Autoantibodies detection Thyroglobulin antibody,thyroid perox
19、idase antibodies and testing for thyroid-stimulating hormone receptor antibody and insulin,islet cell antibodies,antibody of adrenal gland,Determination of antibodies can help to clear the nature of endocrine disease and the pathogenesis of autoimmune diseases,and even can be used as the basis for e
20、arly diagnosis and long-term follow-up.2.White blood cells chromosome examination With or without distortion,missing,increasing.3.Identification of HLA.人类白细胞抗原 Principle of Treatment Using the following treatments for overactive:1.Surgery to remove the hyperplasia tissue and tumor which lead to over
21、active 2.Radiation therapy destroy tumor or hyperplasia tissue,reducing the secretion of hormones.3.Drug treatment control hormone synthesis and release.The three treatments can cooperate with each other in order to improve curative effect.Using the following treatments for hypothyroid:1.We can use
22、another hormone with the same effect to replace the hormone deficiency or supplement the deficient hormone.2.Endocrine gland tissue transplants.2.Laboratory tests and data analysis（1）Evidence of metabolic disorder：measure the basic condition of the blood glucose,blood lipid spectrum,serum sodium,pot
23、assium（钾）,calcium，ect.（2）Hormone secretion：Generally,to determine hormone levels of basic condition of pituitary and target gland,can help to understand its function and pathogenic site.(3)Determination of dynamic capabilities：include Inhibition test and Excitation test,actually evaluating hormone l
24、evels,we should consider of age,gender,nutritional status,whether in a stress state and take blood time and so on,and combine with the clinical status in order to make every effort to correct.Common clinical endocrine system diseasesDiabetes MellitusHyperthyroidismHypothyroidismThyroiditisCushings s
25、yndromeDiabetes insipidus（尿崩症）Primary aldosteronism（原醛）Chronic adrenocortical hypofunction(Addison)Dyslipidemia（血脂异常）ObesityHyperuricemia and gout（高尿酸及痛风）Osteoporosis（骨质疏松）Gigantism（巨人症）Acromegaly（肢端肥大症）.Syndrome 综合征综合征Acute&Chronic 急性急性 慢性慢性 Dys-不良，坏不良，坏Lipid/o 脂质，油脂脂质，油脂-oporosis 疏松的疏松的 What is th
26、e most commom disease in endocrine systerm?Diabetes MellitusEstimated number of adults with diabetes in developed and developing countries by age group in 2000 and 2030 Diabetes Mellitus diabetes mellitus,or simply diabetes,is a group of metabolic diseases in which a person has high blood sugar,eith
27、er because the pancreas does not produce enough insulin,or because cells do not respond to the insulin that is produced there are 3 main types of DM Type 1 DM Type 2 DM Gestational diabetesThe most common form of diabetes-Type 2 DM Nearly 95%belongs to type 2 DM,it often associated with older age,ob
28、esity,family history of diabetes e.t.c.In type 2 diabetes,the pancreas is usually producing enough insulin,but for unknown reasons the body cannot use the insulin effectively,a condition called insulin resistance.After several years,insulin production decreases.So thus glucose builds up in the blood
29、 and the body can not make efficient use of its main source of fuel.胰岛素抵抗/耐受Classical manifestations of diabetes Polyuria（多尿）increased urination Polydispia（多饮）increased thirst,which occurs as a result of excess loss of fluid associated with osmotic diuresis.Polyphagia（多食）increased appetite which res
30、ults from the catabolic state induced by insulin deficiency Lose weight（体重下降）If the diabetes mellitus can not be controlled well,it can cause complications,and it cannot be cured.Risk factors for diabetes Obesity/overweight Family history of diabetes Having high blood pressure Occupational physical
31、activity Too much sweet food intake Overstress Infection Hyperlipemia And so on The Major Complications of DiabetesRetin/o 视网膜 糖尿病足Nephr/o Rena-肾的The Measurement of Plasma Glucose Fasting plasma glucose(FPG):measurement after an 8-12h fast.Oral glucose tolerance testing(OGTT):2h after ingestion of a
32、 concentrated glucose solution.OGTT is more sensitive for Dx DM and impaired tolerance but is more expansive and less convenient and reproducible than FPG.It is rarely used routinely,except for Dx of gestational DM.HbA1c:testing for glycosylated hemoglobin.HbA1c levels reflect glucose control over t
33、he preceding 2-3 months.HbA1c is not considered as reliable as FPG or OGTT testing for Dx DM and used mainly for monitoring DM control.Diagnostic criteria (by intravenous glucose prevail)(1)Diabetes symptoms:(Typical symptoms include polyphagia,polydipsia,polyuria,and unexplained weight loss)plus:1)
34、Random blood glucose(refers to not consider the last meal,blood glucose any time of day)11.1mmol/L(200mg/dl)Or2)Fasting glucose(fasting state refers to at least eight hours without eating calories)7.0mmol/L(126mg/dl)Or3)2 hours after glucose load 11.1mmol/L(200mg/dl)(2)Without diabetes symptoms,an e
35、xtra day repeat examination to confirm the diagnosis Treatment principles The basic principles of treatment of diabetes,including diabetes education,diet control,exercise therapy,disease monitoring,and integrative medicine medications,both so-called “Five Carriages”Health EducationExerciseNutrition
36、TherapyDisease SurveillanceOral Anti-diabetic Agent Diabetes Health Education Health education is considered the key to the success of treatment.Medical Nutrition TherapyThere isnt one diabetes diet.The amount of food you can eat daily depends on:-Age-Body size-Activity level-Gender-Pregnancy or bre
37、astfeeding(母乳喂养)With the help from a dietician,a diet is planned based on the recommended amount of calories,protein,carbohydrates,and fats.A meal plan is a guide that tells you what kinds of food you can choose at meals and snack time and how much to have.For most people with diabetes(and those wit
38、hout,too),a healthy diet consists of 40%to 60%of calories from carbohydrates,20%from protein and 30%or less from fat.Exercise Exercise:Before diabetic patients engage in exercise program,they should consult with their healthcare provider because they need to have a complete history and physical exam
39、ination.Exercise includes anything that keeps them move.Exercise(total of about 30 minutes a day,at least 5 days a week)lowers blood sugar levels by improving cell uptake of glucose,causing the body to process glucose faster.Exercise Disease Surveillance Regular monitoring of blood glucose is recomm
40、ended to use a portable blood glucose meter（便携式血糖测量仪）;periodic review every three to June HBA1c,in order to adjust treatment.Comprehensive review once or twice a year,early detection related complications.定期检查定期检查便携式，手提式 Oral Anti-diabetic Agent Biguanides-Metformin(Glucophage)双胍类 decreasing liver g
41、lucose release and cellular insulin resistance.Alpha-Glucose Inhibitors:-糖苷酶抑制剂-Slows digestion and absorption of carbohydrates to maintain normal blood glucose levels.Sulfonylureas and Meglitinides:(Prandin)磺脲类和格列奈类-Stimulates pancreas to secrete insulin.Thiazolidinediones:(Avandia,Actos)噻唑烷二酮类-Inc
42、reases insulin sensitivity at receptor sites on liver,muscle,and fat cells.The medication works by helping make your cells more sensitive to insulin.The insulin can then move glucose from your blood into your cells for energy.Insulin TherapyInsulin therapy is an important means to control high blood
43、 sugar.After starting insulin therapy should continue to adhere to diet and exercise,and to strengthen the patients mission to encourage and guide the patient to self-monitoring of blood glucose,in order to adjust the insulin dose and prevention of hypoglycemia.Insulin treatment programs should simu
44、late physiological insulin secretion patterns,including basal insulin and prandial two complementary parts.Classification of Insulin:regular(short-acting)insulin,intermediate-acting insulin and long-acting insulin(including ultra-long-acting insulin analogue)and premixed insulin(including premixed i
45、nsulin analogues)Therapy In TCM Diabeties Mellitus in western medcine is“xiao ke”areas in TCM。According to chinese medicine theory,the basic pathogenesis of“xiao ke”（consumptive thirst）is yin scorching on the root while fire preponderance on the branch,besides,it could involve different organs and p
46、arts,and could also cause the disordering of qi,blood,jin,yin and yang.Xiaoke is usually classified into four types of syndrome：1、The yin deficiency:The yin deficiency syndrome is mostly found in the early stage of diabetes,clinical incidence rate is about 50%2、Deficiency of both QI and yin:Accordin
47、g to reports,more than 80%diabetic patients are found this syndrome,this can appear by diabetes history.3、Blood-stasis obstructing：It is more common in the late diabetes,expecially combining a variety of complications.its found 35%in the earlier and middle stage,and 60%in the latter stage.4、Deficien
48、cy of both yin and yang：This type of syndrome is more common in patients with latter severe diabetes,approximately 20%of patientsFour types of syndrome Therapy In TCM A variety of prescription has significant effect on diabetes,for example,improve metabolism,promote insulin secretion,reduce glucagon
49、,decrease blood glucose,promote blood circulation and regulate immune function.Baihu renshen decoction XIaoke Fang Yun Nv Jian Medcine Huangqi:it has a certain effect for diabetes and its complications.For example,reduce blood glucose,improve blood circulation,protect endothelial cells and inhibits
50、the incidence of microvascular diseases.MedicineGegen:It can reduce blood glucose significantly,improve blood circulationShihu:It can reduce blood glucose,protection and restoration of the function of pancreatic tissueJianghuang:reduce blood glucose,reduce inflammation,can prevent diabetic vascular
