ENDOCRINOLOGYby Chandra Sirait Faculty Of Pharmacy University Of Pancasila Monday, September 21, 2009 Chandra Sirait FF-UP 1 HORMONE CLASSIFICATIONS a. Extent of Effect 1. Local Hormone 2. General Hormone b. Chemical structure 1. Steroid (= Cholesterol) Adrenal Cortex: Cortisol and Aldosterone Ovary : Estrogen and Progesterone Testis : Testosterone 2. Tyrosine Amino Acid Derivate Thyroid : Thyroxine and Triiodothyronine Adrenal Medulla : Epinephrine and Nor- Epinephrine 3. Peptide/Protein Chandra Sirait FF-UP Monday, September 21, 2009 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Kemampuan Komunikasi Kejujuran/Integritas Kemampuan Bekerja Sama Kemampuan Interpersonal Beretika Motivasi/Inisiatif Kemampuan Beradaptasi Daya Analitik Kemampuan Komputer Kemampuan Berorganisasi Berorientasi pada Detail Kepemimpinan Kepercayaan Diri Ramah Sopan Bijaksana Indeks Prestasi (>=3.0) Kreatif Humoris Kemampuan Berwirausaha Monday, September 21, 2009 4.69 4.59 4.54 4.5 4.46 4.42 4.41 4.36 4.21 4.05 4 3.97 3.95 3.85 3.82 3.75 3.68 3.59 3.25 3.23 Kualitas Lulusan Perguruan Tinggi yangDiharapkan Dunia Kerja (Skala 1 – 5) Diterbitkan oleh National Association of Colleges and Employers, USA, 2002 (disurvei dari 457 pimpinan) Kesimpulan : Soft skills (kemampuan interaksi sosial) dibutuhkan untuk sukses! 3 Chandra Sirait FF-UP C. Action of Mechanism → Solubility 1. Hydrophylic (water soluble) : Most of the hormones 2. Hydrophobic (water insolube) : Steroid and Thyroid Hormones HORMONE FUNCTIONS : Controlling the Activity Level of Target Tissue by : 1. Changing Chemical Reactions within Cells 2. Changing Cell Membrane Permeability against Specific Agents HOMEOSTASIS Monday, September 21, 2009 Chandra Sirait FF-UP 4 HORMONE ACTION MECHANISM 1. Through Cyclic AMP → Most of the hormones Membrane R E Adenylcyclase C E P T O R Cytoplasma ATP HORMONE Cyclic AMP (cAMP) = Second Messenger Enzyme Activation PHYSIOLOGICAL EFFECT · Monday, September 21, 2009 Fast Reaction Chandra Sirait FF-UP 5 2. Activating gene from cells, affecting the formation of specific protein Steroid Hormone Cytoplasma Receptor-bound Steroid Hormone (Specific Receptor within Cell) Nucleus Specific Gene Activation Creating m-RNA Cytoplasma Ribosome Creating New Protein • Long Reaction Monday, September 21, 2009 Chandra Sirait FF-UP 6 ATP Adenylcyclase Cyclic AMP (Active) Phosphodiesterase Caffeine 5-AMP (Non Active) HORMONE MEASUREMENT 1. Bioassay 2. RIA (Radio Immuno Assay) 3. ELISA (Enzyme Linked Immunosorbent Assay) Monday, September 21, 2009 Chandra Sirait FF-UP 7 HIPOTHALAMUS HIPOPHYSIS Anterior H. = Adenohypofisis Pars Intermedialis Rudimentary Except Animals Posterior H. = Neurohipophysis Monday, September 21, 2009 Chandra Sirait FF-UP 8 HIPOTHALAMUS Hormone Secretion Secretion RH (Releasing Hormone) IH (Inhibitory Hormone) Hypothalamic Hypophyseal Portal Vessels Hypothalamico Hypophysial Tract Posterior Hypophysis Anterior Hypophysis Hormone Preserved Monday, September 21, 2009 Chandra Sirait FF-UP Hormon Production 9 NEGATIVE FEEDBECK MECHANISM Hypothalamus IH RH Adenohyphophysis _ Tropic Hormone + Target Gland Target Gland Hormone POSITIVE FEEDBACK MECHANISM Estrogen ↑ Monday, September 21, 2009 LH ↑ Chandra Sirait FF-UP 10 HORMON SECRETION a. Posterior Hypophysis 1. Antidiuretic Hormone (ADH) 2. Oxcytocin b. Anterior Hypophysis 1. Growth Hormone (GH) 2. Adrenocorticotropic Hormone (ACTH, Adrenocorticotropin) 3. Thyroid Stimulating Hormone (TSH, Thyrotropin) 4. Prolactin (LTH = Luteotropic Hormone) 5. Follicle Stimulating Hormone (FSH) 6. Luteinizing Hormone (LH) Gonadotropic Hormone Monday, September 21, 2009 Chandra Sirait FF-UP 11 c. Pars Intermedialis • Melanocyte Stimulating Hormone (MSH) → in fish, reptiles, and amphibian • Human has no MSH Monday, September 21, 2009 Chandra Sirait FF-UP 12 SETELAH LULUS, LALU APA ? Monday, September 21, 2009 Chandra Sirait FF-UP 13 Apa yang sebenarnya saya inginkan? Seperti apakah saya 5 tahun dari sekarang? 10 tahun dari sekarang? Definisikan “SUKSES” yang ingin Anda capai… Monday, September 21, 2009 Chandra Sirait FF-UP 14 ANTIDIURETIC HORMONE (ADH, VASOPRESIN) a. Secretion : Hypothalamus Posterior Hypophysis → Site of Storage b. Effect : • Reducing Urine Volume • ADH controls water and regulates body fluid osmotic pressure • ADH in Moderate and High Concentration has Pressor Effect → VASOPRESIN Monday, September 21, 2009 Chandra Sirait FF-UP 15 Hypertonic Extracellular Fluid Water Secreted from Supraoptic Nuclei (OSMORECEPTOR) Shrinked & Stimulated Stimulating Posterior Hypophysis ADH Secretion Increasing the Permeability of Distal Tubule, Collecting Tubule and Collecting Ducts to Water Water Reabsorption ↑ Urine ↓ Monday, September 21, 2009 Chandra Sirait FF-UP 16 Low Blood Pressure (Bleeding) Low Atrial Pressure Stretch Receptor in Atrium Relaxation Baroreceptor - Sinus Caroticus - Aorta - Pulmonary Area ADH Secretion↑ Vasoconstriction Monday, September 21, 2009 Blood Pressure ↑ Chandra Sirait FF-UP 17 Stimulating and Inhibiting Factors of ADH Secretion : • Trauma • Illness • Anxiety ADH ↑ • Drugs ( Morphine, Nicotine, Tranquilizer) • Alcohol → ADH ↓ Alcohol Arteriol Afferent Dilatation GFR (glomerulo filtration rate) ↑ Diuresis DIABETES (Diuresis : 15 times/day) Monday, September 21, 2009 Chandra Sirait FF-UP 18 ADH Secretion↓ OXYTOCIN FUNCTIONS : 1. Human milk secretion (Milk Ejection = Milk Letdown) 2. Uterine contraction : * Partus * Ovum Fertilization Mammary Gland Alveoli → Myoepithelium ↑ Contraction Oxytocin Monday, September 21, 2009 Chandra Sirait FF-UP 19 INFANT STIMULATION/SUCKLING TO THE PAPILLA/MAMMARY AREOLA Medulla Spinalis HYPOTHALAMUS Posterior Hypophysis Emosi Anterior Hypophysis Oxytocin ↑ Prolactin ↑ Milk production ↑ Myoepithelial Cells Contraction MILK EJECTION 0,5-1 minutes after stimulation ± 1.5 l/day Monday, September 21, 2009 Chandra Sirait FF-UP GnRH ↓ FSH & LH ↓ OVULATION BIRTH CONTROL 20 GRAVIDITY • Uterus : Receptor Oxytocin ↑ → More Sensitive • Gravid End : Oxytocin Secretion ↑ • Stimulation/IrRitation/Stretching in Uterine Cervix, Uterus and Vagina → Oxytocin ↑ → SMOOTH PARTUS • Hypophysectomy → PROLONGED PARTUS Monday, September 21, 2009 Chandra Sirait FF-UP 21 STIMULATION/IRRITATION/STRETCHING (UTERINE CERVIX, UTERUS, VAGINA) Medulla Spinalis Hyphothalamus Emotion Posterior Hypophysis Oxytosin ↑ PARTUS 1. 2. 3. Infant Placenta Stop Bleeding SUCKING PUMP FASTER SPERMATOZOA ARRIVAL AT FALLOPIAN TUBE FERTILIZATION Monday, September 21, 2009 Chandra Sirait FF-UP 22 Langkah-langkah apa yang harus Anda lakukan untuk mencapai keinginankeinginan tersebut? Monday, September 21, 2009 Chandra Sirait FF-UP 23 OPINI “Apapun yang kita mau, harus disadar resource kita terbatas. Jadi, kita harus me-manage; bagaimana mengatur waktu, tenaga, uang dan segala macam. Tapi, menentukan tujuan ke mana kita pergi, adalah hal pertama yang harus dilakukan.” Palgunadi T. Setyawan Mantan Dirut PT Astra International Alumnus Teknik Mesin ITB ‘57 Monday, September 21, 2009 Chandra Sirait FF-UP 24 GROWTH HORMONE (GH) SYNONIMES = Somatotropic Hormone = Somatotropin SECRETED BY : Anterior pituitary somatotropes/acidophil cells 30-40 % STRUCTURE : GH : Polypeptide, 191 amino acids IGF-I : Polypeptide, 70 amino acids FUNCTION : Stimulating the growth of all tissues in the body Cell count = Hyperplasia Cell 2009 = Hypertrophy Monday, September 21, size Chandra Sirait FF-UP 25 In early growth Adult : Whole organs of the body : * Post epiphysial closure Bone growth ceases * Soft tissues keep growing GROWTH AFFECTING HORMONES : 1. Growth hormone 2. Thyroid hormone Thyroxin 3. Sex hormone Androgen : Testosteron Estrogen 4. Insulin 5. Glucocorticoid Cortisol Monday, September 21, 2009 Chandra Sirait FF-UP Genetic and Nutrition 26 FAST GROWTH PERIOD : Infants : Growth hormone Thyroxin Adolescences : Androgen 1. Testis 2. Ovary 3. Adrenal Cortex : Estrogen Monday, September 21, 2009 Chandra Sirait FF-UP 27 GH Secretion Stimulator : Hypoglycemia Amino Acid (Arginine, Lecithen) Exercise Fasting Sleeping GH Secretion Inhibitor : Increased Blood Glucose Somatostatin Cortisol GH Secretion : Children to Adults Increasad/Decreased Secretion depend on: Nutrition, Hypoglycemia, Exercise, etc. Monday, September 21, 2009 Chandra Sirait FF-UP 28 GH SECRETION REGULATION : Stimulus * Reduced glucose * Reduced free fattu acid * Increased amino acid (arginin) * Fasting * Calorie loss in a long time * Sleeping * Exercise * Puberty * Estrogen * Androgen * Dopamine * Acetylcholin * Serotonin * α-Adrenergic agonists * γ-Amino butyric acid * Encephaline Monday, September 21, 2009 Chandra Sirait FF-UP Inhibitors * Somatostatin * Increased glucose * Increased free fatty acid * Somatomedin * GH * β-Adrenergic agonists * Cortisol * Senescence * Obesity * Pregnancy 29 GH SECRETION REGULATION PATHWAY: Stimulus/Inhibitor HYPOTHALAMUS GHRH ↑ Somatostatin ↓ + ANTERIOR PITUITARY GH ↑ _ Liver and other tissues IGF-I/Somatomedin ↑ * Growth ↑ * Protein synthesis ↑ * Gluconeogenesis ↑ * Lypolisis ↑ Monday, September 21, 2009 Chandra Sirait FF-UP 30 SOMATOMEDIN C /Insulin-Like Growth Factor I (IGF-I) GH → Bone and cartilage growth Indirectly GH Liver/Kidney IGF-I/Somatomedin C Bone and Cartilage Growth Closed epiphysis (Puberty) : - Bone stops to lengthen - Bone thickening keeps in progress Monday, September 21, 2009 Chandra Sirait FF-UP 31 GH METABOLIC EFFECTS : 1. Increased protein synthesis 2. Reduced use of carbohydrate as energy source 3. Increased fat mobilization Protein Metabolism: A.a transport through cell membrane into the cell ↑ More activated ribosome within the cell Intranuclear RNA formation ↑ Increased protein synthesis Reduced protein and a.a. catabolism Monday, September 21, 2009 Chandra Sirait FF-UP 32 Lipid metabolism Increased lipid mobilization (energy source) Lipid tissue ----- Increased fatty acid release Increased Acetyl Co A Energy Lipid mobilization High amount of hepatic acetoacetic acid production Ketosis Monday, September 21, 2009 Chandra Sirait FF-UP 33 Carbohydrate metabolism 1. Reduced glucose use of energy Unclear mechanism, possibly : Increased fatty acid mobilization Increased fatty acid Feedback Glycolysis inhibition Monday, September 21, 2009 Chandra Sirait FF-UP 34 Energy source 2. Increased glycogen deposition Less use of glucose and glycogen as the source of energy Glucose into the cell Glycogen 3. Reduced cellular glucose uptake, blood glucose ↑ First, glucose uptake into the cells increases Glycogen ↑ Then, glycogen becomes saturated Reduced glucose uptake Increased blood glucose level (50-100% of normal) Monday, September 21, 2009 Chandra Sirait FF-UP 35 GH causes the reduction of glucose use as energy, so that GH has DIABETOGENIC effect GH Glucose enters the cell Glycogen saturated cell Reduced glucose uptake by the cell Increased blood glucose level Glycogen Enhancing beta pancreatic cells/Islets of Langerhans Increased insulin secretion Monday, September 21, Increased 2009 glucose uptake into the cell Chandra Sirait FF-UP 36 Results in damaged beta cells Reduced insulin production capability Diabetes mellitus GH GROWTH EFFECTS: Requiring : - Carbohydrate - Insulin Insulin ----- a.a & ch transport into the cells Carbohydrate Required for Energy of growth If pancreas removed Diet without carbohydrate Monday, September 21, 2009 Chandra Sirait FF-UP GH fails to affect growth 37 - ANTERIOR HYPOPHYSIS HORMONE Increasing blood glucose level : GH ACTH TSH Have Diabetogenic Effect Prolactin PITUITARY DIABETES GH CONCENTRATION In the past: GH was thought to disappear post-puberty ---- WRONG Facts : GH secretion in children – adults almost similar GH secretion is pulsatile Children : 5 milimicrogram/milimeter Adults : 3 milimicrogram/milimeter GH concentration may increase to 50 mmcg/ml in the loss of : - Protein Monday, September 21, 2009 Chandra Sirait FF-UP - Carbohydrate 38 In acute condition : hypoglycemia In chronic condition : protein deficiency GH secretion strong stimulator GH SECRETION ABNORMALITIES I. Panhypopituitarism Reduced secretion of all hormones from anterior hypophysis May occur : - Congenital - Suddenly/slowly 1. DWARFISM/CRETINISM * during childhood * proportional growth, but the degree * children of 10 y like those of 4-5 y * children of 20 y like those of 7-10 y Monday, September 21, 2009 Chandra Sirait FF-UP 39 * Theoretically, the followings may also be found : - Thyroid deficiency - Adrenocortical deficiency Small body --- few needs Deficiency syndromes are subtle * Inhibited sexual development during adulthood Only 1/3 have sexual function 2. PANHYPOPITUITARISM IN ADULTS Causes : - Tumor --- suppresses Anterior hypo. --- function ↓ - Thrombosis in hypophysis (often in post partus shock) Effects : - Hypothyroidism - Adrenal cortex secretion ↓ - Gonadotropic hormone secretion ↓ --- sexual hormone ↓ - Therapy : satisfactory with hormone substitution E.g. : Thyroid hormone Monday, September 21, 2009 Chandra Sirait FF-UP Adrenocortical hormone 40 II. Increased GH secretion 1. GIANTISM/GIGANTISM in childern Cause : acidophil cell activity ↑ or tumor Effect : Hyperglycemia β cell Islets of Langerhans GH Stimulation↑ degeneration Diabetes Mellitus because Epiphyseal Height unclosed More severe tumor ---- Damaged Ant. Hypo. --Panhypopituitarism Monday, September 21, 2009 Chandra Sirait FF-UP 41 2. ACROMEGALY in adults Cause : acidophil cell tumor emerges in adulthood (the epiphysis has closed) Effects : Not tall, but bone thickens : * Small bones in arms and legs * Membranous bones * Soft tissues keeps growing body organ enlarge : • Tongue • Liver • Kidney • etc Monday, September 21, 2009 Chandra Sirait FF-UP 42 Monday, September 21, 2009 MANAJEMEN WAKTU Chandra Sirait FF-UP 43 Con’t Jika Anda hidup 60 tahun, maka : Tidur 8 jam sehari totalnya 20 tahun seumur hidup Menonton TV 2 jam sehari totalnya 5 tahun seumur hidup Makan (3 kali) 2 jam sehari totalnya 5 tahun seumur hidup Terjebak macet 3 jam sehari totalnya 7.5 tahun seumur hidup BERAPA WAKTU YANG TERSISA UNTUK BERKARYA ? Monday, September 21, 2009 Chandra Sirait FF-UP 44 TOP SECRET : THEY’LL PUSH YOU TO THE LIMIT ! Pada awal-awal, Anda hanya diberi beban tidak seberapa. Lama-kelamaan, pekerjaan yang diberikan akan lebih banyak dari waktu yang tersedia. Kunci : Manajemen Waktu ! Monday, September 21, 2009 Chandra Sirait FF-UP 45 PROLACTIN 1. Effect on Mammary Gland Lactation Process • Mammary Gland Growth and Differentiation • Lactogenesis : Human Milk Production • Galactopoisis : Lactation Maintenance In Pregnancy : Progesterone Progesterone ↑ Lactogenesis Prolactin ↓ Lactogenesis None 46 Monday, September 21, 2009 Estrogen ↑ Human Milk Production Chandra Sirait FF-UP Not Inhibiting Prolactin The End of Pregnancy : Progesteron ↓ → Estrogen ↑ Milk not Ejected Prolactin secretion : Partus → Prolactin ↑ ↑ and ↓ ↓ DEPENDS ON : 1. Lactation frequency 2. Touch of mammary papillae 3. Visual 4. Auditive Hyperprolactinemia → Lactation ↑ → Amenorrhoea KB → Positive Estrogen-LH Feedback Mechanism Monday, September 21, 2009 Chandra Sirait FF-UP 47 2. Effect on the Testis Improving Spermatogenesis ICSH Receptor Sensitiveness ↑ → Androgen ↑ Spermatogenesis ↑ Monday, September 21, 2009 Chandra Sirait FF-UP 48 THYROID STIMULATING HORMONE/TSH Hypothalamus TSH-RH Anterior Hypophysis (cold temperature) TSH Thyroid Gland Needs of Energy ↑ Energy Fulfilled Thyroxin Monday, September 21, 2009 Rate of Metabolism ↑ ↑ Chandra Sirait FF-UP 49 ADRENOCORTICOTROPIC HORMONE/ACTH Hypothalamus ACTH-RH Anterior Hypophysis ACTH Adrenal Cortex Corticosteroid Stressor (individual) Anti stress Monday, September 21, 2009 Chandra Sirait FF-UP 50 FOLLICLE STIMULATING HORMONE/FSH LUTEINIZING HORMONE/LH Hypothalamus FSH-RH, LH-RH Anterior Hypophysis Testis Ovarium FSH, LH Spermatogenesis Follicle growth Monday, September 21, 2009 Chandra Sirait FF-UP 51 ADRENOCORTICAL (ADRENAL/SUPRARENAL) 1. Adrenal Medulla Sympathetic stimulation → Epinephrine Nor Epinephrine 2. Adrenal Cortex • Zona Glomerulosa → Mineralocorticoid • Zona Fasciculata Glucocorticoid and Androgen • Zona Reticulosa Musculinizing Effect Small amount of Progesterone & Estrogen Monday, September 21, 2009 Chandra Sirait FF-UP 52 MINERALOCORTICOID (ALDOSTERON) EFFECT : 1. In the Kidney : Ion Exchange Aldosteron Na Reabsorption Reabsorption Hypernatremia Polydipsia Extracellular vol. ↑ Paralis Blood vol. Monday, September Blood Pressure ↑ 21, 2009 Chandra DIURESIS Sirait FF-UP 53 Reabsorption Secretion Secretion Water ↑ Anion (Cl-) H+ ↑ Alcalosis K+ ↑ Hypokalemia 2. In Sweat Gland, Salivary Gland, Intestine Aldosterone ↓ → Absorbsi Na ↓ (menahan air) → Diare Aldosterone ↑ • Extracellular K ion ↑ • Na Ion ↓ • Angiotensinogen II ↑ Aldosterone ACTH ↓ ↓ Permissive Effect Monday, September 21, 2009 Chandra Sirait FF-UP 54 GLUCOCORTICOID (CORTISOL, CORTICOSTERONE, DESOXYCORTICOSTERONE) = Anti Stress EFFECTS : 1. Carbohydrate Metabolism : • Amino acid mobilization from extrahepatic tissue (muscle) → Amino acid in the plasma ↑ • Transpor A.a transport into hepatsic cells ↑ → Gluconeogenesis ↑ • Glucose use by the cells ↓ → Blood glucose ↑ ADRENAL DIABETES 2. Protein Metabolism • Protein Synthesis ↓ • Protein Catabolism ↑ → Blood amino acid ↑ • Amino acid transport into hepatic cells ↑ → Preservation cellular protein ↓ EXCLUDING that in hepatic cells 3. Lipid Metabolism • Lipid metabolism ↑ → Fatty in the plasma ↑ → Energy • Requiring GH and ACTH Monday, September 21, 2009 Chandra Sirait FF-UP 56 4.Others * Stress → ACTH ↑ → Cortisol * Anti Inflammation * Anti Alergy CIRCADIAN RHYTHM ACTH-RH, ACTH, CORTISOL 1. In the morning → High 2. Afternoon/evening → Low Monday, September 21, 2009 Chandra Sirait FF-UP 57 ABNORMAL 1. Hypoadrenalism (ADDISON’S DISEASE) • Failure in Adrenal Cortex • Aldosterone ↓ → Na Reabsorption ↓ → Extracellular NA ↓ → Blood volume ↓ → SHOCK • Cortisol ↓ → Gluconeogenesis ↓ → Energy ↓ • Stress → Death 2. Hyper Adrenalism (CUSHING DISEASE) • Adrenal Hypersecretion • Cortisol ↑ • Androgene ↑ → Musculinizing effect ↑ and Acne • Lipid mobilization ↑ → BUFFALO TORSO • Steroid ↑ → Oedema Face → MOON FACE • Protein Catabolism ↑→ Protein Tissue ↓ → Weak → OSTEOPOROSIS • Blood glucose ↑→ ADRENAL DIABETES Monday, September 21, 2009 Chandra Sirait FF-UP 58 MENINGKATKAN MOTIVASI Monday, September 21, 2009 Chandra Sirait FF-UP 59 CONTOH PENYEBAB KURANG MOTIVASI Merasa beban terlalu berat Telah berulang kali gagal Mengalami konflik berat yang menghilangkan konsentrasi Jenuh Lingkungan yang permisif Terpengaruh lingkungan / teman Monday, September 21, 2009 Chandra Sirait FF-UP 60 TIPS MEMOTIVASI DIRI Bagi tugas yang besar Gunakan aturan 5 menit Tetapkan sasaran tiap kegiatan Beri hadiah pada diri Cari bantuan bila Monday, September 21, 2009 perlu Chandra Sirait FF-UP 61 MEMBANGKITKAN KEMBALI MOTIVASI Miliki motivator internal & eksternal Evaluasi tanggung jawab Jangan menghindar Buat skala prioritas Monday, September 21, 2009 Chandra Sirait FF-UP 62 PAN CREAT IC GLAN D Consists of : 5. 6. ACCINI : digestive enzymes secretion ISLETS OF LANGERHANS * ALPHA CELLS : glucagon secretion * BETA CELLS : insulin secretion * DELTA CELLS : somatostatin secretion * F CELLS Monday, September 21, 2009 Chandra Sirait FF-UP 63 GLUC OSE TRAN SPO RT : Fa cil it ate d diffusi on G + C C G GC GC Insulin Monday, September 21, 2009 Chandra Sirait FF-UP 64 Glucose Transport : • • • • Without insulin → ¼ of normal With insulin → 5 times of normal Insulin effective in SKELETAL MU SCL E and AD IPOSE TISS UE Insulin does not enhance glucose transpor in : 1. Brain cells 2. Red blood cells 3. Intestinal mucosa Simp le D iffusi on 4. Renal tubular epithelium Monday, September 21, 2009 Chandra Sirait FF-UP 65 The Imp ortan ce of Glu co se Lev el Re gu lat io n 2. Energy obtained from glucosa, lipid and protein 3. Glucose is the only nutrient for : * Brain * Retina gluco se l evel shoul d never b e lo w * Germinal epithelium 7. If glucose level is high : * Extracellular osmotic pressure ↑ → Water out of cell → DEHYDRATION * Glucose in renal tubule ↑ → 1. Glucose wasting in urine 2. Osmotic diuretic → high loss of fluid Normal Blood Glucose Level : • Fasting : 80-90 mg% • 1 h post prandial : 120-140 mg% • Monday, September 21, 2009 2 h post prandial : <120 mg% Chandra Sirait FF-UP 66 IN SULIN MET AB OLIC EFFECT S 3. Carbohydrate Metabolism * Glucose transport ↑ * Glycogen ↑ * Glucose metabolism ↑ Burnt Glucose Glucose Glycogen Insulin Monday, September 21, 2009 Chandra Sirait FF-UP 67 2. Lipid Metabolism Glucose Insulin Glucose Gly coly sis Alpha Glycerophosphat Triglyceride Glycerol Monday, September 21, 2009 Chandra Sirait FF-UP * Synthesis * Lipoprotein Fatty Acid Fatty Acid 68 TRIG LYC ERID E SYNTHES IS WIT HI N AD IP OSE TI SS UE Glucose Glucose-6-phosphate Pyruvic acid α-glycerol phosphate Lipoprotein Acetyl CoA Lip oro tei n lip ase Fatty acids Fatty Acids Triglyceride Glycerol ADIPOSE TISSUE FF-UP Monday, September 21, 2009 Chandra Sirait PLASMA PLASMA 69 Insulin ↓ FATT Y ACI Fatty Acid ↑ sy nt hesiz ed by the li ver oxi dat io n D Cholesterol Acetyl Co A Triglyceride Phospholipid Energy Aceto-acetic acid Atheroscerosis β-(OH)-butyric acid Aceton KETO BO DI ES Monday, September 21, 2009 Chandra Sirait FF-UP 70 3. Protein Metabolism Sufficient insulin Amino Acid Active Transport into the Cells ↑ Protein synthesis ↑ Growth ↑ (having potential effect with GH) N balance (+) Monday, September 21, 2009 Chandra Sirait FF-UP 71 Insufficient Insulin Amino Acid Transport into the Cells ↓ Protein Synthesis ↓ Plasma amino acid ↑ Li ver AA Deg ra da tion Energy Excretion ↑ Gluconeogenesis Monday, September 21, 2009 Chandra Sirait FF-UP Urea 72 • Pe mecah an Pro te in brea kd own no t bal an ces w it h new pro te in syn the si s • Pr otein was ti ng Both may cause : 1. A utoat roph y 2. F at ig ue 3. D iso rde red orga n funct ion Pro te in was tin g BODY WEIG HT ↓ Lipoly si s Monday, September 21, 2009 Chandra Sirait FF-UP 73 PA RAT HY RO ID GLAND • 2 glands around thyroid gland • Function : Regulating blood Ca level Blood Ca : 10 mg% (5 mEq/L) Monday, September 21, 2009 Chandra Sirait FF-UP 74 HY PO CA LCEMIA Extracellular Ca Nerve cells more excitable (Permiability ↑) Potential of spontaneous action TETANY Monday, September 21, 2009 Chandra Sirait FF-UP 75 HY PERC AL CEMIA • • • • Reflex ↓ Constipation Appetite ↓ Suppressed Nerve System AB NOR MAL 9. HYPOPARATHYROID parathormone level ↓ EFFECT : a. Calcium ↓ TETANY Monday, September 21, 2009 Chandra Sirait FF-UP 76 Laryngeal muscle most sensitive → Spasm/Obstruction of respiratory tract FATAL b. Phosphate ↑ (normal 4 mg%) →12 mg% 2. HIPERPARATIROID Kadar parathormone ↑ → Calcium ↑ Phosphate ↓ Causes : 1. Tumor 2. Female, more frequent due to Lactation and Pregnancy Plasma Ca ↓ Stimulating parathyroid tissue Monday, September 21, 2009 Chandra Sirait FF-UP (if prolonged, hypertrophy) 77 3. RIC KETTSIA • In children • Ca and Phosphate deficiency in extracellular fluid Cause : Vitamin D deficiency 7-dehydrocholesterol (pro-vitamin D) Ultra violet ↓ Vitamin D Digestive tract Ca Absorption ↓ and Phosphate ↓ Monday, September 21, 2009 Chandra Sirait FF-UP 78 Rickettsia Physiological Effects : • Parathyroid Tissue Hyperplasia • Bone Strength ↓ • Tetany Treatment : Vitamin D and Calcium Phosphate If Vitamin D only : • Absorption ↑ in digestive tract but Ca absorption is absent • Bone reabsorption ↑ but bone is loss • Bone formation ↑ so that blood Ca ↓ Monday, September 21, 2009 Chandra Sirait FF-UP 79 If Ca and Pho sph ate only Ca wit hout vi t. D Ca Ab so rpti on ↓ Ph osp hat e Abs orpt io n↑ Ph osp hat e Pl as ma Ca ↓ Bone forma ti on Monday, September 21, 2009 Chandra Sirait FF-UP 80 THY RO ID G LAND Secr et io n : 1. Thy roxi n {tet rai odothy ro nin (T4 ) } 2. T ri io do thyr oni n (T 3) Io di ne req uir eme nt : 50 mg /yea r 1 mg/wee k Io di ne def icie ncy → MEN TA L RET AR DA TI ON Goitroge nic Ar ea : ar ea whe re the lan d co ntai ns no io dine. e. g. : mo nt ain ous are a Monday, September 21, 2009 Chandra Sirait FF-UP 81 THY RO ID H ORMO NE SYN THESIS Iodine in food → entering plasma in the form of iodide (J’) J’ I’ I’ Peroxydase I 2 Thy reog lob ul in Thy reog lob ul in Thy roxi ne Thy reog lobuli n –Thy roxi ne Ly so som al Protease (C oup ling MIT , DIT ) Plas ma Thy roid ce lls I ntrafo lli cle Monday, September 21, 2009 Chandra Sirait FF-UP 82 MET AB OLIC EFFEC TS 3. 4. 5. Stimulating metabolism in general except in brain, retina, lymph, testis and lung Carbohydrate metabolism, protein and lipid increase Enhanced bone growth AB NOR MAL • Hyperthyroid Cause : 1. LATS (long acting thyroid stimulation) Antibody (TSH like)→Thyroid →Thyroxin ↑ 2. Thyroid gland adenoma Symptoms : Heat intolerance, exophthalmos, sweating, fatigue, unable to sleep, BW ↓ Monday, September 21, 2009 Chandra Sirait FF-UP 83 2. Hyp othyr oid Goitro gen esis : The process of thy roid gla nd en lar ge men t due to co lo id ret en tio n an d wat er wi th in folli cle or tumo r. Cau se : a. Io dine de ficien cy (Io din e de f./en demi c go iter /goitro ge ni c ar ea) Monday, September 21, 2009 Chandra Sirait FF-UP 84 Hypothalamus TSH-RH Anterior Hypophysis TSH Thyroid Tissue Thyroglobulin ↑ → Enlargement gland cells Thyroxin (T2, T4) ↓ → due to Iodine absence Negative Feed Back TSH ↑↑ → Thyroid gland enlarges due to numerous follicles Thyreoglobulin and enlarged gland cells Monday, September 21, 2009 Chandra Sirait FF-UP 85 b. Id iopa th ic Non-toxi c Goite rcoll oid Normal amo unt of thyr oid ho rmo ne se cret ion, bu t inh ibi ted du e to mil d thyr oidit is c. Thio cy an at e (A nti thyr oid ) In hib it ing iodin e pump d. Thio ca rb ami de (An tit hyr oid) In hib it ing iodin at ion Monday, September 21, 2009 Chandra Sirait FF-UP 86 MENJAGA KESEHATAN & PENAMPILAN Monday, September 21, 2009 Chandra Sirait FF-UP 87 MENJAGA PENAMPILAN Pada 3 – 30 detik pertama berjumpa, orang akan berpersepsi tentang : Status sosioekonomik Anda Tingkat keterpelajaran Menyenangkan atau tidakkah Anda Monday, September 21, 2009 Chandra Sirait FF-UP 88 TIPS BERPENAMPILAN Tarik perhatian, jangan alihkan Kenakan pakaian yang tepat Pilih sepatu yang sesuai Rambut yang rapi Asesoris yang tepat Pancarkan percaya diri Monday, September 21, 2009 Chandra Sirait FF-UP 89 AN DRO GEN HOR MO NE LH (L utei niz ing Ho rmo ne) IC SH ( I nters titial Ce ll Stimulatin ACT H g Hor mone ) Sel Ley di g In ter st it ial Ce ll s Ad ren al Co rtex (Pa rs R eticular is ) An dro gen H ormo ne • Pe ak secr etio n in age of 20 years and decrea ses th ereafter Monday, September 21, 2009 Chandra Sirait FF-UP 90 FU NCT ION : 2. Mal e s exu al ity ch ar act er is tics : a. Pr imar y → Sexu al organ deve lo pme nt b. Seco ndar y : * Ha ir - Co ar se - Typ ical dist ribu tio n * Skin - Mo re co ar se - Swe at ↑ - Lipi d ↑ - Da rk er * Vo ice * Th yroid car til ag e * Hi p Monday, September 21, 2009 Chandra Sirait FF-UP 91 Ag e mo re tha n 4 5 ye ar s → AN DRO PO USE (ma le) → MEN OPA USE (femal e) Symp to ms : • Depr essio n • Hy pe rt ens io n • He ad ach e • Psy hcolo gi cal Monday, September 21, 2009 Chandra Sirait FF-UP 92 ES TRO GEN Secretion : 4. Ovary 5. Adrenal Cortex Functions : 8. Primary sexual characteristics: a. Uterus : - Sensitive to mechanic and oxytocin stimulation - Endometrial proliferation b. Tuba Fallopii : - Sensitive to mechanic and oxytocin stimulation - Endometrial proliferation - More numerous and more active cilia c. Vagina : cornification Monday, September 21, 2009 Chandra Sirait FF-UP 93 2. Secondar y sexu al ch ar act eri st ics: * Mam mar y * Hi p * Vo ice * Lipi d * Epy ph yseal lin e cl ose s faste r Monday, September 21, 2009 Chandra Sirait FF-UP 94 PRO GES TERO NE Se cretion : 4. Place nta 5. Cor pu s Lu teum Fun ction s : 8. Uteru s : - In crea se d gland and bl ood ves sel - Se cretory ph ase - Les s sensitiv e to mechan ic and o xytocin sti mu latio n → AN TI A BO RTU S 2. Fal lo pi an Tube : simi la r ef fect to that in th e uter us 3. Ca ta bo li sm ↑ Monday, September 21, 2009 Chandra Sirait FF-UP 95