Pemeriksaan Laboratorium Gangguan Sistim Endokrin

Dr. D.A.A.MandagiBagian Patologi Klinik

FK UNSRAT

TIU / TIK

TIU : Mengenal beberapa pemeriksaan laboratorium pada gangguan endokrin.

TIK :1. Dapat mengenali beberapa pemeriksaan

laboratorium pada gangguan endokrin.2. Dapat mengenali metoda pemeriksaan laboratorium

pada gangguan endokrin.3. Dapat mengenali faktor pra-analitik pemeriksaan

laboratorium pada gangguan endokrin.

Cell Signaling

• Endocrine Signaling• Neuroendocrine Signaling • Autocrine Signaling• Paracrine Signaling• Juxtacrine Signaling

ENDOCRINE GLANDS

• Hypothalamus• Pituitary / Hypophysis• Thyroid• Parathyroid• Pancreas• Adrenal• Ovary• Testes

Hormone Classification

1) Proteins / Polypeptides2) Steroids3) Amino Acids Derivatives

Hypothalamus(Neuroendocrine)

Hormone Action Site Action

TRH Anterior Pituitary TSH (PRL) ReleaseGnRH Anterior Pituitary FSH / LH ReleaseCRH Anterior Pituitary ACTH Release

GHRH Anterior Pituitary GH ReleaseGHIH Anterior Pituitary Inhibition of many hormonesADH ---- ----

Oxytocin ---- ----

Hypothalamus(Neuroendocrine)

• TRH• GnRH• CRH• GHRH• GHIH (Somatostatin =

SS)• ADH / Vasopressin• Oxytocin

Anterior PituitaryAdeno-Hypophysis

Hormone Action Site Action

TSH Thyroid Formation / Secretion of Thyroid Hormones

FSH Ovary Follicle Growth, Estrogen Secretion, OvulationTestes Spermatogenesis, Develop. Tubul. Seminiferi

LH Ovary Ovulation, Corpus Luteum, Progesteron Sec.Testes Androgen Secretion, Stim. Interstitial Tissue

PRL Mammary Glands Proliferation of M. Glands, Milk Secretion

GH Liver Production of IGF-1 (Promoting Growth)Liver / Peripherals Anabolic / Anti-Insulin

ACTH Adrenal Cortex Stimulation of Adrenocortical Steroids Formation and Secretion

Alfa-MSH Skin Darkning of Skin

Anterior PituitaryAdeno-Hypophysis

• TSH / TSHs• FSH• LH• PRL• GH / Somatotropin

– IGF-1– ITT / OGTT

• ACTH / Corticotropin• Alfa-MSH

Posterior PituitaryNeuro-Hypophysis

Hormone Action Site Action

ADH / Vasopressin

Arteriole Blood Pressure Elevation

Renal Tubules Water ReabsorptionOxytocin Smooth Muscles

(Uterus / Mammary)Contraction; Action in Parturition; Sperm Transport; Ejection of Milk

Posterior PituitaryNeuro-Hypophysis

• ADH / Vasopressin– Osmolality

• Direct (Measured)• Indirect (Calculated)

– Water Deprivation Test– Arginine Vasopressin

• Oxytocin

Thyroid / Parathyroid

Hormone Action Site Action

T4 / T3 General Body Tissue Stimulation of Oxygen Consumption and Metabolic Rate

Calcitonin Skeleton Decreased Bone ResorptionPTH Kidney Increased Ca Reabsorption / Decreased

PO4 ReabsorptionSkeleton Increased Bone Resorption

Thyroid / Parathyroid

• THYROID :– T4 / Thyroxine– T3 / Triidothyronine– fT4– fT3– Calcitonin

• PARATHYROID :– PTH

PancreasIslets of Langerhans

Hormone Action Site Action

Insulin Liver, Fat, Muscle Regulation of CBH Metabolism; Lipogenesis

Glucagon Liver GlycogenolysisSomatostatin

(GHIH)Pancreas Inhibition of Secretion of Insulin /

Glucagon.

PancreasIslets of Langerhans

• Insulin• Glucagon• Somatostatin

Adrenal Cortex

Hormone Action Site Action

Aldosterone Kidney Salt and Water Balance

Cortisol Many Metabolism of CBH, Fat, Protein; Antiinflammatory Effect.

“DHEA(S)” Hormone Precursor Converted to Estrogen / Testosterone

Adrenal Cortex

• Mineralocorticoids– Aldosterone

• Glucocorticoids– Cortisol

• Androgens– DHEA / DHEAS– Testosterone / Estrogen

Adrenal Medulla

Hormone Action Site Action

Norepinephrine; Epinephrine

Sympathetic Receptor

Stimulation of Sympathetic Nervous System.

Epinephrine Liver, Muscle GlycogenolysisAdipose Tissue Lipolysis

Adrenal Medulla

• Epinephrine• Norepinephrine

OvariumFollicle / Corpus Luteum

Hormone Action Site Action

Estrogen Female Accessory Sex Organ

Development of Secondary Sex Charcteristic

Bone Control of Skeletal MaturationProgesterone Female Accessory

Reproductive Structure

Preparation of the Uterus for Ovum Implantation; Maintenance of Pregnancy

“HCG” Ovary Prolongation of Corpus Luteal Function

OvariumFollicle / Corpus Luteum

• Progesterone• Estrogens

– Estradiol

Testes

Hormone Action Site Action

Testosterone Male Accessory Sex Organ

Development of Secondary Sex Characteristic, Maturation and Normal Function

Testes

• Androgens– Testosterone

• Estradiol

Analytical Methods

• Bioassay• Receptor based• Immunoassay• Instrumental

Preanalytical Factors

• Uncontrollable• Controllable

Preanalytical FactorsUncontrollable

• Biological– Age, Sex, Race

• Environmental– Altitude, Ambient Temprature, Place of residence

• Long-term Cyclical Influences– Seasonal, Mentruation

• Underlying Medical Conditions– Obesity, Blindness, Pregnancy, Stress, Fever, Shock /

Trauma, Transfusion, Infusion

Preanalytical FactorsControllable

• Physiological variables– Posture, Prolonged bed rest, exercise / physical

training, Circadian variation, Travel• Diet

– Food ingestion, Ingestion of specific foods and beverages, Vegetarian, Malnutrition, Fasting / Starvation

• Lifestyle– Smoking, Alcohol

• Drugs, Herbal, Recreational drugs

Kepustakaan1. Michael Kleerekoper : Hormones; in : Tietz Textbook of Clinical Chemistry

and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1019 – 1031

2. Helena A.Gruber et.al.: Chapter 24: Evaluarion of Endocrine Function; in : Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed., Copyright © 2006 W. B. Saunders Company

3. Laurence M.Demers : Pituitary Function; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1967 – 1991

4. Laurence M.Demers : The Adrenal Cortex; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 2003 – 2036

5. Laurence N.Demers : The Thyroid : Pathophysiology and Thyroid Function Testing; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 2053 – 2084

6. David B.Endres : Hormone Regulating Mineral Metabolism; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1912 – 1918.

7. Donald S.Young et.al.: Preanalytical Variables and Biological Variation; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 449 – 474