Endocrinology

ENDOCRINOLOGY by Chandra Sirait Faculty Of Pharmacy University Of Pancasila Monday, September 21, 2009

Chandra Sirait FF-UP

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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. September Peptide/Protein Monday, 21, 2009 Chandra Sirait FF-UP

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1

Kemampuan Komunikasi

4.69

2

Kejujuran/Integritas

4.59

3

Kemampuan Bekerja Sama

4.54

4

Kemampuan Interpersonal

4.5

5

Beretika

4.46

6

Motivasi/Inisiatif

4.42

7

Kemampuan Beradaptasi

4.41

8

Daya Analitik

4.36

9

Kemampuan Komputer

4.21

10

Kemampuan Berorganisasi

4.05

11

Berorientasi pada Detail

12

Kepemimpinan

3.97

13

Kepercayaan Diri

3.95

14

Ramah

3.85

15

Sopan

3.82

16

Bijaksana

3.75

17

Indeks Prestasi (>=3.0)

3.68

18

Kreatif

3.59

19

Humoris

3.25

20

Kemampuan Berwirausaha

3.23

Monday, September 21, 2009

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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!

Chandra Sirait FF-UP

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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

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HORMONE ACTION MECHANISM 1. Through Cyclic AMP → Most of the hormones

HORMONE

·

Membrane R E Adenylcyclase C E P T O R

Fast Reaction

Monday, September 21, 2009

Cytoplasma ATP

Cyclic AMP (cAMP) = Second Messenger

Enzyme Activation

PHYSIOLOGICAL EFFECT

Chandra Sirait FF-UP

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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

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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

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HIPOTHALAMUS HIPOPHYSIS

Anterior H. = Adenohypofisis

Pars Intermedialis Rudimentary

Posterior H. = Neurohipophysis

Except Animals

Monday, September 21, 2009

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HIPOTHALAMUS

Hormone Secretion

Secretion RH (Releasing Hormone) IH (Inhibitory Hormone)

Hypothalamico Hypophysial Tract

Hypothalamic Hypophyseal Portal Vessels

Posterior Hypophysis

Anterior Hypophysis

Hormone Preserved

Hormon Production

Monday, September 21, 2009

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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

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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

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c.   Pars Intermedialis • Melanocyte Stimulating Hormone (MSH) → in fish, reptiles, and amphibian • Human has no MSH

Monday, September 21, 2009

Chandra Sirait FF-UP

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SETELAH LULUS, LALU APA ?

Monday, September 21, 2009

Chandra Sirait FF-UP

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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

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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

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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

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Low Blood Pressure (Bleeding)

Low Atrial Pressure

Baroreceptor - Sinus Caroticus - Aorta - Pulmonary Area

Stretch Receptor in Atrium Relaxation

ADH Secretion↑

Vasoconstriction Monday, September 21, 2009

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Blood Pressure ↑

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Stimulating and Inhibiting Factors of ADH Secretion : • Trauma •        Illness •        Anxiety ADH ↑ •        Drugs ( Morphine, Nicotine, Tranquilizer) •

Alcohol → ADH ↓ Alcohol

ADH Secretion↓

Arteriol Afferent Dilatation GFR (glomerulo filtration rate) ↑

Diuresis DIABETES (Diuresis : 15 times/day) Monday, September 21, 2009

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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

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INFANT STIMULATION/SUCKLING TO THE PAPILLA/MAMMARY AREOLA Medulla Spinalis

HYPOTHALAMUS Posterior Hypophysis

Anterior Hypophysis

Oxytocin ↑

Prolactin ↑

Milk production ↑

GnRH ↓

Myoepithelial Cells Contraction

FSH & LH ↓

MILK EJECTION

OVULATION

0,5-1 minutes after stimulation ± 1.5 l/day Monday, September 21, 2009

Emosi

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BIRTH CONTROL

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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

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STIMULATION/IRRITATION/STRETCHING (UTERINE CERVIX, UTERUS, VAGINA) Medulla Spinalis Hyphothalamus

Emotion

Posterior Hypophysis Oxytosin ↑ PARTUS 1. 2. 3.

SUCKING PUMP

Infant Placenta Stop Bleeding

FASTER SPERMATOZOA ARRIVAL AT FALLOPIAN TUBE

FERTILIZATION Monday, September 21, 2009

Chandra Sirait FF-UP

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Langkah-langkah apa yang harus Anda lakukan untuk mencapai keinginankeinginan tersebut?

Monday, September 21, 2009

Chandra Sirait FF-UP

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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

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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 = Hypertrophy Monday, September 21, size 2009 Chandra Sirait FF-UP

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In early growth

: Whole organs of the body

Adult

: * 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

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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

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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

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GH SECRETION REGULATION : Stimulus

Inhibitors

* 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

* Somatostatin * Increased glucose * Increased free fatty acid * Somatomedin * GH * β-Adrenergic agonists * Cortisol * Senescence * Obesity * Pregnancy

Chandra Sirait FF-UP

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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

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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

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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

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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

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Carbohydrate metabolism 1.    Reduced glucose use of energy Unclear mechanism, possibly : Increased fatty acid mobilization Increased fatty acid

Energy source

Feedback Glycolysis inhibition Monday, September 21, 2009

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2.    Increased glycogen deposition Less use of glucose and glycogen as the source of energy Glucose

Glycogen into the cell

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

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GH causes the reduction of glucose use as energy, so that GH has DIABETOGENIC effect GH

Glucose enters the cell

Glycogen

Glycogen saturated cell Reduced glucose uptake by the cell Increased blood glucose level Enhancing beta pancreatic cells/Islets of Langerhans Increased insulin secretion Monday, September 21, Increased 2009

glucose uptake Chandra Sirait FF-UP into the cell

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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

GH fails to affect growth

Chandra Sirait FF-UP

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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 2009 Chandra Sirait FF-UP - 21, Carbohydrate

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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

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* 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

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      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

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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

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MANAJEMEN WAKTU

Monday, September 21, 2009

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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

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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

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PROLACTIN   1. Effect on Mammary Gland Lactation Process • Mammary Gland Growth and Differentiation • Lactogenesis : Human Milk Production • Galactopoisis : Lactation Maintenance In Pregnancy : Progesterone Progesterone ↑

Estrogen ↑

Monday, September 21, 2009

Lactogenesis Prolactin ↓

Human Milk Production Chandra Sirait FF-UP Not Inhibiting Prolactin

Lactogenesis None 46

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

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2. Effect on the Testis Improving Spermatogenesis ICSH Receptor Sensitiveness ↑ → Androgen ↑ Spermatogenesis ↑

Monday, September 21, 2009

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THYROID STIMULATING HORMONE/TSH Hypothalamus TSH-RH Anterior Hypophysis (cold temperature)

Needs of Energy ↑

TSH Thyroid Gland

Thyroxin Monday, September 21, 2009

Energy Fulfilled

Rate of Metabolism ↑ ↑ Chandra Sirait FF-UP

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ADRENOCORTICOTROPIC HORMONE/ACTH Hypothalamus ACTH-RH Anterior Hypophysis ACTH Adrenal Cortex Corticosteroid

Monday, September 21, 2009

Stressor (individual) Anti stress

Chandra Sirait FF-UP

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FOLLICLE STIMULATING HORMONE/FSH LUTEINIZING HORMONE/LH

Hypothalamus FSH-RH, LH-RH Anterior Hypophysis Testis Ovarium

Monday, September 21, 2009

Chandra Sirait FF-UP

FSH, LH Spermatogenesis Follicle growth

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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

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MINERALOCORTICOID (ALDOSTERON) EFFECT : 1.    In the Kidney : Ion Exchange Aldosteron Na Reabsorption Reabsorption

Hypernatremia

Water ↑

Reabsorption Secretion Secretion

Anion (Cl-) Polydipsia

H+ ↑

K+ ↑

Alcalosis

Hypokalemia

Extracellular vol. ↑ Paralis Blood vol. September BloodMonday, Pressure ↑ 21, 2009

Chandra Sirait FF-UP DIURESIS

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2.    In Sweat Gland, Salivary Gland, Intestine Aldosterone ↓ → Absorbsi Na ↓ (menahan air) → Diare Aldosterone ↑ • Extracellular K ion ↑ • Na Ion ↓ • Angiotensinogen II ↑ Aldosterone ACTH ↓

↓

Monday, September 21, 2009

Permissive Effect

Chandra Sirait FF-UP

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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

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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

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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

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MENINGKATKAN MOTIVASI

Monday, September 21, 2009

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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

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TIPS MEMOTIVASI DIRI

Bagi tugas yang besar

Gunakan aturan 5 menit

Beri hadiah pada diri

Tetapkan sasaran tiap kegiatan Cari bantuan bila Monday, September 21, 2009 perlu

Chandra Sirait FF-UP

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MEMBANGKITKAN KEMBALI MOTIVASI

Monday, September 21, 2009

Miliki motivator internal & eksternal Evaluasi tanggung jawab Jangan menghindar Buat skala prioritas

Chandra Sirait FF-UP

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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

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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

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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

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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, 2 h post prandial : <120 mg% September 21, 2009 Chandra Sirait FF-UP

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IN SULIN MET AB OLIC  EFFECT S 3.

Carbohydrate Metabolism * Glucose transport ↑ * Glycogen ↑ * Glucose metabolism ↑

                                                            Burnt   Glucose                 Glucose       Glycogen                     Insulin           Monday, September 21, 2009

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2. Lipid Metabolism Glucose Insulin

        Glucose

* Synthesis * Lipoprotein

         Gly coly sis       Alpha Glycerophosphat

Fatty Acid

      Triglyceride Glycerol  Monday, September 21, 2009

Fatty Acid Chandra Sirait FF-UP

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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

                                    ADIPOSE TISSUE Monday, September 21, 2009 Chandra Sirait FF-UP PLASMA     

  Glycerol

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PLASMA     

Insulin ↓                                                                                           FATT Y ACI Fatty Acid ↑                    sy nt hesiz

ed               by the li ver

D

      oxi dat io n

                      Cholesterol        Acetyl Co A           Triglyceride       Phospholipid                        Energy  Aceto-acetic acid

         Atheroscerosis                          β-(OH)-butyric acid             Aceton

Monday, September 21, 2009

Chandra Sirait FF-UP

       KETO BO DI ES

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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

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Insufficient Insulin Amino Acid Transport into the Cells ↓

              Protein Synthesis ↓                            Plasma amino acid ↑

  Li ver                                     AA 

                                                     Energy Excretion ↑        Gluconeogenesis Monday, September 21, 2009

Chandra Sirait FF-UP

Deg ra da tion

     Urea 

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• 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

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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

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HY PO CA LCEMIA Extracellular Ca

Nerve cells more excitable (Permiability ↑)

Potential of spontaneous action

TETANY Monday, September 21, 2009

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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

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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)

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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

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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

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If  Ca  and  Pho sph ate  only Ca

Ph osp hat e wit hout vi t.  D

Ca  Ab so rpti on ↓

Ph osp hat e  Abs orpt io n↑

Pl as ma  Ca  ↓    Bone  forma ti on Monday, September 21, 2009

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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

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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    September                                       FF-UP         I ntrafo lli cle Monday, 21, Thy 2009roid  ce lls   Chandra Sirait

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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

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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

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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

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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

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MENJAGA KESEHATAN & PENAMPILAN

Monday, September 21, 2009

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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

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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

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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

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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

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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

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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

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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

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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

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