Documente Academic
Documente Profesional
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NeuroEndocrinologie
Sistem nervos
Sistem imun
citokine
Sistem endocrin
Proprietati
Comune
Potentiale de actiune Secretie Mediatori (Peptide) Receptori
Specifice
Amploarea raspunsului Latenta Durata Reglaj
Neurosecretie
Neurohormoni
Neuromodulatori
Hipotalamus
= sub talamus
Functii
Responsiv la: Lumina: lungimea zilei si fotoperioada pentru a genera ritmurile circadian si sezonier Olfactie: stimuli, inclusiv feromoni (parfumuri) Steroizi: gonadali si corticosteroizi Informatii vegetative periferice : cardiovascular, stomac, tract reproductiv
SN Autonom Stimuli hormonali: leptina, ghrelin, angiotensina, insulina, hormoni adenohipofizari, citokine, glicemie, osmolaritate etc.
Nuclei hipotalamici
Lateral Area Medial Area Anterior Anterior Lateral preoptic nucleus Medial preoptic nucleus Supraoptic nucleus Lateral nucleus Paraventricular nucleus Part of supraoptic nucleus Anterior nucleus Suprachiasmatic nucleus Tuberal Lateral nucleus Tuberal Lateral tuberal nuclei Dorsomedial nucleus Posterior Ventromedial nucleus Arcuate nucleus Lateral nucleus Posterior Mammillary nuclei (part of mammillary bodies) Posterior nucleus
Neurohormonii
Corticotropin-releasing hormone (CRH) Dopamina Gonadotropin-releasing hormone (GnRH) Growth hormone releasing hormone (GHRH) Somatostatin Thyrotropin-releasing hormone (TRH) Oxytocin Antidiuretic Hormone (Vasopresina, ADH)
Median Eminence
Organ circumventricular
INTRACRINE
AUTOCRINE PARACRINE
ENDOCRINE
NEUROENDOCRINE
Transport axonal
part of dorsal vagal complex chemoreceptive (no BBB) site of neural integration bi-directional projections to the GI tract (via vagal afferents and efferents)
Hypothalamus
ARC
NTS/AP
Spinal nerves
GI tract
Modified from Marx, Science 2003 February 7; 299: 846-849. (in News)
Obezitatea endocrina
Neuroimagistica setei
Zece subiecti au efectuat PET-CT si o evaluare psihologica a setei (Denton, PNAS, 96, 5304-5309, 1999)
Sete
Antidiureza
Osmoreceptori
Osmoreceptori CNS
Descarca ADH Antidiureza Conservarea apei Sete Apetit de Na
Baroreceptori Angiotensina II
Vasopressin-like peptides
1 2 3 4 5 6 7 8 9 Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly (NH2)
Oxytocine
* * * * * * * Ile *
Vasopressine
* * * * * * * Lis *
Mesotocine
*
*
* * Ser * *
* * Ser * *
*
*
Ile *
Glu *
Lisine-vasopressine
* Phe * * * * * * *
Isotocine Glumitocine
*
*
Phenipressine
* * * * Ile * * * * * *
* * *
* *
* Val *
*
Valitocine
* * Asn * *
Vasotocine
Aspargtocine
Receptor V1a
TM IV TM III TM II
TM V TM VI
TM VII
TM I
Noyau paraventriculaire
Noyau supraoptique
Hipotalamus
Vasopresina Rinichi
Muschi neted
Oxitocina
Uter
Sin
Gonade ? AH ?Adipocite Creier
AH Ficat
Suprarenale
Creier
Sindroame poliuro-polidipsice
Hipotalamus
Sete
Polidipsie psihogena Absenta AVP Vasopresinaza Rinichi: rezistenta la AVP insuficienta renala
AVP
IRM normal
Lechan RM. Neuroendocrinology of Pituitary Hormone Regulation. Endocrinology and Metabolism Clinics 16:475-501, 1987
Diabet Insipid
Caracteristici clinice sunt rezultatul deficientei de AVP Excreia unor volume mari de urin (poliurie) Excreia de urin diluat (OSM <200 mOsm/L) Cresterea osmolaritatii plasmei (i Na+ seric) Stimularea setei (polidipsie)
Craniofaringiom
Infiltrat hipotalamic
Sarcoidoza Histiocitoza Metastaza Tumora de tija Germinom Agenti patogeni
Diabet Insipid
Cele mai multe cazuri de diabet insipid central sunt datorate unor leziuni care implica zona hipotalamusului i n jurul bazei ventriculului trei. Deoarece pacienii cu diabet insipid devin simptomatici numai la o reducere de 80-85% din celulele AVP, leziunea trebuie s fie suficient de mare.
Pe msur ce crete osmolalitatea plasmatic, AVP se ridic la subiecii normali, dar rmne sczut la pacienii cu deficit de AVP complet sau parial.
Raspunsul la Deshidratare
Pacienii cu diabet insipid complet hipotalamic, in momentul de deshidratare maxim vor avea: o osmolalitatea urinar <200 mOsm o osmolalitatea serica crescuta (> 295) (au un nivel sczut de AVP) creterea osmolaritii in urin cu mai mult de 50% dac este administrat exogen AVP
Hipernatremia
Na+> 145 mEq/L
Neurologic: astenie, stare confuzionala, convulsii, deficit focal. Trat: Desmopresina 10 mg intranazal sau
0.12 mg x 3/zi slg (Minirin Melt) aport hidric po sau 5% glucoza: 1-2 L
Hiponatremia
Neurologic:
greata,
Semnele afectiunii de baza (Addison, hipopituitarism, SIADH) Scadere Na+ hTa Rapiditatea instalarii hNa+ Na+ < 120 mEq/L: risc vital
Hiponatremia - tratament
Etiologic SIADH: Restrictie hidrica Antagonist Rec V2 AVP = Vaptan
Substitutie corticoida (HHC Fludrocortizon, 2 x 0.1 mg/zi)
Concluzii
Somatotroph
Lactotroph Corticotroph Thyrotroph Gonadotroph
Growth hormone
Prolactin Adrenocorticotropic hormone Thyroid stimulating hormone Luteinizing hormoneFollicle-stimulating hormone
50
15 15 10 10
Substances
Peptides:
Activin B, inhibin, follistatin Aldosterone-stimulating factor Angiotensin II (angiotensinogen, angiotensin I-converting enzyme, cathepsin B, renin) Atrial naturetic peptide Corticotropin-releasing hormone-binding protein Dynorphin Galanin GAWK (chromogranin B) Growth hormone-releasing hormone Histidyl proline diketopiperazine Motilin Neuromedin B Neuromedin U Neuropeptide Y Neurotensin Protein 7B2 Somatostatin 28 Substance P (Substance K) Thyrotropin-releasing hormone Vasoactive intestinal poltpeptide Basic fibroblast growth factor Chondrocyte growth factor Epidermal growth factor Insulin-like growth factor I Nerve growth factor Pituitary cytotropic factor Transforming growth factor alpha Vascular endothelial growth factor Interleukin-I beta Interleukin-6 Leukemia inhibitory factor Acetylcholine Nitric oxide
Cell Types
F, G UN C,G,L, S G C G L, S,T G UN UN S T C T UN G, T UN G,L,T G, L,S,T G,L,T C,F UN G,T S,F UN UN L,S,G F T F C,F C,L F
Growth factors:
Cytokines:
Neurotransmitters:
Reglarea Axei GH
GHRH (44) SMS (14) GH
IGF1
GHRP Ghrelin
Contraindicate
Epileptic seizures Severe heart ischemia
Cortisol
Leptina Citokine GR, CRHR, V1b, ACTH R,
Control - VCI
IPS: -5, 0, 2, 5, 10 min
T4 / T3
Type II deiodinase Leptina TR, TRH R, TSH R
TRH test
400 mg i.v. TRH TSH is measured each 30 mins, for 3 h
Prolactina
Testosteron /E2, Pg Inhibina /activina
GnRH este eliberat in sistemul port hipotalamo- hipofizar, pornind din eminena median i legnd vascular adeno-hipofiza. Eliberarea este pulsatil tonic, iniial nocturn, apoi i diurn, ulterior apare o descrcare major, pre-ovulatorie. Eliberarea tonic provine din MBA, cea pre-ovulatorie din AHPO
Stage 2
Stage 3
Stage 4
Stage 5
CONCLUZII
Evaluarea bazala pentru hormonii cu secreie cvasiconstanta. Evaluare dinamica pentru hormoni cu ritm, sau secretie pulsatila. Teste de inhibiie pentru sindroame de hipersecretie. Teste de stimulare pentru deficit hormonal. Integrarea rezultatelor clinice, biochimice, imagistice.