Endocrine System Hormones Introduction Hormones is a substance
Endocrine System (Hormones)
Introduction Hormones : is a substance secreted by glandes (endocrine system ). Endocrine glands : 1 - Hypothalamuses gland. 2 - Pituitary gland. 3 - parathyroid gland 4 - Pancreas 5 - Adrenal gland.
Examples in Hypothalamuses hormones 1 - Growth hormone( GH) this hormone release in pulsatile manner , highest level occur during sleep Somatotropin : is used in the treatment of GH deficiency in children. Adverse reaction : Increase tension , hypercalcemia Prolactin : Its primary function is to stimulate and maintain lactation. There is no preparation available for hypoprolactinemic conditions. Hyperprolactinemia: is usually treated with D 2 -receptor agonists, such as bromocriptine and cabergoline.
Pituitary gland Oxytocin: it is secreted from posterior pituitary gland Its only use is in obstetrics, where it is employed to stimulate uterine contraction to induce or reinforce labor Adverse reaction : Decrease urine output , increase blood pressure Vasopressin: Vasopressin has both antidiuretic and vasopressor effects. (increase water permeability and resorption in the collecting tubules) The major use of vasopressin is to treat diabetes insipidus. It also finds use in controlling bleeding due to esophageal varices
Thyroid Hormones: Thyroxine , triiodothyronine: The thyroid gland facilitates normal growth and maturation by maintaining a level of metabolism in the tissues that is optimal for their normal function. Hypothyroidism: In enough secretion of thyroid hormone results , bradycardia, poor resistance to cold, and mental and physical slowing (in children, this can cause mental retardation ).
Hyperthyroidism: excess of thyroid hormones is secreted. then tachycardia and cardiac arrhythmias, body wasting, nervousness, tremor, and excess heat production can occur. The thyroid gland also secretes the hormone Calcitonin ” a serum calcium lowering hormone. Treatment of hypothyroidism : levothyroxine. The drug is given once daily because of its long half-life. Steady state is achieved in 6 to 8 weeks.
Treatment of hyperthyroidism(Thyrotoxicosis). The goal of therapy is to decrease symptoms or release of additional hormone. This can be accomplished by: 1 - Removing part or all of the thyroid gland 2 - By inhibiting synthesis of the hormones 3 - by blocking release of the hormones.
Treatment of hyperthyroidism (thyrotoxicosis) 1 - Removal of part or all of the thyroid surgically or by radioactive iodine. 2 - Inhibition of thyroid hormone synthesis: We can use the drugs Propylthiouracil. Carbimazole. Propranolol: ( β blockers ) are effective to relive sympaths that occurs in hyperthyroidism. An alternative in patients suffering from severe heart failure or asthma is the calcium channel blocker: diltiazem.
Pancreas Hormones Insulin : is the most important hormone secreted from pancreas If there is any defect in Insulin production , Insulin action or both this will case Diabetes Mellitus Diseases (DM). The defect of diabetes mellitus include long term damage , dysfunction and failure of various organs. The symptoms of diabetes : thirst , polyuria , blurring in vision and weight loss.
Diabetes Long-term Effects The long–term effects of diabetes mellitus include progressive development of the specific complications of retinopathy with potential blindness, nephropathy that may lead to renal failure, or neuropathy with risk of foot ulcers, amputation, Charcot joints, and features of autonomic dysfunction, including sexual dysfunction. People with diabetes are at increased risk of cardiovascular, peripheral vascular. Types of Diabetes Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus
Type 1 Diabetes Was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 2 diabetes Was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.
Gestational diabetes A form of glucose intolerance that is diagnosed in some women during pregnancy. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes.
Management of Diabetes Mellitus
Management of DM The major components of the treatment of diabetes are: A • Diet and Exercise B • Oral hypoglycaemic therapy C • Insulin Therapy
Management of patients with insulin dependent diabetes 1. Give a short-acting insulin 15— 30 minutes before three main meals and an intermediate-acting insulin at night 2. a short- and intermediate-acting insulin can be given before breakfast and the evening meal. 3. In some patients, a single injection of an intermediate-acting insulin is adequate.
Injection of insulin The best sites for injection are the front of the thighs, the abdomen and the outer side of the upper arm insulin is given subcutaneously A different site should be used each time Insulin pens are devices which contain a cartridge of insulin which is automatically injected. more convenient for the patient. Precautions : 1 - Overdose ----- Hypoglycemia which characterized by : Anxiety , sweating , tremor , convulsion , Coma
Hypoglycemia Over dosage with insulin causes a decrease in the blood sugar. This leads to faintness, dizziness, tremor, sweating and abnormal behavior If no treatment is given convulsions, coma and death may occur. It can quickly be relieved by giving sugar or glucose, fruit juice followed by two biscuits being effective. Glucagon by injection is also effective and is useful if the patient is too drowsy to swallow.
Diabetic coma (hyperglycemic ketoacidosis) Patients with diabetes who are not treated, or develop some infection during treatment, may pass into a diabetic coma. These patients have not only a very high blood and urinary glucose level, but are producing large quantities of ketone bodies which can be detected in the urine and which, being acids, lead to an acidosis.
Management of patients with non-insulindependent diabetes (NIDDM) The main objective in treating NIDDM is to prevent the development of the late complications of the disease such as: myocardial infarction , vascular disease, renal failure, retinopathy and neuropathy. This is best achieved by controlling plasma glucose, lipids and blood pressure (if raised) and by avoiding risk factors such as smoking and obesity. 1 - the treatment of choice is diet 2 - Regular exercise, tailored to the abilities of the patient 3 - is beneficial by increasing insulin sensitivity.
B. Oral Anti-Diabetic Agents There are currently five classes of oral anti-diabetic agents: 1 - Suphonylureas (first and second generation ) ex: Acetoheramid , Glipizide 2 - Biguanides ( Metformin( Glucophage ) 3 - α-glucosidase inhibitors (Miglitol) 4 - Thiazolidinedione's (TZDs) (Pioglitazone) 5 - Meglitinds ( Nateglinide )
Oral Agent Monotherapy As first line therapy: Obese type 2 patients : consider use of metformin, Acarbose or TZD. Non-obese type 2 patients: consider the use of metformin or insulin Metformin is the drug of choice in overweight/obese patients. TZDs and acarbose are acceptable alternatives in those who are intolerant to metformin. If monotherapy fails, a combination of TZDs, acarbose and metformin is recommended. If targets are still not achieved, insulin may be added
Oral Hypoglycaemic Medications
Adrenal Cortical Hormones Glucocorticoids (Cortisone ) : Uses : 1 - Increase the blood sugar. 2 - Reduce synthesis of protein from amino acid. 3 - Number of lymphoid cells reduce. 4 - Suppress inflammatory response. 5 - Suppress Immune response. 6 - Cause retention of Na and water
Adrenal Cortical Hormones Glucocorticoids (Cortisone ) : Adverse Reaction : 1 - Diabetes in board line in collapse if it already high. 2 - Wasting Muscles 3 - Hypertension 4 - Peptic ulcer 5 - Dependence in a certain dose : Sudden withdrawal: Cataract , Glaucoma Delay wound Healing
Male Sex Hormons Testosterone : Uses : Male: 1 - Develop secondary sexual characteristic 2 - Skeletal Muscles Development and bone grow. Women : 1 - In treat osteoporosis Adverse reaction : 1 - Increase body weight 2 - change voice and grow hair for women 3 - if given to a child shortness in height will occur.
Male Sex Hormones Anabolic storied : Uses : 1 - Anima 2 - Osteoporosis for late age 3 - Growth delay Contradictions : 1 - do not give for pregnant women. 2 - Infant and children 3 - Renal , Cardiac and Liver patients.
Female Hormones Estragon : Uses : 1 - treat post menopausal symptoms 2 - treat any inflammation in vagina 3 - Large dose inhabit lactation. 4 - used to diagnose pregnancy. Adverse Reaction : 1 - Headache , hot flushing , multiple pregnancies.
Female Hormones Rogerstone : Uses : 1 - Contraceptive (prevent pregnancy ) 2 - Hermon replacement therapy in menopausal 3 - with Estragon treat dysfunction and uterine bleeding Adverse Reaction : 1 - Breast enlargement 2 -Increase in body temperature. 3 - Change mood
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