Pemeriksaan Laboratorium Gangguan Sistim Endokrin

Dr. D.A.A.Mandagi Bagian 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 / Polypeptides 2) Steroids 3) Amino Acids Derivatives

Hypothalamus (Neuroendocrine)
Hormone
TRH

Action Site
Anterior Pituitary

Action
TSH (PRL) Release

GnRH
CRH GHRH GHIH

Anterior Pituitary
Anterior Pituitary Anterior Pituitary Anterior Pituitary

FSH / LH Release
ACTH Release GH Release Inhibition of many hormones

ADH
Oxytocin

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Hypothalamus (Neuroendocrine)
TRH GnRH CRH GHRH GHIH (Somatostatin = SS) ADH / Vasopressin Oxytocin

Anterior Pituitary Adeno-Hypophysis

Hormone TSH FSH Action Site Thyroid Ovary Testes Action Formation / Secretion of Thyroid Hormones Follicle Growth, Estrogen Secretion, Ovulation Spermatogenesis, Develop. Tubul. Seminiferi

LH
PRL GH ACTH

Ovary
Testes Mammary Glands Liver Liver / Peripherals Adrenal Cortex

Ovulation, Corpus Luteum, Progesteron Sec.

Androgen Secretion, Stim. Interstitial Tissue Proliferation of M. Glands, Milk Secretion Production of IGF-1 (Promoting Growth) Anabolic / Anti-Insulin Stimulation of Adrenocortical Steroids Formation and Secretion Darkning of Skin

Alfa-MSH Skin

Anterior Pituitary Adeno-Hypophysis

TSH / TSHs FSH LH PRL GH / Somatotropin
IGF-1 ITT / OGTT

ACTH / Corticotropin Alfa-MSH

Posterior Pituitary Neuro-Hypophysis

Hormone Action Site Action Blood Pressure Elevation Water Reabsorption Contraction; Action in Parturition; Sperm Transport; Ejection of Milk

ADH / Arteriole Vasopressin Renal Tubules Oxytocin Smooth Muscles (Uterus / Mammary)

Posterior Pituitary Neuro-Hypophysis

ADH / Vasopressin
Osmolality
Direct (Measured) Indirect (Calculated)

Water Deprivation Test Arginine Vasopressin

Oxytocin

Thyroid / Parathyroid

Hormone T4 / T3 Calcitonin

Action Site General Body Tissue Skeleton

Action Stimulation of Oxygen Consumption and Metabolic Rate Decreased Bone Resorption

PTH

Kidney
Skeleton

Increased Ca Reabsorption / Decreased PO4 Reabsorption

Increased Bone Resorption

Thyroid / Parathyroid
THYROID :
T4 / Thyroxine T3 / Triidothyronine fT4 fT3 Calcitonin

PARATHYROID :
PTH

Pancreas Islets of Langerhans

Hormone Insulin Glucagon Action Site Liver, Fat, Muscle Liver Action Regulation of CBH Metabolism; Lipogenesis Glycogenolysis

Somatostatin Pancreas (GHIH)

Inhibition of Secretion of Insulin / Glucagon.

Pancreas Islets of Langerhans

Insulin Glucagon Somatostatin

Adrenal Cortex

Hormone Aldosterone Cortisol DHEA(S)

Action Site Kidney Many Hormone Precursor

Action Salt and Water Balance Metabolism of CBH, Fat, Protein; Antiinflammatory Effect. Converted to Estrogen / Testosterone

Adrenal Cortex
Mineralocorticoids
Aldosterone

Glucocorticoids
Cortisol

Androgens
DHEA / DHEAS Testosterone / Estrogen

Adrenal Medulla

Hormone

Action Site

Action Stimulation of Sympathetic Nervous System. Glycogenolysis

Norepinephrine; Sympathetic Epinephrine Receptor Epinephrine Liver, Muscle

Adipose Tissue

Lipolysis

Adrenal Medulla

Epinephrine Norepinephrine

Ovarium Follicle / Corpus Luteum

Hormone Estrogen Action Site Female Accessory Sex Organ Bone Action Development of Secondary Sex Charcteristic Control of Skeletal Maturation

Progesterone Female Accessory Reproductive Structure

HCG Ovary

Preparation of the Uterus for Ovum Implantation; Maintenance of Pregnancy

Prolongation of Corpus Luteal Function

Ovarium Follicle / Corpus Luteum

Progesterone Estrogens
Estradiol

Testes

Hormone
Testosterone

Action Site
Male Accessory Sex Organ

Action
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 Factors Uncontrollable

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 Factors Controllable

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

Kepustakaan
1.
2. 3. 4. 5. 6. 7.

Michael Kleerekoper : Hormones; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1019 1031 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 Laurence M.Demers : Pituitary Function; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1967 1991 Laurence M.Demers : The Adrenal Cortex; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 2003 2036 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 David B.Endres : Hormone Regulating Mineral Metabolism; in : Tietz Textbook of Clinical Chemistry and Molecular Diagnostics; 4th.Ed. 2006; Elsevir-Saunders; p 1912 1918. 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