2. Curs hipotalamus si hipopituitarism 2014.pptx

8/9/2019 2. Curs hipotalamus si hipopituitarism 2014.pptx

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NeuroEndocrinologie

Sistem nervos

Sistem

endocrin

Sistem

imun

citok

ine

neurohorm

oni

citokine


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Proprietati

Comune

Potentiale de actiune Secretie

Mediatori (Peptide)

Receptori

Specifice

mploarea raspunsului !atenta

"urata

Re#la$


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Neurosecretie

Neurohormoni Neuromodulatori


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Sistemul port hipotalamo-hipofizar

%r& Popa and '& ieldin#, !ancet, 23, 1*30


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+-./.

su talamus

!ocali4at inferior de talamus, portiunea ma$ora a diencefalului 5entral

Re#lea4a procese metaolice si acti5itati ale S67

!ea#a sistemul ner5os de sistemul endocrin 5ia #landa pituitara, prinsinte4a si secretia neurohormonilor, (lierine si statine)&

6euronii care secreta %nR8 sunt conectati cu sistemul limic, care esteimplicat primar in controlul emotiilor si acti5itatii se9uale&

8ipotalamusul controlea4a temperatura, foamea, setea si ritmul circadian&

8ipotalamusul este conectat cu S6C, formatiunea reticulata, sistemullimic (ami#dala, septum, anda dia#onala Broca, ulul olfacti5) sicorte9ul cereral)&

Hipotalamus


7/91Martin, eichlin, !"#$


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Functii

Responsi5 la: !umina: lun#imea 4ilei si fotoperioada pentru a #enera ritmurile circadian

si se4onier ;lfactie: stimuli, inclusi5 feromoni (parfumuri) Steroi4i: #onadali si corticosteroi4i


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6uclei hipotalamici

Medial %rea %nterior Medial preoptic nucleus

Supraoptic nucleus

Para5entricular nucleusnterior nucleusSuprachiasmatic nucleus

&uberal "orsomedial nucleus

7entromedial nucleusrcuate nucleus

Posterior Mammillar= nuclei (part of

mammillar= odies)Posterior nucleus

'ateral %rea

%nterior

!ateral preoptic nucleus!ateral nucleus

Part of supraoptic nucleus&uberal

!ateral nucleus!ateral tueral nucleiPosterior

!ateral nucleus
http://en.wikipedia.org/wiki/Medial_preoptic_nucleushttp://en.wikipedia.org/wiki/Supraoptic_nucleushttp://en.wikipedia.org/wiki/Paraventricular_nucleushttp://en.wikipedia.org/wiki/Anterior_nucleushttp://en.wikipedia.org/wiki/Suprachiasmatic_nucleushttp://en.wikipedia.org/wiki/Dorsomedial_nucleushttp://en.wikipedia.org/wiki/Ventromedial_nucleushttp://en.wikipedia.org/wiki/Arcuate_nucleushttp://en.wikipedia.org/wiki/Mammillary_bodyhttp://en.wikipedia.org/wiki/Posterior_nucleus_%28hypothalamus%29http://en.wikipedia.org/wiki/Lateral_preoptic_nucleushttp://en.wikipedia.org/wiki/Lateral_nucleushttp://en.wikipedia.org/wiki/Lateral_nucleushttp://en.wikipedia.org/w/index.php?title=Lateral_tuberal_nuclei&action=edithttp://en.wikipedia.org/wiki/Lateral_nucleushttp://en.wikipedia.org/wiki/Lateral_nucleushttp://en.wikipedia.org/w/index.php?title=Lateral_tuberal_nuclei&action=edithttp://en.wikipedia.org/wiki/Lateral_nucleushttp://en.wikipedia.org/wiki/Lateral_nucleushttp://en.wikipedia.org/wiki/Lateral_preoptic_nucleushttp://en.wikipedia.org/wiki/Posterior_nucleus_%28hypothalamus%29http://en.wikipedia.org/wiki/Mammillary_bodyhttp://en.wikipedia.org/wiki/Arcuate_nucleushttp://en.wikipedia.org/wiki/Ventromedial_nucleushttp://en.wikipedia.org/wiki/Dorsomedial_nucleushttp://en.wikipedia.org/wiki/Suprachiasmatic_nucleushttp://en.wikipedia.org/wiki/Anterior_nucleushttp://en.wikipedia.org/wiki/Paraventricular_nucleushttp://en.wikipedia.org/wiki/Supraoptic_nucleushttp://en.wikipedia.org/wiki/Medial_preoptic_nucleus


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Neurohormonii

(orticotropin-releasing hormone )(H* Dopamina +onadotropin-releasing hormone )+nH*

+roth hormone releasing hormone )+HH* Somatostatin &hrotropin-releasing hormone )&H* ./tocin

%ntidiuretic Hormone )0asopresina, %DH*


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Median Eminence

.rgan circumventricular

>pendimal: ti#ht ?&@anicitele (@A@3)

9tern: capilarefenestrate


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IN&%(INE

%1&.(INE

P%%(INE

END.(INE

NE1.END.(INE

Semnalizare

chimica /

Hormonala


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(ontrol genetic

2iosinteza

&ransport a/onal


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Slide Source:www.obesityonline.org


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Neuroendocrinologia aportului alimentarTrunchiul cerebral - tinta pentru semnale de satietate periferice

Modified from Marx, Science2003 February 7 2!!" #$%-#$!& 'in Ne(s)

*eptin+nsulin

.hrelin.+ tract

/pinalneres

1ag

4ypothalamus56

NT/5

Area Postrema: part of dorsal vagal complex

chemoreceptive (no BBB)

site of neural integration

bi-directional projections to the

GI tract (via vagal afferentsand efferents)

bi-directional projections to the

hpothalamus! amgdala and

other regions

5mylin8 peptide intestinale


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6eglarea aportului alimentar

reier 3actori e/terni>motii@ipul de alimenteComportament alimentaractori de mediu

6P

%RP

#alanin

;re9inD

d=norphin

Stimulea4a.DMS8

CR8E'C6

%!PD

FD8@


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5fectiuni pulmonareApneea obstructiva

de somn"indrom de hipoventilatie

4epatopatia steato:icanon-alcoolicasteato#a

steatohepatitaciro#a

;oala coronariana

$iabet

$islipidemie

%ipertensiune arteriala

5nomalii ginecologice&ulburari de '

infertilitate"indromul ovarelor polichistice

9steoartrita

5fectiuni cutanate

*itia:a biliara

ancersan! uter! col! colon! esofag!

pancreas! rinichi! prostata

Flebita"ta#a venoasa

.uta

omplicatiile medicale ale obe:itatii4ipertensiuneintracraniana idiopatica

51

ataracta

ancreatita


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Tulburarile alimentatiei

Anorexia nervosa &eama intensa de castig ponderal Imagine corporeala distorsionata

efu#ul de a mentine greutatea corporalaminima recomandata

Amenoree secundara *+ din femeile tinere sunt afectate ,+ - femei


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Tulburarile alimentatiei

Bulimia nervosa .pisoade repetate de apetit exagerat

urmate de inducerea varsaturilor

Acest comportament apare de /-0 ori 1sapt! 0 luni "imptomele pot apare independent de

anorexie *-/+ din tinerele femei sunt afectate ,+ -femei


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(ai neurale implicate in homeostazia osmotica

%ntidiureza .smoreceptori

Sete


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eeves et al, !""#

0olum circulant

.smolaritate 'E(

Setea si balanta apei

45(restere

.smolaritatea 'E(!65 Scadere

0olum circulant

.smoreceptori(NS 2aroreceptori

Descarca %DH %ngiotensina II

%ntidiureza

Stimuli

Sete

%port de apa(onservarea apei

%NP72NP %NP72NP

%petit de Na

N i i ti t i


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Neuroimagistica setei

8ece subiecti au efectuat PE&-(& si o

evaluare psihologica a setei )Denton, PN%S,

"9, :;6


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;9=tocinDlike peptides1 2 3 A F I J *

C=sD@=rD


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&M I

&M III

&M II

&M I0

&M 0

&M 0I

&M 0II

eceptor 0!a


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Noau paraventriculaire


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Noau supraopti>ue

Neurohpophse de rat -ME


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Neurohpophse de rat -ME


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0asopresina ./itocina

1ter

Sin

+onade

? %H

?%dipocite

(reier

Suprarenale

3icat

%H

Muschi neted

inichi

Hipotalamus

(reier

Sindroame poliuro-polidipsice


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Sete

%0P

Sindroame poliuro-polidipsice

Hipotalamus

Polidipsie psihogena

%bsenta %0P

0asopresinaza

inichi@

rezistenta la %0P

insuficienta renala


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Diabet Insipid

(aracteristici clinice sunt rezultatul deficientei de %0P

>9cre ia unor 5olume mari de urinK (poliurie)

>9cre ia de urinK diluatK (;SM L200 m;smE!)

Cresterea osmolaritatii plasmei ( i 6aH

seric) Stimularea setei (polidipsie)


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Craniofarin#iom


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Diabet Insipid

Cele mai multe ca4uri de diaet insipid central sunt datorate

unor le4iuni care implica 4ona hipotalamusului i n $urula4ei 5entriculului trei&

"eoarece pacien ii cu diaet insipid de5in simptomatici numaila o reducere de 0DFN din celulele 7P, le4iunea treuie sKfie suficient de mare&


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Nivelurile AVP la pacien ii cu DI Central

Pe mKsurK ce cre te osmolalitateaplasmaticK, 7P se ridicK la

suiec ii normali, dar rKmOnescK4utK la pacien ii cu deficit de7P complet sau par ial&


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Diagnosticul Diabetului Insipid

"etermina i dacK pacientul are un rKspuns adec5at la deshidratare, care

pro5oacK atOt 8iperosmolalitate 8ipo5olemie

mele ar treui sK stimule4e o cre tere a 7P

@estul de pri5are de apK permite dia#nosticul COnd pacientul a pierdut 2D3N din #reutatea totala a corpului i

douK urini consecuti5e diferK n osmolalitate cu L10N, esteo inutK o proa de san#e pentru sodiu si osmolalitate

plasmatica (rar se do4ea4a "8)&


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Raspunsul la Deshidratare

Pacien ii cu diaet insipid complet hipotalamic, in momentulde deshidratare ma9imK 5or a5ea:

o osmolalitatea urinarK L200 m;sm

o osmolalitatea serica crescuta ( 2*F)

(au un ni5el scK4ut de 7P)

cre terea osmolaritK ii in urinK cu mai mult de F0N dacK este administratK e9o#en 7P

& t t


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&ratament

Diabet Insipid

DD%0P )Desamino-D-%rginine 0asopressin*-

!6-46 g !-; Azi instilatii nazale

Per os , DD%0P cp 6,4 mg , ! cp la #-!4 ore

S'+@ !46- 4


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%ipernatremia

4a; *6 m.


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%iponatremia

4eurologic: greata!

edem cerebral!

cefalee!

obnubilare! coma

"emnele afectiunii de ba#a (Addison! hipopituitarism! "IA$%)

"cadere 4ah&a apiditatea instalarii h4a

4a> */8 m.


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%iponatremia - tratament

.tiologic "IA$%: estrictie hidrica ? Antagonist ec @/ A@P @aptan

"ubstitutie corticoida (%%' ? ludrocorti#on! / x 83* mg1#i)

"ubstitutie tiroidiana: 2&6 in do#e de la / la *88 g1#i! subprotectie antiagreganta

'resterea capitalului de 4a: > *8-* m.< 1 /6h

"olutii fi#iologice sau saline hipertone 83 - / 21#i

'reste; *m.


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+nsuficien


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C ll i di li


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(ell &pe Secretor Products (ell Population 5

Somatotroph %roQth hormone F0

!actotroph Prolactin 1F

Corticotroph drenocorticotropic hormone 1F

@h=rotroph @h=roid stimulatin# hormone 10

%onadotroph !uteini4in# hormoneDollicleDstimulatin# hormone

10

Cell t=pes inpars distalis


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CDcorticotroph: Dolliculostellate cell %D#onadotroph !D!actotrophSDsomatotroph, @ Dth=rotroph '6DunknoQn&


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Insuficiena adenohipofizara Deficit de H

%fectarea sintezei adenohipofizare

&ransportul i metabolismul hormonilor

esistenF la aciunea hormonilor

1&


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@ i hi fi (P l i )


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@umori hipofi4are (Prolactinom) menoreeD#alactoree

>fect de masK (SCh;, ostructie na4alK) 8ipopituitarism

PR!: FJ00 n#Eml

M hi fi


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Metasta4e hipofi4are

8i l i hi fi K


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8ipopla4ia hipofi4arK

Sh h


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Sheehan

S8nd, @3102 n#Ed!, @A 3 #N, cortisol12 #N


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eglarea %/ei +H

%8R8 (AA) SMS

(1A) %8


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;ral %lucose @olerance @est

;ral #lucose JF#

%8 peak le5el 1 #E!

%cromegal@positive 7 differential

diagnosis

Diabetes Mellitus


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( t l l i t i 'H i 3SH d Ft + h


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8=pothalamic8=poph=sealPortal S=stem

%onadotrophs

%nR8 este elierat in sistemulport hipotalamoD hipofi4ar,pornind din eminenamedianF ile#Ond 5ascular adenoDhipofi4a&

>lierarea este pulsatilK tonicK,iniial nocturnK, apoi Ti diurnK,ulterior apare o descKrcare ma$orK,

preDo5ulatorie&>lierarea tonicK pro5ine din MB,cea preDo5ulatorie din 8P;

(ontrolul sintezei 'H i 3SH de cFtre +nh

Pulsatile !8 Pattern in 8uman


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Pulsatile !8 Pattern in 8uman

Pulsatilit in gonadal a/is


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Pulsatile hormones@ Mi/ 7 Measure


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androgenitestosteron

precursor - colesterol

%0' '%0

'%0'%0

'%0

%C

%ipofi#a

2% "%

germ line cells

Sertoli cellsLeydig cells

plasma

acetate

Stadiile dezvoltarii pubertare


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"tage *: Prepubertal! no pubic hair groDth

"tage /: &estes groDE scrotal sFin

becomes redder and coarserE

sparse and fine hair develops at

base of penis

"tage 0: Penis lengthens Dith smallincrease in diameterE scrotal sFin

reddens! thicFens and

crinFles! pubic hair thicFer and

coarser

"tage 6: Penis and testes continue togroDE pubic hair coarser! darFer

and more curl

"tage : Penis at adult si#eE pubic hair

covers smphsis pubis and

extends to inner thighs

Stage !

Stage 4

Stage ;

Stage

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2. Curs hipotalamus si hipopituitarism 2014.pptx

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