7 Pharmacology Lecture Hormones

7/27/2019 7 Pharmacology Lecture Hormones

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Kevin Kunkel PhD, MSPT, MLD-CDT


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Male sex hormonesAndrogens

Synthesis& secretion

Regulation

Pharmacological

actions

Anabolic steroids

Differ from androgens?

Preparations

Therapeutic uses

Adverse effects

Pharmacokinetics

Preparations

Therapeutic uses

Adverse effects

Anti-androgens

Danazole

Cyproterone acetate

Flutamide

Finasteride

Sildenafil


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Androgens

- Includes- Testosterone,- Dihydrotestosterone (DHT)

-

- Testosterone serves s !rohor"one #or Dihydrotestosterone (DHT) estrdiol


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Cholesterol

Pregnenolone

Progesterone

17-- Hydroxypregnenolone

17- Hydroxyprogesterone

Dehydro-epiandrosterone

Andro-stenedione

Oestrone

Oestriol

TESTOSTERONE estradiol


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Regulation of secretion

estrogen similar to Testosterone

Inhibin inhibits FSH secretion at A.P level


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Testosterone & DHT

growth of genitals in a young male

production of sperm

growth of facial, pubic & axillaryhairs


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Testosterone & DHT

muscular development

growth of larynx & voice deepens

inhibition of bone growth


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Testosterone & DHT

thickening of skin, loss ofsubcutaneous fat

behavioral changes in men

nitrogen retaining effect

erythropoietin secretion increased

Increased LDL & decreased HDL


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TestosteronePreparations

Dose

Testosterone aq.suspension

50-100mg / 2 weeks

Testosteroneesters:

Testo. propionate Testo.phenylpropionate

Testo. cypionate

25-50 mg / 3 times a week

40-60mg / 1 or 2 week100 200mg / 2 weeks

250 mg / 2 weeks

.

Orally activepreparations:

Methyltestosterone tab.

Fluoxymesterone

Mesterolone

40mg/ day for 4-6 weeks

Transdermalpatches

2 patches /day

(back,abdomen,thigh)

Implants wall of abdomen/thigh

http://www.youtube.com/watch?v=Fm8sPnii6ro


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Pharmacokinetics

Absorption: undergoes high first pass

metabolism Therefore im in!ections or

synthetic preparations areused

Transport:

highly protein bound

"etabolism: by liver en#ymes :

androsterone &etiocholanolone e$cretion by urine


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Clinical uses of testosterone

Testicular failure:

Primary % originates in thetestes

Secondary % originates inthe pituitary

rectile Dysfunction

"enopause '(ot )lashes*

ron c ness

(,-

.urns

/steoporosis


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Clinical uses of testosterone

0ong term corticosteroidtherapy

/steoporosis

Decreased production 123

Pituitary d4arfism

+arcinoma of breast

(ereditary angioneuroticoedema

Anemia 'refractory*


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Adverse effects of testosterone

Virilization (female) Feminizing side effects

(male) Precocious puberty &

stunted growth

Enlargement ofprostate

Atherosclerosis Hepatic carcinoma

Edema


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Anabolic steroids


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Anabolic Steroids

Drug Preparation &Dose

Methandienone 5 15 mg/day, p.o.

Nandrolonephenylpropionate

10 50 mg/wk, i.m.

Nandrolone 25 50 mg/3 wk,ecanoate .m.

Stanozolol 2 - 6 mg/day, p.o.

Ethyloestrenol 8 - 16 mg/day, p.o.

Oxandrolone 5 10 mg/day, p.o.

Fluoxymesterone 5 10 mg/day, p.o.


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Uses of anabolic steroids

/steoporosis

+atabolic states

Short stature

Anemia

'refractory*

Athletic

performance


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Anti-androgens

Danazol

Cyproterone acetate

Flutamide

Finasteride


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Danazol

Uses:

Side effects:

FSH & LH release in both sexes Binding of steroids to receptors

Enzymes needed for steroid synthesis

Weak androgenic, anabolic, progestational & glucocorticoid action

Menorrhagia

Fibrocystic breast disease

Hereditary angioneurotic

oedema

Gynecomastia

Infertility

Amenorrhea (High doses)

Androgenic side effects


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Cyproterone acetate Block androgen receptors

secretion of gonadotropins

Uses:

Acne

Hirsutism

Ca. of rostate

Virilizing syndrome

Precocious puberty

Inappropriate sexual behavior

Male pattern of baldness


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lutamide 5on6steroidal anti6

inflammatory

Antagoni#e androgens: Accessory se$ organs

Pituitary

7ses:

+ancer of prostate along 4ith8nR( agonist +ompetes 4ith Testosterone

and D(T to androgenreceptors

)emale hirusitism


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Orally active DHT levels

Finasteride (Proscar)

Prostate volume

Symptom score

5 reductase inhibitorsEnzyme that converts Testosterone

to DiHydroTestosterone (DHT)

hyperplasia

DHT level inprostate

Side effects: Loss of libido & impotence in 5 % pts.

Also used for prevention of hair loss Dutastride (Avodart)


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Parasympathetic Sympathetic

HypothalamusHypothalamusHypothalamusHypothalamus

ANSANSANSANS

AcetylcholineNoradrenaline

Muscarinic Receptors vasoconstriction

Penile flaccidityPenile erection


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Sildenafil Inhi$its c%MP-S!eci#ic

!hos!hodiesterse ty! & (PD'&) inthe cor!us cvernos o# the !enis 'ny"e !ro"otes deredtion o# c%MP

*hich reultes $lood #lo* in the !enis

,

!otentite nitrte/s hy!otensionctivity

Side e##ects0

hedche, #lushin, dys!e!si,"yli


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emale sex hormonesstrogens

Synthesis & secretion

Regulation

Pharmacological actions Pharmacokinetics

Preparations

Progestrogens

Synthesis& secretion

Regulation

Pharmacological actions Pharmacokinetics

Preparations

Adverse effects

Anti6estrogens

+lomiphene citrate

+yclofenilTamo$ifen citrate

Ralo$ifene

/rmelo$ifene

Adverse effects

Anti6progestrogens

"ifepristone


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Cholesterol

Pregnenolone

Progesterone

17-- Hydroxypregnenolone

17- Hydroxyprogesterone

Dehydro-epiandrosterone

Andro-stenedione Oestrone

Oestriol

TESTOSTERONE estradiol

Premenopausal : ovaries (10-100 g)

Postmenopasual :adipose tissue(2-10 g)

Pregnancy : placenta (up to 30mg)


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Progesterone

Estrogen

LH FSH


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!strogens

5atural

estrdiol

1estrone 1estriol

Synthetic

1.Steroidal Ethinyl estradiol Mestranol

2.Non-steroidal Diethylstilbesterol

Hexestrol Dienestrol Chlortrianisene


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Pharmacokinetics

Absorption:

9ell absorbed by oral parenteral &transdermal admn

estradiol undergoes high first pass

metabolism Therefore other syntheticpreparations are more commonly used

estradiol esters im admn Slo4ly absorbed

Transport: highly protein bound 'Se$Steroid .inding 8lobulin 'SS.8*albumin*

"etabolism:

by liver en#ymes

Significant entero6hepatic circulation

e$cretion by urine after con!ugation


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!strogen "re"arations

/ral +on!ugated estrogen

'; 1=> mg tab => mg in!*

thinyl estradiol';;1 ;>;1mg*

"estranol ';1 mg tab* /esradiol succinate '1 = mg tab*

intramuscular

,ntravenous )osfestrol tetrasodium

'; mcg ;=>mg*


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estrogens# Actions

Sex organs:

vagina, uterus & fallopian

tubes

vaginal cornificationendometrium: proliferative

& secretary phase

menstruation

cervical secretion watery

Secondary sexual

characteristics:

Growth of breast

facial, pubic & axillary

hairs

estrogens# Actions


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estrogens# Actions"etabolic ffects

Anabolic effect '4eak*

)usion of epiphysis

Salt & 4ater retention

.P

,mpaired glucose tolerance

.lood coagulability

+holesterol content of bile

+arcinogenic Action


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Adverse effects of Estrogen Nausea, anorexia, vomiting, diarrhea

Libido, gynaecomastia & feminization (male)

Stunted growth

Adenocarcinoma of vagina & cervix ( offspring)

Postmenopausal : endometrial cancer Premenopausal : Ca. breast

Coronary & thrombo-embolic disorders

Gall stone Benign hepatoma

LDL and HDL & TG, hyperglycaemia


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Substitution therapy:

menopausal syndrome

Senile vaginitis

Clinical uses of estrogens

delayed puberty


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as oral contraceptive steroids

Dysmenorrhea

Dysfunctional uterinebleeding


Acne

hirsutism


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/steoporosis

Prevention of heart attacks


+a of breast

+a of prostate

Postpartum lactation


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Hormone $e"lacement Thera"%

2ene#its0

3elie# o# hot #lushes 4vso"otor sy"!to"s

Crdio-!rotection

1steo!orosis

/

Dr*$cks0

endo"etril 4 $one

cncer

thro"$oe"$olic

diseses

Tib l


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Tibolone

1B6 norsteroidal drug estrogen progesterone 4eak androgen

Preparation: =>mg tab

7se: Hor"one 3e!lce"ent Ther!y 'menopausal symptomsurogenital atrophy psychological symptoms libido and osteoporosisimproved*

Adverse Drug Reaction: 4eight gain increased facial hairoccasional vaginal spotting

+ontra,ndications: hormone dependent malignancy of breast

uterus undiagnosed vaginal bleeding thromboembolic diseasesvere liver disease migraine epilepsy


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T if it t


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Response rate:

ER +ve: 50%

ER & PR +ve: 60-70%ERve: 10%

Tamoxifen citrate

For 5 years :

Recurrence by 47 50%Death 26 -28%Contralateral Ca. breast 47%


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Raloxifene

.one & +-S: partial agonist

ndometrium & breast:antagonist

Postmenopausal 4omen:prevents bone loss

Reduce 0D0 cholesterol


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Th%roid and Parath%roid Agents


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Th%roid and Parath%roid Agents

and agents affecting bonedemineralization

Thyroid hor"onesThyroid hor"ones 55 the $i !icturethe $i !icture '##ects o# thyroid hor"ones'##ects o# thyroid hor"ones

3eultion o# thyroid hor"ones3eultion o# thyroid hor"ones

ynt es s o t yro or"onesynt es s o t yro or"ones

Disese sttes resultin #ro" thyroidDisese sttes resultin #ro" thyroidhor"ones nd their tret"entshor"ones nd their tret"ents

Prthyroid hor"one nd clciu"Prthyroid hor"one nd clciu"


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Axes Controlled ia the Anterior Pituitar%

HypothalamusHypothalamus

AnteriorAnteriorituitarituitar

BreastBreast

ProlactinProlactin

AdrenalAdrenal

cortexcortex

LiverLiverBoneBone

MuscleMuscle

ThyroidThyroid OvaryOvary

TestesTestes

ACTHACTH

GHGHTSHTSH

FSH/LHFSH/LH

$ l ti f H $ l


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$egulation of Hormone $elease

GHRH (+)GHRH (+) GH (+)GH (+)(Somatotropin)(Somatotropin)

Liver and othersLiver and others SomatomedinSomatomedin(IGF(IGF--1)1)

SOMATOSTATINSOMATOSTATIN((--))

GH (GH (--)) Liver and othersLiver and others

Hypothalamus Pituitary Target Organ Hormone

((--))

--

PRH (+)PRH (+) Prolactin (+)Prolactin (+) BreastBreast

CRH (+)CRH (+) ACTH (+)ACTH (+) Adrenal CortexAdrenal Cortex Glucocorticoid,Glucocorticoid,mineralocorticoidmineralocorticoid

TRH (+)TRH (+) TSH (+)TSH (+) ThyroidThyroid T3, T4T3, T4

GNRH (+)GNRH (+) FSH (+)FSH (+)LH (+)LH (+)

GonadsGonads Estrogen,Estrogen,progesterone,progesterone,testosteronetestosterone

h id


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Th%roid

Anto"ic !ro"inence6 one o# #irst endocrineAnto"ic !ro"inence6 one o# #irst endocrinelnds to $e correlted *ith clinicl conditionlnds to $e correlted *ith clinicl condition

cused $y "l#unctioncused $y "l#unction 3eleses t*o ty!es o# hor"ones03eleses t*o ty!es o# hor"ones0

,, TTFF:: triiodothyroninetriiodothyronine (7 iodine residues,(7 iodine residues,

T@:: thyro$inethyro$ine (: iodine(: iodine resideusresideus, ;&, ;&99iodine)iodine)I"!ortnt in ro*th nd develo!"ent6I"!ortnt in ro*th nd develo!"ent6reulte enery "et$olis"6 "intin $odyreulte enery "et$olis"6 "intin $odyte"!erturete"!erture

,,,, +alcitonin+alcitonin0 i"!ortnt in reultin0 i"!ortnt in reultinclciu" "et$olis"clciu" "et$olis"


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!ffects of Th%roid Hormones!ffects of Th%roid Hormones %ro*th nd Develo!"ent%ro*th nd Develo!"ent

ClorienicClorienic '##ects'##ects

Crdiovsculr '##ectsCrdiovsculr '##ects Met$olic '##ectsMet$olic '##ects

'ro(th and Deelo"ment'ro(th and Deelo"ment


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'ro(th and Deelo"ment'ro(th and Deelo"ment Thyroid hor"one (TH)Thyroid hor"one (TH)

reultesreultes o!ti"lo!ti"l ro*th ndro*th nd

develo!"ent o# ll $ody tissue6develo!"ent o# ll $ody tissue6

sti"ultessti"ultes proteinprotein synthesissynthesis!resu"$ly $y incresin D


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Calorigenic !ffect Thyroid hor"ones increseThyroid hor"ones increse

restin or $sl "et$olic rterestin or $sl "et$olic rteo# *hole ornis"o# *hole ornis"

Most sensitive tissues0 hert,Most sensitive tissues0 hert,skeletl "uscle, liver, kidneysskeletl "uscle, liver, kidneys

Thyroid hor"ones increseThyroid hor"ones increse$od te" erture$od te" erture

Altertions in $odyAltertions in $odyte"!erture reulte THte"!erture reulte TH!roduction!roduction

Cold Incresed TCold Incresed T77

nd Tnd T:: !roduction!roduction

Cardioascular !ffects


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Cardioascular !ffects

ThyroidThyroid hor"ones0hor"ones0 increseincrese herthert rterte

increseincrese #orce o##orce o#

contrctioncontrction incresedincresed crdiccrdic

out!utout!ut

DirectDirect effecteffect0 $indin0 $indinto thyroid hor"oneto thyroid hor"onerece!tors in hert6 notrece!tors in hert6 not>ust res!onse to>ust res!onse toincrese in $slincrese in $sl"et$olis""et$olis"

,ndirect,ndirect effecteffect00Incresed nu"$er o#Incresed nu"$er o#$et dreneric$et drenericrece!tors in hertrece!tors in hert

M t b li !ff t


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Metabolic !ffects Sti"ulte "et$olis"Sti"ulte "et$olis"

o# cholesterol to $ileo# cholesterol to $ilecidscids

Increse $indin o#Increse $indin o#

LDL $y liverLDL $y liver Increse cr$ohydrteIncrese cr$ohydrte

"et$olis""et$olis"

u!tkeu!tke

Pit itarPit itar H "othalam sH "othalam s


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Pituitar%Pituitar%--H%"othalamusH%"othalamus

Hy!othl"usHy!othl"us

Anterior PituitryAnterior Pituitry

TRH

(-)

(-)

ThyroidThyroid

T: nd T7T: nd T7

TSH


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Thyroid hormones T3H 5 thyroid-relese

hor"one Secreted $y

hy!othl"us

2inds to sites in then er or ! u ry

TSH 5 thyroid-sti"ultin hor"one 5Thyrotro!in Secreted $y the nterior

!ituitry %lyco!rotein hor"one

Th id $ l tiTh id $ l ti


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Th%roid $egulationTh%roid $egulation AutoregulationAutoregulation

AutoreultionAutoreultion 55 reultion o# thereultion o# thethyroid lnd *ithout e.ternl sinlinthyroid lnd *ithout e.ternl sinlin

Incresed iodine decresed iodideIncresed iodine decresed iodide

u!tkeu!tke ndnd orni#ictionorni#iction (conversion(conversionto iodine)to iodine)

8raves disease8raves disease00 !roduction!roduction o# thyroid sti"ultino# thyroid sti"ultin

i""unolo$ulini""unolo$ulin (nti$ody) $y ly"!hocytes6(nti$ody) $y ly"!hocytes6

"i"ics"i"ics ction o# TSH6ction o# TSH6

lonerloner durtion ction6durtion ction6

utoi""uneutoi""une disesedisese

TumorsTumors00 thyroto.icosisthyroto.icosis--

e.cessivee.cessive hor"one !roductionhor"one !roduction

Th%roid H%"erfunctionTh%roid H%"erfunction


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% %"% %"

)igns and )%m"toms)igns and )%m"toms

Incresed $ody te"!ertureIncresed $ody te"!erture Incresed "otor ctivityIncresed "otor ctivity

Incresed sy"!thetic nervousIncresed sy"!thetic nervoussyste" ctivitysyste" ctivity

SkinSkin-- #lushed, *r"#lushed, *r" ?ek "uscles #ti ue?ek "uscles #ti ue Incresed hert rte6 rrhyth"is6Incresed hert rte6 rrhyth"is6

CH@CH@ Incresed !!etiteIncresed !!etite itteryittery Incresed $sl "et$olic rte6Incresed $sl "et$olic rte6

decresed cholesterol nddecresed cholesterol ndtrilyceridestrilycerides

Menstrul irreulrities6 decresedMenstrul irreulrities6 decresed#ertility#ertility

h id f i


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Th%roid H%"erfunction

$cessive secretion$cessive secretionthyroid hormonesthyroid hormones

8raves Disease8raves Disease 66 Diffuse To$icDiffuse To$ic

8oiter8oiter the "ost co""on hy!erthyroidthe "ost co""on hy!erthyroid

cusecuse I%I% nti$odies to TSH rece!torsnti$odies to TSH rece!tors--

ctivte rece!torsctivte rece!torsincresed Tincresed T77 nd Tnd T:: releserelese

Chrcteried $yChrcteried $y thyroto.icosisthyroto.icosisndnd o!thl"yo!thyo!thl"yo!thy Most co""on in youn, "iddleMost co""on in youn, "iddle

e #e"les (0 over "en)e #e"les (0 over "en) Autoi""une diseseAutoi""une disese

Anti$odies $ind to ndAnti$odies $ind to ndctivte TSH rece!tors t thectivte TSH rece!tors t the

thyroidthyroid Cn lso $e cused $y eneticCn lso $e cused $y enetic

de#ect in TSH, cusinde#ect in TSH, cusinovere.!ressionovere.!ression o# TSH ndo# TSH ndthere#ore incresed thyroidthere#ore incresed thyroidhor"one relesehor"one relese


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Graves disease

opthalmyopathyopthalmyopathy

goitergoiter



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$cessive secretion thyroid$cessive secretion thyroidhormoneshormones

To$ic 5odular 8oiterTo$ic 5odular 8oiter'PlummerGs Disease*'PlummerGs Disease*-- 1ccurs in older !tients1ccurs in older !tients-- --oiteroiter

-- second "ost co""on hy!erthyroidsecond "ost co""on hy!erthyroiddisesedisese-- one node o# the thyroid "y hveone node o# the thyroid "y hve$eco"e unreulted nd $eins to$eco"e unreulted nd $eins torelese thyroid hor"one *ithout nyrelese thyroid hor"one *ithout ny

controlcontrolThyroiditisThyroiditis

66 sometimes leads tosometimes leads tohyperthyroidism but usuallyhyperthyroidism but usuallyresolves on its o4nresolves on its o4n


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Th%roidTh%roid H%"erfunctionH%"erfunction TreatmentTreatment


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Th%roidTh%roid H%"erfunctionH%"erfunction TreatmentTreatment

AntiAnti--thyroid druthyroid dru

ther!yther!y Thyroidecto"yThyroidecto"y

77IodineIodine

Thyroid StormThyroid Storm((thyroto.icthyroto.ic crisis)crisis)

li#e thretenin6 needli#e thretenin6 need

i""edite tret"ent0i""edite tret"ent0propanololpropanolol


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Anti-th%roid Hormone Drugs

%oitroens%oitroens0 ents tht0 ents tht

decresedecrese !roduction!roduction o#o#THTH

ThionamidesThionamides methima#olemethima#ole

propylthiouracilpropylthiouracil

carbima#olecarbima#ole '7H*'7H*

Accu"ulte in thyroidAccu"ulte in thyroid

Anti th%roid Hormone Drugs


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Anion ,nhibitorsAnion ,nhibitors"onovalent"onovalent anions:anions:

rese"$le Iodide6rese"$le Iodide6co"!etitive inhi$itorsco"!etitive inhi$itors

inhi$it trns ort o# iodideinhi$it trns ort o# iodideinto thyroid overco"e $yinto thyroid overco"e $yincresed Iodideincresed Iodide PerchlortePerchlorte (Cl1(Cl1::

--))

PertechnettePertechnette (Tc1(Tc1::--))

ThiocynteThiocynte (SC


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-- 1ldest re"edy1ldest re"edy-- Prdo.icl ctionPrdo.icl ction

-- 1$serve e##ects *ithin B: hours1$serve e##ects *ithin B: hours

IodidesIodides

-- . "u" e ects0 +. "u" e ects0 + 55& ys& ys

-- '##ects'##ects te"!orrilyte"!orrily-- Inhi$it TH relese, inhi$itInhi$it TH relese, inhi$it

orni#ictionorni#iction o# iodideo# iodide

-- Decresed sie ndDecresed sie nd vsculrityvsculrity o#o#hy!er!lstichy!er!lstic lndlnd

--


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$adioactie *odine +$adioactie *odine +

,,,,

*.*.-- 3!idly $sor$ed (orlly)3!idly $sor$ed (orlly)

-- Concentrted in thyroidConcentrted in thyroid

-- '"its'"its rditionrdition destruction o#destruction o#thyroid lnd (!inless)thyroid lnd (!inless)

--

-- ?idely used to tret hy!erthyroidis"?idely used to tret hy!erthyroidis"-- Disdvnte0 delyed hy!othyroidis"Disdvnte0 delyed hy!othyroidis"

--Alterntive0Alterntive0 B7B7I6 e"its .I6 e"its .--rys6rys6

used #or thyroid scns6 hl# li#e 7 hrused #or thyroid scns6 hl# li#e 7 hr


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*odinated Contrast Media*odinated Contrast Media

I!odteI!odte ndnd

Io!noicIo!noic AcidAcid

--Inhi$it conversion TInhi$it conversion T::77 T in liver,T in liver, kidney,kidney,!ituitry nd $rin!ituitry nd $rin

--Esed in d>unct ther!yEsed in d>unct ther!y


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Adrenoce"tor /locking AgentsAdrenoce"tor /locking AgentsMny sy"!to"s o#Mny sy"!to"s o# thyroto.icosisthyroto.icosis

"i"ic sy"!thetic sti"ultion"i"ic sy"!thetic sti"ultion


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Th%roid H%"ofunction

,nsufficient secretion thyroid hormones,nsufficient secretion thyroid hormonesHshi"oto/sHshi"oto/s ThyroiditisThyroiditis

Autoi""uneAutoi""une thyroiditisthyroiditis 55 the i""une syste" ttcks nd destroysthe i""une syste" ttcks nd destroys!rt o# the thyroid lnd!rt o# the thyroid lnd

Medicl tret"ents s cuse #orMedicl tret"ents s cuse #or hy!o#unctionhy!o#unction Mny o# the tret"ents #or hy!erthyroidis" cn cuseMny o# the tret"ents #or hy!erthyroidis" cn cuse

hy!othyroidis"hy!othyroidis" IB& tret"ent to destroy !rt o# the thyroid lnd cn leve not enouh le#t toIB& tret"ent to destroy !rt o# the thyroid lnd cn leve not enouh le#t to

llo* #or nor"l thyroid #unctionllo* #or nor"l thyroid #unction

Suricl re"ovl o# tu"ors o# the thyroidSuricl re"ovl o# tu"ors o# the thyroid

Proloned oiter cn d"e the thyroid lndProloned oiter cn d"e the thyroid lnd

Th%roid H%"ofunction#Th%roid H%"ofunction#


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)igns and )%m"toms)igns and )%m"tomsPle !u##y skinPle !u##y skin

Droo!y eyelidsDroo!y eyelids

Decresed !eri!herl vsculrDecresed !eri!herl vsculrresistnceresistnce

Decresed hert rte nd crdicDecresed hert rte nd crdic

$rdycrdi$rdycrdiDecresed !!etiteDecresed !!etite

Lethry, slo*in o# "entl !rocessesLethry, slo*in o# "entl !rocesses

Decresed kidney nd re!roductiveDecresed kidney nd re!roductive

#unction (in#ertility)#unction (in#ertility)Decresed $sl "et$olis"Decresed $sl "et$olis"

Children0 "entl retrdtion,Children0 "entl retrdtion,d*r#is"d*r#is"


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Diagnosis and Treatment of H%"oth%roidismDiagnosis and Treatment of H%"oth%roidism

DiagnosisDiagnosis0 decresed T0 decresed T::!roduction6!roduction6 ndForndFor !resence o# nti!resence o# nti--thyroidthyroid

nti$ody (utoi""une)nti$ody (utoi""une)

rea menrea men 00

3e!lce"ent3e!lce"ent ther!y *ithther!y *ithlevothyro$inelevothyro$ine 'T'T@@**66 St$leSt$le,, lonlon hl#hl#--li#e (G d),li#e (G d), convertedconverted to Tto T7766

usedused to tret hy!othyroidis",to tret hy!othyroidis","y.ede""y.ede", co", cretinis",, co", cretinis",si"!le oiter, nodulr oitersi"!le oiter, nodulr oiter


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Parathyroid gland S"ll lnds tht lie $ehind the

thyroid

Hihly vsculried ndcontinully "onitors the

$lood Prthyroid hor"one 5

@unctions to control clciu" inthe $lood

Indirectly, this i"!cts ho*"uch clciu" reches the $ones

Parath%roid 'lands


75/80

'"$edded in thyroid

Secrete (PTH)parathyroid hormone

clciu" levels Sti"ultes osteoclsts

Pro"otes clciu"re$sor!tion $y

kidneys

CalciumCalcium


76/80

)unctions

"uscle contrction $one su!!ort

cell sinlin

CalciumCalcium

Plasma levels maintained by Diet

2one store

3ecycled

Control of Calcium /alance andControl of Calcium /alance and


77/80

MetabolismMetabolism Prthyroid Hor"one

Clcitrol

Jit"in D SunFdiet

Thyroid Phos!hte $lnce


78/80

Diseases of the parathyroid Hy!er!rthyroid

disorders 5

2ones ive u! clciu"to increse $loodc c u"

Cn led to osteo!enind osteo!orosis

0steo"orosis# Disease of /one 'ro(th and0steo"orosis# Disease of /one 'ro(th and


79/80

Calcium MetabolismCalcium Metabolism

2one re$sor!tion

e.ceeds de!osition 1steoclsts "o$ilie

B

@ctors0 inde=uteCB intke, enes,hor"ones, s"okin


80/80

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Date post:	13-Apr-2018
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7 Pharmacology Lecture Hormones

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