p ng Khi Cng thngnguy himstress

BS L HNG THNH

Bit c H ni tit l g Bit c Hormone l g K tn c cc tuyn ni tit c bn K tn mt s hormone c bn Nm c 1 s chc nng c bn ca hormone.

 C ch thn kinh: H thn kinh C ch th dch:

H ni tit Thnh phn v nng cc cht trong huyt tng p sut thm thu Th tch dch ni bo, ngoi bo pH

Nhiu tuyn ni tit

Sn xut Hormone

Bi tit vo mu

Duy tr & iu ha chc nng c th

Cao ln? Thng minh? Dy th? Sinh sn? Min dch, v.v

i n c quan ch
Gn vm receptor

Tuyn gip
4 tuyn cn gip

 Khng phi l 1 tuyn, nm gian no. Cha nhiu trung tm kim sot chc nng v cm xc Thnh phn: cht xm

ADH, oxytocin
Sn xut hormone

D tr hu yn (thy sau)

Vng Di i

Hormone iu ha

Kim sot Tuyn yn

Kch thch tit (RH)

c ch tit (IH) S tit Epinephrine/ Norepinephrine

Truyn tn hiu

Tuyn thng thn

(-)/ (+)

Nm y no Trn mi Tuyn nh, hnh bu dc To # qu nho C 2 thy:

Trc: tin yn Sau: hu yn

GH = Growth Hormone (+) tng trng

Sn xut hormone

TSH (+) T.gip

Tit Thyroxine (tng chuyn ha NL)

Prolactin (+) tit sa, T.v

Tin yn 3 H. Sinh dc

FSH (+) nang trng (+) tinh hon sx tinh trng LH (+) hong th ha, (+) rng trng & s tit Estrogen, progesterone t bung trng (+) Tinh hon sx Testosterone

ACTH = Adreno-corticotropic (+) v thng thn

Tit cortisol, Aldosterone, sex hormone

D tr hormone

ADH = antidiuretic hormone

chng li tiu

Ti hp thu Na+ thn, gi nc li, nc i vo mu, tng HA

Hu yn

Khi mt mui, nc (tiu chy, nn, m hi) (+) vng di i sx ADH (+) hu yn tit ADH ra mu, mc ch iu ha mui - nc cho c th chuyn d sanh (+) tng co c t cung, y em b ra ngoi

Oxytocin

Sau sanh

Em b b m (+) co c gn ng tuyn v tit sa

Vng di i GnRH (+) Tuyn yn LH, FSH (+) Sinh dc hor.sd

Tc dng: m ch l tuyn v chu tc dng ca estrogen v progesteron gy bi tit sa vo nang sa

 Vng di i PIH (-) Tuyn yn Prolactin ng tc mt nm v ca tr. Tc ng ca mt s thuc.

Tc dng: M ch: tt c t bo trong c th. Tc dng gin tip thng qua Somatomedin (IGF: insulin-like growth hormon) Tc dng ch yu: pht trin c th

+ Trn xng

Tng to khung protein. Tng t bo to xng. Tng ct ha sn lin hp.

+ Trn chuyn ha protein

ARNm ADNARNm Sao m ARNvc aa

aa

Dch m
Protein aa aa

Kt qu: tng tng hp protein

+ Chuyn ha glucid
Hp thu rut

Glucose huyt

T bo O2 Nng Glucose lng

Gan .Glucose Glycogen .Glucose tha a. bo .Tn to ng: Glucose aa, acid bo

Kt qu: tng ng huyt

+ Chuyn ha lipid
Glycerol a. bo
Nng

Glycerol a. bo
Triglycerid

lng

a. bo

M M D TR

Kt qu: tng thoi ha lipid

Vng di i GHRH (+) Tuyn yn GH Vng di i GHIH (-) Tuyn yn GH

 Do thy trc yn tng tit GH 80% l do khi u tuyn yn Tng pht trin xng, m mm
Mi, hm, ngn chi Tr em (xng di)

Din tin t t, pht hin tr (trung nin) iu tr:

phu thut ct b khi u Dng thuc c ch tit GH

V TT (80%)

Ty TT (20%)

Tit ra khi cng thng, co mch, tng nhp tim, tng HA, gin PQ, tng Glucose mu
Tng ti hp thu Na+ Thn, iu ha cn bng mui nc Tit ra khi stress (b bnh, s hi, gin d), Tng to Glucose khi i, Tng ly gii m to NL Androgen, nam (2/3 VTT, 1/3 tinh hon sx), n (VTT sx ton b)

Vng di i CRH (+) Tuyn yn ACTH (+) V TT cortisol

B phn

Suy

Cng
- Loi chuyn ho: Hi chng Cushing. - Cng adosteron: bnh Conn.

Bnh Addison - Cng hormone SD nam ca v thng thn (androgen)

Tu

Khng c Phrocromocytom.

 Addison gim tit hormone v TT Nguyn nhn: 70% do ri lon t min (c th t sx khng th tn cng tiu dit cc TB ca v TT)
Lao thng thn: nc ngho, lc hu Thuc chng ng gy XH thng thn Ri lon ng mu Tc M thng thn (thai nghn, chn thng) Ct c 2 tuyn TT (phu xthut) Bnh SIDA

4 triu chng chnh (kinh in): 1. Da xm en: mu ch, da thm bn, u v. vng da h hay tip xc nng. Vng da b c xt: khuu tay, u gi, vai, tht lng. Nim mc mi, li. 2. Mt mi: yu lc c 3. H HA (tm thu + tm trng): hoa mt, d ngt 4. Gy, st nhanh: 3-4 kg/ vi thng
iu tr: b sung cortisol (thuc) lin tc

Gim Aldosteron

Gim hp thu Natri, gim V mu, h huyt p Gim d tr Glucose ti gan, gim to ng H ng huyt Gim huy ng v s dng m gy, st cn

Gim cortisol

Gim androgen
Tng MSH lp nh b (da)

Teo tinh hon/ bung trng, v kinh, lnh cm (n), bt lc (nam) Tng sc t melanin gy xm da

N: l cng chc nng VTT tin pht (do u/ cng sn) gy tng tit nhiu glucocorticoid (ch yu l cortisol) Nguyn nhn Do thuc: ung Corticoid liu cao/ ko di Cng sn /u VTT: u lnh/ u c Cng sn/ u tuyn yn (bnh Cushing) Ung th nhau thai, u bung trng, k tB nh phi, u i trng, u tuyn c tng tit ACTH.

Mt trn, , m di da sau gy

T m (c, ngc, bng) Chn tay gy khng khiu Teo c gc chi Yu c (h Ka+) Da kh tng mng, d XH khi chm Vt rn da mu tm (bng, di v, i)

Mn trng c ton thn Rm lng (nch,mu, ria mp n)

Tng HA (70-80%)
D b lot DD-TT (DD tng tit acid & pepsin)

Ri lon SD/ RL kinh nguyt RL tm thn kinh (trm cm)

 Hnh con bm - gia l eo gip - 2 bn l 2 thy gip (T,P) Nm trc & 2 bn kh qun Mu xm (nhiu MM)

Nang Gip (cha keo gip)

Thyroxine (do nang gip tit ra, cn c Iod) Tng chuyn ha cc cht Pht trin tr tu, bn chn, (+) Tng nhp tim Nam: iu ha b my sinh dc, thiu (mt dc tnh), tng nhiu (bt lc) N: thiu gy rong kinh, a kinh. Tha gy t kinh, v kinh, gim dc tnh

 Calcitonin (do TB cn nang gip tit ra) Gim H ca TB hy xng Gim to TB xng mi gim Calci mu, gip gi Calci nhiu trong xng (ph hp vi TE ang ln)
iu ha: nng Calci mu.

Vng di i TRH (+) Tuyn yn TSH (+) Tuyn gip T3, T4

Bnh Basedow (mt trong nhng bnh cng gip hay gp) Nhiu tn gi: N > nam (gp 5-7 ln) Bnh Graves 20-40 tui hay gp Bnh Parry Lin quan di truyn (15%) Thai nghn (hu sn) Bu gip c lan ta Nhim trng, virus Bnh cng gip t min

Biu hin chnh:

Nhim c gip km bu gip ln lan ta, Li mt, tn thng ngoi bin

Li mt, bu gip

 Bu gip: to, lan ta, mm/ n hi, da c ,nng HC nhim c gip (do tng T3,T4): Tim mch: tim nhanh, hi hp, lon nhp, kh th, mnh nhanh, mnh, HA tm thu tng. TK c: run tay, yu c, d (+), cu gt, ni nhiu, bt an, mt ng. Ri lon vn mch ngoi vi: mt khi khi ti, tng tit m hi, lng bn tay-chn m, yu c, teo c du gh u, yu c h hp kh th, yu c TQ kh nut Tiu ha: n nhiu, vn gy st cn Tit niu SD: Tiu nhiu, gim tnh dc, RLKN, v sinh, chng v to nam gii

 Li mt Ph nim (trc x chy) To cc u chi: ngn chi di trng, tiu mng tay C th km bnh l t min khc: suy VTT, suy cn gip, T, nhc c.

 C th t sx cc khng th (+) tng tit TSH (+) tuyn gip tng H tng T3,T4 nhim dc gip

Ti mt: vim nguyn bo si hc mt, vim c hc mt sng hc mt, li nhn cu, chng nhn i, , sung huyt v ph kt mc, ph quanh hc mt (bnh l li mt tuyn gip)
Ti da v u chi: ph nim mt trc xng chy & thng tn quanh mng xng u ngn chi

 T3, FT3, T4,FT4 : u tng TSH : gim Siu m tuyn gip: to, eo gip dy,
Siu m mt, khm y mt, o li nhn cu Sinh thit vng ph nim trc xng chy, nhum PAS (+): c s lng ng glycosaminoglycan

Case lm sng: (cn Th)

- B ny c M 21 tui b basedow, sinh ra 1600g - suy DD bo thai - tim nhanh >160l/pht - th nhanh co lm ngc - XN mu: m v con u tng FT3,FT4 - iu tr: cho b ung propylthiouracil (PTU) 50mg (mg/kg/ngy) - tin trin tt, nhp tim n.

C 4 tuyn. Nm sau tuyn gip. Tuyn sinh mng. Tit hormone PTH

 Tc dng: tng calci mu -Xng: tng tiu xng, gim to xng. -Thn: tng ti hp thu calci. -Rut: tng tc dng ca vitamin D.
iu ha bi tit: calci mu.

Ty ni tit gm nhng o Langerhans (1-2 triu) 1 tiu o c 4 loi TB

glucagon (tng ng mu) insulin (h ng mu) Delta somatostatin (iu ha bi tit insulin & glucagon) PP tit polypeptid ty (cha r CN)

 Gy h ng huyt = 2 cch:
Tng s dng: a G mu gan, c (dng glycogen d tr), tng hy G rut, chuyn G acid bo. Gim to G t glycogen, gim to ng mi t protid

Gy tng ng huyt,
(+) gan ly gii glycogen glucose ra mu.

Tng ly gii lipid (m m) to NL

 c ch s gii phng insulin v glucagon

c ch bi tit dch tiu ha, hp thu thc n ti d dy, rut non.

 Tn thng t bo Beta thiu INSULIN U t bo Anpha tng GLUCAGON INSULIN c , nhng ko gn vi Receptor trn m ch c ko a c Glucose mu vo TB tng ng huyt Ngui Bo ph: gim Receptor tip nhn insulin ti
t bo

hi chng 4 nhiu n nhiu (i) Ung nhiu (kht) Tiu nhiu St cn nhanh.

Nguyn nhn
Di truyn Dinh dng. Nhim trng

T bo beta ty mt/ gim tit

INSULIN Gim i tnh ca Rc vi insulin

Tng hormon: Glucagon, GH, corticoid

T type I
10-20% Khi pht < 40

T type II 80-90% Khi pht > 40 Bo ph Insulin bnh thng Bin chng MM ln n king, th dc, thuc C tin s gia nh (30%)

Gy Tit insulin t
Bin chng vi mch sm iu tr : insulin + n king

C tin s gia nh (10%) Tin s: nhim siu vi,

nhim c

Bnh thng: Glucose huyt : 3,9 6,4 mmol/L

Chn on T khi c 1/3 tiu chun sau, v phi XN t nht 2 ln 2 thi im khc nhau 1. Glucose huyt bt k trong ngy 11,1 mmol/L, km theo hi chng 4 nhiu 2. Glucose huyt lc i 7 mmol/L (i l sau n 8g) 3. Glucose huyt sau 2 gi ung 75g Glucose 11,1 mmol/L

- Hn m:
- Nhim toan ceton (T type 1)
- Nhim toan acid lactic, tng p lc thm thu do tng Glucose mu (T type 2)

- H ng huyt

Bin chng vi mch Vng mc (m) Suy thn mn Bnh l TK ngoi bin

BC MM ln
XVMM TMCT im lng, NMCT, TBMM No
Tc mch thn THA, suy thn Vim tc M chi di gy hoi t kh

Tc MM bn chn, cng chn on chi

- Nhim trng tiu (ng tiu thp) dai dng & ti pht nhiu ln vim b thn ngc dng, suy thn.
- Da nim: nht t cu vng, vim m h, vim bao quy u. - Lao, siu vi

- Tng HA
- Bin chng Da: vim teo da, ph i/teo m m, d ng da do insulin.

- Bn chn T: nhim trng Lot

 Lm mt bin chng, trnh bin chng mn

Kim sot Glucose mu tt Glucose mu lc i < 7 mmol/L Glucose mu bt k < 10 mmol/L HbA1C < 7% iu chnh ri lon Lipid tt

Trnh tai bin do iu tr: H ng huyt, teo m m do insulin.

Thuc

n King

Vn ng

 Gim Glucid (m, go,)

Gim cht bo bo ho (axit bo no) d gy va x ng mch. n nhiu rau v cc loi tri cy c v (v tri cy, go lt...) c nhiu x. n cht x gim hp thu ng, gim (+) ng rut, gim to bn, tng vitamin

 n m va phi, nn chn c > tht

Nn chia nh 4 6 ba n/ ngy Nn n thm ba ti trnh h ng huyt ban m, nht l BN ang dng insulin. Ru bia c ch to ng d gy h ng huyt n nht khi c THA i km, 2-3 g mui/ ngy

 i b, tp bi Tp dng sinh
p xe Trnh qu sc h ng huyt

Thuc ung h ng huyt 1. Nhm sulfonylurea (sulfamid): Tolbutamide, Gliclazid (diamicron), Glimepirid (Amaryl):

2mg 4mg x 1-2 ln/ ngy 2. Nhm Biguamid: methyl biguanid (Metformin) vin 500-850mg: 2-3 vin/ngy 3. Nhm Acarbose 4. Nhm Benfluorex (mediator) 150mg

 T type 1 Cp cu tin hn m/ hn m do T BN st cn nhiu, suy DD/ bnh nhim trng T type 2 khng p ng vi thuc ung T c nhiu bin chng/ 1 trong 3 c quan: tim, thn, no T ph n mang thai

INSULIN
NHANH (Regular, standard solube)

MU

BT U TC DNG
5 pht sau tim TM 30 pht sau tim Di Da 2h

Trong

BN CHM (lente, NPH) RT CHM (ultra-lente, PZI)

4h

 Tim di da Liu u tin: 0,3-0,5 IU/kg/ngy Phi hp 2/3 loi nhanh v 1/3 loi chm Nu tim < 30 IU: 1 ln vo bui sng Nu tim > 30 IU: chia 2 ln sng ti Insulin tc dng nhanh nn tim trc n 30pht
Insulin bn chm c th tim trc khi n sng/ n chiu

 H ng huyt: qu liu insulin, b n/ n tr, stress D ng: ti ch tim/ ni mn ton thn Lon dng m do insulin: teo m m/ ph i m m ta nn tim nhiu ch khc nhau trnh Khng insulin: ko p ng vi liu > 200 IU