endokrinologi-tyroid dan adrenal, 11 -1-2011.pptx
TRANSCRIPT
7/26/2019 Endokrinologi-Tyroid dan Adrenal, 11 -1-2011.pptx
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KELAINAN PADA KELENJAR
TIROID:
Oleh:
dr. Pandji M,SpPD,KEMD FINASIM
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BIOSINTESIS HORMON TIROID
BERAT : ± 2 !ra"
MIKROS : Ban#a$ %&li$el ' ( ' µ" )eri*i KOLOID, +erdiri dari LIKO PROTEIN
TIROLOB-LIN : Sejeni* al)"in #an! "enjadi MIT / DIT
YODIUM → Merupakan unsur pokok
Hormon TyroidBanyak terdapat pada : MakananLaut, Susu, Daging, Telur, AirMinum, aram.Di*erap ** hal* 0 la")n!.
13 di+an!$ap $el. T#r&id, *i*a → air $e"ih.
4'5 *i"panan 6&di" +)h dala" $el. T#r&id.Si*an#a dala" *ir$la*i / jarin!an den!an pr&*e*r"i+,
6&di" #an! +er+an!$ap *el ini → di)ah 7h&r"&n"elali)e)erapa +ahapan → 8 +ahap9
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IODINE METABOLISM
THYROID
LIVER &
OTHER
TISSUE
As T3 & T4 :80 µgI-
120 µgI-
40 µgI-
60 µgI-
Feces :
20 µgI-Feces :
480 µgI-
Daily intake : 500µ
gI-
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#r& ne an +* pre;r*&r*: +r;+reS#n+he*i*
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Th#r&ine and i+* pre;r*&r*:A;+i<i+#
T= "ainl# %n;+i&n* a* a pr&h&r"&ne. T3 i* +he "ain a;+i<e +h#r&id h&r"&neand ha* +he hi!he*+ )indin! a>ni+#%&r +h#r&id h&r"&ne re;ep+&r 7TR9.
Th#r&id h&r"&ne a;+i<i+# ;an )ein;rea*ed in pla*"a ?i+h&+ ne?
*#n+he*i* )# ;&n<er+in! T= +& T3. I% +&& ";h +h#r&id a;+i<i+# i* pre*en+ T= i* ;&n<er+ed +& +he ina;+i<e"e+a)&li+e rT3 +& red;e a;+i<i+#.
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Kelainan embrio:
Laringeal thyroid
Retrosternal thyroid
Agenesis satu/dua lobus
T! "engaruhi ste"#ste" "rodu$si hormon
Tra""ing o% I
&ero'idase lin$ing o% I to tyrosine
(ou"ling o% m/o to %orm T) and T* Release o% T) and T*
e+retes → T* ,,, T)
- dari T) a$ti0e di sir$ulasi adalah hasil deiodenaseT* 1 dire+t %eed ba+$ inhibition T! 1TR!.
-- thyroid hormon di sir$ulasi teri$at oleh T23hanya yang %ree hormon → be$er4a di rese"tor inti sel
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&563AM2ILA6IODIUMel! Ti"#i$ %elakkan t"an'(#"t akti) *i#$i$e-t"a((ing
%e+,ani'%e ata (#%(a i#$i$a! Mekani'%et"an'(#" akti) I $i"ang'ang TSH. /ga e"gantng Na1.
1 AT2-a'e
elen/a" ''. %k#'a la%ng. (la'enta. kelen/a"%a%ae /ga %elakkan t"an'(#"t I#$i$a %ela3an
g"a$ien k#n'ent"a'i teta(i ti$ak $i(enga",i TSH!
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T3 / T= @&n+r&l Pa+h?a#* / Di*ea*e* %r&"
Mal%n;+i&n
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T3 / T= @&n+r&l Pa+h?a#* / Di*ea*e* %r&"Mal%n;+i&n
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EFEK METABOLIK ORMON T6ROIDEFEK METABOLIK ORMON T6ROID
1. Kal&ri!eni$
2. Ter"&re!la*i
3. Me+a)&li*"e pr&+ein 7e$*e*9→
$a+a)&li*"e pr&+ein
=. Me+a)&li*"e $ar)&hidra+ → a)*&r)*i ↑
'. Me+a)&li*"e lipid → ↑re;ep+&r DL di ha+i
↓
↑ Pen!elaran $&le*+er&l dari*ir$la*i
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. METABOLISME CITAMIN→ MER-BA @AROTEN → CIT A DALAM ATI
→ METAB ↑, KEB-T-AN CIT ↑
8. -NT-K PERT-MB-AN SARAF SENTRAL / PERIFERPADA PERIFER KT REAKSI REFLEK TEAN LEBI
SINKAT
PADA SARAF P-SAT PERKEMBANAN OTAK (AN-AN MELINISASI SINAPS
. LAINLAIN
PADA JANT-N MENINKATKAN J-MLA / AFINITASRESEPTOR β ADRENERIK → MENINKATN6A EFEKKEPEKAAN KINOTROPIK / KONOTROPIK KATEKOLAMIN
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PEN YAKITN YA
1. Fungsional Hipertr + Hyperplasi
a. T&$*i$ → di%* → Fra<eG* T&$*i$ → n&dlar → Pl""er
). T&$*i$ → n&dlar
2. Neoplasma
a. Jina$ → Aden&"a
). ana* → @a → Papilar# → F&lli;lar# → Anapla*+i$
3. Infeksia. A$+a). S) a$+a H N&n *pp+ir&idi+a*
e er<ain;. Kr&ni* → Tir&idi+a* TB@
→ Tir&idi+a* a*hi"&+&
→ Tir&idi+a* Riedel
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Pe"eri$*aan +ir&id
Ana"ne*a
Pe"eri$*aan *i$
La)&ra+&ri" 7T3,T=,TS9 I"a!in! 7%&+&,-S,@TMRI9
FNA
N&dl +n!!al N&dl $era*
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Dia!n&*i* $lini*
M&r%&l&!i -nin&d&*a
Ml+in&d&*a
Di*a Fn!*i
E+ir&id
iper+ir&id
hip&+ir&id
Pa+&*i&l&!i
?
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3O6DOK 56D5MIK
2atasan &enyebab De7siensi Iodium
Diagnosis tudy 5"idemiologi Ang$a &re0alensi Ang$a Insiden
Mana4emen u"lementasi Iodium Oral8 In4e+tion
u"lementation hormon Tiroid
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3O6DOK 56D5MIK
De7siensi iodium meru"a$an"enyebab timbulnya gondo$endemi$ 9sering disebut sebagaiIDD.
Kelebihan asu"an iodium da"at"ula menimbul$an "embesarangondo$ 9namun bu$an endemi$
sebagai a$ibat adanya hambatanhormogenesis tiroid 9;ol<(hai$o< e<e+t sertamening$atnya T! yang a$anmerangsang timbulya hi"er"lasi$elen4ar gondo$.
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Iodium da"at menembus"lasenta dan ber"eran "ada"ertumuhan 4aringan ota$ "ada
masa $andungan. Ke$urangan iodium "ada masa$ehamilan a=al a$an sangatber"engaruh terhada"
intelegensi 4anin "ada masamendatang. 2ebera"a bahan mem"unyai
e%e$ goitrogeni$ yang a$an
menghambat "enyera"an iodium
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&565TA&A6 DA5RA! 56D5MIK
Berda*ar$an ha*il UR>5Y &O&ULAI
⇒ &o"ulasi A6AK UIA 5KOLA!
&re0alensi , ?
⇒
&o"ulasi TOTAL &56DUDUK &re0alensi , @
Berda*ar$an ha*il &5M5RIKAA6
KA6DU63A6 IODIUM URI65⇒ Rata#rata e$s$resi iodium urine"endudu$ ? mi$ro g/hari.
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5&ID5MIOLO3I(AL (RIT5RIA %or A5I63T!5 5>5RITY o% IDD 2A5D O6 T!5 &R5>AL56(5 o% 3OIT5R I6 (!OOL#A35D (!ILDR56
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DAAR &565TA&A6 TRATA 25RAT#RI63A6 UATUDA5RA! 56D5MIK
Berda*ar$an ha*il UR>5Y &O&ULAI⇒ RI63A6 , @ # ?⇒ 5DA63 , ? # )
⇒
25RAT , ) Berda*ar$an ha*il &5M5RIKAA6
KADAR IODIUM URI65⇒ RI63A6 @ # ? mi$ro#g/L
⇒
5DA63 C@ # @ mi$ro#g/L⇒ 25RAT C@ mi$ro#g/L
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T!5 &5(TRUM o% IDD
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O&TIO6 (ORR5(TIO6 o% IDD
Administration o% iodiel oil+a"sules e0ery E#?F months.
Dire+t administration o% iodine
solutions8 LugolGs iodine8 at regularinter0als 9on+e a month issuH+ient.
Iodiation o% salt su""lies. Iodiation o% =ater su""lies by
dire+t addition o% iodine solution. >ia s"e+ial deli0ery me+hanism
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Tiroto$si$osis
A"a"un sebabnya mani%estasi$linisnya sama
2erhubungan dengan : Lama tiroto$si$osis U$uran dan bentu$ $elen4ar
tiroid Ada tida$nya mani%estasi e$stra
tiroid dari "enya$it 3ra0es
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5tiologi Tiroto$si$osis !i"ertiroidism
BENTUK PALING SERING Ambilan Iodium radioaktif di leher
Diffuse toi! "oiter #Gra$es% disease& 'enin"kat
Toi! multinodular "oiter #Plummer%s disease& 'enin"kat
(ase tirotoksikosis dari Tiroiditis subakut 'enurun
Adenoma toksik #Goets!h%s disease& 'enin"kat
BENTUK TIDAK TERLALU SERING
Tirotoksikosis terinduksi iodium Bera"am
Kelebihan )*G #mola + !horio *a& 'enurun
Tirotoksikosis fa!titia 'enurun
BENTUK ,ARANG
Tumor Pituitari -en"hasil hormon tiroid 'enin"kat
Resistensi kelen.ar -ituitari thd hormon tiroid 'enin"kat
Ke"anasan tiroid metastase 'enurun
Struma o$arium den"an tirotoksikosis 'enurun
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5<e+ts and ym"toms !y"erthyroidism
Ener"2 metabolism↑
30 !on4
sum-tion ↑
)2-er4$entilation
Li-ol2sis
)2-erli-id4
a!idemia
5ei"htloss
Proteol2sis
De!reased inmus!le mass
)eat metabolism ↑
)2-erthermiaS6eatin"
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5<e+ts and ym"toms !y"erthyroidism
A!!elerated
breakdo6n of
7LDL and LDL/
stimulation of bile
se!retion7LDL ↓
*holesterol ↓
Stimulation of
"l2!o"enolisis/
"lu!oneo"enesis
)2-er"l2!emia
Sielberna"l/ 0111
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5<e+ts and ym"toms!y"erthyroidism
A!!elerated
"ro6th
in !hildren
Bone
metabolism ↑3steo-orosis
)2-er!al!emi
a
)2-er!al!iuria
Sielberna"l/ 0111
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5<e+ts and ym"toms !y"erthyroidism
Sielberna"l/ 0111
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5<e+ts and ym"toms !y"erthyroidism
Sielberna"l/0111
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5<e+ts and ym"toms!y"erthyroidism
Sielberna"l/
0111
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Sielberna"l/0111
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DIA36OI TIROTOKIKOI
KLI6I Inde$* $lini* a#ne 7E+ir&id 19 Inde$* $lini* Ne? @a*+le E+ir&id 7(119 (
70239 Kri+eria $lini* @a*+ell&
&56U6JA63 Pe"eri$*aan $adar h&r"&n 7FT3, FT=, TS*9
Pe"eri$*aan $adar +ir&!l&)lin -ji +an!$ap I131 S;in+i!raph# Fine needle aspiration biopsy An+i)&di +ir&id 7ATPOA), AT A)9
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SYM2TOMS & SI4NS RELEVANT t# DISORDERED
THYROID UN6TION in ADULT
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I6D5 65; (ATL5
No Ge.ala NilaiDera.at: Umur saat timbul
0 Pen!etus -sikolo"i
? Frequent checking
Severe anticioatory -
Nafsu makan 4 menurun
anxiety
1: 4 09 0 4 ?
9 C? 4
9 :0 4
9 :<
4 Ada 1Tidak
4 ?Ada
1Tidak
4 ?Ada
1Tidak
9 Ada 1Tidak
No NilaiDera.at Goiter
F Bisin" tiroid
C Eksoftalmus
Lid retraction
:1 Tremor halus
:: Nadi #-ermenit&
9 ?Ada 1Tidak
9 :CAda
1Tidak
9 Ada
1Tidak9 0Ada
1Tidak
9 FAda
1Tidak
9 :< 1
9 CC1 4 11@ C1
Ge.ala
INTERPRETASI ,umlah
EUTIR3ID # 4::& > #90?&
'UNGKIN )IPERTIR3IDI #90& > #9?&
PASTI )IPERTIR3IDI #91& > #9C1&
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Kriteria Klinis Tiroto$si$osis (astello
"ite"ia Min#" Be"ke"ingat anyak
Tangan le%a
Na$i 7 80 9 %nt ata
i"ila'i at"ial
T"e%#" ,al' /a"i
"ite"ia Ma/#"
B"it $iata' kelen/a"
Hi(e"kine'ia
Ek'#;tal%'
Tirotoksikosis a-abila =: kriteria ma.or #9& atau kriteria minor #9&
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Membeda$an 3ra0esG Disease dengansebab lain dengan mengguna$an U4i I#?)?
Tinggi
Toksikosis den"an hi-ertiroidisme
Ren$a,
Toksikosis tan-a hi-ertiroidisme
Gra$es% Disease #'orbusBasedo6&
'ultinoduler toksik "oiter
#'orbus Plummer&
Adenoma toksik #'orbus
Goets!h&
Tiroksin berlebihan
'edikamentosa
(aktisia healt food%
Post-artum
De Huer$ain
*a infiltratif Struma o$arii
'etastase *a folli!ulare
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HI2OTHYROID
6AUSES #; HI2OTHYROID
2RIMARY Autoimmune hypothyroid (thropic! "shimoto#
$trogenic ($-131 therpy% thyroidectomy% nec rdition#
'rugs (nti thyroid% iodine% ithium#
)ongenit
$''
TRANSIENT *ostprtum thyroiditis
+u,cute thyroiditis
*ost $-131 tretment su,tot thyroidectomy SE6ONDARY "ypophysis ,normities (tumor% rdition% trum% d#
T+" de.iciency incti/e
"ypotmic disorders (tumor% trum% idioptic#
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SI4NS & SYM2TOMS HY2OTHYROIDISM
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2ENDEATAN TERA2I HI2ERTIROID
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INDIASI 2EN4OBATAN
OBAT ANTI TIROID Terpi se,eum opersi
eno opersiterpi ,si
risis tiroid
*d ehmin
TERA2I ABLASI <I-=>=? eps seteh penghentin pengo,tn
eps seteh opersi
si 5 20 th% tid hmi
TIROIDETOMI
eps seteh penghentin pengo,tn eps seteh opersi
ehmin
An-n
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OM2LIASI 2EN4OBATAN
OBAT ANTI TIROIDTERA2I ABLASI <I-=>=?
risis tiroid
"ipotiroid
.e rsinogeni
TIROIDETOMI
"ipotiroid
"ipoprtiroidisme
"iposemi
*rise n-ringeus
*erdrhn risis tiroid
"ipertiroid ,erung
$n.esi
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Indi$a*i &pera*i +ir&id
7 1. $e!ana*an
72. !ejala pene$anan7 3. hiper+ir&idi
7 =. "en!!an!! pena"pilan
7 '. ra*a $ha?a+ir
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K&"pli$a*i &pera*i +ir&id7 1. perdarahanhe"a+&"a 71,59
7 2. le*i n.larin!e* *peri&r 7'59
7 3. le*i n.re$ren 7+: 3=5, p: 159
7 =. +ra$e&"ala*ia7 '. ede"a larin! 7=,59
7 . hip¶+ir&idi 7+: 25, p: 3,159
7 8. hip&+ir&idi
7 . hiper+ir&idi *e$nder
7 4. $ri*i* +ir&id
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OBAT ANTI-TIROID YAN4 SERIN4 DI4UNAAN
*T : 0-300 mghri
etym9o : -30 mghri
et-,oer
*ropnoo : 10-80 mghri
Atenoo : 0-100 mghri
etoproo : 100-200 mghri
YAN4 TIDA DI4UNAAN SE6ARA RUTIN
$odium : tts ;ugo<s tid
;itium : 300 mg tid
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Thyroto'i+ (risis T!yroid Storm
9 A""elerated !ypert!yroidism#is an e'treme a++entuation o%
thyroto'i+osis.
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Thyroto'i+ (risis 9 T!yroid Storm
7 Accelerated hyperthyroidism)
7 Rare )+ li%e+hrea+enin! %&r" &%
de;&"pen*a+ed h#per+h#r&idi*"7 Th#r&id *+&r" ≈ Se<ere +h#r&+&i;&*i*
7 N& a;+e in;rea*e &% T <ale*
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Pa+h&!ene*i* 7 A;+e ↑ &% T3 and T= 7a%+er radi&i&dine
+herap#, +h#r&ide;+&"#, di*;&n+ina+i&n&% an+i+h#r&id dr!9
7 De;rea*e pr&+ein )indin! 7+ran*+h#re+in9&% T3 and T= in *er" 7a;+e illne**9 → %ree T3 and T=
7 S#"pa+he+i; ner<&* *#*+e" a;+i<a+i&n
7 A!"en+a+i&n &% peripheral ;elllarre*p&n*e +& T 7h#p&e"ia, $e+&a;id&*i*,la;+i; a;id&*i*, in%e;+i&n9
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DIA36OI
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(lini+al Diagnosis
=o ,ortory tests re
dignostic o. thyroid storm
Diagnosis o% Thyroid
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Diagnosis o% ThyroidtormSe<ere *i!n and *#"p+&"* &%
+h#r&+&i;&*i*Pre*en;e &% de;&"pen*a+i&n &% +he
%n;+i&n &% &ne &r "&re &r!an *#*+e"*in a +h#r&+&i; pa+ien+*7i.e.*+r"a,&r)i+&pa+h#9
Bi&;he"i;al ;&nr"a+i&n 0
S+ar+ +rea+"en+ QQQ
E<en+* A**&;ia+ed ?i+h Th#r&id S+&r"
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Events Associated with the Onset of ThyroidStorm
Di*;&n+ina+i&n &%&% an+i +h#r&id dr!
In%e;+i&n
A;+e "edi;alillne**e*
N&n +h#r&id*r!er#
Ci!&r&* palpa+i&n&% +h#r&id !land
Par+ri+i&n
Tra"a
P&*++h#r&ide;+&"# P&*+ radi&i&dine
+herap#
i!hd&*e i&dine
ad"ini*+ar+i&n I&dina+ed
radi&!raphi;
;&n+ra*+ a!en+ A;+e p*#;h&*i*
A;+e e"&+i&nal*+re**
>orto.s % 2000
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Clinical Features
Te"pera+re ele<a+i&n 7=1&@ &r hi!her9
Mar$ed +a;h#;ardia
E+re"e re*+le**ne**
A!i+a+i&n and +re"&r
Men+al de+&ria+i&n 7deliri&*, p*#;h&+i;9
@&"a
#p&+en*i&n ?i+h ;&n!e*+i<e hear+ %ailre
A;+e a)d&"en
S@ORIN S6STEM B-R@ and ATORFSK6
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S@O S S - @ a d O SThermoregutory
'ys.unction
)rdio/scur
'ys.unction
)ongesti/e "ert
Fiure
A,sent
id
oderte
+e/ere
Atri Fi,rition
Temperture(o)#
3!2 @ 3!
3!8 - 38!3
38!4 @ 38!838! @ 3!4
3! @ 3!
40
Tchycrdi
0 @
110 @ 11120 @ 12
130 @ 13
140
+core
10
1
202
30
10
120
2
0
10
1
10
Bstrointestin-
"eptic'ys.unction
A,sent
id+e/ere
=europsychitric
ni.esttion
A,sent
id
oderte
+e/ere
/ents Associtedith Thyroid +torm
'irrhe%
/omittingCundice#
Agittion#
'eirium%psychotic%
se/ere ethrgy
+ei9ure% com
A,sent
*resent
0
10
20
20
0
10
20
30
0
10
+)D :
4 highy possi,e
2 @ 44 impending
E uniey
A%+er Br;h, 1443
Management o% Thyroid
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Management o% Thyroidtorm
1. Inhi)i+i&n &% +h#r&id h&r"&nepr&d;+i&n and *e;re+i&n
2. S#"pa+he+i; )l&;$ade
3. l;&;&r+i;&id )l&;$ade 7inhi)i+i&n &%e+ra+h#r&idal ;&n<er*i&n &% T= +& T39
=. Spp&r+i<e +herap#
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Inhi)i+i&n &% T
*#n+he*i* and
*e;re+i&n
PT- = "! hPOna*&!a*+ri;
+)eS&di" I&dide 1 ! IC2= hr &r
Sa+ra+ed *&l+i&n &% KI 7SSKI9'
dr&p* hS#"pa+he+i;)l&;$ade
Pr&pan&l&l, 2 = "! =h,&r1 "!
i< *l&?l# 7repea+ d&*e n+il
hear+
ngement o. Thyroid +torm
=ot indicted in ptients ith sthm or congesti/e hert .iure
ngement o. Thyroid +torm (cont #
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Bucocorticoid therpy "ydrocortisone% 0 @ 100 mg i/ G6h
'eHmethsone 2 mg *D G6h
+upporti/e therpy
- $ntr/enous .uids
- Temperture contro
- D2 i. reGuired
- For congesti/e hert
.iure nd to so/entricur response
- *recipitting e/ent
'epending on indiction: gucose%
.uid%eectroytes% muti/itmins
)ooing ,nets% cetminophenIavoid salicylates**
'igitis
e!g nti,iotic .or in.ection
ngement o. Thyroid +torm (cont!#
*al#;#la+e* ;&"pe+e ?i+h T3 and T= %&r )indin! +& TB and +ran*+h#re+in 7TTR9
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I"pr&<e"en+ ?i+hin 1 ( 2da#*
Re;&<er# ?i+hin 1 ?ee$
MANA4EMEN RISIS TIROID
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REHIDRASI
'isesuin dengn de.isit cirn
MENURUNAN SUHU TUBUH
+eimut es D,t penurun pns
Cngn di,erin setos
2TU ATAU METIMA@OL
'i,erin meui =BT
'osis tinggi (sd 6H dosis ,is#
BETA BLOER
*ropnoo 60-80 mg6 JmI 1-3 mgi/ pen4 Jm
HIDROORTISON 100-00 mgi/12 Jm
LARUTAN LU4OL tetes8 Jm!
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ADA&U6 K5TUJU! TA!A&A6T5R52UT ADALA! :
1. TRAPPIN
2. OKSIDASI
3. @O-PLIN
=. STORAE
'. DEIODINASI
. PROTEOLISIS
8. PENEL-ARAN
D;D$'+; FD;$;'AA"
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TRE2IN4
Kodide
I
Codide
T+"
"2D2
Kodide
KodideL $T L '$T
esidu TrosiA2LIN4
III
T3 L T
4
Tiroglobolin
T3 T4
$T '$T
T3 L T4
OR4ANIIASI
II
$T - '$T
SERESI
IV
Protease
T3 L T4
T+"
YodinasiTirosin
Oksidasi
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Th#r&id &r"&ne E;e**@lini;al Fea+re*
7 eneral
@ ea+ in+&leran;e, %a+i!e, +re"&r.
7 @ardi&<a*;lar
@ Ta;h#;ardia, hear+ %ailre.7 a*+r&in+e*+inal
@ ei!h+ l&**, diarrh&ea
7 Oph+hal"&l&!i;al
@ Lid la!, &ph+hal"&pa+h#
THYROID DIAGNOSIS
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THYROID DIAGNOSIS
Anatomy :
Phyical examinationX-rayUSG
CT-can! "RI#$nction :
Phyical examinationHormone mea$rement
%T&'T(-total! #-T&'T(-I! TSH or TSH! TRH)Protein *in+in, mea$rement
%TG! er$m thyro,lo*$lin)Other :
Ra+ioio+ine $.ta/e#NA 0 *io.y
Urine io+ine
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TAR35T OR3A6 OB T!5 T!YROID!ORMO6
7 2rain
7 (ardio0as+ular7 Lung
7 3astrointestinal
7 Mus+ulos$eletal
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!ORMO6 K5L56JAR ADR56AL
i O tik
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Vent"ikel IIIia'%a O(tik%
Si'te% 2#"tal
Hi(#tala%'
Hi(#;i'iali'Tangkai Hi(#;i'i'
A$en#,i(#;i'i'
Sela T"'ikaNe"#,i(#;i'i'
Gambar skematis kelenjar hipofisis. Pembuluh portal
hipotalamo-hipofisealis menghubungkan hipotalamus dengan
lobus anterior hipofisis dan bertindak sebagai saluran transpor
untuk releasing hormone yang dibentuk dalam hipotalamus
Rang'ang Sa"a;
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g g
Hi(#tala%'
2'at "elea'ing+#"ti+#t"#(in
,i(#tala%'
#n'ent"a'ik#"ti'#l (la'%a
Hi(#;i'i'
ante"i#"
Gambar pengaturan umpan balik fungsi
adrenokortikal dan pelepasan ACTH
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Gambar diagramatik sistem pengaturan umpan-
balik dimana substrat metabolik hormon mengatur
kerja pelepasan hormon.
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Gambar siklus bulanan pelepasan gonadotropin pada
anita yang mengalami menstruasi normal. !ang
digambarkan adalah gelombang tengah siklus "#H dan
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Gambar irama sirkadian sekresi kortisol
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3AM2AR DIA3RAMATIK IT5M &563ATURA6 UM&A6 2ALIK8DIMA6A !ORMO6 K5L56JAR AARA6 M563ALIR 2ALIK K5
!I&OTALAMU YA63 DIIKUTI OL5! &5L5&AA6 DARI!ORMO6#!ORMO6 TRO&IK !I&OBII
A 6B
DAAR#DAAR DIA36OA T &56Y ADR56AL
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T. &56Y. ADR56AL
App! CuHt Bom
enin
Angiotensin $$ M! Bomeruos
e! Adren
Adosteron :
+indr! )onn
"ipotmus
"ipo.ise
A)T"
M! Fsicut
M! eticuris
Androgen :
+indr! Androgenit
strogen :
+indr! Feminin
Adren
*eny! Addison
+indr! )ushing
ortiso
De,i$"#e(ian$"#'te"#n <DHEA?
- an$"#'tene$i#n
Te't#'te"#n <$i,a'ilkan (la #le,
#)a"i%. te'ti'. /a"!
(e"i;e"!?
DHT
2a$a 3anita ggn %eta#li'%e→
,e"'ti'%e
$i%eta#li'i"
DAAR#DAAR DIA36OA T &56Y ADR56AL
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T. &56Y. ADR56AL
"ipotmus
+r. *regngioni +impti
edu - ;! 'op - 'opmin teomin Feoromositom
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KORT5K ADR56AL I6T5I
5KR5I :?. 3lu$o$orti$oidC. Mineralo$orti$oi
d
). Androgen*. 5strogenELEBIHAN 4LUOORTIOID MENYEBABAN :
?. Metabolisme K! &rotein
C. Distribusi JaringanAdi"ose
). 5le$trolit*. istem Ke$ebalan
@. e$resi Lambung
6#n$iti#n 6a'e A6TH 6#"ti'#l
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A@T
Dependen+
@*hin!G*di*ea*e
Pi+i+ar# h#p&+hala"i;di*ea*e
In;rea*ed In;rea*ed
E;+π A@T*#ndr&"e
Mali!nan+ &r )eni!n n&nend&;rine +"&r*
In;rea*ed In;rea*ed
La+r&!eni; A@T ad"ini*+ra+i&n %&rina""a+&r# &ri""n&l&!i;al di*&rder*
In;rea*ed In;rea*ed
N&n A@T
Dependen+
Adrenaladen&"a
Sppre*ed In;rea*ed
Adrenal;ar;in&"a
Sppre*ed In;rea*ed
La+r&!eni; @&r+i;&*+er&idad"ini*+ra+i&n %&rina""a+&r# &ri""n&l&!i;al di*&rder*
Sppre*ed @&r+i*&l &ranal&!ein;rea*ed
Beberapa Penyakit dengan Gangguan Faal
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drenal
Korte$s!i"o%ungsi :1. A$+ 7$ri*i* adrenal pada pen#a$i+ Addi*&n, p&*+
adrele$e"i,p&*+ +erapi den!an *+er&id a+a A@T9
2. Kr&ni$ 7pen#a$i+ addi*&n9!i"er%ungsi 7+er!an+n! "a;a" *e$re*i
h&r"&nn#a9:1. K&r+i*&l ( Sindr&"a @*hin!2. Ald&*+er&n ( iperald&*+er&ni*"e Pri"er
7*indr&"a ;&nn9
3. Andr&!en ( Sindr&"a Adren&!eni+al=. E*+r&!en ( Sindr&"a Fe"inin ( Adrenal
7Fe"ini*a*i, jaran!9
2ADA 2ROTEIN EE ATABOLI
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2ADA 2ROTEIN→
EE ATABOLI→
↓
EMAM2UAN SINTESA 2ROTEIN→
EHILAN4AN
2ROTEIN 2ADA SEMUA OR4AN
Din$ing (e%l, $a"a, & /a"ingan (e"i)a'kla→
%$a, ti%l %e%a". (te+,ial. eki%#'i'
R(tie" 'e"at-'e"at ela'ti' klit → ga"i'-ga"i'
ng <'t"ial?
2a$a tlang → #'te#(#"#'i' → ;"akt"a (at#l#gi'
lit "'ak→
at"#(i. %$a, "'ak
2ADA ARBOHIDRAT
MERAN4SAN4 4LUO4ENESIS 1 MEN44AN44U
ERA INSULIN→
HI2ER4LIEMIA
AUMULASI ARIN4AN ADI2OSE DAERAH SENTRAL
DISERTAI OBESITAS TRUNUS MUA BULAT <CAAH
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DISERTAI OBESITAS TRUNUS. MUA BULAT <CAAH
BULAN? MEMADATNYA OSA SU2RA 6LAVI6ULARIS
& 2UN44UN4 6ORVI6ODORSAL <BUALO HUM2
2UN44UN4 ERBAU?
Oe'ita' t"nk' $i'e"tai $engan (eng"angan
ek't"e%ita' ata' & a3a, <akiat at"#;i?
2ENAM2ILAN 6USHIN4OID
MEN4HAMBAT EEBALAN HORMONAL
↑ HCl LAMBUN4 DAN 2E2SIN
2ERUBAHAN 2SIIS
INVOLUSI ARIN4AN LIMOID. RAN4SAN4AN
2ELE2ASAN NEUTRO2IL & ↑ ENTRO2OESIS
%&$&'IHA( H)*+)( %)*TI#)$
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A pa+ien+ ?i+h @*hin!G* *#ndr&"e
Aku tidak kelebihan
hormon kortisol….
M f ? N
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M&&n %a;e in a pa+ien+?i+h @*hin! *#ndr&"e
Moon face ? No way ….
ldosteron
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!"#!$%&IN#
1. TERDAPAT 2 MA@AM RESEPTOR 6AIT- α DAN β 7β1 -NT-K JANT-N DAN β2 -NT-K
BRONK-S DAN PEMB-L- DARA PERIFER9.
&ed ll
Hiperfungsi' Feokromositoma
1. Menin!$a+$an rea)*&r)*i Na0 pada +)l*
di*+ali*
2. Menin!$a+$an e$*$re*i K
0
.
lanj+
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lanj+
2. N&r adrenalin : *+i"la+&r $a+n+$ re*ep+&r α dan peran!*an!anre*ep+&r ini dapa+ "ele"ah$an $erja
** 7parali+i$&)*+ipa*i9 dan j!a"ene$an *e$re*i in*lin &leh *el)e+a pan$rea*.
Adrenalin lebih ber"eranmerangsang rese"tor
? dan
C
drenalin
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drenalin
1. Meran!*an! :a. Kerin!a+ dan Vpil& ere&+i&nW
). Dila+a*i ppil;. Ta$hi$ardi 7per*i*+en pada ner&pa+i &+&n&"
dia)e+i$9d. Pe"e;ahan !li$&!en hepar, "enin!$a+$an
&#!en ;&n*"p+i&n dan "enin!$a+$an BMR.e. Se$re*i : !l$a!&n, +ir&$*in, para+h&r"&n,;al;i+&nin, renin, dan !a*+rin. 2. Men!ha")a+ : $erja &+&+ p&l&* ar+eri&l 7+er+a"a
&+&+9, )r&n$*, **, $andn! *eni dan +er*.
PADA NE-ROPATI OTONOM DIABETIK BIASAN6A 6AN
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PADA NE-ROPATI OTONOM DIABETIK BIASAN6A 6ANR-SAK LEBI DA-L- ADALA IT5M&ARAIM&ATIK , SEINA AKAN TERDAPAT
VIPERF-NSI RELATIFW DARI SISTEM SIMPATIK DANAKIBATN6A :
1. KERINAT BERLEBIAN DAN B-L- ROMA M-DA
BERDIRI2. P-PIL MELEBAR3. TAKIKARDI 7BIASAN6A NADI ≥ 4MENIT, INAT DDDENAN PEN6AKIT RACE APATETIK 6AN TIMB-LPADA DM DIIDAP LAMA AKIBAT DARI PROSES
A-TOIM-N9.=. LEBI M-DA MENALAMI DEKOMPENSASI KORDIS7O6EN @ONS-MPTION MENINKAT9.
lanj+
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lanj+
'.Re!la*i DM le)ih *li+ $arenahiper*e$re*i h&r"&nh&r"&n $&n+rain*lin dan hip&*e$re*i dari in*lin
*endiri.. Penderi+a a*"a le)ih "dah $"a+.8. Le)ih "dah &)*+ipa*i, re+en+i& rinae,dan par+* le)ih la"a $arena $&n+ra$*i
+er* +er!an!!.. Le)ih "dah "en!hidap hiper+en*i.
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N$()(#N%IN
1. EFEK METABOLIK LEBI K-RAN DARI PADA ADRENALIN.2. MERANSAN TON-S ARTERIOL PERIFER, SEINA TEKANAN DARA NAIK 7TIMB-LN6A IPERTENSI TERANT-N PERIMBANAN ANTARA ADRENALIN DANINADRENALIN9
LOB-S POSTERIOR MENEL-ARKAN :
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LOB-S POSTERIOR MENEL-ARKAN :
1. CASOPRESIN7ORMON ANTI DI-RETIK, AD9
EFEKN6A : MENINKATKAN RETENSI AIR
2. OKSITOKSIN
MEN6EBABKAN PENEL-ARAN S-S-,KONTRAKSI -TER-S AMIL
ADDISON
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ADDISON
In,reased pigmentation
in areas eposed tofri,tion
'u,,al pigmentation
K5L56JAR !I&OBI5
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Akromegali pasien
sama sekali
asimtomatik
Tangan akromegali
dibandingkan dgn
tangan normal
K5L56JAR !I&OBII
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Pada "an*ia ada h&r"&n #an!di*e$re*i$an &leh hip&*i* an+eri dan e%e$
e%e$ +a"an#a, #ai+ :1. Thyroid Stimulating Hormone TSH! tirotro"in#
Merangsang sekresi tiroid dan pertumbuhan kelenjar.
$. Adrenocorticoto"ic Hormone A%TH# Merangsang sekresi dan pertumbuhan zona fasikulata
dan zona niticularis korteks adrenal.
&. 'uteini(ing Hormone 'H# Merangsang ovulasi dan luteinizing folikel ovarium
pada wanita dan sekresi testosteron pada pria.
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Lanj+
). *ollicle Stimulating Hormone *SH#
Merangsang pertumbuhan folikel ovarium pada wanitadan spermatogenesis pada pria.
+. ,rolactin ,-'#
Merangsang sekresi susu dan perilaku ibu.
. /rowth Hormone hormon "ertumbuhan#
Mempercepat pertumbuhan tubuh, merangsang sekresi
!" .
M!
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M!
↑ pigmentsi uit dengn merngsng dispersi
grnu-grnu menin dm menosit!
+eresi ditur oeh +" reesing " dn dihm,t
oeh enin dr oestero! +ehingg de.isiensi
ortiso dpt merngsng peepsn +"!
2"#la+tin
*erem,ngn mme dn seresi susu!
FSH + N Bondotropin hormon!
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FSH +
LH
Bo dot op o o
SH*$A → memperthnn dn rngsng spermtogenesis
>A=$TA→ rngsng perem,ngn .oie dn
seresi estrogen!
LH
*$A → memperthnn dn rngsng seresi
testosteron oeh se-se ;eydegse intertio testis!
>A=$TA→ memperthnn dn merngsng seresi
progesteron oeh corpus uteum!
SH 1 LH*$A → ontinue tu secr toni!
>A=$TA→ ,ersi.t sii pd pertenghn sius
eduny meningt
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TERIMA KASIH