Endocrine diseases

In recent years, modern endocrinology has made significant progress in understanding the diverse manifestations of the influence of hormones on the processes of vital activity of the body. A special role is given to the endocrine system in the mechanisms of reproduction, information exchange, and immunological control. The structural and organizational period of the organism is also closely related to endocrine factors. For example, the lack of androgens during the development of the brain in men can be the cause of his female organization, the emergence of homosexuality. Excess of these hormones in women in the phase of brain differentiation leads to his male organization, which can cause acyclic secretion of gonadotropins, behavioral characteristics of the organism.

The framework of clinical endocrinology has significantly expanded. Endocrine diseases are identified, the genesis of which is associated with impaired function or interaction of various systems and organs. A number of endocrine syndromes have become known, in which the primary pathogenesis link is associated with gastrointestinal tract damage, impaired liver function or other internal organs. It is known that cancer cells can secret adrenocorticotropic hormone (ACTH), beta-endorphins, growth hormone, vasopressin and other hormonally active compounds in tumors of the lungs, liver and other organs, which leads to the development of endocrine syndromes that are close in clinical manifestations with the pathology of the function glands of internal secretion.

At the heart of the pathogenesis of endocrine diseases are violations of complex interactions of the endocrine, nervous and immunological systems on a specific genetic background. Endocrine diseases can arise as a result of primary damage to the function of the endocrine gland, disorders in the regulation of secretion and metabolism of hormones, as well as a defect in the mechanism of action of hormones. Clinical forms of endocrine diseases have been identified, in which disorders of hormone-receptor interaction are the cause of pathology.

Primary defeat of the function of endocrine glands

The endocrine system is a chemical system that regulates the activity of individual cells and organs. The hormones released into the blood contact practically with any cell of the body, but they act only on target cells, which have a genetically determined ability to recognize individual chemicals with the help of appropriate receptors. Nervous regulation is of particular importance in the case of a very rapid change in the physiological function, for example, to initiate and coordinate voluntary movements. Hormones, apparently, better meet the need for long-term adaptation to environmental conditions, maintenance of homeostasis and the implementation of the genetic program of various cells. This division of the two systems is relatively relative, as more and more data on their interaction in the regulation of individual physiological processes accumulate. This makes special demands for the definition of the concept of "hormone", which is currently combined substances that are released under the influence of specific signals by endocrine cells and, as a rule, have a distant effect on the function and metabolism of other cells. A characteristic property of hormones is their high biological activity. The physiological concentrations of most of them in the blood range from 10 ^-7 -10 ^-12 M. The specificity of hormonal effects is determined by the presence of discriminant proteins in cells that can recognize and bind only a certain hormone or substances close to it. Any function of cells and the body is regulated by a complex of hormones, although the main role belongs to one of them.

Hormones are most often classified by chemical structure or by the glands that produce them (pituitary, corticosteroid, sex, etc.). The third approach to the classification of hormones is based on their function (hormones that regulate water-electrolyte metabolism, glycemia, etc.). By this principle, hormonal systems (or subsystems) are distinguished, which include compounds of different chemical nature.

Endocrine diseases can be determined by the deficiency or excess of a hormone. Hyposecretion of hormones can depend on genetic (congenital absence of the enzyme involved in the synthesis of the hormone), dietary (eg, hypothyroidism due to lack of iodine in the diet), toxic (necrosis of the adrenal cortex caused by insecticide derivatives), immunological (the appearance of antibodies that destroy or other gland). So, with type I diabetes mellitus, there is a violation of cell-mediated and humoral immunity, the manifestation of which is the presence of immune complexes in the blood. Antigens HLA DR are found on thyroid cells of patients with diffuse toxic goiter and Hashimoto's thyroiditis. They are absent in the norm, their expression was induced by leucine and γ-interferon. Antigens DR are also found on beta cells in type II diabetes mellitus.

In some cases, hypoxecretion of hormones can be iatrogenic, i.e., caused by the actions of a physician (eg, hypoparathyroidism due to thyroidectomy due to goiter). The most common principle of treating hypoecretion of hormones is hormone replacement therapy (introduction of the missing hormone from the outside). It is important to consider the specific specificity of the hormone administered. In an optimal variant, the hormone administration and dosage regimen must mimic its endogenous secretion. It must be remembered that the introduction of the hormone leads to suppression of the residual endogenous secretion of its own hormone, so a sharp abolition of hormone replacement therapy completely deprives the body of this hormone. A special form of hormone replacement therapy is the transplantation of endocrine glands or fragments thereof.

To reduce the secretion of hormones can cause infections, tumors, tuberculosis. When the cause of the disease is not clear, talk about the idiopathic form of the endocrine disease.

Among the reasons for the hypersecretion of hormones, the first place is occupied by hormone-active tumors (acromegaly with a pituitary tumor), as well as autoimmune processes (thyroid stimulating autoantibodies in thyrotoxicosis). The clinical picture of hormonal hypersecretion can be conditioned by the intake of hormones with a therapeutic purpose.

To treat hypersecretion, surgical methods are used, as well as agents that block the synthesis, secretion or peripheral action of hormones - antihormones. The latter themselves have little or no hormonal activity, but prevent the binding of the hormone to the receptor, taking its place (for example, adrenoblockers). Antihormones should not be confused with hormone-antagonists. In the first case, we usually talk about synthetic preparations, whereas in the second case we have in mind natural substances that have their own hormonal activity, but which have the opposite effect (for example, insulin and adrenaline have the opposite effect on lipolysis). Being antagonists to one function, the same hormones can be synergistic with the other.

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