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1、 Feedback MechanismsPituitary hormones (to blood) (TSH, LH, FSH, ACTH)Target GlandsTSH Thyroid T3, T4 ACTH adrenal cortisol FSH testes testosterone LH ovaries oestradiol progesterone Growth hormone prolactinNo discrete target gland-veBrainHypothalamusIncreased Serum Ca2+PTH-veHypothyroidismsluggishn
2、ess mental dullness feel cold slow speech hoarse, croaking voice weight gain sparse brittle hair constipation dry skin Slow reflexes reduced heart rateCretin, aged 38 years. Mental age of 4 years and less than 4 feet in height (120 cm).Deep croaking voice, coarse dry skin and hairEndocrinology from
3、past yearsHyperthyroidismgoitre and eye-signs(Graves Disease) warm, and sweating increased body temperature weight loss restlessness Irritability nervousness muscular weakness rapid heart rateLaboratory InvestigationTSH Thyroid hormones TBII (binding reagent TSH receptorUp to hundredsNote elevated l
4、evels in hypothyroidismEstimation of the thyroid hormones themselves is also importantOther Investigations requiring immunoassay of pituitary and steroid hormonesInvestigation of infertility (male and female)LH, FSH, prolactin commonly used assays Oestrogens and progesterone SHBG testosteroneCushing
5、s Syndrome and Addisons Disease (pituitary-adrenal cortex)ACTH and cortisolOther needs for steroid hormone assays - adrenal and ovarian tumours (androstenedione, DHEA-sulphate) - congenital adrenal hyperplasia (17-hydroxyprogesterone) etcPeptide hormone analysis of less value in Diabetes, except in
6、researchAssay of parathyroid hormone important in investigation ofPrimary parathyroid disease Secondary hyperparathyroidsm, especially in renal diseaseCalcitonin assay is important in the diagnosis, monitoring and family screening in medullary thyroid carcinoma25-hydroxyvitamin D assay is also impor
7、tant in the investigation of disorders of calcium metabolismDisorders of Calcium metabolism10203040GH (mU/l)Time20 21 22 23 24 1 2 3 4 5 6 7 8 Patient CT, aged 11 years. Investigation of short stature20 21 22 23 24 1 2 3 4 5 6 7 8 Time51015GH mU/lPatient CC, girl aged 10 years. Investigation and Tre
8、atment of short stature 0 0 4th October X X 18th October after GHRHEstimation of Growth Hormone is important in the diagnosis of gigantism, and acromegaly* 2.7 m, 216 KgWith apologies to Escher!Also genetic variant 1-antitrypsin 1 Amino acid differencespecific bone alkaline phosphatase assay glycosy
9、lation differencesGlucGlucThyroglobulin assay with monoclonal antibodies*Thyroglobulin- Endogenous antibodiesTumour MarkersCarcinoembryonic antigen -foetoprotein both especially useful in liver carcinomaMore Specific markersHCG choriocarcinoma and germ cell carcinoma, rare ectopic tumours ACTH ectop
10、ic ACTH syndrome Calcitonin medullary thyroid carcinoma Prostate-specific antigen (no longer prostate specific!) c-erb-B2 gene product (c-neu, HER) breast cancerNon-identified antigensCA-125 (especially ovarian tumours) CA-19-9 (especially pancreas. Lung tumours) CA-15-3 (especially breast). Now kno
11、wn to be product of MUC-1 geneValue of monoclonal antibodies!Clearplan OneStep (assay for LH no cross-reaction with HCG!)Some other applications of ImmunoassayBacteria, viruses and toxins - Clinical Food industry Water industryAntibodies hepatitis B, HIV, e.g. blood bank screeningDrugs of abuse heroin, cocaine, cannabis, LSD etc.Therapeutic drug monitoring - digoxin, gentamicinAbuse of drugs by athletes and “body builders”testosterone other androgens testosterone/LH ratio erythropoetin (EPO) Growth hormone(also illegal use of GH in cattle)
