Endocrinology is a branch of medicine dealing with disorders of the endocrine system र its specific secretions called hormones. Hormones are molecules that act as signals from one type of cells to another. Most hormones reach their targets via the blood. Although every organ system secretes र responds to hormones (including the brain, lungs, heart, intestine, skin, र the kidney), the clinical specialty of endocrinology focuses primarily on the endocrine organs, meaning the organs whose primary function is hormone secretion. These organs include the pituitary, thyroid, adrenals, ovaries र testes, र pancreas.
An endocrinologist is a doctor who specializes in treating disorders of the endocrine system, such as diabetes, hyperthyroidism, र many others (see list of diseases below). A disease due to a disorder of the endocrine system is often called a "hormone imbalance," but is technically known as an endocrinopathy or endocrinosis.
Background [सम्पादन गर्ने]
All multicellular organisms need “Coordinating systems to regulate र integrate the function of differentiating cells.” Two mechanisms perform this function in higher animals: the nervous system र the endocrine system. The endocrine system acts through the release (generally into the blood) of chemical agents र is vital to the proper development र function of organisms. As Hadley (2000) notes, the integration of developmental events such as proliferation, growth, र differentiation (including histogenesis र organogenesis) र the coordination of metabolism, respiration, excretion, movement, reproduction, र sensory perception depend on “chemical cues, substances synthesised र secreted by the specialised cells within the animal.”
Endocrinology is concerned with the study of the biosynthesis, storage, chemistry, र physiological function of hormones र with the cells of the endocrine glands र tissues that secrete them. The study of endocrinology began when Berthold (1849) noted that castrated cockerels did not develop combs र wattles or exhibit overtly male behaviour. He found that replacement of testes back into the abdominal cavity of the same bird or another castrated bird resulted in normal behavioural र morphological development, र he concluded (erroneously) that the testes secreted a substance that "conditioned" the blood that, in turn, acted on the body of the cockerel. In fact, one of two other things could have been true: that the testes modified or activated a constituent of the blood or that the testes removed an inhibitory factor from the blood. It was not proven that the testes released a substance that engenders male characteristics until it was shown that the extract of testes could replace their function in castrated animals. Pure, crystalline testosterone was isolated in 1935 by David et al.
Although most of the relevant tissues र endocrine glands had been identified by early anatomists, a more humoral approach to understanding biological function र disease was favoured by classical thinkers such as Aristotle, Hippocrates, Lucretius, Celsus, र Galen, according to Freeman et al (2001), र these theories held sway until the advent of germ theory, physiology, र organ basis of pathology in the 19th century.
Hormones [सम्पादन गर्ने]
Overview [सम्पादन गर्ने]
The endocrine system consists of several glands, in different parts of the body, that secrete hormones directly into the blood rather than into a duct system. Hormones have many different functions र modes of action; one hormone may have several effects on different target organs, and, conversely, one target organ may be affected by more than one hormone.
In 1902 Bayliss र Starling performed an experiment in which they observed that acid instilled into the duodenum caused the pancreas to begin secretion, even after they had removed all nervous connections between the two. The same response could be produced by injecting jejunal mucosa, showing that some factor in the mucosa was responsible. They named this substance "secretin" र coined the term "hormone" for chemicals that act in this way. They specified that, to be classified as a hormone, a chemical must be produced by an organ, be released (in small amounts) into the blood, र be transported by the blood to a distant organ to exert its specific function. This definition holds for most ‘classical’ hormones, but there are also paracrine mechanisms (chemical communication between cells within a tissue or organ), autocrine signals (a chemical that acts on the same cell), र intracrine signals (a chemical that acts within the same cell) (Nussey र Whitehead, 2001). A neuroendocrine signal is a ‘classical’ hormone that is released into the blood by a neurosecretory neuron (see article on Neuroendocrinology).
Hormones act by binding to specific receptors in the target organ. As Baulieu (1990) notes, a receptor has at least two basic constituents: a recognition site, to which the hormone binds, र an effector site, which precipitates the modification of cellular function. Between these is a "transduction mechanism" in which hormone binding induces allosteric modification that, in turn, produces the appropriate response.
Griffin र Ojeda (2000) identify three different classes of hormone based on their chemical composition:
Amines [सम्पादन गर्ने]
Amines, such as norepinephrine, epinephrine, र dopamine, are derived from single amino acids, in this case tyrosine. Thyroid hormones such as 3,5,3’-triiodothyronine (T3) र 3,5,3’,5’-tetraiodothyronine (thyroxine, T4) make up a subset of this class because they derive from the combination of two iodinated tyrosine amino acid residues.
Peptide र Protein [सम्पादन गर्ने]
Peptide hormones र protein hormones consist of three (in the case of thyrotropin-releasing hormone) to more than 200 (in the case of follicle-stimulating hormone) amino acid residues र can have molecular weights as large as 30,000. All hormones secreted by the pituitary gland are peptide hormones, as are leptin from adipocytes, ghrelin from the stomach, र insulin from the pancreas.
Steroid [सम्पादन गर्ने]
Steroid hormones are derivatived from cholesterol र are subdivided into those with an intact steroid nucleus (gonadal र adrenal steroids) र those with a broken steroid nucleus (vitamin D). Steroid horomones include estrogen र progesterone from the ovary, testosterone from the testes, र cortisol र aldosterone from the adrenal gland.
Work [सम्पादन गर्ने]
The medical specialty of endocrinology involves the diagnostic evaluation of a wide variety of symptoms र variations र the long-term management of disorders of deficiency or excess of one or more hormones.
The diagnosis र treatment of endocrine diseases are guided by laboratory tests to a greater extent than for most specialties. Many diseases are investigated through excitation/stimulation or inhibition/suppression testing. This might involve injection with a stimulating agent to test the function of an endocrine organ. Blood is then sampled to assess the changes of the relevant hormones or metabolites. An endocrinologist needs extensive knowledge of clinical chemistry र biochemistry to understand the uses र limitations of the investigations.
A second important aspect of the practice of endocrinology is distinguishing human variation from disease. Atypical patterns of physical development र abnormal test results must be assessed as indicative of disease or not. Diagnostic imaging of endocrine organs may reveal "spots," called incidentalomas, which do not represent disease.
Endocrinology involves caring for the person as well as the disease. Most endocrine disorders are chronic diseases that need life-long care. The most common of these is diabetes mellitus. Care of diabetes र other chronic diseases necessitates understanding the patient at the personal र social level as well as the molecular, र the physician-patient relationship can be an important therapeutic process.
Training [सम्पादन गर्ने]
There are roughly 7,000 to 8,000 endocrinologists in the United States. Endocrinologists are specialists of internal medicine or pediatrics. Reproductive endocrinologists deal primarily with problems of fertility र menstrual function - often training first in obstetrics. Most qualify as an internist, pediatrician, or gynecologist for a few years before specializing, depending on the local training system. In the U.S. र Canada, training for board certification in internal medicine, pediatrics, or gynecology after medical school is called residency. Further formal training to subspecialize in adult, pediatric, or reproductive endocrinology is called a fellowship. Typical training for a North American endocrinologist involves 4 years of college, 4 years of medical school, 3 years of residency, र 3 years of fellowship.
Professional organizations [सम्पादन गर्ने]
In North America the principal professional organizations of endocrinologists include The Endocrine Society (www.endo-society.org), the American Association for Clinical Endocrinology (www.aace.com), the American Diabetes Association (www.diabetes.org), the Lawson Wilkins Pediatric Endocrine Society (www.lwpes.org), American Thyroid association ( www.thyroid.org ), र the Academy of Clinical Thyroidologists,(www.thyroidologists.com). In the United Kingdom, the Society for Endocrinology (www.endocrinology.org) र the British Society of Paediatric Endocrinology र Diabetes (www.bsped.org.uk) are the main professional organisations. The European Society of Paediatric Endocrinology  is the largest international professional association dedicated solely to paediatric endocrinology.
There are numerous similar associations around the world.
Diseases [सम्पादन गर्ने]
Among the hundreds of endocrinological diseases are
- Adrenal disorders:
- Glucose homeostasis disorders:
- Metabolic bone disease:
- Pituitary gland disorders:
- Parathyroid gland disorders:
- Sex hormone disorders:
- Disorders of sex development or intersex disorders
- Disorders of Gender
- Disorders of Puberty
- Menstrual function or fertility disorders
- Thyroid disorders:
- Tumours of the endocrine glands not mentioned elsewhere
- Autoimmune polyendocrine syndromes
- Incidentaloma - an unexpected finding on diagnostic imaging, often of endocrine glands
See also [सम्पादन गर्ने]
References [सम्पादन गर्ने]
- Griffin JE, Ojeda SR. Textbook of Endocrine Physiology 4th ed. New York: Oxford University Press, 2000.
- Hadley ME. Endocrinology 5th ed. London: Prentice –Hall International (UK) Ltd, 2000.
- Chester-Jones I, Ingleton PM, Phillips JG. Fundamentals of Comparative Vertebrate Endocrinology New York: Plenum Press, 1987.
- Berthold AA. Transplantation der Hoden Arch. Anat. Phsiol. Wiss. Med. 1849;16:42-6.
- David K, Dingemanse E, Freud J et al. Uber krystallinisches mannliches Hormon aus Hoden (Testosteron) wirksamer als aus harn oder aus Cholesterin bereitetes Androsteron. Hoppe Seylers Z Physiol Chem 1935;233:281.
- Freeman ER, Bloom DA, McGuire JE. A Brief History of Testosterone. J Urol 2001;165:371-373.
- Bayliss WM, Starling EH. The mechanism of pancreatic secretion. J Physiol 1902;28:325–352.
- Nussey S, Whitehead S. Endocrinology: An integrated approach. Oxford: BIOS Scientific Publishers Ltd., 2001.
- Laylock J, Wise P. Essential Endocrinology Oxford: Oxford University Press, 1996.
- Baulieu EE. Hormones: From molecules to disease Baulieu, E-E. र Kelly, P.A., (eds) Paris: Hermann, 1990.
- Endocrinology (British online textbook)
- Endotext (American online textbook)
- On-Line Endocrinology Journal Club (via JournalReview.org)
- Useful Endocrinology Resources for Residents
Societies र associations [सम्पादन गर्ने]
- Endocrine Society
- American Association of Clinical Endocrinologists
- American Diabetes Association
- Lawson Wilkins Pediatric Endocrine Society
- Society for Endocrinology
- Society for Behavioral Neuroendocrinology