enrinology內(nèi)分泌總論-全文預(yù)覽
【正文】 and laboratory examination and diagnosis History and physical examination ? Many syndromes of hormonal excess or deficiency display manifestations that are readily apparent at the time of initial presentation, ., severe thyrotoxicosis and cushing’s syndrome. ? In other instances, the clinial presentation is more subtle and the physician must rely on laboratory testing to establish a diagnosis. Laboratory testing ? The level of free rather than total hormone is usually the best index of the effective hormone concentration in plasma. ? A measurement of the 24h urine free cortisol usually provides a reasonable estimate of the integrated levels of free plasma hormone. 正常人 75502502550751002400 0800 1600 庫(kù)欣病患者 1520253035402400 0800 1600 正常人和庫(kù)欣患者的血 F晝夜節(jié)律 Clinical interpretation ? The clinicians must remember that in both mormal subjects and patients with endocrine and other diseases, hormone levels are extensively regulated. ? For instance, plasma insulin levels should be evaluated in relation to the plasma glucose concentration, and PTH levels should be considered in relation to serum calcium levels. Clinical interpretation ? Since cortisol production integrated over a 24h period is increased in cushing’s syndrome, the 24h urinary free cortisol provides a more accurate index of cortisol hypersecretion. Clinical interpretation ? Sometimes the significance of hormone levels can be evaluated only by the simultaneous measurement of more than one hormone. ? For instance, with progressive damage to the thyroid hormones, secretion of TSH increases in a pensatory fashion so that normal plasma levels of the thyroid hormones may be maintained. GD的自身免疫發(fā)病機(jī)制 Clinical interpretation ? Plasma estrogens are low in ovarian failure. ? If ovarial failure is due to disease of the ovary, plasma gonadotropins will be elevated. ? If ovarian failure is secondary to pituitary or hypothalamic disease, plasma gonadotropin levels will be normal or decreased. Dynamic testing ? Provocative testing assesses the ability of a gland to respond to stimuli as an index of its reserve capacity. ? Insulin induced
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