endocrine and Metabolic Disorders

内分泌系统在不同器官之间通过激素坐标，这些化学物质是从内分泌（无管）腺体内特定类型的细胞中释放到血液中的化学物质。循环后，激素会影响靶组织的功能，这可能是另一个内分泌腺或末端器官。一些激素对释放的器官细胞产生影响（旁分泌效应），有些甚至对相同的细胞类型（自分泌作用）。

metabolic processes continually produce acid and, to a lesser degree, base. Hydrogen ion (H⁺）特别反应性；它可以连接到带负电荷的蛋白质上，并以高浓度改变其整体电荷，配置和功能。为了维持细胞功能，人体具有维持血液H的精细机制⁺在狭窄范围内的浓度 - 典型37至43 NEQ/L（37至43 nmol/L），pH为7.43至7.37，其中pH = -Log [H⁺]. Ideally, H⁺is 40 nEq/L (40 nmol/L) and pH = 7.40. Disturbances of these mechanisms can have serious clinical consequences.

the adrenal glands, located on the cephalad portion of each kidney (see figure ), consist of a

淀粉样变性是一组不同的不同疾病，其特征是由不溶性原纤维的细胞外沉积，由盘片的蛋白质组成。这些蛋白质可能在本地积累，导致相对较少的症状或广泛涉及多个器官，并导致严重的多机器人衰竭。可能发生淀粉样变性从头或继发于各种传染病,inflammatory, or malignant conditions. Diagnosis is by biopsy of affected tissue; the amyloidogenic protein is typed using a variety of immunohistologic and biochemical techniques. Treatment varies with the type of amyloidosis.

Carcinoid tumors develop from neuroendocrine cells in the gastrointestinal tract (90%), pancreas, pulmonary bronchi, and rarely the genitourinary tract. More than 95% of all gastrointestinal carcinoids originate in only 3 sites: the appendix, ileum, and rectum.

diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia, polyphagia, polyuria, and blurred vision. Later complications include vascular disease, peripheral neuropathy, nephropathy, and predisposition to infection. Diagnosis is by measuring plasma glucose. Treatment is diet, exercise, and drugs that reduce glucose levels, including insulin, oral antihyperglycemic drugs, and non-insulin injectable drugs. Complications can be delayed or prevented with adequate glycemic control; heart disease remains the leading cause of mortality in diabetes mellitus.

Hypernatremia is a serum sodium concentration > 145 mEq/L (> 145 mmol/L). It implies a deficit of total body water relative to total body sodium caused by water intake being less than water losses. A major symptom is thirst; other clinical manifestations are primarily neurologic (due to an osmotic shift of water out of brain cells), including confusion, neuromuscular excitability, seizures, and coma. Diagnosis requires measurement of serum sodium and sometimes other laboratory tests. Treatment is usually controlled water replacement. When the response to treatment is poor, testing (eg, monitored water deprivation or administration of vasopressin) is directed at detecting causes other than decreased water intake.

尽管饮食摄入量，代谢活性和环境应力差异很大，但通常仍保持体液体积和电解质浓度。体液的稳态主要由肾脏保存。

脂质是从食物吸收或由肝脏合成的脂肪。尽管所有脂质在生理上都很重要，但甘油三酸酯（TGS）和胆固醇对疾病做出了最大的贡献。

the multiple endocrine neoplasia (MEN) syndromes comprise 3 genetically distinct familial diseases involving adenomatous hyperplasia and malignant tumors in several endocrine glands.

there are typically four parathyroid glands. As the name implies, they are located near the thyroid gland, although the number and particularly the location is quite variable. These pea-sized glands play a vital role in maintaining the body's calcium level. (See also Hypercalcemia and Hypocalcemia.)

the pituitary gland controls the functions of peripheral endocrine glands (see figure ). Pituitary structure and function and relationships between the hypothalamus and the pituitary gland are discussed in Overview of the Endocrine System.

polyglandular deficiency syndromes (PDS) are characterized by sequential or simultaneous deficiencies in the function of several endocrine glands that have a common cause. Etiology is most often autoimmune. Categorization depends on the combination of deficiencies, which fall within 1 of 3 types. Diagnosis requires measurement of hormone levels and autoantibodies against affected endocrine glands. Treatment includes replacement of missing or deficient hormones and sometimes immunosuppressants.

卟啉症是罕见的疾病,血红蛋白is abnormally metabolized due to genetic or acquired deficiencies of enzymes of the heme biosynthetic pathway. These deficiencies allow heme precursors to accumulate, causing toxicity. Porphyrias are defined by the specific enzyme deficiency. Two major clinical manifestations occur: neurovisceral abnormalities (the acute porphyrias) and cutaneous photosensitivity (the cutaneous porphyrias).

the thyroid gland, located in the anterior neck just below the cricoid cartilage, consists of 2 lobes connected by an isthmus. Follicular cells in the gland produce the 2 main thyroid hormones: