ENDOKRINOLOGI REPRODUKSI

Bayu Kurniawan, dr.

Topik Pembelajaran

• Dasar Endokrinologi Reproduksi
Wanita

• Dasar Endokrinologi Reproduksi Pria

Dasar Endokrinologi Reproduksi Wanita

Tujuan Pembelajaran
Mahasiswa mampu memahami &
menjelaskan :
 Fenotip wanita  Sistem endokrin & reproduksi  Konsep Menstruasi

THE FEMALE PHENOTYPE
W hat makes a woman ?
1. Chromosomal composition of female is XX 2. Gonads that are functionally and str uctur ally ovaries 3. Female sex hor mone production 4. Appropriate inter nal and exter nal genitalia 5. Self - Acceptance of female role

Endocrine System
• Communication system
– Allows for cells in distant parts of body to communicate – Communication generally slower in onset, but longer in duration, compared to nervous system communication

• Consists of all the organs that secrete
hormones (endocrine organs)

Hor mones
   Chemical Messengers Produced by an endocrine gland Released into and carried via bloodstream to target tissues
 Target tissues = tissues bearing receptors that can bind and physiologically respond to the chemical messenger in question  Amount of chemical messenger produced and released intocirculation is generally very small

SEX HORMONES - FEMALE
Hormones responsible for development and maintenance of female phenotype: Peptides 1. Gonadotrophin-releasing hormone (GnRH) (decapeptide) LH Releasing Factor, FSH Releasing Factor 2. Luteinising hormones (LH) 3. Follicle stimulating hormone (FSH) 4. Inhibin (Protein hormone) 5. Activin (Protein hormone) Steroids 6. estrogens, progesterons & androgens

TRADITIONAL ENDOCRINE SYSTEM
stimulus hormone A
Ca
2 +

B

nucleus

Hormone producing cell

second messengers

hormone

capillary general blood circulation

Target Cell

Feedback loop Norman, A.W.; Litwack, G. (1997) Hormones 2nd Ed. Academic Press

nucleus

second messengers cellular effects

biological response

Reproductive System
• Survival of the organism
– Other systems of the body work together to maintain homeostasis and promote survival of the organism under varying environmental conditions

• Survival of the species
– Reproductive system is designed to package and transmit genetic information from generation to generation, therefore promotes survival of the species over time

Major Functions of Male and Female Repr oductive Systems
 Production of gametes
 Male gametes = sperm
 Spermatogenesis = production of mature sperm

 Female gametes = eggs (ova)
 Oogenesis = production of mature eggs

 Steroidogenesis
 Production of steroid hormones  estrogens, progesterons, androgens

PEPTIDE/ PROTEIN HORMONES INVOLVED IN FEMALE DEVELOPMENT AND REPRODUCTION
Hormone Site of Production GnRH Hypothalmus FSH and LH Principal target tissue Biological function

Adenohypophysis

Stimulation of release of

FSH AdenohypoOvarian Granulosa Growth ovarian follicle physis and thecal cells Stimulation estrogen production LH Adenohypophysis Follicle granulosa cell Follicle granulosa Corpus luteum production Hypothalmuspituitary Hypothalmus Stimulate progesterone

Inhibin

Participate in feedback inhibition of FSH secretion Increase secretion of FSH

Activin

Female Reproductive System (1)
• Fase Intrauterine • Fase Bayi • Fase Anak • Fase Pra-pubertas • Fase Reproduksi • Fase Klimakterium • Fase Senium

Female Reproductive System (2) • Poros Hormon Reproduksi
- Susunan Sentral - Pineal - Hipotalamus - Hipofise - Susunan Perifer - Ovarium - Endometrium • Organ Endokrin Ekstra Gonad - Timus - Tiroid - Adrenal - Pankreas

PINEAL (1)

•Kelenjar kecil di posterior
hipotalamus •Embriologis berasal dari diensefalon posterior •Organ sisa ?

PINEAL (2)
• Sintesis
   Melatonin (>> aktif) 5-Metoksi-Triptofol Arginin Vasotosin

• Sekresi
 Belum seluruhnya diketahui  Irama Sirkadian, Pulsatil (Melatonin)

PINEAL (3)
 Fungsi
 Belum seluruhnya diketahui

- Poros hipotalamus-hipofise-gonad - Reproduksi - Siklus Seksual & Siklus haid - Seks Sekunder - Genitalia Interna - Ovulasi

 Dipengaruhi cahaya & hormon  Terdapat reseptor hormon steroid seks & prolaktin  Berpengaruh terhadap :

Hypothalamic-Pituitary Axis

Hypothalamus
• Region of brain (diencephalon) • Lies below third ventricle at base of brain • Important regulator of endocrine action

Pituitary Gland (hypophysis)
• Endocrine gland connected to hypothalamus by infundibulum (stalk containing nerves and small blood vessels)

Hypothalamus (1)
• Contains neuroendocrine cells that
release neurohormones which
1. enter the portal vessels and are transported to anterior pituitary 2. regulate anterior pituitary hormone production

• Contains neuroendocrine cells whose
– cell bodies lie within hypothalamus • Hypothalamus = site of hormone production – axons travel through hypothalamicpituitary stalk and terminate in posterior pituitary • Posterior pituitary = site of hormone storage
and release

Hypothalamus (2)
Hypothalamus Hormones
 

Hypothalamic Releasing Hormones Hypothalamic Inhibitory Hormones

Hypothalamic Releasing Hormones
• Produced in and released from
hypothalamus • Enter portal blood vessels and are transported to ANTERIOR PITUITARY • Stimulate discrete cell types within anterior pituitary to secrete additional hormone(s)

Hypothalamic Releasing Hormones
• Corticotropin Releasing Hormone
(CRH)
– Acts on corticotrophs – Stimulates AP production of adrenocorticotropic hormone (ACTH)

• Thyrotropin Releasing Hormone (TRH)
– Acts on thyrotrophs – Stimulates AP production of Thyroid Stimulating Hormone (TSH)

Hypothalamic Releasing Hormones
• Gonadotropin Releasing Hormone
(GnRH)
– Previously known as Luteinizing Hormone Releasing Hormone (LHRH) – Acts on lactotrophs to stimulate AP production of Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH)

Hypothalamic Releasing & Inhibitory Hormones
• Growth Hormone Releasing Hormone
(GHRH = somatotropin)
– Acts on somatotrophs – Stimulates AP production of Growth Hormone (GH)

• Growth Hormone Inhibitory Hormone
(GIH = somatostatin)
– Acts on somatotrophs – Inhibits AP production of Growth Hormone

Pituitary Gland
In humans has two lobes = distinct glands
• Anterior (toward front of head) lobe = adenohypophysis • Posterior (toward back of head) lobe = neurohypophysis

Lobes connected to hypothalamus by different means
• Anterior lobe connected by (portal) blood vessels • Posterior lobe connected by nerves (axons)

Anterior Pituitary (AP)
 Endocrine
    

(hormone-secreting) gland containing several different cells types
Lactotrophs; secrete prolactin Gonadotrophs; secrete LH and FSH Somatotrophs; secrete Growth hormone Thyrotrophs; secrete Thyroid stimulating hormone Corticotrophs; secrete Adrenocorticotropic Hormone

 Connected

to hypothalamus by portal blood

vessels

Prolaktin
 Fungsi o Merangsang galaktopoeisis
(mempertahankan laktasi & laktogenesis untuk membentuk air susu) o Memicu mammogenesis

FSH & LH
 Fungsi
- Pematangan folikel - Ovulasi - Pembentukan korpus luteum - Sintesis steroid seks

Posterior Pituitary
 Outgrowth

of the hypothalamus; composed of neural tissue  Specific neuroendocrine cells in hypothalamus have axons that project through the stalk and into the posterior pituitary  Secretes two important hormones
 

Oxytocin (OXY) Antidiuretic hormone (ADH)

 Fungsi

Oxytocin  Persalinan : kontraksi uterus  Pengeluaran air susu dgn kontraksi mioepitel payudara
 Fungsi ADH 

Mengendalikan osmolalitas & volume plasma

Ovarium

Fungsi Utama 1. Fungsi Proliferatif Sumber ovum selama fase reproduksi 2. Fungsi Sekretorik Pembentukan & pengeluaran hormon steroid seks (estrogen, progesteron & androgen)

Estrogen (1)
• Hormon steroid dgn 10 atom C, dibentuk
dari 17-ketosteroid androstendion • Estrogen alamiah : estradiol (E2), estron (E1), estriol (E3) E2:E1:E3 = 10:5:1 • Disintesis di ovarium, adrenal, plasenta, testis, jaringan lemak, SSP

Estrogen (2)
• Khasiat Umum
- Merangsang sintesis DNA melalui RNA - Membentuk messenger RNA

Meningkatkan sintesa protein

Estrogen (3)
• Khasiat Khusus
- Endometrium : memicu proliferasi endometrium, memperkuat kontraksi uterus - Serviks : mengubah konsentrasi getah serviks saat ovulasi - Vagina : perubahan selaput vagina, meningkatkan produksi getah, meningkatkan kadar glikogen, peningkatan produksi asam laktat, memperkecil kemungkinan infeksi - Ovarium : memicu sintesis reseptor FSH & LH, mengatur kecepatan keluarnya ovum, mempersiapkan spermatozoa

Estrogen (4)
Others: • Increase clotting factors in the blood • Decrease rate of bone resorption • Increase sodium and water retention • Mood & behavior • Spermatogenesis • Increase HDL and decrease LDL

Progesteron (1)
Hormon steroid dgn 21 atom C Dibentuk di folikel, plasenta & adrenal Khasiat Umum Mempersiapkan tubuh untuk kehamilan (syarat mutlak konsepsi & implantasi)  Terjadi karena pengaruh estradiol, karena estradiol mensintesis reseptor progesteron   

Progesteron (2)
 Khasiat Khusus - Endometrium : perubahan sekretorik (fase luteal) - Serviks : barier terhadap spermatozoa (fase luteal) - Miometrium : menurunkan tonus miometrium - Suhu Basal Badan : peningkatan suhu basal badan segera setelah ovulasi (termogenik)

Androgens: Physiological & Pharmacological Actions

  

Necessary for development of male fetus Responsible for major changes that occur in males at puberty Anabolic actions Maintains sexual function in males Participates in pubertal growth spurt & hair growth in females

Endometrium

•Fungsi
o o o Nidasi Menstruasi Petunjuk gangguan fungsional & steroid seks

Organ Endokrin Ekstra Gonad
Thymus Thyroid Adrenal Pankreas

THYMUS
Berubah mengikuti usia  Tumbuh kembang  Puncak sesaat sebelum pubertas  Aktivasi HypothalamicPituitary Axis  Terdapat reseptor estrogen & androgen

THYMUS

•Sekresi & Fungsi
- Timosin a-1 & Timosin β-4  Aktivasi sekresi LH-RH
Hipotalamus  Sekresi kortikosteroid

- Didapatkan Oksitosin & Vasopresin  Fungsi ???  Parakrin

THYROID
• Sekresi Hormon Thyroxin • Gangguan sekresi : Hipertiroid – Hipotiroid • Hipertiroid - Gangguan silkus haid (ringan) • Hipotiroid - Gangguan fertilitas (gangguan siklus haid berat sd anovulasi) - Galaktorea

Hipotiroid
• • • • • • T3 & T4 rendah TRH tinggi PRL tinggi PRL hambat FSH & LH Tingkatkan kadar androgen Hambat pematangan folikel

Adrenal
• Produksi androgen wanita : ovarium & adrenal >>> berlebihan >>> Ggn. Reproduksi • Intake kalori +++ >>> aktivitas adrenal meningkat • Androgen +++ >>> Ggn. Gonadostat
hipotalamus-hipofise >> Ggn. HypothalamicPituitary Axis >>Resistensi folikel ovarium

Pankreas
• Sekresi Insulin • Normal: Insulin merangsang FSH – LH (Hipofise) • Fungsi :

- meningkatnya sintesis estrogen & progesteron - sintesis & sekresi proteoglikan & aktivator plasminogen - timbulnya reseptor LH & Prolaktin • Kadar Insulin ~ Kadar androgen (androstendion & testosteron) • Obesitas – Anovulasi - Hirsutisme

PROSTAGLANDIN

• Ovulasi

• Spermatozoa • Menstruasi

Memicu pecahnya folikel dg mempengaruhi vaskuler & kontraksi ovarium PG dari spermatozoa >> kontraksi & relaksasi uterus – tuba

• Dismenorea

Merangsang otot polos Hiperkontraktilitas uterus (kadar progesteron rendah)

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