Stofwisseling en
hormonen
TWEEDE BACHELOR
ESTHER NIJHOFF
,Normaal=uitgelegd in de les, dikgedrukt=benoemd dat het belangrijk is om te kennen,
schuingedrukt=informatie, maar geen leerstof
INHOUD
Endocriene pancreas ........................................................................................................................................................................ 5
Eilandjes van langerhans.............................................................................................................................................................. 5
Biosynthese van insuline ............................................................................................................................................................. 5
Insuline en C-peptide structuur ............................................................................................................................................... 6
Secretie van insuline .................................................................................................................................................................... 6
Werking van insuline ................................................................................................................................................................... 7
Acties van insuline op de lever ................................................................................................................................................. 8
Acties van insuline op de spier ................................................................................................................................................. 9
Acties van insuline op de adipocyt .......................................................................................................................................... 9
Fysiologische werking van insuline........................................................................................................................................ 10
Glucagon...................................................................................................................................................................................... 10
Somatostatine ............................................................................................................................................................................ 11
Diabetes mellitus ........................................................................................................................................................................... 12
Definitie van diabetes mellitus ............................................................................................................................................... 12
Diagnose van diabetes mellitus .............................................................................................................................................. 12
Type I diabetes mellitus ............................................................................................................................................................... 13
Definitie van type I diabetes mellitus ................................................................................................................................... 13
Pathogenese van diabetes mellitus type I ............................................................................................................................ 13
Autoimmuniteit van diabetes mellitus type I ...................................................................................................................... 14
Symptomatologie....................................................................................................................................................................... 15
Type II diabetes mellitus .............................................................................................................................................................. 16
Pathogenese van type II diabetes mellitus ........................................................................................................................... 16
Acute en chronische verwikkelingen van diabetes mellitus ................................................................................................ 18
Chronische complicaties ......................................................................................................................................................... 18
HbA1c .......................................................................................................................................................................................... 19
Metabole controle .................................................................................................................................................................... 19
Het hypothalamo-hypofysair systeem: fysiologie en fysiopathologie ............................................................................... 20
Anatomie van de hypofyse ...................................................................................................................................................... 20
Ontwikkeling van de hypofyse ............................................................................................................................................... 20
Bevloeiing van de hypofyse ..................................................................................................................................................... 20
Omgeving rondom de hypofyse ............................................................................................................................................ 21
Hypothalamus en hypofyse ..................................................................................................................................................... 22
Verschil neurohypofyse en adenohypofyse ........................................................................................................................ 22
Werking van hypothalamische of hypofysiotrope hormonen ....................................................................................... 22
Hormonen van de neurohypofyse ........................................................................................................................................ 23
Hormonen van de adenohypofyse ........................................................................................................................................ 25
Hypothalamo-hypofysaire gonadale as ................................................................................................................................ 25
1
,Normaal=uitgelegd in de les, dikgedrukt=benoemd dat het belangrijk is om te kennen,
schuingedrukt=informatie, maar geen leerstof
Hypothalamo-hypofysaire-schildklier as .............................................................................................................................. 26
Hypothalamo-hypofysaire bijnier as ..................................................................................................................................... 26
Hypothalamo-hypofysaire-mammaire as ............................................................................................................................. 27
Hypothalamo-hypofysaire groeihormoon as...................................................................................................................... 28
Hypopituitarisme ....................................................................................................................................................................... 28
Groeihormoon: fysiologie en fysiopathologie ........................................................................................................................ 29
Synthese en secretie van groeihormoon ............................................................................................................................ 29
Metabole acties van groeihormoon ...................................................................................................................................... 30
Werking van groeihormoon................................................................................................................................................... 30
Fysiologische effecten van groeihormoon .......................................................................................................................... 30
Pathofysiologie ........................................................................................................................................................................... 31
Gonadale as (gefocust op de man) ............................................................................................................................................ 32
Ontwikkeling van mannelijke gonaden in-utero ................................................................................................................ 32
Anatomie ..................................................................................................................................................................................... 32
Splicing van pro-hormoon naar GnRH molecule .............................................................................................................. 32
GnRH en aanmaak van FSH/LH (adeno-hypofyse) ........................................................................................................... 32
Leydigcellen ................................................................................................................................................................................ 33
Sertolicellen ................................................................................................................................................................................ 33
Testosteron ................................................................................................................................................................................ 34
Testosteron, dihydrotestosteron en oestrodiol ............................................................................................................... 34
Bijnieren: fysiologie en fysiopathologie .................................................................................................................................... 35
Anatomie en bloedvoorziening.............................................................................................................................................. 35
Hormonen van de bijnier ........................................................................................................................................................ 35
Synthese van bijnierschorshormonen .................................................................................................................................. 35
Pathologie.................................................................................................................................................................................... 37
Glucocorticoiden – cortisol (bijnierschors) ....................................................................................................................... 38
Mineralocorticoiden – aldosteron (bijnierschors) ............................................................................................................ 39
Bijnierandrogenen (bijnierschors) ......................................................................................................................................... 39
Catecholamines (bijniermerg) ................................................................................................................................................ 40
Pathofysiologie ........................................................................................................................................................................... 41
Gewichthomeostase ..................................................................................................................................................................... 43
Lichaamssamenstelling ............................................................................................................................................................. 43
Metabolisme ............................................................................................................................................................................... 43
Het brein ..................................................................................................................................................................................... 44
Hoe het autonome zenuwstelsel met het brein communiceert ................................................................................... 44
Hoe vetcellen met het brein communiceren ..................................................................................................................... 45
Hoe het gastro-intestinaal stelsel met het brein communiceert .................................................................................. 46
Hoe de pancreas met het brein communiceert ................................................................................................................ 48
2
, Normaal=uitgelegd in de les, dikgedrukt=benoemd dat het belangrijk is om te kennen,
schuingedrukt=informatie, maar geen leerstof
Hoe smaakpapillen communiceren met het brein ............................................................................................................ 48
Hoe de lever communiceert met het brein ....................................................................................................................... 49
Hoe het brein communiceert met het brein ..................................................................................................................... 49
Schildklier: fysiologie en fysiopathologie .................................................................................................................................. 50
Anatomie en histologie ............................................................................................................................................................ 50
Synthese van iodothyroines .................................................................................................................................................... 50
Transport van jodothyronines ............................................................................................................................................... 51
Transformatie van jodothyronines ....................................................................................................................................... 51
Regeling van de schildklierwerking ....................................................................................................................................... 51
Pathofysiologie ........................................................................................................................................................................... 52
Pathofysiologie - hyperthyroidie ........................................................................................................................................... 53
Pathofysiologie - hyperthyroidie ........................................................................................................................................... 54
Bijschildklieren: fysiologie ............................................................................................................................................................ 56
Anatomie en histologie ............................................................................................................................................................ 56
Synthese van PTH ..................................................................................................................................................................... 56
Werking van PTH ..................................................................................................................................................................... 57
Calcium metabolisme ............................................................................................................................................................... 58
Vitamine D .................................................................................................................................................................................. 59
Calcitonine .................................................................................................................................................................................. 60
Fysiologie van de lipiden deel 1 .................................................................................................................................................. 61
Lipiden, Apo-proteines en apo-lipoproteines .................................................................................................................... 61
Lipiden synthese en metabolisatie ........................................................................................................................................ 61
Lipiden transport ....................................................................................................................................................................... 62
Cholesterol transport: exogene cholesterol pathway ..................................................................................................... 63
Cholesterol transport: endogene cholesterol pathway .................................................................................................. 64
Cholesterol transport: reverse cholesterol pathway ...................................................................................................... 65
Fysiologie van de lipiden deel 2 .................................................................................................................................................. 66
Lipidenparameters in het bloed ............................................................................................................................................. 66
Implicaties voor de kliniek ...................................................................................................................................................... 66
Fysiologie van de lipiden deel 3 .................................................................................................................................................. 67
Lipiden verlagende medicatie – statines .............................................................................................................................. 67
Lipiden verlagende medicatie – PCSK9 ............................................................................................................................... 67
Lipiden verlagende medicatie – Ezetimibe en galzoutbinders ........................................................................................ 67
Lipiden verlagende medicatie – Fibrate ............................................................................................................................... 68
Lipiden verlagende medicatie – Omega 3 vetzuren ......................................................................................................... 68
Voeding............................................................................................................................................................................................. 69
Algemene aanbevelingen ......................................................................................................................................................... 69
Koolhydraten ............................................................................................................................................................................. 69
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