HORMON SINH DC

HORMON SINH DCPhan Th Nh Qunh, MSc.B mn Ha DcKhoa Dc, HYD HuHormon sinh dc nCc cht estrogenCc cht progestogen (progestin)Cc estrogen Estrogen thin nhin:Hormon chnh l estradiol do bung trng sinh raEstron, estriol l cht chuyn ha ca estradiol gan

EstradiolEstronEstriol3

Cc estrogenCc estrogen tng hp:C cu trc gn ging estrogen thin nhinu im: tng tc dng estrogen, gim tc dng ph, tng thi gian tc dng, dng c ng ungTc dng sinh l:Liu sinh l: pht trin c quan sinh dc n, cc c tnh th pht ca phi n; pht trin xng, tc. liu cao: c ch tit FSH, khng androgenEstradiol Thng dng di dng alcol hoc ester

EstradiolEstradiol monobenzoatDng ester benzoat bn gii phng dn estradiol trong c th Tc dng ko di do to cht chuyn ha c hot tnh6Estradiol Tc dng:Duy tr cu trc bnh thng ca da v thnh mch ph n.Gim tc tiu xng nhng khng kch thch to xng.Lm tng HDL, lm gim nh LDL, gim cholesterol, nhng lm tng nh triglycerid.Trn ng mu: estrogen lm tng ng mu, lm tng hm lng plasminogen v lm tng kt tp tiu cu.7Estradiol Ch nh:iu tr thay th: sau mn kinh, thiu nng bung trng, sau ct bung trngChm pht trin, suy gim bung trng tui dy thTc dng ph: Nguy c ung th (v, ni mc t cung), vim tc mch, thay i chuyn ha ng v lipid, tng huyt p, bnh ti mt (do tng cholesterol trong mt), bun nn, thay i tnh tnh.8Estradiol Chng ch nhTuyt i khng dng cho trc tui dy th, khi c thaiKhi u ph thuc vo estrogen nh carcinom ni mc t cung, v.Chy mu ng sinh dc, bnh gan ang trong giai on chn on, c tin s vim tc mch.

Ethinylestradiol iu ch: bn tng hp t estron

Tc dng:17-ethinyl ngn cn tc dng ca enzym chuyn ha gan gi c tc dng mnh theo ng ung:Tim: hiu lc tng ng estradiolUng: hiu lc gp 15-20 ln estradiolChng rng non, phi hp progestin chng th thai dng ng ung

10Ethinylestradiol Ch nh:iu tr thay th sau mn kinhPN thiu nng sinh dc, ung th v PN mn kinhUng th tuyn tin litC 2 nhm ch phm tng hp: nhm c nhn steroid ging estrogen t nhin nh ethinyl estradiol, mestranol, quinestrol; nhm khng c nhn steroid nh diethylstilbestrol (DES), mnh ngang estradiol nhng t/2 di), clorotrianisen, methallenestril. 11Thuc khng estrogen c im:Cht tng hp phi steroidC kch thc v v tr cc nhm chc tng quan vi estradiolC mch nhnhThuc:ClomiphenTamoxifen Clomiphen C ch tc dng:Clomiphen tranh chp vi estrogen ni sinh ti cc receptor vng di i v tuyn yn tng gii phng estrogen ca bung trng.Nu iu tr vo trc giai on phng non, s gy c phng non.Ch nhDng chn on d tr gonadotrophin ca tuyn ynDng trong iu tr v sinh do khng phng non.

13Tamoxifen Tamoxifen l dn xut ca triphenyl ethylen khng mang nhn steroid.

Ch nhUng th v ph thuc vo hormon trn ph n mn kinh

14Tamoxifen

15Tamoxifen C ch tc dng:Ngn cn phc hp estrogen - receptor gn vo v tr tc dng trn ADN ca t bo ch ngn cn s pht trin ca cc khi u ph thuc vo estrogen.

Cc progestinHormon t nhin: progesteronCc cht bn tng hp: cc cht progestin

Khung pregnanProgesteron iu ch:

PseudodiosgeninDehydropregnenolon acetatPregnenolon acetat18Progesteron Tc dng:Trn t cung: Lm chm giai on tng sinh ni mc t cung to iu kin cho trng lm tKhi c thai, progesteron c ch to vng kinh, c ch co bp t cung c tc dng gi thaiTrn tuyn v: Tng sinh chm nang tuyn v chun b cho vic tit saTrn thn nhit: Tng thn nhitTrn chuyn ha: Kch thch lipoproteinlipase lm tng ng m, gim LDH v gim tc dng c li ca estrogen trn chuyn ha m

19Progesteron Ch nh:Phi hp vi estrogen hoc dng ring trong "vin trnh thai" Liu php thay th hormon. Thng phi hp vi estrogen lm gim nguy c gy ung th v, t cung

20Cc progestin tng hp

Levonorgestrel Medroxyprogesteron Norethindron Hormon sinh dc namCc androgenHormon t nhin: Testosteron: hot tnh mnh c5 hydrotestosteron: hot tnh mnh trn tinh hon v tuyn tin litCht chuyn ha: androsteron, hot tnh bng 1/10 testosteronHormon tng hp:Dng ng ung, tc dng ko di, tc dng chuyn bitTestosteron propionat, methyltestosteron, fluoxymesteron c hot tnh androgen mnhNandrolon decanoat, nandrolon phenpropionat c hot tnh tng dng mnhTestosteron iu ch:

24Testosteron Chuyn ha:

Testosteron khng phi l dng c hot tnh mnh. Ti t bo ch, di tc dng ca 5 - reductase, n chuyn thnh dihydrotestosteron c hot tnh. C 2 cng gn vo receptor trong bo tng pht huy tc dng. Trong bnh lng tnh gi, tuy c th vn tit testosteron bnh thng, nhng t bo ch thiu 5 - reductase hoc thiu protein receptor vi testosteron v dihydrotestosteron (Griffin, 1982), nn testosteron khng pht huy c tc dng.Di tc dng ca aromatase mt s m (m, gan, h khu no), testosteron c th chuyn thnh estradiol, c vai tr iu ha chc phn sinh dc.

25Testosteron Tc dng:Tc dng androgen: Lm pht trin tuyn tin lit, ti tinh, c quan sinh dc nam v c tnh sinh dc th yu. i khng vi estrogen.Tc dng tng dng: Lm tng tng hp protein, pht trin xng, lm cho c th pht trin nhanh khi dy th (c bp n nang, xng di ra). Kch thch to hng cu, lm tng tng hp heme v globin.

Tc dngLm pht trin tuyn tin lit, ti tinh, c quan sinh dc nam v c tnh sinh dc th yu.i khng vi oestrogen.Lm tng tng hp protein, pht trin xng, lm cho c th pht trin nhanh khi dy th (c bp n nang, xng di ra). Sau sn ni b ct ha.Kch thch to hng cu, lm tng tng hp heme v globin.26Testosteron Ch nh:iu tr thay th i vi namPN ri lon TK, tun honUng th v, t cung, bung trng (liu cao)Ch :Ung mt tc dng v b ph hy ganTim bp dng ester, testosteron phng thch dn ko di tc dngGc acid ca chc ester cng ln thi gian tc dng cng di Methyltestosteron Androgen bn tng hp t DHEA

Tc dng:Nhm 17-methyl: t b chuyn ha gan hn testosteron Hot tnh sinh dc nam gim 4 ln so vi testosteron

Methyltestosteron Ch nh:Tng t testosteronPhi hp estrogen iu tr a kinh, ri lon kinh nguyt, cc triu chng thi k mn kinh, mt kinh, chng long xng, suy dinh dng, cai saChng ch nh:Nam ung th tuyn tin litPh n c thaiNgi c bnh ganCht khng androgenCht c ch androgenKetoconazol, liarozol, spironolacton Cht c ch 5-reductaseFinasterid Cht i khng androgen ti receptorCyproteron acetat, flutamid, bicalutamid Thank you!