激素（hormone）
藉由專一性接受器調節標的細胞功能，例如：
Hormones regulate target cell function by binding to specific receptors. For example:
1. 胰島素與胰島素受體結合後，可以促進細胞對葡萄糖的攝取和利用，從而降低血糖水平，但糖尿病的病人胰島素分泌失常，所以嚴重的狀況需注射胰島素，施打胰島素須注意下列事項：
Insulin binds to insulin receptors, promoting glucose uptake and utilization by cells, thus lowering blood glucose levels. In patients with diabetes, insulin secretion is impaired, necessitating insulin injections in severe cases. When administering insulin, the following precautions should be observed:
準備胰島素前 30 分鐘，將胰島素自冰箱取出，避免注射冷的胰島素，可能引起疼痛，且影響吸收速度
Insulin should be removed from the refrigerator 30 minutes prior to injection to avoid pain and impaired absorption caused by cold insulin.
抽取混濁型的胰島素應先將藥瓶置於手掌中滾動混合均勻，不可搖晃藥瓶，避免產生氣泡
Cloudy insulin should be gently rolled between the palms to mix before drawing up the dose. Shaking the vial should be avoided to prevent the formation of bubbles.
胰島素推入皮下後需靜待 3～5 秒再拔出針頭，確保胰島素完全注入皮下，避免藥物回流，且以藥棉輕壓防止出血，切勿搓揉導致吸收過快。
After injecting the insulin subcutaneously, the needle should be held in place for 3-5 seconds to ensure complete delivery and prevent leakage. The injection site should be gently pressed with a cotton ball to prevent bleeding and avoid rubbing the area, which could accelerate absorption.
皮下注射胰島素的吸收速率，腹部(血管最多吸收最快) > 上臂 > 大腿 > 臀部
The absorption rate of subcutaneously injected insulin varies by site, with the abdomen (highest blood flow, fastest absorption) > upper arm > thigh > buttocks. 2. 甲狀腺素與甲狀腺激素受體結合後，可以促進細胞的氧化代謝，從而提高新陳代謝。
Thyroid hormone binds to thyroid hormone receptors to promote cellular oxidative metabolism, thereby increasing metabolism.
3. 生長激素與生長激素受體結合後，可以促進細胞的生長和分化。
Growth hormone binds to growth hormone receptors to promote cellular growth and differentiation.
4. 促性腺激素與促性腺激素受體結合後，可以促進性腺的生長和分泌性激素。
Gonadotropins bind to gonadotropin receptors to promote the growth and secretion of sex hormones by the gonads.
人類胚胎時期性激素（sex hormone）的分泌量與青春期前（prepuberty）相比胚胎時期較高，尤其是在妊娠早期。
In the human embryo, the secretion of sex hormones is higher than in prepuberty, especially in early pregnancy.
在妊娠第8周，胎兒的血液中睪丸酮（testosterone）的濃度是成年男性的100倍。
In the 8th week of pregnancy, the concentration of testosterone in the fetal blood is 100 times that of an adult male.
在妊娠第12周，胎兒的血液中雌激素（estrogen）的濃度是成年女性的10倍。
In the 12th week of pregnancy, the concentration of estrogen in the fetal blood is 10 times that of an adult female.
這是因為胚胎需要性激素來促進生殖器官的發育。在妊娠早期，胎兒的性腺（卵巢或睪丸）還沒有發育成熟，因此性激素主要由母體的卵巢或胎盤分，之後在青春期前，性激素的分泌量會逐漸降低。這是因為在青春期之前，人體的性腺還沒有完全發育成熟。在青春期後，性激素的分泌量會再次增加，並達到成人水平。
This is because the embryo needs sex hormones to promote the development of the reproductive organs. In early pregnancy, the fetal gonads (ovaries or testicles) have not yet matured, so sex hormones are mainly secreted by the mother's ovaries or placenta.
After that, the secretion of sex hormones will gradually decrease before puberty. This is because the sex glands in the human body have not yet fully matured before puberty. After puberty, the secretion of sex hormones will increase again and reach adult levels.
腦下垂體前葉
腦下垂體前葉的分泌物，有：促甲狀腺素（thyroid-stimulating hormone）、促腎上腺皮質素（adrenocorticortropic hormone）及生長激素（growth hormone）。
生長激素（Growth Hormone，GH）是一種由腦下垂體分泌的重要激素，其作用範圍涵蓋身體的多個方面，包括生長、代謝、免疫和細胞修復。
高強度運動（high intensity exercise）能促進腦垂體分泌生長激素（growth hormone），可促進骨骼、肌肉和器官生長也可以促進脂肪分解，幫助減肥。
例如在進行 30 分鐘高強度間歇訓練 (HIIT) 後，受試者的生長激素水平比休息時高出 450%。
High-intensity exercise (HIE) can promote the secretion of growth hormone (GH) from the pituitary gland. GH promotes the growth of bones, muscles, and organs, and can also promote lipolysis and help with weight loss.
For example, after 30 minutes of high-intensity interval training (HIIT), subjects' GH levels were 450% higher than at rest.
高強度運動（high intensity exercise）能促進腦垂體分泌生長激素（growth hormone），可促進骨骼、肌肉和器官生長也可以促進脂肪分解，幫助減肥。
例如在進行 30 分鐘高強度間歇訓練 (HIIT) 後，受試者的生長激素水平比休息時高出 450%。
High-intensity exercise (HIE) can promote the secretion of growth hormone (GH) from the pituitary gland. GH promotes the growth of bones, muscles, and organs, and can also promote lipolysis and help with weight loss.
For example, after 30 minutes of high-intensity interval training (HIIT), subjects' GH levels were 450% higher than at rest.
然而，研究顯示，長期過量的生長激素可能與胰島素節抗有關，其中一個機制是減少胰島素受體數目。
胰島素受體位於細胞膜上，它們是胰島素作用的關鍵部位，通過與胰島素結合，促使細胞內的葡萄糖攝入。然而，過量的生長激素可能會導致胰島素受體數目減少，從而減弱細胞對胰島素的敏感性，使得細胞對胰島素的反應減弱，甚至產生胰島素抵抗。
胰島素抵抗是一種導致血糖升高的情況，這可能導致糖尿病和其他代謝性疾病的風險增加。因此，生長激素過量可能通過減少胰島素受體數目，影響胰島素代謝，進而對代謝健康產生影響。
糖尿病相關藥物
Alogliptin 是一種 DPP-4 抑制劑，可以減少胰島素的分解，從而增加胰島素的活性。
Alogliptin is a DPP-4 inhibitor that works by reducing insulin breakdown, thereby increasing insulin activity.
canagliflozin是一種鈉-葡萄糖轉運蛋白 2 (SGLT2) 抑制劑，SGLT2 是位於腎臟近端小管的轉運蛋白，負責將葡萄糖從尿液中重新吸收回血液，其主要作用機制為抑制SGLT2 的活性，減少葡萄糖再吸收，增加葡萄糖從尿液排除的量來降低血糖。
Canagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. SGLT2 is a transporter protein located in the proximal tubule of the kidney that is responsible for reabsorbing glucose from the urine back into the blood. Canagliflozin works by inhibiting the activity of SGLT2, reducing glucose reabsorption, and increasing the amount of glucose excreted in the urine to lower blood sugar.
Empagliflozin 是一種 SGLT2 抑制劑，可以增加尿液中的葡萄糖排泄，對於有心血管疾病併發症的糖尿病患者來說，Empagliflozin 是一個不錯的選擇。
Empagliflozin is a SGLT2 inhibitor that works by increasing urinary glucose excretion. It is a good choice for people with type 2 diabetes who have cardiovascular disease complications.
Insulin glulisine 是一種胰島素類似物，可以直接作用於胰島細胞，刺激胰島素的分泌。Insulin glulisine 是一種強效降血糖藥物，因此對於有嚴重併發症的糖尿病患者來說，Insulin glulisine 可以幫助快速控制血糖。
Insulin glulisine is an insulin analog that works by directly stimulating insulin secretion from pancreatic beta cells. It is a potent hypoglycemic drug, so it can help to quickly control blood sugar in people with severe diabetes complications.
Metformin 是一種口服降血糖藥物，主要作用是減少肝臟的葡萄糖生成，並增加胰島素對葡萄糖的敏感性，最適合給與初診斷為第二型糖尿病且尚無併發症之病人
Metformin is an oral hypoglycemic drug that works by reducing hepatic glucose production and increasing insulin sensitivity. It is the preferred first-line therapy for newly diagnosed type 2 diabetes without any complications.
松果體
（又叫做松果腺、腦上體或第三隻眼）是一個位於脊椎動物腦中的小內分泌腺體。它負責製造褪黑素，一種會對醒睡模式與(季節性)晝夜節律(en:Circadian rhythm)功能的調節產生影響的激素其形狀像是一顆小松果(這也是其名字的由來)，並座落在腦部中央的附近，介於兩個大腦半球(en:Cerebral hemisphere)之間，被裹在兩個圓形的丘腦的接合處。從神經外胚層(neuroectoderm)化而來。
腮腺
腮腺是最大的唾液腺，主要位於耳朵的前下方所以又俗稱耳下腺，其導管穿過頰肌開口於口腔，其分泌液內含唾液澱粉酶
甲狀腺體
甲狀腺於頸部甲狀軟骨下方(大約頸部喉結下方)，氣管的兩旁，形狀像蝴蝶，其功能主要是吸收血液中的碘，生成並分泌甲狀腺素 (荷爾蒙)，有調節身體細胞的新陳代謝、生長及發育的作用，懷孕期間，為了滿足胎兒對碘的需求，甲狀腺會增大。
The thyroid gland is located in the neck, below the thyroid cartilage (approximately below the Adam's apple) and on either side of the trachea. Shaped like a butterfly, its primary function is to absorb iodine from the blood, synthesize, and secrete thyroid hormone. Thyroid hormone regulates cellular metabolism, growth, and development throughout the body. During pregnancy, the thyroid gland enlarges to meet the increased iodine demands of the fetus.
而甲狀腺素的分泌是由腦部腦下垂體所分泌的促甲狀腺激素所調節。
The secretion of thyroid hormone is regulated by thyroid-stimulating hormone (TSH), which is secreted by the pituitary gland.
高敏感性促甲狀腺激素 (hsTSH)： 促甲狀腺激素由腦下垂體所分泌，促進甲狀腺生成和分泌甲狀腺素，因此腦下垂體本身的狀況會影響促甲狀腺激素的分泌。
Highly sensitive thyroid-stimulating hormone (hsTSH): TSH is produced by the pituitary gland and stimulates the thyroid gland to produce and secrete thyroid hormone. Therefore, the condition of the pituitary gland itself can affect the secretion of TSH.
降鈣素及骨質密度
關於骨質密度/About bone mineral density
1. 雙羥維生素 D〔1,25-(OH)2D〕是一種活性維生素 D，可以促進腸道對鈣的吸收，並抑制骨骼的破骨細胞活性，有利於增加骨質密度。
25-dihydroxyvitamin D (calcitriol) is an active form of vitamin D that promotes calcium absorption in the intestine and inhibits bone resorption. Therefore, an increase in calcitriol levels is beneficial for increasing bone mineral density.
2. 降鈣素（英語：Calcitonin，又譯為抑鈣激素）是一種負反饋調節激素(含有32個胺基酸的直線型多肽類激素)，在人體裡是由甲狀腺的濾泡旁細胞（parafollicular cells，又稱C細胞）製造，，它可以抑制骨骼破骨細胞的活性，從而減少骨質流失。但降鈣素濃度下降並不能直接增加骨質密度，因為它只是抑制了骨質流失的速度，而不能增加骨質的形成。
Calcitonin is a negative feedback hormone that inhibits bone resorption. However, a decrease in calcitonin levels does not directly increase bone mineral density because it only inhibits the rate of bone loss, not the formation of bone.
甲狀腺的濾泡旁細胞（parafollicular cell of thyroid gland）分泌激素的主要功能，與副甲狀腺素（parathyroid hormone）的作用相反，相反的地方主要是呈現在血鈣的影響。
副甲狀腺素會促進骨骼的鈣釋放、減少尿液中鈣的排泄，以及增加腸道對鈣的吸收，而甲狀腺濾泡旁細胞分泌的降鈣素則會讓鈣沉積在骨骼、增加尿液中鈣的排泄，也減少腸道對鈣的吸收
The main function of the hormone secreted by the parafollicular cells of the thyroid gland is opposite to that of parathyroid hormone, mainly in terms of their effects on blood calcium levels.
Parathyroid hormone (PTH) promotes the release of calcium from bones, decreases the excretion of calcium in the urine, and increases the absorption of calcium from the intestines. On the other hand, calcitonin, which is secreted by the parafollicular cells of the thyroid gland, promotes the deposition of calcium in bones, increases the excretion of calcium in the urine, and decreases the absorption of calcium from the intestines.
所以若副甲狀腺功能亢進會分泌過多的副甲狀腺素（PTH），導致血鈣濃度升高，臨床表徵為骨痛、便秘(血鈣濃度過高時，肌肉的興奮性可能會受到抑制，導致腸道平滑肌的蠕動減慢)
Hyperparathyroidism leads to excessive secretion of parathyroid hormone (PTH), resulting in hypercalcemia. Clinical manifestations include bone pain and constipation. Elevated calcium levels can inhibit muscle excitability, leading to decreased intestinal smooth muscle motility.
3. 皮質醇是一種糖皮質激素，它可以抑制骨骼的形成，並促進骨質流失。
Cortisol is a glucocorticoid that inhibits bone formation and promotes bone loss.
4. 雌激素是一種女性激素，它可以促進骨骼的形成，並抑制骨質流失。因此，皮質醇濃度上升和雌激素濃度下降都會不利於增加骨質密度。
Estrogen is a female sex hormone that promotes bone formation and inhibits bone loss. Therefore, an increase in cortisol levels and a decrease in estrogen levels are both detrimental to increasing bone mineral density.
膠體
甲狀腺是由許多濾泡所組織成的，每個濾泡就像一個中空的球形，在濾泡腔中含有膠體，儲存有甲狀腺荷爾蒙。此外有一些神經脊來源的細胞，散佈於濾泡之間，稱為濾泡旁細胞或C細胞。濾泡上皮細胞可分泌三碘甲狀腺素(T3)和甲狀腺素(T4)等甲狀腺荷爾蒙；
甲狀腺是由濾泡所組成，而其中有膠體(Colloid)的構造，來儲存甲狀腺賀爾蒙。
副甲狀腺體
位置：甲狀腺後方有4顆像豌豆的小腺體
功能：分泌副甲狀腺荷爾蒙。它的主要作用是維持體內血鈣濃度在正常範圍內，低血鈣主要會刺激副甲狀腺內分泌腺體的激素分泌，以增加血鈣濃度，若手術不小心移除副甲狀腺，最可能造成血鈣濃度下降。。使肌肉與神經系統能運作正常，雖然它與甲狀腺在解剖位置上相當靠近，但兩者的功能卻不相關
腎上腺體
腎上腺體位置：腎上腺位於胸腹中、腎臟之前上方
腎上腺體是一個位於腎臟上方的內分泌腺體，而腎上腺體可分為兩部分：
The adrenal gland is an endocrine gland located on top of each kidney. It consists of two parts:
腎上腺皮質： 外層，負責分泌糖皮質激素（如皮質醇）、鹽皮質激素（如醛固酮）和性激素。
the adrenal cortex and the adrenal medulla. The adrenal cortex, the outer layer, is responsible for producing glucocorticoids (such as cortisol), mineralocorticoids (such as aldosterone), and sex hormones.
腎上腺髓質： 內層，主要分泌腎上腺素和去甲腎上腺素，參與應激反應。
The adrenal medulla, the inner layer, primarily secretes epinephrine and norepinephrine, which are involved in the stress response.
嗜鉻性細胞（chromaffin cells）主要位於腎上腺髓質（medulla of adrenal gland）中。
腎上腺體功能：其主要功能為通過合成皮質類甾醇和鄰苯二酚胺（例如皮質醇和腎上腺素）來調控身體對壓力產生的反應。 若因自體免疫破壞所有腎上腺皮質組織時，腎上腺皮質激素與雄激素合成會受影響。
腎上腺體 是位於腎臟上方的內分泌腺體，分泌多種激素，包括糖皮質激素、鹽皮質激素和性激素。
The adrenal glands are endocrine glands located on top of the kidneys. They produce various hormones, including glucocorticoids, mineralocorticoids, and sex hormones.
先天性腎上腺增生症（CAH）
而先天性腎上腺增生症（CAH） 是一種先天性的內分泌疾病，
CAH 就是由於腎上腺合成這些激素的酵素缺乏，導致激素分泌異常而引起的一系列疾病。
Congenital adrenal hyperplasia (CAH) is a congenital endocrine disorder. CAH occurs due to a deficiency in the enzymes responsible for synthesizing these hormones in the adrenal glands, leading to a series of hormonal imbalances.
常見的CAH類型 是21-羥化酶缺乏症，這會影響皮質醇和醛固酮的合成，導致多種臨床表現，如女性外生殖器男性化、鈉流失、高血鉀等。
The most common type of CAH is 21-hydroxylase deficiency. This affects the synthesis of cortisol and aldosterone, resulting in various clinical manifestations such as virilization in females, sodium loss, and hyperkalemia.
主要是由於腎上腺合成類固醇激素的酵素缺乏所致。
The underlying cause is a deficiency in the enzymes involved in the synthesis of adrenal steroid hormones.
若新生兒篩檢診斷為先天性腎上腺增生症（congenital adrenal hyperplasia, CAH），則需進行下列護理指導：
If a newborn is diagnosed with congenital adrenal hyperplasia (CAH) through newborn screening, the following care instructions should be provided:
1.教導父母觀察小琪有無脫水情形，CAH可能導致鈉流失，造成脫水。
Educate parents to monitor the child for signs of dehydration, as CAH can lead to sodium loss and dehydration.
2.確實監測身高和體重的變化，此為長期治療效果的評估指標之一。
Closely monitor height and weight, as these are indicators of long-term treatment effectiveness.
Administer cortisone as prescribed to supplement the deficient cortisol levels.
3.需要按時服用皮質醇（cortisone），以補充不足的皮質醇。
醛固酮
醛固酮是一種腎上腺皮質激素，主要功能是調節體內鈉離子與鉀離子的平衡。在先天性腎上腺增生症（CAH）患者中，由於特定酵素缺乏，導致類固醇合成途徑異常，不僅會影響皮質醇的合成，也可能影響醛固酮的合成，進而導致鈉離子流失、鉀離子滯留。若合併醛固酮不足，患者容易出現脫水、電解質紊亂等症狀，因此需要補充鹽分。
Aldosterone is a mineralocorticoid hormone primarily responsible for regulating sodium and potassium balance in the body. In congenital adrenal hyperplasia (CAH), a deficiency in specific enzymes disrupts the steroidogenic pathway, affecting both cortisol and aldosterone synthesis. This can lead to sodium loss and potassium retention. If aldosterone deficiency is present, patients may experience dehydration and electrolyte imbalances, necessitating salt supplementation.
相反地，若因醛固酮分泌腺瘤導致醛固酮過度分泌，則會引起原發性醛固酮過多症，也就是所謂的康氏症候群。患者會出現高血壓、低血鉀、代謝性鹼中毒等症狀。
Conversely, primary aldosteronism, also known as Conn's syndrome, is caused by excessive aldosterone secretion due to an aldosterone-producing adenoma. Patients with primary aldosteronism typically present with hypertension, hypokalemia, and metabolic alkalosis.
所以CAH的治療主要是補充缺乏的激素，如皮質醇、增加鹽分的攝取，由於不同類型的酵素缺乏，患者可能出現不同的臨床表現，需要針對病因進行治療。
Therefore, the primary treatment for CAH is to supplement the deficient hormones, such as cortisol, and increase salt intake. Due to the varying types of enzyme deficiencies, patients may exhibit different clinical manifestations, requiring tailored treatment based on the underlying cause.
腎上腺皮質功能低下症
If primary adrenal insufficiency develops
1.原發性腎上腺皮質功能不全常因腎上腺皮質慢性破壞所致
It is often caused by chronic destruction of the adrenal cortex.
2.腎上腺皮質組織被破壞的程度與症狀出現的早晚並非完全線性關係。有些患者在腎上腺皮質組織破壞程度較輕時，就可能出現明顯症狀；而有些患者即使腎上腺皮質組織破壞較嚴重，症狀也可能較不明顯。這與個體差異、疾病進展速度等因素有關。
The degree of adrenal cortical destruction does not always correlate linearly with the onset of symptoms. Some patients may experience significant symptoms even with mild adrenal cortical damage, while others may have more severe damage but fewer symptoms. This variability depends on individual differences and disease progression.
3.原發性腎上腺皮質功能不全病人常因促黑色細胞素（MSH）的過多分泌而使皮膚變深
Patients with primary adrenal insufficiency often develop hyperpigmentation due to increased production of melanocyte-stimulating hormone (MSH).
4.下視丘分泌的促腎上腺皮質素釋放因子（CRF）不足亦會導致腎上腺皮質功能低下
Additionally, inadequate secretion of corticotropin-releasing factor (CRF) from the hypothalamus can also lead to adrenal insufficiency.
留言