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Stress in Early Pregnancy:The Role of Endocrine Immune System and Management
Noor Pramono NoerpramanaFakultas Kedokteran Universitas Diponegoro
Actual Management in Complicated PregnancyFK. Universitas Sebelas Maret ,Surakarta 15 Juli 2012
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1. Stress
2. Hypothalamus hormones
3. Pituitary anterior hormones
4. HPA
5. HPG
6. Thyroid hormones
7. ADH
8. Stress CRH (HPA), GnRH (HPG), TRH, GHRH
9. Desidual prolactin, circulation prolactin
10. Stress Th1, Th2, immune system
11. Pregnancy failure, fetal programming
12. Management stress in early pregnancy
Contents
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Stres
• Stres : Proses adaptasi
• Stres : - Aksis hypothalamo-pituitary-adrenal
(HPA)
- Aksis hypothalamo-pituitary-gonadal
(HPG)
- Sistem imun
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Hormones of the hypothalamus
Hormone Target cells in the anterior pituitary gland
Effect on the anterior pituitary gland
Growth hormone releasing hormone (GHRH)
Somatotrophs ↑ GH release
Growth hormone inhibiting hormone (GHIH also called somatostatin)
Somatotrophs and thyrotrophs
↓ GH and TSH release
Corticotrophin releasing hormone (CRH)
Corticotrophs ↑ ACTH release
Gonadotrophin releasing hormone (GnRH)
Gonadotrophs ↑ LH and FSH release
Thyrotrophin releasing hormone (TRH)
Thyrotrophs and lactotrophs
↑ TSH and prolactin release
Prolactin releasing factors (PRF) Lactotrophs ↑ Prolactin release
Dopamine (prolactin inhibiting hormone)
Lactotrophs ↓ Prolactin release
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Hormone of the anterior pituitary
The hormone secreted by anterior pituitary are large peptides ( about 200 amino acid residues) or glycopeptides
The six main hormones are– Growth hormone (GH)– Thyroid stimulating hormone (TSH also called
thyrotrophin).– Adrenocorticotrophic hormone (ACTH)– Luteinizing hormone (LH)– Follicle stimulating hormone (FSH)– Prolactin (PRL)
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Hormones of the anterior pituitary gland
Hormone Synthesized by Stimulated by Inhibited by Target organ Effect
GH Somatotrophs GHRH GHIH and IGF-1 Liver Stimulates IGF-1 production and opposes insulin
TSH Thyrotrophs TRH T3 Thyroid gland Stimulates thyroxine release
ACTH Corticotrophs CRH Glucocorticoids Adrenal cortex Stimulates glucocorticoid and androgen release
LH+FSH Gonadotrophs GnRH, sex steroids
Prolactin, sex steroids
Reproductive organs
Release of sex steroids
Prolactin Lactotrophs PRF and TRH Dopamine Mammary glands and reproductive organs
Promotes growth of these organs and initiates lactation
MSH Corticotrophs - - Melanocytes in skin
Stimulates melanin synthesis
Beta-endorphin
Corticotrophs - - Unknown May be involved in pain control
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Hormones of the anterior pituitary gland and their receptive target organs
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HPA : Hormonal regulation of cortisol. (ACTH, adrenocorticotropic
hormone; CRH, corticotrophin releasing hormone)
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HPG : Regulasi hormon FSH , LH, Prolaktin, Estrogen, Progesterone
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Hormonal regulation of the thyroid hormones. (T3, Tri- iodothyronine; T4,thyroxine;TRH,thyrotrophin;releasing hormone; TSH, thyroid stimulating
hormone
prolactin
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Hormonal regulation of plasma osmolarity by antidiuretic hormone (ADH)
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Hormonal regulation of growth hormone
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HPAHypothalamusCRH
ACTH
AdrenalCortex Medula
Glucocorticoid (cortisol), mineralocorticoid, androgen
Catecholamin : adrenalin. noradrenalin
Metabolic effect Immune system :-Immune activity-Cytokines-Inflammation
Stress
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Hypothalamus
GHRH CRH Dopamin (PIH)
PRF TRH GnRH
Anterior Pituitary
GH ACTH Prolactin Prolactin Prolactin ProlactinLH , FSH
- Growth- Anabolisme Prolactin
Immune System- Regulation cytokine- IL10, IL12
Corpusluteum Reproductive Function
Stimulate LH progesterone
Inhibit 20α-HSD progesterone
S t r e s s
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Desidua (Maternal)
• Prolaktin didalam Desidua :
1. Implantasi dan plasentasi
- Deferensiasi sel epitel
- Pertumbuhan trofoblast
- Angiogenesis
- Regulasi Immun
2. Gen yang berbahaya untuk kehamilan dilawan
(termasuk IL6 dan 20α-HSD)
• Prolaktin didalam Sirkulasi : Efek pada desidua ?
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Pregnancy
Progesterone
PIBF Progesterone Receptor
Fetomaternal Interface
Th 1 Th 2 Dendritic Cells( IL2, 12, 18, IFNγ, TNF ) ( IL4, 5,6, 10, 13)
Stress
Note : Glucocorticoid ( cortisol ) & 11β-HSD Decidua Progesterone, Prolactin ??
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Diagram manifestasi hormonal akibat stres maternal
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Diagram gangguan keseimbangan hormonal maternal akibat stres
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Managemen Stres pada Kehamilan
• Stres :
1. Berupa fisik, psikik, hormonal,
lingkungan
2. Bersifat berat/ringan, akut/kronis
• Penyakit (kelainan) mental :
akibat dari rangsangan stres yang cukup kuat dan lama.
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Managemen Stres pada Kehamilan
• Terapi Stres :
1. Prinsip menghindari stres
2. Dukungan sosial
3. Konseling
4. Psikoterapi
5. Medikomentosa (untung rugi efek
samping)
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Ringkasan
• Stres interaksi kompleks sistem neuro–endokrin-imun (HPA-HPG-Imun).
• Stres awal kehamilan : 1. Progesterone 2. PIBF 3. Prolactin 4. Th1 cytokines : Th2 cytokines 5. GC (Glucocorticoid / Cortisol) ?
• Berakibat : kegagalan pregnancy or fetal programming
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