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DANYLO HALYTSKI LVIV NATIONAL MEDICAL UNIVERSITY
DEPARTMENT OF PATHOPHYSIOLOGY
Methodical guide
for English-speaking students 3 rd – year in studying
of General medicine in practical training
on the theme
“Pathophysiology of endocrine system.”
On the subject Pathological Physiology
Lviv-2014
3
DANYLO HALYTSKYI NATIONAL MEDICAL UNIVERSITY OF LVIV
DEPARTMENT OF PATHOPHYSIOLOGY
Methodical guide
for English-speaking students 3 rd – year in studying
of General medicine in practical training
on the theme
“Pathophysiology of endocrine system.”
On the subject Pathological Physiology
Subject
Pathological physiology
Module 2
Pathophysiology of organs and systems.
Year of study
3rd
Faculty
Medical
Lviv-2014
4
Methodical instructions for practical classes in pathological physiology - section
“Pathophysiology of endocrine system” intended for medical students have been
prepared by: Prof. M.S.Reheda MD, assist. prof. Sementsiv N.G., assist. prof. M.A.
Kolishetska, assist. prof. Baida M.L.
Methodical guide for practical training of medical students on the theme ˝
Pathophysiology of endocrine system.˝ is compiled in accordance with the demands of
typical curriculum program on pathophysiology syllabus for the students of higher
educational medical establishments of the ІІ-ІІІ levels of accreditation, Kyiv 2006.
Reviewed by :
Associate professor
of the Department of Pathological Anatomy
with the course of Forensic Medicine
of Danylo Halytski Lviv National Medical University
Servetnyk M.I.
Associate professor
of the Department of Pharmacology
of Danylo Halytski Lviv National Medical University
Havryluk I.M.
Associate professor
head of the Department of Foreign languages
of Danylo Halytski Lviv National Medical University
Isayeva O.S.
Approved and recommended for publication at the sitling of the Cycle Methodical
Commission in Danylo Halytski Lviv National Medical University
Proceedings №1
2014
5
Pathophysiology of endocrine system.
I. SIGNIFICANCE OF THE THEME
The endocrine system relates the most important regulatory systems. It carries out
regulatory influence with the help of hormones practically on all functions of an
organism – metabolism , growth, reproduction, mental activity, adaptation, functional
activity of all organs.
The endocrine system contains a highly integrated and widely distributed group of
organs that orchestrates a state of metabolic equilibrium, or homeostasis, between the
various tissues of the body. Signaling by extracellular secreted molecules can be
classified into three types: autocrine, paracrine, or endocrine, based on the distance over
which the signal acts. In endocrine signaling, the secreted molecules, which are
frequently called hormones, act on target cells distant from their site of synthesis. An
endocrine hormone is frequently carried by the blood from its site of release to its target.
Increased activity of the target tissue often down-regulates the activity of the gland that
secretes the stimulating hormone, a process known as feedback inhibition.
Several processes may disturb the normal activity of the endocrine system,
including impaired synthesis or release of hormones, abnormal interactions between
hormones and their target tissues, and abnormal responses of target organs to their
hormones. Endocrine diseases can be generally classified as diseases of underproduction
or overproduction of hormones and their resulting biochemical and clinical
consequences, and diseases associated with the development of mass lesions, which may
be nonfunctional or may be associated with overproduction or underproduction of
hormones. The study of endocrine diseases requires integration of morphologic findings
with biochemical measurements of the levels of hormones, their regulators, and other
metabolites.
II. CONCRETE TEACHING GOALS
Students have to:
1. Know the main etiological factors and mechanisms of the functional activity of
endocrine glands violations.
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2. Know the role of the hypothalamic-pituitary-adrenal system for nonspecific
resistance of the organism. (H. Selie theory)
3. The role of the genetic factors and infant infection in endocrine pathology
creation; dependence of endocrine violations on human age.
4. The role of intoxication, infection and quantitative changes of content of some
food minerals and environment minerals in an etiology of endocrine diseases.
5. Know the main hypothalamic and pituitary syndromes, to explain their
development.
6. Reproduct Gally-Maininy and Torn reactions and to explain the contact character
between the pituitary and peripheral glands in normal and pathological conditions
on the base of the results.
7. Define the pathological disease and protective and adaptive disease in case of
different endocrine violations.
III. BASIC KNOWLEDGE, ABILITIES AND SKILLS NECESSARY TO COMPREHEND
THE THEME (interdisciplinary integration)
Names of previous subjects
Normal anatomy
Histology
Normal physiology
Obtained knowledge and skills
Structural and functional features of
endocrine glands.
Kinds, properties and mechanisms of
hormonal action.
IV. ASSIGNMENTS FOR INDEPENDENT WORK TO BE DONE WHILE
PREPARING FOR THE PRACTICAL CLASS
1. Basic terms, parameters and characteristics necessary to learn while
preparing for the practical class
№
1
2
3
4
Term
Endocrine glands
Definition
Special composites of secretory cells that create
and secrete their specific products – hormones into
the blood.
Hormones
Biologically active substances; their genesis is
nonprotein or protein; they are secreted by special
cells groups and separated organs; they are
contained in the blood and they make distant effects
on target cells
Endocrine hyperfunction Increasing the production of hormones by the
endocrine glands.
Endocrine hypofunction Decreasing in hormone production
7
5
Endocrine dysfunction
6
Stress
7
8
General adaptation
syndrome
Adaptation diseases
9
10
Hypopituyitarism
Panhypopituyitarism
11
12
Hyperpituyitarism
Hyperaldosteronism
13
14
Goiter
Hypothyroidism
15
Hyperthyroidism
Discordant changes in the endocrine glands
function.
Stressful state of non-specific adaptation
mechanisms that is caused in case of pathogen
factors action for organism.
Stress that is a complex of structural, functional and
biochemical changes.
Diseases that are caused by excessive stress and
stress injury mechanism.
Hypofunction of adenohypophysis
Decreasing of the adenohypophysis hormones
creation.
Hyperfunction of adenohypophysis
Pathological state that is resulted from the
hyperfunction of adrenal cortex glomerular zone.
A great increasing of the thyroid
State in case of deficiency of thyroid hormones in
the body
Syndrome after increasing of thyroid function
2. Theoretical questions for the practical class:
1. General characteristic of functional activity of endocrine system violations:
hyperfunction, hypofunction, glands dysfunction, primary and secondary
endocrinopathies.
2. Reasons of creation and development mechanism of endocrinopathies.
3. Knowledge about stress as nonspecific, stereotyped adaptive reaction to stimulator
actions. Development levels of general adaptation syndrome. Long-term adaptation
mechanisms. Knowledge about stress injuries and “adaptation diseases”.
Preventing principles of stress injuries.
4. Dysregulatory endocrinopathies: nervous, endocrine neuroendocrine and metabolic
regulation
of
the
endocrine
glands
violation.
Forward
and
backward
communications regulatory violation.
5. Glandular endocrinopathies: reasons and mechanisms of the synthesis, deposition
and hormones secretion violation.
6. Peripheral disorders of endocrine function. Violation of the hormonal
transportation and metabolic inactivation.
8
7. Hormonal reception violation, mechanisms of desensitization and hormonal
resistance (prereceptor, receptor, postreceptor).
8. Hypothalamic-pituitary system pathology. Reasons and development mechanisms
of the pituitary hormones excess and deficiency syndrome.
9. The main characteristic of such system activity violation as hypothalamic-pituitarythyroid, hypothalamic-pituitary-adrenal, hypothalamic-pituitary- gonadal.
10.Etiology, pathogenesis, clinical manifestations of panhypopituitarism.
11.Reasons, mechanisms and clinical manifestations of partial deficiency of hormones
of the adenohypophysis. (HGH, TSH, ACTH, gonadotropins).
12.Etiology, pathogenesis, clinical manifestations of partial overactivity of
adenohypophysis (HGH, TSH, ACTH, gonadotropins, prolactin).
13.The neurohypophysis pathophysiology. Diabetes insipidus: reasons, mechanisms
and clinical manifestations.
14.Adrenal glands pathology. An insufficiency of the adrenal gland cortex: types
(primary,
secondary,
acute,
chronic),
etiology,
pathogenesis,
clinical
manifestations.
15.Hyperfunction of the adrenal gland cortex: types (primary, secondary), etiology,
pathogenesis,
clinical
manifestations.
Itsenko-Cushing
syndrome,
Conn's
syndrome, adrenogenital syndrome.
16.Types, reasons, mechanisms and clinical manifestations of an activity of the
adrenal medulla violation.
17.Thyroid pathologies. Hypothyroidism: reasons, mechanisms and pathogenesis of
the main violations in organism.
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18.Hyperthyroidism: reasons, mechanisms and pathogenesis of the main violations in
organism.
19.Goiter: types (endemic, sporadic, nodular and diffuse toxic), their etiology and
pathogenesis; violations of gland functions.
20.Violations of parathyroid glands functions: types, reasons, mechanisms, clinical
and pathophysiological manifestations.
21.Violations of genital glands functions: primary and secondary states of
hypogonadism
and
hypergonadism.
Reasons,
mechanisms,
extragenital
manifestations of genital glands functions violations.
22.Violations of an endocrine function of the pancreas.
23.Epiphysis pathology: hypofunction, hyperfunction, the main manifestations.
24.Principles of diagnosis and treatment methods of endocrine glands pathology.
3. Practical work (assignments) to be done during the class:
Test 1. To investigate the changes of the functional state of the adrenal cortex
in case of stressful situation. (Thorne’s sample)
Task
Prescription
Determine the number of eosinophilic
The granules are colored in black,
3
granulocytes in the rat at 1 mm of blood. cytoplasm becomes in pink color.
Collect blood from the tail vein in to
melanger for counting leukocytes to the
level of 0,5. Dilute liquid Winckelmann
to the level of 11.
Eosinophils are counted in the FuchsRosenthal chamber. The result is
multiplied by 6.25. It is multiplied by 50
in the Hemocytometer(Goriaeva
chamber). For making the result at
International System of Units, to multiply
it by 106 granulocytes.
Provide a cold stress to the rat. Put it into
the refrigerator with temperature +4o C in
10
30 minutes. Then determine the number
of eosinophilic granulocytes in this rat
again.
Show the result in the chart. Notice the
number of eosinophilic granulocytes in
the rat’s blood before and after cold
stress.
Explain an eozynopenic reaction’s
mechanism in case of stress. Write about
reaction’s absence and reaction’s changes
in case of an adrenal cortical substance
hall’s hypo- and hyperfunction.
Make a decision.
Test 2.
To investigate a gonadotrophins influence on the frog’s
spermatogenesis. (Galli-Mainini reaction).
Task
Examine the frog’s cloacal contents for
the spermatozoon presence.
Prescription
Pour a drop of cloacal contents on the
substantive glass. At first observe it
under low microscope magnification
(×10), then under high microscope
magnification (×40).
When spermatozoons are absent to enter Enter the urine into dorsal lymph sac in
the first frog 4-5ml of pregnant
the direction from the head to the hind
women’s urine, to use the second frog
limbs.
for a control
Investigate the cloacal contents in an
hour.
Omit a condenser.
Show result as a picture. Make a
decision.
Explain an appearance of
spermatozoons in male frog using the
pregnant women’s urine.
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V. CONTENT OF THE THEME
Disorders of endocrine gland regulation
Regulation of endocrine gland activity can be carried out with the help of four
mechanisms:
1. Nervous (impulse-mediators) or parahypophysis regulation. With the help of
direct nervous influences the activity of following structures is regulated: а) adrenal
medulla; b) neuroendocrine structures of hypothalamus; c) epiphysis.
2. Neuroendocrine or transhypophysar regulation. It is carried out by
neuroendocrine cells of hypothalamus, which transform nervous impulses in specific
endocrine
process.
Along
releasing-hormones,
which
regulate
activity
of
adenohypophysis are synthesized and get secreted in the system of portal vessels of
hypophysis .
3. Endocrine regulation. It is that some hormones influence on synthesis and other
influence secretion of the others. An example of this mechanism is the influence of
adenohypophysis tropic hormons on activity of adrenal cortex, thyroid gland, sexual
glands.
4. Non-endocrine humoral regulation is carried out by unspecific humoral factors,
in particular by metabolites, ions.
Structure-logical scheme 1
12
Hereditary
disorders
of
endocrine
gland
structure
and
biosynthes
is of
hormones
Pathophysiology of endocrine system
Hyperfunction
Dysfunction
Trauma
Disorders of biosynthesis
and secretion of hormones
Tumor
Autoimmune
aggression
Intoxication
Infection
Vascular
disorders
(thrombosis)
Disorders of central
regulation of endocrine
function
Infl
am
mati
on
Hypofunction
Disorders of transport,
metabolism and biological
action of hormone
Disorders of the intracellular
messengers
Disorders of inactivation of
hormones and their
metabolism in the liver and in
the tissues
Disorders of binding of
hormones with blood proteins
Hereditary
Acquired
Disorder of hypothalamus
regulation and mechanism
of reverse connections
Disorder of cortex
regulation, emotion
VI. MATERIALS FOR SELFCONTROL
A. Assignments for self-control
№
Assignments
Instructions for the assignments
1
Point the main reasons of the genetic Point 5-6 defects.
damage to the thyroid hormones synthesis.
2
Mechanism of the autoimmune thyroiditis Show as a scheme.
development.
3
Give an example of diseases that are Write what exchange is violated
connected with an adrenal cortex hypo- or at this pathology.
hyper-function.
4
Point the syndromes that are connected Write hormones and diseases
with hypophysis affection.
5
Explain the diabetes insipidus symptoms. Write
symptom
and
its
mechanism.
13
6
Characterize the stages of the general 3 stress stages and the main
adaptation syndrome
pathogenetic processes that may
cause to the adaptation diseases.
B. Tasks for self-control:
Task 1. A patient aged 23 complains of headache, changes of his appearance (increase of
size of feet, fingers, features of the face), hoarseness of the voice, worsening of the
memory. The disease has begun 3 years ago without any causes. Increase of superciliarry
arches, nose, and tongue were found during physical examination of this patient; the
blood sugar was normal; the urinalysis is out of changes.
What pathology develops in this patient?
Task 2. A women aged 44 complains of general malaise, pain in the heart area, and
considerable increase of body weight. At examination of this patient following symptoms
are revealed: lunar face, hirsutism, BP 165/100 mmHg, height is 164 cm, weight is
103kg, the adipose deposits mainly on the neck, shoulders, abdomen, persistent
hyperglycemia.
What is the mechanism of hyperglycemia in this case?
Task 3. A woman complains of increased irritability, perspiration, weakness, loss of
body weight, tremor of extremities, increased heartbeat rate, and exophthalmia.
What endocrine gland functions are impaired and what direction in?
Task 4. In a patient excessive development of bones and soft tissues of his face,
enlargement of his tongue, and widened interspaces between teeth in enlarged teeth arch
were found out.
What is called this pathology?
Task 5. Persistent hyperglycemia developed in a patient with Cushing’s syndrome under
the influence of excessive amount of glucocorticoids.
What are the difference between Cushing’s syndrome and Cushing’s disease?
Task 6. A patient aged 41 complains of weakness, sweating, fever, tremor of hands, BP160/90 mm Hg. Diffuse toxic goiter was diagnosed (Basedow’s disease).
What is the leading part of pathogenesis of this state?
Task 7. A patient aged 50 complains of thirst, he drinks much water, has marked
polyuria. His blood glucose - 4.8 mmol/L, glucose and acetone bodies are absent in the
urine; urine is colourless, its specific gravity - 1.002-1.004.
What pathology does this patient suffers from?
Task 8. A woman aged 40 complains of general malaise, pain in the heart area, increase
of body weight. At examination of the patient: she is 164 cm height and 104 kg weight;
she has predominant deposits of fat at face, neck, shoulders, and abdomen; her BP –
165/100 mmHg; content of glucose in her blood – 7.8 mmol/L.
14
What pathology develops in this patient and what hormone secretion is connected with?
Task 9. After physic exertion a patient with with pheochromocytoma complains of
tachycardia, increased arterial pressure, and sharp pain in epigastric area.
What is origin of this tumor?
Task 10. The examined has the following results of glucose-tolerance test: level of
sugar in blood fasting is 7.0 mmol/l, in 1 hour after reception of glucose it equals to 8,8
mmol/l, in 2 hours after reception of glucose – 7.2 mmol/l.
What do these results testify about?
Task 11. The experimental models of diabetes mellitus are received by the way of
pancreas removal, introduction of allocsan, somatotropic hormone, glucagon.
In what cases does absolute insulin insufficiency is occurred in what - relative?
Task 12. Parathyreoid gland are removed during the operation on thyroid gland.
What pathological state will be the consequence of this operation?
Task 13. A woman with primary hyperparathyroidism has periodically repeated attacks
of renal colic. Ultrasound examination shows presence of small stones in her kidneys.
What is the cause of the formation of these stones?
C.Tests for self-control:
1. The height of an adult is 100cm, in proportional constitution and normal mental
development. What hormone insufficiency do the indicated signs characterize?
A. Growth hormone
B. Thyroxin
C. Antidiuretic
D. Mineralocorticoids
E. Gonadotropic hormone.
2. Under the influence of harmful ecological factors the normal formation of
lysosomes is inhibited in thyrocytes. What stage of hormone production of thyroid
gland will be impaired?
A. Synthesis of colloid
B. Iodinisation of colloid
C. Synthesis of thyroglobulin
D. Reabsorption of colloid
E. Proteolysis of phagocytosed colloid from follicles.
3. Diabetes insipidus appeared in a patient after cerebral infarction with
impairment of hypothalamus nuclei. What is the cause for increased urination in
this patient?
A. Decrease of reabsorption of sodium
B. Acceleration of glomerular filtration
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C. Decrease of water reabsorption
D. Decrease of arterial pressure
E. Hyperglycemia
4. What hormone stimulates inclusion of calcium in osteoblasts of bone tissue in
tooth?
A. Insulin
B. Thyroxin
C. Parathormone
D. Hydrocortisone
E. Calcitonin
5. A 10-year-old child has a height of 178 cm and weight of 64 kg. What
endocrine gland disorder does this connected with?
A. Sexual glands
B. Adrenal glands
C. Parathyroid glands
D. Pituitary gland
E. Thyroid gland.
6. A patient with thyrotoxicosis has hyperthermia, bulimia, and loss of weight.
What kind of impairment does this connected to?
A. Reaction of fat synthesis
B. Lyses of adenosintriposphoric acid
C. Conjunction oxidation and phosphorylation
D. Reaction of citric acid cycle
E. Reaction of beta-oxidation of fatty acid.
7. During an experiment on animals the nervous tracts leading to the crus of
hypophysis were broken. That impaired the entrance of the fallowing hormones
into the blood.
A. Hypophysis hormones
B. Vasopressin and oxytocin
C. Adenohypophysis hormone
D. Thyrotropic hormone
E. Adenocorticotropic hormone
8. A careless student suddenly meets his dean. What hormone concentration will
be increased in student’s blood more rapidly?
A. Somatotropin
B. Hydrocortisone
C. Corticotropin
D. Thyroliberine
E. Adrenalin
16
9. A women aged 44 complains of general malaise, pain in the heart area, and
considerable increase of body weight. At examination of this patient following
symptoms are revealed: lunar face, hirsutism, BP 165/100 mmHg, height is 164
cm, weight is 103kg, the adipose deposits mainly on the neck, shoulders,
abdomen. What is the main pathogenic mechanism of the woman’s obesity?
A. Decrease of thyroid hormone production
B. Decrease of glycogen production
C. Increase of glucocorticoid production
D. Increase of insulin production
E. Increase of minerelocorticoid production.
10. A child has a time disturbance of teeth eruption, enamel anomalies, and its lips
and tongue are enlarged. What hormone deficiency causes these changes?
A. Thyroxin
B. Parathormone
C. Thyrocalcitonin
D. Insulin
E. Somatotropin
11. At clinical examination of a woman it was determined increase of basal
metabolism rate by 40%, increased perspiration, tachycardia, and leanness. What
endocrine gland functions are impaired and what direction in?
A. Sexual glands, hypofunction
B. Cortical substance of adrenal glands, hyperfunction
C. Medulla of adrenal glands, hyperfunction
D. Thyroid gland, hyperfunction
E. Pancreatic gland, hyperfunction
12. A young man aged 17 has the signs of retention of sexual development; his
height is 184 cm; he is asthenic; his secondary sexual characters are weakly
developed. Sex chromatin is absent in this patient’s cells. At the age of 4 he
endured epidemic parotitis. What was the cause of hypogonodism?
A. Deficiency of gonadoliberine
B. Deficiency of gonadotropin
C. Cryptorchism
D. Orchitis
E. Chromosomal anomalies (XXY)
13. A patient aged 20 complains of polydipsia and abundant urination (up to 10
liters for 24 hrs); concentration of glucose in his blood is normal; in his urine
glucose is absent. What hormone absence may cause such clinical picture?
A. Oxytocin
B. Vasopressin
C. Insulin
D. Hydrocortisone
17
E. Triiodothyronine
14. A woman with primary hyperparathyroidism has periodically repeated attacks
of renal colic. Ultrasound examination shows presence of small stones in her
kidneys. What is the cause of the formation of these stones?
A. Hypercholesterolemia
B. Hyperuricemia
C. Hyperkalemia
D. Hyperphosphatemia
E. Hypercalcemia
15. Substances which imitate morphine effects but which are produced in CNS
may be used for analgesia. Indicate them:
A. Somatotropin
B. Oxytocin
C. Beta-endorphin
D. Vasopressin
E. Calcitonin
16. Dilated pupils, dryness of mucous membranes, accelerated heart rate,
constipation, and tremor are observed in some people during emotional exertion.
What system activation will lead to such changes in the organism?
A. Pituitary-adrenal system
B. Sympathetic nervous system
C. Sympathoadrenal system
D. Somatic nervous system
E. Parasympathetic nervous system
17. In ancient India those people who were suspected in committing crimes were
given swallow a handful of dry rice. Criminals couldn’t swallow rice due to
decreased salivation (oligosalivation) caused by:
A. Decrease of blood supply of salivary glands
B. Activation of sympathoadrenal system
C. Activation of parasympathetic nucleus of glossopharyngeal nerve
D. Inhibition of sympathoadrenal system
E. Activation of parasympathetic nucleus of facial nerve
18. A patient aged 23 complains of headache, changes of his appearance (increase
of size of feet, fingers, features of the face), hoarseness of the voice, worsening of
the memory. The disease has begun 3 years ago without any causes. Increase of
superciliarry arches, nose, and tongue were found during physical examination of
this patient; the blood sugar was normal; the urinalysis is out of changes. What is
the cause of such condition?
A. Excessive production of corticosteroids
B. Excessive production of somatotropin
18
C. Insufficiency of aldosterone
D. Insufficiency of glucagon
E. Insufficiency of thyroxin
19. Adrenalin is used to prolong Novocain action in infiltration anesthesia. What
adrenalin action is this effect connected with?
A. Potentiation of Novocain action at the level of CNS
B. Inhibition of function of nerve ending and conductors
C. Dilatation of vessels
D. Constriction of vessels
E. Inhibition of tissue esterases
20. A patient aged 80 complains of increased appetite, thirst, excretion of large
amount of urine, and worsening of general condition after taking sweet food.
What disease is it?
A. Hypercorticoidism
B. Hyperthyroidism
C. Hypothyroidism
D. Diabetes insipidus
E. Diabetes mellitus
ANSWERS:
1.-A2.-E3.-C4.-E5.-D6.-C7.-B8.-E9.-C10.-A11.-D12.-D13.-B14.-E15.-C16.C17.-B18.-B19.-D20.-E
19