Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Metabolic syndrome wikipedia , lookup
Neuroendocrine tumor wikipedia , lookup
Growth hormone therapy wikipedia , lookup
Hypothalamus wikipedia , lookup
Hyperandrogenism wikipedia , lookup
Signs and symptoms of Graves' disease wikipedia , lookup
Hypopituitarism wikipedia , lookup
Diabetic neuropathy wikipedia , lookup
Diabetic foot ulcer wikipedia , lookup
Hypothyroidism wikipedia , lookup
Pathology of the Endocrine System Zhang Wenyan Department of Pathology Sichuan University 2003 Endocrine System • Endocrine glands(pituitary, thyroid, parathyroid, adrenal gland, pineal body, and islet) • Dispersed neuroendocrine cells(thyroid C cells, gastrointestinal and bronchopulmary neuroendocrine cells ) Purpose of Endocrine System • To maintain a state of homeostasis among the various organs of the body • Endocrine cells secrete hormones to regulate the activity of target organs TRH TSH T3, T4 Abnormal activity of Endocrine System • Impaired synthesis or release of hormones • Abnormal interactions between hormones and their target tissues • Abnormal responses of target organs to their hormones hyperplasia neoplasm inflammation disturbance of blood supply genitics factors over-/underproduction of hormones biochemical consequences hyperplasia, hypertrophy or atrophy of target organs/tissue clinic consequences A proper understanding of endocrine diseases requires a careful integration of morphologic findings with biochemical measurements of the levels of hormones, their regulators, and other metabolites. contents • Pituitary Adenomas • Diseases of Thyroid • Diseases of Adrenal Gland • Diabetes Mellitus Posterior pituitary • Antidiuretic hormone, ADH • Oxytocin, OT Anterior pituitary • Acidophile cell Growth hormone, GH Prolactin, PRL • Basophile cell Thyroid stimulating hormone, TSH Follicle stimulating hormone, FSH Luteinizing hormone, LH Adrenocoticotrophin hormone, ACTH Lipotrophic hormone, LPH • Chromophobe cell Pituitary 1.5×0.9×0.6cm 0.5~0.9g Anterior pituitary Prolactin, PRL Pituitary Adenoma • Benign neoplasm arising from anterior pituitary cells • 25% of all intracranial tumors • 20% of the general population • Their prevalence increases with advancing age • Both sexes are equally affected • They are usually invasive in children Pituitary adenoma Microadenoma • diameter <1cm • 5%~10% of the adults • rare functional Clinical Features • Hyperpituitarism • Hypopituitarism • Local mass effects Gigantism • Growth hormone adenoma occurs before puberty • Generalized increase in body size Acromegaly • Growth hormone adenoma occurs after puberty • Protruding jaw • Broaden lower face • Enlarged hands acromegaly Pituitary Adenomas Diseases of Thyroid Diseases of Adrenal Gland Diabetes Mellitus normal thyroid gland Diseases of Thyroid • hyperthyroidism • hypothyroidism • goiter • thyroiditis • neoplasms of thyroid Hyperthyroidism • Excessive secretion of thyroid hormones • A consequence of an increase in body’s metabolism Clinical Features of Hyperthyroidism • feeling hot • increased sweating • weight loss, with proximal muscle weakness • rapid heart rate, palpitations • atrial fibrillation (occasionally) • diarrhoea • anxiety and restless hyperactivity Diseases of Thyroid • hyperthyroidism • hypothyroidism • goiter • thyroiditis • neoplasms of thyroid Hypothyroidism Decreased production of thyroid hormone • Hypothyroidism present at birth: cretinism • Hypothyroidism present in adults: myxoedema cretinism • mental retardation • short stature • coarse facial features • protruding tongue • umbilical hernia myxoedema Diseases of Thyroid • hyperthyroidism • hypothyroidism • goiter • thyroiditis • neoplasms of thyroid Goiter Simple enlargement of the thyroid • diffuse toxic goiter/Grave’s disease • diffuse nontoxic goiter Diffuse Toxic Goiter/Graves Disease • Excessive secretion of thyroid hormones in the bloodstream • Organ-specific autoimmune disorder • Occurs primarily in younger adults • F︰M=8︰1 Graves disease Histological changes • Hyperplasia of follicular epithelium • Reduction of stored colloid • Local accumulation of lymphocytes Clinical features • Diffuse enlargement of the thyroid • Exophthalmos (protruding eyes) • Hyperthyroidism • Pretibial myxedema exophthalmic goiter Diffuse Nontoxic Goiter / Multinodular Goiter • Most common thyroid disease • Most common cause for an enlarged thyroid Pathogenesis dietary iodine deficiency impairment of thyroid hormone synthesis compensatory rise in the serum TSH level hypertrophy & hyperplasia of thyroid follicular cells gross enlargement of the thyroid gland diffuse nontoxic goiter multinodular goiter multinodular goiter multinodular goiter Clinical features • Neck mass • Compression symptoms airway obstruction dysphagia compression of large vessels compression of upper thorax • normal thyroid function Diseases of Thyroid • hyperthyroidism • hypothyroidism • goiter • thyroiditis • neoplasms of thyroid Hashimoto’s thyroiditis/ chronic lymphocytic thyroiditis anti-thyroglobulin antibody thyroid gland (atrophy) subacute granulomatous thyroiditis (DeQuervain's disease) Clinical features of subacute granulomatous thyroiditis • Painful enlarged thyroid • Self-limited clinical course Diseases of Thyroid • hyperthyroidism • hypothyroidism • goiter • thyroiditis • neoplasms of thyroid Neoplasms of thyroid gland • Range from adenoma to carcinoma • Present with thyroid nodules • Carcinomas of thyroid are uncommon, accounting for under 1% of thyroid nodules Clinical criteria to the nature of a thyroid nodule (Ⅰ) • Solitary nodules are more likely to be neoplastic than are multiple nodules • Solid nodules are more likely to be neoplastic than are cystic nodules • Nodules in younger patients are more likely to be neoplastic than are those in older patients Clinical criteria to the nature of a thyroid nodule (Ⅱ) • Nodules in males are more likely to be neoplastic than are those in females • Nodules that do not take up radioactive iodine in imaging studies ( “cold” nodules ) are more likely to be neoplastic, “hot” nodules are almost benign Thyroid Adenoma follicular adenoma. Thyroid Carcinoma • Papillary carcinoma (75%~85% of cases) • Follicular carcinoma (10%~20% of cases) • Anaplastic carcinoma (5% of cases) • Medullary carcinoma (5% of cases) Papillary Carcinoma Follicular Carcinoma •F Medullary Carcinoma • Neoroendocrine neoplasm derived from parafollicular cells • Secrete carcitonin, the measurement of which play an important role in the diagnosis and postoperation follow-up of patients Medullary carcinoma Congo red staining anaplastic carcinoma anaplastic carcinoma Pituitary Adenomas Diseases of Thyroid Diseases of Adrenal Gland Diabetes Mellitus Hormones of the adrenal gland • Cortex Mineralocorticoid Glucocorticoid Androgen / Estrogen • Medulla Catecholamines (Adrenaline, Noradrenaline) Disorders of Adrenal Gland • Hypercortisolism (Cushing Syndrome) • Adrenocortical Insufficiency • Adrenocortical Neoplasms • Pheochromocytoma Cushing Syndrome The symptoms and signs are associated with prolonged inappropriate elevation of glucocorticoid levels. Forms of Cushing syndrome • Endogenous Cushing syndrome • Exogenous Cushing syndrome Primary hypothalamicpituitary diseases associated with hypersecretion of ACTH Primary adrenocortical hyperplasia or neoplasia The section of ectopic ACTH by nonendocrine neoplasms Administration of exogenous glucocorticoids Clinic features • Central obesity and moon face • Plethora and acne • Menstrual irregularity • Hirsutism and hair thinning • Hypertension • Diabetes • Osteoporosis • Muscle wasting and weakness • Atrophy of skin and dermis: paper thin skin with bruising tendency, purple stride Cushing syndrome Normal Cushing syndrome Disorders of Adrenal Gland • Hypercortisolism (Cushing Syndrome) • Adrenocortical Insufficiency • Adrenocortical Neoplasms • Pheochromocytoma Primary adrenocortical insufficiency • Chronic adrenocortical insufficiency (Addison disease) • Acute adrenocortical insufficiency Clinical features of Addison disease • gastrointestinal disturbances • hyperpigmentation • hyperkalemia • hyponatremia • volume depletion • hypotension Waterhouse-Friderichsen syndrome • Primary acute adrenal insufficiency • Caused by G- (usually meningococcal) septicaemia • Bilateral adrenal hemorrhage Waterhouse-Friderichsen syndrome Disorders of Adrenal Gland • Hypercortisolism (Cushing Syndrome) • Adrenocortical Insufficiency • Adrenocortical Neoplasms • Pheochromocytoma Adrenocortical Neoplasms • Adrenocortical adenoma • Adrenocortical carcinoma 1.3 cm adrenal adenoma adrenocortical adenoma Adrenocortical carcinoma Disorders of Adrenal Gland • Hypercortisolism (Cushing Syndrome) • Adrenocortical Insufficiency • Adrenocortical Neoplasms • Pheochromocytoma Pheochromocytoma Neoplasm composed of chromaffin cells, which synthesize and release catecholamines Rule of 10s • 10% of pheochromocytomas arise in association with one of several familial syndromes • 10% of pheochromocytomas are extra-adrenal • 10% of adrenal pheochromocytomas are bilateral • 10% of adrenal pheochromocytomas are biologically malignant Bilateral pheochromocytoma Clinic features Hypertension an abrupt, precipitous elevation in blood pressure, associated with tachycardia, palpitation, headache, sweating, tremor,and a sense of apprehension Pituitary Adenomas Diseases of Thyroid Diseases of Adrenal Gland Diabetes Mellitus normal pancreatic islet Pancreatic islet • 10%~15% of the pancreatic substance • Each islet contains 1000 cells beta cells alpha cells delta cells PP (pancreatic polypeptide) cells insulin glucagon Diabetes Mellitus, DM Definition A chronic disorder of carbohydrate, fat, and protein metabolism, which is characterized by hyperglycemia due to inadequate insulin action/production Incidence • Affects 13million people in U.S.A. • Annual mortality rate of 35,000 • The seventh leading cause of death in U.S.A. Classification • Type 1 diabetes (insulin-dependent DM, IDDM) immune mediated (type 1A) idiopathic • Type 2 diabetes (non-insulin-dependent DM, NIDDM) • Other specific types of diabetes • Gestational diabetes mellitus Type 1 childhood/adolescent 1/3 F=M acute/subacute thin ketoacidosis common plasma insulin absent/low insulin sensitive autoimmune mechanism genetic predisposition associated with HLA-DR Type 2 middle-aged/elderly 2/3 F>M(by4:1) gradual obese ketoacidosis rare normal/raised insulin insensitive non-autoimmune polygenic inheritance Diagnosis Diagnosis Venous whole blood glucose fasting sample 2hs after 75g glucose load Normal <5.6mmol/l < 6.7mmol/l Impaired < 6.7mmol/l 6.7~10mmol/l glucose tolerance Diabetic mellitus >6.7mmol/l >10mmol/l Morphology & Late Complication • Pancreas • Vascular system • Diabetic microangiopathy • Diabetic nephropathy • Diabetic ocular complications • Diabetic neuropathy Insulitis (type 1 diabetes mellitus) Amyloidosis (type 2 diabetes mellitus) Morphology & Late Complication • Pancreas • Vascular system • Diabetic microangiopathy • Diabetic nephropathy • Diabetic ocular complications • Diabetic neuropathy Late Complication of Vascular System • Accelerated severe atherosclerosis in aorta, large- and medium-sized arteries • Myocardial infarction • Gangrene of the lower extremities • Hyaline arteriolosclerosis Hyaline arteriolosclerosis in afferent arteriole of the kidney Morphology & Late Complication • Pancreas • Vascular system • Diabetic microangiopathy • Diabetic nephropathy • Diabetic ocular complications • Diabetic neuropathy Morphology & Late Complication • Pancreas • Vascular system • Diabetic microangiopathy • Diabetic nephropathy • Diabetic ocular complications • Diabetic neuropathy Diabetic nephropathy • Glomerular lesions thickening of glomerular capillary basement membranes diffuse glomerulosclerosis nodular glomerulosclerosis • Renal vascular lesions arteriolosclerosis • Pyelonephritis diffuse glomerulosclerosis nodular glomerulosclerosis nephrosclerosis Morphology & Late Complication • Pancreas • Vascular system • Diabetic microangiopathy • Diabetic nephropathy • Diabetic ocular complications • Diabetic neuropathy Morphology & Late Complication • Pancreas • Vascular system • Diabetic microangiopathy • Diabetic nephropathy • Diabetic ocular complications • Diabetic neuropathy