Download 15_part_1. Endocrine system Diseases

Diseases of pituitary gland.
Diabetes mellitus.
Diseases of Thyroid glands.
Suprarenal glands diseases.
Endocrine Pancreas diseases.
(V.Voloshyn)
(Frank H. Netter’s illustrations)
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1 Endocrine Function
consists of a number of
organized glands, groups of
cells, and dispersed solitary
cells that control the functional
balance of internal organs by
means of chemical messengers
called hormones.
Because the nervous system
"supervises" the endocrine
organs, particularly the
hypothalamus, it is more
appropriate to speak of the
neuroendocrine system.
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3 Anatomy of Hypophysis
CRH
TRH
LHRH
GHRH
arginine vasopressin
(AVP),
somatostatin,
dopamine
extraneous physical
and emotional stimuli
as well as to internal
feedback control
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2 Endocrine Function II
(TSH), (ACTH), (FSH),
(LH), (ICSH), (LTH),
(STH), (MSH)
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3 Anatomy of Hypophysis
ADHD
and
oxytocin
The adenohypophysis,
which composes
approximately 80% of
the organ, is the major
hormone-producing
part of the pituitary
gland. The epithelial
cells of the
adenohypophysis are
classified as
acidophilic, basophilic,
and chromophobe
cells, depending on
their hormonal
functions.
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4 Acidophil Adenoma
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5 Basophil Adenoma
Cushing syndrome:
truncal obesity with
moon facies,
systemic
hypertension, muscle
weakness (decreased
muscle mass),
hyperglycemia, and
thirst. Osteoporosis,
hirsutism (male-type
hair distribution in
females) and
amenorrhea, mood
swings, and
depression are also
charac teristk
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6 Chromophobe Adenoma
Clinical features differ
according to adenoma type
with signs of hypogonadism
and virilization, acromegaly,
hypothyroidism, and others.
Some adenomas produce
more than 1 hormone
including corticotropins.
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7 Hypopituitarism
by destruction of the gland by tumor metastases, local tumors extending into the sella
turcica, infiltrative processes such as infections (e.g., tuberculosis), metabolic disorders
(e.g., hemochromatosis, Hand-Schiiller-Christian disease), ischemic postpartum
necrosis (Sheehan syndrome), hemorrhagic infarction (pituitary apoplexy), or,
rarely, hypophyseal atrophy secondary to subarachnoid space herniation (empty sella
syndrome).
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8 Diabetes Insipidus
uncontrolled water
diuresis, polyuria, and
polydipsia (excessive
thirst), ensues
is caused by a variety of
processes (head trauma,
infection, neoplasm), but
may cases develop without
recognizable underlying
disease.
Craniopharyngioma, a
dysontogenetic tumor
derived from displaced
epithelium of the Rathke
pouch, is one of the more
common tumors that
compresses and destroys
the neurohypophysis
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9 Physiology of Thyroid Hormones
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10 Hyperthyroidism
diffuse or nodular goiter, Graves
disease,
thyroid adenoma and
carcinomas,
and certain forms of early
thyroiditis
hypothyroidism after
secondary chronic
nonspecific thyroiditis
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11 Congenital Hypothyroidism
and Myxedema
Hypothyroidism -- a reduction
of the physiologic thyroid
function with respectively
reduced thyroid hormone
excretion
Congenital hypothyroidism - to developmental defects and
may occur endemically. In
addition, there exists a sporadic,
intrauterine post-inflammatory
or post-toxic hypothyroidism
with unresponsiveness of the
thyroid gland to TSH stimuli and
deficient thyroid hormone
synthesis.
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11 Congenital
Hypothyroidism
and Myxedema
(continued)
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Laboratory tests
Primary Myxedema
Pituitary Myxedema
PBI and BEI; low-no rise after TSH
Low, but rise after TSH
I"1; 24-hour uptake low—no rise after TSH
Low, but rise after TSH
Cholesterol; elevated (usually)
Normal (usually)
Uric acid; elevated in males and
postmenopausal females
Same
Urinary gonadotropins; positive
Absent
17-Ketosteroids; low
Lower
BMR; usually low, but very variable
Same
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12 Goiter
Goiter (struma) refers to an
enlargement of the thyroid related
to either hyperthyroidism or
hypothyroidism. Goiter in
combination with
hyperthyroidism, as is seen in
Plummer syndrome (toxic goiter), is
usually autonomous but not
cancerous
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13 Thyroiditis
Forms of primary
thyroiditis
Lymphofollicular thyroiditis
(Hashimoto
thyroiditis),
chronic
Granulomatous thyroiditis (de
Quervain
thyroiditis),
subacute
Chronic sclerosing thyroiditis
(Riedel thyroiditis)
Painless subacute thyroiditis
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PRIMARY INFLAMMATION OF
THE THYROID GLAND
Entity
Lymphofollicular
thyroiditis
(Hashimoto
thyroiditis), chronic
Pathology
Pathogenesis
Lymphocytic/plasmacellular
T-cell autoimmune reaction
infiltrate with lymph follicles, (TPO,
TMA),
genetic
follicle
destruction,
oxyphilic predisposition
metaplasia of follicle cells (Hurthle
or Askanazy cells)
Microfocal neutrophilic
Granulomatous
thyroiditis
(de infiltrates, follicle destruction with
Quervain
secondary
giant
cell
thyroiditis),
granulomatous reaction, marked
subacute
lymphoplasmacellular infiltrates
Eg, virus infection: coxsackie,
adenovirus, mumps, and
others,
secondarily
autoimmune
Chronic sclerosing Lymphocytic
thyroiditis
with Suggestively autoimmune!
thyroiditis
(Riedel progressive glandular atrophy and
thyroiditis)
fibrosis extending to adjacent
tissues
Painless subacute Lymphocytic
infiltrates
with Unknown
thyroiditis
eventual follicular destruction, associated
usually self-limited, hyperthyroid
HLA-DR3
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14 Thyroid Adenomas
and carcinoma
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TYPES OF THYROID CARCINOMA
Prognosis1
Carcinoma
Frequenc Pathology and Spread
y*
Papillary
carcinoma
Approxim
ately
80%
Solitary or multifocal lesions with 10-year survival 90%
papillary
structures
and
(in
younger
ground glass "empty" nuclei;
persons)
preferentially lymphatic spread
Follicular
carcinoma
Approxim
ately
15%
Infiltrative follicular structures 10-year survival 85%
without ground glass nuclei;
(early
cancer);
preferentially hematogenous
45% in invasive
spread
form
Medullary
Up to 5%
carcinoma
originate
from C cells
Solitary or multifocal lesions with 5-year survival <10%
pale round or spindle cells and
stromal amyloid deposits;
hematogenous and lymphatic
spread
Anaplastic
carcinoma
Highly anaplastic: pleomorphic 5-year survival <10%
with giant cells or spindle
cells,
sarcomatous
appearance;
rapid
hematogenous metastases
Rare
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Parathyroid Glands
15 Hyperparathyroidism
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16 Hypoparathyroidism
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Adrenal Cortex
17 Anatomy and Hyperplasia
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18 Adrenogenital Syndrome
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19 Hyperaldosteronism
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20 Acute Adrenal
Cortical Insufficiency
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21 Chronic Adrenal
Cortical Insufficiency
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Adrenal Medulla
CLASSIFICATION OF MULTIPLE ENDOCRINE
NEOPLASIA
Type
Synonym
MEN type I Wermer
syndrome
Pathologyt
Adenomas
Pituitary
Parathyroid
Pancreatic islet cells
(insulinomas,
gastrinomas,
syndrome) Hyperplasia
Parathyroid
Adrenal cortex
Thyroid C cells Neoplasia
Pancreatic islet cell carcinoma
Zollinger-Ellison
MEN type Sipple syndrome
II (Ma)
Hyperplasia
Parathyroid Neoplasia
Thyroid medullary carcinoma
Pheochromocytoma
MEN type Mucosal
III (lib)
neuroma
syndrome
Neoplasia
Pheochromocytoma Thyroid medullary
Mucocutaneous ganglioneuroma
carcinoma
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22 Pheochromocytomas
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Endocrine Pancreas
23 Hyperinsulinism
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24 Insulin-Dependent
Diabetes Mellitus
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25 Non-Insulin-Dependent
Diabetes Mellitus
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THE END
Thank
You!!!
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