Endocrine System

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Ductless glands

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Endocrine glands - hormones secreted into blood or extracellular space

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Endocrine effect

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Hormones released into circulation act on distant organs

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Pituitary gland location

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Sella turcica (intracranial, indentation of the base of cranium)

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Pituitary gland structure

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Anterior and posterior, connected to hypothalamus via a stalk of neurons and vessels

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Adenohypophysis

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Anterior pituitary

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5 cell types of anterior pituitary

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GH, PRL, ACTH, LH and FSH, TSH

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Regulation of anterior pituitary secretion

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Positive stimulation from hypothalamus, and negative feedback inhibition from hormones produced by the target endocrine cells (thyroid, adrenals, gonads)

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Neurohypophysis

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Posterior pituitary

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Posterior pituitary hormones

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Oxytocin (pitressin) and ADH

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Posterior vs anterior pituitary hormones

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Anterior hormones are trophic, while posterior hormones are not

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Trophic

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Stimulates functions of other endocrine glands

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Oxytocin

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Stimulates contraction of pregnant uterus

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Thyroid gland structure

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2 butterfly-shaped lobes connected by narrow band of tissue called the isthmus

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Thyroid location

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In the neck

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2 types of thyroid cells

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Follicular cells and C cells

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Follicular cells

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Secrete thyroid hormones: T4 (thyroxine) and T3 (triidothyronine)

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T3 and T4 secretion regulated by

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TSH

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T3 and T4 essential for maintaining

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The intermediate metabolism

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C cells

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Secrete calcitonin, polypeptide involved in calcium homeostasis

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Calcitonin secretion influenced by

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Concentration of calcium in serum

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Exocrine

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Secretion via duct into GI system

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Syndrome

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Group of symptoms common to several diseases

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Disease

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Specific cause unknown

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Hypertrophy

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Grow in size due to constant stimulus

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Autonomous

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With no feedback control

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Primary

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Disease caused within the gland

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Secondary

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Caused by something external

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Tertiary

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Secondary becomes autonomous

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Pituitary function regulated by

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Hypothalamic releasing factors

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GnRH

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Gonadotropin releasing hormone, example of a hypothalamic releasing factor

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Effect on thyroid when over-stimulated by TSH

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Enlarges and becomes nodular

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ACTH over-stimulation of adrenal cortex

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Adrenocortical hyperplasia

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Hypodunction of endocrine glands usually attributable to

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Destruction of secretory cells (through inflammation, tumors, medical interventions)

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Bitemporal hemianopsia

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Bilateral loss of peripheral vision due to enlarged pituitary compressing optic nerve

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Tumor of one endocrine gland may be associated with

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Neoplasia and/or hyperplasia of other glands

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MEN

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Multiple endocrine neoplasia - hereditary

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Pituitary hyperfunction enlargement may be attributable to

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Macroscopic or microscopic adenomas (benign tumors) composed of one or more cell types

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Prolactinomas are

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Tumors composed of lactotropic cells - most common

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Somatotropic and corticotropic adenomas

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Less common than prolactinomas

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Tumors of TSH-, LH-, or FSH-secreting cells

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Extremely rare

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Panhypopituitarism (Simmonds' disease)

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Hypofunction of all pituitary cells - weakness - also dwarfism in children

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Diabetes insipidus

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Lack of ADH secondary to destructive lesions - patients secrete large amounts of hypotopic urine

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Pituitary dwarfism

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GH deficiency in children

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Single GH deficiency in adults

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No disease

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Hypopit syndrome

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Multiple GH deficiency in adults

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Gigantism

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GH excess in children

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Acromegaly

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GH excess in adults - enlargement of acral part of extremities

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Cushing's disease

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ACTH hyperfunction

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Stimulation test used when

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Hypofunction is suspected

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Suppression test used when

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Hyperfunction is suspected

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TRH

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Thyrotropin releasing hormone - released from hypothalamus to anterior pituitary

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Grave's disease can cause

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Hyperthyroidism from thyroid overactivity

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Hashimoto's disease can cause

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Goitrous hypothyroidism

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Primary hyperthyroid

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High T4, low TSH

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Secondary hyperthyroid

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High T4, high TSH

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Primary hypothyroid

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Low T4, high TSH

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Secondary hyperthyroid

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Low T4, low TSH

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What type of thyroid carcinoma does not originate from follicular cells?

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Medullary carinomas

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Papillary carcinoma

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Most common, low-grade, hormonally inactive, cold nodule on radioscans, metastasizes to local lymph nodes, mostly female, occurs relatively early, favorable prognosis

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Follicular carcinoma

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Less common than papillary, most patients older and female, more aggressive than papillary, still good prognosis. Clinically presents as slowly growing nodule

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Medullary carcinoma

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Derived from C cells instead of follicular cells, produce calcitonin, round or oval neuroendocrine cells arranged into groups and nests, good prognosis if familial and discovered early and removed, less favorable if sporadic (in older patients)

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Anaplastic carcinoma

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Originates from follicular cells, rare, extremely unfavorable prognosis, tumors composed of undifferentiated, large or small tumor cells that bear not resemblance to normal thyroid cells