Chapter 25 The Endocrine Glands. Learning Objectives (1 of 2) Explain normal physiologic functions...
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Transcript of Chapter 25 The Endocrine Glands. Learning Objectives (1 of 2) Explain normal physiologic functions...
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Chapter 25
The Endocrine Glands
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Learning Objectives (1 of 2)
• Explain normal physiologic functions of pituitary hormones, common endocrine disturbances, and treatment
• Describe major thyroid abnormalities, clinical manifestations, and treatment
• Explain normal physiologic functions of adrenal cortex and medulla, common disturbances, and treatment
• Define causes and effects of parathyroid dysfunction and treatment
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Learning Objectives (2 of 2)
• Discuss concept of ectopic hormone production by nonendocrine tumors
• Explain adverse health effects of obesity, surgical procedures for obesity and their rationale
• Explain stress and its effects on the endocrine system
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Endocrine Glands (1 of 2)
• Major endocrine glands– Pituitary– Thyroid– Parathyroid– Adrenal cortex and medulla– Pancreatic islets– Ovaries and testes
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Endocrine Glands (2 of 2)
• Level of hormone in circulation: controls amount of hormone synthesized and released by an endocrine gland
• Disorders: hypersecretion or hyposecretion• Determination of clinical effects
– Degree of dysfunction– Age and sex of affected individual
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Pituitary Gland (1 of 6)• Suspended by stalk from hypothalamus at base of
brain– Anterior lobe– Intermediate lobe: rudimentary structure– Posterior lobe
• Tropic hormones (regulate other endocrine glands)– Regulated by level of hormone produced by the target
gland– Self-regulating mechanism maintains uniform hormone
output– Prolactin secretion controlled by prolactin inhibitory factor– Thyroid stimulating hormone stimulates release of prolactin
and thyroid hormones
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Pituitary Gland (2 of 6)• Anterior lobe hormones
– Growth hormone: stimulates growth of tissues– Prolactin: stimulates milk production– Thyroid-stimulating hormone (TSH)– Adrenocorticotrophic hormone (ACTH)– Follicle-stimulating hormone (FSH)– Luteinizing hormone (LH)
• Posterior lobe hormones– Antidiuretic hormone (ADH): causes more
concentrated urine– Oxytocin: stimulates uterine contractions and
milk secretion
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Normal mechanisms controlling elaboration of tropic hormones by the pituitary gland
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Pituitary Gland (3 of 6)
• Panhypopituitarism– Anterior lobe fails to secrete all hormones
• Pituitary dwarfism– Deficiency of growth hormone– Causes retarded growth and development
• Diabetes insipidus– Failure of posterior lobe to secrete ADH or failure of
kidney to respond to ADH (nephrogenic diabetes insipidus)
– Unable to absorb H2O– Causes excretion of large amounts of diluted urine– From a pituitary tumor
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Pituitary Gland (4 of 6)
• Growth hormone overproduction– Caused by pituitary adenoma– Causes gigantism in children– Causes acromegaly in adults– May cause visual disturbances from tumor
encroachment in optic chiasm
• Prolactin overproduction– Result of small pituitary adenoma– Also from conditions affecting function of hypothalamus– Causes amenorrhea and galactorrhea (milk secretion
from non-pregnant breasts)
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Pituitary Gland (5 of 6)
• Pituitary tumors– Many pituitary endocrine disturbances caused by
anterior lobe pituitary tumors– Clinical manifestations depend on size of tumor
and the hormone produced• Functional tumors: produce hormones that cause
clinical manifestations• Nonfunctional tumors: do not produce hormones but
exert other effects• May encroach on important structures adjacent to
optic chiasm; disrupt hormone-producing functions of anterior lobe cells
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Pituitary Gland (6 of 6)
• Pituitary tumors– Treatment determined by type, size, and
hormone produced by tumor• Drugs to suppress tumor growth• Surgical resection: usual surgical approach is
through the nasal cavity (transsphenoidal resection)
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Acromegaly© Courtesy of Leonard Crowley, M.D./University of Minnesota Medical School
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Factors regulating prolactin secretion and pathogenesis of amenorrhea-galactorrhea syndrome
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Transsphenoidal resectin of a pituitary tumor
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Thyroid Gland
• Structure– Two lateral lobes connected by isthmus– Composed of thyroid follicles that produce
and store hormones– Hormone production regulated by TSH
(thyroid stimulating hormone)– Parafollicular cells: secrete calcitonin
• Actions– Controls rate of metabolic processes– Required for normal growth and development
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Normal thyroid gland, illustrating two lateral lobes connected by narrow isthmus
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Low-magnification photomicrograph of cellular structure of normal thyroid gland.
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High-magnification photomicrograph of normal thyroid follicles.
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Thyroid Gland
Hyperthyroidism Hypothyroidism
Rapid pulse Slow pulse
Increased metabolism Decreased metabolism
Hyperactive reflexes Sluggish reflexes
Emotional lability Placid and phlegmatic
GI effect: diarrhea GI effect: constipation
Warm, moist skin Cold, dry skin
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Nontoxic Goiter• Thyroid gland enlarges to increase hormone
secretion• Causes
– Inadequate hormone output– Iodine deficiency– Enzyme deficiency– Inefficient enzyme function– Increased hormone requirements
• Treatment: administer thyroid hormone; may need surgical removal
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The pathogenesis of nontoxic goiter
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Hyperthyroidism
• Toxic goiter or Graves disease• Caused by antithyroid antibody that
stimulates gland• Mimics effects of TSH but not subject to
normal control mechanisms• Treatment
– Antithyroid drugs, thyroidectomy, large doses of radioactive iodine
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Toxic Goiter
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Nodular goiter obstructing veins draining blood from head, neck, and chest.
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Large nodular goiter
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Hypothyroidism
• In adult– Myxedema– Causes metabolic slowing– Treatment: administration of thyroid hormone
• In an infant– Cretinism– Causes impaired growth and CNS development– Causes hypometabolism– Early diagnosis and treatment required for normal
development
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The characteristic appearance of neonatal hypothyroidism (cretinism) as a result of a congenital
absence of thryroid gland.
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Myxedema
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Chronic Thyroiditis or Hashimoto Thyroiditis
• Autoantibody destroys thyroid tissue• Results in hypothyroidism• An immunologic reaction, not from an
infection• Cellular infiltration from an immunologic
reaction between antigen and antibody
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Low-magnification photomicrograph of cellular structure in chronic thyroiditis.
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Thyroid Tumors• Benign adenoma• Carcinoma
– Well-differentiated follicular and papillary carcinoma• Good prognosis; treatment by surgical resection
– Poorly-differentiated carcinoma• Poor prognosis; rapidly growing• Treatment: surgery, radiation, chemotherapy
– Medullary carcinoma• Rare, secretes calcitonin
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Radiation and Thyroid Tumors
• Radiation: increases incidence of benign and malignant thyroid tumors after latent period of 5-10 years
• Most tumors are well-differentiated and easily treated
• Persons who received head or neck radiation should have periodic follow-up examinations
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A benign, well-circumscribed adenoma of the thyroid gland (arrows).
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Well-differentiated papillary carcinoma of thyroid. Higher magnification.
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Parathyroid Glands
• Blood calcium level is in equilibrium with calcium in the bone
• Actions: Calcium level: regulated by parathyroid glands– Low calcium in blood: causes tetany (increased
neuromuscular excitability causing spasm of skeletal muscle)
– High calcium in blood: causes lowered neuromuscular excitability
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Hyperparathyroidism• Usually from a hormone-secreting
parathyroid adenoma• Effects
– Hypercalcemia: blood calcium rises– Renal calculi: from excessive calcium excreted
in urine– Calcium deposition in tissues– Decalcification of bone: from excessive
calcium withdrawn from bone• Treatment: Removal of tumor
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Hypoparathyroidism
• Usually from accidental removal of parathyroid glands during thyroid surgery
• Effects– Hypocalcemia: blood calcium falls precipitously– Leads to neuromuscular excitability and tetany
• Treatment: raise calcium levels– High-calcium diet– Supplementary vitamin D
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Adrenal Cortex (1 of 2)
• Adrenals: paired glands above kidneys• Hormones secreted by adrenal cortex
– Glucocorticoids– Mineralocorticoids– Aldosterone: major hormone– Renin-angiotensin system is main stimulus– Sex hormones
• Overproduction of aldosterone– From aldosterone-producing tumor of adrenal cortex– High sodium, blood volume, blood pressure– Low potassium level leading to neuromuscular
manifestations
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Adrenal Cortex (2 of 2)
• Overproduction of adrenal sex hormones– Congenital adrenal hyperplasia– Sex-hormone-producing tumors
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Adrenal Medulla• Produces catecholamines that stimulate the
sympathetic nervous system– Norepinephrine (noradrenaline)– Epinephrine (adrenaline)
• Pheochromocytoma: increased secretion of catecholamines– Produces pronounced CV effects– May cause cerebral hemorrhage from
hypertension– Any emotional stress causes release of
hormones– Treatment: tumor resection
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Biosynthesis of adrenal cortical hormones and the site of enzymatic block leading to overproduction of adrenal
androgens.
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Addison Disease• An adrenal cortical hypofunction• Deficiency of all steroid hormones
– Glucocorticoid deficiency: hypoglycemia– Mineralocorticoid deficiency: lowblood volume
and low blood pressure– Hyperpigmentation: from increased ACTH due
to loss of feedback inhibition• Autoimmune disorder
– Treatment: administration of corticosteroids
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Appearance of hand (right side of photograph) of patient with Addison’s disease compared with hand of normal
subject.
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Cushing Disease
• Excessive production of adrenal corticosteroids– Glucocorticoid excess: disturbed carbohydrate, fat, and
protein metabolism– Mineralocorticoid excess: high blood volume and high
blood pressure– Treatment: tumor removal
• Causes– Hormone-producing pituitary microadenoma– Hormone-producing adrenal cortex adenoma– Hyperplastic adrenal glands– Administration of large amounts of corticosteroid– Other tumors
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Cushing’s disease before treatment.
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Cushing’s disease after treatment.
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Overproduction of Other Adrenal Cortex Hormones
• Overproduction of aldosterone– Aldosterone secreting adenoma
• Overproduction of adrenal sex hormones– Congenital adrenal hyperplasia– Adrenal sex-hormone–producing tumor
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Pancreatic Islets
• Pancreatic tissue that functions as an endocrine gland
• Produce hormones– Beta cells: insulin production– Alpha cells: glucagon– Delta cells: somatostatin
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Gonads
• Function– Production of germ cells– Production of sex hormones: controlled by
gonadotropic hormones of pituitary gland FSH and LH
• Tumors may secrete hormones• Treatment: surgical excision
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Nonendocrine Tumors
• Ectopic hormones: hormones secreted by nonendocrine tumors that are identical with or mimic action of true hormones
• Usual origin: produced by malignant tumors• Lung, pancreas, kidneys, connective tissue
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Stress and Endocrine System
• Stress: any event that disturbs homeostasis• Causes: injury, surgery, prolonged exposure to
cold, vigorous exercise, pain, or strong emotional stimulus such as anxiety or fear
• Acute response to stress– Fear-fight-flight reaction– Mediated by sympathetic nervous system and adrenal
medulla
• Chronic response to stress: alters metabolism, taxes CV system, impairs inflammatory and immune responses– Involves adrenal cortex; predisposes to illness
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Obesity (1 of 2)
• Occurs when caloric intake > requirements
• Usually NOT result of endocrine or metabolic disturbance
• Health consequences– Cardiovascular disease– Diabetes– Cancer– Musculoskeletal problems– Impaired pulmonary function
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Obesity (2 of 2)• Treatment• Medical: diet• Drugs: suppress appetite
– Combination of fenfluramine and phentermine (fen-phen) causes heart valve damage
• Surgery– Ileal bypass: several complications,
infrequently performed– Gastric bypass– Vertical-banded gastroplasty
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Types of Bariatric Surgery
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Discussion
• What are the major hormones produced by the pituitary gland?
• What are the major effects of abnormal output of thyroid hormone?
• What is the usual cause of obesity and its complications?