Endocrinology

Dr. Amani Filimban

1 Endocrinology Dr. Amani Filimban

 Adrenal Gland
• Adrenal Gland
• The adrenal glands name
directly relates to their
location (ad = near or at,
renes = kidneys).
• Location
• The adrenal (or
suprarenal) glands are
two triangular-shaped
organs that measure
about 1.5 inches in
height and 3 inches in
length.
• They are located on top
of each kidney.

2 Endocrinology Dr. Amani Filimban

• Structure
• The gland is surrounded
by a thick connective
tissue capsule, vessels
and nerves.
• The adrenal glands
made up of two parts,
the cortex and the
medulla.

3 Endocrinology Dr. Amani Filimban

• 1-Cortex
• The adrenal cortex is the
outer and main part of the
adrenal glands that is
divided into three zones.
• Zona glomerulosa
• Zona fasciculata
• Zona reticularis

4 Endocrinology Dr. Amani Filimban

• Zona glomerulosa (accounting for about 15% of the
cortical thickness). Cells of the zona glomerulosa are
organised into small rounded groups or curved columns
with dark and round nuclei.
• Cells are smaller than in the two other zones.
5
• Zona fasciculata (accounting for about 75%) consists of
cells arranged in bundles of cords separated by sinusoid
capillaries.
• The nucleus is located centrally and the cytoplasm has a
characteristic spongy appearance that is called spongycyts.
6
• Zona reticularis (accounting for about 10%).
• Cells are typically smaller than in the zona fasciculata.
• The nucleus is large. and the cytoplasm is less spongy
than that of other cells in the cortex.

7
 2-Medulla
• The medulla is an inner
region of the gland
(which accounts for
about 10% of the
adrenal glands).
• Cells are arranged in
small clusters that called
chromaffin cells.
• Chromaffin cells
correspond to the
adrenaline- (80%) and
noradrenaline-
producing cells of the
medulla.
8 Endocrinology Dr. Amani Filimban
 Control of adrenal cortex and medulla

9 Endocrinology Dr. Amani Filimban

 Function Adrenal Cortex Hormones

• 1. Mineralcorticoids is secreted from zona glomerulosa,

the outermost zone of the adrenal cortex .
• These hormones are important for fluid homeostasis.
These include aldosterone, which regulates
absorption/uptake of K+ and Na+ levels in the kidney
and helps control blood pressure.
10 Endocrinology Dr. Amani Filimban
11 Endocrinology Dr. Amani Filimban
 Function
Adrenal Cortex Hormones

• 2. Glucocorticoids is secreted from zona fasciculata, the middle

zone of the adrenal cortex which helps regulate metabolism of
carbohydrate, protein and lipid.
• An example is cortisol which raises blood glucose and cellular
synthesis of glycogen, so it helps the body during stressful
situations and helps maintain the proper glucose concentration in
the blood between meals.
• Cortisol also reduces the inflammatory response and allergic
reactions. 12 Endocrinology Dr. Amani Filimban
13 Endocrinology Dr. Amani Filimban
 Function Adrenal Cortex Hormones

• 3. Sex hormones is secreted from zona reticularis,

the innermost layer of the cortex.
• The adrenal cortex releases small amounts of male
and female sex hormones (such as small amount of
androgens, estrogen and progesterone)
14 Endocrinology Dr. Amani Filimban
15 Endocrinology Dr. Amani Filimban
16 Endocrinology Dr. Amani Filimban
17 Endocrinology Dr. Amani Filimban
18 Endocrinology Dr. Amani Filimban
 Adrenal Medulla Hormones

• Epinephrine (Adrenaline) and Norepinephrine

(Noradrenaline)
• The adrenal medulla produces two
hormones epinephrine and
norepinephrine which are commonly
referred to as the fight-or-flight
hormones because they are prepared the
body for stressful status that demands
vigorous physical activity.
•

19 Endocrinology Dr. Amani Filimban

20 Endocrinology Dr. Amani Filimban
 Adrenal Medulla Hormones
• Epinephrine is secreted in large amounts while
the norepinephrine is secreted in small
amounts.
• In general, epinephrine and norepinephrine
have the same effects on target organs as
direct stimulation by sympathetic nerves and
rapidly responding to stress.

21 Endocrinology Dr. Amani Filimban

22 Endocrinology Dr. Amani Filimban
 • The Major effects during stress situation are:
1- Increased force and rate of contraction of the heart muscle by
epinephrine through beta receptors resulting in increased rushing blood
to the muscles and brain.

23 Endocrinology Dr. Amani Filimban

 • The Major effects during stress situation are:

• 2- Constriction of blood vessels by

norepinephrine causes vasoconstriction, resulting
in increased resistance and high blood pressure.

24 Endocrinology Dr. Amani Filimban

• The Major effects during stress situation are:
• 3. Dilation of bronchioles assists in pulmonary
ventilation.
• 4. Stimulation of breaking down of fat in adipose
tissues and glycogen in skeletal muscle to supply
glucose for energy production and to conserve of blood
glucose.
• 5. Increased metabolic rate thus increase oxygen
consumption and heat production throughout the
body through epinephrine.
• 6. Dilation of the pupils specially, under conditions of
low surrounding light.
• 7. Inhibition of certain processes for example,
inhibition of gastrointestinal secretion and motor
activity.

25 Endocrinology Dr. Amani Filimban

• Control of adrenal gland
• The hypothalamus secretes
corticotropin-releasing hormone
(CRH) to pituitary gland in response to
many types of stress.
• The anterior pituitary gland produces
adrenocorticotropic hormone (ACTH)
that stimulates the adrenal gland to
secrete steroid hormones.
• More specifically, it stimulates
secretion of glucocorticoids such as
cortisol, and has little control over
secretion of aldosterone.
• CRH itself is inhibited by
glucocorticoids hormones
concentration in the blood via
negative feedback loop
26 Endocrinology Dr. Amani Filimban
 Disorders

• The effect of hypophysectomy on adrenal cortex

• Hypophysectomy is the surgical removal of the
pituitary gland. After removal of pituitary gland no
steroidogenesis occurs in the zona fasciculata or
reticularis in cortex, but the zona glomerulosa
continuous to function.
• This status causes atrophy of the adrenal glands
specially the adrenal cortex because hypophesectomy
results in tremendous shrinkage of the cortex
while,the medulla is not influenced by
hypophysectomy
27 Endocrinology Dr. Amani Filimban
 Hyperadrenalism
•
• It is excessive levels of adrenal hormones in the body.
• Cushing’s syndrome
• Cushing’s syndrome is an uncommon status that is caused by
overproduction of the hormone cortisol. There are two reasons for
cushing's syndrome; adrenal cortex tumours and some midication such as
cortisol-like steroid drugs which treat allergies or asthma.

28 Endocrinology Dr. Amani Filimban

 Hyperadrenalism
•
• It is excessive levels of adrenal
hormones in the body.
• Cushing’s syndrome
1. Moon face (Fullness and rounding of
the face).
2. Buffalo hump (Added fat on back of
neck).
3. Skin ulcers (Easy bruising of the skin).
4. Abdominal striae (Purplish stretch
marks on the abdomen).
5. Obesity (Excessive weight gain in the
abdominal region, while the legs and
arms remain thin).
6. Red cheeks.
7. Excess hair growth on the face, neck,
chest, abdomen.
8. Cardiac hypertrophy.
9.
29
Osteoporosis. Endocrinology Dr. Amani Filimban
 Hyperadrenalism
•
• Cushing’s syndrome
• Treatment
• The aim of treatment is to reduce the high level of
cortisol in the body. Treatment options include:
• Surgery by using complete surgical removal for
tumors.
• Reducing midication use and reducing the dosage of
the drug over a period of time.

30 Endocrinology Dr. Amani Filimban

 Hypoadrenalism

31 Endocrinology Dr. Amani Filimban

32 Endocrinology Dr. Amani Filimban
33 Endocrinology Dr. Amani Filimban
1 Endocrinology Dr. Amani Filimban
 Parathyroid Gland

• Location
• The parathyroid glands
are four tiny glands,
located in the neck on
the posterior surface of
the thyroid gland.
• The size of each gland
weighs approximately
30 milligrams and is 3-4
millimeters in
diameter.

2 Endocrinology Dr. Amani Filimban

 Parathyroid Gland
• Structure
• The parathyroid glands include:
• 1- Parathyroid Gland Capsule, each
parathyroid gland is surrounded by a
thin connective tissue capsule.
• 2- Parathyroid Chief Cells are the
most abundant type. They are small,
a round, light, centrally placed
nucleus and a very weakly acidophilic
cytoplasm. These cells synthesize and
regulate secretion of PTH.
• 3- Oxyntic cells are less frequent.
• They contain large amounts of
mitochondria, the nucleus is small
and a strongly acidophilic cytoplasm.

3 Endocrinology Dr. Amani Filimban

 • Calcium regulation

• There are three hormones

involved in the regulation of
calcium level in the blood:

• 1. Parathyroid hormone (PTH).

• 2. Calcitonin(CT).
• 3. 1, 25 Dihydroxyvitamin D
(the active form of vitamin D).

4 Endocrinology Dr. Amani Filimban

5 Endocrinology Dr. Amani Filimban
6 Endocrinology Dr. Amani Filimban
7 Endocrinology Dr. Amani Filimban
• Function
• Parathyroid hormone (PTH)
• The parathyroid glands produce a hormone
called parathyroid hormone (PTH), which
regulates calcium levels within the blood in a
very narrow range between (8.5 - 10.2 mg/dl).
• When the blood calcium level is too low, PTH
is released to bring the calcium level back up
to normal.
• When the calcium level is normal,
parathyroids will stop releasing PTH.
•
8 Endocrinology Dr. Amani Filimban
• Calcium has many benefits:
1. It is the primary element that
causes muscles to contract
2. Allows the normal conduction
of electrical currents along
nerves, so the nervous and
muscular systems can function
properly.
3. It strengthens the bones.
4. Regulates the heartbeat,
5. It is needed in blood clot
formation

9 Endocrinology Dr. Amani Filimban

• PTH elevates the blood calcium level by:
• 1-Breaking down the bone: PTH acts on a bone (where
most of the body's calcium is stored) by stimulating
osteoclasts to break down bone and release calcium
into the bloodstream.
• 2-Increasing the ability to absorb calcium from food:
PTH acts on the gastrointestinal tract by increasing the
activity of the enzyme in the intestines to absorb
calcium. Vitamin D helps the intestines to absorb
calcium. First the vitamin D must be activated by
parathyroid hormone (PTH). Once activated, vitamin D
acts to highly increase the amount of calcium that
absorbed from food.
• 3-Increasing the kidney's ability to hold on to calcium:
PTH also signals the kidney to reclaim more calcium in
the nephrons before it is excreted in the urine

10 Endocrinology Dr. Amani Filimban

 • Disorders
• 1- Hypoparathyroidism and Hypocalcemia

• Hypoparathyroidism is the condition of decreased secretion of parathyroid

hormone (PTH) which leads to decrease blood levels of calcium (hypocalcemia)
and to increase levels of blood phosphorus (hyperphosphatemia).
• Other causes of hypocalcemia include malnutrition and malabsorption.
• Hypoparathyroidism is caused by destruction of the parathyroid glands by the
immune system, radiation therapy to the neck for thyroid cancer and the
accidental injury to the parathyroid glands during surgery of neck.
• Symptoms
• - The most common sign of hypocalcemia is neuromuscular irritability that
includes the muscle cramps in the legs or arms.
• - A tingling sensation in the hands, feet or around the mouth.
• - Feeling tired, irritable, anxious or depressed.
• - Eye problems.
• - Dry, thick skin.
• - Breaking fingernails easily.

11 Endocrinology Dr. Amani Filimban

• Treatment
• The aim of therapy is to relieve the symptoms
and keep calcium in the normal range.
• Calcium carbonate and vitamin D supplements
usually calcitriol or one alpha can be taken to
restore normal levels. It is also recommended to
follow high calcium and low phosphorus diet.
• Complications
• Hypoparathyroidism can sometimes lead to
stunted growth, slow mental development and
cataracts.

12 Endocrinology Dr. Amani Filimban

• Hyperparathyroidism and Hypercalcaemia
• Hyperparathyroidism is the condition where the
parathyroid glands produce too much PTH that causes
blood calcium levels to rise above normal
(hypercalcaemia) and blood phosphorus levels to fall
(hypophosphatemia).
• Hyperparathyroidism is caused by primary and
secondary reasons:
• Primary reason is a non cancerous tumour called an
adenoma (hyperplasia) growing on one of the
parathyroid glands causing it to become overactive.
• Secondary reason by kidney failure or vitamin D
deficiency that lowers calcium, so the body reacts by
producing extra PTH to stop calcium levels from falling
to a very low level.

13 Endocrinology Dr. Amani Filimban

• Symptoms
• Depression
• Fatigue
• Feeling thirsty and passing a lot of urine
• Losing your appetite
• Muscle weakness
• Loss of concentration

14 Endocrinology Dr. Amani Filimban

• Treatment
• The aim of therapy is to reduce calcium level
to the normal range. It can be treated with
surgery to remove the adenoma from the
parathyroid gland. Bisphosphonate medicines
are used intravenous drip to lower very high
calcium levels.
• Complications
• Complications of hyperparathyroidism are rare
but may include kidney stones, peptic ulcers
and pancreatitis.
15 Endocrinology Dr. Amani Filimban
 Endocrinology
Bio 450
Dr. Amani Filimban •

1 Endocrinology Dr. Amani Filimban

2 Endocrinology Dr. Amani Filimban
 Ovary
• Location
• The female reproductive system includes the ovaries,
fallopian tubes, uterus and vagina.
• The ovaries are paired oval bodies located on the left
and right sides of the pelvic cavity to the superior
portion of the uterus.

3 Endocrinology Dr. Amani Filimban

 Ovary
• Ovary
• The gonads (ovaries and
testes) secrete sex
steroids hormones.
• These include female sex
hormones such as
estrogens and
progesterone and male
sex hormones such as
androgens( testosterone)

4 Endocrinology Dr. Amani Filimban

 Ovary
• The ovary secretes principal estrogens Known as estrdiol-
17ß while, the testis secretes testosterone.
• During pregnancy the principal estrogen becomes a
weaker estrogen that called estriol secreted by the
placenta.
• In addition, after menopause, the principal estrogen
becomes estrone that produced primarily by fat cells.

5
Endocrinology Dr. Amani Filimban
• Function
• Ovary as heterocrine
gland is involved in
the production of
female gametes
(ova) which
classifies as exocrine
glands whereas its
production of sex
hormones such as
estrogen and
progesterone and it
classifies as exocrine
glands.
6 Endocrinology Dr. Amani Filimban
7 Endocrinology Dr. Amani Filimban
• Function
• Ova are produced from Graafian follicle which is
the mature form of oocyte.

8 Endocrinology Dr. Amani Filimban

• Function
• After puberty of girl, each month during ovulation, a
mature ovum is released from the ovary and travels to the
fallopian tube, where it may be fertilized before reaching
the uterus.

9 Endocrinology Dr. Amani Filimban

• Function
• The ovaries produce several steroid hormones
including estrogens, progesterone (PROG),
inhibin and relaxin(RLX).

10 Endocrinology Dr. Amani Filimban

• Estrogen and Progesterone
• The female sex hormone estrogen and progesterone
are responsible for the development of female sexual
characteristics.
• Along with follicle stimulating hormone (FSH) and
luteinizing hormone (LH) from anterior pituitary gland,
the sex hormones also regulate the menstrual cycle,
maintain pregnancy and prepare the mammary gland
for lactation.
• Relaxin
• Relaxin is produced from corpus lutum during
pregnancy and placenta to facilitate delivery.
• Inhibin
• Inhibin is secreted by corpus luteum to inhibit
secretion of FSH and LH. This is important to end the
menstrual cycle.
11 Endocrinology Dr. Amani Filimban
• Ovarian Cysts
Disorders
• Ovarian cysts are fluid filled sacs that affect women
of all ages. The majority of cysts are harmless.
Cysts are simply part of normal menstruation and
the cysts will go away after a few cycles.

12 Endocrinology Dr. Amani Filimban

 Causes

13 Endocrinology Dr. Amani Filimban

14 Endocrinology Dr. Amani Filimban
 Disorders

• symptoms of pathological cysts:

• Pain and discomfort in the abdomen.
• Bloating
• Irregular periods
• Weight gain
• Bleeding
• Vomiting
• Increased hair growth on face, back, and chest
15 Endocrinology Dr. Amani Filimban
 Treatment

• Surgery
• Large ovarian cysts (more than 5 cm in diameter) or cysts that are
causing symptoms usually need to be removed surgically because
large cysts can disrupt blood from supplies the ovary
• also, if there are concerns that the cyst could be cancerous.
16 Endocrinology Dr. Amani Filimban
17 Endocrinology Dr. Amani Filimban