Review of Endocrine Organs and

Introduction to the Pelvis

Dr’s M Pratten & D Merrick

November 2018
Learning objectives
Review of Endocrine organs:
 
•Describe the anatomical relations of the Pituitary,
Thyroid, Adrenal glands and Pancreas
•Outline the blood supply and innervation of the
Pituitary, Thyroid, Adrenal glands and Pancreas
•Identify the histological appearance and describe the
microscopic structure of the Pituitary, Thyroid,
Adrenal glands and Pancreas
Intro to pelvis:
•Appreciate the main features and surface landmarks
of the bony pelvis
•Understand some characteristic features of the male
and female pelvis  
 the Endocrine System
Haven’t we done this
already?
Importance for medical intervention – what
cells? Can they be stimulated or inhibited?
Can they be removed? How can surgery be
achieved safely?
Characteristics of Endocrine System

Try to think of
characteristics that all
endocrine tissues and
cells have in common
Characteristics of Endocrine System
 An extensive blood supply to provide the transport route

 A mechanism for storing the hormones – usually storage granules which are shed
by exocytosis

 Organelles for manufacturing hormones – the Endoplasmic Reticulum (smooth for

steroids, rough for peptides)

 Organelles for processing and packaging hormones - the Golgi apparatus

 Numerous mitochondria to provide energy

 A mechanism to trigger release of the hormone

 Receptors on cells to receive the message

Why are structure and
relations of endocrine glands
important?

Diagnosis
Ectopic tissue
Treatment
Surgery
Histology
 

How are cells arranged?

How does the arrangement
parts of gland differ?
Mode of secretion
Mode of storage
Blood supply
Adjacent tissue
 1 2

3
4

Give yourself marks

Look for these structures and those surrounding in the DR

Blood vessel and neuronal pathways between
hypothalamus and anterior pituitary
 Tumours Of The Pituitary Gland
Tumours of the pituitary gland can be regarded as a type of brain tumour. Almost
all are benign and do not spread. They are called craniopharyngomas or
adenomas.

https://www.youtube.com/watch?v=ybl2OpjLA_w
Clinical relevance: Tumours of the pituitary gland are relatively common but as they
grow may put pressure on surrounding structures .
 Tumours Of
The Pituitary
Gland

They are frequently

benign but cause
problems because of
pressure on surrounding
structures.
Bilateral Hemianopia –
temporal field of view lost
(peripheral vision)
 Lack of specificity:

Anterior Pituitary Acidophil pituitary cells produce

growth hormone or prolactin.

Basophil pituitary cells produce

TSH, ACTH, or FSH or LH.

High power view of Anterior

pituitary stained with a
Trichrome stain.

Acidophils staining pink,

Basophils staining purple
Chromophobes
Capillaries can be seen
containing acidophilic red
blood cells
High power view of Anterior
pituitary stained with PAS
and Orange G.

Acidophils [A], staining

yellow,
Basophils [B], staining pink
Chromophobes [C]
Capillaries can be seen
containing yellow-staining
red blood cells
Staining the Cells of the Anterior Pituitary –
Relevance to Tumour Diagnosis
 The advantages of Immunocytochemistry for diagnosis
of pituitary tumours are:
 Can demonstrate the low levels of granules and hormones
in chromophobes.
 Can further separate pituitary acidophils and basophils
into exactly what hormone they are producing.

Gonadotrophs Corticotrophs
FSH ACTH

Gonadotrophs
Somatotrophs
LH
GH
Pituitary tumour
Tumour
Normal

Note the presence of many

somatotrophs – excess secretion of
GH causing acromegaly
Anatomy of
the Thyroid
Gland

2
5

3 4
Anatomy of
the Thyroid
Gland
Revise fascial layers of neck from Semester 2
Clinical relevance: ectopic thyroid tissue may be found
at sites along thyroglossal duct – if removing thyroid,
need to check for these.
Histology of Thyroid
Look for the follicular cells which produce thyroid hormones. Amongst the follicular
cells are large pale-staining cells with an eccentric nucleus and clear, unstained
cytoplasm. These are the parafollicular cells that produce (thyro) calcitonin.

Immunostaining for
H&E parafollicular or ‘C’ cells
using antibodies to the
peptide calcitonin
PAS
Considerations
for thyroid
surgery
 Investigations into Thyroid Anatomy
eg Surg Radiol Anat. 2007 Feb;29(1):21-7

The pyramidal lobe - source of pitfalls in thyroidectomy - frequency but unreliable

preoperative diagnosis on scintigraphic images - to avoid leaving residual tissue
when complete removal of the thyroid is indicated.
•60 cadaveric specimens examined:
•A pyramidal lobe was found to be present in 55% of the cadavers (32/58).
•It was found more frequently in men than in women.
•In men the median length was 14 mm and in women 29 mm.
•An accessory thyroid gland was present in one specimen, in four cases the isthmus was
missing.
•The pyramidal lobe branched off more frequently from the left part of the isthmus (16)
than from the right (7) or the midline (9).In two cases it originated from the left lobe.

•Additionally 23 scintigraphic images were analyzed to evaluate the

visualization of a pyramidal lobe.
•Onlythree of them showed enlargements of the isthmus that could be taken as a
pyramidal lobe.

Conclusion - Due to its frequency the pyramidal lobe should be regarded as a normal component of the
thyroid. It is not reliably diagnosed by scintigraphic imaging because scintigraphy can only give functional
information but not morphological one. Therefore the anterior cervical region has to be investigated very
carefully during operation in order not to leave residual thyroid tissue in total thyroidectomy.
Embryology: The Adrenal Gland
Each gland is composed of two separate endocrine organs - An
embryological and surgical complication

The outer cortex, developed from coelomic mesothelium (mesoderm),

producing steroid hormones and controlled by the adenohypophysis.

The inner medulla, derived from neural crest (neuroectoderm), consisting of

cells secreting catecholamines (chromaffin cells), under nervous control.
The Adrenal Gland

1 5

3 4
 Addison’s Disease
Normal Adrenal Hypoplasia
Pancreas
 2 3

5
Revise from GIM
What do the Pancreatic Islets produce?

 Beta cells producing Insulin & Amylin (65-80%)

 Alpha cells releasing Glucagon (15-20%)
 Delta cells producing Somatostatin (3-10%)
 PP cells containing Pancreatic polypeptide (1%)
 Epsilon cells containing Ghrelin

 Islets can influence each other through

paracrine and autocrine communication, and
beta-cells are coupled electrically to beta-cells
(but not to other cell-types).
Tumour arising in the pancreatic islet cells.
Zollinger-Ellison syndrome - GASTRIN-SECRETING
tumour (GASTRINOMA) which leads to excess stomach
acid.
 Routine histology shows that the tumour has the histological
features of a peptide secreting endocrine gland.
 Immunocytochemistry may show that the tumour cells react
with a specific antibody eg anti-gastrin.
 Electron microscopy may show that the tumour cells have
membrane-bounded storage vesicles.
 Radioimmunoassay may demonstrate that a biopsy of the
tumour demonstrates excessive amounts of a particular
hormone.
Learning Outcomes

Review of Endocrine organs:

•Describe the anatomical relations of the Pituitary,
Thyroid, Adrenal glands and Pancreas
•Outline the blood supply and innervation of the
Pituitary, Thyroid, Adrenal glands and Pancreas
•Identify the histological appearance and describe
the microscopic structure of the Pituitary, Thyroid,
Adrenal glands and Pancreas

Intro to pelvis:

•Appreciate the main features and surface

landmarks of the bony pelvis

•Understand some characteristic features of the

male and female pelvis  
The pelvis
Pelvic inlet/brim

Greater (false)
pelvis

Lesser (true)
pelvis

Pelvic outlet
Bony Pelvis Sacroiliac joint
Ilium Sacrum

Ischium

Coccyx

Subpubic Pubic
angle symphysis
Medial view Pubis
(hip bone) Anterior view
(pelvic girdle)
Checklist
Surface landmarks

Iliac crest

Pubic
Pubic
symphysis ASIS PSIS
tubercle Coccyx
 Sacroiliac
Pelvic Inlet ligament

• Pubic symphysis
• Pubic crest
• Pecten pubis
• Arcuate line of ilium
• Ala of sacrum
• Sacral Promontory

Pubic
Symphysis
 Pelvic outlet

• Pubic symphysis
• Ischiopubic ramus
• Ischial tuberosity
• Sacrotuberous ligaments
• Coccyx

Sacrotuberous
ligament
Male pelvis
Female Pelvis
 Characteristics Male Female

General structure Thick/heavy Thin/light

Greater pelvis Deep Shallow

Lesser pelvis Narrow, deep Wide, shallow

Inlet Heart shaped Oval/rounded

Outlet Small Large

Subpubic angle <70° >80°
Obturator foramen Round Oval
Acetabulum LargeLarge Small

Deep Thick/heavy

Small Shallow Thin/light

The Plan…

Tasking room 1: Tasking room 2:

Pituitary Thyroid

Main DR – Bony Pelvis (and pelvic viscera in-situ)

Tasking room 4: Tasking room 3:

Pancreas Adrenal