Endocrinology

Objectives
• Upon successful completion of this lecture the
students should be able to:
– define what is endocrine system
– identify different types of endocrine glands
– ennumerate different functions of the endocrine
glands
– distinguish a variety of medical disorders of the
endocrine system
Endocrine System
• Composed of glands that secrete
hormones into the circulatory system
• Helps regulate various metabolic
functions
• Hormones function in a lock and key
fashion
• All hormones operate
within a feedback system
Hormones
• Act on target organs elsewhere in the
body
• Control and coordinate wide spread
processes on organs, tissues, or
general effects on the entire body
– homeostasis
– reproduction
– growth & development
– metabolism
– response to stress
 Endocrine Glands
 Hypothalamus
– located deep within the cerebrum of the
brain; serves as a connection between
the central nervous system (CNS) and
the endocrine system
– secretes hormones that make other
endocrine glands secrete hormones
Hyothalamus
Pitutary
Pitutary

 Pituitary - anterior &

posterior
– located in the brain;
size of a pea
– secretes hormones
essential to growth,
reproduction, and
water balance in the
body
 Endocrine Glands cont’d
 Thyroid
– 2 lobes located in anterior neck
– plays important role in controlling
metabolism
Thyroid

 Parathyroid
– normally 4 glands
found next to thyroid
gland
– secretes hormone to
increase blood
calcium levels
Parathyroid gland
Endocrine Glands cont’d

Thymus gland
located in mediastinum
behind sternum
during childhood secretes
a hormone critical in
maturing T lymphocytes
(cells responsible for cell-
mediated immunity)
 Pancreas
– located in upper retroperitoneum behind
stomach
– secretes digestive enzymes for digestion of
fats & proteins
– controls production or inhibition of the
hormones glucagon & insulin
Endocrine Glands cont’d
 Adrenal gland
– located on superior surface of each kidney
– adrenal medulla - secretes the
catecholamine hormones epinephrine &
norepinephrine
– adrenal cortex - secretes 3 steroidal
hormones
 Gonads
– chief responsibility for sexual maturation or
puberty and subsequent reproduction
– ovaries produce eggs
–
 Regulation of Hormone Secretion
• Hormones operate within a positive or negative
feedback system to maintain homeostasis
• Negative feedback
– Most common feedback mechanism
– Usually refers to an increase in the serum
level of hormone or hormone-related
substance that suppresses further hormone
output
– Hormone production is stimulated when the
serum levels fall
Negative Feedback Mechanism
Specific Disorders of the
Endocrine System
• Disorders of the endocrine system arise
from:
– the effects of an imbalance in the
production of one or more hormones
– the effects of an alteration in the body’s
ability to use the hormones produced
Specific Disorders of the
Endocrine System

• Clinical effects of endocrine gland

imbalance are determined by:
the degree of dysfunction
the age and gender of the affected
person
Disorders of The Thyroid Gland
• Usually seen more as part of the medical
history than as a medical emergency
– hyperthyroidism - too much thyroid hormone
in the blood (goiter)
– thyrotoxicosis - prolonged exposure to
excess thyroid hormones (Grave’s disease)
– hypothyroidism - inadequate thyroid hormone
– myxedema - long term exposure to
inadequate levels of thyroid hormones
 Grave’s Disease
• A type of excessive thyroid activity
characterized by a generalized enlargement of
the gland (goiter), leading to a swollen neck
and often protruding eyes (exophthalmos)
– More common in women than men (6 times)
– Typical onset young adulthood (20’s & 30’s)
– Strong hereditary role in
predisposition of the disorder
 Thyrotoxicosis
• A term that refers to any toxic condition that
results from prolonged excess thyroid hormone
• Thyroid storm is a heightened and life-threatening
manifestation of thyroid hyperfunction
– A relatively rare condition; can be fatal
– Usually associated with exposure to physiological
stress (trauma, infection)
– signs & symptoms indicate extreme hypermetabolic
state (high fever (1060F), irritability, delirium or coma,
tachycardia, hypotension, vomiting, diarrhea)
Disorders of Adrenal Glands
Adrenal cortex - outer portion of adrenal gland
• Secretes steroidal hormones
– glucocorticoids - increase blood glucose levels
– mineralocorticoids - contributes to salt & fluid
balance
– androgenic hormones - influences similar to the
gonads (role in puberty and reproduction)
• Two medical emergencies of the adrenal
cortex
Cushing’s syndrome
Addison’s disease
 Cushing’s Syndrome
• Caused by an abnormally high circulating level
of corticosteroid hormones produced naturally
by the adrenal glands
• May be produced:
– Directly by an adrenal gland tumor
– By prolonged administration of
corticosteroid drugs (ie: Prednisone,
hydrocortisone)
– By enlargement of both adrenal glands due to
a pituitary tumor
• Relatively common problem of adrenals
Adrenal glands Adrenal glands

Kidneys
 Cushing’s Syndrome
• Characteristic appearance
– Face appears round (“moon-faced”) and red
– Trunk tends to become obese from disturbances
in fat metabolism; “buffalo hump” on back
– Limbs become wasted from muscle atrophy
– Mood swings , impaired concentration
– Purple stretch marks may appear on the
abdomen, thighs, and breasts
– Skin often thins and bruises easily
– Weakened bones are at increased risk for
fracture
Moon Face
Cushing’s
Syndrome
Signs &
Symptoms
 Addison’s Disease
• Pathophysiology
– Reduction in Adrenal steroids
Glucocorticoids
Mineralocorticoids
Androgens
– Most common cause is idiopathic atrophy of
adrenal tissue (cause unknown)
– Less common causes include hemorrhage,
infarctions, fungal infections, auto immune
disease, therapy with steroids (ie:
prednisone)
 Addison’s Disease
• Signs and symptoms
– Progressive weakness, fatigue
– Decreased appetite & weight loss
– Hyperpigmentation of skin, especially
over sun-exposed skin areas
– Disturbances in water & electrolyte
balance
– Low blood volume
– EKG changes
– Abrupt stoppage of steroids may trigger
Addisonian crisis with cardiovascular
collapse
Addison’s Disease
• Management
– Evaluate ABC’s & correct issues
– Cardiac status - watch for
dysrhythmias and circulatory collapse
• Fluid resuscitation
– Respiratory status - evaluate SaO2
levels
– Blood glucose levels
• Hypoglycemia very common
 Diabetes Mellitus
• Disease marked by inadequate insulin activity
in the body
• Glucose is important to all body cells but
critical for the brain
– Glucose only substance used by the brain
for energy
• Insulin maintains normal blood glucose levels
– Enables body to store energy as glycogen,
protein & fats
– Action of insulin allows glucose to flow into
cells
Typical Blood Glucose Levels

• Healthy persons
– Overnight fast - 80-90 mg/dL
– 1st hour after a meal - 120-140 mg/dL
– <80mg/dL reflects hypoglycemia
– >140 mg/dL reflects hyperglycemia
• Intervention necessary
– Hypoglycemia -blood glucose <60 mg/dL
• Hyperglycemia - blood glucose
>300mg/dL not uncommon
 Type I Diabetes
• Low or absent production of insulin in the
pancreas
• Too much sugar, not enough insulin
• Patients require supplemental insulin
• If untreated, glucose levels rise
– excess glucose spills into urine; patient
loses large amounts of water (becomes
dehydrated); fatty acids used as energy
source resulting in ketosis from fat
catabolism
Untreated Type I Diabetes
• Signs & symptoms due to elevated
blood glucose levels
Polydipsia (constant thirst)
Polyuria (excessive urination)
Polyphagia (ravenous appetite)
Weakness
Weight loss
• Above signs & symptoms are what
usually prompt people to seek a medical
checkup for “not feeling well”
Type II Diabetes
• More common than Type I diabetes (90%
of cases)
• Moderate decline in insulin production
and inefficient use of the insulin that is
produced
• Risk factors: heredity, obesity
• Treatment: dietary changes, increased
exercise, oral hypoglycemics (to stimulate
insulin production), possible addition of
insulin if necessary