Overview of the

Endocrine System
Makbul Aman

Introduction

The endocrine system includes the organs

of the body that secrete hormones directly
into body fluids such as blood

Regulates chemical reaction in cells and

therefore control functions of the organs,
tissues, and other cells
bloodstream

Glands

secrete

into

to

34-2

ENDOCRINE SYSTEM

Endocrine system maintains homeostasis:

Composed of glands or glandular tissue:

Growth, maturation, reproduction, energy,

metabolism, behavior
Synthesize, store, and secrete hormones

Exocrine- secretions passed along ducts

that empty outside body or lumen of
organ
Endocrine- glands &/or cells are ductless
but highly vascular; secretion hormones
into bloodstream

What is the hormon ?

1.

2.

3.

A chemical messenger or hormone produced by

an organ is released into circulation to produce
an effect on a distant target organ
An integrated network of multiple organs
derived from different embryologic origins that
release hormone ranging from small peptides
to glycoprotein which exert their effects either
in neighboring or distant target cells
Three basic component make up the core of the
endocrine system :
a. Endocrine gland
b. Hormone
c. Target organs

Definitions

Endocrinology- the study of hormone and

glandular abnormalities- diabetes, thyroid
problems, and circus performers
Hormones- biologically active substances
secreted by glands.
Endocrine- hormones that have a
biological effect far away.
Paracrine - hormones that have a
biological effect nearby.
Autocrine - hormones that have a local
effect

ENDOCRINE

STIMULUS

1
CELL A

TRANSPORT VIA BLOODSTREAM TO

DISTANT PARTS OF THE BODY

CELL B

HORMONE
SECRETION

RESPONSE

NEUROCRINE

CELL A
NEURON

CELL B

TRANSPORT VIA BLOODSTREAM TO DISTANT TARGET TISSUES

HORMONE

HORMONE

3
CELL
TYPE A

PARACRINE
SIGNALLING BETWEEN
NEIGHBORING BUT
DIFFERENT
CELLS VIA ECF

4
CELL
TYPE B

CELL
TYPE X

AUTOCRINE
CELL
TYPE X

CELL
TYPE X

SIGNALLING
BETWEEN
NEIGHBORING
IDENTICAL
CELLS OF SAME
TYPE

DYSFUNCTIONS
DEFINITIONS

HYPERFUNCTION: excessive hormone

production/function
HYPOFUNCTION: deficient hormone
function/production
HYPERTROPHY: increase in size of
organ, or tissue elements as a result of
increased function
HYPERPLASIA: excessive proliferation of
normal cells in normal tissue arrangement
of an organ

FEEDBACK
MECHANISMS

Negative- increased levels of substance inhibit

hormone synthesis and secretion; decreased
levels stimulate production and release (heat
thermostat)
Positive- increased levels stimulate hormone
production and release; decreased levels inhibit
synthesis and secretion
Complex- thyroid stimulating hormone (TSH) in
pituitary is activated by thyroid releasing hormone
(TRH) and inhibited by somatostatin (in
hypothalamus). Decreased T3 & T4 leads to
increased TSH release. Increased levels lead to
inhibit TSH secretion

DYSFUNCTIONS
CLASSIFICATIONS

PRIMARY: disease within endocrine

gland
FUNCTIONAL: hormonal
imbalances resulting from disease in
an organ or tissue other than
endocrine gland
SECONDARY: disease in a target
gland

Classification & secretion of hormones

a. Proteins & polypeptides
ACTH, GH, TSH, PRL, LH, FSH,
Oxytocin, Vasopressin, PTH,
Insulin, Glucagon .. etc.

b. Steroids
Androgens, estrogens, progesterone,
glucocorrticoids, mineralocorticoids

c. Amino acid derivertives

Epinephrine, Norepinephrine,
Triiodothyronine(T3), Thyroxine(T4) etc.

Hormone Functions

Growth and development: Thyroid,

GH, Sex Steroids, Cortisol
Reproduction: Estrogen,
Testosterone, FSH, LH, Thyroid
Homeostasis: Thyroid, Cortisol
Changes in environment: Cortisol,
Thyroid Aldosterone

Functions of endocrine system

The Endocrine
System
regulates

Metabolism

Calcium
and glucose
levels

Response
to stress

by means
of the

by means
of the

by means
of the

by means
of the

Testes

Thyroid

Growth

Water
balance

Reproduction

by means
of the

by means
of the

Pituitary

Ovaries

Pancreas

Parathyroids

Adrenals

Six Highlighted Endocrine Glands

GLANDS

HYPOTHALAMUS:
Autonomic NS and endocrine functions
Works thru releasing/inhibiting factors
Hypothalamic-hypophysial portal system
Functions are visceral, somatic,
behavioral/emotional; temp. regulation,
perspiration, GI secretion/motility,
appetite, thirst, B/P, respiration, sexual
behavior, fear, rage, sleep,& menstrual
cycles

GLANDS

PITUITARY:

Size of pea (hypophysis); 1 cm

diameter
Located in sella turcica
Anterior- largest lobe; growth
hormone, thyroid stimulating,
adrenocorticortrophic, follicle
stimulating, leutinizing, prolactin
Posterior- lies behind anterior;
anti-diuretic, oxytocin
Connected to hypothalamus by
hypophyseal stalk

Hormones Released by the

Anterior Pituitary
HORMONE

TARGET TISSUES

FUNCTION

Most tissues

Stimulates body growth

12 year
old boy
1. Growth
Acromegaly
Hormone (GH)

Measure
6-5
2. Thyroid Occurs
Thyroid Gland
in
adults
Stimulating
Oversecreation
Hormone (TSH)

Bones
of
hands
3.
Adernal Cortex
of
growth
Adrenocorticotropic
face
and
feet
are
Hormone (ACTH)
hormone
enlarged
Ovaries/Testis
4. Luteinizing
Hormone
(LH)

Occurs
during
Do to the
childhood
Follicles in ovary
5. Folliclerelease
of
Stimulating
Hormone (FSH)

growth
6. Prolactin (PRL)
hormone.

Seminiferous Tubules in
Testis

Ovary & Mammary

Gland in females, testis
in males

Stimulates release of
T3 and T4
Stimulates secretion of
hormones from cortex
FEMALE -Promotes
ovulation & hormone
production
MALE Sperm production
FEMALE egg production
MALE - sperm production

Promotes lactation
(low levels in males; high
levels affect testosteron
levels)

Diseases of the Posterior

Pituitary

Syndrome of inappropriate
antidiuretic hormone secretion
(SIADH)
Hypersecretion of ADH
For diagnosis, normal adrenal and
thyroid function must exist
Clinical manifestations are related to
enhanced renal water retention,
hyponatremia, and hypoosmolarity

17

Diseases of the Posterior

Pituitary

Diabetes insipidus
Insufficiency of ADH
Polyuria and polydipsia
Partial or total inability to concentrate
the urine
Neurogenic

Nephrogenic

18

Insufficient amounts of ADH

Inadequate response to ADH

Diseases of the Anterior

Pituitary
Hypopituitarism

Pituitary infarction
Sheehan syndrome
Hemorrhage
Shock

Others: head trauma, infections, and tumors

Panhypopituitarism

ACTH deficiency
TSH deficiency
FSH and LH deficiency
GH deficiency

19

Dwarfism

Insufficient secretion of
growth hormone (GH) during
childhood that limits growth
Body parts usually correctly
proportioned, normal mental
development
Usually accompanied by
deficient secretion of other
anterior pituitary hormones
additional symptoms
Treatment with hormone
therapy

Diseases of the Anterior

Pituitary

Hyperpituitarism
Commonly due to a benign, slowgrowing pituitary adenoma
Manifestations

Headache and fatigue

Visual changes
Hyposecretion of neighboring anterior
pituitary hormones

21

Diseases of the Anterior

Pituitary

Hypersecretion of growth hormone

(GH)

Acromegaly

Gigantism

22

Hypersecretion of GH during adulthood

Hypersecretion of GH in children and
adolescents

Acromegaly

Acromegaly
Excess growth hormone
Usually due to pituitary adenoma
RARE

2-3 cases per million

Acromegaly

Characteristic features
Large tongue

Prognathism

Excess hair

Interdental separation

Large Spade-like
hands / feet

Thick, greasy skin

Myopathy / arthritis

Diabetes

Prominent supraorbital
ridge

High blood pressure

Broad nose

Heart failure

Acromegaly

Characteristic features
Large tongue

Prognathism

Excess hair

Interdental separation

Large Spade-like
hands / feet

Thick, greasy skin

Myopathy / arthritis

Diabetes

Prominent supraorbital
ridge

High blood pressure

Broad nose

Heart failure

Acromegaly

Diseases of the Anterior

Pituitary
Hypersecretion
of prolactin

Caused by prolactinomas
In females, increased levels of prolactin
cause amenorrhea, galactorrhea, hirsutism,
and osteopenia
In males, increased levels of prolactin cause
hypogonadism, erectile dysfunction,
impaired libido, oligospermia, and
diminished ejaculate volume

28

The Thyroid Gland

Anterior neck on
trachea just inferior to
larynx
Two lateral lobes and
an isthmus
Produces two hormones

Thyroid hormone:
tyrosine based with 3 or
4 iodine molecules

T4 (thyroxine) and T3

Calcitonin involved with

calcium and phosphorus
metabolism
29

Some Effects of Thyroid

Hormone
(Thyroxine)

Increases the basal metabolic rate

The rate at which the body uses oxygen to

transform nutrients (carbohydrates, fats and
proteins) into energy

Affects many target cells throughout the

body; some effects are

Protein synthesis
Bone growth
Neuronal maturation
Cell differentiation
30

The Effects of Calcitonin

Secreted from thyroid parafollicular

(C) cells when blood calcium levels
are high
Calcitonin lowers Ca++ by slowing
the calcium-releasing activity of
osteoclasts in bone and increasing
calcium secretion by the kidney
Acts mostly during childhood
31

Thyroid Disease

Disease
Common
Manifestations

Thyroxine excess

Thyroxine lack

HYPERTHYROIDISM
HYPOTHYROIDISM

Thyroid mass

GOITRE

Thyroid Disease

Hyperthyroidism

Epidemiology

Common

2-3% women
0.2% men
Age 20-40 years

Pathophysiology

Rarely pituitary driven

Toxic multinodular goitre / Solitary toxic adenoma

Excess TRH
Autonomous thyroid function

Commonest form auto-immune GRAVES DISEASE

Antibodies act directly on TSH receptor causing unregulated

thyroxine production
May also act on ORBITAL tissues

Hyperthyroidism
Symptoms

Sweating, heat intolerance

Irritability, poor sleep, anxiety, palpitations
Excess appetite, weight loss, diarrhoea
Muscle weakness
Eye problems

Signs

Warm moist skin

Tachycardia, irregular heart rate
Increased blood pressure, heart failure
Fine tremor
Goitre
Eye disease

Exopthalmos
Opthalmoplegia
Lid lag / retraction
Loss of visual acuity

Hyperthyroidism

Diagnosis
Clinical
Blood tests

Low TSH (unless pituitary)

High Thyroxine levels (T3 and T4)
Auto-antibodies

Radiology sometimes

Hypothyroidism

Epidemiology

Common

2% women
0.2% men
Mean age at diagnosis 60

Symptoms reduced metabolism

Cold intolerance
Weight gain, constipation
Hoarse voice, puffed face & extremities
Mental slowness, poor memory
Hair loss
Cold intolerance

Hypothyroidism

Signs
Slow pulse
Large tongue, deep voice
Thin / dry hair, loss of eyebrows
Goitre
Coarsening of features
Acute (rare)

Coma, hyopothermia

Hypothyroidism

Diagnosis

Clinical
Blood tests

Radiology sometimes

High TSH (unless pituitary)

Low Thyroxine levels (T3 and T4)
Auto-antibodies
See ahead

Management

Replacement

Thyroxine

Level guided by TSH

Hypothyroidism

39

Hypothyroidism
Before and After
Treatment

40

Cretinism

41

Goitres

Thyroid masses - GOITRES

No associated thyroid disease

Associated with thyroid disease

Autoimmune
Toxic multi-nodular goitre
Toxic adenoma

Malignant

Simple cysts / adenomas

Iodine deficiency

Rare

Management

Investigations

Radiology

Ultrasound scan
Radioisotope scan

Fine needle aspiration

Thyroid function tests

Management
Underlying
cause
May need
surgery

The Parathyroid
Glands
Most people have
four
On posterior
surface of thyroid
gland
(sometimes
embedded)

43

Parathyroids
(two types of
cells)

Rare chief cells

Abundant oxyphil cells
(unknown function)
Chief cells produce
PTH

Parathyroid hormone,
or parathormone
A small protein
hormone
44

Function of PTH

(parathyroid hormone or
parathormone)

Increases blood Ca++ (calcium)

concentration when it gets too low
Mechanism of raising blood calcium
1.
2.
3.

Stimulates osteoclasts to release more Ca++

from bone
Decreases secretion of Ca++ by kidney
Activates Vitamin D, which stimulates the
uptake of Ca++ from the intestine

Unwitting removal during thyroidectomy

was lethal
Has opposite effect on calcium as
calcitonin (which lowers Ca++ levels)
45

Adrenal (suprarenal) glands

(suprarenal means on top of the

kidney)

Each is really two endocrine glands

Adrenal cortex (outer)

Adrenal medulla (inner)

Unrelated chemicals but all help with extreme situatio

46

Located just above

the kidney
Secretes many
hormones
Epinephrine
Norepinephrine
Many steroid
hormones, inc
estrogen and

Adrenal Gland

Adrenal cortex

Secretes lipid-based steroid hormones,

called corticosteroids cortico as in
cortex

MINERALOCORTICOIDS

GLUCOCORTICOIDS

Aldosterone is the main one

Cortisol (hydrocortisone) is the main one

Adrenal medulla

Secretes epinephrine and norepinephrine

47

Adrenal disease
Flat, pyramid-shaped structures lying on top of
kidneys, surrounded by thick capsule; crucial to
metabolism, stress response, and fluid & e-lytes
balance
Cortex- firm, yellow, outer portion; 3 specific
layers
Outer layer secretes mineralocorticoids
Middle layer secretes glucocorticoids
Inner layer secretes androgens

Medulla- reddish brown; produces and secretes

catecholamines

Cushings syndrome

Excess corticosteroid production

Pathophysiology

Excess ACTH

Excess corticosteroids

Pituitary adenoma most common non-iatrogenic

Ectopic production by cancers
Adrenal adenomas, carcinomas

Pathophysiology

Iatrogenic

Commonest cause

Cushings syndrome

Symptoms

Weight gain, change in appearance

Easy bruising, impaired wound healing
Hirsutism, acne
Weakness
Back pain osteoporosis
Depression, psychosis

Signs

Evidence of symptoms
Easy bruising, thin skin
High blood pressure
Muscle wasting
Diabetes
Skin infections
Moon face, buffalo hump, centripetal obesity

Cushings syndrome

Diagnosis

May be simple if iatrogenic

Complicated otherwise!

Blood and urine tests

Radiology

Locate site of excess production

Management

Address underlying cause

Iatrogenic

Try to reduce

Non-iatrogenic

Surgery ideally

Cushings Syndrome

Too many steroids

DANGERS OF STEROIDS

Steroids that weightlifters take are synthetic testosterone,

and they are taken in doses 100x larger than a prescription,
so they are dangerous.
Although they increase muscle size, they increase rage and
aggression, cause kidney and liver disease, cancer, severe
acne, high blood pressure, high cholesterol, impotence,
baldness, decreases the size of testicles and causes a low
sperm count and sterility.
In women it causes hair on their face and chest, and
decreases the breasts.
In males, it causes baldness and increases the breasts.
In children, it stunts the growth.
In everyone, they can shorten the life span by several
decades.
57

Steroids or
Photoshop?

58

Addisons disease

Loss of corticosteroid production

Pathophysiology

Iatrogenic

Hypopituitarism

Withdrawal of steroids after long term use

Cancer, infection, vascular, trauma

Adrenal destruction

Auto-immune disease

Addisons disease

Symptoms

Chronic

General malaise
Hypothyroid if hypopituitarism

Acute usually in response to stress

Infection, trauma, surgery

Life-threatening
Shock, hypoglycaemia, vomiting, abdominal pain

Signs

Hyperpigmentation

Buccal mucosa
Scars
Pressure points
Skin creases

Vitiligo
Hypotension

Addisons disease

Management

Replacement therapy

Hydrocortisone

Fludrocortisone
Increase at times of stress

20 mg am
10 mg pm

Infection
Trauma
Surgery

Acute Addisonian crisis

Medical emergency!

Fluid replacement
Glucose
Hydrocortisone injections
Treat infection if present

Need hospitalisation

Pheochromocyto
ma
Definition: Tumor of adrenal medulla and/or

sympathetic ganglion from chromaffin cell lines that

produces catecholamines (norepinephrine and
epinephrine).

Pheochromocytoma is a rare tumor with

excess production of

adrenaline
and derives from

the inner layers of the adrenal glands

Signs and Symptoms of Pheochromocytoma

treatment resistant hypertension
(95%)
classic triad
headache
sweating
palpitations
chest pain
anxiety
glucose intolerance
increased metabolic rate

ALDOSTERONISM

Excessive secretion of mineralocorticoids,

especially aldosterone
Primary:

Called Conns syndrome, usually benign

Aldosterone producing adenoma

Secondary:

Excess renin-angiotension stimulation;

stimulation occurs with conditions involving
low circulating blood volume: pregnancy,
hypvolemia, CHF, cirrhosis, oral
contraceptives, chronic renal failure

The Pineal Gland and

Thymus

This is located in the diencephlaon

and its primary hormone is
melatonin (pinealocytes), which
influences daily rhythms and may
antigonadotropic effects in
humans.
The thymus gland, located
importqant in the upper thorax,
declines in size and function with
age. Its hormones thymosins and
thymopoietins are important to
the normal development of the
immune response.

The Gonads (testes and ovaries)

main source of the steroid sex hormones

Testes

Interstitial cells secrete androgens

Primary androgen is testosterone

Maintains secondary sex characteristics

Helps promote sperm formation

Ovaries

Androgens secreted by thecal folliculi

Directly converted to estrogens by follicular granulosa cells

Granulosa cells also produce progesterone

Corpus luteum also secretes estrogen and
progesterone
69

The Female Gonads

The ovaries of the female, located in the

pelvic cavity, release two main hormones.
Secretion of estrogens by the ovarian follicles
begins at puberty under the influence of FSH.
They stimulate maturation of the female
reproductive system and development of
secondary sex characteristics. Progesterone
is released in response to high blood levels of
LH. It works with estrogens in establishing
the menstrual cycle.

The Male Gonads

These are the testes located in the

outside.
The testes of the male begin to produce
testosterone at puberty in response to
LH.
Testosterone promotes maturation of the
male reproductive organs, development
of secondary sex characteristics, and
production of sperm by the testes.

PANCREAS

Islets of langerhans
Alpha cells

Glucagon
Stimulates liver
glycogenolysis
Increases blood sugar

Islets of langerhans
Beta cells
Insulin
Increases glucose
metabolism

Decreases blood
sugar

Diabetes

Diabetes mellitus

Pathophysiology

Type I 10%

Auto-immune destruction of pancreatic insulin

producing cells - Islets of Langerhans
Commonly presents in young people

Type II 90%

Insulin resistance and deficiency

More likely if obese
Usually presents after age 40
10% of over 70s

Diabetes

Symptoms

Type I

Short history

Thirst
Excess urine
Polyuria
Nocturia
Weight loss
Malaise

May present as emergency

Type II

Milder symptoms as Type I

Complications
Asymptomatically

Screening
Medicals

Diabetes

Diagnosis
Fasting blood sugar 126 mg/dl
OGTT 200 mg/dl

Glucose tolerance test if borderline

May be labelled impaired glucose

tolerance
( between normal and diabetes )

Diabetes

Complications ( Multiple!)
- Acute complication ( Hypo & hyperglycaemic crisis )
- Chronic complication
a. micro vascular
- Retinophaty
- Nephrophaty

b. macrovascular
- Stroke
- CVD
- PAD

Diabetes

Complications

Management

Normalise blood sugar

Type II (never Type I)

Diabetes

Initially dietary weight loss

Oral medication
Sulphonylureas
Non-SU insulin secretogogue
Biguanides
Acarbose
Glitazones
DPP IV Inhibitor

Minimise other risk factors

Physical activity
High cholesterol
Smoking
High blood pressure

Diabetes

Management

Normalise blood sugar

Self-management

Blood sugar monitoring

The more the better

OBESITY & METS

Causes of Obesity

Heredity
Familial
Demographic factors
age
gender
ethnicity
social class
marital status

Physical inactivity
Dietary intake
Smoking cessation
Drugs ( steroids, lithium,
sulphonylureas)
rarely endocrine disorders

Todays
Older environments:
environment provides
an unreliable
a constant
food supply
supply&of
high
high energy
need for
food
physical
with reduced
activity to
needs
procure
for physical
food to
survive.
activity.

Psychosocial
consequence
Economical impact
of obesity
Prejudice and Discrimination
Considered lazy, incompetent and more
often absent due to illness
Confronted with more problems at job
application

Summary of The Endocrine

System

SUMMARY OF THE MAJOR COMPONENTS OF THE

ENDOCRINE SYSTEM

BRAIN
ANTERIOR LOBE
OF PITUITARY
GnRH

PRL

BREAST

LH/FSH

GHRH

GH

LIVER

GONADS

IGF-1

MILK

VASOPRESSIN

POSTERIOR LOBE
OF PITUITARY
TRH

DIET

CRH

TSH

ACTH

GLUCOSE

THYROID

ADRENAL
CORTEX

PANCREAS

T3 +T4

STEROIDS

STEROIDS

ADRENAL
CORTEX

OXYTOCIN

TARGET TISSUES

CALCIUM

PARATHYROID

GLUCAGON

PTH

INSULIN

FEEDBACK LOOPS