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ENDOCRINE PATHOLOGY

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ENDOCRINE
PATHOLOGY
Bocharova Tetiana
All diseases of the endocrine system
system are divided into two group:
congenital and developed.
The most frequent endocrine pathology
are pathology of

pituitary body

adrenal glands

thyroid gland

pancreas

parathyroid gland

sexual glands
All diseases of the
endocrine system may be
represented by
hypofunction
 hyperfunction
 dysfunction

Anterior and posterior pituitary
Anterior pituitary
(adenohypophysis)
Produces: Somatotropin
(GH), ACTH, TSH, LH,
FSH and prolactin.
Hormone production is
controlled by
hypothalamus.
Posterior pituitary
(neurohypophysis)
oxytocin, ADH
(vasopressin)
hypothalamus
makes them
posterior pituitary
accumulate them
The most frequent pathology of
pituitary body are

acromegaly

gigantism

Cushing’s disease

hypophyseal nanism

cerebro-hypophyseal cachexia

diabetes insipidus

tumors
Hyperpituitarism

increased synthesis of anterior pituitary
hormones

most common cause: pituitary adenoma
Pituitary adenoma
Growth hormone stimulates of growth
of all mesenchymal derivatives
(bones, cartilages, connective tissue)
If the disease occurs at a young
age it is called gigantism.
If the disease occurs at an older
age it is called acromegaly (the
bones does not grow but ears,
nose, lower jaw, feet and hands
enlarge).
Robert Wadlow
was born in 1918, he is still to this day known as the tallest
person in medical history. By the time of his death at just
aged 22, he had grown to 2 m 72 cm".
Sultan Kösen (1982) is a Turkish farmer
who holds the Guinness World Record for
tallest living male. His growth is 251 cm.
Acromegaly
Acromegaly is a hormonal disorder
that develops when pituitary gland
produces too much growth hormone
during adulthood.
Bones increase in size (hands, feet
and face).
Acromegaly usually affects middleaged adults.
Acromegaly
Irwin Keyes (March 16, 1952 – July 8, 2015) was an
American actor and comedian.
Hypopituitarism

Definition
too little anterior pituitary hormones

Causes
Pituitary destruction
Ischemic necrosis
Pituitary apoplexy

Symptoms
Dwarfism
Loss of libido, menstrual abnormalities
Hypothyroidism
Adrenal insufficiency
Sultan Kösen and
Chandra Bahadur Dangi
Cushing’s disease
is a serious condition of an excess of
the steroid hormone cortisol in the
blood level caused by a pituitary
tumor producing adrenocorticotropic
hormone (ACTH).
ACTH stimulates the adrenal glands to
produce cortisol, commonly referred
to as the stress hormone.
occurs in
adenoma or
adenocarcinoma
from basophil
cells of anterior
pituitary.
It results in obesity
of face and body,
elevation of
arterial pressure,
diabetes mellitus,
sexual gland
dysfunction.
Osteoporosis,
nephrolithiasis and
chronic
pyelonephritis may
also develop.
Cushing’s disease should be
differentiated from Cushing’s
syndrome (Cushingoid).
Cushing’s syndrome
Children with Cushing’s syndrome
Adrenal glands
cortex
1.
glomerular zone (mineralocorticoids aldosterone),
2.
zona fasciculata (glucocorticoids),
3.
reticular zone (sexual hormones),
 medullar substance
(adrenalin, norepinephrine).

Addison’s disease
In 1849 English physician Thomas
Addison described the so-called
bronze disease which develops in
bilateral lesion of adrenal cortex
with the development of acorticosis
(absence of hormones) or
hypoadrenocorticosis
Primary and secondary
Addison’s disease

Primary Addison's disease (genetic
autoimmune disturbances).

Secondary Addison's disease is caused
by metastases in the adrenal glands,
amyloidosis, hemorrhage, tuberculosis,
necrosis due to vascular thrombosis,
damage of the pituitary body (decreases
ACTH or corticotrophin releasing factor).
 hyperpigmentation of
skin and mucous
membrane due to
excessive production of
melanin stimulating
hormone,
myocardial atrophy,
changes of the lumen in
the aorta and large
vessels,
hyperplasia of the cells
of islet of Langerhans in
the pancreas
(hypoglycemia),
gastric mucosa atrophy,
hyperplasia of thymus
and lymphatic peripheral
tissue.
Kennedy was
diagnosed with
Addison's disease in
1940. In 1955 he was
diagnosed with
hypothyroidism.
Symptoms can include
many of those
associated with
Addison's, as well as
paleness, intolerance
to cold, depression
and a low heart rate.
The cause of death
 acute
adrenal failure
 cachexia (adrenal cachexia)
 cardiovascular insufficiency
Thyroid gland
The pathology of the thyroid gland
include follow diseases:
 goiter (struma)
 thyroiditis
 tumors
All these diseases are accompanied by
either hyperthyroidism (thyrotoxicosis)
or hypothyroidism (mixedema).
Goiter
is pathologic enlargement
of the thyroid gland
The goiters are classified according to
Morphology
 diffuse
 Nodular
 diffuse nodular
 Histology
 colloid
 parenchymal
 Epidemiology
 endemic
 sporadic
 diffuse toxic (Basedow's disease)

Colloid goiter
Classification:
 Macrofollicular
 Microfollicular
 Mixed type
It consists of
follicles. It’s
usually nodular.
Parenchymatous goiter
Epithelium proliferation
with formation of small
follicle-like structures
without colloid are
observed. It’s usually
diffuse.
Basedow’s disease
Graves-Basedow’s disease is an
immune disorder of the endocrine
system that stimulates and attacks
the thyroid gland, being the most
common cause of hyperthyroidism.
Also known simply as Graves' disease,
it occurs most frequently in women
(8:1 compared to men) of middle age.
Enlargement of thyroid gland
exophthalmos
Lid leg
Masha Tyelna
is a fashion
model
Causes of hypothyroidism
Congenital hypothyroidism
Cretinism is
inadequate thyroid
hormone production
in newborn infants.
It can occur
because of an
anatomic defect in
the gland, an inborn
error of thyroid
metabolism, or
iodine deficiency.
Hashimoto’s thyroiditis
Is autoimmune disease which
associated with appearance of
antibodies of thyrocytes as
well as thyroglobulin.
Microscopically characteristic
Riedel's thyroiditis
is a rare inflammatory process involving the
thyroid gland and surrounding cervical tissues
and is associated with various forms of
systemic fibrosis.
Riedel's presentation include a thyroid mass
associated with local symptoms, characteristic
biochemical abnormalities such as
hypocalcemia and hypothyroidism, as well as
the involvement of a wide range of other organ
systems.
Diagnosis of Riedel's thyroiditis requires
histopathological confirmation.
Diabetes
Common, common, common!
 100 million worldwide have it (3% of the world)!
 13 million in US have it (only half diagnosed)!
 54,000 die in US each year (7 cause of death)!
 Lifetime risk of getting diabetes: up to 5%!
Etiopathogenetic factors:
 genetically
determined disturbances
of the number and structure of betacells,
 environmental factors (bacterial,
viruses, autoimmune reactions),
 increase of activity of adrenergetic
nervous system
classification
The disease is due to relative or absolute insulin
insufficiency.
 spontaneous
1.
2.



type 1 (insulin-dependent)
type 2 (insulin-independent)
secondary
diabetes of pregnant
latent (subclinical)
Types of
diabetes
Microscopically
characteristic
Complications

Infections

angiopathy

retinopathy

nephropathy

neuropathy
infections
angiopathy
retinopathy
nephropathy
causes of death
coma
diabetic
glomerulosclerosis
(uremia)
gangrene
Examples of KROK questions
A 40-year-old female patient has undergone
thyroidectomy. Histological study of thyroid gland
found the follicles to be of different size and
contain foamy colloid, follicle epithelium is high
and forms papillae, there is focal lymphocytic
infiltration in stroma. Diagnose the thyroid gland
disease:
A.
Basedow’s disease
B.
Hashimoto’s thyroiditis
C.
Riedel’s thyroiditis
D.
De Quervain’s disease
E.
Nodular goiter
A 50 year old patient has been taking
treatment thrice for the last 6 months
because of fractures caused by domestic
accidents. Microscopical examination of bony
tissue revealed foci of lacunar resolution,
giant-cell granulomas in the tumour-like
formations, cysts. Bony tissue was substituted
by fibrous connective tissue. Examination
revealed also adenoma of parathyroid gland
and hypercalcemia. What is the most
probable diagnosis?
A. Parathyroid osteodystrophy
B. Myelomatosis
C. Osteomyelitis
D. Osteopetrosis
E. Paget’s disease
A woman complains of visual impairment.
Examination revealed obesity in the patient
and her fasting plasma glucose level is
hyperglycemic. What diabetes complication
can cause visual impairment/blindness?
A.
Microangiopathy
B.
Macroangiopathy
C.
Atherosclerosis
D.
Neuropathy
E.
Glomerulopathy
During the histologic examination of thyroid
gland of a man who died of cardiac
insufficiency together with hypothyroidism
there was found the diffusive infiltration of
gland by lymphocytes and plasmocytes,
parenchyma atrophy and growth of
connective tissue. Formulate a diagnosis:
A.
Hashimoto’s thyroiditis
B.
Thyroid gland adenoma
C.
Purulent thyroiditis
D.
Thyrotoxic goiter
Autopsy of a 67-year-old man who died after
presenting with hypoglycemic coma revealed
some areas of connective tissue growth and
necrosis foci, atrophy of Langerhans islets in
pancreas. What disease might have induced
such changes in pancreas?
A.
Diabetes mellitus
B.
Mucoviscidosis
C.
Acute pancreatitis
D.
Cancer of the head
of pancreas
A.
Pancreas hypoplasia
A 35-year-old woman complains of swollen neck.
Subtotal thyreoidectomy is performed. On
histological examination of the removed part of
the thyroid gland the following was detected:
atrophy of parenchyma, moderate sclerosis
development,
diffuse
infiltration
by
lymphocytes and plasma cells leading to
formation of lymphatic follicles. What
pathology has developed in the thyroid gland?
A.
Hashimoto's thyroiditis
B.
Follicular adenoma
C.
Riedel's thyroiditis
D.
Papillary carcinoma of the thyroid gland
E.
Diffuse toxic goiter
A 29-year-old female patient has moon
face, upper body obesity, striae on her
anterior abdominal wall, hirsutism; urine
shows an increased rate of 17-oxy
ketosteroids. What disease are these
presentations typical for?
A.
Itsenko-Cushing syndrome
B.
Pheochromocytoma
C.
Conn’s syndrome
D.
Primary aldosteronism
E.
Secondary aldosteronism
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