Pathology of the Endocrine System Zhang Wenyan Department of Pathology Sichuan University 2003 - PowerPoint PPT Presentation

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Pathology of the Endocrine System Zhang Wenyan Department of Pathology Sichuan University 2003

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  1. Pathology of the Endocrine System Zhang Wenyan Department of Pathology Sichuan University 2003

  2. Endocrine System • Endocrine glands(pituitary, thyroid, parathyroid, adrenal gland, pineal body, and islet) • Dispersed neuroendocrine cells(thyroid C cells, gastrointestinal and bronchopulmary neuroendocrine cells )

  3. Purpose of Endocrine System • To maintain a state of homeostasis among the various organs of the body • Endocrine cells secrete hormones to regulate the activity of target organs

  4. TRH TSH T3, T4

  5. Abnormal activity of Endocrine System • Impaired synthesis or release of hormones • Abnormal interactions between hormones and their target tissues • Abnormal responses of target organs to their hormones

  6. over-/underproduction of hormones hyperplasia neoplasm inflammation disturbance of blood supply genitics factors biochemical consequences hyperplasia, hypertrophy or atrophy of target organs/tissue clinic consequences

  7. A proper understanding of endocrine diseases requires a careful integration of morphologic findings with biochemical measurements of the levels of hormones, their regulators, and other metabolites.

  8. contents Pituitary Adenomas Diseases of Thyroid Diseases of Adrenal Gland Diabetes Mellitus

  9. Posterior pituitary • Antidiuretic hormone, ADH • Oxytocin, OT

  10. Anterior pituitary • Acidophile cell Growth hormone, GH Prolactin, PRL • Basophile cell Thyroid stimulating hormone, TSH Follicle stimulating hormone, FSH Luteinizing hormone, LH Adrenocoticotrophin hormone, ACTH Lipotrophic hormone, LPH • Chromophobe cell

  11. Pituitary 1.5×0.9×0.6cm 0.5~0.9g

  12. Anterior pituitary

  13. Prolactin, PRL

  14. Pituitary Adenoma • Benign neoplasm arising from anterior pituitary cells • 25% of all intracranial tumors • 20% of the general population • Their prevalence increases with advancing age • Both sexes are equally affected • They are usually invasive in children

  15. Pituitary adenoma

  16. Microadenoma • diameter <1cm • 5%~10% of the adults • rare functional

  17. Clinical Features • Hyperpituitarism • Hypopituitarism • Local mass effects

  18. Gigantism • Growth hormone adenoma occurs before puberty • Generalized increase in body size

  19. Acromegaly • Growth hormone adenoma occurs after puberty • Protruding jaw • Broaden lower face • Enlarged hands

  20. acromegaly

  21. Pituitary Adenomas Diseases of Thyroid Diseases of Adrenal Gland Diabetes Mellitus

  22. normal thyroid gland

  23. Diseases of Thyroid hyperthyroidism hypothyroidism goiter thyroiditis neoplasms of thyroid

  24. Hyperthyroidism • Excessive secretion of thyroid hormones • A consequence of an increase in body’s metabolism

  25. Clinical Features of Hyperthyroidism feeling hot increased sweating weight loss, with proximal muscle weakness rapid heart rate, palpitations atrial fibrillation (occasionally) diarrhoea anxiety and restless hyperactivity

  26. Diseases of Thyroid hyperthyroidism hypothyroidism goiter thyroiditis neoplasms of thyroid

  27. Hypothyroidism Decreased production of thyroid hormone • Hypothyroidism present at birth: cretinism • Hypothyroidism present in adults: myxoedema

  28. cretinism • mental retardation • short stature • coarse facial features • protruding tongue • umbilical hernia

  29. myxoedema

  30. Diseases of Thyroid hyperthyroidism hypothyroidism goiter thyroiditis neoplasms of thyroid

  31. Goiter Simple enlargement of the thyroid diffuse toxic goiter/Grave’s disease diffuse nontoxic goiter

  32. Diffuse Toxic Goiter/Graves Disease • Excessive secretion of thyroid hormones in the bloodstream • Organ-specific autoimmune disorder • Occurs primarily in younger adults • F︰M=8︰1

  33. Graves disease

  34. Histological changes • Hyperplasia of follicular epithelium • Reduction of stored colloid • Local accumulation of lymphocytes

  35. Clinical features • Diffuse enlargement of the thyroid • Exophthalmos (protruding eyes) • Hyperthyroidism • Pretibial myxedema

  36. exophthalmic goiter

  37. Diffuse Nontoxic Goiter / Multinodular Goiter Most common thyroid disease Most common cause for an enlarged thyroid

  38. Pathogenesis dietary iodine deficiency impairment of thyroid hormone synthesis compensatory rise in the serum TSH level hypertrophy & hyperplasia of thyroid follicular cells gross enlargement of the thyroid gland

  39. diffuse nontoxic goiter

  40. multinodular goiter

  41. multinodular goiter

  42. multinodular goiter

  43. Clinical features • Neck mass • Compression symptoms airway obstruction dysphagia compression of large vessels compression of upper thorax • normal thyroid function

  44. Diseases of Thyroid hyperthyroidism hypothyroidism goiter thyroiditis neoplasms of thyroid

  45. Hashimoto’s thyroiditis/ chronic lymphocytic thyroiditis