Far Eastern University – Nicanor Reyes Medical Foundation

Gross B – Endocrine System (Part 1 and 2)

James Taclin Banez M.D. & Michael Capulong M.D.

Endocrine System:
 A collection of ductless organs (glands) that produce and store
hormones.
 One of the most important systems in the body simply because
the production of hormones in the body will dictate the
metabolic functions of the body.

Location of the Major Endocrine Glands:

There are two ways by which secretions are transferred to different
parts of the body:
 Exocrine System which is composed of glands with ducts.
 Endocrine System which is composed of ductless glands.
All endocrine glands are located in the axial system of the body,
none of which is found in the appendicular system.
PITUITARY GLAND:

Hormones:
 Hormones are chemical substances that are released into the
extracellular fluid (blood or interstitial fluid) to reach their target
tissues.
 Hormones control several major process:
 Reproduction
 Growth and development
 Mobilization of body defence/immune defence
 Maintenance of homeostasis
 Regulation of metabolism
 They regulate the activity of other cells and the control of
secretion is via the negative feedback mechanism which is
dependent on the concentration of the hormone.
 Also known as the Hypophysis Cerebri
Hypothalamic–Hypophyseal Axis:  By function, the control center of the endocrine system is the
 Also known as the Hypothalamic-Pituitary-Target Gland System. pituitary gland.
 A check and balance system wherein the hypothalamus secrete  The anterior pituitary gland is the master endocrine gland.
secretory (excitatory) or inhibitory hormones to regulate the  It oversees all hormonal production.
secretion of the specific hormone. (negative feedback  Small, oval (pea) size structure
mechanism)  Is situated in the cranial cavity which is the most superior part of
the body. Located in the sella turcica (turk’s saddle) on the
Example of the HH Axis: sphenoid bone at the base of the brain.
Thyroid gland
 Connected to the base of the brain via the infundibulum or
 If there is a decrease in thyroid function, the hypothalamus will
produce secretory hormones (TRH) to stimulate the anterior
infundibular stalk. Part of the infundibulum is connected to the
pituitary to produce more TSH, which stimulates the thyroid gland posterior pituitary lobe creating a direct communication to the
into producing more thyroid hormones. hypothalamus.
 If there is an increase in thyroid function, the hypothalamus will  Has two functional lobes:
produce inhibitory hormones to stop production or the negative a. Anterior pituitary lobe (Adenohypophysis)
feedback mechanism will be in effect.  Glandular in origin; Glandular tissue
 Bigger in size and produces hormones
 Activities of the hypothalamus are modified by information b. Posterior pituitary lobe (Neurohypophysis)
received along numerous nervous afferent pathways from  Neural in origin; Nervous tissue
different parts of the central nervous system and by the plasma  Smaller in size and does not synthesize hormones. It stores
two hormones from the hypothalamus.
levels of the circulating electrolytes

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Boundaries of the Pituitary Gland: Blood Supply of the Pituitary Gland:

 Anterior:
 Sphenoid sinus (below sphenoid bone)
 Posterior:
 Dorsum sella
 Basilar artery
 Pons
 Superior:
 Diaphragmatic sella – separates the anterior lobe from the
optic chiasma
 Optic chiasma
a. Branches of the Internal Carotid Artery
 Supplies both the Anterior and Posterior Lobe
 Inferior:
 Superior hypophyseal artery
 The body of the sphenoid
 Middle hypophyseal artery
 Sphenoid air sinuses
 Inferior hypophyseal artery
 Lateral:
b. Capillary network
 Cavernous sinus and contents
 Terminal branches that serves as drainage or venous flow.
c. Hypothalamic–Hypophyseal Vascular Portal System
 Supplies venous blood to the anterior pituitary only.
 Where anterior pituitary hormones drain to go to the specific
target glands.
The Anterior Pituitary Lobe and the Liver are the only
structures with dual blood supply.

Venous Drainage of the Pituitary Gland:

 Capillary Network
The Internal Carotid artery and Abducens nerve are not located on center,  Intercavernous sinus
but rather on the edge, but still on the confines of the sinus. Structures at
the center of the sinus are the Oculomotor, Trochlear, Ophthalmic and
Maxillary Nerve. Hormones of the Anterior Pituitary Lobe:

Segments of the Anterior Pituitary Lobe:

a. Pars Distalis (pars anterior)
 Largest segment
 Produces most hormones of the anterior lobe:
 Chromophils:
 Acidophils – Somatotrophs, Lactotrophs
 Basophils – Thyrotrophs, Gonadotrophs, Corticotrophs
 Chromophobes:
 Reserve cells
b. Pars Tuberalis / Pars Infundibularis
 In contact with the infundibulum
 Projections of the pars distalis
c. Pars Intermedia
 Between the anterior and posterior lobe
 Seperated by a cleft that is remnant of an embryonic pouch

The posterior pituitary gland has no segments.

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I. Growth Hormone (GH) / Somatotropin
 General metabolic hormone. Its action is focused on the early
childhood years where musculoskeletal growth is observed.
 Directed to the growth of skeletal muscles and long bones.
Clinical Correlation:
 Gigantism
 Excess hormone production before closure of epiphyseal plate
of long bones.
 Manifestations have equal distribution making an individual
very tall with proportional extremities.
 Acromegaly
 Excess hormone production after closure of epiphyseal plates.
 Manifestations have unequal distribution because linear
growth has already been achieved. May manifest as frontal
bossing, abnormally large hands and feet.
 Causes:
 Over secretion of acidophils, particularly, somatotrophs in
the pars distalis of the anterior pituitary gland.
 Treatment:
 If there is a tumor or abnormal growth within the pituitary
gland, surgery can be done via the nose through Functional
Endoscopic Sinus Surgery (FESS).
 The location of the pituitary gland is within the sella turcica
making it very near the cribriform plate of the ethmoid (roof
of the nose). Therefore, breaking through the cribriform
plate of the ethmoid will give access to the sphenoid bone
and eventually to the pituitary gland.
II. Prolactin (PrL) / Lactotropin
 Target Organ: Breast tissue / Mammary glands during Pregnancy
and Lactation
 Stimulates milk production prior and during delivery and
maintains milk production following childbirth.
 Abnormal watery or milky discharge of the breast even when not
pregnant, including males, may happen when there are
abnormal prolactin levels. Adenomas may cause this.
V. Gonadotropic Hormone (GnH) / Gonadotropin
 Regulate hormonal activity of the gonads.
 Target Organs: Testis and Ovary
 Follicle Stimulating Hormone (FSH)
 Stimulates Follicle Development in the Ovaries
 Stimulates Sperm Development in the Testis
 Has a lower concentration in males. Effects in males are early
and very limited to stimulation of spermatogenesis. Later on,
it will be replaced by Androgens.
 Lutenizing Hotmone (LH)
 Referred to as Interstitial Cell – Stimulating Hormone (ICSH)
in males
 Triggers ovulation, it causes ruptured follicle to become the
corpus luteum, evident on menarche. The corpus luteum has
two fates: (a) Corpus Luteum Hemmorhagicum, which
triggers menstruation and (b) Corpus Luteum of Pregnancy
which is established during fertilization.
 Stimulates testosterone production in males
Clinical Correlation:
 Simmond’s Disease
 Panhypopituitarism
 Manifestations:
 Hypothyroidism
 Hypoadrenocorticalism
 Hypogonadism
 Dwarfism
 Cause:
 Excess production of chromophobes or reserve cells. All
anterior pituitary hormones are affected due to the failure of
these reserve cells to differentiate into hormonal cells.
 Treatment:
 Hormone supplementation
Hormones of the Posterior Pituitary Lobe:

III. Adrenocorticotropic Hormone (ACTH) / Corticotropin

 Increase secretion of Cortisol.
 Target Gland: the Adrenal Gland (adrenal cortex), situated on the
upper pole of the kidneys.
 Binds to melanocyte in the skin to increase skin pigmentation
which is evident during pregnancy. Pregnancy increases all
hormone production.

Clinical Correlation:
 Cushing’s Syndrome
 Manifestations include moon face, broad shoulders, buffalo
hump, truncal obesity and masculinization of females
(increase in hair production). The Posterior Pituitary Lobe doesn’t synthesize its own hormone. The two
 Causes: hormones are synthesized by the hypothalamus and the posterior pituitary stores it.
 Over secretion of basophils, particularly, corticotrophs in
the pars distalis of the anterior pituitary gland.
 Increase ACTH, increase cortisol levels. I. Oxytocin
 Synthesized in the Paraventricular Nucleus of the hypothalamus.
 Target Organ: Uterus
IV. Thyroid Stimulating Hormone (TSH) / Thyrotropin
 Stimulates contraction of the uterus during labor. Commercially
 Influences growth and activity of the thyroid gland
prepared oxytocin may be given via IV fluid if uterine contraction
 Target Organ: Thyroid Gland
is inadequate during labor.
 Oxytocin production may be increased through nipple
stimulation. The harder the nipple gets, the more oxytocin is
produced.

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  During pregnancy, hormonal production is at its peak. Sex during
pregnancy is allowed as long as the nipple is not stimulated to
avoid premature contraction.
 Causes milk ejection during latching right after delivery.
II. Anti-Diuretic Hormone (ADH) / Vasopressin
 Synthesized in the Supra-Optic Nucleus of the hypothalamus.
 Target Organ: Kidney tubules
 Triggered by low flow state or hypovolemia causing a cascade of
hormonal production to preserve fluid.
 Can inhibit urine production.
 In large amounts, can cause severe vasoconstriction, leading to
increased blood pressure due to increase peripheral resistance.
PINEAL GLAND:
 Found on the Third Ventricle of the Brain connected by a
Peduncle, located posteriorly.
 Evident in children and degenerates as you grow old. In children,
the outline is still appreciated while in adults, a calcified density
is appreciated which represents the degenerated pineal gland.
 Secretes only one hormone, Melatonin.
I. Melatonin
 Helps establish the body’s Sleep-Wake Cycle (Circadian Rhythm)
 Found to have an inhibitory effect on the hormonal production
of the thyroid, parathyroid, pancreas and adrenal glands.
THYROID GLAND:
 Found at the base of the throat, in the anterior neck area
 Consist of two lobes and a middle connecting isthmus.
 To locate the thyroid gland, palpate for the thyroid cartilage and
cricoid cartilage. From the cricoids cartilage, count the level of
the tracheal rings.
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40-50% of individuals have another lobe called Pyramidal Lobe.
It attaches the thyroid to the hyoid bone.
 As the thyroid descends during its embryonic development, it
creates a canal that later on solidifies. Some individuals,
however, retain the parenchyma of the lower part thus giving
rise to the pyramidal lobe. When the canal remains patent, a
thyroglossal duct cyst is created.
 Visceral fascia of deep fascia of the neck is called the thyroid
fascia. It covers the thyroid and parathyroid glands.
 Produces two hormones: Thyroid Hormone (T3 and T4) and
Calcitonin.
Relations of the Lobe:
 Anterolateral:
 Sternothyroid
 Superior belly of omohyoid
 Sternohyoid
 Anterior border of sternocleidomastoid
All of the muscles of the neck except for the sternocleidomastoid and
omohyoid are called strap muscles. Sternothyroid and sternohyoid are
strap muscles that are in close contact with the lobes of the thyroid.
 Posterolateral:
 Carotid sheath with common carotid artery
 Internal jugular vein - Comes from the sigmoid sinus, beside
the cranial cavity
 External jugular vein - Formed by the union of the
retromandibular vein and the posterior auricular vein
 Vagus nerve
 Medial
 Larynx
 Trachea
 Esophagus
 Pharynx
 Associated with these structures are the cricothyroid muscles
and its nerve supply, the superior laryngeal nerve.
 The cricothyroid muscle tenses the vocal cords, when
injured; it can alter the pitch of the voice.
 In the groove between esophagus and trachea is the recurrent
laryngeal nerve responsible for voice production. As the
recurrent laryngeal nerve course the trachea-esophageal groove,
it will move anteriorly and enters into the hyoid to supply the
vocal cords.
 This is critical point during surgery because accidentally
cutting of one nerve may cause hoarseness and partial loss
of voice.
 Cutting both nerves may cause total absence of voice and
airway spasm because the vocal folds will remain in one
position when it remains closed.
 When dissecting the neck area, the following structures will be
seen from the superficial part to the deep part: skin,
subcutaneous tissues, platysma muscle (outermost covering of
the neck, innervated by the facial nerve and pulls the face
downward when contracted. By function and innervation, it is
considered a muscle of facial expression) then the strap muscles.
Strap muscles are deflected sideways exposing the thyroid gland.
Below the thyroid is the trachea, then the esophagus.
Relations of the Isthmus:
 Anterior:
 Strap muscles
 Sternothyroid
 Sternohyoid
 Anterior jugular veins
 Formed by the anastomosis of all the superficial veins
beneath the mandibular area.
 The anterior jugular vein courses anteriorly or diagonally. So
during surgery, it can be ligated. Note, anterior jugular vein
can be ligated, not the internal jugular vein.
 Fascia
 Skin
 Posterior:
nd rd th
 2 , 3 and 4 rings of the trachea
 The approximate level of the thyroid gland
nd rd
 2 and 3 tracheal ring are used for airway access for
placing the tracheostomy tube in cases of upper airway
compromise
nd rd
 Any area lower than the 2 and 3 tracheal rings are not
used due to the danger of eroding great vessels.
Blood Supply of the Thyroid Gland:
a. Superior Thyroid Artery
 From the External Carotid Artery (first branch)
 Supplies the superior pole of the thyroid
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b. Inferior Thyroid Artery
 From the Thyrocervical Trunk, a branch of subclavian
 Supplies the inferior pole and part of isthmus
c. Thyroidea Ima
 12% of individuals has it
 Supplies the isthmus and part of the inferior pole of the
thyroid
 Multiple origin: may originate from the brahiocephalic artery
(40%), carotid, subclavian and arch of aorta
 Will be ligated if midline thyroidectomy is performed
Venous Drainage of the Thyroid Gland:
a. Superior Thyroid Vein
 From the internal jugular vein
b. Middle thyroid vein
 From the internal jugular vein
 Needs to be ligated during thyroidectomy to minimize
bleeding
c. Inferior thyroid vein
 From the brachiocephalic vein
Hormones of the Thyroid Gland:
 Composed of two active iodine-containing hormones.
 Affect 90-95% of the body’s metabolic activity from growth,
reproduction, neurologic function, bone development and
muscular development.
I. Thyroxine (T4)
 Tetraiodothyronine
 Secreted by thyroid follicles
 Storage form, prohormone
 Conversion from T4 to T3 requires removal of one iodine
molecule and occurs at the peripheral tissues
 The cleaved iodine molecule will again form a T4
II. Triiodothyronine (T3)
 Result of conversion of T4 at target cell
 Secreted by thyroid follicles
 Active form
Clinical Correlation:
 Hypothyroidism
 Decrease in thyroid hormone concentration causes cretinism.
 Manifestations include obesity, narcoleptic and cold
intolerance
 Hypometabolic activity, increase in weight, retarded activity,
decreased libido.
 Cretinism is the severe form of hypothyroidism.
 Happens in an individual born with a hypothyroid
mother.
 Hypothyroidism started in utero. Hormones are shared
between the fetus and the mother.
 Manifestations include mental retardation, no skeletal or
mental development and small for gestational age.
 Hyperthyroidism
 Increase in thyroid hormone causes Grave’s Disease.
 Hypermetabolic activity, burning more calories, negative
balance, doesn’t increase in weight.
 Manifestations are weight loss, palpitations, tremors, heat
intolerance, proptosis, exopthalmos of the eye (secondary to
the hyperstimulation of the adipose tissue in the orbital cavity
which causes a pushing effect, irreversible)
  Diagnosis: serum TSH, T4 and T4  In cases of accidental removal of the parathyroid glands, return
 Serum tsh is the most important indicator of thyroid it by:
function. a. Reimplanting on an area with a good blood supply
 Normal tsh level: 0.2-2.5ml µ/l b. Reimplanting on forearm muscle pockets
 Hyperthyroidism: below 0.2
 Hypothyroidism: above 2.5 Blood Supply of the Parathyroid:
 Nodular Goiter a. Superior thyroid artery
 Has two types: b. Inferior thyroid artery
 Nodular toxic goiter - Hyperthyroid with multiple nodules  Primary supply
 Nodular non-toxic goiter - Either euthyroid or hypothyroid
with multiple nodules
ADRENAL GLANDS:
 The typical goiter is cystic and soft when touched because of
iodine deposition on the follicle. It is usually aspirated to
remove the deposited iodine.
 In cases when solid nodule is present, surgery is indicated.

III. Calcitonin
 Preserves calcium by decreasing blood calcium levels by causing
its deposition on bone.
 Antagonist to Parathyroid Hormone which increases blood
calcium levels.
 Produced by parafollicular cells or c cells.
 In post menopausal women, hormone levels are decreased
making the calcium leak from the bone going to the circulation
predisposing women to osteoporosis.
 In a homeostatic state, the action of calcitonin and parathyroid
hormone are equal.
 Paired glands situated at the upper pole of the kidneys.
 Due to the location, it is also called as suprarenal glands.
PARATHYROID GLAND:  Two layers:
 Cortex
 Outer glandular region with three layers
 Medulla
 Inner neural tissue region
 Considered as the second neuron of the autonomic
nervous system

Hormones of the Adrenal Cortex:

 Tiny masses on the posterior of the thyroid gland.
 It is difficult to identify the parathyroid because it is just like a
mass of fat tissue.
 Can be located through the extracapsular dissection of the
thyroid. Meaning, during thyroidectomy, you leave the posterior
capsule of the thyroid, where the parathyroid is usually located.
 Composed of two pairs (one superior pair and one inferior pair)
 Secretes one hormone, the Parathyroid Hormone.
I. Parathyroid Hormone
 Stimulates the kidneys and intestine to absorb more calcium.
 Raises calcium levels in the blood.
 Low levels of calcium can cause muscle cramps or tetany
(hypocalcemic state)
 In total thyroidectomy, accidental removal of the parathyroid
causes manifestations of hypocalcemia immediately after 1-2
hours.
 Manifestations:
 Carpo-pedal spasm: inability of the fingers and toes to extend.
 Chvostek’s sign: spasm on the chin upon tapping.
I. Mineralcorticoids (mainly Aldosterone)
 Produced in the outer adrenal cortex layer, Zona Glomerulosa
 Retain sodium, increase the effective fluid circulating volume,
increase water reabsorption
 Regulate mineral content in blood, water and electrolyte balance
 Target Organ: Kidney Tubules
 Production is stimulated by renin and inhibited by atrial
natriuretic peptide
 Not affected by ACTH
II. Glucocorticoids (mainly Cortisol)
 Produced in the middle layer of the cortex, Zona Fasciculata
 Promote normal cell metabolism
 Help resist long-sterm stressors
 Released in response to increase blood levels of ACTH
III. Sex Hormones (Androgens)
 Produced in the inner layer of the adrenal cortex, Zona
Reticularis
 Produces androgens in male and a few estrogens in female
 Breast cancer is estrogen-related; even during menopause
there are still chances of recurrence so patients are
subjected to hormonal therapy (anti-estrogen). Even if
ovaries are not functioning the adrenals still produce minimal
amount of estrogens.

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  Testicular cancer can still occur even after the testis is
removed because the adrenals still produce androgens.
 Tumors in adrenal glands can cause masculinizing effect in
the individual due to hypersecretion.
Hormones of the Adrenal Medulla:
 Produces two similar hormones called Cathecolamines:
 Epinephrine
 Norepinephrine (more predominant)
 Prepares body for short term stressors.
Blood Supply of the Adrenal Gland:
a. Superior Adrenal Artery
 Branch of the inferior phrenic artery
b. Middle Adrenal Artery
 Branch of the abdominal aorta
 Main blood supply
c. Inferior Adrenal Artery
 Branch of the renal artery
Venous Drainage of the Adrenal Gland:
a. Right Adrenal Vein
 Tributary of the inferior vena cava
b. Left Adrenal Vein
 Tributary of the left renal vein
PANCREATIC ISLETS / ISLETS OF LANGERHANS:
 Pancreas is a mixed gland (has both endocrine and exocrine
function)
 Exocrine: the Pancreatic Acini
 Produces pancreatic juiced for digestion
 Secreted through the Pancreatic ducts of Wirsung and
Santorini
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 Endocrine: the Islets of Langerhans
 Α cells: glucagon – increase blood glucose levels
 Β cells: insulin – decrease blood glucose levels
 Δ cells: somatostatin – regulate balance between sugar
levels, inhibits growth hormone
 F cells: pancreatic polypeptide
Clinical Correlation:
 Diabetes Mellitus
 Abnormal utilization of sugar
 Normally, insulin facilitates entry of sugar inside the cell
 There is destruction of β cells in the pancreas. There is
predominance of the action of glucagon.
THYMUS:
 Active during childhood to mid-teen years; as the individual
reaches the age of 20, it degenerates.
 Located posterior to the sternum, in the superior mediastinum
 Produces Thymosin
 Stimulate leukocytes and mature some type of wbcs.
Important in developing immune system especially t
lymphocytes.
OVARIES:
 Located at the side of the uterus, beneath the fallopian tube
 It has a cortex and a medulla. The cortex contains the the
oogania while the medulla contains the vascular system and
connective tissues
 Supporting structures:
 Ovarian ligament – connects the ovary and the uterus,
attached to the uterus between the body and the fundus,
more anterior to the fundus.
 Broad ligament – most important ligament tha supports the
internal genitalia of the female. It is attached laterally to the
pelvic wall and has three parts:
 Mesometrium – beside the uterus
 Mesosalpinx – beside the oviducts
 Mesovarium – beside the ovaries
 Suspensory ligament – contains and supports the vascular
system of the ovaries.
 Hormones of the Ovaries: Hormones of the Placenta:
I. Estrogen I. β Human Chorionic Gonadotropin
 Main source is the ovaries, particularly the Graafian Follicles, but  Hormone that is used to check for pregnancy
also produced in the adrenal cortex and placenta.  The concentration of the hormone usually peaks during the
 Major female hormone. initial onset of missed periods and gradually lowers during the
 Stimulates the development of secondary sex characteristics and first 4-8 weeks of pregnancy
helps in the maturation of the female reproductive organs.  Levels can also increase in the presence of a mass or tumor
 Prepares the uterus in receiving a fertilized egg. called H. Mole (molar pregnancy) which is a form of cancer in
 Maintains pregnancy and prepares the breast produce milk the females.
 Rejuvenating effect on skin
 Has an effect in the maturation of sexual characteristics and OTHER HORMONE PRODUCING GLANDS:
sperm of the males.  Parts of the Small Intestine
 Considered to be the largest endocrine gland
II. Progesterone  Parts of the stomach
 Responsible for maintaining pregnancy  Kidneys
 Produced by the corpus luteum  Heart
 Acts with estrogen to bring about menstrual cycle
 Helps in the implantation of an embryo to the uterus.
 If egg is not fertilized the corpus luteum becomes the corpus
luteum hemmorhagicum which signals the next cycle
 If egg is fertilized the corpus luteum becomes the corpus
luteum of pregnancy. There is increased production of
progesterone and decrease production of estrogen.
Progesterone supports the pregnancy.

FSH, LH, Estrogen and Progesterone are evident during

menarche.

TESTIS:

 Has an endocrine and reproductive part: the reproductive part is

contributed by the presence of the seminiferous tubules which
is responsible for the formation of the sperm cells
 Main structures that produce the testicular hormone are the
leydig cells, which is located on the lobular septum, an inward
extension of the tunica albuginea
 Produce several androgens

Hormones of the Testis:

I. Testosterone
 Most important androgen
 Appearance and maturation of the male secondary sex
characteristics
 Growth and maturation of male reproductive system
 Required for sperm cell production

PLACENTA:
 Produces hormones that maintain the latter part of the Syri avy ujus dohaeragon!
pregnancy “May it serve you well!”
 Some hormones play a part in the delivery of the baby

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