Controls many body functions

exerts control by releasing special chemical substances into the blood called hormones Hormones affect other endocrine glands or body systems

Derives its name from the fact that various glands release hormones directly into the blood, which in turn transports the hormones to target tissues via ducts.

Exocrine glands transport their hormones to target tissues via ducts.

Endocrine Emergencies:
from common: Diabetes to the unusual: Thyrotoxicosis

Consists of several glands located in various parts of the body.

Pituitary gland: a small gland located on a stalk hanging from the base of the brain The Master Gland Primary function is to control other glands. Produces many hormones. Secretion is controlled by the hypothalamus in the base of the brain.

The Pituitary Gland is divided into 2 areas, which differ structurally and functionally each area has separate types of hormone production.

The two segments are: Posterior Pituitary: produces oxytocin and antidiuretic hormone (ADH) Anterior Pituitary: produces thyroid-stimulating hormone (TSH) growth hormone (GH) adrenocorticotropin (ACTH) follicle-stimulating hormone (FSH)

And even more

luteinizing hormone (LH) prolactin

Posterior Pituitary Oxytocin (the natural form of pitocin) stimulates gravid uterus causes let down of milk from the breast. ADH (vasopressin) causes the kidney to retain water.

Anterior Pituitary Primarily regulates other endocrine glands rarely a factor in endocrinological emergencies TSH stimulates the thyroid gland to release its hormones, thus metabolic rate

Anterior Pituitary Growth hormone (GH) glucose usage consumption of fats as an energy source ACTH stimulates the adrenal cortex to release its hormones FSH & LH stimulates maturation & release of eggs from ovary.

The Thyroid Gland

lies in the anterior neck just below the larynyx. Two lobes, located on either side of the trachea, connected by a narrow band of tissue called the isthmus. Sacs inside the gland contain colloid

Within the colloid are the thyroid hormones: thyroxine (T4) triiodothyronine (T3) When stimulated (by TSH or by cold), these are released into the circulatory system and the metabolic rate. C cells within the thyroid produce the hormone calcitonin.

brownish-red, highly vascular gland Location: ant neck at C5-T1, overlays 2nd 4th tracheal rings Avg width: 12-15 mm (each lobe) Avg height: 50-60 mm long Avg weight: 25-30 g in adults (slightly more in women) **enlarges during menstruation and pregnancy**

Pyramidal lobe: often ascends from the isthmus or the adjacent part of either lobe (usu L) up to the hyoid bone may be attached by a fibrous/fibromuscular band levator of the thyroid gland

Under middle layer of deep cervical fascia (pretracheal) thyroid inner true capsule thin and closely adherent to the gland capsule extensions within the gland form septae, dividing it into lobes and lobules lobules are composed of follicles = structural units of the gland layer epithelium enclosing a colloid-filled cavity

colloid (pink on H&E stain) contains an iodinated glycoprotein, iodothyroglobulin (precursor of thyroid hormones).

Follicles = variable size surrounded by dense plexuses of fenestrated capillaries, lymphatic vessels, and sympathetic nerves.

Epithelial cells = 2 types: principal (ie: follicular) formation of colloid (iodothyroglobulin) parafollicular (ie: C cells -clear, light), lie adjacent to follicles w/in basal lamina produce calcitonin

Lateral - sternothyroid Anterior - omohyoid muscle - sternohyoid Inferior - SCM (lower portion) ** careful - motor nerve supply from the ansa cervicalis enters these muscles inferiorly.

Recall: innervates all larynx except cricothyroid Closely assoc with ITA (see next slides for details) NB: non recurrent LN ~5/1000 pts on R side When retroesophageal R SCA from dorsal aortic arch NRLN - branches fr X at ~ cricoid cartilage directly enters the larynx without looping around SC L sided - only when R aortic arch and ligamentum arteriosum concurrent w/ L retroesophageal subclavian artery.

ARTERIAL: superior and inferior thyroid arteries (occ thyroidea ima) ++ collateral anastomoses (ipsi and contralaterally) thyroid ima (when pres) originates from aortic arch or innominate artery, enters the thyroid at inferior border of isthmus.

SUPERIOR THYROID ARTERY

first anterior branch ECA descends laterally to the larynx under the omohyoid and sternohyoid muscles runs superficially on the anterior border of the lateral lobe, sending a branch deep into the gland before curving toward the isthmus where it anastomoses with the contralateral artery

SUPERIOR THYROID ARTERY: Relationship with SLN: Cephalad to the superior pole, ext branch of SLN runs w/ STA before turning medially supply cricothyroid muscle
**careful when ligating artery**

INFERIOR THYROID ARTERY

SCA thyrocervical trunk ITA ITA ascends vertically and then curves medially to enter the tracheoesophageal groove (posterior to carotid sheath) Branches penetrate the posterior aspect of the lateral lobe

Relationship with RLN: RLN ascends in the TE groove and enters the larynx b/w the inferior cornu of the thyroid cartilage and the arch of the cricoid RLN can be found after it emerges from the superior thoracic outlet:
Sup: thyroid lobe Lat: common carotid artery Medial: trachea

**Careful - relationship between RLN and ITA highly variable (Redd, 1943 described 28 variations) Examples: Deep to ITA (40%) superficial (20%) b/w branches of the artery (35%)
**also only 17% of the time is the nerve/artery relationship the same on both sides **at level ITA extralaryngeal branches RLN present 5% of the time

VENOUS: 3 pairs of veins: 1) STV asc along STA and becomes a tributary of the IJV 2) MTV directly lateral IJV 3) ITV (variable):

R passes ant to innominate a R BCV or ant trachea L BCV L drainage L BCV **occ both inf veins form a common trunk thyroid ima vein empties into L BCV

Extensive, multidirectional flow periglandular prelaryngeal (Delphian) pretracheal paratracheal (along RLN) brachiocephalic (sup mediastinum) deep cervical thoracic duct
NB: regional mets of thyroid carcinoma are superior and lateral, along IJV ie: invasion of the pretracheal and paratracheal LNs and obstruction of normal lymph flow.

Principally from ANS Parasympathetic fibers from vagus Sympathetic fibers from superior, middle, and inferior ganglia of the sympathetic trunk Enter the gland along with the blood vessels.

Calcitonin, when released, lowers the amount of calcium in the blood. Inadequate levels of thyroid hormones = hypothyroidism, or Myxedema.

Myxedema symptoms: Facial bloating weakness cold intolerance lethargy altered mental status oily skin and hair TX: replacement of thyroid hormone.

Increased thyroid hormone release causes hyperthyroidism, commonly called Graves disease. Signs and symptoms: insomnia, fatigue tachycardia hypertension heat intolerance weight loss

Long term hyperthyroidism: Exopthalmos bulging of the eyeballs (picture Barbara Bush) In severe cases - a medical emergency called thyrotoxicosis can result.

Parathyroid Glands
small, pea-shaped glands, located in the neck near the thyroid usually 4 - number can vary regulate the level of calcium in the body

produce parathyroid hormone - level of calcium in blood Hypocalcemia can result if parathyroids are removed or destroyed.

Pancreas

a key gland located in the folds of the duodenum has both endocrine and exocrine functions secretes several key digestive enzymes

Islets of Langerhans
specialized tissues in which the endocrine functions of the pancreas occurs include 3 types of cells:
alpha ( ) beta () delta ()

each secretes an important hormone.

Alpha () cells release glucagon, essential for controlling blood glucose levels. When blood glucose levels fall, cells the amount of glucagon in the blood .

The surge of glucagon stimulates the liver to release glucose stores (from glycogen and additional storage sites). Also, glucagon stimulates the liver to manufacture glucose gluconeogenesis.

Beta Cells () release insulin (antagonistic to glucagon). Insulin the rate at which various body cells take up glucose. Thus, insulin lowers the blood glucose level.

Insulin is rapidly broken down by the liver and must be secreted constantly. Delta Cells () produce somatostatin, which inhibits both glucagon and insulin.

Adrenal Glands

2 small glands that sit atop both kidneys.

Each has 2 divisions, each with different functions.

the Adrenal Medulla secretes the catecholamine hormones norepinephrine and epinephrine (closely related to the sympathetic component of the autonomic nervous system).

The Adrenal Cortex secretes 3 classes of hormones, all steroid hormones:

gluticocorticoids mineralocorticoids androgenic hormones

One at a time

gluticocorticoids: accounts for 95% of adrenal cortex hormone production the level of glucose in the blood Released in response to stress, injury, or serious infection like the hormones from the adrenal medulla.

Mineralocorticoids:
work to regulate the concentration of potassium and sodium in the body.

Signs & Symptoms of Cushings Disease:

in blood sugar levels unusual body fat distribution rapid mood swings

Prolonged in adrenal cortex hormone results in

Cushings Disease.

And - if there is an in mineralocorticoids as well

A serious electolyte imbalance will occur due to the potassium excretion by the kidney, which results in hypokalemia.

Sodium can also be retained by the kidney, resulting in hyponatremia.

Causes:
dysrhythmias coma death

usually results from a tumor - TX? Removal of tumor.

Gonads and Ovaries:

Ovaries:

both have endocrine functions.

the endocrine glands associated with human reproduction. Female ovaries produce eggs Male gonads produce sperm

located in the abdominal cavity adjacent to the uterus. Under the control of LH and FSH from the anterior pituitary they manufacture
estrogen protesterone

Estrogen and Progesterone have several functions, including sexual development and preparation of the uterus for implantation of the egg.

Testes:

located in the scrotum produce sperm for reproduction manufacture testosterone -

Controlled by anterior pituitary hormones FSH and LH.

promotes male growth and masculinization

Endocrine Emergencies: Diabetes Mellitus

one of the most common diseases in North America. insulin secretion by the Beta () cells of the islets of Langerhans in the pancreas.

Complications of Diabetes:
contributes to heart disease stroke kidney disease blindness

Pathophysiology of Diabetes: Glucose Metabolism

The other 2 major food sources are Most sugars in the human diet are complex and must be broken down into simple sugars: glucose, galactose and fructose - before use.
proteins fats

Glucose (dextrose) is a simple sugar required by the body to produce energy. Sugars, or carbohydrates, are 1 of 3 major food sources used by the body.

Breakdown of sugars is carried out by enzymes in the gastro intestinal system.

As simple sugars, these are absorbed from the GE system into the body. More than 95% enter the body as glucose.

To be converted into energy, glucose must first be transmitted through the cell membrane. BUT the glucose molecule is large and doesnt readily diffuse through the cell membrane.

Glucose must pass into the cell by binding to a special carrier protein on the cells surface.
Facilitated diffusion doesnt use energy. The carrier protein binds with the glucose and carries it into the cell.

The rate at which glucose can enter the cell is dependent upon insulin levels.
Insulin serves as the messenger - travels via blood to target tissues. Combines with specific insulin receptors on the surface of the cell membrane.