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Endocrine system
Primary function : control of HOMEOSTASIS .
Endocrine disease ---- result from pathogenetic mechanism----incl abnormality :in the synthesis and secretion of hormonal stimulation. Homeostasis ??-------------.
In general;endocrine disorder
Production of hormone :
Underproduction
Overproduction
Hyperfungtional state
Clinical apearance
Hypofungtional
Pituitary gland
Embryology and anatomy of pituitary gland
Sheehanss yndrome
Usually causes by infarction of the anterior pituitary Ass: with obtetrichemorrhage/shock It may also occur in male ?and non pregnant woman ? (trauma, vascular accident, DIC, sickle cell anemia) Gen ass with destruction of 90 to 95 % of the gland
Craniopharyngioma
5% of intracranial neoplasm Most are found in patients during 2-3 decades Characteristic: cystic ,calsification 75% Microscopically: composed of a mixture of squamous apithelial elements and delicate reticular stroma Appearance of the enamel organ of a developing tooth Gliosis is common at the perifer Malignancy is rare
THYROID GLAND
Embryologi and anatomi
Hyperthyroidism
hypothyroidism
Goiter
Neoplasm
Congenital lesions
Thyroglossal duct cysts Represent persistence of thyroid anlage extending from the foramen cecum Midline cysts anterior to the trachea Histopatologic : varying mixtures of squqmous and columnar epithelialand lymphoid cells May become secondary infection
Hyperthyroidism
A hypermetabolic state secondary to increased levelsof circulating T3 andt4 Clinical : nervousness,heat intolerance excessive perspiration, fatigue, palpitation, tachycardi, weight loss despite good appetite.Wide-eyed Laboratory:elevated T3 and T4 Thyroid storm
Hypothyroidism
A hypometabolic state caused by deficiency of thyroid hormones Clinic: Cretinism if thyroid defisiency develops during perinatal period or infancy,and myxedema in older chidren and adults
Thyroiditis
Infectious thyroiditis Hashimotos Thyroiditis Subacute granulomatous thyroiditis Lymphocytic thyroiditis Riedel thyroiditis
Infectious thyroiditis
Agents: staphylococus aureus,streptococci,sarmonella,ent erobacter,mycobacteria and fungi May be hematogenous or associated with local trauma RRR
Hashimoto thyroiditis
Autoimun disorder Female predominance(10:1) Peak incidence is 30 to50 years of age Associated with HLA-DR5 and other autoimun disorders eg: SLE Clinical:symmetric or focal rubbery enlargementof the gland with an intake capsule Microscopic:exuberant lympocytic infiltrate with germinal centers.
Subacute lymphocyticthyroiditis
An inflamatory disorder of unknown etiology defined histologically by nonspesific lymphoid infiltrationof the thyroid parenchyma No germinal center formation No significantplasma cell infiltrate No clear with viral infection
Neoplasms
Adenomas Multiple histologic all representing follicular neoplasms Mic: fibrous capsule Architecture distinct from the ajacent gland Abcence of multinodularity in the remaining gland Carcinomas Female predominance Causes 7000 U.S deaths annually Morphologic variants: Papillary.follicular,m edullary,others(sarco ma,lymphomas)
Papillary carcinoma
Most common form of thyroid cancer in children & adults All thyroid neoplasms with papillary architecture Typically infiltratif;fibrosis and calcification are common,often multifocal Clearground-glassnuclei are common and diagnostic of papillary carcinoma Psamomas bodies are found in papillaein one half of patients
Follicular carcinoma
One fourth of thyroid malignancies Peak incidence in the fith to sixth decades Gross resembling follicular adenoma.fibrosis,hemorhage,necrosis and cyst formation are relatively common Ground glass nuclei and psamomas bodies are absent Clinical features,more aggressive than papillary ca
Medllary carcinoma
Rare tumor Arising from calcitonin producing cells of the thyroid Blood calcitonin is high
Parathyroid glands
Hyperfunction : a. primary---due to hyperplasia b.Secondary---reaction to hypocalcemia Hypoparathyroidsm -accidental surgical removal of the parathyroid duringthyroidectomi -autoimun disease -conggenital defisiency
Adrenal cortex
Developmental anomalies Hypofunction of adrenal cortex (hypoadrenalism) Hyperfungtion of adrenal cortex Hyperadrenalism Cushings disease
Cushings syndrome
Pheochromocytoma
Thymus
Thymic agenesis and hypoplasia Thymic hyperp[lasia tumors
The skin