Physiologic anatomical peculiarities of endocrine system in children. Methodics of endocrine glands investigation. Semiotics of hypo- and hyperfunction.

Physiologic anatomical peculiarities of endocrine system in children. Methodics of endocrine glands investigation. Semiotics of hypo- and hyperfunction of some endocrine glands and diseases of the endocrine system.By Nykytyuk S  

Physiologic anatomical peculiarities of endocrine system in children. Methodics of endocrine glands investigation. Semiotics of hypo- and hyperfunction of some endocrine glands and diseases of the endocrine system.By Nykytyuk S  

The endocrine glands consist ofThe endocrine glands consist of

1.Hypotalamus 2.Hypophysis 3.the epiphysis 4.the thyroid gland 5.the parathyroid glands 6.the thymus 7.the islands of Langerhans in the pancreas 8.the adrenal glands 9.the gonads (testis and ovaries)

The main function of the endocrine systemThe main function of the endocrine system

1.to take an active part in metabolism 2.influence on water-mineral metabolism 3.influence on growth and development of a

child 4.regulation of differentiation of tissues 5.ensuration of adaptation of the organism to its

enviroment

embriologyembriology

Pituitary, thyroid, adrenal-begin to function during the intrauterine

period The hypophysis is organized at 4 weeks of

gestation Starts to secrete ACTH at 9-10 weeks

Close relationship between functions of the endocrine system and those of the hypotalamusClose relationship between functions of the endocrine system and those of the hypotalamus

Major endocrine glands. (Male left, female on the right.) Major endocrine glands. (Male left, female on the right.)

1. Pineal gland 2. Pituitary gland 3. Thyroid gland 4. Thymus 5. Adrenal gland 6. Pancreas 7. Ovary 8. Testis

The hypotalamus regulates activityThe hypotalamus regulates activity

The hypotalamus regulates activity of the hypophysis by producing neurohormones (releasing hormones).

Some of them activate and others inhibit secretion of trophic hormones of the hypophysis

Endocrine glands and the hormones secreted Endocrine glands and the hormones secreted Hypothalamus produces 1. Thyrotropin-releasing hormone

(TRH) 2. Gonadotropin-releasing hormone

(GnRH) 3. Growth hormone-releasing hormon

e (GHRH)

4. Corticotropin-releasing hormone (CRH)

5. Somatostatin (SS; also GHIH, growth factor-inhibiting hormone)

6. Dopamine (DA)

Pineal Gland produces 1. Melatonin

Pineal glandPineal gland

The pineal gland is a reddish-gray body about the size of a pea (8 mm in humans), located just rostro-dorsal to the superior colliculus and behind and beneath the stria medullaris, between the laterally positioned thalamic bodies. It is part of the epithalamus.

Pituitary gland Pituitary gland The pituitary gland, or

hypophysis, is an endocrine gland about the size of a pea that sits in a small, bony cavity (sella turcica) at the base of the brain.

The pituitary gland secretes hormones regulating homeostasis, including trophic hormones that stimulate other endocrine glands. It is functionally connected to the hypothalamus by the median eminence.

Anterior pituitary (Adenohypophysis) Anterior pituitary (Adenohypophysis)

The anterior pituitary produces and secretes:

1. growth hormone 2. prolactin 3. follicle-stimulating hormone 4. luteinizing hormone 5. thyroid-stimulating hormone 6. adrenocorticotropic hormone endorphins and other hormones

It does this in response to releasing hormones produced by the hypothalamus. These travel to the anterior lobe by way of a special capillary system, called the hypothalamic-hypophyseal portal system. These hypothalamic signalling hormones include:

TRH (thyrotropin-releasing hormone) CRH (corticotropin-releasing hormone) DA (dopamine, "prolactin inhibiting

factor"/PIF) GnRH (

gonadotropin-releasing hormone) GHRH (

growth hormone releasing hormone)

In new born periodIn new born period

Concentrations of ACTH, CTG, and TSH are high, later they decrease

Late school periodLate school period

Concentrations of luteal and follicle-stimulating hormones increases

Hypofunction of the hypophysisHypofunction of the hypophysis

Causes pituitary nanism (dwarfism)

Hyperfunction of hypophysis –(hyperpituitarism)Hyperfunction of hypophysis –(hyperpituitarism)

Pituitary gigantism and acromegaly

Hypofunction of the adrenohypophysis Hypofunction of the adrenohypophysis

Hypophyseal cachexia, Simmonds disease

ProlactinProlactin

Prolactin is a peptide hormone synthesised and secreted by lactotrope cells in the adenohypophysis (anterior pituitary gland). It is also produced in other tissues including the breast and the decidua. Pituitary prolactin secretion is regulated by neuroendocrine neurons in the hypothalamus, most importantly by neurosecretory dopamine neurons of the arcuate nucleus, which inhibit prolactin secretion.

Disease StatesDisease States

Relative elevations In children with precocious puberty of

pituitary or central origin, LH and FSH levels may be in the reproductive range and not at the low levels typically for their age.

High LH levels Persistently high LH levels are

indicative of situations where the normal restricting feedback from the gonad is absent, leading to an unrestricted pituitary production of both, LH and FSH. While this is typical in the menopause, it is abnormal in the reproductive years. There it may be a sign of:

1. Premature menopause 2. Gonadal dysgenesis, Turner syndrome 3. Castration 4. Swyer syndrome 5. Certain forms of CAH 6. Testicular failure

Deficient LH activityDeficient LH activity

Diminished secretion of LH can result in failure of gonadal function (hypogonadism). This condition is typically manifest in males as failure in production of normal numbers of sperm. In females, amenorrhea is commonly observed. Conditions with very low FSH secretions are:

1. Kallmann syndrome 2. Hypothalamic suppression 3. Hypopituitarism 4. Eating disorder 5. Hyperprolactinemia 6. Gonadotropin deficiency

Growth hormone Growth hormone Growth hormone (GH

or somatotropin) is a polypeptide hormone synthesised and secreted by the anterior pituitary gland which stimulates growth and cell reproduction in humans

Examination of hypophysisExamination of hypophysis

1. laboratory investigatios of the level of hypophysis hormones

2.R-graphy of the cranial Turkish saddle 3.CT of the brain

ThyroidThyroid

The thyroid (from the Greek word for "shield", after its shape) is one of the larger endocrine glands in the body. It is a double-lobed structure located in the neck and produces hormones, principally thyroxine (T4) and triiodothyronine (T3), that regulate the rate of metabolism and affect the growth and rate of function of many other systems in the body. The hormone calcitonin is also produced and controls calcium blood levels. Iodine is necessary for the production of both hormones. Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) are the most common problems of the thyroid gland.

ThymusThymus

The thymus plays an important role in the development of the immune system in early life, and its cells form a part of the body's normal immune system. It is most active before puberty.

The thymus of a full-time fetus, exposed in situ.

Immature thymocytes undergo a process of selection, based on the specificity of their T cell receptors. This involves selection of T cells that are functional (positive selection), and elimination of T cells that are autoreactive (negative selection).

Cells that pass both levels of selection are released into the bloodstream to perform vital immune functions.

PancreasPancreas

The pancreas is an organ in the digestive and endocrine system that serves two major functions: exocrine (producing pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin).

PancreasPancreas 1: Head of pancreas

2: Uncinate process of pancreas3: Pancreatic notch4: Body of pancreas5: Anterior surface of pancreas6: Inferior surface of pancreas7: Superior margin of pancreas8: Anterior margin of pancreas9: Inferior margin of pancreas10: Omental tuber11: Tail of pancreas12: Duodenum

There are four main types of cells in the islets of Langerhans.

There are four main types of cells in the islets of Langerhans.

beta cells-Insulin and Amylin

alpha cells-Glucagon Deltacells-Somatostatin

PP cells-Pancreatic polypeptide

50-80% lower blood sugar

15-20%raise blood sugar 3-10%inhibit endocrine

pancreas 1%inhibit exocrine

pancreas

InsulinInsulin

The structure of insulin. The left-hand side is a space-filling model of the insulin monomer, believed to be biologically active. Carbon is green, hydrogen white, oxygen red, and nitrogen blue. On the right-hand side is a cartoon of the hexamer, believed to be the stored form. A monomer unit is highlighted with the A chain in blue and the B chain in cyan. Yellow denotes disulfide bonds, and magenta spheres are zinc ions.

InsulinInsulin Computer-generated

image of insulin hexamers highlighting the threefold symmetry, the zinc ions holding it together, and the histidine residues involved in zinc binding.

Insulin (from Latin insula, "islandInsulin (from Latin insula, "island

", as it is produced in the Islets of Langerhans in the pancreas) is a polypeptide hormone that regulates carbohydrate metabolism. Apart from being the primary effector in carbohydrate homeostasis, it has effects on fat metabolism and it can change the liver's ability to release fat stores. Insulin's concentration has extremely widespread effects throughout the body.

Glucose test Glucose test

The World Health OrganizationThe World Health Organization

recognizes three main forms of diabetes: type 1, type 2 and gestational diabetes (or type 3, occurring during

pregnancy)[1], although these three "types" of diabetes are

more accurately considered patterns of pancreatic failure rather than single diseases.

Endemic cretinizmEndemic cretinizm

Hypotyrosis congenitalHypotyrosis congenital

Thyroid \\ crisis\\Thyroid \\ crisis\\

1.AN ACUTE ONSET OF HYPERTHERMIA, 2.TACHYCARDIA 3.RESTLESSNESS

Hypotyrosis congenitalHypotyrosis congenital

Laboratory investigationLaboratory investigation

Newborns screening for T4 TSH X-ray delayed bone development ECG depressed P and T waves and QRS

complex,low voltage

HyperthyroidismHyperthyroidism Appear in the school period 1.Emotional lability 2.tremor 3.increased appetite 4.loss of body weight 5.exophthalmos 6.eyelid leg 7.sweating and tachycardia

Laboratory investigationLaboratory investigation

T4 and T3 elevated X-ray of bones: osteoporosis and bones

resorption

hypoparathyroidismhypoparathyroidism

Muscle pains, Cramps, Numbness, tingling and convulsions The teeth are soft and erupt late Dry and scaly skin Cataracts may occurs

Laboratory findingsLaboratory findings

1.low calcium 2.elevatedphosphorus, 3.low vitamin D, 4,Low PTH X-ray ;increased metaphyseal thickening ECG:prolonged QT interval

Glucocorticoids functionGlucocorticoids function

Affect tissue metabolism Increase protein and glucogen content in the

liver Influence the immune and nervous systems

Adrenal medulla secretesAdrenal medulla secretes

Catecholamines: dopamine, norepinephrine epinephrine

Cushing s syndromeCushing s syndrome Etiology: Adrenocortical tumor, ACTH-dependent

bilateral hyperplasia Pituitary adenoma Abnormal production of

ACTH

Clinical manifestation: Moon face, a double chin, a buffalo hump, obesity,

masculinization, hypertrichosis on the

face and trunk, acne, clitoral enlargement, impaired growth and hypertension.

Cortisol excess.Cortisol excess.

Cortisol excess as a result of organic causes or of prolonged cortisone therapy also has an adverse effect on growth in children.

OvaryOvary

Ovaries are egg-producing reproductive organs found in female organisms. They are part of the vertebrate female reproductive system. Ovaries in females are homologous to testes in males. The term gonads refers to the ovaries in females and testes in males.

TesticleTesticle

The testicles, or testes (singular testis), are the male generative glands. Male mammals have two testicles, which are often contained within an extension of the abdomen called the scrotum.

Grows of thyroid cartilageGrows of thyroid cartilage

Phase No signs of grows Lо Beginning of cartilage projectionL1 Distinct projection of Adam’s-appleL2

Change of voice timbreChange of voice timbre

Phase Childish voiceVо Mutation (creaking)of voice V1 Male timble of voiceV2