ENDOCRINE PATHOLOGY
The endocrine system acts as a communication
system that uses chemical messengers or
hormones for the transmission of information
from cell to cell and from organ to organ.
Hormones
Hormones act by binding to receptors that
are specific for the different types of
hormones.
Many of the endocrine glands are under the
regulatory control of other parts of the
endocrine system.
Control of Hormone Levels
The hypothalamus and the pituitary gland
form a complex integrated network that joins
the nervous system and the endocrine
system; this central network controls the
output from many of the other glands in the
body.
Diagnostic Tests
Endocrine function can be measured directly
by measuring hormone levels or indirectly by
measuring the effects that a hormone has on
the body (e.g. measurement of insulin
function through blood glucose)
General Aspects of Altered Endocrine
Function (Hypofunction & Hyperfunction)
Endocrine disorders are the result of hypo-
function or hyper-function of an endocrine
gland.
They can occur as a primary defect in
hormone production by a target gland or as a
secondary or tertiary disorder resulting from
a defect in the hypothalamic-pituitary system
that controls a target gland’s function.
Thyroid gland
Thyroid Disorders
Control of Thyroid Function
Thyroid hormones play a role in the metabolic
process of almost all body cells and are necessary
for normal physical and mental growth in the
infant and young child.
Alterations in thyroid function can manifest as a
hypothyroid or a hyperthyroid state
NORMAL THYROID GLAND
Thyroid histology
GOITER
Definition:
Enlargement of thyroid gland not due to
inflammation or tumour
Types:
1. Simple goiter
Diffuse
Nodular
2. Toxic goiter
Primary
Secondary
Simple goiter
Definition: this is non-toxic goiter
Etiology:
Endemic goiter in areas with endemic iodine
deficiency
Sporadic type occur during increase demand
for iodine as during mensis, lactation and
pregnancy
Multi-nodular goiter (non-
toxic goiter)
Clinical presentation:
1. Female> males
2. Frequently asymptomatic
3. Typically euthyroid
4. Goiter
5. The thyroid gland is enlarged with multiple
colloid nodules
• Multinodular goiter in an
elderly patient.
• Nodules vary in size and
firmness.
Multi-nodular goiter
HYPERTHYROIDISM (Toxic goiter)
Hyperthyroidism causes an increase in metabolic
rate and alterations in body function
Clinical features:
1. Tachycardia and palpitation
2. Nervousness
3. Heat intolerance
4. Weakness and tremors
5. Diaorrhoea
6. Weight loss despite a good appetite
Laboratory Investigations in
a case of hyperthyroidism:
1. Elevated Thyroxine
2. Primary hyperthyroidism decreased TSH
(Thyroid Stimulating Hormone released from
the anterior pituitary gland)
3. Secondary hyperthyroidism elevated TSH
GRAVE'S DISEASE
Definition:
An autoimmune disease where the thyroid is
overactive and produces an excessive amount
of thyroid hormones causing hyperthyroidism
and thyrotoxicosis
Clinical features:
1. Female> males
2. Age: 20-40 years
3. Hyperthyroidism
4. Diffuse goiter
5. Opthalmopathy exophthalmus
The goiter in Graves' disease is diffusely enlarged and smooth
• Graves' ophthalmopathy may
present in association with
thyrotoxicosis.
• Eye signs demonstrated in this
patient are exophthalmos with
supr-aorbital and infra-orbital
swelling, congestion and edema
of the conjunctiva.
Other causes of hyperthyroidism
1. Toxic multi-nodular goiter
2. Toxic adenoma: functioning adenoma
producing thyroid hormone (hot nodule)
3. Hashimoto's thyroiditis (transient
hyperthyroidism)
Hypothyroidism
Hypothyroidism can occur as a congenital or an
acquired defect.
Congenital hypothyroidism leads to mental
retardation and impaired physical growth unless
treatment is initiated during the first months of
life.
Acquired hypothyroidism leads to a decrease in
metabolic and causes a mucous type of edema
called myxedema.
Clinical features of hypothyroidism:
1. Fatigue and lethargy
2. Sensitivity to cold temperatures
3. Decreased cardiac output
4. Myxoedema: accumulation of mucopolysaccharides
and water leads to:
Facial and periorbital edema
Peripheral edema of the hands and feet
Deep voice
Macroglossia
5. Constipation
6. Anovulatory cycle
Lab Investigations in a case
of hypothyroidism:
1. Decreased free T4
2. Primary hypothyroidism elevated TSH
3. Secondary hypothyroidism decreased TSH
Iatrogenic Hypothyroidism
Most common cause of hypothyroidism
Secondary to thyroidectomy or radioactive
iodine treatment
-Treatment: thyroid hormone replacement
Congenital Hypothyroidism
(Cretinism)
Etiology:
Endemic regions: iodine deficiency during
intra-uterine and neonatal life
Non-endemic regions: thyroid dysgenesis
Clinical presentation:
1. Failure to thrive
2. Stunted bone growth and dwarfism
3. Spasticity and motor incoordination
4. Mental retardation
5. Goiter (endemic cretinism)
• Children born with
cretinism develop
facies similar to that of
Down syndrome or
dwarfism.
•
• Immediate treatment
of affected children at
birth lessens the
neurological and
intellectual deficits,
which frequently are
severe
Hashimoto’s Thyroiditis:
Definition: Chronic auto-immune disease
characterized by immune destruction of the
thyroid gland and hypothyroidism
Clinical presentation:
1. Female > males
2. Age: 40-65
3. Painless goiter
4. Hypothyroidism
5. Initial inflammation may cause transient
hyperthyroidism
Gross:
Pale atrophic thyroid gland
Microscopic:
-Lymphocytic inflammation with germinal centers
Complication:
Increase risk of non-Hodgkin lymphoma
Hashimoto thyroiditis: Pale
atrophic thyroid gland
THYROID NEOPLASIA
ADENOMAS
Follicular adenomas are the most common
Clinical features:
1. Usually painless, solitary nodules
2. Cold or hot nodules on thyroid scans
3. May be functional and cause hyperthyroidism
(toxic adenoma)
Follicular adenomas
PAPILLARY CARCINOMA
Accounts for 80% of malignant thyroid
tumors
Females > males
Age: 20-50 years
Risk factor: radiation
Microscopic:
1. The tumor typically exhibits a papillary pattern
2. Occasional psammoma bodies (minute
calcifications)
3. Lymphatic spread to cervical nodes is common
PAPILLARY CARCINOMA
Papillary Carcinoma
Psammoma bodies
FOLLICULAR CARCINOMA
Accounts for 15% of malignant thyroid
tumors
Females> males; age 40-60
Haematogenous metastasis to the bones or
lungs is common
Microscopically:
Follicular carcinoma resembles follicular
adenoma
Diagnosis of malignancy depends on either
vascular invasion or capsular invasion
Vascular invasion in a case of follicular carcinoma
Causes of thyroid nodules
1. Nodular goiter (60%)
2. Adenoma (30%)
3. Carcinoma (5%)
4. Thyroiditis (5%)