HORMONES &

ENDOCRINE
DISORDERS
Dr. (NM) Shehla Unmbreen
 BASIC CONCEPT OF ENDOCRINES
The development, structure and functions of human body
are governed and maintained by 2 mutually interlinked
systems—
1. The endocrine system
2. The nervous system
a third system combining features of both these systems
is appropriately called neuroendocrine system.
 NEUROENDOCRINE SYSTEM
●This system forms a link between endocrine glands and nervous system.
●The cells of this system elaborate polypeptide hormones;
●However, though having common biochemical properties, the cells of this system
are widely distributed in the body in different anatomic areas;
●Hence it is currently called dispersed neuroendocrine system. Cells comprising this
system are as under:
1. Neuroendocrine cells which are present in the gastric and intestinal mucosa and elaborate
peptide hormones.
2. Neuroganglia cells lie in the ganglia cells in the sympathetic chain and elaborate amines.
3. Adrenal medulla elaborates epinephrine and norepinephrine.
4. Parafollicular C cells of the thyroid secrete calcitonin.
5. Islets of Langerhans in the pancreas (included in both endocrine and neuroendocrine
systems) secrete insulin.
6. Isolated cells in the left atrium of the heart secrete atrial natriuretic (salt-losing) peptide
hormone.
 NEUROENDOCRINE SYSTEM
● In addition to above, other non-endocrine secretions include
neurotransmitter substances
● Such as acetylcholine and dopamine released from neural synapses,
and
● Erythropoietin and vitamin D3 elaborated from the kidney.
 THE ENDOCRINE SYSTEM

Anatomically, the endocrine system consists of 6 distinct organs:

1. Pituitary
2. Adrenals
3. Thyroid
4. Parathyroids
5. Gonads
6. Pancreatic islets
The last one is included in neuroendocrine system also.
Broadly speaking, human hormones are divided into 5 major classes which are
further grouped under two headings depending upon their site of interactions on
the target cell receptors (whether cell membrane or nuclear receptor):
Group I: Those interacting with cell-surface membrane receptors:
1. Amino acid derivatives: thyroid hormone, catecholamines.
2. Small neuropeptides: gonadotropin-releasing hormone (GnRH), thyrotropin-
releasing hormone (TRH), somatostatin, vasopressin.
Group II: Those interacting with intracellular nuclear receptors:
3. Large proteins: insulin, luteinising hormone (LH), parathormone hormone.
4. Steroid hormones: cortisol, estrogen.
5. Vitamin derivatives: retinol (vitamin A) and vitamin D.
● The synthesis of these hormones and their precursors takes place through a
prescribed genetic pathway that involves:
● Transcription → mRNA → protein synthesis → post- translational protein
processing → intracellular sorting/ membrane integration → secretion.
 Major functions
Major Functions of hormones are as under:
i) Growth and differentiation of cells: by pituitary hormones, thyroid,
parathyroid, steroid hormones.
ii) Maintenance of homeostasis: by thyroid (by regulating BMR), parathormone,
mineralocorticoids, vasopressin, insulin.
iii) Reproduction: sexual development and activity, pregnancy, foetal
development, menopause etc.
 ● The stimulatory or regulatory action by endocrine hormonal secretions may
follow paracrine or autocrine pathways:
”. Paracrine regulation means that the stimulatory/regulatory factors are
released by one type of cells but act on another adjacent cell of the system.
”. Autocrine regulation refers to action of the factor on the same cell that
produced it.

A basic feature of all endocrine glands is the existence of both negative

and positive feedback control system that stimulates or regulates
hormone production in a way that levels remain within the normal range
(abbreviated as S or R respectively with the corresponding hormone e.g.
TSHTRH pathway, GnRH-LH/FSH pathway etc). This system is
commonly termed hypothalamic- pituitary hormone axis
● Hyperfunction This results from excess of hormone secreting tissues e.g.
hyperplasia, tumours (adenoma, carcinoma), ectopic hormone production,
excessive stimulation from inflammation (often autoimmune), infections,
iatrogenic (drugs-induced, hormonal administration).

● Hypofunction Deficiency of hormones occurs from destruction of hormone-

forming tissues from inflammation (often autoimmune), infections, iatrogenic
(e.g. surgical removal, radiation damage), developmental defects (e.g.
Turner’s syndrome, hypoplasia), enzyme deficiency, haemorrhage and
infarction (e.g. Sheehan’s syndrome), nutritional deficiency (e.g. iodine
deficiency).

● Hormone resistance There may be adequate or excessive production of a

hormone but there is peripheral resistance, often from inherited mutations in
receptors (e.g. defect in membrane receptors, nuclear receptors or receptor for
signal transduction).
 PITUITARY GLAND
NORMAL STRUCTURE
● ANATOMY The pituitary gland or hypophysis in an adult weighs about 500 mg
and is slightly heavier in females.
● It is situated at the base of the brain in a hollow called sella turcica formed out of
the sphenoid bone.
● The gland is composed of 2 major anatomic divisions: anterior lobe
(adenohypophysis) and posterior lobe (neurohypophysis).
”. The anterior lobe or adenohypophysis is an ectodermal derivative formed from
Rathke’s pouch which is an upward diverticulum from the primitive buccal cavity.
The adenohypophysis has no direct neural connection but has indirect connection
through capillary portal circulation by which the anterior pituitary receives the blood
which has already passed through the hypothalamus.
”. The posterior lobe or neurohypophysis is a downgrowth from the primitive
neural tissue. The neurohypophysis, therefore, has direct neural connection superiorly
with the hypothalamus.
 HISTOLOGY AND FUNCTIONS

● The histology and functions of the anterior and posterior lobes of the pituitary
gland are quite distinct.
A. ANTERIOR LOBE (ADENOHYPOPHYSIS) It is composed of round to
polygonal epithelial cells arranged in cords and islands having fibrovascular
stroma. These epithelial cells, depending upon their staining characteristics and
functions, are divided into 3 types, each of which performs separate functions:
1. Chromophil cells with acidophilic granules
These cells comprise about 40% of the anterior lobe and are chiefly located in the
lateral wings. The acidophils are further of 2 types:
i) Somatotrophs (GH cells) which produce growth hormone (GH).
ii) Lactotrophs (PRL cells) which produce prolactin (PRL). Cells containing both
GH and PRL called mammosomatotrophsare also present.
2. Chromophil cells with basophilic granules
These cells constitute about 10% of the anterior lobe and are mainly found in the
region of median wedge. The chromatophils include 3 types of cells:
i) Gonadotrophs (FSH-LH cells) which are the source of the FSH and LH or
interstitial cell stimulating hormone (ICSH).
ii) Thyrotrophs (TSH cells) are the cells producing TSH.
iii) Corticotrophs (ACTH-MSH cells) produce ACTH, melanocyte stimulating
hormone (MSH), β-lipoprotein and β-endorphin.
3. Chromophobe cells without visible granules
These cells comprise the remainder 50% of the adenohypophysis. These cells by
light microscopy contain no visible granules, but on electron microscopy reveal
sparsely granulated corticotrophs, thyrotrophs and gonadotrophs.
● All these functions of the adenohypophysis are under the
indirect control of the hypothalamus through stimulatory
and inhibitory factors synthesised by the hypothalamus
which reach the anterior lobe through capillary portal
blood.
 B. POSTERIOR LOBE (NEUROHYPOPHYSIS)
The neurohypophysis is composed mainly of interlacing nerve fibres in which are
scattered specialised glial cells called pituicytes.
● These nerve fibres on electron microscopy contain granules of neurosecretory
material made up of 2 octapeptides— vasopressin or antidiuretic hormone
(ADH), and oxytocin, both of which are produced by neurosecretory cells of
the hypothalamus but are stored in the cells of posterior pituitary.
1. ADH It causes reabsorption of water from the renal tubules and is essential for
maintenance of osmolality of the plasma.
● Its deficiency results in diabetes insipidus characterised by uncontrolled
diuresis and polydipsia.
2. Oxytocin It causes contraction of mammary myoepithelial cells resulting in
ejection of milk from the lactating breast and causes contraction of myometrium of
the uterus at term.
 ● The pituitary gland and hypothalamus are so closely interlinked that diseases
of the pituitary gland involve the hypothalamus, and dysfunctions of the
hypothalamus cause secondary changes in the pituitary. The pituitary gland is
involved in several diseases which include:
● non-neoplastic (e.g. inflammations, haemorrhage, trauma, infarction and many
other endocrine diseases) and neoplastic diseases. However, functionally and
morphologically, diseases of the pituitary can be classified as below, each of
which includes diseases of the anterior and posterior pituitary and the
hypothalamus, separately:
i) Hyperpituitarism
ii) Hypopituitarism
iii) Pituitary tumours
 HYPERPITUITARISM
● Hyperpituitarism is characterised by oversecretion of one or more of the
pituitary hormones.
● Such hypersecretion may be due to diseases of the anterior pituitary, posterior
pituitary or hypothalamus.
● For all practical purposes, however, hyperfunction of the anterior pituitary is
due to the development of a hormone-secreting pituitary adenoma , and rarely,
a carcinoma.
● A few important syndromes are as follows:
 A. HYPERFUNCTION OF ANTERIOR PITUITARY

Three common syndromes of adenohypophyseal hyperfunction are:

1. Gigantism and acromegaly
2. Hyperprolactinaemia
3. Cushing’s syndrome
 1. GIGANTISM AND ACROMEGALY

1. GIGANTISM AND ACROMEGALY Both these clinical syndromes result from

sustained excess of growth hormone (GH), most commonly by somatotroph (GH-
secreting) adenoma.
 Gigantism

Gigantism When GH excess occurs prior

to epiphyseal closure, gigantism is
produced.
 Gigantism, therefore, occurs in
prepubertal boys and girls and is much less
frequent than acromegaly. The main
clinical feature in gigantism is the
excessive and proportionate growth of the
child.
There is enlargement as well as
thickening of the bones resulting in
considerable increase in height and
enlarged thoracic cage.
 Acromegaly

● Acromegaly Acromegaly results when there is overproduction of GH in

adults following cessation of bone growth and is more common than gigantism.
● The term ‘acromegaly’ means increased growth of extremities (acro=extremity).
● There is enlargement of hands and feet, coarseness of facial features with
increase in soft tissues, prominent supraorbital ridges and a more prominent
lower jaw which when clenched results in protrusion of the lower teeth in front
of upper teeth (prognathism).
● Other features include enlargement of the tongue and lips, thickening of the skin
and kyphosis.
● Sometimes, a few associated features such as TSH excess resulting in
thyrotoxicosis, and gonadotropin insufficiency causing amenorrhoea in the
females and impotence in the male, are found.
 2. PROLACTINAEMIA
● Prolactinaemia is lactotroph (PRLsecreting) pituitary adenoma, also called
prolactinoma having excessive production of prolactin. Occasionally,
hyperprolactinaemia results from hypothalamic inhibition of
● PRL secretion by certain drugs (e.g. chlorpromazine, reserpine and
methyl-dopa). In the female, hyperprolactinaemia causes amenorrhoea-
galactorrhoea syndrome characterised clinically by infertility and
expression of a drop or two of milk from breast, not related to pregnancy
or puerperium.
● In the male, it may cause impotence or reduced libido. These features
result either from associated inhibition of gonadotropin secretion or
interference in gonadotropin effects.
 3. CUSHING’S SYNDROME
● Pituitary-dependent Cushing’s
● syndrome results from ACTH excess. Most frequently, it is caused
by corticotroph (ACTH-secreting) adenoma.
 B. HYPERFUNCTION OF POSTERIOR PITUITARY AND HYPOTHALAMUS

Lesions of posterior pituitary and hypothalamus are uncommon. Two of

the syndromes associated with hyperfunction of the posterior pituitary
and hypothalamus are:
● Inappropriate release of ADH and
● Precocious puberty.
 1. INAPPROPRIATE RELEASE OF ADH
● Inappropriate release of ADH results in its excessive secretion which
manifests clinically by passage of concentrated urine due to increased
reabsorption of water and loss of sodium in the urine, consequent
hyponatraemia, haemodilution and expansion of intra- and extracellular fluid
volume.
● Inappropriate release of ADH occurs most often in paraneoplastic syndrome
e.g. in oat cell carcinoma of the lung, carcinoma of the pancreas, lymphoma
and thymoma. Infrequently, lesions of the hypothalamus such as trauma,
haemorrhage and meningitis may produce ADH hypersecretion.
● Rarely, pulmonary diseases such as tuberculosis, lung abscess,
pneumoconiosis, empyema and pneumonia may cause overproduction of
ADH.
 2.PRECOCIOUS PUBERTY

● A tumour in the region of hypothalamus or the pineal gland may

result in premature release of gonadotropins causing the onset of
pubertal changes prior to the age of 9 years.
● The features include premature development of genitalia both in the
male and in the female, growth of pubic hair and axillary hair. In the
female, there is breast growth and onset of menstruation.
 HYPOPITUITARISM

● In hypopituitarism, there is usually deficiency of one or more of the

pituitary hormones affecting either anterior pituitary, or posterior
pituitary and hypothalamus.

A. HYPOFUNCTION OF ANTERIOR PITUITARY

B. HYPOFUNCTION OF POSTERIOR PITUITARY AND
HYPOTHALAMUS
A.HYPOFUNCTION OF ANTERIOR PITUITARY
● Adenohypophyseal hypofunction is invariably due to destruction of the
anterior lobe of more than 75% because the anterior pituitary possesses a large
functional reserve.
● This may result from anterior pituitary lesions or pressure and destruction from
adjacent lesions.
● Lesions of the anterior pituitary include nonsecretory (chromophobe) adenoma,
metastatic carcinoma, craniopharyngioma, trauma, postpartum ischaemic
necrosis (Sheehan’s syndrome), emptysella syndrome, and rarely, tuberculosis.
● Though a number of syndromes associated with deficiency of anterior pituitary
hormones have been described, two important syndromes are
panhypopituitarism and dwarfism
 1. PANHYPOPITUITARISM
The classical clinical condition of major anterior pituitary insufficiency is
called panhypopituitarism.
Three most common causes of panhypopituitarism are:
● Non-secretory (chromophobe)
● Adenoma (discussed later),
● Sheehan’s syndrome and simmond’s disease, and empty-sella syndrome.
TABLE OF CONTENTS
ABOUT IT PATHOLOGY
01 You can describe the topic of the 04 You can describe the topic of the
section here section here

DIAGNOSIS TREATMENT
02 You can describe the topic of the 05 You can describe the topic of the
section here section here

RECOMMENDATIONS CONCLUSIONS
03 You can describe the topic of the 06 You can describe the topic of the
section here section here
 01
ABOUT IT
You can enter a subtitle here
if you need it
ABOUT THE DISEASES

MERCURY MARS VENUS

It’s the closest planet to the Despite being red, Mars is Venus has a beautiful name and
Sun and the smallest one in the actually a cold place. It’s full of is the second planet from the
Solar System iron oxide dust Sun
 INTRODUCTION
You can give a brief description of the topic
you want to talk about here. For example, if
you want to talk about Mercury, you can say
that it’s the smallest planet in the entire Solar
System
ABOUT THE DISEASES

MERCURY MARS
Mercury is the closest planet to Despite being red, Mars is
the Sun actually a cold place

JUPITER VENUS
Jupiter is a gas giant and the Venus is the second planet
biggest planet from the Sun
CONCEPTS AND TYPOLOGY

TYPE A TYPE B
Venus has a beautiful name and is Jupiter is the fourth-brightest object
the second planet from the Sun. It’s in the night sky and the biggest
terribly hot planet

TYPE C TYPE D
Despite being red, Mars is actually a Saturn is a gas giant and has several
cold place. It's full of iron oxide dust rings. It's composed of hydrogen
and helium
PATHOLOGY
MERCURY
Mercury is the closest planet to the Sun and
the smallest one in the Solar System

MARS
Despite being red, Mars is actually a cold
place. It's full of iron oxide dust

VENUS
Venus has a beautiful name and is the second
planet from the Sun
 A PICTURE ALWAYS
REINFORCES
THE CONCEPT
Images reveal large amounts of data, so remember:
use an image instead of a long text. Your audience
will appreciate it
SYMPTOMS OF THE DISEASE

DIFFICULTY SLEEPING
Mercury is the smallest planet
01

SENSITIVITY TO HEAT
Jupiter is the biggest planet
02

INCREASED SWEATING
Saturn is a gas giant with rings 03

WEIGHT LOSS
Neptune is far away from Earth
04
RISK FACTORS
JUPITER
20% Jupiter is the biggest planet
of them all

VENUS
35% Venus is the second planet
from the Sun

SATURN
Follow the link in the graph to modify its data 45%
and then paste the new one here. Saturn is a gas giant and has
For more info, click here several rings
A PICTURE IS WORTH A
THOUSAND WORDS
KEY NUMBERS

500 3,000 4,378

Diagnoses per day Consider stable per month Person in treatment
“This is a quote, words full of wisdom that
someone important said and can make the
reader get inspired.”
—SOMEONE FAMOUS
DIAGNOSES

MERCURY MARS JUPITER

Mercury is the closest planet Mars is actually a very cold Jupiter is the biggest planet
to the Sun place of them all

VENUS NEPTUNE SATURN

Venus is the second planet It’s the farthest planet from It’s composed of hydrogen
from the Sun the Sun and helium
PREVENTION

TYPE 1 TYPE 2
Mercury is the Venus has a very
OBSERVATION OBSERVATION
smallest planet toxic atmosphere

Mars is actually a Neptune is far away

EXAM EXAM
very cold place from Earth
Jupiter is the biggest Saturn is a gas giant
ROUTINE ROUTINE
planet with rings
TREATMENT
01
MARS
Despite being red, Mars is a cold place.
It's full of iron oxide dust

02
JUPITER
Jupiter is a gas giant and the biggest
planet in the Solar System
RECOMMENDATIONS

● You can describe what the patient ● You can describe what the patient
shouldn’t do here should do here
● You can describe what the patient ● You can describe what the patient
shouldn’t do here should do here
● You can describe what the patient ● You can describe what the patient
shouldn’t do here should do here
● You can describe what the patient ● You can describe what the patient
shouldn’t do here should do here
AWESOME
WORDS
PREVALENCE

VENUS
Venus has a beautiful name
and is the second planet
from the Sun

MERCURY
Mercury is the closest planet
to the Sun and the smallest
one
150,000
Big numbers catch your audience’s attention
 CONCLUSION
Venus has a beautiful name and is the second planet
from the Sun. It’s terribly hot, even hotter than
Mercury, and its atmosphere is extremely poisonous.
It’s the second-brightest natural object in the night
sky after the Moon
OUR TEAM

DRA. JENNAD DOE DR. JIMMY TIMMY

You can speak a bit about this person You can speak a bit about this person
here here
REFERENCES
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
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