Methods of examination of the endocrine system in children. Functional activity of the endocrine glands in various physiological conditions of the body and methods for its assessment

Course work
Methods for studying the endocrine system in normal and pathological conditions

Completed:
5th year student of OZO
Group A
Usachev S. A.

Ufa 2010
Content
Introduction……………………………………………………………………………4
1. Review of methods for studying the endocrine system
in norm and pathology………………………………………………………… …6
1.1. Brief historical outline…………………………………………...6
1.2. Review of modern methods for studying the endocrine system..12
1.3. Modern methods of studying the endocrine system on
an example of a study of the thyroid gland………………………………28
2. Problems and prospects of methods for studying endocrine
systems………………………………………………………………………45
Conclusion………………………………………………………………………..58
List of used literature……………………………………………59

List of abbreviations adopted in the work
AOK - antibody-forming cells
AG - antigen
ACTH - adrenocorticotropic hormone
HPLC - High Speed ​​Liquid Chromatography
GI - compensatory hyperinsulinemia
DNA - deoxyribonucleic acid
LC - liquid chromatography
ELISA - enzyme immunoassay
IR - insulin resistance
CT - computed tomography
LH - luteinizing hormone
MS - metabolic syndrome
MRI - magnetic resonance imaging
PCR - polymerase chain reaction
RIA - radioimmunoassay
DHRT - delayed-type hypersensitivity reaction
DM 2 - diabetes mellitus type 2
TSH - thyroid stimulating hormone
T4 - thyroxine
T3 - triiodothyronine
TBG - thyroxine-binding globulin test
Ultrasound - ultrasonography
FIA - fluorescent immunoassay
CFD - color Doppler mapping
CNS - central nervous system
thyroid - thyroid gland

Introduction
Over the past few years, as a result of the development of more subtle, sensitive and specific methods for determining hormones and other methods for studying the endocrine system in health and disease, clinical endocrinology and biochemistry has largely turned from an art form into a branch of applied chemistry, physiology, physics and genetics. This progress was made possible due to the introduction into practice of a large number of the latest and high-tech methods for studying the endocrine system, the isolation and subsequent biological and biochemical characterization of various highly purified polypeptide hormones, steroids, vitamins, derivatives of small polypeptides and amino acids, which are classified as hormones, as well as the production of radiolabeled atoms of hormones with high specific activity.
Relevance of the topic:
At present, on the threshold of understanding the most hidden and mysterious phenomena of a living organism, the most important task is to find the most reliable, accessible and high-tech research methods. The new era of nanotechnologies and highly specialized discoveries is beginning to make its contribution to biological chemistry, which has long been using methods not only of chemical analysis, but the most modern technologies of all branches of physics, computer science, mathematics and other sciences. Time dictates its conditions to mankind - to know deeper, to know thoroughly, to find the cause of the processes occurring in a living organism in normal and pathological conditions. The search for new research methods does not stop, and the scientist simply does not have time to generalize, systematize this area of ​​knowledge, to highlight what he needs at the moment. In addition, when I studied the problem of endocrine system research, I did not find a sufficiently complete, generalizing manual on this topic. many researchers, in particular biochemists, are faced with such a problem as the search and systematization of modern methods for studying the endocrine system in normal and pathological conditions. This is primarily due to the fact that new sources of literature, new research methods appear daily, but there is not a single guide to research methods that would systematize data on methods. It is for these reasons that the relevance of the topic I have chosen is very high.
Objective:
To systematize data on the state of methods for studying the endocrine system in normal and pathological conditions in the modern world.
Tasks:

Make a historical overview of the topic.
To reflect modern knowledge about the methods of studying the endocrine system, without a detailed description of the methods and techniques of research.
Describe research methods on the example of one endocrine gland.
To highlight the problems and prospects of modern methods of studying the endocrine system in normal and pathological conditions.

1. Review of methods for studying the endocrine system in normal and pathological conditions
1.1. Brief historical outline
The study of the endocrine system and endocrinology itself are relatively new phenomena in the history of science. The endocrine system was an inaccessible part of the human body until the early 20th century. Prior to this, researchers could not unravel the secrets of endocrine formations due to the fact that they could not isolate and study the fluids they secrete (“juices” or “secrets”). Scientists have not found any "juices" or special excretory ducts, through which the produced liquid usually flows out. Therefore, the only method for studying the functions of the endocrine gland was the method of excision of a part or the whole organ.
Scientists - historians argued that the organs of the endocrine system in the East were known even in ancient times and respectfully called them "glands of fate". According to Eastern healers, these glands were receivers and transformers of cosmic energy pouring into invisible channels (chakras) and supporting human vitality. It was believed that the well-coordinated work of the "glands of fate" could be upset by catastrophes that occur at the behest of evil fate.
The mention of the disease, most likely diabetes, is contained in the Egyptian papyri of 1500 BC. The goiter and the effects of castration in animals and humans belong to the first clinical descriptions of diseases, the endocrine nature of which was subsequently proven. Old clinical descriptions of endocrine diseases were made not only in the West, but also in ancient China and India.
If we arrange significant discoveries in many areas of endocrinology in time, then the resulting picture will reflect in miniature the history of all biology and medicine. After fragmentary clinical observations made in antiquity and the Middle Ages, these sciences progressed extremely slowly. The second half of the 19th century saw a rapid leap in the development of many fields of medicine, both in terms of the quality of clinical research and understanding of disease mechanisms. This process was due to the complexity of the relationship of historical causes.
First, the industrial revolution led to the accumulation of capital, which was used to develop many sciences, mainly chemistry and biology.
Another revolution that took place in the second half of the 19th century and was of fundamental importance for the development of not only endocrinology, but also medicine and biology, was the emergence of experimental animal modeling. Claude Bernard and Oskar Minkowski demonstrated the possibility of conducting controlled and reproducible experiments in the laboratory. In other words, the possibility of "cross-examination" of nature was created. Without the work of these pioneers, we would be deprived of most of the modern knowledge in the field of endocrinology. The study of all those substances that are called hormones began with experiments on whole animals (and often preceded by observations on sick people). These substances were called substance "X" or factor "?". The postulates of "Koch" for endocrinology provided for the following order of work:
1. Removal of the alleged gland. After the removal of any endocrine gland, a complex of disorders arises due to the loss of the regulatory effects of those hormones that are produced in this gland. Due to the invasiveness of surgery, instead of surgical removal of the endocrine gland, the introduction of chemicals that disrupt their hormonal function can be used. For example, the administration of alloxan to animals disrupts the function of pancreatic β-cells, which leads to the development of diabetes mellitus, the manifestations of which are almost identical to the disorders observed after extirpation of the pancreas. one
2. Description of the biological effects of the operation. For example, the assumption that the pancreas has endocrine functions was confirmed in the experiments of I. Mering and O. Minkowski (1889), which showed that its removal in dogs leads to severe hyperglycemia and glucosuria; animals died within 2-3 weeks. after surgery on the background of symptoms of severe diabetes mellitus. Subsequently, it was found that these changes occur due to a lack of insulin, a hormone produced in the islet apparatus of the pancreas.
3. Introduction of gland extract.
4. Evidence that the administration of the extract eliminates the symptoms of the absence of the gland.
5. Isolation, purification and identification of the active principle.
During the Second World War, a large amount of data was accumulated in the field of endocrinology, many of which were of fundamental importance for the subsequent development of science. After the war, in connection with the emergence of many new methods, there was an unprecedented acceleration in the pace of research. And now, as a result of a sharp influx of technical and creative forces, the number of publications, both in endocrinology and in all other aspects of biomedical knowledge, is growing at an impressive rate. This means a constant flow of new data, which requires periodic revision of old ideas in their light. 2
The 20th century was marked by the birth of the science of hormones, or endocrinology. The word "hormone" itself was introduced in 1905 by the British physiologist, Professor Ernst Starling at a lecture at the Royal College of Physicians in London. It was formed by two professors at the University of Cambridge from the Greek word hormao, which means "quickly to set in motion", "raise" or "excite". Starling used it to describe the "chemical carriers" released into the blood by the endocrine glands, or endocrine glands (endon - internal + krino - to produce), for example, the testes, adrenal glands and thyroid gland, as well as from external, exocrine (exo - external) glands such as the salivary and lacrimal glands. This new science developed very rapidly, exciting the minds not only of physicians, but also of society.
As a rule, the history of the study of any hormone goes through four stages.
First, there is an effect that a secret secreted by the gland produces on the body.
Secondly, methods are being developed for determining the internal secretion and the degree of its effect on the body. First, this is done through biological tests to determine the effect of the hormone on an organism in which it is deficient. Later, chemical methods for such measurement are established.
Thirdly, the hormone is isolated from the gland and isolated.
And finally, fourthly, its structure is determined by chemists, and it is synthesized. 3
Nowadays, researchers who start with observations at the level of the whole organism have more and more questions as their work progresses until they try to solve the original problem at the molecular level. Here, biological chemistry and its branch, molecular biology (endocrinology), take over endocrinological research.
As soon as new morphological, chemical, electrophysiological, immunological and other methods appear, they find very rapid application in endocrinology. For example, in the 30s and 40s, very complex methods were used to study steroids. This led to great advances in understanding the structure and biosynthesis of steroid hormones. The possibility of using radioactive isotopes, which appeared in the late 1940s and 1950s, expanded our knowledge about many aspects of the iodine cycle, intermediate metabolism, ion transport, etc. To study the functional activity of the endocrine gland, its ability to capture from the blood and accumulate certain compound. It is known, for example, that the thyroid gland actively absorbs iodine, which is then used for the synthesis of thyroxine and triiodothyronine. With hyperfunction of the thyroid gland, the accumulation of iodine increases, with hypofunction, the opposite effect is observed. The intensity of iodine accumulation can be determined by introducing the radioactive isotope 131I into the body, followed by an assessment of the radioactivity of the thyroid gland. Compounds that are used for the synthesis of endogenous hormones and are included in their structure can also be introduced as a radioactive label. Subsequently, it is possible to determine the radioactivity of various organs and tissues and thus evaluate the distribution of the hormone in the body, as well as find its target organs.
Later, a combination of polyacrylamide gel electrophoresis with autoradiography was creatively used to study many proteins, including hormone receptors. Simultaneously with these impressive advances in chemistry, the use of histochemical, immunohistochemical, and electron microscopy methods proved to be even more fruitful.
All variants of chromatography - column, thin-layer, paper, multidimensional, gas-liquid (with or without mass spectrometry), high-performance liquid - were used by endocrinologists immediately after their appearance. They made it possible to obtain important information not only about the amino acid sequence of peptides and proteins, but also about lipids (especially prostaglandins and related substances), carbohydrates, and amines.
With the development of molecular biological research methods, endocrinologists are rapidly applying them to study the mechanisms of action of hormones. Currently, the recombinant DNA method is used not only for this purpose, but also for the production of protein hormones. Indeed, it is difficult to name a biochemical or physiological method that would not be adopted by endocrinologists. four

1.2. Overview of modern methods for studying the endocrine system
When examining patients with suspected endocrine pathology, in addition to collecting an anamnesis of the disease, examining and complaining of the patient, the following diagnostic methods are used: general laboratory methods (clinical and biochemical), hormonal research, instrumental methods, molecular genetic methods.
In most cases hormonal study has not a key, but a verifying value for the diagnosis. For the diagnosis of a number of endocrine diseases, a hormonal study is not used at all (diabetes insipidus and diabetes mellitus); in some cases, a hormonal study is of diagnostic value only in combination with biochemical parameters (calcium level in hyperthyroidism).
A hormonal study can reveal a decrease in the production of a particular hormone, an increase and its normal level (Table 1). The most commonly used methods for determining hormones in clinical practice are various modifications. radioimmune method . These methods are based on the fact that the hormone labeled with a radioactive label and the hormone contained in the test material compete with each other for binding to specific antibodies: the more this hormone is contained in the biological material, the less labeled hormone molecules will bind, since the number of hormone-binding sites in sample constantly. More than 20 years ago, Berson and Yalow proposed a radioimmunoassay method for the determination of insulin.
This method was based on their observation that a protein (later shown to be a globulin) that binds 131I labeled insulin is present in the peripheral blood of diabetic patients treated with insulin. The significance of these findings and the subsequent development of a radioimmunoassay for insulin detection is highlighted by the award of the Nobel Prize to Yalow and Berson.
Soon after the first reports of these researchers, other laboratories developed and described appropriate methods for the determination of other hormones. These methods use either antibodies or serum proteins that bind a specific hormone or ligand and carry a radioactive methhormone that competes with the standard hormone or hormone present in the biological sample.
Principle radioreceptor method is essentially the same as radioimmunoassay, only the hormone, instead of binding to antibodies, binds to a specific hormone receptor on the plasma membrane or cytosol. Specific receptors for most polypeptide hormones are located on the outer surface of the plasma membrane of cells, while receptors for biologically active steroids, as well as thyroxine and triiodothyronine, are located in the cytosol and nuclei. The sensitivity of radioreceptor assay is lower than that of radioimmunoassay and most biological methods in in vitro systems. In order to interact with its receptor, the hormone must have the appropriate conformation, i.e., be biologically active. A situation is possible in which the hormone loses its ability to bind to its receptor, but continues to interact with antibodies in the system for radioimmunoassay. This discrepancy reflects the fact that antibodies and receptors "recognize" different parts of the hormone molecule.
A number of radioreceptor methods for hormonal analysis have been proposed. Usually, a tissue of an organ specific for a given hormone is obtained and receptors are isolated from it using standard techniques. The isolated plasma membrane receptors in the sediment are relatively stable when stored at temperatures below -20°C. However, solubilized receptors for polypeptide and steroid hormones isolated from plasma membranes or from the cytosol and not associated with ligands turn out to be unstable, which is manifested by a decrease in their ability to bind specific hormones, even if they were stored frozen for a relatively short time.
Recently, non-radioactive methods have become the most widely used. As a standard method for the determination of various compounds in clinical chemistry, immunoassay , characterized by good sensitivity, specificity and wide scope. In particular, immunoassay is used to determine hormones. These methods include:

1) enzyme-linked immunosorbent assay (ELISA), solid-phase ELISA type ELISA or homogeneous ELISA type EMIT.

2) fluorescent immunoassay (FIA), based on the measurement of amplification, quenching or polarization of fluorescence or on the study of fluorescence with time resolution.

3) bio- or chemiluminescent immunoassay.

Table 1. Pathogenesis of endocrine diseases 7

Most often in clinical practice, the determination of the basal level of a particular hormone is used. Usually blood is taken on an empty stomach in the morning, although food intake does not affect the production of many hormones. To assess the activity of many endocrine glands (thyroid, parathyroid), an assessment of the basal level of hormones is quite enough. When determining the basal level of the hormone, certain difficulties may arise due to the circulation in the blood of several molecular forms of the same hormone. First of all, it concerns parathyroid hormone.
Most hormones circulate in the blood bound to carrier proteins. As a rule, the level of free, biologically active hormone in the blood is tens or hundreds of times lower than the total level of the hormone.
The levels of most hormones have a characteristic daily dynamics (circadian secretion rhythm), and very often this dynamics acquires clinical significance. The most important and illustrative in this regard is the dynamics of cortisol production (Fig. 1.1). eight

Other examples in this regard are prolactin and growth hormone, whose secretion rhythm is also determined by the sleep-wake cycle. The pathogenesis of a number of endocrine diseases is based on a violation of the daily rhythm of hormone production.
In addition to the circadian rhythm, most biological parameters can be reflected in the hormone level in the blood. For many hormones, reference indicators largely depend on age (Fig. 1.2) 9 , gender, phase of the menstrual cycle.

The level of a number of hormones can be influenced not only by concomitant somatic diseases and medications taken for them, but also by such factors as stress (cortisol, adrenaline), environmental features (thyroxine levels in regions with different iodine consumption), the composition of food taken the day before ( C-peptide) and many others.
The fundamental principle for assessing the activity of the pituitary-dependent (thyroid gland, adrenal cortex, gonads) and a number of other endocrine glands is the determination of the so-called diagnostic pairs of hormones. In most cases, hormone production is regulated by a negative feedback mechanism. Feedback can take place between hormones belonging to the same system (cortisol and ACTH), or between hormones and its biological effector (parathyroid hormone and calcium). In addition, between the hormones that make up a pair, there should not necessarily be a direct interaction. Sometimes it is mediated by other humoral factors, electrolytes, and physiological parameters (renal blood flow, potassium levels, and angiotensin for the renin-aldosterone pair). An isolated assessment of the indicators that make up a pair can lead to an erroneous conclusion.
Despite the improvement in the methods of hormonal analysis, functional tests are still of great diagnostic value in the diagnosis of endocrinopathies. Functional tests are divided into stimulation and suppressive (suppressive). The general principle of conducting tests is that stimulation tests are prescribed if endocrine gland insufficiency is suspected, and suppressive tests are prescribed if its hyperfunction is suspected.
Along with the assessment of the level of hormones in the blood, in some cases, the determination of their excretion in the urine may have a certain diagnostic value. The diagnostic value of these studies, such as determining the excretion of free cortisol, is significantly less than that of modern functional tests. Similarly, the use of hormone metabolite excretion tests has now almost completely disappeared, with the only exception being the determination of catecholamine metabolites for the diagnosis of pheochromocytoma.
In recent years, fully automated methods of hormonal research have become widespread, which reduces the number of errors such as incorrect blood sampling, storage, delivery, and other “human factors”.
From instrumental methods The studies most commonly use ultrasonography (ultrasound), radiography, computed tomography (CT), and magnetic resonance imaging (MRI). In addition, special methods are used in endocrinology: angiography with selective sampling of blood flowing from the endocrine gland, radioisotope examination (thyroid scintigraphy), bone densitometry. The main instrumental methods used to study the endocrine glands are presented in Table 2.
Molecular genetic research methods.
The rapid development of science over the past few decades and research in the field of molecular biology, medical genetics, biochemistry, biophysics, closely linked with microbiology, immunology, oncology, epidemiology, etc., have led to the creation and active implementation in practice of diagnostic laboratories for molecular biological methods for studying the human genome, animals, plants, bacteria and viruses. These methods are most commonly referred to as DNA studies.
DNA research methods allow for early and more complete diagnosis of various diseases, timely differential diagnosis and monitoring of the effectiveness of therapy. The active development of DNA diagnostic methods and their introduction into practice suggest that the moment is not far off when these methods will significantly narrow the range of tasks of more traditional diagnostic studies, such as cytogenetics, and maybe even displace them from practical medicine into the scientific field.

Table 2. Main instrumental methods
endocrine gland studies 10

Currently, there are two directions of DNA diagnostics: hybridization analysis of nucleic acids and diagnostics using polymerase chain reaction.
PCR was immediately put into practice, which made it possible to raise medical diagnostics to a qualitatively new level. The method has become so popular that today it is difficult to imagine work in the field of molecular biology without its use. The PCR method has received especially rapid development thanks to the international program "Human Genome". Modern sequencing technologies (deciphering DNA nucleotide sequences) have been created. If in the recent past it took a week to decipher DNA of 250 base pairs (bp), modern automatic sequencers can determine up to 5000 bp. per day. This, in turn, contributes to the significant growth of databases containing information about nucleotide sequences in DNA. Currently, various modifications of PCR have been proposed, dozens of different applications of the method have been described, including “long PCR”, which allows copying extra-long DNA sequences. For the discovery of PCR, K. V. Mullis was awarded the Nobel Prize in Chemistry in 1993.
All approaches to gene diagnostics can be divided into several main groups:
1. Methods for identifying certain DNA segments.
2. Methods for determining the primary nucleotide sequence in DNA.
3. Methods for determining the content of DNA and analysis of the cell cycle. eleven
PCR makes it possible to find in the test material a small section of genetic information contained in a specific sequence of DNA nucleotides of any organism among a huge number of other DNA sections and multiply it many times. PCR is an "in vitro" analogue of the biochemical reaction of DNA synthesis in a cell.
PCR is a cyclic process, in each cycle of which thermal denaturation of the double strand of the target DNA occurs, followed by the attachment of short oligonucleotide primers and their extension using DNA polymerase by adding nucleotides. As a result, a large number of copies of the original target DNA are accumulated, which are easily detectable.
The discovery of PCR resulted in immediate practical use of the method. In 1985, an article was published that described a test system for the diagnosis of sickle cell anemia based on PCR. Since 1986, more than 10,000 scientific publications have been devoted to PCR. The prospects for the use of PCR seem more than impressive. 12
Cytochemical research methods.
These methods are variants of the in vitro biological assays described. They are usually more sensitive than radioimmunoassay methods, but are much more cumbersome and expensive per determination. The results of cytochemical biological studies are quantified on histological sections using a special device - a microdensitometer.
Histological sections are prepared from target tissues or cells specific for a given hormone, previously exposed to different concentrations of the standard and test hormone. Using a densitometer, an area with a diameter of 250 - 300 nm is scanned to quantify the color reaction caused by a change in the object's redox state under the influence of hormonal stimulation. For quantitative analysis, histological dyes sensitive to these changes are used.
The first cytochemical biological assay system was developed for ACTH, and the adrenal cortex served as the target tissue in this system. Other methods for the biological determination of ACTH are either too insensitive or require large plasma volumes. Thus, the cytochemical determination of the redox state of the tissue is a valuable tool for analyzing the normal and altered function of the hypothalamus-pituitary-adrenal system in terms of ACTH levels.
A cytochemical method for determining LH was also developed, but significant difficulties were encountered due to significant fluctuations in the results of different determinations and the variable sensitivity of the object, which possibly reflects known biological discrepancies in different animals. Sensitive specific cytochemical methods have been proposed for the determination of parathyroid hormone, ADH, and thyrotropin.
With further complication of the equipment, which will increase the number of studies in one definition, this method can be more widely used. It is particularly attractive because it does not require the use of radioactive compounds. Cytochemical methods are not widely used in the clinic and are used mainly as a sensitive method in scientific research. 13

1.3. Modern methods of studying the endocrine system on the example of the study of the thyroid gland
In my work, limited in volume, I will consider modern methods for studying the endocrine system in normal and pathological conditions using the example of the study of the endocrine gland, which is relevant due to the large spread of thyroid diseases in the Republic of Bashkortostan.
1. Ultrasound examination.
Ultrasound allows to verify rather subjective data of palpation. Optimum for research are sensors with a frequency of 7.5 MHz and 10 MHz. Currently, color Doppler imaging is used to visualize small vessels in the thyroid gland and provide information on the direction and average flow velocity. The capabilities of the method depend on the experience and qualifications of the specialist conducting the study. The principle of the method is that ultrasound, sent by frequent pulses, penetrates into human organs, is reflected at the interface between media with different ultrasonic resistance, is perceived by the device and reproduced on the screen and ultraviolet paper. The method is harmless and has no contraindications (Fig. 1.3).

Fig.1.3. Ultrasound of the thyroid gland.
Now, complex ultrasound is also widely used using color Doppler mapping (CDC), (Fig. 1.4). 14

Rice. 1.4. AIT with nodulation of the thyroid gland in the CDI mode.
2. Fine-needle puncture biopsy of the thyroid gland.
Fine-needle puncture biopsy of the thyroid gland is the only preoperative method for the direct assessment of structural changes and the establishment of cytological parameters of formations in the thyroid gland. The efficiency of obtaining adequate cytological material with a fine-needle puncture biopsy is significantly increased if this diagnostic procedure is carried out under ultrasound control, which makes it possible to identify the most altered areas of the thyroid gland, as well as to choose the optimal direction and depth of puncture. fifteen

3. Cytological examination.
Cytological diagnosis of formations in the thyroid gland is based on a combination of certain features, such as the amount of material obtained, its cellular composition, morphological features of cells and their structural groups, smear quality, etc.
4. Radioisotope study (scanning), scintigraphy.
Radioisotope scanning (scanning) is a method of obtaining a two-dimensional image that reflects the distribution of a radiopharmaceutical in various organs using a scanner apparatus.


Fig.1.6. The result of radioisotope scanning
thyroid gland

Scanning allows you to determine the size of the thyroid gland, the intensity of accumulation in it and in its individual sections of radioactive iodine, which allows you to assess the functional state of both the entire gland and focal formations (Fig. 1.6).
Scintigraphy- a method of functional imaging, which consists in introducing into the bodyradioactive isotopesand obtaining an image by determining the emitted by them radiation . The patient is injected radio indicator - a preparation consisting of a vector molecule and a radioactive marker. The vector molecule is absorbed by a certain body structure (organ, fluid). The radioactive label serves as a "transmitter": it emits gamma rays, which are recorded by a gamma camera. The amount of radiopharmaceutical administered is such that the radiation emitted by it is easily captured, but it does not have a toxic effect on the body.
For thyroid scintigraphy, the most commonly used isotope of technetium is 99m Tc-pertechnetate. The use of 131 iodine is limited to the detection of functioning thyroid cancer metastases. For the diagnosis of retrosternal and aberrant goiter, as well as in some cases with congenital hypothyroidism (athyreosis, dystopia, defect in organization), 123 iodine is used. 16
5. Determination of the level of TSH and thyroid hormones.
A study of the level of TSH and thyroid hormones (free thyroxine and triiodothyronine) is indicated for everyone with suspected thyroid pathology. At present, it is more expedient to conduct a study of free fractions of thyroid hormones in combination with the determination of the level of TSH.
6. Determination of the level of thyroglobulin in the blood.
An increased content of thyroglobulin in the blood is characteristic of many thyroid diseases, it is also detected within 2-3 weeks after a puncture biopsy, and also within 1-2 months after surgery on the thyroid gland.
7. Determination of the level of calcitonin in the blood.
In patients with a burdened family history of medullary thyroid cancer (syndrome of multiple endocrine neoplasia of the 2nd and 3rd types), it is mandatory to determine the level of calcitonin in the blood. In all other cases, the determination of calcitonin is not shown.
The normal content of calcitonin in the blood does not exceed 10 pg / ml. The level of this marker is more than 200 pg / ml, which is the most important diagnostic criterion for medullary thyroid cancer.

8. Thyroid function test.
Thyroid function tests are blood tests used to evaluate how well the thyroid gland is working. These tests include thyroid stimulating hormone (TSH) test, thyroxine (T4), triiodothyronine (T3) test, thyroxine-binding globulin (TBG) test, triiodothyronine tar test (T3RU), and long-acting thyroid stimulator test (LATS). ).
Thyroid function tests are used to:

help in diagnosing an underactive thyroid gland (hypothyroidism), and an overactive thyroid gland (hyperthyroidism)
assessment of thyroid activity
monitoring response to thyroid therapy

Diseases diagnosed by MRI:

? pituitary tumors (eg.prolactinoma , Itsenko-Cushing's disease)

? adrenal formations (eg, Cushing's syndrome, aldosteroma, pheochromocytoma)

? osteoporosis

? and etc.

? allows you to get slices with a thickness of 2-3 mm in any plane

? the ability to judge by the nature of the signal not only the presence of education, but also its internal structure (hemorrhages, cysts, etc.)

? no exposure of the patient to ionizing radiation and almost complete harmlessness, which is important when examining children, as well as, if necessary, multiple repeated studies.

Rice. 1.8. The CTLM system is one of the world's first serial optical tomographs.
10. Immunohistochemical study of thyroid tumor tissue.
They are carried out in the tissue of thyroid tumors obtained as a result of surgery. The main purpose of this study is prognostic. In the thyroid tissue, the presence of substances such as p53 (tumor growth suppressor), CD44, Met (proteoglycans responsible for metastasis), PTC, ras-oncogenes (oncogenes that regulate tumor progression) and others are determined. The most important in clinical practice is the detection of immunoreactivity p53, Met and RTS in thyroid cancer tissue. The presence of these markers in the tumor tissue is a sign of the rapid (within 2-5 months) development of metastatic disease in the operated patient. The study is expensive and requires special laboratory equipment. Currently, the determination of tumor markers is mainly carried out in specialized oncological clinics for certain indications, namely, if the patient has other prognostic signs of tumor recurrence or the development of metastatic disease (poorly differentiated thyroid cancer, the patient's age is over 55 years, invasion of surrounding tissues by the tumor and etc.). eighteen
11. Immunological methods.
Immunological methods primarily include enzyme immunoassay (ELISA). ELISA is a method for detecting antigens or antibodies, based on the determination of the antigen-antibody complex due to:

preliminary fixation of the antigen or antibody on the substrate;
adding a test sample and binding the fixed antigen or antibody to the target antigen or target antibody;
subsequent addition of an antigen or antibody labeled with an enzymatic label with its detection using an appropriate substrate that changes its color under the action of the enzyme. A change in the color of the reaction mixture indicates the presence of a target molecule in the sample. Determination of the products of enzymatic reactions in the study of test samples is carried out in comparison with control samples.

LECTURE #33

Topic: Anatomical and physiological features of the endocrine system.

The main symptoms and syndromes in diseases of the endocrine glands

Methods for diagnosing diseases of the endocrine glands

The role of the nurse in the study of patients suffering from diseases of the endocrine system

Endocrine system- a system for regulating the activity of internal organs by means of hormones secreted by endocrine cells directly into the blood, or diffusing through the intercellular space into neighboring cells.

The neuroendocrine (endocrine) system coordinates and regulates the activity of almost all organs and systems of the body, ensures its adaptation to constantly changing conditions of the external and internal environment, maintaining the constancy of the internal environment necessary to maintain the normal functioning of this individual. There are clear indications that the implementation of the listed functions of the neuroendocrine system is possible only in close interaction with the immune system.

The endocrine system is divided into the glandular endocrine system (or glandular apparatus), in which the endocrine cells are brought together to form the endocrine gland, and the diffuse endocrine system. The endocrine gland produces glandular hormones, which include all steroid hormones, thyroid hormones, and many peptide hormones. The diffuse endocrine system is represented by endocrine cells scattered throughout the body that produce hormones called aglandular - (with the exception of calcitriol) peptides. Almost every tissue in the body contains endocrine cells.

Functions of the endocrine system

It takes part in the humoral (chemical) regulation of body functions and coordinates the activity of all organs and systems.

It ensures the preservation of the body's homeostasis under changing environmental conditions.

Together with the nervous and immune systems regulates: growth; body development; its sexual differentiation and reproductive function; takes part in the processes of formation, use and conservation of energy.

In conjunction with the nervous system, hormones are involved in providing: emotional reactions; mental activity of a person.

The endocrine system is represented by endocrine glands, which carry out the synthesis, accumulation and release into the bloodstream of various biologically active substances (hormones, neurotransmitters, and others). The classic endocrine glands: pineal gland, pituitary gland, thyroid, parathyroid glands, pancreatic islet apparatus, adrenal cortex and medulla, testicles, ovaries belong to the glandular endocrine system. In the glandular system, endocrine cells are concentrated within a single gland. The central nervous system takes part in the regulation of the secretion of hormones of all endocrine glands, and hormones, by a feedback mechanism, affect the function of the central nervous system, modulating its activity and state. The nervous regulation of the activity of the peripheral endocrine functions of the body is carried out not only through the tropic hormones of the pituitary gland (pituitary and hypothalamic hormones), but also through the influence of the autonomic (or autonomic) nervous system. In addition, a certain amount of biologically active substances (monoamines and peptide hormones) are secreted in the central nervous system itself, many of which are also secreted by the endocrine cells of the gastrointestinal tract. Endocrine glands (endocrine glands) are organs that produce specific substances and secrete them directly into the blood or lymph. These substances are hormones - chemical regulators necessary for life. Endocrine glands can be both independent organs and derivatives of epithelial (border) tissues.

Hypothalamus and pituitary have secretory cells, while the hypothalamus is considered an element of an important "hypothalamic-pituitary system".

AT hypothalamus secreted actually hypothalamic (vasopressin or antidiuretic hormone, oxytocin, neurotensin) and biologically active substances that inhibit or enhance the secretory function of the pituitary gland (somatostatin, thyroliberin or thyrotropin-releasing hormone, luliberin or gonadoliberin or gonadotropin-releasing hormone, corticoliberin or corticotropin-releasing hormone and somatoliberin or somatotropin-releasing hormone). One of the most important glands in the body is pituitary , which controls the work of most endocrine glands. The pituitary gland is small, weighing less than one gram, but very important for the life of iron.

In terms of the importance of the functions performed in the body, the pituitary gland can be compared with the role of the conductor of an orchestra, which, with light waving of the stick, shows when this or that instrument should come into play. Hypothalamic hormones (vasopressin, oxytocin, neurotensin) flow down the pituitary stalk to the posterior lobe of the pituitary gland, where they are deposited and from where, if necessary, are released into the bloodstream.

Thyroid(lat. glandula thyr(e)oidea) is an endocrine gland in vertebrates that stores iodine and produces iodine-containing hormones (iodothyronines) that are involved in the regulation of metabolism and the growth of individual cells, as well as the body as a whole - thyroxine (tetraiodothyronine, T 4) and triiodothyronine (T 3). The thyroid gland, whose weight ranges from 20 to 30 g, is located in the front of the neck and consists of two lobes and an isthmus located at the level of ΙΙ-ΙV cartilage of the trachea (windpipe) and connects both lobes. On the back surface of the two lobes, there are four parathyroid glands in pairs. Outside, the thyroid gland is covered with neck muscles located below the hyoid bone; with its fascial sac, the gland is firmly connected to the trachea and larynx, so it moves following the movements of these organs. The gland consists of follicles - vesicles of an oval or round shape, which are filled with a protein iodine-containing substance such as a colloid; loose connective tissue is located between the vesicles. The vesicle colloid is produced by the epithelium and contains the hormones produced by the thyroid gland - thyroxine (T 4) and triiodothyronine (T 3).

Parathyroid gland regulates the level of calcium in the body within a narrow range, so that the nervous and motor systems function normally. When the level of calcium in the blood falls below a certain level, calcium-sensing parathyroid receptors are activated and secrete the hormone into the blood. Parathyroid hormone stimulates osteoclasts to release calcium from bone tissue into the blood.

The pancreas is a large (12-30 cm long) secretory organ of double action (secretes pancreatic juice into the lumen of the duodenum and hormones directly into the bloodstream), located in the upper part of the abdominal cavity, between the spleen and duodenum.

The endocrine pancreas is represented by the islets of Langerhans located in the tail of the pancreas. In humans, islets are represented by various types of cells that produce several polypeptide hormones:

alpha cells - secrete glucagon (regulator of carbohydrate metabolism, direct antagonistinsulin);

beta cells - secrete insulin (a regulator of carbohydrate metabolism, lowers blood glucose levels);

delta cells - secrete somatostatin (inhibits the secretion of many glands);

PP-cells - secrete pancreatic polypeptide (suppresses pancreatic secretion and stimulates secretion of gastric juice);

Epsilon cells - secrete ghrelin ("hunger hormone" - stimulates appetite).

On the upper poles of both kidneys are small glands of a pyramidal shape - adrenal glands. They consist of an outer cortical layer (80-90% of the mass of the entire gland) and an inner medulla, the cells of which lie in groups and are entwined with wide venous sinuses. The hormonal activity of both parts of the adrenal glands is different. The adrenal cortex produces mineralocorticoids and glycocorticoids, which have a steroidal structure. Mineralocorticoids (the most important of them is aldosterone) regulate ion exchange in cells and maintain their electrolytic balance; glycocorticoids (eg, cortisol) stimulate protein breakdown and carbohydrate synthesis. The medulla produces adrenaline, a hormone from the catecholamine group, which maintains the tone of the sympathetic nervous system. Adrenaline is often referred to as the fight-or-flight hormone, as its secretion rises sharply only in moments of danger. An increase in the level of adrenaline in the blood entails corresponding physiological changes - the heartbeat quickens, blood vessels constrict, muscles tighten, pupils dilate. The cortex also produces small amounts of male sex hormones (androgens). If disorders occur in the body and androgens begin to flow in an extraordinary amount, the signs of the opposite sex increase in girls. The adrenal cortex and medulla differ not only in the production of different hormones. The work of the adrenal cortex is activated by the central, and the medulla - by the peripheral nervous system.

The maturation and sexual activity of a person would be impossible without the work of the gonads, or gonads which include the male testicles and female ovaries. In young children, sex hormones are produced in small quantities, but as the body grows older, at a certain point, a rapid increase in the level of sex hormones occurs, and then male hormones (androgens) and female hormones (estrogens) cause a person to develop secondary sexual characteristics.

Function epiphysis not fully elucidated. The pineal gland secretes hormonal substances, melatonin and norepinephrine. Melatonin is a hormone that controls the sequence of sleep phases, and norepinephrine affects the circulatory system and the nervous system.

The immune system, including the thymus gland, produces a large number of hormones that can be divided into cytokines or lymphokines and thymic (or thymic) hormones - thymopoietins, which regulate the growth, maturation and differentiation of T-cells and the functional activity of mature immune cells. systems.

Some endocrine functions are performed by the liver (secretion of somatomedin, insulin-like growth factors, etc.), kidneys (secretion of erythropoietin, medullins, etc.), stomach (secretion of gastrin), intestines (secretion of vasoactive intestinal peptide, etc.), spleen (secretion of splenins) and others. Endocrine cells are found throughout the human body.

Regulation of the endocrine system

Endocrine control can be seen as a chain of regulatory effects in which the outcome of a hormone directly or indirectly influences the element that determines the amount of available hormone.

The interaction occurs, as a rule, according to the principle of negative feedback: when a hormone acts on target cells, their response, influencing the source of hormone secretion, causes suppression of secretion.

• Positive feedback, in which secretion is enhanced, is extremely rare.

The endocrine system is also regulated through the nervous and immune systems.

Endocrine diseases are a class of diseases that result from a disorder of one or more endocrine glands. Endocrine diseases are based on hyperfunction, hypofunction or dysfunction of the endocrine glands.

Methods for studying the endocrine system

The manifestations of diseases of the endocrine glands are very diverse and can be detected already during the traditional clinical examination of the patient. Only the thyroid gland and testicles are available for direct examination (examination, palpation). Laboratory studies currently allow determining the content of most hormonal substances in the blood, however, the nature of metabolic disorders associated with changes in the content of these hormones can also be established using special methods. For example, in diabetes mellitus, the determination of blood glucose often more accurately reflects metabolic disorders than the level of insulin itself, which controls glucose metabolism.

In the diagnosis of endocrinopathies, it is important to focus primarily on the diverse symptoms from various organs and systems - the skin, the cardiovascular system, the gastrointestinal tract, the musculoskeletal and excretory systems, the nervous system, the eyes, comparing them with the data of biochemical and other additional studies. . It should be borne in mind that the individual clinical manifestations of the disease may be due to differences and uneven distribution in the tissues of receptors with which hormones interact.

Physical methods for studying the endocrine system

Inspection and palpation

As already noted, only the thyroid gland and testicles are available for examination and palpation. However, it is very important in these cases, and in case of damage to other endocrine glands (which cannot be examined and felt), to focus on the results of a physical examination of various organs and systems (skin, subcutaneous fatty tissue, cardiovascular system, etc.).

Already with a general examination, a number of significant signs of the pathology of the endocrine system can be identified: growth changes (dwarf growth while maintaining the proportionality of the body of pituitary origin, giant growth with an increase in pituitary function), disproportionate sizes of individual parts of the body (acromegaly), hairline features characteristic of many endocrinopathies , and a wide range of other symptoms.

When examining the neck area, they make an approximate idea of ​​the size of the thyroid gland, a symmetrical or asymmetric increase in its various departments. On palpation of the lobes and isthmus of the thyroid gland, the size, consistency, and also the nature (diffuse or nodular) of the increase are assessed. The mobility of the gland during swallowing, the presence or absence of pain and pulsation in its area is assessed. To palpate the nodes located behind the upper sternum, it is necessary to immerse the fingers behind the sternum and try to determine the pole of the node.

When examining the skin, hirsutism (ovarian pathology, hypercorticism), hyperhidrosis (hyperthyroidism), hyperpigmentation (hypercorticism), ecchymosis (hypercorticism), purple-bluish striae are sometimes revealed - peculiar areas (stripes) of atrophy and stretching, usually on the lateral areas of the abdomen (hypercorticism).

Examination of subcutaneous adipose tissue reveals both excessive development of subcutaneous adipose tissue - obesity (diabetes mellitus) and significant weight loss (hyperthyroidism, diabetes mellitus, adrenal insufficiency). With hypercortisolism, excessive deposition of fat on the face is observed, which gives it a moon-shaped rounded appearance (Itsenko-Cushing's syndrome). Peculiar dense swelling of the legs, the so-called mucous edema, is observed with hypothyroidism (myxedema).

Examination of the eyes may reveal characteristic exophthalmos (hyperthyroidism) as well as periorbital edema (hypothyroidism). Perhaps the development of diplopia (hyperthyroidism, diabetes mellitus).

Important data can be obtained in the study of the cardiovascular system. With a long course of some endocrine diseases, heart failure develops with typical signs of edematous syndrome (hyperthyroidism). One of the important causes of arterial hypertension is endocrine diseases (pheochromocytoma, Itsenko-Cushing's syndrome, hyperaldosteronism, hypothyroidism). Orthostatic hypotension (adrenal insufficiency) is less common. It is important to know that in most endocrine diseases, such changes in the electrocardiogram are noted due to myocardial dystrophy, such as rhythm disturbances, repolarization disorders - displacement of the ST segment, T wave. Echocardiography can occasionally reveal pericardial effusion (myxedema).

Sometimes a full range of symptoms of malabsorption develops with typical diarrhea and associated laboratory changes such as anemia, electrolyte disturbances, etc. (hyperthyroidism, adrenal insufficiency).

Urinary disorders with polyuria characteristic of diabetes mellitus against the background of polydipsia are often missed both by the patients themselves and by doctors. Urolithiasis with symptoms of renal colic occurs in hyperparathyroidism and Itsenko-Cushing's syndrome.

In the study of the nervous system, nervousness (thyrotoxicosis), fatigue (adrenal insufficiency, hypoglycemia) are revealed. There may be disturbances of consciousness up to the development of coma (for example, hyperglycemic and hypoglycemic coma in diabetes mellitus). Tetany with convulsions is characteristic of hypocalcemia.

Additional methods for studying the endocrine system

Visualization of the endocrine glands is achieved by various methods. Less informative is the usual x-ray study. Contemporary ultrasound procedure more informative. The most accurate picture allows you to get CT scan, X-ray or based on magnetic nuclear resonance. The latter study is especially valuable in the study of the pituitary gland, thymus, adrenal glands, parathyroid glands, pancreas. These studies are primarily used to detect tumors of the corresponding endocrine glands.

It has become widespread radioisotope research various endocrine glands, which primarily refers to the thyroid gland. It allows you to clarify the structural features (value), as well as functional disorders. The most widely used are iodine-131 or pertechnetate labeled with technetium-99. With the help of a gamma camera, gamma radiation is recorded on photosensitive paper, and thus a scan occurs that allows you to evaluate the size, shape, and areas of the gland that actively accumulate isotopes (the so-called hot nodes). Radioisotope scanning is used in the study of the adrenal glands.

There are various methods for determining the content of hormones in the blood. Among them, the most noteworthy radioimmunoassay(RIA-radioimmunoassay). Using this method, small amounts of insulin, pituitary tropic hormones, thyroglobulin and other hormones can be detected with great accuracy in blood and urine. However, it should be borne in mind that an increase in the content of hormones in the blood can occur due to their protein-bound fraction. In addition, the radioimmune method makes it possible to quantitatively evaluate substances that are chemically very similar to hormones, lacking hormonal activity, but having an antigenic structure common with hormones. Of some importance is the determination of the content of hormones after special stress tests, which allow assessing the reserve function of the gland.

Among biochemical blood tests the most important is the determination of glucose in the blood and urine, which reflects the course of the pathological process in diabetes mellitus. A decrease or increase in the level of cholesterol in the blood is characteristic of a dysfunction of the thyroid gland. A change in calcium metabolism is detected in the pathology of the parathyroid glands.

Control questions for consolidation:

Features of the structure of the endocrine system

Causes leading to diseases of the endocrine system

What is the prevention of endocrine diseases

Emergency pre-medical care: textbook. allowance / I. M. Krasilnikova, E. G. Moiseeva. - M. : GEOTAR-Media, 2011. - 192 p. : ill.

Medical manipulations / ed. S.V. Gulyaev. - M. : GEOTAR-Media, 2011. - 152 p.

Therapy with a course of primary health care. Collection of tasks: textbook. allowance for students of institutions environments. prof. education, students in the specialty 060101.52 "General Medicine" in the discipline "therapy with a course of primary health care" / L. S. Frolkis. - M. : GEOTAR-Media, 2010. - 448 p. : ill.

Organization of specialized nursing care: textbook. allowance / N.Yu. Koryagin [and others]; ed. Z.E. Sopina. - M.: GEOTAR-Media, 2009. - 464 p.: ill.

The state of the endocrine system can be judged indirectly by the study of the skin, subcutaneous fat, physical development, somatometry, since most of the endocrine glands are not available for direct examination, with the exception of the thyroid gland, testicles in boys and thymus in infants with its increase.

Palpation of the thyroid gland is carried out with bent fingers, which are deeply wound behind the outer edges of the sternocleidomastoid muscles and gradually penetrate the posterolateral surface of the lateral lobes of the thyroid gland. The thumbs are placed on the anterior surface of the lateral lobes of the gland. When swallowing, the gland shifts upward, and its sliding at this time along the surface of the fingers greatly facilitates palpation examination. The isthmus of the thyroid gland is examined with the help of sliding movements of the fingers along its surface in the direction from top to bottom, towards the handle of the sternum. On palpation of the thyroid gland, it is necessary to note its size, surface features, the nature of the increase (diffuse, nodular, diffuse-nodular), the consistency of its softened sections, mobility (displacement when swallowing), and pulsation.

Palpation of the testicles: it is necessary to note whether the testicles are lowered or not lowered into the scrotum, the shape, texture, presence of seals, dropsy, etc., the length and diameter of the testicles are noted.

An enlarged thymus gland can be determined percussion. Percussion is quiet, direct, similar to the definition of a symptom of Philosophov's bowl (see respiratory organs). The presence of a dullness outside the sternum is suspicious for thymus enlargement.

The study of the endocrine system also includes symptoms of increased mechanical excitability of muscles (with spasmophilia). For this purpose, determine:

1. Tail's symptom - tapping with a percussion hammer on the fossa canina leads to a contraction of the muscles of the eyelid, and sometimes the upper lip.

2. Trousseau's symptom - when a tourniquet is applied or the middle of the shoulder is squeezed by the hand, the child's hand takes the form of the obstetrician's hand (carpopedal spasm).

3. Lust's symptom - when tapping with a hammer behind the head of the fibula or when compressing the gastrocnemius muscle between the middle and lower thirds, we get the abduction of the foot.

Puncture (puncture biopsy) of the thyroid gland- Puncture of the thyroid gland under ultrasound control.

This method is prescribed only if no other methods provide sufficient information for prescribing treatment.

Indications:

• diagnosis of thyroid diseases;
• the presence of cysts or nodules larger than 1 cm;
• the likelihood of a malignant process.

The procedure is carried out under ultrasound control and allows you to absolutely accurately prescribe the type of treatment.

A very thin needle is used for puncture. Under ultrasound guidance, the needle is placed precisely in the right place, which reduces the likelihood of injury. The procedure is safe and has no contraindications.

After the puncture, the patient may feel a slight soreness at the site of manipulation, which quickly passes.

Ultrasound of the pancreas.

Pancreatic ultrasound is recommended for suspected acute and chronic pancreatitis (inflammation of the pancreas), as well as for jaundice (suspected tumor or cancer of the pancreas), and symptoms of other pancreatic diseases (for example, type 1 diabetes).

Preparation for ultrasound of the pancreas as for ultrasound of all organs of the abdominal cavity.

Ultrasound of the thyroid gland.

Ultrasound of the thyroid gland is one of the methods for examining the thyroid gland, which allows you to assess its size and identify the presence of some structural changes observed in diseases of the thyroid gland (goiter, thyroid tumors, thyroid adenoma, etc.). With the help of ultrasound of the thyroid gland, its smallest changes, reaching 1-2 mm in diameter, can be detected.

Ultrasound of the thyroid gland does not require special preparation. This is an absolutely safe and painless research method.

Ultrasound of the adrenal glands.

Ultrasound of the adrenal glands is an ultrasound examination of the structures of the adrenal glands located above the upper poles of the kidneys.

Indications for ultrasound of the adrenal glands:

• Suspicion of a tumor of the adrenal gland.
• Clinical manifestations of hyper- or hypofunction of the adrenal glands.
• Clarification of the causes of hypertension.
• Episodes of causeless muscle weakness.
• Clarification of the causes of obesity.
• Clarification of the causes of infertility.

Preparation for an ultrasound of the adrenal glands is not required, however, some specialists in ultrasound diagnostics prescribe a 3-day slag-free diet, a light dinner no later than 19 hours on the eve of the study, and an ultrasound of the adrenal glands on an empty stomach.

X-ray of the bones of the skull ( study of shape, size and contours Turkish saddle- bone bed of the pituitary gland) - is performed to diagnose a pituitary tumor.

Radioisotope scanning (scintigraphy) of the thyroid gland with radioactive iodine, according to the degree of absorption of which they make a conclusion about the function of the thyroid gland and determine the iodine-binding ability of blood serum proteins

COMPUTED TOMOGRAPHY (CT)- method of X-ray examination, based on the unequal absorption of X-ray radiation by various tissues of the body, is used in the diagnosis of pathology of the thyroid gland, pancreas, adrenal glands.

MAGNETIC RESONANCE IMAGING (MRI)- an instrumental method of diagnostics, with the help of which endocrinology assesses the state of the hypothalamic-pituitary-adrenal system, skeleton, abdominal organs and small pelvis.

References

Tutorials:

1. Propaedeutics of clinical disciplines / E.V. Smoleva [and others]; ed. E.M. Avanesyants, B.V. Kabarukhin. – Ed. 4th. - Rostov n / D: Phoenix, 2009. - 478 p. : ill. - (Secondary vocational education).

2. Ambulance paramedic: a practical guide / A.N. Nagnibed.-SPb: SpecLit, 2009.-3rd ed., corrected. and additional - 253 p.; ill.

3. The human body outside and inside, a complete guide to medicine and clinical pathology, De Agostini LLC, 2009.

4. A practical guide to propaedeutics of internal diseases / ed. Shulenin. - M .: LLC "Medical Information Agency", 2006. - 256 p.

5. Ryabchikova T.V., Smirnov A.V., Egorova L.A., Rupasova T.I., Karmanova I.V., Rumyantsev A.Sh. Practical guide to propaedeutics of internal diseases.- M.: GOU VUNMTs, 2004.-192 p.

6. Stary Oskol Medical College, Medical history with the basics of propaedeutics of clinical disciplines in the subject "Syndromic pathology, differential diagnosis and pharmacotherapy", 2000.

7. Nikitin A. V., Pereverzev B. M., Gusmanov V. A. Fundamentals of Diagnosis of Diseases of Internal Organs, Voronezh State University Publishing House, 1999.

8. M. G. Khan. Quick ECG analysis. St. Petersburg: "Medicine", 1999, p. 286 p.

9. Propaedeutics of internal diseases / ed. prof. Yu.S. Maslova. - S.-Pb., Special literature, 1998.

10. V.V. Murashko, A.V. Srutynsky. Electrocardiography. Medicine, 1987.

1. Complaints from the CNS

2. From the CCC

3. From the genital area

4. Complaints due to metabolic disorders

1 - irritability, increased nervous excitability, causeless anxiety, insomnia, neurovegetative disorders, tremors, sweating, feeling hot, etc. (diffuse toxic goiter, thyroid disease); hypothyroidism - lethargy, indifference, indifference, drowsiness, memory impairment.

2 - shortness of breath, palpitations, pain in the region of the heart, interruptions in the work of the heart, changes in the pulse, blood pressure.

3 - decrease in sexual function. Violation of menstruation, impotence, decreased libido - leads to infertility.

4 - violation of appetite. Change in body weight. Polyuria, thirst, dry mouth. Pain in muscles, bones, joints.

May complain of slow growth (in diseases of the pituitary gland); appearance changes. They may complain of hoarseness, rough voice, difficulty speaking. Changes in the skin, hair, nails.

Objective examination.

Changes in the appearance of the patient and features of his behavior. With diffuse toxic goiter - mobility, fussiness, lively gestures, a frightened facial expression, exophthalmos.

Hypothyroidism - slowness, low mobility, swollen sleepy face, poor facial expressions, ballroom closed, indifferent, etc.

A change in the growth of the patient, a change in the size and ratio of body parts - a gigantic growth (above 195 cm), with diseases of the pituitary gland, as well as the gonads, develop according to the female type. Dwarf growth - less than 130 cm - children's body proportions. Acromegaly - a disease of the pituitary gland - an increase in the size of the limbs - a large head with large facial features.

Changes in the hairline of the body - with the pathology of the gonads - discharge of hair. Premature graying and loss.

Accelerated hair growth.

Features of fat deposition and the nature of nutrition - weight loss up to cachexia (DTZ), with hypothyroidism - weight gain, obesity. Predominantly the deposition of fat in the pelvic girdle. Diseases of the pituitary gland.

Change in the skin - the skin is thin, tender, hot, moist - DTZ. With hypothyroidism, the skin is dry, flaky, rough, pale.

Palpation. Thyroid. Size, texture, mobility.

1. 4 bent fingers of both hands are placed on the back of the neck, and the thumb on the front surface.

2. The patient is offered swallowing movements in which the thyroid gland moves along with the larynx and moves between the fingers.

3. The isthmus of the thyroid gland is examined by sliding movements of the fingers along its surface from top to bottom.

4. For the convenience of palpation, each of the lateral lobes of the gland is pressed on the thyroid cartilage from the opposite side. Normally, the thyroid gland is not visible and usually not palpable.

Sometimes the isthmus can be palpated. In the form of a transversely lying smooth, painless roller of elastic consistency, not more than the middle finger of the hand. With swallowing movements, the SC moves up and down by 1-3 cm.

There are three degrees of thyroid enlargement:

0 - no goiter.

I. The thyroid gland is not visible, but palpable. Moreover, its dimensions are larger than the distal phalanx of the patient's thumb.

II. The thyroid gland is visible and palpable. "thick neck"

Palpation results:

1. The thyroid gland is uniformly enlarged, of normal consistency, painless, displaced.

2. The thyroid gland is enlarged, with nodes, painless, displaced - endemic goiter.

3. Thyroid gland with dense nodular or tuberous formations soldered to the skin, growing into the surrounding tissues and not moving when swallowed - thyroid cancer

Laboratory methods.

Blood chemistry.

Blood test for hormones - TSH, T3 - triiodothyranine, T4 - triiodothyraxine.

Determination of glucose in the blood. OTTG is an oral glucose tolerance test.

Urine study. General urine analysis. Daily amount of urine for sugar. 2 cans are given - one 3 liters, the second 200 ml. before the study, the usual drinking regimen. No night urine. Mixed. Pour into a small jar. We attach the direction, with the inscription of the amount of urine.

Instrumental research. X-ray. ultrasound.

Clinical Syndromes:

1. Hyperglycemia syndrome

2. Hypoglycemia syndrome

3. Syndrome of hyperthyroidism

4. Syndrome of hypothyroidism

5. Syndrome of hypercortisolism

6. Syndrome of hypocorticism