Diagnosis and symptoms of diseases of the endocrine system

METHOD OF STUDY OF THE ENDOCRINE SYSTEM

Indirectly, the size of the pituitary gland is judged by the size, shape and structure of the Turkish saddle on radiographs. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently being performed.

To determine the functional state of the pituitary gland, radioimmunological methods are used to study the levels of hormones in the blood of a child.

Growth hormone in the highest concentration is determined in newborns, which is associated with an increase in lipolysis and a decrease in glycemia in the postnatal period. The natural release of growth hormone occurs during nighttime sleep. To assess the level of growth hormone, its basal content is determined, as well as the release after provocative tests, such as insulin administration.

The highest level of ACTH is also observed in newborns, providing adaptation processes, then its level decreases.

The level of TSH in newborns is 15-20 times higher than in subsequent age periods. On the contrary, the level of gonadotropic hormones - LH and FSH - increases by puberty in both boys and girls.

During a clinical examination, it is possible to identify certain signs of dysfunction of the pituitary gland, for which it is necessary to assess the state of trophism of the child's tissues, the weight and length of his body and the dynamics of their increase, the development and distribution of the subcutaneous fat layer, the development of secondary sexual characteristics. In addition, diuresis should be measured, the frequency of urination should be determined, and the relative density of urine should be assessed.

RESEARCH METHOD

When examining the anterior surface of the neck, one can get an idea of the size of the thyroid gland, which is normally not visualized (see the degree of magnification below).

At palpation SHCHZH it is necessary to pay attention to the following. a Dimensions (normally, the thyroid gland can be palpable, while the size of its lobe should not exceed the size of the nail plate of the patient's thumb). Based on the data of examination and palpation of the thyroid gland, five degrees of its increase are distinguished:

1 degree - the thyroid gland is not visualized and is weakly palpable;

Grade 2 - The thyroid gland is palpable and visible with full extension of the neck;

3 degree - the thyroid gland is clearly visible with the usual location of the neck ("thick neck" due to a noticeable goiter);

4 degree - the thyroid gland is significantly enlarged and extends beyond the outer edges of the sternocleidomastoid muscle;

5 - greatly enlarged thyroid gland deforms and disfigures the contours of the neck.

* Consistency (normally soft elastic).

* The nature of the surface (normally smooth).

* The nature of the increase (diffuse or nodular).

* Degree of mobility when swallowing (normally mobile).

* Presence or absence of pulsation (normally there is no pulsation).

Acute adrenal insufficiency can develop with bilateral damage to the adrenal cortex or hemorrhage caused by birth trauma, thrombosis or embolism of the veins (Waterhouse-Frideriksen syndrome), DIC. Hemorrhagic adrenal infarction often occurs against the background of severe infections, primarily with meningococcal, pneumococcal or streptococcal.

Acute hemorrhages in the adrenal glands can occur during stress, major operations, sepsis, burns, during treatment with anticoagulants, in patients with AIDS. Acute adrenal insufficiency can occur with a sudden cessation of corticosteroid treatment - "withdrawal syndrome", as well as in patients after bilateral adrenalectomy.

At chronic adrenal insufficiency(HNN) patients complain of general weakness, fatigue, poor appetite, need for salt, weight loss, occasional nausea, vomiting, loose stools, abdominal pain. Hyperpigmentation of the skin and mucous membranes, decreased muscle strength, low blood pressure, hyponatremia and hyperkalemia, and hypoglycemia are noted.

Chronic adrenal insufficiency most often develops as a result of an autoimmune process in which antibodies are formed against the tissue of the adrenal glands. In addition, it may be associated with a bilateral tuberculous process in the adrenal glands. Rarer causes include tumors (angiomas, ganglioneuromas), metastases, amyloidosis, infections (syphilis, fungal diseases), chronic intoxications, such as insecticides. The adrenal cortex is destroyed during thrombosis of veins and arteries, with AIDS, etc.

Secondary (central) forms of adrenal insufficiency may be due to ACTH deficiency due to damage to the adenohypophysis or hypothalamus.

There are cases of cortisol resistance associated with abnormalities of the glucocorticoid receptors.

Congenital dysfunction of the adrenal cortex - a hereditary disease in which the biosynthesis of corticosteroids is impaired due to a congenital deficiency of a number of adrenal enzyme systems.

There are 3 main clinical forms of the disease:

Viril - with a deficiency of 21-hydroxylase;

Salt-losing - with a more significant deficiency of 21-hydroxylase, when the formation of both glucocorticoids and mineralocorticoids is impaired;

hypertonic - with an excess of 21-hydroxylase.

To ensure a normal level of hydrocortisone, increased stimulation of the adrenal glands by ACTH is necessary, which leads to increased production of hormones in those areas where synthesis is not disturbed, mainly in the reticular zone, where androgens are formed. In the hypertensive form, a lot of 11-deoxycorticosterone and 11-deoxycortisol accumulate, which have a hypertensive effect.

The viril form is observed in both boys and girls. In girls, virilization of the external genitalia of varying severity is noted, at puberty, the mammary glands do not develop, and menstruation does not appear. In boys, there is hypertrophy of the penis, early sexual hair growth, hyperpigmentation in the vulva, accelerated skeletal maturation, and early closure of growth zones.

In the salt-losing form, first of all, symptoms of a violation of the water-electrolyte balance are observed: increased excretion of sodium and chlorine, potassium retention. This leads to repeated vomiting, loose stools, dehydration, muscle hypotension, and convulsions.

In the hypertensive form, in addition to virilization, there is persistent arterial hypertension.

Manifestation hypercortisolism There are Itsenko-Cushing's disease and syndrome: in patients, weakness, increased fatigue, headache, pain in the legs and back, drowsiness, and thirst are expressed. Characterized by a moon-shaped face with a bright blush on the cheeks, hypertrichosis, obesity with a predominant deposition of fat in the neck in the form of an "elk scruff", in the back, abdomen. On the skin of the abdomen, back, shoulders, hips, mammary glands, stretching strips are formed - striae of purple or purple color. Osteoporosis develops, arterial hypertension, steroid cardiomyopathy are noted, glucose tolerance decreases. In the blood, lymphopenia, eosinopenia, erythrocytosis, a tendency to increase blood coagulation are found.

Primary hypercortisolism is observed in tumors of the adrenal glands, its manifestations are usually called Itsenko-Cushing's syndrome.

Secondary hypercortisolism is caused by an excess of ACTH, which is produced by a tumor of the anterior pituitary gland basophilic adenoma, leading to the development of Itsenko-Cushing's disease.

Substances similar to ACTH can be secreted in ectopic foci in tumors and metastases of bronchogenic cancer, cancer of the thyroid gland, pancreas, uterus, ovaries, etc.

Sometimes the cause of hypercortisolism can be excessive production of corticoliberin in the hypothalamus, which leads to the synthesis of an increased amount of ACTH in the pituitary gland, accompanied by hyperplasia of the adrenal cortex and increased secretion of corticosteroids.

Hypoaldosteronism(insufficient production of aldosterone) is characterized by a number of symptoms: due to hyperkalemia and hyponatremia and their effect on the function of the kidneys, cardiovascular system and skeletal muscles. Patients have fatigue, muscle weakness, arterial hypotension, periodically fainting, bradycardia, heart block.

Hypoaldosteronism - an isolated deficiency in the production of aldosterone - is rare - in violation of an enzyme defect in the glomerular zone of the adrenal cortex, as well as after removal of an aldosteroma in one adrenal gland and atrophy of the glomerular zone in another.

There is pseudohypoaldosteronism, due to the low sensitivity of the epithelium of the renal tubules to aldosterone.

Hyperaldosteronism(excess production of aldosterone) leads to renal retention of sodium and loss of potassium. Patients have arterial hypertension, periodically convulsions in various muscle groups. Initially, daily diuresis is reduced, then polyuria, polydipsia, nocturia, and resistance to antidiuretic drugs develop.

Hyperaldosteronism can be primary or secondary. Primary hyperaldosteronism (Conn's syndrome) develops with a hormonally active tumor of the glomerular zone. Secondary hyperaldosteronism can be observed in a number of diseases accompanied by hypovolemia and renal ischemia, including after acute blood loss, with heart failure, with nephritis and other kidney diseases. Secondary hyperaldosteronism can occur in women during menstruation, pregnancy and lactation, as well as in people of both sexes with strong physical exertion, intense sweating, etc.

Hyperaldosteronism in liver disease is associated with impaired aldosterone metabolism in liver failure.

At excessive secretion of catecholamines patients experience weakness, fatigue, sweating, loss of appetite, weight loss, headaches, blurred vision, tachycardia, peripheral vasospasm, arterial hypertension that cannot be treated, which can be crisis or non-crisis (permanent).

Excessive secretion of catecholamines occurs in pheochromocytes and other tumors of chromaffin tissue. In addition, hypersecretion of catecholamines is observed with great physical exertion, stress, and pain.

Insufficient secretion of catecholamines as an independent endocrinopathy does not occur.

RESEARCH METHOD

When examining a child, attention is paid to growth, fat deposition, body proportions, muscle development, hair growth. Evaluate the severity of secondary sexual characteristics: in girls, the development of the mammary glands, pubic hair and hair development in the armpit, the formation of menstrual function; in boys, hair growth of the armpit, pubis and face, growth of the thyroid cartilage, changes in the timbre of the voice, the condition of the testicles, penis and scrotum. Determine the stage of puberty according to Tanner.

For girls:

Stage I - the mammary glands are not developed, the nipple rises. Sexual hair growth is absent;

II stage - the stage of swelling of the mammary gland; increase in areola diameter. The growth of sparse, long, slightly pigmented hair; hair is straight, occasionally curly, located along the labia;

Stage III - further enlargement of the mammary gland and areola without separation of their contours. Hair darkens, coarsens, curls more, spreads beyond the pubic joint;

Stage IV - protrusion of the areola and nipple with the formation of a secondary tubercle above the contour of the gland. Sexual hair growth of the female type, but does not cover the entire pubic region;

Stage V - the mammary glands correspond to those of an adult woman; the areola fits into the general contour of the mammary gland. Sexual hair growth occupies the entire suprapubic region.

For boys:

Stage I - the penis, testicles and scrotum of children. Sexual hair growth is absent;

Stage II - enlargement of the testicles and scrotum; the penis usually does not increase, the skin of the scrotum turns red. The growth of sparse, long, slightly pigmented hair; hair straight, occasionally curly, mainly at the base of the penis;

Stage III - further enlargement of the testicles and scrotum and enlargement of the penis, mainly in length. Hair becomes darker, coarser, more curly; slightly spread beyond the pubic articulation;

Stage IV - further enlargement of the testicles and scrotum; the penis increases, mainly in diameter. Sexual hair growth according to the male type, but does not occupy the entire pubic area;

Stage V - the external genitalia correspond in shape and size to the organs of an adult male. Sexual hair growth occupies the entire suprapubic region.

When examining the genital organs, pay attention to the correctness of their structure. In boys, anomalies such as hypospadias (lower cleft urethra), epispadias (upper cleft urethra), and penile hypoplasia (micropenis) can be identified. In girls, agenesis, hypoplasia or hypertrophy of the clitoris, fusion of the labia minora and labia majora, infection of the hymen, splitting of the clitoris, aplasia of the labia and hymen are possible.

During palpation in boys, the presence of testicles in the scrotum is determined, their consistency and size are assessed, and then they are compared with the standards for each age.

If necessary, an ultrasound examination of the pelvic organs in girls and testicles in boys is performed.

To assess the function of the sex glands, the level of sex hormones in the blood and urine is determined.

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.

Collection of anamnesis

When interviewing a patient, it is possible to identify a number of important data indicating violations of the functions of certain endocrine glands, the time and causes of their occurrence, and the dynamics of development.

Already at the beginning of the conversation with the patient, certain features can be quite clearly detected: hasty, confused speech, some fussiness in movements, increased emotionality, characteristic of hyperfunction of the thyroid gland, and, conversely, lethargy, apathy, and some inhibition with its hypofunction.

Complaints. Complaints of patients with endocrine disorders are often of a general nature (poor sleep, fatigue, mild excitability, weight loss), but may be more characteristic of damage to the corresponding endocrine gland, including they may be associated with involvement in the process (due to metabolic -hormonal disorders) of various organs and systems.

Patients may complain of skin itching (diabetes mellitus, hyperthyroidism), hair loss (thyroiditis), joint pain (acromegaly) and bones (hyperparathyroidism), bone fractures (hyperparathyroidism, Itsenko-Cushing syndrome), muscle weakness (Itsenko-Cushing syndrome, hyperaldosteronism), pain in the region of the heart, palpitations with atrial tachyarrhythmia (hyperthyroidism, pheochromocytoma). Often there are complaints of poor appetite, dyspeptic symptoms (hypothyroidism, adrenal insufficiency), sexual dysfunction - amenorrhea (hyperthyroidism, hypogonadism, Itsenko-Cushing syndrome), menorrhagia (hypothyroidism), impotence (diabetes mellitus, hypogonadism).

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 disorders, 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. Conventional X-ray examination is considered less informative. Modern ultrasound is more informative. The most accurate picture allows you to get computed tomography, 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.

The radioisotope study of various endocrine glands, especially the thyroid gland, has become widespread. 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, radioimmunoassay (RIA-radioimmunoassay) deserves the most attention. Its principle is as follows: antibodies (antiserum) are preliminarily prepared for the test substance, which is an antigen, then a standard amount of the resulting antiserum is mixed with a standard amount of the original antigen labeled with radioactive iodine-125 or iodine-131 (up to 80% of the labeled antigen binds to antibodies, forming a radioactive precipitate with a certain radioactivity). Blood serum containing the test substance is added to this mixture: the added antigen competes with the labeled antigen, displacing it from complexes with antibodies. The more analyte (hormone) contained in the test sample, the more radioactive labels are displaced from the complex with the antibody. Next, the antigen-antibody complex is separated by precipitation or selective absorption from the free labeled hormone and its radioactivity (i.e., amount) is measured on a gamma counter. The radioactivity of the precipitate falls. The more antigen in the test sample, the lower the radioactivity of the remaining precipitate. 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.

8.Functional and diagnostic methods of research in diseases of the endocrine system.ppt

Number of slides: 29

To facilitate the understanding of this lecture, we recall a brief anatomical and physiological data on the endocrine system. n The endocrine system is the system that releases hormones into the blood. "Hormones" are chemicals secreted into the blood or lymphatic vessels and have various effects on target organs. n Back in the middle of the 20th century, it mainly included clearly organized morphological formations called glands. n n. To date, this concept has become much broader. It turned out that many other organs and tissues have an endocrine function.

n For example, one of these places was the hypothalamus. n It turned out that the hypothalamus secretes: thyroliberin, luliberin, corticoliberin, prolactoliberin, folliculoliberin, somatoliberin, melanocytoliberin, luteostatin, melanocytostatin, which regulate the functioning of the pituitary gland

n The liver secretes angiotensin. Kidneys - erythropotin and renin. Stomach - gastrin, somatostatin. n 12 duodenum and small intestine - motilin, secretin, cholecystokinin pancreozymin, somatostatin. Cardiac atria and brain - atrial and cerebral natriuric peptides, respectively. Connective tissue and cells of mesenchymal origin - somatomedins. n Adipose tissue - leptin, adiponectin, etc.

n. In our subject, it is not possible to analyze in detail all these hormones and their actions. But this information must be remembered once and for all: the endocrine system is not only endocrine glands. However, here and today we are forced to talk about the endocrine glands and their functions.

n The system of endocrine glands is scattered throughout the body (Fig.) 1. Pituitary gland. 2. Thyroid gland. 3; 4 and 7. Adrenals. 5. Sex glands. 6. Pancreas. 8. Thymus (thymus) 9. Parathyroid glands. 10. Epiphysis. Briefly consider their morphology and functions

n. The pineal gland secretes the hormone melatonin, which activates the division of pigment cells in the skin and has an antigonadotropic effect. n. The pituitary gland consists of the anterior adenohypophysis and the posterior - neurohypophysis and intermediate parts (lobes). In the anterior lobe of the pituitary gland, growth hormone is produced; gonadotropic hormones that stimulate the male and female sex glands; lactogenic hormone that supports the secretion of estrogens and progesterone by the ovaries; ACTH, which stimulates the production of adrenal hormones; TSH, which regulates the functioning of the thyroid gland. The posterior pituitary contains two hormones: oxytocin, which regulates the birth act and secretion of the mammary glands, and vasopressin or antidiuretic hormone, which mainly regulates the reabsorption of water from the renal tubules. The intermediate part is the hormone intermedin, which regulates pigment metabolism in integumentary tissues .

THYROID produces thyroxine (T 4) and triiodothyronine (T 3), which regulate the overall metabolism in the body, influence the formation of the skeleton, accelerate bone growth and ossification of epiphyseal cartilage; calcitonin, which regulates the exchange of calcium and phosphorus. ITS functions are studied by determining these hormones.

The parathyroid glands regulate the exchange of calcium and phosphorus. Removal of the parathyroid glands causes convulsions and can lead to death. n Thymus (the thymus gland is the most important organ of the body's immunological defense. It ensures the differentiation and proliferation of bone marrow stem cells; it produces the enzyme thymosin, which ensures the immunological competence of lymphocytes throughout the body. T lymphocytes formed in the bone marrow enter the thymus and, under the influence of thymosin, become differentiated, immunologically competent and become the main mediators of cellular immunity n n

n The adrenal glands consist of two layers - cortical and medulla n The medulla produces two hormones of the mediator of the sympathetic nervous system - adrenaline and norepinephrine. They increase the contractility and excitability of the heart, narrow the blood vessels of the skin, increase blood pressure. . n The cortical substance is an extremely important formation of the human body. It produces about 30 different hormones that regulate the concentration of sodium, potassium and chlorine in the blood and tissues, carbohydrate, protein and fat metabolism, as well as the production of sex hormones.

The pancreas is an organ that has both exocrine and endocrine functions. Exocrine function was discussed in the section on diseases of the digestive system. Endocrine function is provided by special cells collected in small islands (islets of Langerhans), which are interspersed in the tissue of the gland throughout its volume. They produce the hormone insulin. Insulin mainly regulates carbohydrate metabolism - the consumption of glucose by various body systems, ensuring the transfer

Let us now consider the questions of the norm of hormones secreted by these glands. Here, unfortunately, we must immediately make a reservation that in various sources in Russia one can find significantly different values of these hormones in the norm, which depends on the lack of standardization of research methods and on the chaos that today has place in this country. Even if there were uniform standards in Russia, no one is going to adhere to them - everyone uses the method that is easier for him to implement or more like. Nevertheless, we must state to you approximate norms, and you should know them. n As mentioned above, the anterior pituitary gland secretes a significant amount of a wide variety of hormones.

The level of STH on an empty stomach is 8 ng / ml. As you know, hyperproduction of this hormone can be observed with gigantism or acromegaly, and hypoproduction with pituitary dwarfism, which we talked about in the lecture “Question, examination ... in endocrine diseases” n TSH is 0.45 - 6.2 microns. IU/ml Thyroid-stimulating hormone regulates the function of the thyroid gland, and its overproduction can lead to hyperthyroidism, and a decrease in production - to myxedema n

ACTH - (on an empty stomach, at 8 o'clock in the morning, in the supine position) -

Delirium gets me everywhere - Delusion of newspapers, television, radio. Nonsense shelling: flight underflight, But he always hits and injures. It is impossible to interrupt this nonsense, You can’t hide from it with earplugs ... Who creates misfortunes from victories, And trades in lost souls And others, in order to block the op, So that they can finally be heard, Show hysterical agility Even in church in prayers to the Almighty.

n The level of PL in men is 2–12 ng/ml, in women 2–20 ng/ml. n The level of ADH in the blood is 29 ng / ml. n Great help in the diagnosis of diseases of the pituitary gland is provided by targeted radiography of the "Turkish saddle" and especially nuclear - magnetic - resonance (NMR) research and computed tomography. n These methods can detect pituitary tumors up to 0.2 cm in diameter (microadenomas) with a 97% certainty.

Pancreas The main methods of studying the endocrine function of the pancreas is the direct determination of the level of insulin and glucagon in the blood. However, these methods have not yet entered into widespread practice. The methods of indirect study of the insulin-producing function of the pancreas, the determination of glucose in the blood and urine, and the glucose tolerance test, are most widely used.

n Determination of glucose in the blood produced on an empty stomach. Normal is the level with fluctuations from 3.33 to 5.5 (according to some methods up to 6.105) mmol / l. n An increase in blood glucose is called n This indicator is almost hyperglycemia. a sign of a reliable presence of diabetes mellitus in humans (it should be remembered that hyperglycemia can also be of another origin). n There may also be a decrease in blood glucose levels, which is called hypoglycemia. Such a condition can occur both in diabetes mellitus and in a number of diseases, which may be based on tumors or damage to the endocrine glands of a different order.

n Determination of glucose (sugar) in the urine is usually performed in the daily volume of urine. Normally, there is no glucose in the urine. Its appearance is called glycosuria and is a serious sign of diabetes, although sometimes it can be after heavy consumption of sweet foods and a rare disease - renal diabetes. n Glucose tolerance test. In many people, diabetes occurs latently, latently (the so-called impaired glucose tolerance). Such people may have slight stigmata of diabetes that are not confirmed by routine urine and blood tests. To clarify the diagnosis in these cases, this test was developed.

Typically, the test is performed as follows: blood is taken from the subject for fasting glucose, then they are given to drink 75 g (or, more precisely, 50 g per m 2 of body area) of glucose dissolved in 100-200 ml of water, and the blood is examined for glucose every 30 minutes in over the next 3 hours. n Interpretation of the results: in a healthy person, the rise in glucose levels after 1 hour does not exceed 80% of the original, by 2 hours it falls to normal, and by 2.5 hours it may fall below normal. n In patients, the maximum rise is observed later than 1 hour, reaches figures above 80% of the original, and normalization is delayed for 3 hours or more. n

n n n Thyroid Gland The methods of studying the functions and clinical morphology of the thyroid gland include the determination of protein-bound iodine, the level of thyroid hormones, the shape and size of the gland. Determination of protein-bound iodine (PBI) is one of the most important and accurate methods for studying the function of the gland. SBI is 90-95% composed of thyroid hormone thyroxine. Normally, SBI is 315.18630.37 nmol/l. With thyrotoxicosis, its level is higher than 630.37 nmol/l, with hypothyroidism it is less than 315.18 nmol/l.

n Thyroxine (T 4) and triiodothyronine (T 3) are determined from thyroid hormones. Approximate norms: T 4 60 160 nmol / l, and T 3 1.2 2.8 nmol / l. Simultaneously with them, as a rule, the level of TSH is determined, which, according to the same methods, normally equals 0.17-4.05 nmol / l. n One of the objective methods for studying the morphology and function of the thyroid gland is scanning using radioactive isotopes. On scans, the size of the thyroid gland, areas of hypo- and hyperfunction can be outlined. n n

n. In recent years, ultrasonography (ultrasound) has been widely used to examine the thyroid gland. Ultrasound is currently the method of choice in determining the size of the thyroid gland and the presence of changes in its structure. n A highly effective research method is CT, which allows you to study the size and structure, identify tumors or other changes in it.

Adrenal glands (cortical layer) To study the function of the adrenal cortex, aldosterone is determined in the urine, 17 oxycorticosteroids (17 OKS) in the blood and urine, and neutral 17 ketosteroids (17 KS) in the urine. n Determination of aldosterone. It is believed that there is a directly proportional relationship between the amount of aldosterone in the urine and the mineralocorticoid activity of the adrenal cortex. n In healthy people, from 8.34 to 41.7 nmol / day is excreted. aldosterone. n An increase in the excretion of aldosterone in the urine can be observed with the so-called primary and secondary hyperaldosteronism (adenoma or tumor or hyperfunction of the cortical layer). n

Definition 17 ACS reflects the level of glucocorticosteroids in the blood. n Normally, 17 ACS in the blood contains from 0.14 to 0.55 µmol / l. n A persistent increase in the level of 17-ox is observed in tumors of the adrenal glands and in Itsenko Cushing's syndrome. n A decrease in 17 ACS is found with hypofunction of the adrenal cortex or insufficiency of the anterior pituitary gland. n n Excretion of 17-OX in the urine normally goes in parallel with changes in the blood. Even more specific for the study of glucocorticosteroid function of the adrenal glands is the determination of cortisol in the urine. n Norm 55 248 nmol / day. n

n Definition 17 COP. Most of the 17 SCs originate from androgens, so their determination allows one to make a judgment about the androgenic function of the adrenal cortex. Normally, 27.7-79.7 µmol/day is excreted in men and 17.4-55.4 in women. n Decreased release of 17 CS is characteristic of adrenal insufficiency, an increase for tumors. n There are also methods for indirectly determining the functions of the adrenal cortex. These include the determination of sodium and potassium in the blood and urine. n

It is known that in the regulation of the level of electrolytes (especially sodium and potassium), the main role belongs to mineralocorticoids, in particular aldosterone, and to a lesser extent glucocorticoids. n In this regard, the level of sodium and potassium in the blood and their excretion in the urine will indirectly show the state of production of these hormones by the adrenal glands. Normally, sodium in the blood plasma contains 135 145 mmol / l, and potassium 3.8 4.6 mmol / l. n With urine, 122,260 mmol / day is normally excreted. sodium and 25 100 mmol / day. potassium. n In practice, determination in urine is rarely made. n

Adrenal glands (medulla) The study of the function of the adrenal medulla is most often resorted to when a tumor is suspected. n Study 3 hormones - adrenaline, norepinephrine, dopamine in the blood or plasma. n Their plasma level is equal to - adrenaline

4.3.1. Methods for determining hormones

Currently, the methods most used in clinical practice for determining hormones are:

radioimmune,

immunoradiometric,

radioreceptor,

Chemical methods and others.

Until the end of the 60s, the only method for determining the level of hormones was biological, the basic principle of which was that a sample containing an unknown amount of a hormone is introduced into a biological system (animal, organ, tissue), and the level of the hormone in it in biological units of action is determined by the degree of the response. Thus, prolactin dose-dependently stimulates the growth of the epithelium of the goiter of pigeons, testosterone stimulates the growth of the prostate gland in immature and castrated rats.

Radioimmunoassay(RIA) determination of hormones is based on the competitive binding of radiolabeled and unlabeled hormones with specific antibodies. The hormone acts as an antigen. The advantages of RIA are high sensitivity, high specificity, accuracy, reproducibility and ease of implementation. The disadvantage is the use of radioactive isotopes, which determines the limited shelf life of test kits.

Immunoradiometric analysis(IRMA) is a modification of RIA, in which not an antigen (hormone), but specific antibodies are marked with a radioactive label.

Radioreceptor analysis(PRA) - instead of antibodies to hormones, their own receptors are used.

In addition to the radioactive label, enzymes can be used as markers in hormonal analysis ( linked immunosorbent assay) and luminescent substances ( luminescent analysis).

By using chemical methods determine the metabolites of hormones and their precursors (for example, norepinephrine and adrenaline, dopamine, serotonin in the urine). Determining the content of hormones in the blood gives more reliable and accurate results.

Determination of hormones produced in biopsy or sectional material.

4.3.2. Instrumental Methods

Instrumental methods complete the diagnostic search for diseases of the endocrine glands. The most commonly used: ultrasound (ultrasound), radiography, computed tomography (CT), magnetic resonance imaging (MRI). In addition, special methods are used, such as angiography with selective sampling of blood flowing from the endocrine gland to determine hormones, scintigraphy (radioisotope study) of the thyroid gland, adrenal glands, and bone densitometry.

Ultrasound procedure most commonly used in endocrinology. The principle of the method is that a sensor with a piezocrystal sends ultrasonic waves into the human body, and then perceives the reflected pulses, converting them into electrical signals, which through the amplifier enter the video monitor. Ultrasound helps to determine the size and echostructure of the organ, as well as performing a puncture biopsy of organs.

CT scan is based on obtaining a "slice" of the body by computer processing of data on the absorption capacity of tissues when a collimated X-ray beam passes through them. In computed tomographs, the narrow X-ray beam emitted by the tube, passing through the layer under study, is captured by detectors and processed. Each fabric, depending on the density, absorbs radiation differently. The minimum size of the pathological focus, determined using CT, ranges from 0.2 to 1 cm.

Magnetic resonance imaging(MRI) is based on the possibility of changing the resonance and relaxation processes in hydrogen protons in a static magnetic field in response to the application of a radio frequency pulse. After the termination of the pulse, the protons return to their original state, "dumping" the excess energy that is captured by the device. The construction of the image is carried out by the difference in energies from different points. MRI scanners allow you to make sections with a thickness of 0.5 - 1 mm. The advantages of MRI are non-invasiveness, absence of radiation exposure, “transparency” of bone tissue, and high differentiation of soft tissues.

Genetic analysis

Molecular biological diagnostics is a highly informative method for diagnosing many endocrine diseases.

All hereditary diseases are divided into three main groups of chromosomal, gene and diseases with a hereditary predisposition.

For the diagnosis of chromosomal endocrine diseases, the method of karyotyping and the study of sex chromatin (Down, Shereshevsky-Turner, Klaifelter syndromes) are used. To determine gene mutations, the method of compiling pedigrees (family tree) is widely used.

The development of diseases with hereditary predisposition is determined by the interaction of certain hereditary factors (mutations or combinations of alleles and environmental factors). Among the diseases of this group, the most studied are autoimmune diseases such as diabetes mellitus, hypocorticism, hypo- and hyperthyroidism.

In addition to predisposition to the disease, the genotype can determine its prognosis, the development of complications, as well as the prognosis of the effectiveness of the treatment methods used.

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 that 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, the 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

Physical methods for studying the endocrine system

Inspection and palpation

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

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