Endocrine

Fajar L. Gultom
Patologi Anatomik FK-UKI
2017
 Endocrine system
• Integrated – widely distributed organs
• Metabolic equilibrium
• Signal – secreted molecules: autocrine,
paracrine, endocrine
• Endocrine: molecules (hormones) 
blood stream  target tissue (distant)
• Target tissue  secrete factors  down
regulate – feedback inhibition
 Endocrine system
Endocrine diseases:
1. Underproduction/ overproduction
hormones – biochemical & clinical
consequences.
2. Development of mass lesions.
nonfunctional – under/ overproduction
hormones.
Morphologic findings – levels of hormones –
regulators – metabolits
 Endocrine
• Pituitary: anterior – posterior
• Thyroid
• Parathyroid
• Pancreas
• Adrenal: cortex – medula
• Non-neoplastic: hyper – hypo function
• Neoplastic: functional – non-fuctional
Histology
 Pituitary Gland
Anterior – Adenohypofisis
Colorful array of cells: Acidophil, Basophil,
Chromophobe
• Acidophils (Growth) – eosinophilic
cytoplasm
Growth hormone, Prolactine
• Basophils – basophilic cytoplasm
TSH, ACTH
Hormones released by anterior
pituitary
 Pituitary Gland
Posterior – Neurohypofisis
Modified glial cells (pituicytes)
• Oxytocin
Contraction uterine smooth muscle – labor
Induce labor – synthetic oxytocin

• Vasopressin (ADH)
Conserve water, restricting diuresis
 Clinical Manifestation
• Hyper – Hypo Pituitarism
Hyper: Growth(a), lactation(a),
thyroid(b), adrenal cortex (b)

• HYPO: growth, thyroid, adrenal

cortex

• MASS EFFECT: visual fields, brain

 Pituitary Adenoma and
Hyperpituitarism
• Most common: Adenoma anterior lobe
• Based on autopsy, prevalence 14%
• Functional – non-functional
• Secrete 2 hormones: GH & Prolactin OR
plurihormonal
• Adult, 35-60 yrs
• Microadenoma (< 1 cm), Macroadenoma (> 1
cm)
• G proteins mutations – most common
 Pituitary Adenoma

MRI. Sagital & axial view. Large pituitary mass (> 1 cm).
Impinge optic chiasm – visual field defects  bitemporal
hemianopsia
Pituitary Adenoma
BITEMPORAL
HEMIANOPSIA
 Pituitary Adenoma

• Macroscopic: Macroadenoma, impinge ventricular system –

intracranial pressure elevation.
• Microcopic: monotonous rounded cells, capillary
 Posterior Pituitary
Diabetes Insipidus
• Excessive urination (polyuria) – inability
kidney resorb water
• Head trauma, tumors, inflammatory

SIADH (Syndrome of Inappropriate ADH)

secretion
• ADH excess by ectopic ADH malignant
neoplasm (small cell ca lung)
 Hypopituitarism
• Decreased secretions of pituitary hormones
• Hypofunction – 75% parenchym lost
• Etiology:
– Tumor, mass lesion
– Traumatic brain injury, Subarachnoid hemorrhage
– Pituitary surgery/ radiation
– Pituitary apoplexy
– Ischemic necrosis – Sheehan syndrome
– Inflammatory disorder & infection
Thyroid
 Thyroid
• Below anterior larynx
• Two bulky lobes connected by isthmus
• Thin fibrous septa – lobules – Folicles lined
kuboidal/ low columnar epithelium
• C cells – parafollicular cells - calcitonin
 Hyperthyroidism
• Thyrotoxicosis  hypermetabolic state –
elevated fT3 & T4
• Diffuse hyperplasia (Graves)
• Multinodular goiter
• Adenoma
• Carcinoma
• Secondary to TSH pituitary adenoma
 Hyperthyroidism
• BMR ↑
• Tachycardia, Palpitation, Cardiomegaly
• Sympathetic nervous system ↑ (tremor,
hyperactivity, emotional lability, anxiety,
insomnia)
• Ocular changes
• Skeletal system
• Thyroid “Storm”
Exophtalmus
 Hypothyroidism
Primary
• Developmental
• Post-ablative (surgery, I-131, ext radiation)
• Autoimun – Hashimoto
• Iodine deficiency
• Drugs (lithium, p-aminosalicylates)
Secondary
• Pituitary failure
• Hypothalamic failure
Cretinism - Myxedema
• Severe
retardation
• Protruding
tongue
• Hernia umbilical

• Sluggishness
• Cool skin, LDL ↑
 Thyroiditis
• Hashimoto’s – autoimun – lymphoid follicles with
germinal centres – MOST common
hypothyroidism in iodine sufficient area

• Granulomatous thyroiditis (DeQuervain)

• Subacute lymphocytic thyroiditis – just like

Hashimoto but No germinal center n fibrosis –
often post partum
Hashimoto’s
DeQuervain
 Grave’s Disease
Triad:
• Hyperthyroidism – diffuse
enlargement of gland
• Ophtalmophathy – exopthalmos
• Dermopathy – pretibial myxedema

• Autoimun – autoantibodies to TSH receptor –

TSI (Thyroid Stimulating Immunoglobulin)
Graves
 Goiters/ Struma
• Diffuse – Multinodular
• Impaired synthesis thyroid hormone – def diet
iodine
• Endemic – Sporadic
• Goitrogen – cabbage, cauliflower, turnip,
cassava
Goiter/ Struma
 Neoplasms
Nodules VS Neoplasms
Adenoma VS Carcinoma
• Solitary OR Multiple
• Younger OR Older
• He OR She
• Radiation history
• Cold or Hot nodules
 Neoplasms
Adenoma
• Discrete, soliter, derived from follicular
epithelium
• Follicular adenoma – HÜrthle cell adenoma

Carcinoma
• Follicular (10%)
• Papillary – most common (70-80%)
• Medullary
• Anaplastic
Adenoma
 Follicular Carcinoma
• Morphology similar with adenoma
• Capsular and/ vascular invasion distinquish
with adenoma
 Papillary Thyroid Carcinoma (PTC)
• Diagnosis: Nuclear features – ground
glass nuclei (Orphan Annie eye),
pseudoinclusion, nuclear groove (coffee
bean)
• Papillae structure not required
Macroscopic
Microscopic
Microscopic
 Parathyroid
• 4 glands: chief cells (predominate), oxyphil
cells
• Secretory granules – PTH
• Regulate Ca homeostasis

http://medical-
dictionary.thefreedictionary.com/
 Parathyroid Disorder
Hyper
• Primary – adenoma (common),
hyperplasia, Carcinoma
• Secondary – hypoCa2+ due renal chronic
renal failure

Hypo: surgical, congenital, familial,

idiopathic
Pancreas

SKIP…
 Adrenal
• Paired endocrine organ
• Retroperitoneum
• Cortex (3 zones):
–Glomerulosa – mineralocorticoid (SALT)
–Fasciculata – Glucocorticoid (SUGAR)
–Reticularis – Gonadocorticoid (SEX)
• Medulla – Cathecolamines
 Microscopic

S
S SUGAR S
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 Hyperadrenalism
(Adrenocortical hyperfunction)
1. Cushing Syndrome – HyperCortisolism
Exogen – Endogen (ACTH producing)
1. Hyperaldosteronism – Aldosterone
2. Adrenogenital/ Virilizing syndrome –
androgen
 Hypoadrenalism
• Primary Adrenocortical Insufficiency
– acute/ chronic
• Secondary….
Thank You