Chapter 8 - Endocrinology:

Endocrinology is the study of hormones, the glands that produce them and the tissues
that they act on. Classic model of an endocrine system: Hormone produced by a gland
-> released into circulation -> where it becomes available to bind a specific receptor on
the target cell or tissue. The hormone then triggers a signaling cascade that results in a
change in cellular function. It is important to know that hormones dont necessarily need
to be released into circulation -> to have its intended effect. Hormones can also act in
a paracrine fashion (ie: on neighbouring cells).\ or in an autocrine fashion (ie: on the
cells in which theyre produced).
Key concept in endocrinology is -ve feedback loops, particularly
their role in the hypothalamicpituitary-axis (HPA axis). The
CNS controls the release of
hypothalamic and anterior
pituitary hormones which act as
trophic hormones on target
endocrine organs. Target
endocrine organs are stimulated
to release target hormones which
go on to have specific effects on
particular tissues and also
feedback to regulate the release
of trophic hormones from the
hypothalamus and anterior
pituitary.

Embryology Facts:
The thyroid gland is the first endocrine gland to develop at ~24 th day of gestation. The
foramen cecum and pyramidal lobe of the thyroid are normal remnants of the cranial
and caudal parts of the thyroglossal duct, respectively. In instances, with persistence of
additional thyroglossal duct the formation of its respective cyst, is possible. Based on
thyroid development, the most common site of ectopic thyroid tissue, is the tongue. Its
possible to differentiate a thyroglossal duct cyst (midline and will move with swallowing)
from a branchial cleft cyst (lateral neck, and wont move with swallowing) that results
from a persistent cervical sinus by location and exam.

Since cortisol is not produced in significant amounts until late gestation, premature

babies have low surfactant and are more susceptible to infantile respiratory distress
syndrome (RDS).
Chapter 8 (Continued) Anatomy:

Note the gross depiction of the adrenal gland (diagram above), and in the middle, we
see a representation of its cellular composition. Note the photomicrograph: at the
bottom, showing its zones.
The adrenal glands are located just above kidneys and are responsible for secreting
several critical hormones: mineralocorticoids (ie: aldosterone), glucocorticoids (ie:
cortisol), sex hormones and catecholamines. The outermost layer of the adrenal cortex
(which is just below the capsule), is the zona glomerulosa (which secretes
mineralocorticoids in response to stimulation by circulating angiotensin II). The middle
layer of cortex is the zona fasciculata (which releases glucocorticoids and sex
hormones, after being stimulated by circulating ACTH). ACTH also stimulates the zona
reticularis to secrete sex hormones.
Now lets talk about innermost region of gland, the medulla. The adrenal medulla is

comprised of chromaffin cells that are directly innervated by preganglionic sympathetic

fibers and release epinephrine and norepi, into the circulation. Critical distinction from
pharmacology lectures. While other regions of the autonomic nervous system cause
direct release of these signaling molecules -> onto specific target cells, the adrenal
gland releases epinephrine and norepi, directly into the bloodstream affecting the entire
body. Lastly, there are two uncommon but frequently tested tumors -> that can grow in
the adrenal gland:
1) Pheochromocytoma -> more common in adults
2) Neuroblastoma -> more common childhood tumor.

Venous drainage from the adrenal gland is similar to that of the gonads.

Pituitary gland is situated in the sella turcica (which is a depression of the sphenoid
bone). The gland itself, has two unique parts: i) the posterior pituitary (or

neurohypophysis) and ii) the anterior pituitary (or adenohypophysis).

Posterior pituitary is true neural tissue (basically, an extension of the hypothalamus ->
down to the sella turcica). Only two hormones are released by the posterior pituitary:
i) Vasopressin (ADH) -> acts directly on the kidney to increase H20 reabsorption.
ii) Oxytocin -> involved in milk letdown and uterine contractions during labour.
Pituitary -> is one of the few regions where the BBB is absent -> so it is able to sense
changes and plasma osmolarity and blood volume => which affect vasopressin release.
** Note that both hormones are produced by neurons in the hypothalamus (NOT gland
cells), and are transported down axons into the posterior pituitary by a class of
chaperone proteins known as neurophysins, where they are then released into the
bloodstream.
Anterior Pituitary arises from the invagination of oral ectoderm known as Rathkes
pouch. Hormones from the anterior pituitary are produced by gland cells (NOT BY
NEURONS) -> and this is 1 of only 2 locations in the body -> with its own portal
circulation. (Liver is the 2nd place with portal circulation).
Several hormones are produced and secreted by the anterior pit. (-> memorize with
mnemonic: FLAT Pig.)
Anterior Hormones:
FSH & LH: Involved in reproduction.
ACTH: Acts primarily on adrenal gland.
TSH: Acts on thyroid.
Prolactin: Involved in milk production
GH: wide-ranging effects on metabolism.
-> Melanotropin (or MSH) is a derivative of POMC (the parent molecule for ACTH).
Failure of adrenal gland to respond to ACTH in Addisons disease leads to an increase
in POMC, ACTH and melanotropin. High levels of melanotropin are responsible for
characteristic skin darkening associated with Addisons disease.
-> HPA fits well into this discussion. The hypothalamus secretes releasing hormones
which travel to the anterior pituitary via the portal system. The gland cells in the anterior
pituitary, respond by releasing their respective hormones into the circulation. These
hormones exert an effect on the target glands. Importantly, the products of these target
glands negatively feedback on the hypothalamus and anterior pituitary to inhibit further
production of hormones.

One commonly tested concept: involves how to differentiate these hormones from each
other biochemically. -> Theres an alpha subunit common to: TSH, LH, FSH and hCG.
These hormones each have unique beta subunits (this second piece determines their
specificity).

Note the histological image above, of the pancreas. Associate endocrine function with
Islet of Langerhans (see in mid-right of image above).

Schematic diagram of islet. Islets are small clusters of cells, scattered throughout the
pancreas (most numerous in the tail of the pancreas). Beta cells produce insulin and are
located centrally within the islets while alpha cells produce glucagon and are located
peripherally. Delta cells produce somatostain and are interspersed throughout the islet.