General concept of

endocrine glands and

hormones

Gatot Sugiharto, dr, SpPD

 Endocrine System
Introduction

• The system formed by all the glands of the body that secrete
hormones directly into the blood stream.
• They do not contain ducts, some glands may be both
endocrine and exocrine (ex: pancreas).
• Endocrine glands may be stimulated by the nervous system
or chemical changes in the body
• Brain, heart, lungs, liver, skin, GI mucosa & placenta also
produce and release hormones (but they are not a gland)
 Endocrine gland

• Some are “pure” in that the entire structure is composed

of endocrine cells :
– Pituitary gland, Pineal gland, thyroid, parathyroid gland &
adrenal glands.
• The others are part of functions in other system :
– Pancreas, thymus, testes, ovaries, and hypothalamus.
• Mostly have a high supply of blood and lymph vessels
 Hormones

• Chemical stimulants that control changes in the body or chemical

messenger which targets a specific group of cells (target cells) do
some activity or stop doing an activity
• Target cells have receptors that bind the specific hormone and
are stimulated by that reaction.
• Each hormone had its own chemical structure and thus performs
different/specific actions
• Classes of hormones :
– Amino acid-based
– Steroids (contain a cholesterol group)
– Peptide
Hormone
receptor
 Endocrine vs
nervous system
Endocrine
• They work together to help maintain
homeostasis & balance thru
hypothalamus, a collection of
specialized cells located in the brain,
Hypo
as the primary link between the them.
thalamus
• Hypothalamus produces chemicals
that either stimulate or suppress
hormone secretions of the pituitary
gland.
Nervous
 Hormone secretion

Neural stimuli:

Hormonal stimuli:
• • • •
Humoral stimuli:

Feedback loops:
Gland responds to Some glands are Some endocrine Hormone levels are

chemical changes in signal by nervous glands are controlled also controlled by

the body such as system (sympathetic by other endocrine feedback loops that

changing levels or nerves) to release glands and thus either stimulate or

ions or nutrients in the hormones in order to respond to hormone. halt the production of

blood induce physiological a hormone

changes.
Control of hormone secretion
Major endocrine organs
 Pineal gland

• Located in the brain and

controlled by the
hypothalamus, it secretes:
• Secrete melatonin, a
serotonin derived
neurotransmiter : regulates
the internal body clocks,
apetite, mood & induces
sleep.
Pituitary gland
 The pituitary gland

• Synonym : the hypophysis, master gland

• Adenohypophysis/anterior pituitary
– Controled by neurotransmitter/hormone from
hypothalamus through the hypophyseal portal system
• Neurohypophysis/posterior pituitary gland
– Technically part of the brain and it composed of neurons.
– Stores hormone produced by the hypothalamus rather
than making hormones
Pituitary ant & post
 Adenohypophysis (anterior pituitary gland)
• Growth hormone (GH) : signals growth of
the body, enhances protein synthesis,
decreases the use of glucose, and
promotes fat destruction
• Somatotropic hormone (SH) or
somatotropin: signals growth of the body
• Prolactin: stimulates the breast tissue to
produce milk
• Thyroid stimulating hormone (TSH):
stimulates the thyroid gland to secrete
hormones that influence our metabolism.
• Adrenocorticotropic hormone (ACTH) :
stimulates adrenal gland to signal its
hormones that help us deal with stress.
• Melanocyte stimulating hormone (MSH):
stimulates melanocytes of the epidermis
to produce more melanin  darkening
the skin.
• Follicle stimulating hormone (FSH): act
on testes or ovaries an stimulate the
maturation of egg/sperm and induce
secretion of sex hormones
• Luteinizing hormone (LH) : signals
ovulation during the menstrual cycle
 Neurohypophysis

(posterior pituitary gland)

• Antidiuretic hormone (ADH) : stimulates the collecting
tubules of the kidney to concentrate the urine in order to
reduce water loss.
• Oxytocin : induces contractions of smooth muscle of the
uterus during labor.
Thyroid gland
 The thyroid gland

• Located just inferior to the larynx, it has two lobes that give it the
appearance of butterfly wings, produce
– Thyroid :
hormone: T4 and T3, amino acid
based hormones that contain iodine, main
function is to increase metabolic rate.
– Calcitonin : reduces excessive levels of
calcium ion in the blood by slowing down
osteoclast activity, actively secreted during
childhood.
Parathyroid gland
 Parathyroid gland

• Small yellowish, lie posterior or the thyroid

gland. There are at least two pairs or more of
glands
• Produce parathyroid hormone (PTH):
– Has the opposite effect if calcitonin
– Increase calcium ion levels in the blood by either
activating the osteoclast,
– stimulating the kidney to reabsorb more calcium
– Activation vitamin D production for calcium to be
absorbed from food.
 Thymus

• Located in lower neck, anterior

thorax, and posterior to the
sternum, is part of the lymphatic
system
• Secretes amino acid based
hormones called thymic hormones
(thymopoeitin and thymosin):
stimulate T-lymphocytes to
become immunocompetent.
Adrenal gland
 The adrenal
(suprarenal) gland

• Located superiorly to the kidney

and are actually two different
glands within one structure.
– Adrenal medulla: considered part
of the autonomic nervous system
– Adrenal cortex: secretes steroids
hormone
 Adrenal cortex

• Aldosterone (mineralcorticoid):
– Regulate electrolyte and water balance by promoting sodium and chloride
retention and potassium excretion
– Secreted in response to a decrease in blood volume or
– Stimulating the kidneys to reabsorb more water or sodium.
• Cortisol (glucocorticoids):
– Keep blood glucose levels high to maintain brain activity during stressful
situations, regulate protein, and fat metabolism
– Direct lymphocytes & anti inflammatory
• Androgens : several hormones including testosterone; they promote the
development of secondary sex characteristics
 Adrenal medulla

• Part of the autonomic nervous system, it releases :

• Adrenaline or epinephrine: to assist in the “fight or flight” response
– Elevates systolic BP, increases heart rate and CO
– Release of glucose from the liver
– Dilates the bronchial tubes and relaxes airways
– Dilates the pupils to see more clearly.
– Counteract an allergic/anaphylactic reaction
• Norepinephrine : released when the body is under stress act like epinephrine
• Dopamine : treat shock, dilates the arteries, elevates systolic BP increases CO,
increases urinary output.
Pancreas
 Pancreas

• Located in the abdominal cavity & it

contains endocrine cells called the
islets of Langerhans that produce
amino acid based hormones.
• ß cell : release insulin which
stimulates absorption of glucose by
tissue
•  cell : releases glucagon that
stimulates the liver to release sugar
into the blood
 Ovaries

• Produce estrogen hormones and

progesterone.
– This hormones prepare the uterus for
pregnancy
– Promote the development & growth of
mammary glands and maintenance of female
sex organs
– Sex drive
– Development 2nd sex characteristics in the
female.
 Testes

• Produce the male sex

hormone called testosterone.
– Essential for normal growth
and development of the male
sex organs.
– Responsible for the erection
process.
Other endocrine organs
 GI tract
• Gastrin : produced by mucosa of the pyloric area of the
stomach, which stimulates the production of gastric acid for
digestion
• Secretin : produced by mucosa of the duodenum and
jejunum, which stimulates pancreatic juice, bile, and intestinal
secret
 Placenta

• During pregnancy, the

placenta serves as an
endocrine gland
• It produces chorionic
gonadotropin hormone,
estrogen, and progesterone
 Kidneys Skin

• Release rennin which regulates

blood pressure and
• Erythropoietin which stimulates
erythrocyte production
• Produces a steroid hormone
precursor to vitamin D when
exposed to UV rays
• Vitamin D help calcium
absorption
Endocrine Disorders
Homeostasis concept
 Mechanisms of hormonal
alterations

Elevated or depressed hormones level

• Dysfunction of endocrine gland
• Unable to produce or do not obtain an adequate quantity of required hormone precursors
• Unable to convert the precursors to the appropriate active form of hormone
• Synthetize and release excessive amounts of hormone
• Degradation of hormones or inactivated by antibodies before reaching the target cell
• Ectopic sources of hormones

Failure of the target cells to respond to hormone

• Receptor-associated disorders
• Intracellular disorders
• Decrease number of receptors -> ↓ hormone -
receptor binding
• Impaired receptor function  ↓ sensitivity to the
hormone
• Antibodies against specific receptors
• Unusual expression of receptor function
Receptor associated
disorders
• nd
Inadequate synthesis of the 2 messengers
• Decrease number of intracellular receptors or its
affinity
• Alterations in generation of new mesenger RNA
• Absence of substrates for new protein synthesis
Intracellular
disorders
Thyroid Gland Disorders
 Thyroid Gland Disorders

• Congenital hypothyroidism
– Infant suffers abnormal bone development, thickened facial features, low temperature,
lethargy, brain damage, cretinism in children
• Myxedema (adult hypothyroidism)
– low metabolic rate, sluggishness, sleepiness, weight gain, constipation, dry skin and
hair, cold sensitivity, ↓ blood pressure and tissue swelling
• Endemic goiter (goiter = enlarged thyroid gland)
– dietary iodine deficiency, no TH, no neg feedback, ↑ TSH
• Toxic goiter (Graves disease)
– Antibodies mimic TSH, ↑TH, exophthalmos
• Hyperthyroidism :
– elevated metabolic rate, high heart rate and exophthalmos (bug eyes), and usually
weight loss.
 Hyperthyroidism

• A condition in which thyroid hormones (TH) exert greater-than-normal

response
• Causes:
– Graves disease
– Exogenous hyperthyroidism (iatrogenic, iodine induced)
– Thyroiditis
– Toxic nodular goiter (Plummer syndrome)
– Thyroid cancer
• Metabolic effect : ↑ metabolic rate with heat intolerance and increased
tissue sensitivity to stimulation by sympathetic division of the autonomic
nervous system
Pathomechanism
TH disorders
 The major manifestations of
hyperthyroidism Gastrointestinal : Integumentary:

• • Excessive sweating, flushing, and warm

Weight loss, increase in appetite due to

increased catabolism skin & heat loss

• • Hair fall, soft, and straight, temporary
Endocrine: Reproductive: Increased peristalsis, less formed &

more frequent stools due to hair loss

• Enlarged thyroid gland (TG) with
• Oligomenorrhea or amenorrhe due to •
malabsorption of fat Nails that grow away nail beds
systolic or continous bruit over thyroid hypothalamic or pituitary disturbances • Nausea, vomiting, anorexia, abdominal
due to ↑ blood flow
• Impotence and decreased libido in men
pain
• ↑ cortisol degradation due to ↑ metabolic • Increased use of hepatic glycogen
rate
stores, adipose & protein stores
• Hypercalcemia and decreased PTH • Decrease of tissue stores of vitamins,
secretion due to excess bone resorption
hyperlipid, acidemia (due to ↑ lipolysis)
• Diminished sensitivity to exogenous

insulin due to hyperglycemia (↑

glycogenolysis and gluco-neogenesis)

 Hypothyroidism
• Decrease production of TH by the thyroid gland and/or ↓
their action to the tissue
• Primary hypothyroidism :
– Congenital defects or loss of thyroid tissue
– Defective hormone synthesis due to: autoimmune thyroiditis,
endemic iodine deficiency, antithyroid drugs
• Secondary hypothyroidism
– Insufficient stimulation of the normal gland
– Peripheral resistance to TH

• Low basal metabolic rate, cold intolerance, slightly
lowered basal body temperature
• ↑ production of TSH  goiter
• Mixedeme:
– Increased protein and mucopolysaccharides in dermis 
↑ water binding  nonpitting edema, tickening of the
tongue, laryngeal & pharyngeal mucous membranes 
hoarsenes
• Neurologic :
– Confusion, syncope, slowed thinking, memory loss,
lethargy, hearing loss, slow movements cerebellar ataxia
• Endocrin :
– ↑ TSH production (in primary hypothyroidism), ↑ serum
prolactin levels with galactorrhea, ↓ rate of cortisol
turnover, but normal cortisol levels
The major manifestations
of hypothyroidism (1)
• Reproductive :
– ↓ androgen secretion in men, ↑ estriol formation in
women due to altered metabolism of estrogens &
androgens
– Anovulation, decreased libido spontaneous abortion
• Hematology :
– ↑ RBC mass, normocytic, normochromic anemia
– Macrocytic anemia due to vitamin B12 deficiency &
inadequate folate absorption
• CV
– ↓ hart rate & stroke volume  ↓ CO
– ↑ peripheral vascular resistance  cool skin
– enlarged heart, pericardial effusion
– ECG changes : low amplitude QRS, flattened or
inverted T, depressed P, prolonged PR, sinus
bradycardia
 The major manifestations of
Respiratory :
hypothyroidism(2)
• Dyspnoe due to pleural effusions
• Myxedematous changes of respiratory muscle weakness 

hypoventilation

GI Tract :
• ↓ appetite, constipation, weight gain,
• ↓ sensitivity to exogenous insulin
Renal : • ↑ protein metabolism, ↓ glucose uptake, dyslpidemia
• ↓ renal blood flow, ↓GFR, ↓renal excretion of wate  ↑

total body fluid  dilutional hyponatremia

• ↓ production of EPO

Musculoskeletal:
• Muscle & joint aching & stiffness
Skin • Slow movement & tendon jerk reflexes
• Dry flaky skin
• Decreased bone formation & resorption  ↑ bone density
• Dry, brittle head and body hair
• Reduced growth of nails and hair