Chapter 13
Zhou Hongyan
The Endocrine
System Diseases
diffuse nontoxic goiter
diffuse toxic goiter
diabetes mellitus
pituitary
thyroid
hypothalamus
TRH
TSH
T3,T4
TG
T3 T4
TG
T3 T4
I-
I-
pituitary
thyroid
hypothalamus
TRH
I-
TSH
T3,T4
diffuse nontoxic goiter
diffuse toxic goiter
diabetes mellitus
diffuse nontoxic goiter:
or simple goiter
is the most common thyroid
disease.
types:
endemic goiter
sporadic goiter
most often caused by
iodine deficiency
Pathogenesis:
Morphology:
1.diffuse hyperplasia goiter
2.diffuse colloid goiter
3.nodular goiter
1.diffuse hyperplasia goiter
diffuse enlargement of the
thyroid gland,
smooth and soft;
the follicles are lined by
crowded columnar cells,
which may pile up and
form projections
2.diffuse colloid goiter
the thyroid gland is
more enlarged than before,
smooth and soft;
cut surface,usually brown,
somewhat glassy,and
translucent;
follicle epithelial cells flattened,
colloid is abundant
3,nodular goiter:
gross appearance:
a more irregular enlargement;
termed nodular ;
cut surface:
fibrosis,hemorrhage,
calcification,cystic change
cut surface
microscopic appearance:
colloid-rich follicle lined by
flattened,inactive epithelium,
and areas of follicle epithelial
hypertrophy and hyperplasia,
accompanied by the regressive
changes noted previously.
diffuse nontoxic goiter
diffuse toxic goiter
diabetes mellitus
an autoimmue disorder ;
a variety of autoantibodies
may be present in the serum,
antibody to TSH receptor,
such as,TSI,TGI
pathogenesis:
pituitary
thyroid
hypothalamus
TRH
TSH
TSI
TGI
T3,T4
more common in females ;
enlargement of the thyroid;
hyperthyroidism ;
ophthalmopathy,
clinical features:
ophthalmopathy
gross appearance:
diffuse enlargement of
the thyroid gland;
cut surface:
gray-red,colloid-poor,
muscle-like
microscope appearance,
hypertrophy and hyperplasia of
thyroid follicular epithelial cells,
tall and columnar,
the formation of small papillae;
pale colloid within the follicular
lumen with scalloped margins;
lymphoid infiltrates.
diffuse nontoxic goiter
diffuse toxic goiter
diabetes mellitus
glucose metabolism
fat metabolism
protein metabolism
hyperglycemia and glycosuria ensue
blood insulin ↓ /insulin effects ↓
polyuria
polydipsia
polyphagia
weight loss
Clinical Features:
primary diabetes mellitus
secondary diabetes mellitus
types:
primary diabetes mellitus
IDDM:
insulin-dependent
diabetes mellitus
NIDDM:
non-insulin-dependent
diabetes mellitus
IDDM,type 1, 10%
children>adults;
normal weight;
decreased blood insulin;
anti-islet cell antibodies;
insulin-dependent on therapy.
NIDDM,type 2,90%
adults > children;
obese;
normal /increased blood insulin;
no anti-islet cell antibodies;
non-insulin-dependent
on therapy.
islet lesions:
type 1,
insulitis early,
marked atrophy and fibrosis,
severe beta-cell depletion.
type 2:
no insulitis,
focal atrophy and amyloid deposits,
mild beta-cell depletion.
alpha-cell,IHS beta-cell,IHS
type 1
type 2
vascular system:
atherosclerosis:
large- and medium-sized arteries
suffer from accelerated severe
atherosclerosis;
arteriolosclerosis
diabetic nephropathy:
1.glomerular lesions
2.renal vascular lesions
3.pyelonephritis,including
necrotizing papillitis
glomerulosclerosis and hyaline
arteriolosclerosis
diabetic ocular complications:
retinopathy
cataract
normal diabetes mellitus
retinopathy
cataract