pendahuluan blok endokrin
TRANSCRIPT
-
7/28/2019 pendahuluan blok endokrin
1/41
SISTEM ENDOKRIN
PATOLOGI ANATOMI
FK UNIMALBANDAR LAMPUNG
-
7/28/2019 pendahuluan blok endokrin
2/41
NORMAL
-
7/28/2019 pendahuluan blok endokrin
3/41
-
7/28/2019 pendahuluan blok endokrin
4/41
Manifestasi Kelainan Hipofisis Hyperpituitarism
Hypoppituitarism
Efek masa lokal
Penyakit hipofisis posterior
-
7/28/2019 pendahuluan blok endokrin
5/41
Pituitary Adenomas and
Hyperpituitarism functional
silent
Pituitary adenomas are classified on thebasis of hormone(s) produced by theneoplastic cells detected by
immunohistochemical stains performedon tissue sections
-
7/28/2019 pendahuluan blok endokrin
6/41
Pituitary Adenomas and
Hyperpituitarism
-
7/28/2019 pendahuluan blok endokrin
7/41
PROLACTINOMASProlactinoma with hyperprolactinemia
- is most common/30% pituitary tumor
- staining
chromophobe- in women amenorrhea &
galactorrhea
- caused by hypothalamic lesions or
medications
methyl dopa, reserpineinterfere with dopamine
(prolactin-inhibitory factors) secretion
- can also be associated with estrogen
therapy
-
7/28/2019 pendahuluan blok endokrin
8/41
GROWTH HORMONE
(SOMATOTROPH CELL) ADENOMAS Somatotropic adenoma with hypersecretion of growth hormone
- 2nd most common pituitary tumor
- staining acidophyl
- causes secondary hyperfunction of somatomedins by the
liver. End organ effects are caused by both growthhormone and somatomedins, especially somatomedin C
(insulin-like growth factor 1/IGF-1)
- results gigantism if adenoma develops before epiphyseal
closure and acromegaly if adenoma develops after
epiphyseal closure
- acromegaly overgrowth of jaws, face, hands and feet,and general enlargement of viscera with hyperglycemia,
osteoporosis and hypertension
- can also result in local compression effects due to
expansion of the tumor within the sella tursica
-
7/28/2019 pendahuluan blok endokrin
9/41
CORTICOTROPH CELL
ADENOMAS Corticotropic adenoma and hypersecretion of ACTH
- results in increased production of ACTH /
hypercorticism
- is called Cushing syndrome or Cushing disease
1. Cushing disease hypercorticism adenoma
most often a basophilic adenoma
basophilic microadenoma
2. Cushing syndrome hypercorticism regardless of
cause, is most often of pituitary and less often of
adrenal origin may be due to ectopic ACTH production by
various tumors especially small cell carcinoma
of lung
-
7/28/2019 pendahuluan blok endokrin
10/41
Hypopituitarism Tumors and other mass lesions
Pituitary surgery or radiation
Ischemic necrosis of the pituitary andSheehan syndrome
Rathke cleft cyst
Empty sella syndrome
Genetic defects
-
7/28/2019 pendahuluan blok endokrin
11/41
Selective deficiency of one or more
pituitary hormones
(1) deficiency of growth hormone
- in children, result in growth retardation (pituitary dwarfism)
- in adults, may result in increased insulin sensitivity with
hypocalcemia, decreased muscle strength and anemia(2) deficiency of gonadotropins
- in preadolescent children, results in retarded sexual
maturation
- in adults, results in loss of libido, impotence, loss of muscular
mass, and decreased hair in men, and amenorrhea and vaginal
atrophy in women
(3) deficiency of TSH
- result in secondary hypothyroidism
(4) deficiency of ACTH
- results in secondary adrenal failure
- does not result in hyperpigmentation of the skin, probably
because of lack of both ACTH and -MSH; this is in contrast to
primary adrenal failure (Addison disease), in which ACTH is
increased and hyperpigmentation is the rule
-
7/28/2019 pendahuluan blok endokrin
12/41
POSTERIOR HYPOPHYSIS
(NEUROHYPOPHYSIS) HORMONES
- are synthesized in the hypothalamus and
transported via axons to the posterior
pituitary
a. Oxytocin : induces uterine contarction
during labor and ejection of milk from
mammary alveoli
b. Anti diuretic hormone (ADH,vasopressin)
- promotes water retention through
action on the renal collecting ducts
-
7/28/2019 pendahuluan blok endokrin
13/41
Syndrome of inappropriate ADH(SIADH) secretion is
most commonly caused by ectopic production of ADH
by various tumors, especially small cell carcinoma of
lung. Results in retention of water with consequent
dilutional hyponatremia, reduced serum osmolality,
and inability to dilute urine
Deficiency of ADH: results in diabetes insipidus;
characterized by polyuria, with consequent
dehydration and insatiable thirst
- can be caused by tumors, trauma, inflammatoryprocesses, lipid storage disorders, and other
conditions characterized by damage of the
neurohypophysis or hypothalamus
-
7/28/2019 pendahuluan blok endokrin
14/41
-
7/28/2019 pendahuluan blok endokrin
15/41
C. NON FUNCTIONING
PITUITARY TUMORS Non secreting pituitary adenomas
- are most often chromophobe
- result in dysfunction because of localpressure phenomena
- are clinically variable ;manifestations
include hypopituitarism, headache,visual
disturbance (bilateral hemianopsia / loss ofperipheral visual fields due to pressure on
optic chiasm), and palsies caused by cranial
nerve damage
-
7/28/2019 pendahuluan blok endokrin
16/41
Craniopharyngioma- is benign childhood tumor derived from remnants of
the Rathke pouch
- is not a true pituitary tumors
- similar to ameloblastoma of the jaw
- is characterized by nests and cords of squamous orcolumnar cells in loose stroma, closely resembling the
appearance of the embryonic tooth bud enamel organ- is often cystic; lining epithelium of flat or columnar cellsoften expands into papillary projections
- is often detected radiographically because of calcification
-
7/28/2019 pendahuluan blok endokrin
17/41
THYROID
-
7/28/2019 pendahuluan blok endokrin
18/41
Hyperthyroidism
Thyrotoxicosisis a hypermetabolic state caused byelevated circulating levels of free T3 and T4
The three most common causes of thyrotoxicosis are
also associated with hyperfunction of the gland andinclude the following: Diffuse hyperplasiaof the thyroid associated
with Graves disease (accounts for 85% of
cases) Hyperfunctional multinodular goiter Hyperfunctional adenomaof the thyroid
-
7/28/2019 pendahuluan blok endokrin
19/41
-
7/28/2019 pendahuluan blok endokrin
20/41
Prolonged hypersecretion of thyroidhormone can result from
(1) abnormal thyroid stimulator (Gravesdisease),
(2) intrinsic disease of the thyroid gland (toxic
multinodular goiter or functional adenoma), and (3) excess TSH production by a pituitary
adenoma (rare).
-
7/28/2019 pendahuluan blok endokrin
21/41
Pathogenesis
IMMUNE MECHANISMS
IgG antibodies that bind to the TSH receptor
on the plasma membrane of thyrocytes stimulate the TSH receptor activatingadenylyl cyclase and increasing thyroidhormone secretion thyroid becomes
diffusely hyperplastic and excessively vascular
-
7/28/2019 pendahuluan blok endokrin
22/41
GENETIC FACTORS
GENDER
EMOTIONALINFLUENCES
SMOKING
OPHTHALMOPATHY
-
7/28/2019 pendahuluan blok endokrin
23/41
-
7/28/2019 pendahuluan blok endokrin
24/41
Major clinical manifestations of Graves disease
-
7/28/2019 pendahuluan blok endokrin
25/41
Hypothyroidism
Hypothyroidism refers to the clinical manifestationsof thyroid hormone deficiency
It can be the consequence of three generalprocesses:
Defective thyroid hormone synthesis, with compensatorygoitrogenesis (goitrous hypothyroidism)
Inadequate thyroid parenchyma function, usually due tothyroiditis, surgical resection of the gland, or therapeuticadministration of radioiodine
Inadequate secretion of TSH by the pituitary or of
thyroid-releasing hormone (TRH) by the hypothalamus
-
7/28/2019 pendahuluan blok endokrin
26/41
-
7/28/2019 pendahuluan blok endokrin
27/41
Primary (Idiopathic) Hypothyroidism is OftenAutoimmune
antibodies that block TSH or TSH receptorswithout activating the thyroid
Goitrous Hypothyroidism ReflectsInadequate Secretion of Thyroid Hormone The etiology of goitrous hypothyroidism includes
iodine deficiency, antithyroid agents (drugs ordietary goitrogens), long-term iodide intake, anda number of hereditary defects in thyroidhormone synthesis
-
7/28/2019 pendahuluan blok endokrin
28/41
Endemic Goiter
Endemic goiter is goitrous hypothyroidism
due to dietary iodine deficiency in localeswith a high prevalence of the disease
Congenital Hypothyroidism is also
Termed Cretinism
-
7/28/2019 pendahuluan blok endokrin
29/41
Dominant clinical manifestations of hypothyroidism
-
7/28/2019 pendahuluan blok endokrin
30/41
Thyroiditis
Thyroiditis describes a heterogeneousgroup of inflammatory disorders of the
thyroid gland, including those that arecaused by autoimmune mechanismsand infectious agents.
-
7/28/2019 pendahuluan blok endokrin
31/41
HASHIMOTO THYROIDITIS
-
7/28/2019 pendahuluan blok endokrin
32/41
SUBACUTE (GRANULOMATOUS)THYROIDITIS
caused by a viral infectionor a postviralinflammatory process
majority of patients have a history of anupper respiratory infection just beforethe onset of thyroiditis
-
7/28/2019 pendahuluan blok endokrin
33/41
-
7/28/2019 pendahuluan blok endokrin
34/41
Neoplasms of the Thyroid
ADENOMAS
CARCINOMAS
Papillary carcinoma (75% to 85% of cases)
Follicular carcinoma (10% to 20% ofcases)
Medullary carcinoma (5% of cases) Anaplastic carcinoma (
-
7/28/2019 pendahuluan blok endokrin
35/41
Parathyroid Glands
-
7/28/2019 pendahuluan blok endokrin
36/41
Hyperparathyroidism
PRIMARY HYPERPARATHYROIDISM
Primary hyperparathyroidism is one of the
most common endocrine disorders, and itis an important cause ofhypercalcemia
Adenoma: 75% to 80%
Primary hyperplasia (diffuse or nodular): 10%
to 15%
Parathyroid carcinoma: less than 5%
-
7/28/2019 pendahuluan blok endokrin
37/41
Secondary Hyperparathyroidism
Renal failure
inadequate dietary intake of calcium,steatorrhea, and vitamin D deficiency, mayalso cause this disorder
-
7/28/2019 pendahuluan blok endokrin
38/41
Hypoparathyroidism
Hypoparathyroidism results from
decreased secretion of PTH or end-organ insensitivity(pseudohypoparathyroidism) due to
congenital or acquired conditions. Thedisease is clinically characterized byhypocalcemia and hyperphosphatemia.
-
7/28/2019 pendahuluan blok endokrin
39/41
Hypoparathyroidism
There are many possible causes of deficientPTH secretion resulting in
hypoparathyroidism: Surgically inducedhypoparathyroidism
Congenital absenceof all glands
Familial hypoparathyroidism Idiopathic hypoparathyroidism
-
7/28/2019 pendahuluan blok endokrin
40/41
Hypoparathyroidism
The major clinical manifestations ofhypoparathyroidism are referable to
hypocalcemia and are related to the severityand chronicity of the hypocalcemia
The hallmark of hypocalcemia is tetany
Mental status changescan include emotionalinstability, anxiety and depression, confusionalstates, hallucinations, and frank psychosis.
-
7/28/2019 pendahuluan blok endokrin
41/41
Hypoparathyroidism
Intracranial manifestationsincludecalcifications of the basal ganglia,
parkinsonian-like movement disorders. Ocular diseaseresults in calcification of the
lens leading to cataract formation.
Cardiovascular manifestationsinclude aconduction defect