Hormones and the Endocrine System

Types, Causes, Symptoms, and Treatments

The endocrine system is a network of glands that produce and release hormones that help control many important body functions, including the body’s ability to change calories into energy that powers cells and organs. The endocrine system influences how your heart beats, how your bones and tissues grow, even your ability to make a baby. It plays a vital role in whether or not you develop diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders.

Glands of the Endocrine System

Each gland of the endocrine system releases specific hormones into your bloodstream. These hormones travel through your blood to other cells and help control or coordinate many body processes.

Endocrine glands include:

• Adrenal glands: Two glands that sit on top of the kidneys that release the hormone cortisol.
• Hypothalamus: A part of the lower middle brain that tells the pituitary gland when to release hormones.
• Ovaries: The female reproductive organs that release eggs and produce sex hormones.
• Islet cells in the pancreas: Cells in the pancreas control the release of the hormones insulin and glucagon.
• Parathyroid: Four tiny glands in the neck that play a role in bone development.
• Pineal gland: A gland found near the center of the brain that may be linked to sleep patterns.
• Pituitary gland: A gland found at the base of brain behind the sinuses. It is often called the “master gland” because it influences many other glands, especially the thyroid. Problems with the pituitary gland can affect bone growth, a woman’s menstrual cycles, and the release of breast milk.
• Testes: The male reproductive glands that produce sperm and sex hormones.
• Thymus: A gland in the upper chest that helps develop the body’s immune system early in life.
• Thyroid: A butterfly-shaped gland in the front of the neck that controls metabolism.

Even the slightest hiccup with the function of one or more of these glands can throw off the delicate balance of hormones in your body and lead to an endocrine disorder, or endocrine disease.

Causes of Endocrine Disorders

Endocrine disorders are typically grouped into two categories:

• Endocrine disease that results when a gland produces too much or too little of an endocrine hormone, called a hormone imbalance.
• Endocrine disease due to the development of lesions (such as nodules or tumors) in the endocrine system, which may or may not affect hormone levels.

The endocrine’s feedback system helps control the balance of hormones in the bloodstream. If your body has too much or too little of a certain hormone, the feedback system signals the proper gland or glands to correct the problem. A hormone imbalance may occur if this feedback system has trouble keeping the right level of hormones in the bloodstream, or if your body doesn’t clear them out of the bloodstream properly.

Increased or decreased levels of endocrine hormone may be caused by:

• A problem with the endocrine feedback system
• Disease
• Failure of a gland to stimulate another gland to release hormones (for example, a problem with the hypothalamus can disrupt hormone production in the pituitary gland)
• A genetic disorder, such as multiple endocrine neoplasia (MEN) or congenital hypothyroidism
• Infection
• Injury to an endocrine gland
• Tumor of an endocrine gland

Most endocrine tumors and nodules (lumps) are noncancerous. They usually do not spread to other parts of the body. However, a tumor or nodule on the gland may interfere with the gland’s hormone production.

Types of Endocrine Disorders

There are many different types of endocrine disorders. Diabetes is the most common endocrine disorder diagnosed in the U.S.

Other endocrine disorders include:

Adrenal insufficiency. The adrenal gland releases too little of the hormone cortisol and sometimes, aldosterone. Symptoms include fatigue, stomach upset, dehydration, and skin changes. Addison’s disease is a type of adrenal insufficiency.

Cushing’s disease. Overproduction of a pituitary gland hormone leads to an overactive adrenal gland. A similar condition called Cushing’s syndrome may occur in people, particularly children, who take high doses of corticosteroid medications.

Gigantism (acromegaly) and other growth hormone problems. If the pituitary gland produces too much growth hormone, a child’s bones and body parts may grow abnormally fast. If growth hormone levels are too low, a child can stop growing in height.

Hyperthyroidism. The thyroid gland produces too much thyroid hormone, leading to weight loss, fast heart rate, sweating, and nervousness. The most common cause for an overactive thyroid is an autoimmune disorder called Grave’s disease.

Hypothyroidism. The thyroid gland does not produce enough thyroid hormone, leading to fatigue, constipation, dry skin, and depression. The underactive gland can cause slowed development in children. Some types of hypothyroidism are present at birth.

Hypopituitarism. The pituitary gland releases little or no hormones. It may be caused by a number of different diseases. Women with this condition may stop getting their periods.

Multiple endocrine neoplasia I and II (MEN I and MEN II). These rare, genetic conditions are passed down through families. They cause tumors of the parathyroid, adrenal, and thyroid glands, leading to overproduction of hormones.

Polycystic ovary syndrome (PCOS). Overproduction of androgens interfere with the development of eggs and their release from the female ovaries. PCOS is a leading cause of infertility.

Precocious puberty. Abnormally early puberty that occurs when glands tell the body to release sex hormones too soon in life.

Testing for Endocrine Disorders

If you have an endocrine disorder, your doctor may refer you to a specialist called an endocrinologist. An endocrinologist is specially trained in problems with the endocrine system.

The symptoms of an endocrine disorder vary widely and depend on the specific gland involved. However, most people with endocrine disease complain of fatigue and weakness.

Blood and urine tests to check your hormone levels can help your doctors determine if you have an endocrine disorder. Imaging tests may be done to help locate or pinpoint a nodule or tumor.

Treatment of endocrine disorders can be complicated, as a change in one hormone level can throw off another. Your doctor or specialist may order routine blood work to check for problems or to determine if your medication or treatment plan needs to be adjusted.

3B Scientific® The Endocrine System Chart

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11.4 Endocrine System – Concepts of Biology – 1st Canadian Edition

Learning Objectives

By the end of this section, you will be able to:

• List the different types of hormones and explain their roles in maintaining homeostasis
• Explain how hormones work
• Explain how hormone production is regulated
• Describe the role of different glands in the endocrine system
• Explain how the different glands work together to maintain homeostasis

The endocrine system produces hormones that function to control and regulate many different body processes. The endocrine system coordinates with the nervous system to control the functions of the other organ systems. Cells of the endocrine system produce molecular signals called hormones. These cells may compose endocrine glands, may be tissues or may be located in organs or tissues that have functions in addition to hormone production. Hormones circulate throughout the body and stimulate a response in cells that have receptors able to bind with them. The changes brought about in the receiving cells affect the functioning of the organ system to which they belong. Many of the hormones are secreted in response to signals from the nervous system, thus the two systems act in concert to effect changes in the body.

Maintaining homeostasis within the body requires the coordination of many different systems and organs. One mechanism of communication between neighboring cells, and between cells and tissues in distant parts of the body, occurs through the release of chemicals called hormones. Hormones are released into body fluids, usually blood, which carries them to their target cells where they elicit a response. The cells that secrete hormones are often located in specific organs, called endocrine glands, and the cells, tissues, and organs that secrete hormones make up the endocrine system. Examples of endocrine organs include the pancreas, which produces the hormones insulin and glucagon to regulate blood-glucose levels, the adrenal glands, which produce hormones such as epinephrine and norepinephrine that regulate responses to stress, and the thyroid gland, which produces thyroid hormones that regulate metabolic rates.

The endocrine glands differ from the exocrine glands. Exocrine glands secrete chemicals through ducts that lead outside the gland (not to the blood). For example, sweat produced by sweat glands is released into ducts that carry sweat to the surface of the skin. The pancreas has both endocrine and exocrine functions because besides releasing hormones into the blood. It also produces digestive juices, which are carried by ducts into the small intestine.

Endocrinologist

An endocrinologist is a medical doctor who specializes in treating endocrine disorders. An endocrine surgeon specializes in the surgical treatment of endocrine diseases and glands. Some of the diseases that are managed by endocrinologists include disorders of the pancreas (diabetes mellitus), disorders of the pituitary (gigantism, acromegaly, and pituitary dwarfism), disorders of the thyroid gland (goiter and Graves’ disease), and disorders of the adrenal glands (Cushing’s disease and Addison’s disease).

Endocrinologists are required to assess patients and diagnose endocrine disorders through extensive use of laboratory tests. Many endocrine diseases are diagnosed using tests that stimulate or suppress endocrine organ functioning. Blood samples are then drawn to determine the effect of stimulating or suppressing an endocrine organ on the production of hormones. For example, to diagnose diabetes mellitus, patients are required to fast for 12 to 24 hours. They are then given a sugary drink, which stimulates the pancreas to produce insulin to decrease blood-glucose levels. A blood sample is taken one to two hours after the sugar drink is consumed. If the pancreas is functioning properly, the blood-glucose level will be within a normal range. Another example is the A1C test, which can be performed during blood screening. The A1C test measures average blood-glucose levels over the past two to three months. The A1C test is an indicator of how well blood glucose is being managed over a long time.

Once a disease such as diabetes has been diagnosed, endocrinologists can prescribe lifestyle changes and medications to treat the disease. Some cases of diabetes mellitus can be managed by exercise, weight loss, and a healthy diet; in other cases, medications may be required to enhance insulin’s production or effect. If the disease cannot be controlled by these means, the endocrinologist may prescribe insulin injections.

In addition to clinical practice, endocrinologists may also be involved in primary research and development activities. For example, ongoing islet transplant research is investigating how healthy pancreas islet cells may be transplanted into diabetic patients. Successful islet transplants may allow patients to stop taking insulin injections.

Hormones cause changes in target cells by binding to specific cell-surface or intracellular hormone receptors, molecules embedded in the cell membrane or floating in the cytoplasm with a binding site that matches a binding site on the hormone molecule. In this way, even though hormones circulate throughout the body and come into contact with many different cell types, they only affect cells that possess the necessary receptors. Receptors for a specific hormone may be found on or in many different cells or may be limited to a small number of specialized cells. For example, thyroid hormones act on many different tissue types, stimulating metabolic activity throughout the body. Cells can have many receptors for the same hormone but often also possess receptors for different types of hormones. The number of receptors that respond to a hormone determines the cell’s sensitivity to that hormone, and the resulting cellular response. Additionally, the number of receptors available to respond to a hormone can change over time, resulting in increased or decreased cell sensitivity. In up-regulation, the number of receptors increases in response to rising hormone levels, making the cell more sensitive to the hormone and allowing for more cellular activity. When the number of receptors decreases in response to rising hormone levels, called down-regulation, cellular activity is reduced.

The endocrine glands secrete hormones into the surrounding interstitial fluid; those hormones then diffuse into blood and are carried to various organs and tissues within the body. The endocrine glands include the pituitary, thyroid, parathyroid, adrenal glands, gonads, pineal, and pancreas.

The pituitary gland, sometimes called the hypophysis, is located at the base of the brain (Figure 11.23 a). It is attached to the hypothalamus. The posterior lobe stores and releases oxytocin and antidiuretic hormone produced by the hypothalamus. The anterior lobe responds to hormones produced by the hypothalamus by producing its own hormones, most of which regulate other hormone-producing glands.

Figure 11.23 (a) The pituitary gland sits at the base of the brain, just above the brain stem. (b) The parathyroid glands are located on the posterior of the thyroid gland. (c) The adrenal glands are on top of the kidneys. d) The pancreas is found between the stomach and the small intestine. (credit: modification of work by NCI, NIH)

The anterior pituitary produces six hormones: growth hormone, prolactin, thyroid-stimulating hormone, adrenocorticotropic hormone, follicle-stimulating hormone, and luteinizing hormone. Growth hormone stimulates cellular activities like protein synthesis that promote growth. Prolactin stimulates the production of milk by the mammary glands. The other hormones produced by the anterior pituitary regulate the production of hormones by other endocrine tissues (Table 11.1). The posterior pituitary is significantly different in structure from the anterior pituitary. It is a part of the brain, extending down from the hypothalamus, and contains mostly nerve fibers that extend from the hypothalamus to the posterior pituitary.

The thyroid gland is located in the neck, just below the larynx and in front of the trachea (Figure 11.23 b). It is a butterfly-shaped gland with two lobes that are connected. The thyroid follicle cells synthesize the hormone thyroxine, which is also known as T₄ because it contains four atoms of iodine, and triiodothyronine, also known as T₃ because it contains three atoms of iodine. T₃ and T₄ are released by the thyroid in response to thyroid-stimulating hormone produced by the anterior pituitary, and both T3 and T4 have the effect of stimulating metabolic activity in the body and increasing energy use. A third hormone, calcitonin, is also produced by the thyroid. Calcitonin is released in response to rising calcium ion concentrations in the blood and has the effect of reducing those levels.

Most people have four parathyroid glands; however, the number can vary from two to six. These glands are located on the posterior surface of the thyroid gland (Figure 11.23 b).

The parathyroid glands produce parathyroid hormone. Parathyroid hormone increases blood calcium concentrations when calcium ion levels fall below normal.

The adrenal glands are located on top of each kidney (Figure 11.23 c). The adrenal glands consist of an outer adrenal cortex and an inner adrenal medulla. These regions secrete different hormones.

The adrenal cortex produces mineralocorticoids, glucocorticoids, and androgens. The main mineralocorticoid is aldosterone, which regulates the concentration of ions in urine, sweat, and saliva. Aldosterone release from the adrenal cortex is stimulated by a decrease in blood concentrations of sodium ions, blood volume, or blood pressure, or by an increase in blood potassium levels. The glucocorticoids maintain proper blood-glucose levels between meals. They also control a response to stress by increasing glucose synthesis from fats and proteins and interact with epinephrine to cause vasoconstriction. Androgens are sex hormones that are produced in small amounts by the adrenal cortex. They do not normally affect sexual characteristics and may supplement sex hormones released from the gonads. The adrenal medulla contains two types of secretory cells: one that produces epinephrine (adrenaline) and another that produces norepinephrine (noradrenaline). Epinephrine and norepinephrine cause immediate, short-term changes in response to stressors, inducing the so-called fight-or-flight response. The responses include increased heart rate, breathing rate, cardiac muscle contractions, and blood-glucose levels. They also accelerate the breakdown of glucose in skeletal muscles and stored fats in adipose tissue, and redirect blood flow toward skeletal muscles and away from skin and viscera. The release of epinephrine and norepinephrine is stimulated by neural impulses from the sympathetic nervous system that originate from the hypothalamus.

The pancreas is an elongate organ located between the stomach and the proximal portion of the small intestine (Figure 11.23 d). It contains both exocrine cells that excrete digestive enzymes and endocrine cells that release hormones.

The endocrine cells of the pancreas form clusters called pancreatic islets or the islets of Langerhans. Among the cell types in each pancreatic islet are the alpha cells, which produce the hormone glucagon, and the beta cells, which produce the hormone insulin. These hormones regulate blood-glucose levels. Alpha cells release glucagon as blood-glucose levels decline. When blood-glucose levels rise, beta cells release insulin. Glucagon causes the release of glucose to the blood from the liver, and insulin facilitates the uptake of glucose by the body’s cells.

The gonads—the male testes and female ovaries—produce steroid hormones. The testes produce androgens, testosterone being the most prominent, which allow for the development of secondary sex characteristics and the production of sperm cells. The ovaries produce estrogen and progesterone, which cause secondary sex characteristics, regulate production of eggs, control pregnancy, and prepare the body for childbirth.

There are several organs whose primary functions are non-endocrine but that also possess endocrine functions. These include the heart, kidneys, intestines, thymus, and adipose tissue. The heart has endocrine cells in the walls of the atria that release a hormone in response to increased blood volume. It causes a reduction in blood volume and blood pressure, and reduces the concentration of Na⁺ in the blood.

The gastrointestinal tract produces several hormones that aid in digestion. The endocrine cells are located in the mucosa of the GI tract throughout the stomach and small intestine. They trigger the release of gastric juices, which help to break down and digest food in the GI tract.

The kidneys also possess endocrine function. Two of these hormones regulate ion concentrations and blood volume or pressure. Erythropoietin (EPO) is released by kidneys in response to low oxygen levels. EPO triggers the formation of red blood cells in the bone marrow. EPO has been used by athletes to improve performance. But EPO doping has its risks, since it thickens the blood and increases strain on the heart; it also increases the risk of blood clots and therefore heart attacks and stroke.

The thymus is found behind the sternum. The thymus produces hormones referred to as thymosins, which contribute to the development of the immune response in infants. Adipose tissue, or fat tissue, produces the hormone leptin in response to food intake. Leptin produces a feeling of satiety after eating, reducing the urge for further eating.

Hormone production and release are primarily controlled by negative feedback, as described in the discussion on homeostasis. In this way, the concentration of hormones in blood is maintained within a narrow range. For example, the anterior pituitary signals the thyroid to release thyroid hormones. Increasing levels of these hormones in the blood then give feedback to the hypothalamus and anterior pituitary to inhibit further signaling to the thyroid gland (Figure 11.24).

 Figure 11.24 The anterior pituitary stimulates the thyroid gland to release thyroid hormones T3 and T4. Increasing levels of these hormones in the blood result in feedback to the hypothalamus and anterior pituitary to inhibit further signaling to the thyroid gland. (credit: modification of work by Mikael Häggström)

Section Summary

Hormones cause cellular changes by binding to receptors on or in target cells. The number of receptors on a target cell can increase or decrease in response to hormone activity.

Hormone levels are primarily controlled through negative feedback, in which rising levels of a hormone inhibit its further release.

The pituitary gland is located at the base of the brain. The anterior pituitary receives signals from the hypothalamus and produces six hormones. The posterior pituitary is an extension of the brain and releases hormones (antidiuretic hormone and oxytocin) produced by the hypothalamus. The thyroid gland is located in the neck and is composed of two lobes. The thyroid produces the hormones thyroxine and triiodothyronine. The thyroid also produces calcitonin. The parathyroid glands lie on the posterior surface of the thyroid gland and produce parathyroid hormone.

The adrenal glands are located on top of the kidneys and consist of the adrenal cortex and adrenal medulla. The adrenal cortex produces the corticosteroids, glucocorticoids and mineralocorticoids. The adrenal medulla is the inner part of the adrenal gland and produces epinephrine and norepinephrine.

The pancreas lies in the abdomen between the stomach and the small intestine. Clusters of endocrine cells in the pancreas form the islets of Langerhans, which contain alpha cells that release glucagon and beta cells that release insulin. Some organs possess endocrine activity as a secondary function but have another primary function. The heart produces the hormone atrial natriuretic peptide, which functions to reduce blood volume, pressure, and Na⁺ concentration. The gastrointestinal tract produces various hormones that aid in digestion. The kidneys produce erythropoietin. The thymus produces hormones that aid in the development of the immune system. The gonads produce steroid hormones, including testosterone in males and estrogen and progesterone in females. Adipose tissue produces leptin, which promotes satiety signals in the brain.

Glossary

adrenal gland: the endocrine gland associated with the kidneys

down-regulation: a decrease in the number of hormone receptors in response to increased hormone levels

endocrine gland: the gland that secretes hormones into the surrounding interstitial fluid, which then diffuse into blood and are carried to various organs and tissues within the body

exocrine gland: the gland that secretes chemicals through ducts that lead to skin surfaces, body cavities, and organ cavities.

hormone: a chemical released by cells in one area of the body that affects cells in other parts of the body

intracellular hormone receptor: a hormone receptor in the cytoplasm or nucleus of a cell

pancreas: the organ located between the stomach and the small intestine that contains exocrine and endocrine cells

parathyroid gland: the gland located on the surface of the thyroid that produces parathyroid hormone

pituitary gland: the endocrine gland located at the base of the brain composed of an anterior and posterior region; also called hypophysis

thymus: the gland located behind the sternum that produces thymosin hormones that contribute to the development of the immune system

thyroid gland: an endocrine gland located in the neck that produces thyroid hormones thyroxine and triiodothyronine

up-regulation: an increase in the number of hormone receptors in response to increased hormone levels

Aging changes in hormone production: MedlinePlus Medical Encyclopedia

The endocrine system is made up of organs and tissues that produce hormones. Hormones are natural chemicals produced in one location, released into the bloodstream, then used by other target organs and systems.

Hormones control the target organs. Some organ systems have their own internal control systems along with, or instead of, hormones.

As we age, changes naturally occur in the way body systems are controlled. Some target tissues become less sensitive to their controlling hormone. The amount of hormones produced may also change.

Blood levels of some hormones increase, some decrease, and some are unchanged. Hormones are also broken down (metabolized) more slowly.

Many of the organs that produce hormones are controlled by other hormones. Aging also changes this process. For example, an endocrine tissue may produce less of its hormone than it did at a younger age, or it may produce the same amount at a slower rate.

AGING CHANGES

The hypothalamus is located in the brain. It produces hormones that control the other structures in the endocrine system, including the pituitary gland. The amount of these regulating hormones stays about the same, but the response by the endocrine organs can change as we age.

The pituitary gland is located just below (anterior pituitary) or in (posterior pituitary) the brain. This gland reaches its maximum size in middle age and then gradually becomes smaller. It has two parts:

• The back (posterior) part stores hormones produced in the hypothalamus.
• The front (anterior) part produces hormones that affect growth, the thyroid gland (TSH), adrenal cortex, ovaries, testes, and breasts.

The thyroid gland is located in the neck. It produces hormones that help control metabolism. With aging, the thyroid may become lumpy (nodular). Metabolism slows over time, beginning at around age 20. Because thyroid hormones are produced and broken down (metabolized) at the same rate, thyroid function tests are most often still normal. In some people, thyroid hormone levels may rise, leading to an increased risk of death from cardiovascular disease.

The parathyroid glands are four tiny glands located around the thyroid. Parathyroid hormone affects calcium and phosphate levels, which affect bone strength. Parathyroid hormone levels rise with age, which may contribute to osteoporosis.

Insulin is produced by the pancreas. It helps sugar (glucose) go from the blood to the inside of cells, where it can be used for energy.

The average fasting glucose level rises 6 to 14 milligrams per deciliter (mg/dL) every 10 years after age 50 as the cells become less sensitive to the effects of insulin. Once the level reaches 126 mg/dL or higher, the person is considered to have diabetes.

The adrenal glands are located just above the kidneys. The adrenal cortex, the surface layer, produces the hormones aldosterone, cortisol, and dehydroepiandrosterone.

• Aldosterone regulates fluid and electrolyte balance.
• Cortisol is the “stress response” hormone. It affects the breakdown of glucose, protein, and fat, and it has anti-inflammatory and anti-allergy effects.

Aldosterone release decreases with age. This decrease can contribute to lightheadedness and a drop in blood pressure with sudden position changes (orthostatic hypotension). Cortisol release also decreases with aging, but the blood level of this hormone stays about the same. Dehydroepiandrosterone levels also drop. The effects of this drop on the body are not clear.

The ovaries and testes have two functions. They produce the reproductive cells (ova and sperm). They also produce the sex hormones that control secondary sex characteristics, such as breasts and facial hair.

• With aging, men often have a lower level of testosterone.
• Women have lower levels of estradiol and other estrogen hormones after menopause.

EFFECT OF CHANGES

Overall, some hormones decrease, some do not change, and some increase with age. Hormones that usually decrease include:

In women, estrogen and prolactin levels often decrease significantly.

Hormones that most often remain unchanged or only slightly decrease include:

• Cortisol
• Epinephrine
• Insulin
• Thyroid hormones T3 and T4

Testosterone levels usually decrease gradually as men age.

Hormones that may increase include:

RELATED TOPICS

Lab 7 Chart-Endocrine – Lecture notes 7 ENDOCRINE CHART Organ Gland Hormone Target Effects Hypothalamus CRH Corticotropin Releasing Hormone Anterior pituitary

ENDOCRINE CHART

Organ/Gland Hormone Target Effects

Hypothalamus CRH Corticotropin-Releasing

Anterior pituitary gland Stimulate secretion of ACTH

PIH prolactin-inhibiting hormone

Anterior pituitary gland Inhibit prolactin secretion

GHRH growth-hormone-releasing

hormone

Anterior pituitary gland Stimulate secretion of growth hormone

GHIH growth-hormone-inhibiting

hormone

Anterior pituitary gland Inhibit growth hormone secretion

TRH thyrotropin-releasing

Anterior pituitary gland Stimulate secretion of TSH

LHRH (GnRH) Luteinizing

hormone-releasing hormone

Anterior pituitary gland Stimulate secretion of FSH and LH

Anterior Pituitary/

Adenohypophysis

FSH Follicle-stimulating hormone Ovary and testis Female: formation of eggs, follicle development

LH Luteinizing hormone Ovary and testis Female: induce estrogen, signal ovulation

Male: induce testosterone

ACTH Adrenocorticotropic

Adrenal cortex (zona fasciculate) Stimulates secretion of glucocorticoids (cortisol)

TSH Thyroid-stimulating

Thyroid gland Stimulate secretion of thyroid hormones (T3, T4)

Prolactin Breast/Mammillary gland Milk production (not secrete milk)

GH Growth hormone Liver, bone, muscle Promotes bone and muscle growth, protein synthesis, cell division,

lipid and carbohydrate metabolism

Posterior Pituitary/

Neurohypophysis

Oxytocin Brain, uterus, breast Milk secretion, uterine contractions during laboring, social bonding

ADH/vasopressin Antidiuretic

Kidney Increase reabsorption of body water (concentration of urine, vascular

constriction, increase blood pressure)

Thyroid TH (T3, T4) thyroid hormone

(produce from Follicular cells)

All cells Control rate of body metabolism

Calcitonin

(produce from Parafollicular cells)

Bone, blood Stimulating calcium deposit in bones (increase Ca uptake), decrease

Parathyroid PTH parathyroid hormone

(produce from Chief cells)

Bone, blood Release Ca in bone, increase blood calcium

Adrenal Cortex Mineralcorticoids:

Aldosterone (zona glomerulosa)

Kidney Increase renal reabsorption of Na and water

Glucocorticoids: cortisol

All cells control blood glucose levels during stress (long-term stress hormone)

Sex hormones: DHEA

dehydroepiandrosterone

Gonad/all cells Convert into testosterone and estrogensecondary sex characteristics

Adrenal Medulla Nor/Epinephrine All cells Increase cardiac activity, blood pressure, glycogen breakdown , blood

glucose levels (short-term stress hormone)

Pancreas Insulin (beta cells) Most cells Facilitate uptake of glucose, decrease blood sugar

Glucagon (alpha cells) Liver, all cells Glycogen breakdown in liver, release glucose, increase blood glucose

levels

Pineal Gland Melatonin Brain Influenced circadian rhythms/sleep-wake cycle

Overview of Endocrine Disorders – Endocrine and Metabolic Disorders

Hormones undergo many changes as a person ages.

• Most hormone levels decrease.

• Some hormone levels remain normal, including thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (basal), thyroxine, cortisol (basal), 1,25-dihydroxycholecalciferol, insulin (sometimes increases), and estradiol (in men).

• Some hormone levels increase.

Hormones that increase, including adrenocorticotropic hormone (ACTH—increased response to corticotropin-releasing hormone), follicle-stimulating hormone, sex-hormone binding globulin, and activin (in men), gonadotropins (in women), epinephrine (in the oldest old), parathyroid hormone, norepinephrine, cholecystokinin, vasoactive intestinal peptide, vasopressin (also loss of circadian rhythm), and atrial natriuretic factor, are associated with either receptor defects or postreceptor defects, resulting in hypofunction.

Many age-related changes are similar to those in patients with hormone deficiency, leading to the hypothesis of a hormonal fountain of youth (ie, speculation that some changes associated with aging can be reversed by the replacement of one or more deficient hormones). Some evidence suggests that replacing certain hormones in the elderly can improve functional outcomes (eg, muscle strength, bone mineral density), but little evidence exists regarding effects on mortality. In some cases, replacing hormones may be harmful, as in estrogen replacement in some older women.

A competing theory is that the age-related decline in hormone levels represents a protective slowing down of cellular metabolism. This concept is based on the rate of living theory of aging (ie, the faster the metabolic rate of an organism, the quicker it dies). This concept is seemingly supported by studies on the effects of dietary restriction. Restriction decreases levels of hormones that stimulate metabolism, thereby slowing metabolic rate; restriction also prolongs life in rodents.

Dehydroepiandrosterone (DHEA) and its sulfate levels decline dramatically with age. Despite optimism for the role of DHEA supplementation in older people, most controlled trials failed to show any major benefits.

Pregnenolone is the precursor of all known steroid hormones. As with DHEA, its levels decline with age. Studies in the 1940s showed its safety and benefits in people with arthritis, but additional studies failed to show any beneficial effects on memory and muscle strength.

Levels of growth hormone (GH) and its peripheral endocrine hormone ( insulin-like growth factor 1 [IGF-1]) decline with age. GH replacement in older people sometimes increases muscle mass but does not increase muscle strength (although it may in malnourished people). Adverse effects (eg, carpal tunnel syndrome, arthralgias, water retention) are very common. GH may have a role in the short-term treatment of some undernourished older patients, but in critically ill undernourished patients, GH increases mortality. Secretagogues that stimulate GH production in a more physiologic pattern may improve benefit and decrease risk.

Levels of melatonin, a hormone produced by the pineal gland, also decline with aging. This decline may play an important role in the loss of circadian rhythms with aging.

90,000 Experts named the most common endocrine diseases in children

“In Russia, about 1.5 million children have abnormalities in the work of the endocrine system. The most common of them are thyroid diseases (25%) and obesity (32%),” she said today Director of the Institute of Pediatric Endocrinology of the National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Professor Olga Bezlepkina.

“Diabetes mellitus in children ranks third in prevalence among endocrine pathologies, but we can call it the first in importance,” the expert notes.- This disease, which accompanies a child all his life, requires constant monitoring – therapy, diagnosis of complications, lifestyle in general. Parents with increased attention monitor the well-being of a small child and his state of health, what he eats, his physical activity and emotional state. Every year in Russia, about 7 thousand children fall ill with type 1 diabetes. “

A separate problem is rare orphan diseases.” In our country, newborn screening is carried out – this is a mass examination of all children for five diseases, two of which are endocrine – congenital hypothyroidism and congenital dysfunction adrenal cortex, – said Olga Bezlepkina.- Diagnosed in the first days after birth, they are amenable to treatment, which is selected by a pediatric endocrinologist. Without therapy, the child has a high risk of dying in infancy or other dangerous consequences. For example, with congenital hypothyroidism, a child who does not receive therapy develops mental retardation. “

Another rare disease is hypopituitarism (the main manifestation of which is growth hormone deficiency) – there are about 4 thousand such children in the country. the child is significantly delayed.But with timely treatment, such children manage to grow up and have the usual average height of a healthy person. I note that all children are provided with growth hormone at the expense of the federal budget, “Professor Bezlepkina noted.

Thanks to the development of molecular genetic methods, it is possible to predict diseases associated with genetic disorders.” Of course, this is a difficult and not accessible diagnosis for everyone, but we many families manage to carry it out, – said Bezlepkina. – This became possible thanks to the Alfa-Endo charitable program, as well as the support of the KAF and Life Line funds.Medical genetic research helps us understand the basis of orphan diseases, not only make a diagnosis, but also predict its course, and give recommendations to parents at the stage of conceiving a child in order to exclude hereditary pathology and ensure the birth of healthy children. Thanks to this, it was possible to interrupt the birth of children with monogenic diseases in several families. Such research is the future. “

Over the past seven years, more than 10 thousand children in Russia have been examined by the method of molecular genetics and received adequate treatment.This is a large figure, given that diseases are rare.

“In terms of prevention, most of the endocrine diseases in children can be prevented. For example, thyroid diseases, which develop as a result of insufficient intake of iodine with food. They lead to the appearance of nodules, an enlarged thyroid gland, a decrease in intelligence and other dangerous consequences”, – concluded the expert.

Diagnostics and treatment of endocrine diseases – World of health

Endocrinology – the science of endocrine glands and diseases associated with dysfunction.

In the medical center “World of Health” you can make an appointment with a paid endocrinologist and receive from him not only advice, but also highly qualified assistance on a wide range of diseases, which are treated by the best endocrinologists of St. Petersburg.

Endocrine glands produce and release hormones into the bloodstream that affect metabolism, changing the function of the whole organism or individual organs and systems.

The endocrine system is extremely important in such vital processes as growth, reproduction and development of the body, metabolism.Diseases of the endocrine system include diabetes mellitus, thyroiditis, hypothyroidism, hyperthyroidism, nodular goiter, hyperparathyroidism, or acromegaly.

Dear patients!

The Medical Center offers the most up-to-date examination and effective treatment of diabetes mellitus, thyroid and adrenal gland pathologies, as well as diagnostics and prevention of their complications. The center guarantees an individual approach to each patient: highly qualified endocrinologists offer optimal treatment programs, taking into account all the characteristics of the course of the disease.The comprehensive treatment programs created by the center’s endocrinologists include not only therapeutic procedures, but also the development of a special diet, as well as a short training course in self-control.

Major endocrinological diseases:

• diabetes mellitus;
• autoimmune thyroiditis;

90,038 nodular or cystic goiter;

90,038 diffuse goiter;

• hyperparathyroidism;
• Itsenko-Cushing’s disease;
• Addison’s disease;
• acromegaly;
• adreno-genital syndrome;
• hyperprolactinemia, etc.d.

Thyroid diseases

The endocrinologist of our center treats thyroid diseases from a modern standpoint, taking into account the latest recommendations of the European and American Thyroid Associations, which can successfully maintain the euthyroid state in hypothyroidism, as well as against the background of conservative therapy for diffuse toxic goiter. Adequate therapy and supervision by an endocrinologist of our center, who will promptly correct the treatment of diffuse toxic goiter, in many cases allows avoiding surgery.Correct diagnosis and treatment of thyroid nodules is the key to reducing their growth and preventing cancer.

Obesity

Diet is a temporary measure that involves limiting food intake, and, most often, replacing the usual food with foods that are not included in the usual diet. In the treatment of overweight and obesity, we proceed from the principles of rational nutrition, which allows you to adjust the diet taking into account individual gastronomic preferences, teach you how to eat right and form habits, thanks to which you can maintain a physiological weight throughout your life.With the help of a specially developed computer program, we will compile an individual menu that will be constantly corrected by you and your attending physician at the stage of weight loss and training. In the future, you will be able to do it yourself, which will allow you to maintain the achieved result.

Diabetes mellitus

The selection of a rational diet, which is most effective in combination with modern principles of therapy, is also necessary for patients with diabetes mellitus.Currently, there are a huge number of certified drugs for the treatment of diabetes mellitus. Knowledge of the characteristics of each of them, as well as the characteristics of the patient’s body, the course of his disease, allows our specialists to choose the most effective treatment and achieve adequate control of blood sugar and reduce the risk of developing complications of diabetes mellitus.

Pregnancy

Timely diagnosis and treatment of diseases of the endocrine system allows you to maintain the health of the mother and give birth to a healthy child.In this regard, in many countries of the world, it is mandatory to consult an endocrinologist both at the stage of pregnancy planning and at the critical stages of pregnancy: from 0 to 8 weeks, from 22 to 24 weeks. The specialists of our center will reveal hidden disorders of the endocrine system, and will also help maintain pregnancy in women with thyroid diseases, diabetes mellitus and other diseases of the endocrine system.

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Title

A specialized department providing inpatient care for children with endocrine pathology.A department was organized in the structure of the institute in 1962 on the initiative and with the active participation of Professor, Doctor of Medical Sciences M.I. Ostashevskaya. From that moment on, the endocrine department has become the leading treatment and diagnostic, research and educational center of the endocrinological profile in the entire South of Russia. Since 1971, the department was headed by P.V. Bondarenko, a veteran of the Great Patriotic War, awarded: the Order of the Red Star, the Medal For Courage, the Order of the Patriotic War of the II Degree, the Medal For Victory over Germany.In 1971, the Department of Pediatric Endocrinology was a member of the USSR Exhibition of Economic Achievements and was awarded a bronze medal for organizing the Pediatric Endocrinology Clinic of the Institute and the Pediatric Endocrinological Service in Rostov.

Currently, the children’s endocrine department of NIIAP operates with 40 beds.

The department employs:

• 4 doctors of medical sciences,
• 3 candidates of medical sciences,
• doctors of the highest category.

The institute provides inpatient diagnostic and treatment assistance to children and adolescents with various endocrine pathologies:

• with type 1 and 2 diabetes,
• diseases of the thyroid and parathyroid glands;
• severe forms of adrenal insufficiency, including congenital dysfunction of the adrenal cortex;
• violation of physical and sexual development;
• diabetes insipidus;
• obesity, etc.

Since 2008, the Center for Insulin Pump Therapy has been operating on the basis of the department. As part of the provision of high-tech medical care, pumps are installed for patients with type 1 diabetes mellitus, and children and their parents are trained in the skills of working with an insulin pump. Among the patients who received high-tech medical care at NIIAP, 35% came from the territories of the Southern Federal District. Seminars and workshops with endocrinologists of the Rostov region, the Southern Federal District, the North Caucasus Federal District on insulin pump therapy are regularly held.

The department organized and regularly conducts the “School of diabetes” for sick children and their parents.

Psychological assistance is provided to children with diabetes mellitus and their parents, as well as to patients with endocrine pathology in stressful situations.

In addition to medical and diagnostic work, research workers and doctors of the department carry out active research work. Over the past 10 years, 4 doctoral and 4 candidate dissertations have been defended.

The main directions of scientific activity are:

• development of criteria for early diagnosis of diabetic microangiopathy and diabetic polyneuropathy;
• identification of risk factors, early diagnosis and prevention of brain damage in children and adolescents with diabetes mellitus;
• development of methods for early diagnosis and treatment of metabolic and reproductive disorders in obese children;
• optimization of methods of diagnosis and treatment of ovarian dysfunctions in girls and girls with hyperandrogenic syndrome;
• development of optimal methods of therapy for disorders of sexual development in adolescent boys;
• development of rehabilitation algorithms for children with endocrine pathology living in ecologically unfavorable regions.

With the participation of researchers, doctors of the department on the basis of NIIAP FGBOU VO “RostGMU” of the Ministry of Health of Russia, training seminars and thematic conferences are held for pediatricians and endocrinologists in Rostov-on-Don, Rostov region, Southern Federal District, North Caucasus Federal District.

The Children’s Endocrine Department of NIIAP is the educational base of the Department of Endocrinology with the course of Pediatric Endocrinology of the Faculty of Advanced Training and Professional Retraining of Specialists of the Rostov State Medical University, which ensures continuity between educational and medical work, allows expanding the possibilities of scientific research and the treatment process.

A new laboratory-warehouse complex will be built on the basis of the Moscow Endocrine Plant

A laboratory-administrative-warehouse complex will be built for the Moscow Endocrine Plant. The corresponding project has been approved by the Moscow City Architecture Committee. According to the chief architect of Moscow, Sergei Kuznetsov, the total area of ​​the building will be about 15 thousand square meters.

The complex is being built according to a departmental investment project with the Ministry of Industry and Trade of Russia.

“Now it is planned to build, reconstruct and re-equip an industrial complex for the production of drugs on the basis of the state enterprise“ Moscow Endocrine Plant ”.The production itself is awaiting modernization, and the appearance of this laboratory, administrative and warehouse complex is one of its stages. The building will be faced with panels of beige, brown and white shades, ”noted Sergei Kuznetsov.

The laboratory-administrative-warehouse complex will be located at 25 Novokhokhlovskaya Street. It will be connected to the existing buildings by overhead crossings. Inside the building will be divided into an administrative part and a large laboratory and warehouse block.

Glavgosexpertiza of Russia approved the project on February 17.

“The city allocated a land plot to the Moscow Endocrine Plant for the construction of a laboratory, administrative and warehouse complex in 2016, now the project has entered an active stage. The volume of investments will be about 1.2 billion rubles. At the same time, the commissioning of the facility is scheduled according to the plan for 2022. It should be noted that both federal subsidies and benefits from the city government contribute to the modernization of the enterprise. Thus, the Moscow Endocrine Plant has been given the status of an industrial complex, which provides a number of preferences: a reduction in the regional part of the income tax, as well as tax on land and property, ”said Alexander Prokhorov, head of the Moscow Department of Investment and Industrial Policy.

Construction and reconstruction of an industrial complex on the basis of the Moscow Endocrine Plant will take place in three stages. Provided for technical re-equipment and reconstruction of the laboratory complex of the enterprise, as well as the site for the production of soft dosage forms.

In the clinics of the Siberian State Medical University you can get free treatment of endocrine ophthalmopathy

The ophthalmological clinic of the Siberian State Medical University provides free treatment of endocrine ophthalmopathy within the framework of high-tech medical care (HMP).

Endocrine ophthalmopathy is a serious progressive disease that manifests itself as an increase in the volume of the tissues of the eyes. At the heart of the disease is a dysfunction of the thyroid gland. As a result, a number of disorders occur in the body, but the main manifestation of the disease is exophthalmos – a progressive increase (hyperplasia) of the soft tissues of the eye. Mostly the process involves the orbital tissue (the fat that surrounds the eye) and the eye muscles, thanks to which the movements of the eyeball are carried out.As a result, the patient experiences decreased vision, double vision (diplopia) and a persistent aesthetic defect, as the eyes protrude sharply forward from the orbits. Both eyes are more often affected, but cases of unilateral damage are not rare.

“If left untreated, the disease can lead to permanent loss of vision in both eyes. Most cases of this disease respond well to medication, for example, hormone therapy is widely used. However, in some cases, surgery is required.The sooner a patient seeks medical help, the more effective the treatment will be, ”said Yana Martusevich, head of the ophthalmological clinic of the Siberian State Medical University, candidate of medical sciences, doctor of the highest category.

Residents of Tomsk and the Tomsk region can receive free treatment for endocrine ophthalmopathy at the leading ophthalmological clinic in the region. To do this, patients need to go to the hospitalization office of the ophthalmological clinic of the Siberian State Medical University at the address: Lenin Ave., 4. The office is open every day, hospitalization is carried out until 9:00.You must have an endocrinologist’s conclusion with an established diagnosis of “Endocrine ophthalmopathy” (diagnosis code – H06.2), passport, compulsory medical insurance policy and SNILS.

Department of Surgery No. 2 (Endocrine Surgery)

Surgical care for endocrine patients has been provided in the regional hospital No. 2 since 1989 since the opening of the surgical department of general surgical profile.

In February 2003, a specialized department of endocrine surgery was opened – surgical department No. 2 with a total capacity of 30 beds.

Based on the order of the Department of Health of the Krasnodar Territory No. 369-OD dated 6.12.2004 “On the development of a network of inter-territorial specialized centers in the Krasnodar Territory” and the order of the Health Department of the Administration of the municipal formation of Krasnodar No. 418 dated 30.12.2004 “On the development of a network of inter-territorial specialized centers” from the beginning of 2005 on the basis of the surgical department No. -2 created: Interterritorial specialized center for endocrine surgery of the 4th level. Until now, this is the only specialized surgical department in the Krasnodar Territory, professionally engaged in endocrine surgery.

Doctors of the department have specialized in endocrine surgery in leading institutions in Moscow, St. Petersburg, Italy and Germany. They have extensive practical experience.

The Center for Endocrine Surgery provides specialized surgical care to the population of Krasnodar and the Krasnodar Territory for surgical diseases of the organs of the endocrine system (diseases of the thyroid gland, adrenal glands). All types of interventions are performed, including minimally invasive (video-assisted) interventions on the thyroid gland and adrenal glands (retroperitoneal removal).Over 15 years of operation of the Department of Endocrine Surgery, more than 15,000 surgical interventions have been performed.

Primary hyperparathyroidism and multiple endocrine neoplasia syndrome (lecture) | Kotova

Syndrome of multiple endocrine neoplasias (MEN) is a hereditary disease transmitted in an autosomal dominant manner, in which there is a tumor lesion of several endocrine glands.

In the structure of MEN there are three different variants: MEN-1, MEN-2A, MEN-2V.With MEN-1 (Vermer’s syndrome), parathyroid hyperplasia (PTG) or adenoma, islet cell tumors of the pancreas, and pituitary adenoma are noted.

In a combined study of tumor maps and connections, it was found that the genetic defect in Vermer’s syndrome is located in the pericentric region of the long arm of the 11th chromosome (1 lg! 3). When there is a loss of the 11th chromosome of a part of the genetic material, it is the endocrine cells that are selectively affected. This leads to their proliferation, as a result of which neoplasia of the endocrine glands develops.

MEN-2A (Sipple syndrome) includes hyperplasia or adenoma of the thyroid gland, a tumor of parafollicular cells of the thyroid gland (thyroid gland) (medullary thyroid cancer (MTC)) and pheochromocytoma.

The genetic basis of Sipple’s syndrome is not well understood. According to some researchers, there is a partial division of the 20th chromosome, but this is not found in all relatives. Other authors point to a connection with the locus of the 10th chromosome. In MEN-2A, point mutations in the RET-proto-oncogenic coding for transmembrane tyrosine kinase have been described in many patients, which can explain the neoplastic activity.

For MEN-2V, thyroid hyperplasia or parathyroid adenoma of the thyroid gland are characteristic. hyperplasia of the adrenal medulla or pheochromocytoma, mucosal neuroma. With MEN-2B, more than 95% of relatives have a RET pro-oncogene mutation in codon 918 (exon 16). The replacement of methionine with threonine is encoded, as a result of which the internal tyrosine kinase part of the same receptor is activated, as in MEN-2A.

The causes of damage to several endocrine glands in MEN are a matter of controversy, despite fairly deep research in this area.Many of these glands are made up of cells capable of decarboxylating various amino acids, converting molecules into amines or peptides that act as hormones and neurotransmitters. These cells are classified as APUD cells and, according to some authors, are of neuroectodermal origin (neural crest). APUD cells contain markers of their common neuroendocrine nature, including neuron-specific enolase, synaptophysin, and chromogranin A. Long after organogenesis, neoplastic degeneration of APUD cells is completed, possibly due to hereditary loss of the tumor-suppressing gene and / or mutation of the proto-oncogene before migration ectodermal cells into the corresponding tissues.Such genetic rearrangement in the early stages of embryonic development can explain the combined changes in various tissues (parafollicular C-cells of the thyroid gland, cells of the adrenal medulla and extraadrenal chromaffin tissue, adenohypophysis cells, parathyroid cells). Recently, the APUD theory has found an increasing number of supporters.

Primary hyperparathyroidism (PGPT) can be of three types: 1) sporadic; 2) family with MEN-1 or MEN-2; 3) family without MEN (or family isolated).

Familial isolated HHPT is rare, therefore such patients are often included in the number of patients with familial HHPT within the “framework” of MEN or are often mixed with benign familial hypocalciuric hypercalcemia. always manifests itself before the age of 10. There has been a relationship between the presence of PHPT and the locus on I lg! 3 (similar or identical to the MEN-1 gene) in family members with familial PHPT without MEN.However, this clinically expressed association has no connection with the DNA index on chromosome 11, which is characteristic of MEN-1, and chromosome 10, which is characteristic of MEN-2.

PHPT is the most frequent manifestation of MEN and is observed in 20-30% with MEN-2A and less often with MEN-2V. With MEN-1, it is observed in more than 95% of patients and is usually the first manifestation. With MEN-1, as a rule, diffuse PTG hyperplasia is detected, and with MEN-2A, PTG adenomas are most common. Studies of 256 patients with PHPT in the “framework” of MEN-1 by the French-Belgian GENEM group showed that from 1985 to 2001there is a tendency to an increase in the number of hyperplasias of the thyroid gland relative to the adenomas of the thyroid gland. Patients with PHPT in the “framework” of MEN are usually younger than those in whom it is observed as an independent disease. In patients with MEN-1, by the age of 40, the incidence of PGPT reaches 100%.

The clinical manifestations of PHPT in patients with Vermeer’s syndrome (MEN-1) are very diverse and often resemble those of PHPT in patients without MEN syndrome. In some patients, it is asymptomatic, while in others, fatigue, nervousness, weakness, loss of appetite, polyuria, polydipsia, kidney stones, and disorders of bone metabolism are observed.The symptoms of HGPT are often masked by the symptoms that develop in Zollinger-Ellison syndrome, insulinoma, and acromegaly. On the other hand, PGPT can provoke a worsening of the clinical picture of various diseases. Parathyroid hormone (PTH) stimulates gastric secretion and thus the course of Zollinger-Ellison syndrome becomes more severe. The levels of PTH, plasma calcium and other biochemical changes in patients with hereditary PGPT are the same as in patients without MEN.

The sensitivity of laboratory diagnostic methods reaches 100%.For the purpose of topical diagnostics, ultrasound examination (ultrasound), computed tomography (CT), magnetic resonance imaging (MRI), thalite-technetium scintiography are used. The combination of these methods increases the diagnostic accuracy up to 90-95%.

When identifying patients with PGPT, it is always necessary to take into account the possibility of its development within the “framework” of MEN, data on the hereditary variant of PGPT and other endocrine diseases in their relatives. The difficulty is that different manifestations of MEN may not appear simultaneously, therefore, not all patients initially develop syndromes of damage to all endocrine glands involved in MEN.The frequency of damage to the endocrine glands in MEN-1: PTG – 90-100%, pancreas – 80%, pituitary gland – 65%, adrenal glands – 36%, thyroid gland – 24%.

The frequency, severity of symptoms of PHPT in patients with MEN-2A is less than in patients with MEN-1. They usually develop PGPT after age 30 and are so rare that they are not diagnosed. The main thing in the diagnosis is the detection of minor hypercalcemia. As a rule, the cause is revealed only during thyroid surgery, during which one or more enlarged thyroid glands are accidentally discovered.

Sometimes PGPT develops years after surgery for MTC. The clinical picture of PGPT is rarely found in patients who have previously undergone thyroidectomy, so some researchers argue that there is a growth factor of the PTG associated with thyroid C-cells, which were removed during surgery for MTC.

As in patients with sporadic PGPT, the diagnosis is based on the determination of the levels of total and ionized calcium, phosphorus, PTH in the blood serum, and alkaline phosphatase activity.

Treatment of PHPT within the “framework” of the MEN syndrome is of great difficulty for surgeons, since the frequency of recurrence of PHPT in this group of patients is higher than in the group of patients with PHPT not associated with MEN-1. Among patients with sporadic PGPT, a single adenoma of the cervical gland is found in 85%, and relapse is quite rare. It was found that in some adenomas the normal order of chromosomes is changed, which binds the cyclic PRAD-1 oncogene and activates the PTG gene. The frequency of mutations in MEN-1, as already indicated, is associated with the presence of a mutation in the 11th chromosome.

As a rule, parathyroid hyperplasia prevails in patients with PGPT developing within the “framework” of MEN. Therefore, treatment should aim to remove all abnormal or potentially abnormal PTGs. Patients with MEN-1 often have additional PTGs.

Hypercalcemia increases gastric secretion in Zollinger-Ellison syndrome, which develops within the “framework” of MEN, therefore, parathyroidectomy should precede surgery for gastrinoma.

Hyperplastic PTGs often differ in size, so the surgeon can take an enlarged PTG for an adenoma, and slightly enlarged hyperplastic PTGs for normal ones.The only method of differential diagnosis in this case is the histological analysis of the “normal” PTG in patients with “adenoma”. Failure to recognize hyperplasia or accessory glands can lead to inadequate surgery and, as a consequence, persistence of hypercalcemia. During surgery, all four glands should be identified and a careful search for accessory glands should be performed, especially in the thymus and peri-thymic intima.

One of the removed PTGs, many endocrinologists undergo cryopreservation in patients who have undergone almost complete or complete parathyroidectomy for autotransplantation, in case hypoparathyroidism develops.Several authors recommend a radical approach to patients with MEN-1 due to the frequent recurrence of HGPT. They insist on complete parathyroidectomy and even thymectomy, as well as simultaneous parathyroid autotransplantation in the forearm for patients with Vermeer’s syndrome. At the same time, there are indications that postoperative hypoparathyroidism develops after some time in patients who underwent total parathyroidectomy after parathyroid autotransplantation. On the other hand, it was found that fresh tissue of the PTG at one-stage autotransplantation is viable in 92% of cases.

During cryopreservation, functional activity is retained only in 67%. It should be emphasized that morphological verification of the absence of malignant PTG is necessary for carrying out one-stage autotransplantation, which is possible not in all medical institutions. The advantage of cryopreservation is also that, since you can never be sure that all PTGs will be removed, it allows autotransplantation of the glands after a certain time, if necessary.Simultaneous autotransplantation and cryopreservation are the most optimal methods in the prevention and treatment of postoperative hypoparathyroidism. Discordant are the reports indicating that parathyroidectomy and parathyroid autotransplantation do not always improve the results of surgery for PGPT. if it is caused by hyperplasia of the cervical gland due to the fact that ectopic glands remain unrecognized. Therefore, during the operation, it is necessary to place special emphasis on the identification of all PTGs both in the places of their typical and atypical location.

According to some authors, with a single PTG adenoma, it is always necessary to conduct a biopsy of the opposite side of the normal PTG that looks like. If, after a biopsy, they are not recognized as pathological and remain viable, only the adenoma and normal PTG on its side are removed. It is believed that this approach, on the one hand, reduces the risk of recurrence and, on the other, avoids hypoparathyroidism. If a relapse develops, then, as a rule, only on the side on which the biopsy of the cervical gland was performed.

To conduct a biopsy of the PTG, a jewelry surgical technique is required, since during it it is difficult to dose the volume of tissue removed. The result of trauma to the cervical gland during biopsy may be hemorrhage into its tissue, damage to the vascular pedicle, which can subsequently lead to hypoparathyroidism. Even if only 1/10 of the cervical gland is removed during a biopsy, the possibility of the development of its hypofunction cannot be ruled out. Nevertheless, in case of PTG adenoma, the operation should consist in its removal and biopsy of one of the other glands [2].The prevailing point of view is that the surgeon should assess the size and color of the PTG and determine which PTGs are pathological. The role of the pathologist during surgery is limited to identifying the tissue of the cervical gland.

MTC within the “framework” of this MEN-2A should be confirmed or excluded based on the data obtained in determining the level of thyrocalcitonin, as well as, if possible, data indicating the presence of a RET mutation in chromosome 10. Genetic screening is carried out specifically for the purpose of detecting MTC.This allows prophylactic thyroidectomy to be performed at the stages preceding tumor growth (diffuse C-cell hyperplasia). In the case of isolation of a RET-protooncogene mutation in peripheral blood leukocytes during genetic analysis, one can be sure that in this particular case MTC is a manifestation of MEN-2A or has a familial character. In the absence of a RET-protooncogene mutation in leukocytes, its presence in the tumor itself indicates sporadic MTC. If the mutation is absent both in the leukocytes and in the tumor itself, no conclusion can be drawn.

Thyroidectomy is recommended for those patients who have a RET proto-oncogene at the age of 5 years. MTC in MEN-2A is extremely rare in people over 40 years of age.

With MEN-2A, not only single or double PTG adenomas can occur, but also PTG hyperplasia, therefore, the tactics of surgical treatment of PGPT is the same as in MEN-1. In the case of PTG hyperplasia, it is recommended to perform total parathyroidectomy with PTG autotransplantation. Parathyroidectomy for MEN-2A is very often performed simultaneously with surgery for MTC (thyroidectomy and lymphadenectomy).At the same time, there is a point of view according to which, with MEN-2A, only macroscopically enlarged PTGs should be removed, since with this variant of MEN, recurrent HGPT are rare, and organ-preserving surgery avoids postoperative hypoparathyroidism.

In the event that the operation was ineffective, the need for a second surgical intervention is discussed. Before the reoperation, the topographic anatomical location of the left PTG should be determined according to the data of ultrasound, MRI, CT, scintiography, the operation protocol and the pathomorphological conclusion should be carefully studied retrospectively.

Patients with recurrent and persistent PHPT need long-term follow-up not only in terms of PHPT, but also for possible postoperative recognition of MEN. It is very important to examine the entire family of those patients who have hereditary HPPT, since it is usually the first manifestation of MEN-l. For example, a national register of patients with MEN-1 has been created in France.

With MEN-2A, medical supervision should continue throughout life, especially in the presence of MTC and pheochromocytoma.

With the discovery of the genetic nature of MEN, it became possible to determine which family members are predisposed to MEN-1 or to MEN-2A, and which are not. This allows you to avoid psychological stress and lifelong medical supervision in individual individuals. Patients who have a predisposition to these diseases should undergo a dynamic examination.

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