Endocrine

System 2: Thyroid, Parathyroid, Pancreas,

Adrenals, Ovary/Testes
Dr. Banez November 13, 2013
Prepared by: Katrina Marie Kabigting, 1D

There are other organs that can be considered as endocrine
organs because every organ that can produce hormones should
be considered an endocrine organ.

Thymus
-
Found in the superior mediastinum (thorax),
produces hormones controlling the red bone marrow
to produce WBC.

Small Intestine
-
Found in the abdomen and is considered the largest
endocrine organ. Produces hormones that control
itself, the stomach, and the biliary tree.

Kidney
-
Produces renin

Heart
-
The atrium produces the atrial natriuretic
polypeptide (ANP).

I. THYROID

Skin superficial fascia (adipose tissue or hypodermis)
platysma deep fascia
The muscle fibers in the hypodermis is called the
platysma. The nerve innervation is the facial nerve. The
origin arises from the pectoral and deltoid fascia, then
goes up to touch the skin of the face. The platysma, when
contracted, pulls the face downward and in effect becomes
a muscle of facial expression by virtue of its nerve
innervation and action.

Figure 1. The muscles of the neck. There are two layers of the deep
fascia of the neck: the muscular and the visceral/somatic part. The
muscular part is the sternohyoid with its origin from the sternum and
its insertion on the hyoid bone. This is also the most superficial and
most medial strap muscle of the neck (i.e. the most superficial muscle is
the platsyma). Another strap muscle is the sternothyroid with its
origin from the manubrium of the sternum and insertion on the thyroid
cartilage. The omohyoid has an inferior belly and a superior belly. The
thyrohyoid can also be seen. These muscles are innervated by the
ansa cervicalis, one of the nerves coming from the cervical plexus of
the spinal nerve.

Structures related to the thyroid:

Anterior jugular vein formed by anastomosis of all
the superficial veins beneath the mandibular area

External jugular vein formed by the union of the

retromandibular vein and the posterior auricular
vein
Internal jugular vein comes from the sigmoid
sinus, beside the cranial cavity

Note: There are no jugular arteries. The accompanying arteries
are the carotids.

The isthmus is usually located anterior to the 3rd, 4th,
or 5th cartilage.
Pyramidal lobe present in 40-50% of the
population.


Lateral to the thyroid: Carotid sheath
o Most lateral: internal jugular vein
o Most medial and most posterior: common
The thyroid came from the base of the tongue between the
anterior two-thirds and posterior one-third, where the
circumvallate papilla is located. This is where the thyroid
follicle really is, and as it goes down during embryonic
development, it drags with it the pharyngeal pouches
creating now the parafollicular cells. At the level of the
trachea the thyroid stops going down. As it descends, it
creates a canal that later on solidifies. Some individuals,
however, retain the parenchyma of the lower part thus giving
rise to the pyramidal lobe. Sometimes, the canal remains
patent creating what we call a thyroglossal duct cyst.
Normally, it is seldom for the thyroid gland to be infected
because the connection with the oral cavity solidifies.

carotid artery
In between the two: vagus nerve
These structures are enclosed in a fascia
called the carotid fascia.
Posterior: Trachea, esophagus, laryngopharynx
Visceral fascia of deep fascia of the neck (thyroid
fascia) ensheaths the thyroid and parathyroid
glands
o
o

Blood supply:

Superior thyroid artery first branch of the
external carotid artery (2nd branch lingual artery,
3rd branch ascending pharyngeal artery, 4th branch
facial artery)

Inferior thyroid artery touching the inferior pole
of the thyroid and a branch of thyrocervical trunk
(has three branches: inferior thyroid, transverse
cervical, and suprascapular arteries)

Thyrodea ima from innominate artery, supplies
isthmus (present in 40-60%)

Veins:

Superior thyroid vein tributary of the internal
jugular vein
Middle thyroid vein tributary of the internal
jugular vein
Inferior thyroid vein tributary of the left and right
innominate veins

Hormones:
T3, T4, Calcitonin secreted into the venous system
T3 and T4 are very important hormones for the
metabolism of the human body. The thyroid is
stimulated by the pituitary gland via the action of the
thyroid stimulating hormone (TSH), and the pituitary

is itself regulated by the hypothalamus via the action

of the thyrotropin releasing hormone (TRH).
The functions of TSH in the thyroid is:
o Uptake of iodine
o Organification of iodine (synthesis)
o Coupling (synthesis)
o Release
Parafollicular cells are located in between the
follicular cells and are the ones that produce
calcitonin. Calcitonin is released when blood calcium
levels are increased. The secretion of which is
dependent on calcium levels not on pituitary
stimulation.

Figure 2. The functions of TSH in thyroid hormone synthesis. The

thyroid gland has thyroid follicles that produce the thyroid hormones.
The follicular cells need an inorganic substance, iodine, in order to
synthesize T3 and T4. Iodine cannot be transported in the blood as iodine,
therefore is converted into iodide. An enzyme in the thyroid to convert it
back into iodine acts upon the iodide. TSH is responsible for this
conversion. The first step in the synthesis of thyroid hormones is the
organification of iodine. Iodide is taken up, converted to iodine, and then
condensed onto tyrosine residues which reside along the polypeptide
backbone of a protein molecule called thyroglobulin. This reaction
results in either a mono-iodinated tyrosine (MIT) or di-iodinated tyrosine
(DIT) being incorporated into thyroglobulin. This newly formed
iodothyroglobulin forms one of the most important constituents of the
colloid material, present in the follicle of the thyroid unit. The other
synthetic reaction, that is closely linked to organification, is a coupling
reaction, where iodotyrosine molecules are coupled together. If two di-
iodotyrosine molecules couple together, the result is the formation of
thyroxin (T4). If a di-iodotyrosine and a mono-iodotyrosine are coupled
together, the result is the formation of tri-iodothyronine (T3).

II. PARATHYROID
-
Two pairs of parathyroid glands
-
The superior pairs are located not on the superior
poles but at the middle posterior part of the thyroid
gland. The inferior pairs however are located on the
inferior poles of the thyroid gland.

Blood supply similar to the blood supply of the thyroid gland
but the primary supply is the inferior thyroid artery because
this is the biggest and closest artery to both pairs of glands as
compared to the superior thyroid artery.

Parathormone released when calcium levels in the blood are
decreased (antagonistic effect to calcitonin)

Recurrent laryngeal nerve left recurrent is longer than the
right; accompanies the inferior thyroid vessels; located in the
tracheoesophageal groove; innervates all the intrinsic muscles
of the larynx except the cricothyroid
Innervates most importantly the posterior
cricoarytenoid which is responsible for abducting
the vocal folds; when injured may cause stridor
(noisy breathing) and difficulty in breathing
Superior laryngeal nerve accompanies superior thyroid
artery; innervates the cricothyroid, the most anterior external
intrinsic muscle of the larynx, which is the muscle that tenses
the vocal cord. If injured, can alter the pitch of the voice.

III. PANCREAS
-
Two roles: endocrine and digestive
-
Parts: head, neck, body, tail
o Posteriorly, the head has a projection called
the uncinate process
-
Two groups of cells:
o Cells of the pancreatic acini - cells for
digestion because these are the cells
responsible for synthesis of enzymes needed
to digest carbohydrates (amylase), lipids
(lipase), and proteins (carboxypeptidase A
and B, trypsinogen)

since these are digestive enzymes

it needs the pancreatic duct of
Wirsung and Santorini to drain the
enzymes into the lumen of the
small intestine (first to the
duodenum then to the jejunum)
o Islets of Langerhans made up of alpha,
beta, delta, and F cells that secrete glucagon,
insulin, somatostatin, and pancreatic
polypeptide, respectively. These secretions
drain directly into the vein.
-
Venous drainage:
o Head

superior
and
inferior
pancreaticoduodenal vein and the splenic
vein unite to go to the portal vein

IV. ADRENAL GLANDS
-
Retroperitoneal
-
Located above the kidneys
-
Left is crescent shaped, right is pyramidal shaped
-
Supporting structures same to those of the kidneys
except perirenal structures
-
Diaphragm located superiorly and can be
considered as a structure that protects and supports
it
-
Blood vessel:
o Superior adrenal artery branch of
inferior phrenic artery
o Middle adrenal artery branch of
abdominal aorta
o Inferior adrenal artery renal artery
-
Veins:
o Right tributary of IVC
o Left tributary of left renal vein

Cortex:

Zona glomerulosa most superficial, just beneath

the fascia, secretes mineralocorticoids (Aldosterone)
the target organ of which is the kidney (PCT, LoH,
DCT exerts greatest effect on PCT according to Dr.
Banez lecture) and the action is to retain Na in the
body to maintain osmotic pressure of the blood

Zona fasciculata glucocorticoids (cortisol)

catabolic hormone, anti-stress hormone

Zona reticualris androgens

-
Controlled by ACTH
-
Zona glomerulosa regulated by Na serum levels and
renin (from the kidneys) via the renin-angiotensin
mechanism.
-
ACTH is the strongest stimulus of the adrenal cortex
(60-70%) as compared to renin and Na serum levels.

Medulla:
-
Stores and releases catecholamines (norepinephrine
is more predominant)
-
Considered the second neuron of the autonomic
nervous system

Cortex and medulla have different embryonic origins.

V. OVARY
-
Located at the side of the uterus, beneath the fallopian
tube
-
Supporting structures:
o Ovarian ligament - connects the ovary and
the uterus, attached to the uterus between
the body and the fundus, more anterior than
the fallopian tube
o Broad ligament most important ligament
that supports the internal genitalia of the
female. It has three parts and attached
laterally to the lateral pelvic wall. The three
parts are:

Mesometrium beside the uterus

Mesosalpinx beside the fallopian

tube

Mesovarium around the ovary

o Suspensory ligament
-
It has a cortex and medulla. The cortex contains the
oogonia present since fetal life and reaches about
300,000 to 400,000 in number. The pituitary gland
only starts releasing FSH and LH once menstruation
has started. Only 200-300 oogonia in each ovary will
be activated and these are surrounded by a single
layer of follicular cells. As it grows, the follicular cell
of these 400-600 oogonia undergoes mitosis. This is
the follicular phase of the ovary controlled by the FSH.
The follicular cells are responsible for the secondary
sex characteristics and are the ones that secrete
estrogen. It is the sudden surge of LH that triggers
ovulation. Once the oocyte has ruptured, the follicular
cell will become a luteal cell and will now secrete
progesterone.

VI. TESTES
-
It has an endocrine and reproductive part. The
reproductive part is contributed by the presence of
the seminiferous tubules which is responsible for the
formation of the sperm.
-
Lobular septum inward extension of the tunica
albuginea where the interstitial cell of Leydig is
located and these cells are the ones responsible for
the secretion of testosterone
-
In males, the FSH stimulates sperm production while
LH stimulates the Leydig cells to produce
testosterone.
-
The testes are descended outside the pelvic cavity to
provide it with an optimal environment for sperm
production. The condition wherein the testes failed to
descend is called cryptorchidism.
-
For pediatric patients, it must be made sure that the
testes are present in the scrotum otherwise, once the
patient has reached two years of age, the chances of
the testes descending will be lower.
-
Epididymis a solid, very coiled tube where the
sperm will pass through and mature. It is located at
the posterior side of the testes, the head of which is
connected to the testis. The vas efferentis connects
the seminiferous tubules to the rete testis.
-
The testes during embryonic development are in the
pelvic area. It descends through the inguinal ring and
finally to the scrotum. It is accompanied by the layers
of the abdominal wall as it descends.
-
Layers of the scrotum:
a. Skin Scrotum
b. Superficial fascia Dartos fascia
c. Campers fascia Dartos muscle
d. Scarpas fascia Colles fascia
e. External oblique aponeurosis external
spermatic fascia
f.
Internal oblique aponeurosis cremasteric
fascia

g.
h.

Parietal peritoneum - Tunica vaginalis

True capsule of the testis is the tunica
albuginea because it has no representation in
the abdominal wall.