1. Fatima Obeidat, MD Department of Pathology and Laboratory Medicine
Endocrine system
Fatima Obeidat, MD
Department of Pathology and Laboratory Medicine

2. I. Thyroid diseases

3. I. Thyroiditis 1. Chronic Lymphocytic (Hashimoto) Thyroiditis - Is the most common cause of hypothyroidism in developed countries where iodine levels are sufficient. - It is characterized by gradual thyroid failure secondary to autoimmune destruction of the thyroid gland

4. - It is most prevalent between the ages of 45 and 65 years and is more common in women - It can affect children

5. Clinically ,
Painless thyroid enlargement
In the usual clinical course, hypothyroidism develops gradually.

6. Hashimoto thyroiditis-Gross

7. 2. Subacute Granulomatous (de Quervain’s) Thyroiditis - Is much less common than Hashimoto disease - More frequently in women than in men. - Is believed to be caused by a viral infection and a majority of patients have a history of an upper respiratory infection just before the onset of thyroiditis.

8. Clinical Features : - Acute onset characterized by neck pain ( with swallowing) ,fever, and malaise. - - The leukocyte count is increased. - It is self-limited, with most patients returning to a euthyroid state within 6 to 8 weeks

9. 3.Subacute Lymphocytic Thyroiditis : - Also is known as silent or painless thyroiditis. - And in a subset of patients the onset of disease follows pregnancy (postpartum thyroiditis).

10. 4. Riedel thyroiditis,:
- A rare disorder of unknown etiology,
Characterized by extensive fibrosis involving the thyroid and contiguous structures simulating a thyroid neoplasm clinically

11. Riedel thyroiditis - Clinically

12. Riedel thyroiditis-Gross

13. II. GRAVES DISEASE - It is characterized by a triad of manifestations: A. Thyrotoxicosis. - Caused by a diffusely enlarged, hyper-functional thyroid, is present in all cases.

14. Graves’ Gross

15. B. Infiltrative ophthalmopathy with resultant exophthalmos in 40% of patients as a result of increased volume of the retroorbital connective tissues C. Infiltrative dermopathy –pretibial myxedema of skin – in about 10% of the cases

16. Exophthalmos

17. Pretibial myxedema

18. Laboratory findings in Graves’ disease
- Elevated serum free T4 and T3 and depressed serum TSH

19. III. DIFFUSE AND MULTINODULAR GOITER - Enlargement of the thyroid, or goiter, is the most common manifestation of thyroid diseases.

20. Goiters can be endemic or sporadic. 1
Goiters can be endemic or sporadic. 1. Endemic goiter : - Occurs in geographic areas where the soil, water, and food supply contain little iodine. - The term endemic is used when goiters are present in more than 10% of the population in a given region.

21. 2. Sporadic goiter : - Less common than endemic goiter
2. Sporadic goiter : - Less common than endemic goiter. - Peak incidence in puberty or young adulthood, when there is an increased physiologic demand for T4. - It may be caused by several conditions, including :

22. a. Ingestion of substances that interfere with thyroid hormone synthesis , such as excessive calcium and vegetables such as cabbage, and cauliflower.

23. Endocrine Pancreas Diabetes Mellitus

24. Laboratory studies:
- Normal blood glucose levels are maintained in a very narrow range, usually 70 to 120 mg/dL.
Diabetes Mellitus is diagnosed by any one of three criteria:
1. A random blood glucose concentration of 200 mg/dL or higher, with classical signs and symptoms

25. 2. A fasting glucose concentration of 126 mg/dL or higher on more than one occasion 3. An abnormal oral glucose tolerance test (OGTT), in which the glucose levels is 200 mg/dL or higher 2 hours after a standard carbohydrate load (75 g of glucose).

26. Notes:
a. Persons with serum fasting glucose values < 110 mg/dL, or < 140 mg/dL for an OGTT, are considered euglycemic
b. Those with fasting glucose > 110 but < 126 mg/dL, or OGTT values of >140 but < 200 mg/dL, have impaired glucose tolerance, known as prediabetes

27. Classification of Diabetes Mellitus TYPE 1 Diabetes : - It accounts for 10% of all cases - Is an autoimmune disease destructing pancreatic β cell leading to an absolute deficiency of insulin

28. - Most commonly develops in childhood, becomes manifest at puberty, and patients depend on exogenous insulin for survival; without insulin they develop complications
- The classic manifestations of the disease occur late in its course, after 90% of the beta cells have been destroyed

29. - Accounts for 80% to 90% of cases - Caused by a combination of
Type 2 diabetes :
- Accounts for 80% to 90% of cases
- Caused by a combination of
a. Peripheral resistance to insulin action
b. An inadequate compensatory response of insulin secretion by β-cells (relative insulin deficiency)

30. Pathogenesis : -Is a complex multifactorial disease. 1
Pathogenesis : -Is a complex multifactorial disease. 1. Environmental factors, such as a sedentary life style and dietary habits 2. Genetic factors are also involved ,

31. Long term complications of Diabetes : - .
Long term complications of Diabetes : -
- There is extreme variability among patients in the time of onset , severity, and the particular organs involved but in persons with tight control of their diabetes, the onset may be delayed.

32. Morphology and clinical manifesations of complications 1
Morphology and clinical manifesations of complications 1. Diabetic Macrovascular Disease.: - The hallmark is accelerated atherosclerosis affecting the aorta , large and medium-sized arteries

33. Note;
- Myocardial infarction due to Coronary artery atherosclerosis is the most common cause of death in diabetics
- Gangrene of the lower extremities is 100 times more common in diabetics than in the general population

34. 2. Diabetic Microangiopathy. : -
Diffuse thickening of basement membranes, is most evident in the capillaries of the skin, skeletal muscle, retina and , renal glomeruli,
- Despite the increase in the thickness of basement
membranes, diabetic capillaries are more leaky than normal to plasma proteins.

35. - It underlies the development of diabetic nephropathy, retinopathy , and some forms of neuropathy - An indistinguishable microangiopathy can be found in aged nondiabetic patients,

36. 3. Diabetic Nephropathy.:
Renal failure is second only to myocardial infarction as a cause of death from this disease :

37. Diabetic nephropathy,clinically
The earliest manifestation is the appearance of small amounts of albumin in the urine (> 30 but < 300 mg/day-( microalbuminuria).
Without specific interventions, some patients will develop overt nephropathy with macroalbuminuria (excretion of more than 300 mg/day) over the succeeding 10 to 15 years,

38. 4. Ocular Complications of Diabetes:
- DM currently is the fourth leading cause of acquired blindness in the United States and visual impairment, and blindness, is one of the morefeared consequences of long-standing DM.
Retinopathy, the most common pattern, consists of changes that are considered by many ophthalmologists to be virtually diagnostic of the disease

39. 5Diabetic Neuropathy.:
- The most frequent pattern of involvement is that of a peripheral, symmetric neuropathy of the lower extremities affecting motor and sensory nerves particularly the latter and other forms include
- Autonomic neuropathy produces disturbances in bowel and bladder function and sometimes sexual impotence,

40. Note
Glycemic control is assessed clinically by measuring the percentage of glycosylated hemoglobin, also known as HbA1C, which is formed by non-enzymatic addition of glucose moieties to hemoglobin in red cells.

41. - HbA1C is a measure of glycemic control over long periods of time (2 to 3 months) and is relatively unaffected by day-to-day Variations and an HbA1C below 7% is taken as evidence of tight glycemic control,