The endocrine system consists of glands that secrete hormones directly into the bloodstream to regulate bodily functions. The major endocrine glands include the pituitary, thyroid, parathyroid, adrenal, pancreas, ovaries/testes, and pineal glands. During examination of the endocrine system, the doctor evaluates the patient's history, performs a physical exam checking for signs of endocrine disorders, and examines the major glands through inspection, palpation, percussion and auscultation. Some common endocrine disorders discussed are hypothyroidism, hyperthyroidism, Cushing's syndrome, acromegaly, Addison's disease, and polycystic ovarian syndrome, along with their

1. ENDOCRINE
SYSTEM

2. DR ABDUL SAMI
MPHIL EASTERN MEDICINE
The Islamia University of Bahawalpur
Pakistan

3. ENDOCRINE SYSTEM
“The endocrine system is the system of glands, each of which secretes
different types of hormone directly into the bloodstream to regulate the
body. The endocrine system does not include exocrine glands such as
salivary glands, sweat glands and glands within the gastrointestinal
tract.”

4. ENDOCRINE GLANDS
 Endocrine glands are glands, which synthesize and release the
classical hormones into the blood. The endocrine glands are also
called ductless glands because the hormones secreted by them are
released directly into the blood without any duct.
 These hormones are transported by blood to the target organs or
tissues in different parts of the body where the actions are executed.

5. MAIN ENDOCRINE GLANDS
 Pineal Gland
 Pituitary Gland
 Thyroid Gland
 Parathyroid Gland
 Adrenal Gland
 Pancreas
 Ovaries (in female only)
 Testes (in male only)

6. PITUITARY GLAND

7. PITUITARY GLAND
The pituitary gland is no smaller than a pea in size.The pituitary gland is
located in the sella turcica of the sphenoid bone.The pituitary stalk
attaches the pituitary gland to the hypothalamus.

8. TYPES
It consists of two glands
• Anterior pituitary gland –adenohypophysis
• Posterior pituitary gland –neurohypophysis

9. HORMONES OF PITUITARY GLANDS
HORMONES OF ANTERIOR PITUITARY GLANDS
 Growth hormone-It stimulates the
synthesis of protein, RNA, DNA .It
promotes amino acid entry into cells.
 Thyroid stimulating hormone-many actions
on thyroid hormone.
 Adrenocorticotropic Hormone-necessary
for activity of adrenal cortex.
 Follicle Stimulating Hormone-cause
secretion of estrogen.
 Luteinizing Hormone-responsible for
ovulation.
 Prolactin-for production and secretion of
milk

10. HORMONES OF POSTERIOR PITUITARY GLANDS
 Oxytocin hormone-It causes ejection of
milk from the mammary glands.Oxytocin
causes contraction of uterus
 Antidiuretic hormone (ADH)-is responsible
for regulating the body's retention of water

11. THYROID GLAND

12. THYROID GLAND
The thyroid gland is located in the neck just inferior to the larynx.

13. HORMONES OF THYROID GLANDS
 Tri-iodothyronine (T3)-great effect on cell
metabolism.
 Tetraiodothyronine (T4)-great effect on
cell metabolism.
 Calcitonin-lower calcium concentration in
the blood.

14. PARATHYROID GLANDS

15. PARATHYROID GLANDS
Small glands found on the back of the thyroid gland. There are usually
four of these glands.

16. HORMONES OF PARATHYROID GLANDS
 Parathyroid Hormone(PTH)-increases Ca+ concentration in
the blood.

17. ADRENAL GLANDS

18. ADRENAL GLANDS
The adrenal glands are located on the top of each kidney.

19. COMPOSITION
 The are composed of two glands :
• Adrenal Cortex
• Adrenal Medulla

20. HORMONES OF ADRENAL GLAND
 Corticosteroids-act on minerals,anti-inflammatory effects,increase
blood glucose.
 Catecholamines-increases heart rate and cardiac output

21. PANCREATIC ISLETS

22. PANCREATIC ISLETS
 Glands are small clumps of cells scattered among the exocrine
pancreatic cells.

23. COMPOSITION OF PANCREATIC ISLETS
 Alpha cells (A cells)
 Beta cells (B cells)
 Delta cells (δ cells)

24. HORMONE OF PANCREAS
 Alpha cells ( A cells ) secrete glucagon-
Glucagon accelerates
glycogenolysis in the liver.Increase blood
glucose
 Beta cells ( B cells ) secrete insulin-
decreases blood glucose levels.
 Delta (δ) cells secrete Somatostatin-Inhibits
secretion of insulin & glucagon

25. OVARIES

26. OVARIES
 Small, egg-shaped glands located in the pelvic cavity
 Function as part of both the female reproductive system and the
endocrine system

27. HORMONES OF OVARY GLAND
 Estrogen hormone-enlargement of uterus,prepare breast for
lactation,development of secondary characters,increase osteoblast
activity.
 Progesterone hormone-inhibit the release of LH,preparation of uterus
for pregnancy and breast for lactation.

28. TESTES

29. TESTES
 Male genital glands, located outside the body in the scrotum

30. HORMONES OF TESTIS
 Testosterone hormone-It is responsible for the proper development
of male sexual characteristics adequate levels of red blood cells,
bone growth .
 Dihydrotestosterone hormone

31. PINEAL GLAND

32. PINEAL GLAND
 Located between the two lobes of the thalamus

33. HORMONES OF PINEAL GLAND
 Melatonin – regulates onset of puberty and menstrual cycle.

34. THYMUS GLAND

35. THYMUS GLAND
 A pink gland with two lobes located in the thoracic cavity posterior to
the sternum
 Large during childhood and puberty but shrinks during adulthood

36. HORMONES OF THYMUS GLAND
 Thymosin-for development and function of immune system.

37. HISTORY TAKING &
CLINICAL EXAMINATION

38. HISTORY

39. HISTORY
A full patient history should be taken
 PASTMEDICALHISTORY
 DRUGHISTORY
 FAMILYHISTORY

40. PAST MEDICAL HISTORY
 Any previous thyroid or parathyroid
surgery
 Any previous iodide131 (radioiodide)
treatment
 Hypertension
 Any previous pituitary or adrenal surgery
 Gestational diabetes

41. DRUG HISTORY
 A detailed medication history should be taken.
Remember to ask especially about the following:
a. Hormonal treatments—including oral
contraceptive pill, and local and systemic steroids
b. Lithium
c. Herbal or other alternative remedies

42. FAMILY HISTORY
Ask especially about family history of the following:-
 Type 2 diabetes
 Related autoimmune disorders
 Pernicious anemia
 Addison’s disease
 Thyroid disease
 Type 1 diabetes

43. GENERAL EXAMINATION

44. GENERAL EXAMINATION
 In general examination, an endocrine examination is focused—
looking for signs to confirm differential diagnosis that you have
developed during history-taking or examining the function of one or
more specific glands

45. HANDS AND ARMS
 We will Check
 Size
 Subcutaneous tissue
 Length of the metacarpals
 Nails
 Palmar erythema
 Sweating
 Tremor
 Skin thickness (thin skin in Cushing’s, thick skin in acromegaly)

46. AXILLAE
In axillae,we will note
 Any skin tags
 Loss of hair
 Abnormal pigmentation

47. FACE AND MOUTH
 On the face we will note
 Acne
 Enlargement of the chin
(macrognathism)
 In the mouth,we will see
 Buccal pigmentation
 Tongue enlargement (macroglossia)

48. NECK
On neck we will note
 any swellings or lymphadenopathy
 Examine the thyroid.
 Palpate the supraclavicular regions &
note any excessive soft tissue

49. CHEST
We will Inspect for
 Any hair excess or loss
 Breast size in females
 Gynecomastia in males
 Nipple color
 Pigmentation

50. ABDOMEN
We will inspect for abdomen for
 Obesity
 Organomegaly

51. LEGS
We inspect legs to see
 Muscle weakness
 Any diabetes-related changes

52. SYSTEMIC EXAMINATION

53. SYSTEMIC EXAMINATION
 Inspection
 Palpation
 Percussion
 Auscultation

54. INSPECTION
 Inspectionof breast
 Degree of enlargement of male breast in gynaecomastia
 Female breast may be atrophied in virilization.
 Inspectionof externalgenitalia
 Male
– Penile length
– Scrotal apperance
Female
– Clitoromegaly
– Pubic hair
 Inspectionof thyroid
Shape, size, surface,margin, skin over swelling,Any visible pulsation

55. PALPATION
 Palpation of breast
• Enlargement of male breast & its degree of
enlargement.
• Any nodule, lump
 Palpation of external genitalia
• Stretched penile length
• Approximate volume of testes & consistency
 Palpation of thyroid
 Temperature
 Tenderness
 Position & extent of swelling

56. PERCUSSION & AUSCULTATION
 Percussion over manubrium sterni for evaluation of retro-sternal
prolongation thyroid swelling
 Any bruit over thyroid audible or not

57. DISORDERS OF ENDOCRINE

58. HYPOTHYROIDISM
 Causes
These include
 Dietary iodine deficiency
 Autoimmune thyroiditis radioactive iodine treatment
 Surgical thyroid injury
 Pituitary adenoma
 Sign & Symptoms
It include tiredness
 weight gain
 Anorexia
 brittle hair
 dry skin muscle weakness
 Constipation
 A croaking voice

59. HYPERTHYROIDISM
 Causes
These include
 Chronic thyroiditis
 Bacterial thyroiditis
 postviral thyroiditis
 Toxic multinodular goitre
 Malignancy
 Symptoms & Sign
these include
 weight loss
 Irritability
 Restlessness
 Muscle weakness
 sweating
 Vomiting
 Irritability and weight loss can occur

60. POLYCYSTIC OVARIAN SYNDROME (PCOS)
 Causes
PCOS is caused by abnormal metabolism of androgens and
estrogen with abnormal control of androgen production.
 Symptoms & Sign
These include
 Oligomenorrhea
 Infertility
 Obesity (50%)

61. CUSHING’S SYNDROME
 Causes
Causes include high ACTH production from
a pituitary adenoma.
 Symptoms & Sign
These include
 menstrual disturbance
 excessive hair growth
 muscle weakness
 moon face
 thinning of skin
 skin infections
 hyperpigmentation (if raised ACTH)

62. ACROMEGALY
 Causes
due to GHRH excess
 Symptoms & Sign
These include
 headache
 change in appearance,
 enlarged extremities
 Tiredness
 Erectile dysfunction
 dysmennorrhea

63. ADDISON’S DISEASE
 Causes
These include
1. autoimmune adrenalitis
2. Bilateral adrenalectomy
3. HIV
 Symptoms & Sign
 Anorexia
 weight loss
 tiredness
 erectile dysfunction
 Amenorrhea
 skin pigmentation
 low-grade fever
 dehydration

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