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MindMap Gallery 15. Endocrine system diseases mind map
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15. Endocrine system diseases mind map
This is a mind map about 15. Endocrine system diseases, including thyroid disease, adrenal disease, pituitary disease, diffuse neuroendocrine disease, etc.
Edited at 2023-11-13 09:09:24
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15. Endocrine system diseases
Pituitary disease
Thyroid disease
Diffuse nontoxic goiter
definition
Also called simple goiter. This disease often has a geographical distribution and is also called endemic goiter.
Often due to insufficient thyroid hormone secretion due to iodine deficiency, increased secretion of thyrotropin TSH, thyroid follicular epithelial hyperplasia, and accumulation of colloid in the follicles lead to goiter. Some patients may develop difficulty swallowing and breathing later. A few patients have symptoms such as hyperthyroidism or hypothyroidism.
Pathological changes
proliferative phase
Also known as diffuse hyperplastic goiter.
To the naked eye, the thyroid gland is diffusely symmetrical and moderately enlarged, generally no more than 150g (normal is 20-40g), and has a smooth surface.
Under a light microscope, the follicular epithelial proliferation is cubic or low columnar, accompanied by the formation of small follicles, less colloid, and interstitial congestion.
colloid storage period
Also called diffuse colloid goiter. And long-term sustained iodine deficiency, a large amount of colloid accumulation
To the naked eye, the thyroid gland is diffusely symmetrically enlarged and weighs 200-300g. The surface is smooth, and the cut surface is light yellow or tan, translucent jelly-like.
Under a light microscope, the follicles were found to be of varying sizes, and most of the follicle epithelium was involution and flattened. The follicular cavity is highly enlarged, and a large amount of colloid is accumulated in the cavity, but epithelial hyperplasia of some small follicles and papilla formation can still be seen.
nodular stage
Also called nodular goiter. In the later stages of the disease, the follicular epithelium is focally hyperplasia, involution or atrophy is inconsistent, unevenly distributed, and nodules are formed.
To the naked eye, the thyroid gland is enlarged in an asymmetric nodular shape, with multiple nodules of varying sizes, and some nodules have clear boundaries. There is often no complete capsule. Hemorrhage, necrosis, cystic degeneration, calcification, and scar formation are common in nodule sections.
Under the microscope, part of the follicular epithelium showed columnar or papillary hyperplasia, the formation of small follicles, part of the epithelium involution or atrophy, glial accumulation, interstitial fibrous tissue proliferation, and septal encirclement, forming nodular lesions of varying sizes.
Etiology and pathogenesis
Iodine deficiency
If iodine deficiency persists for a long time, on the one hand, the follicular epithelium will proliferate, and on the other hand, the thyroglobulin synthesized will not be iodized and cannot be absorbed and utilized by epithelial cells. When the follicular cavity is filled with colloid, the thyroid gland becomes enlarged.
Role of goitrogenic factors.
Large amounts of calcium and fluoride in drinking water can cause goiter.
Cabbage, cassava, etc. can cause goitre.
Hydrosulfide and perchlorate prevent the accumulation of iodine into the thyroid gland.
Thioureas, sulfonamides, lithium, cobalt and perchlorate. Inhibits the concentration of iodide ions or the organicization of iodide ions.
High iodine
Due to excessive iodine intake, the organicization process of iodine is blocked, and the thyroid gland becomes compensatory enlargement.
Heredity and Immunity.
Familial goiter is caused by an inherited deficiency of enzymes involved in hormone synthesis.
diffuse toxic goiter
definition
It refers to a clinical syndrome caused by excessive thyroid hormone in the blood, which acts on various tissues throughout the body. Clinically, it is collectively referred to as hyperthyroidism. Because about 1/3 of patients have exophthalmos, it is also called exophthalmic goiter. (After the symptoms of hyperthyroidism are controlled, the symptoms of exophthalmos will not disappear.) It is often accompanied by decreased secretion of thyroid stimulating hormone (TSH).
The main clinical manifestations are: goiter, increased basal metabolic rate and nerve excitability, such as palpitations, sweating, irritability, rapid pulse, hand tremor, polyphagia, weight loss, fatigue, exophthalmos, etc. Blood T3 and T4 are high, and the iodine absorption rate is high. It is more common in women, between the ages of 20 and 40.
Pathological changes
Macroscopically, the diseased thyroid gland is diffusely and symmetrically enlarged, 2 to 4 times the normal size. The surface is smooth, the blood vessels are congested, and the texture is soft. The cut surface is gray-red and lobulated, with little colloid, no nodules, and the texture is as solid as muscle.
under the mirror
The follicular epithelium was tall columnar, some showed papillary hyperplasia, and follicular epithelium was formed.
The colloid in the follicle cavity is thin, and epithelial cell absorption vacuoles of different sizes appear in the colloid surrounding the follicle.
The interstitial blood vessels are abundant and congested, and lymphoid tissue proliferates.
Immunofluorescence
There is IgG deposition on the follicular basement membrane.
Iodine treatment is required before surgery. After treatment, all previous lesions are reduced.
Causes and pathogenesis.
Autoimmune diseases.
genetic factors.
It can also be caused by mental trauma that interferes with the immune system and promotes the occurrence of autoimmune diseases.
Thyroid tumors
Thyroid adenoma.
definition
Thyroid adenoma is a common benign tumor arising from the thyroid follicular epithelium. It is common in young and middle-aged women, grows slowly, and moves up and down with swallowing activities.
To the naked eye, they are mostly single, round, with a complete capsule, often compressing surrounding tissues, and are generally 3 to 5 cm in diameter. The cut surface is mostly solid and dark red or brown in color. Hemorrhage, cystic changes, fibrosis, and calcification may occur.
Simple adenoma.
The capsule is complete, the tumors are uniform in size, crowded, and contain colloid. Follicular composition similar to normal adult thyroid follicles.
Colloidal tumor.
The tumor is composed of large follicles or follicles of different sizes. The follicles are filled with colloid and can fuse with each other to form a cystic shape.
Fetal adenoma.
Embryonal adenoma.
Oncocytic adenoma.
Atypical adenoma.
Diagnosis and differential diagnosis of nodular goiter and thyroid adenoma.
The former is often multiple and without complete capsule. The latter is usually single and completely enveloped.
In the former, the follicles vary in size and are generally larger than normal, while in the latter, the follicles and follicular epithelium are more consistent in size.
In the former, there is no compression of the surrounding thyroid tissue, but there are similar lesions in the adjacent thyroid gland and in the nodule; in the latter, there is compression of the surrounding thyroid tissue, but the adjacent thyroid tissue is normal.
Thyroid cancer. (Histological classification is related to prognosis.)
Papillary carcinoma.
definition
Accounting for 60% of thyroid cancers, it is more common in adolescent women (the most common), grows slowly, has low malignancy, and has a good prognosis (the best prognosis). The ten-year survival rate is over 80% (the survival rate has nothing to do with whether local lymph node metastasis occurs.), but local lymph node metastasis occurs earlier.
naked eye view
Tumors are generally spherical, about three centimeters in diameter, unencapsulated, gray-white in section, and hard in texture. In some cases, cysts are formed, and nipples can be seen in the cysts, which is also called papillary cystadenoma.
under the mirror
The nipple has many branches, and there is a fibrovascular interstitium in the center of the nipple. Concentric calcified bodies, namely psammoma bodies, with infiltration are common in the interstitium, which is helpful for diagnosis.
The papillary epithelium is often single-layered. Cancer cells have little chromatin and are often transparent and ground glass-like. They have no nucleoli, nuclear grooves, pseudo-inclusions in the nucleus, and overlapping nuclei. The cancer diameter is less than one centimeter, which is called microcarcinoma.
Follicular carcinoma.
It is a malignant tumor formed by the differentiation of thyroid gland into follicles. The prognosis is often worse than that of papillary carcinoma, accounting for 20% to 25% of thyroid cancers. It is more common in women over 40 years old and often metastasizes to blood vessels.
naked eye
It is nodular and has a capsule, but the blood vessels and capsule are infiltrated under light microscopy; some pathologically the capsule is incomplete and infiltrates the surrounding thyroid tissue, and the cut surface is gray and white and soft.
under the mirror
Follicular carcinoma that is well differentiated is difficult to distinguish from adenoma. Multiple sections of the tumor and capsule need to be taken, especially to identify whether there is capsular and vascular invasion.
Poorly differentiated tumors are in the form of solid nests, with significant atypia of tumor cells, few follicles, and low colloid content.
Medullary carcinoma.
Accounting for 5% to 10% of thyroid cancers, it is a malignant tumor arising from parafollicular cells and is an APUD tumor (APUD tumor refers to a tumor occurring in diffuse neuroendocrine cells). The tumor secretes calcitonin, producing severe diarrhea and hypocalcemia.
naked eye
Single or multiple hairs, may have a false capsule, 1 to 11 cm in diameter, grayish white or yellowish brown in section, solid and soft in texture.
under the mirror
Tumor cells are round, polygonal or spindle-shaped. The nucleus is round, the nucleolus is inconspicuous, and mitotic figures are rare. Cancer tissue is formed into solid sheets, nested or papillary, and there is often amyloid deposition in the stroma, which may be related to the secretion of calcitonin.
Electron microscopy
There are neuroendocrine granules of relatively uniform size in the cytoplasm.
Undifferentiated carcinoma.
Accounting for 5% to 10% of thyroid cancers, it is also called anaplastic cancer or sarcomatoid cancer and is more common in women over 50 years old.
It grows quickly, can infiltrate and metastasize at an early stage, has a high degree of malignancy and a poor prognosis.
naked eye
The tumor is large, unencapsulated, often infiltrated, the cut surface is gray, and there is often hemorrhage and necrosis.
under the mirror
Cancer cells vary in size and shape and have many mitoses.
Adrenal gland disease
islet disease
diffuse neuroendocrine disease