Chapter 5
Pathophysiology of endocrine system
5.1 Types of endocrine disor-
ders
Endocrine disorders can be classied according to
the intensity of hormonal activity and according to
the place of endocrine disorder origin. From the
point of view of intensity of hormonal activity of en-
docrine gland we can distinguish:
1. Hyperfunction of endocrine gland, which is
characterized by increased secretion of its hor-
mone (hormones) as well as by increased con-
centration of this hormone (these hormones) in
circulating blood.
2. Hypofunction of endocrine gland, which is char-
acterized by decreased secretion of its hormone
(hormones) as well as by decreased concentra-
tion of this hormone (these hormones) in circu-
lating blood.
If endocrine gland produces several kinds of hor-
mones (e.g.,adenohypophysis) the symptoms re-
sulting from hyperproduction or hypoproduc-
tion of more kinds of hormones may develop,
respectively, at the same time the symptoms of
hyperfunction resulting from overproduction of
one kind of hormones and the symptoms of hy-
pofunction due to a deciency of other kind of
hormones can develop.
3. Eufunction of endocrine gland, which is in the
time of medical examination characterized by
normal secretion of its hormone (hormones) as
well as by normal concentration of this hormone
(these hormones) in circulating blood. Some-
times, however, other symptoms referring to ex-
istence of eufunctional endocrine syndrome can
be present.
According to the place of endocrine disorder ori-
gin, the following types of endocrine disorders can be
distinguished:
1. In endocrine glands regulated by the hypothala-
mic-pituitary system the following disorders can de-
velop:
A. Primary (peripheral) hypofunction or hyper-
function. The cause of the disorder of hor-
monal secretion is in peripheral (target) en-
docrine gland.
B. Secondary (central adenohypophyseal) hypo-
function or hyperfunction. The cause of the
disorder of hormonal secretion of peripheral en-
docrine gland is in the adenohypophysis (the an-
terior pituitary).
C. Tertiary (central hypothalamic) hypofunction
or hyperfunction. The cause of the hormonal
secretion disorder of peripheral endocrine gland
is in the hypothalamus.
2. The cause of the origin of primary hyperfunction
or hypofunction of those endocrine glands, which
are not regulated by the hypothalamic-pituitary
system, is also in the endocrine glands them-
selves, but their secondary hyperfunction is caused
by extra-glandular (non-hormonal) stimulus, e.g.,
secondary hyperaldosteronism or secondary hyper-
parathyreoidism.
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5.2. Etiology of endocrine disorders 309
3. Some hormones can be produced also in the
cells of organs which do not belong to the glands
of internal secretion. It is an ectopic production of
hormones, which is autonomous and causes the ori-
gin of ectopicly conditioned endocrine hyperfunction
(ectopic endocrine syndrome). As a rule it is the
consequence of production of hormones from non-
endocrine neoplastic tissue, and, therefore, this clin-
ical syndrome is also called paraneoplastic endocrine
syndrome (paraneoplastic endocrinopathy).
4. In unique cases, an endocrine disorder can arise
in the consequence of a defect of hormonal transport
from the place of its origin to the place of its action.
This disorder is caused by deciency or by abundance
of a plasma transport protein for the hormone or it is
due to the defect of hormone binding to the specic
carrier protein.
5. The endocrine disorder can also originate as the
consequence of a defect in target tissue for the hor-
mone or in the place of hormone degradation. This
endocrine disorder can be due to:
A. A change of number or function (structure) of
receptors for individual hormones.
B. A presence of antibodies against receptors for
individual hormones.
C. A defect on the level of postreceptor eector
mechanisms for individual hormones.
D. An accelerated or slowed conversion of prohor-
mone to active hormone.
E. A defect of inactivation (degradation) of hor-
mone in peripheral tissues.
The above mentioned defects on the level of target
(peripheral) tissues are called pseudohypofunctional
or pseudohyperfunctional endocrine disorders (pseu-
doendocrinopathies).
6. Adenomas or carcinomas originated from the cells
of disperse endocrine system, known as Amine Pre-
cursor Uptake and Decarboxylation (APUD) system,
are called multiple endocrine neoplasia (MEN). Ade-
nomas or carcinomas can be found in several en-
docrine glands or other endocrine structures. They
are typical familial diseases with autosomal domi-
nant type of heredity.
The common characteristic of the APUD cells is
ability of secretion of polypeptide hormones with lo-
cal or general eects, in less extent also ability of se-
cretion of biogenic amines, and in special cases also
ability to produce prostaglandins and kinins. A neo-
plasm of the APUD system (apudoma) can produce
not only larger amount of hormone, but usually also
more kinds of hormones which cause a variety of the
clinical picture of this disease.
5.2 Etiology of endocrine dis-
orders
The causes of endocrine disorders can be acquired
or genetic.
1. Acquired causes
A. Tumors of endocrine glands. Adenomas
(benign neoplasms) are one of the main
causes of hyperfunctional endocrine syn-
drome. They occur more frequently than
malignant neoplasms. Adenomas may also
cause combinated endocrine disorder char-
acterized by the excess of one hormone
and by the deciency of other hormones
(e.g., adenoma arising from one type of
cells of adenohypophysis causes destruc-
tion of other types of its cells). Malig-
nant neoplasms of endocrine glands are less
frequent. The production of hormones by
malignant tumors depends on the degree
of dierentiation of their cells. If the cells
are insuciently dierentiated they usually
lose their hormonal activity.
B. Inammatory lesions of endocrine glands.
There are a very frequent cause of hypo-
functional endocrine syndromes. Etiologi-
cal factor of these lesions may be autoim-
mune process or viral and bacterial infec-
tion.
C. Disorders of nutrition. The most fre-
quent cause is the deciency of iodium
needed for the synthesis of thyroid hor-
mones. The increased strumigene intake
