Advertising on the portal

Methods for studying the endocrine system. Methods for studying the endocrine glands - abstract

To make this lecture easier to understand, let us briefly recall anatomical and physiological data on the endocrine system. To make this lecture easier to understand, let us recall some brief anatomical and physiological data on the endocrine system. The endocrine system is the system that releases hormones into the blood. "Hormones" - chemicals, secreted into the blood vessels or lymphatic vessels and having different effects on target organs. The endocrine system is the system that releases hormones into the blood. “Hormones” are chemical substances secreted into the blood or lymphatic vessels and have various effects on target organs. Back in the middle of the twentieth century, it mainly included clearly organized morphological formations called glands. Back in the middle of the twentieth century, it mainly included clearly organized morphological formations called glands. By now this concept has become much broader. It turned out that many other organs and tissues have endocrine functions. By now this concept has become much broader. It turned out that many other organs and tissues have endocrine functions.


For example, one of these places turned out to be the hypothalamus. It turned out that the hypothalamus secretes: thyroliberin, luliberin, corticoliberin, prolactoliberin, folliculoliberin, somatoliberin, melanocytoliberin, luteostatin, melanocytostatin, which regulate the functioning of the pituitary gland. It turned out that the hypothalamus secretes: thyroliberin, luliberin, corticoliberin, prolactoliberin, in, somatoliberin, melanocytoliberin, luteostatin, melanocytostatin, which regulate the functioning of the pituitary gland


The liver secretes angiotensin. Kidneys – erythropotin and renin. Stomach – gastrin, somatostatin. The liver secretes angiotensin. Kidneys – erythropotin and renin. Stomach – gastrin, somatostatin. 12 ring and small intestine– motilin, secretin, cholecystokinin-pancreozymin, somatostatin. Cardiac atria and brain - atrial and brain natriuric peptides, respectively. Connective tissue and cells of mesenchymal origin - somatomedins. Duodenum and small intestine – motilin, secretin, cholecystokinin-pancreozymin, somatostatin. Cardiac atria and brain - atrial and brain natriuric peptides, respectively. Connective tissue and cells of mesenchymal origin are somatomedins. Adipose tissue– leptin, adiponectin, etc. Adipose tissue – leptin, adiponectin, etc.


In our subject it is not possible to analyze in detail all these hormones and their actions. But this information must be remembered once and for all: the endocrine system is not only glands internal secretion. However, here and today we are forced to talk specifically about the endocrine glands and their functions. In our subject it is not possible to analyze in detail all these hormones and their actions. But this information must be remembered once and for all: the endocrine system is not only the endocrine glands. However, here and today we are forced to talk specifically about the endocrine glands and their functions.


The system of endocrine glands is scattered throughout the body (Fig.) The system of endocrine glands is scattered throughout the body (Fig.) 1. Pituitary gland. 2. Thyroid gland. 3; 4 and 7. Adrenal glands. 5. Sex glands. 6. Pancreas. 8. Thymus ( thymus) 9. Parathyroid glands. 10. Epiphysis. Let's briefly look at their morphology and functions.


The pineal gland secretes the hormone melatonin, which activates the division of pigment cells in the skin and has an antigonadotropic effect. The pineal gland secretes the hormone melatonin, which activates the division of pigment cells in the skin and has an antigonadotropic effect. The pituitary gland consists of an anterior - adenohypophysis and posterior - neurohypophysis and intermediate parts (lobes). The pituitary gland consists of an anterior - adenohypophysis and posterior - neurohypophysis and intermediate parts (lobes). The anterior lobe of the pituitary gland produces somatotropin - growth hormone; gonadotropic hormones that stimulate male and female sex glands; lactogenic hormone that supports the secretion of estrogen and progesterone by the ovaries; lactogenic hormone that supports the secretion of estrogen and progesterone by the ovaries; ACTH, which stimulates the production of adrenal hormones; TSH, which regulates work thyroid gland The posterior lobe of the pituitary gland contains two hormones: oxytocin, which regulates labor and secretion of the mammary glands and oxytocin, which regulates labor and secretion of the mammary glands, and vasopressin or antidiuretic hormone, which mainly regulates the reabsorption of water from renal tubules, The intermediate part is the hormone intermedin, which regulates pigment metabolism in the integumentary tissues.


THE THREAT GLAND produces thyroxine (T4) and triiodothyronine (T3), which regulate general exchange substances in the body that influence the formation of the skeleton, accelerate bone growth and ossification of epiphyseal cartilage; calcitonin, which regulates the metabolism of calcium and phosphorus. Its functions are studied by determining these hormones.


The parathyroid glands regulate the metabolism of calcium and phosphorus. Removing the parathyroid glands causes seizures and can lead to death. The parathyroid glands regulate the metabolism of calcium and phosphorus. Removing the parathyroid glands causes seizures and can lead to death. Thymus (the thymus gland is the most important body immunological defense of the body. It ensures differentiation and proliferation of bone marrow stem cells; produces the enzyme thymosin, which ensures the immunological competence of lymphocytes throughout the body. Formed in bone marrow T-lymphocytes enter the thymus and, under the influence of thymosin, become differentiated, immunologically competent and become the main mediators cellular immunity The thymus (the thymus gland is the most important organ of the body’s immunological defense. It ensures the differentiation and proliferation of bone marrow stem cells; produces the enzyme thymosin, which ensures the immunological competence of lymphocytes throughout the body. T-lymphocytes formed in the bone marrow enter the thymus and, under the influence of thymosin, become differentiated, immunologically competent and become the main mediators of cellular immunity


The adrenal glands consist of two layers - the cortex and the medulla The adrenal glands consist of two layers - the cortex and the medulla The medulla produces two hormones - the mediator of the sympathetic nervous system- adrenaline and norepinephrine. They increase the contractility and excitability of the heart, constrict the blood vessels of the skin, and increase blood pressure.. The medulla produces two hormones - mediators of the sympathetic nervous system - adrenaline and norepinephrine. They increase the contractility and excitability of the heart, constrict the blood vessels of the skin, and increase blood pressure. The cortex is an extremely important formation of the human body. It produces about 30 different hormones that regulate the concentration of sodium, potassium and chlorine in the blood and tissues, carbohydrate, protein and fat metabolism, as well as the production of sex hormones. The cortex is an extremely important formation of the human body. It produces about 30 different hormones that regulate the concentration of sodium, potassium and chlorine in the blood and tissues, carbohydrate, protein and fat metabolism, as well as the production of sex hormones


The pancreas is an organ that has both exocrine and endocrine functions. The exocrine function was discussed in the section on diseases of the digestive system. Endocrine function is provided by special cells collected in small islands (islets of Langerhans), which are embedded in the gland tissue throughout its entire volume. They produce the hormone insulin. Insulin mainly regulates water exchange– glucose consumption various systems body, ensuring the transfer of glucose from the blood into the cell.


Let us now consider the issues of the norm of hormones secreted by these glands. Here, unfortunately, we must immediately make a reservation that in various sources in Russia you can find significantly different normal values ​​of these hormones, which depends on the lack of standardization of research methods and on the chaos that exists today place in this country. Even if there were uniform standards in Russia, no one is going to adhere to them - everyone uses the method that is easier for them to implement or that they like best. However, we must outline approximate standards for you, and you should know them. As mentioned above, the anterior lobe of the pituitary gland secretes a significant amount of a wide variety of hormones. As mentioned above, the anterior lobe of the pituitary gland secretes a significant amount of a wide variety of hormones.


The fasting GH level is 8 ng/ml. As is known, overproduction of this hormone can be observed in cases of gigantism or acromegaly, and hypoproduction in cases of pituitary dwarfism, which we discussed in the lecture “Questioning, examination...with endocrine diseases» Fasting GH level is 8 ng/ml. As is known, overproduction of this hormone can be observed with gigantism or acromegaly, and underproduction can be observed with pituitary dwarfism, which we discussed in the lecture “Question, examination... for endocrine diseases” TSH is 0.45 - 6.2 µIU/ml. Thyroid-stimulating hormone regulates the function of the thyroid gland, and its overproduction can lead to hyperthyroidism, and decreased production can lead to myxedema. TSH is 0.45 - 6.2 µIU/ml. Thyroid-stimulating hormone regulates the function of the thyroid gland, and its overproduction can lead to hyperthyroidism, and decreased production can lead to myxedema


ACTH – (on an empty stomach, at 8 o’clock in the morning, in the supine position) -


The delusion gets me everywhere - the nonsense of newspapers, television, radio. The shelling is nonsense: it's a short flight, but it always hits and wounds. It’s impossible to interrupt this nonsense, It’s impossible to interrupt this nonsense, You can’t cover yourself from it with earplugs... You can’t cover it up with earplugs... Some people create troubles from victories, Some people create troubles from victories, And sells lost souls And sells lost souls And others, to block the op , And others, in order to block the shouting, So that they are finally heard, Show hysterical agility Even in church in prayers to the Almighty.


The PL level in men is 2–12 ng/ml, in women 2–20 ng/ml. The PL level in men is 2–12 ng/ml, in women 2–20 ng/ml. ADH level in the blood is 29 ng/ml. The level of ADH in the blood is 29 ng/ml. Great help in the diagnosis of diseases of the pituitary gland, targeted radiography of the “sella turcica” and especially nuclear magnetic resonance (NMR) studies and computed tomography. Targeted radiography of the sella turcica and especially nuclear magnetic resonance (NMR) studies and computed tomography are of great help in diagnosing diseases of the pituitary gland. These methods make it possible to detect pituitary tumors up to 0.2 cm in diameter (microadenomas) with 97% confidence. These methods make it possible to detect pituitary tumors up to 0.2 cm in diameter (microadenomas) with 97% confidence.


Pancreas Main methods of study endocrine function pancreas is direct definition levels of insulin and glucagon in the blood. The main methods for studying the endocrine function of the pancreas are the direct determination of the levels of insulin and glucagon in the blood. However, these methods have not yet entered into widespread practice. The most widely used methods for indirectly studying the insulin-producing function of the pancreas are the determination of glucose in the blood and urine and the glucose tolerance test.


Blood glucose is determined on an empty stomach. The normal level is fluctuating from 3.33 to 5.5 (according to some methods up to 6.105) mmol/l. Blood glucose is determined on an empty stomach. The normal level is fluctuating from 3.33 to 5.5 (according to some methods up to 6.105) mmol/l. An increase in blood glucose levels is called hyperglycemia. An increase in blood glucose levels is called hyperglycemia. This figure is almost reliable sign availability diabetes mellitus in humans (it should be remembered that hyperglycemia can also have other origins). This indicator is an almost reliable sign of the presence of diabetes mellitus in a person (it should be remembered that hyperglycemia can also have other origins). A decrease in blood glucose levels, which is called hypoglycemia, may also occur. This condition can occur both with diabetes mellitus and with a number of diseases, which may be based on tumors or damage to the endocrine glands of another order. A decrease in blood glucose levels, which is called hypoglycemia, may also occur. This condition can occur both with diabetes mellitus and with a number of diseases, which may be based on tumors or damage to the endocrine glands of another order.


Determination of glucose (sugar) in urine is usually carried out in a daily volume of urine. Normally, there is no glucose in the urine. Its appearance is called glycosuria and is a serious sign of diabetes mellitus, although sometimes it can occur after heavy consumption of sweet foods and rare disease – renal diabetes. Determination of glucose (sugar) in urine is usually carried out in a daily volume of urine. Normally, there is no glucose in the urine. Its appearance is called glycosuria and is a serious sign of diabetes mellitus, although sometimes it can occur after heavy consumption of sweet foods and a rare disease - renal diabetes. Glucose tolerance test. In many people, diabetes occurs hidden, latently (the so-called impaired glucose tolerance). These people may have minor stigmata of diabetes that are not confirmed by routine urine and blood tests. To clarify the diagnosis in these cases, this test was developed. Glucose tolerance test. In many people, diabetes occurs hidden, latently (the so-called impaired glucose tolerance). These people may have minor stigmata of diabetes that are not confirmed by routine urine and blood tests. To clarify the diagnosis in these cases, this test was developed.


Typically, the test is performed as follows: the subject is taken to test blood for glucose on an empty stomach, then given 75 g (or, more precisely, 50 g per m2 of body area) of glucose dissolved in ml of water to drink, and the blood is tested for glucose every 30 minutes for the next 3 h. Usually the test is performed as follows: the subject is taken to test blood for glucose on an empty stomach, then given 75 g (or, more precisely, 50 g per m2 of body area) of glucose dissolved in ml of water to drink, and the blood is tested for glucose every 30 minutes for the next 3 hours. Interpretation of the results: in a healthy person, the rise in glucose level after 1 hour does not exceed 80% of the initial level, by 2 hours it drops to normal and by 2.5 hours it may fall below normal. Interpretation of the results: in a healthy person, the rise in glucose levels after 1 hour does not exceed 80% of the initial level, by 2 hours it drops to normal, and by 2.5 hours it may fall below normal. In patients, the maximum rise is observed after 1 hour, reaching numbers above 80% of the initial value, and normalization is delayed for 3 hours or more. In patients, the maximum rise is observed after 1 hour, reaching numbers above 80% of the initial value, and normalization is delayed for 3 hours or more.


Thyroid gland Thyroid gland Methods for studying the functions and clinical morphology of the thyroid gland include determination of protein-bound iodine, the level of thyroid hormones, the shape and size of the gland. Methods for studying the functions and clinical morphology of the thyroid gland include determining protein-bound iodine, the level of thyroid hormones, and the shape and size of the gland. Determination of protein bound iodine (PBI) is one of the most important and precise methods studying the function of the gland. 90-95% of SBI consists of thyroxine, a thyroid hormone. Determination of protein-bound iodine (PBI) is one of the most important and accurate methods for studying gland function. 90-95% of SBI consists of thyroxine, a thyroid hormone. Normally, the SBI is 315.37 nmol/l. Normally, the SBI is 315.37 nmol/l. With thyrotoxicosis, its level is higher than 630.37 nmol/l, with hypothyroidism - less than 315.18 nmol/l. With thyrotoxicosis, its level is higher than 630.37 nmol/l, with hypothyroidism - less than 315.18 nmol/l.


Thyroxine (T4) and triiodothyronine (T3) are determined from the thyroid hormones. Approximate norms: T nmol / l, and T3 - 1.2 - 2.8 nmol / l. Thyroxine (T4) and triiodothyronine (T3) are determined from the thyroid hormones. Approximate norms: T nmol / l, and T3 - 1.2 - 2.8 nmol / l. At the same time, as a rule, the TSH level is determined, which, according to the same methods, is normally 0.17 - 4.05 nmol/l. At the same time, as a rule, the TSH level is determined, which, according to the same methods, is normally 0.17 - 4.05 nmol/l. One of the objective methods for studying the morphology and function of the thyroid gland is scanning using radioactive isotopes. The scanograms can outline the size of the thyroid gland, areas of hypo- and hyperfunction. One of the objective methods for studying the morphology and function of the thyroid gland is scanning using radioactive isotopes. The scanograms can outline the size of the thyroid gland, areas of hypo- and hyperfunction.


IN recent years It is widely used to examine the thyroid gland ultrasound examination(ultrasound). Ultrasound is currently the method of choice in determining the size of the thyroid gland and the presence of changes in its structure. In recent years, ultrasound examination (ultrasound) has been widely used to examine the thyroid gland. Ultrasound is currently the method of choice in determining the size of the thyroid gland and the presence of changes in its structure. A highly effective research method is CT, which allows you to study the size and structure, identify tumors or other changes in it. A highly effective research method is CT, which allows you to study the size and structure, identify tumors or other changes in it.


Adrenal glands ( cortex) To study the function of the adrenal cortex, aldosterone is determined in the urine, 17-hydroxycorticosteroids (17-OX) in the blood and urine, and neutral 17-ketosteroids (17-KS) in the urine. To study the function of the adrenal cortex, aldosterone is determined in the urine, 17-hydroxycorticosteroids (17-OX) in the blood and urine, and neutral 17-ketosteroids (17-KS) in the urine. Determination of aldosterone. It is believed that there is a direct proportional dependence between the amount of aldosterone in urine and mineralocorticoid activity of the adrenal cortex. Determination of aldosterone. It is believed that there is a directly proportional relationship between the amount of aldosterone in the urine and the mineralocorticoid activity of the adrenal cortex. U healthy people secreted from 8.34 to 41.7 nmol/day. aldosterone. In healthy people, 8.34 to 41.7 nmol/day is excreted. aldosterone. An increase in urinary aldosterone excretion can be observed with so-called primary and secondary hyperaldosteronism (adenoma or tumor or hyperfunction of the cortical layer). An increase in urinary aldosterone excretion can be observed with so-called primary and secondary hyperaldosteronism (adenoma or tumor or hyperfunction of the cortical layer).


The definition of 17-OX reflects the level of glucocorticosteroids in the blood. The definition of 17-OX reflects the level of glucocorticosteroids in the blood. Normally, 17-OX in the blood contains from 0.14 to 0.55 µmol/l. Normally, 17-OX in the blood contains from 0.14 to 0.55 µmol/l. A persistent increase in 17-ox levels is observed in adrenal tumors and in Itsenko-Cushing syndrome. A persistent increase in 17-ox levels is observed in adrenal tumors and in Itsenko-Cushing syndrome. A decrease in 17-OX is found with hypofunction of the adrenal cortex or insufficiency of the anterior pituitary gland. A decrease in 17-OX is found with hypofunction of the adrenal cortex or insufficiency of the anterior pituitary gland. Excretion of 17-OX in urine normally parallels changes in the blood. Excretion of 17-OX in urine normally parallels changes in the blood. Determination of cortisol in urine is considered even more specific for studying glucocorticosteroid function of the adrenal glands. Determination of cortisol in urine is considered even more specific for studying glucocorticosteroid function of the adrenal glands. Norm nmol/day. Norm nmol/day.


Definition 17-KS. Most of the 17-CS comes from androgens, so their determination allows us to make a judgment about the androgenic function of the adrenal cortex. Definition 17-KS. Most of the 17-CS comes from androgens, so their determination allows us to make a judgment about the androgenic function of the adrenal cortex. Normally, 27.7 - 79.7 µmol/day is excreted in men and 17.4 - 55.4 in women. Normally, 27.7 - 79.7 µmol/day is excreted in men and 17.4 - 55.4 in women. A decrease in the release of 17-KS is characteristic of adrenal insufficiency, an increase is characteristic of tumors. A decrease in the release of 17-KS is characteristic of adrenal insufficiency, an increase is characteristic of tumors. There are also methods for indirectly determining the functions of the adrenal cortex. These include the determination of sodium and potassium in blood and urine. There are also methods for indirectly determining the functions of the adrenal cortex. These include the determination of sodium and potassium in blood and urine.


It is known that in the regulation of electrolyte levels (especially sodium and potassium), the main role belongs to mineralocorticoids, in particular aldosterone, and to a lesser extent glucocorticoids. It is known that in the regulation of electrolyte levels (especially sodium and potassium), the main role belongs to mineralocorticoids, in particular aldosterone, and to a lesser extent glucocorticoids. In this regard, the level of sodium and potassium in the blood and their excretion in the urine will indirectly indicate the state of production of these hormones by the adrenal glands. In this regard, the level of sodium and potassium in the blood and their excretion in the urine will indirectly indicate the state of production of these hormones by the adrenal glands. Normally, sodium in the blood plasma contains mmol/l, and potassium - 3.8 - 4.6 mmol/l. Normally, sodium in the blood plasma contains mmol/l, and potassium - 3.8 - 4.6 mmol/l. Normally, mmol/day is excreted in urine. sodium and mmol/day. potassium Normally, mmol/day is excreted in urine. sodium and mmol/day. potassium In practice, determination in urine is carried out. In practice, determination in urine is rarely performed. rarely.


Adrenal glands (medulla) Studying the function of the adrenal medulla is most often resorted to when a tumor is suspected. To study the function of the adrenal medulla is most often resorted to when a tumor is suspected. 3 hormones are studied - adrenaline, norepinephrine, dopamine in the blood or plasma. 3 hormones are studied - adrenaline, norepinephrine, dopamine in the blood or plasma. Their level in plasma is equal to - adrenaline




The endocrine system, or internal secretion system, consists of endocrine glands, so named because they secrete specific products of their activity - hormones - directly into internal environment body, into the blood. There are eight of these glands in the body: thyroid, parathyroid or parathyroid, goiter (thymus), pituitary gland, pineal gland (or pineal gland), adrenal glands (adrenal glands), pancreas and gonads (Fig. 67).

General function endocrine system comes down to the implementation chemical regulation in the body, establishing connections between its organs and systems and maintaining their functions at a certain level.

Hormones of the endocrine glands are substances with very high biological activity, that is, they act in very small doses. Together with enzymes and vitamins, they belong to the so-called biocatalysts. In addition, hormones have a specific effect - some of them influence certain organs, others control certain processes in the tissues of the body.

Endocrine glands participate in the process of growth and development of the body, in the regulation metabolic processes, ensuring its vital functions, in mobilizing the body’s forces, as well as in restoring energy resources and renewing its cells and tissues. Thus, in addition to nervous regulation vital activity of the body (including during sports) there is endocrine regulation and humoral regulation, closely interconnected and carried out through a “feedback” mechanism.

Since classes physical culture and especially sports require more and more advanced regulation and correlation of the activities of various human systems and organs in difficult conditions of emotional and physical stress, the study of the function of the endocrine system, although it has not yet entered into widespread practice, is gradually beginning to occupy an increasing place in the complex study of the athlete.

Correct assessment functional state of the endocrine system allows us to identify pathological changes in it in case of irrational use physical exercise. Under the influence of rational, systematic physical education and sports, this system is being improved.

Adaptation of the endocrine system to physical activity characterized not simply by an increase in the activity of the endocrine glands, but mainly by a change in the relationships between individual glands. Development of fatigue during long work is also accompanied by corresponding changes in the activity of the endocrine glands.

The human endocrine system, improving under the influence of rational training, helps to increase the body's adaptive capabilities, which leads to improved sports performance, in particular in the development of endurance.

Research of the endocrine system is complex and is usually performed in a hospital setting. But there are a number simple methods studies that allow, to a certain extent, to assess the functional state of individual endocrine glands - anamnesis, examination, palpation, functional tests.

Anamnesis. Information about the period of puberty is important. When questioning women, they find out the time of onset, regularity, duration, abundance of menstruation, and the development of secondary sexual characteristics; when questioning men, the time of onset of voice loss, facial hair, etc. For older people, the time of onset menopause, i.e., the time of cessation of menstruation in women, the state of sexual function in men.

Information about the emotional state is essential. For example, rapid mood swings, increased excitability, anxiety, usually accompanied by sweating, tachycardia, weight loss, low-grade fever, rapid fatigue, may indicate increased thyroid function. When the function of the thyroid gland decreases, apathy is observed, which is accompanied by lethargy, slowness, bradycardia, etc.

Symptoms of increased thyroid function are sometimes almost identical to the symptoms that appear when an athlete overtrains. This aspect of the history should be given particular importance, since cases of increased thyroid function (hyperthyroidism) have been observed in athletes.

Determine the presence of complaints characteristic of patients with diabetes - increased thirst and appetite, etc.

Inspection. Pay attention to following signs: proportionality of development of individual body parts in individuals tall(is there a disproportionate enlargement of the nose, chin, hands and feet, which may indicate hyperfunction of the anterior lobe of the pituitary gland - acromegaly), the presence of bulging eyes, pronounced shine of the eyes (observed with hyperthyroidism), puffiness of the face (noted with hypothyroidism), as well as signs such as an enlarged thyroid gland, sweating or dry skin, the presence of fat (predominant fat deposition in the lower abdomen, buttocks, thighs and chest is characteristic of obesity associated with dysfunction of the pituitary gland and gonads), sudden weight loss (occurs with thyrotoxicosis , diseases of the pituitary gland - Simmonds' disease and adrenal glands - Addison's disease).

In addition, during examination, the hair on the body is determined, since hair growth depends to a large extent on hormonal influences gonads, thyroid gland, adrenal gland and pituitary gland. The presence of hair in men, characteristic of women, may indicate insufficiency of the function of the gonads. The male type of hair in women can be a manifestation of hermaphroditism - the presence in one individual of characteristics characteristic of both sexes (such persons are not allowed to play sports).

Excessive hair growth on the body and limbs, and in women, on the face (mustache and beard) suggests a tumor of the adrenal cortex, hyperthyroidism, etc.

Palpation. Of all the endocrine glands, the thyroid gland and male reproductive glands can be directly palpated (as well as examined); during gynecological examination - female gonads (ovaries).

Functional tests. When studying the function of the endocrine glands, many such tests are used. Of greatest importance in sports medicine are functional tests used in the study of the thyroid gland and adrenal glands.

Functional tests when studying the function of the thyroid gland are based on the study of metabolic processes regulated by this gland. The thyroid hormone - thyroxine stimulates oxidative processes, participating in the regulation of various types of metabolism (carbohydrate, fat, iodine metabolism, etc.). Therefore, the main method of studying the functional state of the thyroid gland is to determine the basal metabolism (the amount of energy in kilocalories consumed by a person in a state of complete rest), which is directly dependent on the function of the thyroid gland and the amount of thyroxine secreted by it.

The value of basal metabolism in kilocalories is compared with the proper values ​​calculated using the Harris-Benedict tables or nomograms, and is expressed as a percentage of the proper value. If the basal metabolism of the examined athlete exceeds the expected one by more than +10%, this suggests hyperfunction of the thyroid gland, if less by 10%, its hypofunction. The higher the percentage of excess, the more pronounced the hyperfunction of the thyroid gland. With significant hyperthyroidism, the basal metabolic rate may be greater than +100%. A decrease in basal metabolism by more than 10% compared to normal may indicate hypofunction of the thyroid gland.

Thyroid function can also be examined using radioactive iodine. This determines the ability of the thyroid gland to absorb it. If more than 25% of the administered iodine remains in the thyroid gland after 24 hours, this indicates an increase in its function.

Functional tests when studying adrenal function provide valuable data. The adrenal glands have a wide range of effects on the body. The adrenal medulla, secreting hormones - catecholamines (adrenaline and norepinephrine), communicates between the endocrine glands and the nervous system, participates in the regulation of carbohydrate metabolism, maintains vascular tone and heart muscles. The adrenal cortex secretes aldosterone, corticosteroids, and androgenic hormones, which play a vital role in the functioning of the body as a whole. All these hormones are involved in mineral, carbohydrate, protein metabolism and in the regulation of a number of processes in the body.

Tense muscle work enhances the function of the adrenal medulla. By the degree of this increase one can judge the effect of the load on the athlete’s body.

To determine functional state adrenal glands, the chemical and morphological composition of the blood (the amount of potassium and sodium in the blood serum, the number of eosinophils in the blood) and urine (determination of 17-ketosteroids, etc.) is examined.

In trained athletes, after a load corresponding to their level of preparedness, there is a moderate increase in adrenal function. If the load exceeds the athlete’s functional capabilities, the hormonal function of the adrenal glands is suppressed. This is determined by a special biochemical test of blood and urine. With adrenal insufficiency, mineral and water metabolism changes: the level of sodium in the blood serum decreases and the amount of potassium increases.

Without a perfect, coordinated function of all endocrine glands, it is impossible to achieve high athletic performance. Apparently various types sports are associated with a predominant increase in the function of various endocrine glands, because the hormones of each gland have a specific effect.

When developing the quality of endurance, the main role is played by hormones that regulate all main types of metabolism, when developing the qualities of speed and strength important has an increase in the level of adrenaline in the blood.

An urgent task of modern sports medicine is to study the functional state of the athlete’s endocrine system to clarify its role in increasing his performance and preventing the development of pathological changes both in the endocrine system itself and in other systems and organs (since dysfunction of the endocrine system affects the body as a whole).

The patient must be undressed.

I. Facial examination:

Pay attention to the harmony of features (with a disease of the pituitary gland, uneven bone growth is determined - an increase lower jaw, nose, brow ridges zygomatic bones, etc.)

2.Skin color:

  • Pink color in diabetes mellitus, possible presence of xanthoma and xanthelasma;
  • Thin face with thin velvety skin, exophthalmos and pigmentation of the eyelids due to thyrotoxicosis;
  • A mask-like, expressionless face with slow facial expressions, a sleepy, waxy expression, puffy eyelids and narrowing palpebral fissures. The skin is dry, flaky – myxedema – a severe form of hypothyroidism;
  • Moon-shaped, purplish-red in color with the presence of pustules, stretch marks (striae), face - excessive production of adrenocorticotropic hormone (ACTH).

II. Hair condition:

  • Thin, brittle, slightly falling hair due to hyperthyroidism;
  • Thick, dull (without shine), brittle hair that falls out easily due to hypothyroidism;
  • Reduction or disappearance of hair in men on the chest, abdomen, pubis (secondary sexual characteristics) and hair growth male type in women (appearance of a mustache, beard).

III. Skin examination:

  1. Note the color, the presence of scratching (diabetes mellitus), pustular rashes, boils (diabetes mellitus, Ischeng-Cushing disease).
  2. Pigmentation (meladerma) – chronic failure adrenal glands Pigmentation is especially pronounced on exposed parts of the body, in skin folds, in the area of ​​the nipples and genitals, oral mucosa.
  3. Determination of dryness and moisture of the skin is carried out visually (if the skin is dry, it becomes rough and thick; with high humidity, beads of sweat are noted) and always by palpation.

IV. Determining the patient's height

  1. Place the patient in such a way that he touches the vertical board of the stadiometer with his heels, buttocks and shoulder blades.
  2. Hold your head so that the upper edge of the outer ear canal and the outer corner of the eye on the same horizontal line.
  3. Lower the horizontal bar onto your head and count the divisions.

V. Weighing the patient

Do it in the morning, on an empty stomach, after bowel movements. bladder and intestines, in underwear(followed by dropping the weight of the laundry)

Weighing is carried out regularly, at certain intervals.

VI. Thickness of the subcutaneous fat layer

  1. Gather the skin on the abdomen at the level of the navel into a fold.
  2. In women, normally it should not exceed 4 cm, in men – 2 cm

VII. Eye symptoms

  • Protruding eyes - exophthalmos
  • Wide opening of the palpebral fissures is Delrymple's symptom.
  • Glare in the eyes is a Kraus symptom.
  • Rare blinking is Stellwag's symptom.
  • Lag upper eyelid when looking down - Graefe's symptom.
  • Convergence disorder – Moebius sign (weakness of convergence)
  • Retraction of the upper eyelid with rapid changes of gaze - Kocher's sign

VIII. The presence of tremor is determined in the Romberg position:

  1. The patient stands with his arms extended in front of his chest, fingers apart, not tense, heels together, eyes closed
  2. Determine the presence of finger tremor
  3. In case of pronounced tremor, it is necessary to carry out a finger-nose test, in which intention tremor can be detected - an increase in the amplitude of vibrations of the fingers when approaching the nose

IX. With disease of the endocrine glands, there may be swelling as a result of damage to the heart (diabetes mellitus, thyrotoxicosis), kidneys (diabetes mellitus), and a kind of tissue swelling ( mucous swelling) with hypothyroidism.

Large massive swellings are determined visually.

In case of slight swelling, it is necessary to use palpation:

  1. Apply pressure with your fingers to the swollen skin, pressing it against the bone. Pits remain under the fingers, which are then smoothed out.

8.Functional and diagnostic methods of research for diseases of the endocrine system.ppt

  • Number of slides: 29

To make this lecture easier to understand, let us recall some brief anatomical and physiological data on the endocrine system. n The endocrine system is the system that releases hormones into the blood. “Hormones” are chemical substances secreted into the blood or lymphatic vessels and having various effects on target organs. n Back in the middle of the twentieth century, it mainly included clearly organized morphological formations called glands. n n. By now this concept has become much broader. It turned out that many other organs and tissues have endocrine functions.

n For example, one of these places turned out to be the hypothalamus. n It turned out that the hypothalamus secretes: thyroliberin, luliberin, corticoliberin, prolactoliberin, folliculoliberin, somatoliberin, melanocytoliberin, luteostatin, melanocytostatin, which regulate the functioning of the pituitary gland

n The liver secretes angiotensin. Kidneys – erythropotin and renin. Stomach – gastrin, somatostatin. n 12 duodenum and small intestine – motilin, secretin, cholecystokinin pancreozymin, somatostatin. Cardiac atria and brain - atrial and brain natriuric peptides, respectively. Connective tissue and cells of mesenchymal origin are somatomedins. n Adipose tissue – leptin, adiponectin, etc.

n. In our subject it is not possible to analyze in detail all these hormones and their actions. But this information must be remembered once and for all: the endocrine system is not only the endocrine glands. However, here and today we are forced to talk specifically about the endocrine glands and their functions.

n The system of endocrine glands is scattered throughout the body (Fig.) 1. Pituitary gland. 2. Thyroid gland. 3; 4 and 7. Adrenal glands. 5. Sex glands. 6. Pancreas. 8. Thymus (thymus gland) 9. Parathyroid glands. 10. Epiphysis. Let's briefly look at their morphology and functions.

n. The pineal gland secretes the hormone melatonin, which activates the division of pigment cells in the skin and has an antigonadotropic effect. n. The pituitary gland consists of the anterior adenohypophysis and the posterior - neurohypophysis and intermediate parts (lobes). The anterior lobe of the pituitary gland produces somatotropin - growth hormone; gonadotropic hormones that stimulate male and female sex glands; lactogenic hormone that supports the secretion of estrogen and progesterone by the ovaries; ACTH, which stimulates the production of adrenal hormones; TSH, which regulates the functioning of the thyroid gland. The posterior lobe of the pituitary gland contains two hormones: oxytocin, which regulates labor and secretion of the mammary glands, and vasopressin or antidiuretic hormone, which mainly regulates the reabsorption of water from the renal tubules. The intermediate part is the hormone intermedin, which regulates pigment metabolism in the integumentary tissues. .

THE THREAT GLAND produces thyroxine (T 4) and triiodothyronine (T 3), which regulate general metabolism in the body, influence the formation of the skeleton, accelerate bone growth and ossification of epiphyseal cartilage; calcitonin, which regulates the metabolism of calcium and phosphorus. Its functions are studied by determining these hormones.

The parathyroid glands regulate the metabolism of calcium and phosphorus. Removing the parathyroid glands causes seizures and can lead to death. n Thymus (the thymus gland is the most important organ of the body’s immunological defense. It ensures the differentiation and proliferation of bone marrow stem cells; produces the enzyme thymosin, which ensures the immunological competence of lymphocytes throughout the body. T lymphocytes formed in the bone marrow enter the thymus and, under the influence of thymosin, become differentiated and immunologically competent and become the main mediators of cellular immunity n n

n The adrenal glands consist of two layers - the cortex and the medulla. n The medulla produces two hormones that mediate the sympathetic nervous system - adrenaline and norepinephrine. They increase the contractility and excitability of the heart, constrict skin blood vessels, and increase blood pressure. . n The cortex is an extremely important formation of the human body. It produces about 30 different hormones that regulate the concentration of sodium, potassium and chlorine in the blood and tissues, carbohydrate, protein and fat metabolism, as well as the production of sex hormones

The pancreas is an organ that has both exocrine and endocrine functions. The exocrine function was discussed in the section on diseases of the digestive system. Endocrine function is provided by special cells collected in small islands (islets of Langerhans), which are embedded in the gland tissue throughout its entire volume. They produce the hormone insulin. Insulin mainly regulates carbohydrate metabolism– consumption of glucose by various systems of the body, providing transport

Let us now consider the issues of the norm of hormones secreted by these glands. Here, unfortunately, we must immediately make a reservation that in various sources in Russia you can find significantly different normal values ​​of these hormones, which depends on the lack of standardization of research methods and on the chaos that exists today place in this country. Even if there were uniform standards in Russia, no one is going to adhere to them - everyone uses the method that is easier for them to implement or that they like best. However, we must outline approximate standards for you, and you should know them. n As mentioned above, the anterior lobe of the pituitary gland secretes a significant amount of a wide variety of hormones.

The fasting GH level is 8 ng/ml. As is known, overproduction of this hormone can be observed with gigantism or acromegaly, and underproduction can be observed with pituitary dwarfism, which we discussed in the lecture “Question, examination... for endocrine diseases” n TSH is 0.45 - 6.2 microns. IU/ml. Thyroid-stimulating hormone regulates the function of the thyroid gland, and its overproduction can lead to hyperthyroidism, and decreased production can lead to myxedema n

ACTH – (on an empty stomach, at 8 o’clock in the morning, in the supine position) -

The delusion gets me everywhere - the nonsense of newspapers, television, radio. Nonsense shelling: the flight is too short, But it always hits and wounds. It is impossible to interrupt this nonsense, You cannot shield yourself from it with earplugs... Those who create troubles from victories, And trade in lost souls, And others, in order to block the shouting, So that they can finally be heard, Show hysterical agility Even in church in prayers to the Almighty.

n The PL level in men is 2–12 ng/ml, in women 2–20 ng/ml. n The level of ADH in the blood is 29 ng/ml. n Targeted radiography of the “sella turcica” and especially nuclear magnetic resonance (NMR) studies and computed tomography are of great help in diagnosing diseases of the pituitary gland. n These methods make it possible to detect pituitary tumors up to 0.2 cm in diameter (microadenomas) with 97% confidence.

Pancreas The main methods for studying the endocrine function of the pancreas are the direct determination of the level of insulin and glucagon in the blood. However, these methods have not yet entered into widespread practice. The most widely used methods for indirectly studying the insulin-producing function of the pancreas are determination of glucose in the blood and urine and a glucose tolerance test.

n Determination of glucose in the blood is carried out on an empty stomach. The normal level is fluctuating from 3.33 to 5.5 (according to some methods up to 6.105) mmol/l. n An increase in blood glucose levels is called n This indicator is almost hyperglycemia. a reliable sign of the presence of diabetes mellitus in a person (it should be remembered that hyperglycemia can also have other origins). n There may also be a decrease in blood glucose levels, which is called hypoglycemia. This condition can occur both with diabetes mellitus and with a number of diseases, which may be based on tumors or damage to the endocrine glands of another order.

n Determination of glucose (sugar) in urine is usually carried out in a daily volume of urine. Normally, there is no glucose in the urine. Its appearance is called glycosuria and is a serious sign of diabetes mellitus, although sometimes it can occur after heavy consumption of sweet foods and a rare disease - renal diabetes. n Glucose tolerance test. In many people, diabetes occurs hidden, latently (the so-called impaired glucose tolerance). These people may have minor stigmata of diabetes that are not confirmed by routine urine and blood tests. To clarify the diagnosis in these cases, this test was developed.

Typically, the test is performed as follows: the subject is taken to test blood for glucose on an empty stomach, then given 75 g (or, more precisely, 50 g per m 2 body area) of glucose dissolved in 100-200 ml of water to drink, and the blood is tested for glucose every 30 minutes at over the next 3 hours. n Interpretation of the results: in a healthy person, the rise in glucose levels after 1 hour does not exceed 80% of the initial level, by 2 hours it drops to normal and by 2.5 hours it may fall below normal. n In patients, the maximum rise is observed after 1 hour, reaches figures above 80% of the initial value, and normalization is delayed for 3 hours or more. n

n n n Thyroid gland Methods for studying the functions and clinical morphology of the thyroid gland include determination of protein-bound iodine, the level of thyroid hormones, the shape and size of the gland. Determination of protein-bound iodine (PBI) is one of the most important and accurate methods for studying gland function. SBI consists of 90-95% of the thyroid hormone thyroxine. Normally, SBI is 315, 18,630, 37 nmol/l. With thyrotoxicosis, its level is above 630.37 nmol/l, with hypothyroidism it is less than 315.18 nmol/l.

n Thyroxine (T 4) and triiodothyronine (T 3) are determined from the thyroid hormones. Approximate norms: T 4 60 160 nmol / l, and T 3 1, 2 2, 8 nmol / l. At the same time, as a rule, the TSH level is determined, which, according to the same methods, is normally 0.17 4.05 nmol/l. n One of the objective methods for studying the morphology and function of the thyroid gland is scanning using radioactive isotopes. The scanograms can outline the size of the thyroid gland, areas of hypo- and hyperfunction. n n

n. In recent years, ultrasound examination (ultrasound) has been widely used to examine the thyroid gland. Ultrasound is currently the method of choice in determining the size of the thyroid gland and the presence of changes in its structure. n A highly effective research method is CT, which allows you to study the size and structure, identify tumors or other changes in it.

Adrenal glands (cortical layer) To study the function of the adrenal cortex, aldosterone is determined in the urine, 17 hydroxycorticosteroids (17 OX) in the blood and urine, and 17 neutral ketosteroids (17 KS) in the urine. n Determination of aldosterone. It is believed that there is a directly proportional relationship between the amount of aldosterone in the urine and the mineralocorticoid activity of the adrenal cortex. n Healthy people secrete from 8.34 to 41.7 nmol/day. aldosterone. n Increased urinary aldosterone excretion can be observed with so-called primary and secondary hyperaldosteronism (adenoma or tumor or hyperfunction of the cortical layer). n

Definition 17 OCS reflects the level of glucocorticosteroids in the blood. n Normally, 17 OCS in the blood contains from 0.14 to 0.55 µmol/l. n A persistent increase in 17-ox levels is observed in adrenal tumors and Cushing's syndrome. n A decrease in 17 OCS is found with hypofunction of the adrenal cortex or insufficiency of the anterior pituitary gland. n n Excretion of 17-OX in urine normally parallels changes in the blood. Determination of cortisol in urine is considered even more specific for studying glucocorticosteroid function of the adrenal glands. n Normal 55,248 nmol/day. n

n Definition 17 CC. Most of the 17 CS come from androgens, so their determination allows us to make a judgment about the androgenic function of the adrenal cortex. Normally, 27.7 79.7 µmol/day is excreted in men and 17.4 55.4 in women. n A decrease in the release of 17 KS is typical for adrenal insufficiency, an increase for tumors. n There are also methods for indirectly determining the functions of the adrenal cortex. These include the determination of sodium and potassium in blood and urine. n

It is known that in the regulation of electrolyte levels (especially sodium and potassium), the main role belongs to mineralocorticoids, in particular aldosterone, and to a lesser extent glucocorticoids. n In this regard, the level of sodium and potassium in the blood and their excretion in the urine will indirectly indicate the state of production of these hormones by the adrenal glands. Normally, sodium in the blood plasma contains 135-145 mmol/l, and potassium 3.8-4.6 mmol/l. n Normally, 122,260 mmol/day is excreted in urine. sodium and 25 100 mmol/day. potassium n In practice, determination in urine is rarely performed. n

Adrenal glands (medulla) Studying the function of the adrenal medulla is most often resorted to when a tumor is suspected. n 3 hormones are studied - adrenaline, norepinephrine, dopamine in the blood or plasma. n Their level in plasma is equal to - adrenaline