METHODS FOR STUDYING THE ENDOCRINE SYSTEM

Indirectly, the size of the pituitary gland is judged by the size, shape and structure of the sella turcica on radiographs. Currently, computed tomography (CT) and magnetic resonance imaging (MRI) are performed.

For determining functional state The pituitary gland uses radioimmunological methods to study the levels of hormones in the child’s blood.

Growth hormone is determined in the highest concentration in newborns, which is associated with increased lipolysis and decreased glycemia in the postnatal period. Natural highlighting growth hormone occurs during night sleep. To assess the level of growth hormone, its basal content is determined, as well as its release after provocative tests, for example, insulin administration.

Most high level ACTH is also observed in newborns, providing adaptation processes, then its level decreases.

TSH levels in newborns are 15-20 times higher than in subsequent age periods. On the contrary, the level of gonadotropic hormones - LH and FSH - increases during puberty in both boys and girls.

At clinical examination it is possible to identify certain signs of dysfunction of the pituitary gland, for which it is necessary to assess the state of trophism of the child’s tissues, the weight and length of his body and the dynamics of their increase, the development and distribution of the subcutaneous fat layer, the development of secondary sexual characteristics. In addition, diuresis should be measured, urination frequency determined, and the relative density of urine assessed.

RESEARCH METHODOLOGY

When examining the front surface of the neck, you can get an idea of ​​the size thyroid gland, which is not normally visualized (see degrees of magnification below).

At palpation The thyroid gland needs to pay attention to the following. a Dimensions (normally the thyroid gland can be palpated, but the size of its lobe should not exceed the size of the nail plate thumb patient's hands). Based on examination and palpation of the thyroid gland, five degrees of its enlargement are distinguished:

1st degree - the thyroid gland is not visualized and is faintly palpable;

2nd degree - the thyroid gland is palpable and visible with full extension of the neck;

3rd degree - the thyroid gland is clearly visible with the usual position of the neck (“thick neck” due to a noticeable goiter);

4th degree - the thyroid gland is significantly enlarged and extends beyond the outer edges of the sternocleidomastoid muscle;

5 - a greatly enlarged thyroid gland deforms and disfigures the contours of the neck.

* Consistency (normally soft-elastic).

* Nature of the surface (normally smooth).

* Nature of the increase (diffuse or nodular).

* Degree of mobility when swallowing (normally mobile).

* Presence or absence of pulsation (normally there is no pulsation).

Acute adrenal insufficiency can develop with bilateral damage to the adrenal cortex or hemorrhage caused by birth trauma, thrombosis or venous embolism (Waterhouse-Friderichsen syndrome), disseminated intravascular coagulation syndrome. Hemorrhagic adrenal infarction often occurs against the background of severe infections, primarily meningococcal, pneumococcal or streptococcal.

Acute hemorrhages in the adrenal glands can occur during stress, major operations, sepsis, burns, during treatment with anticoagulants, in patients with AIDS. Acute adrenal insufficiency can occur with sudden cessation of corticosteroid treatment - “withdrawal syndrome”, as well as in patients after bilateral adrenalectomy.

At chronic adrenal insufficiency(CNN) patients complain of general weakness, fatigue, poor appetite, need for salt, weight loss, occasional nausea, vomiting, loose stools, abdominal pain. There is hyperpigmentation of the skin and mucous membranes, decreased muscle strength, low arterial pressure, hyponatremia and hyperkalemia, hypoglycemia.

Chronic adrenal insufficiency most often develops as a result of autoimmune process, in which antibodies are formed to adrenal tissue. In addition, it may be associated with a bilateral tuberculous process in the adrenal glands. More rare causes include tumors (angiomas, ganglioneuromas), metastases, amyloidosis, infections (syphilis, fungal diseases), chronic intoxication, for example insecticides. The adrenal cortex is destroyed during thrombosis of veins and arteries, with AIDS, etc.

Secondary (central) forms of adrenal insufficiency can be caused by ACTH deficiency due to damage to the adenohypophysis or hypothalamus.

There are cases of cortisol resistance associated with abnormalities of glucocorticoid receptors.

Congenital dysfunction of the adrenal cortex - a hereditary disease in which the biosynthesis of corticosteroids is impaired due to congenital deficiency of a number of adrenal enzyme systems.

3 main ones are identified clinical forms diseases:

· virile - with deficiency of 21-hydroxylase;

salt-wasting - with a more significant deficiency of 21-hydroxylase, when the formation of both glucocorticoids and mineralocorticoids is impaired;

· hypertensive - with an excess of 21-hydroxylase.

To provide normal level hydrocortisone requires increased stimulation of the adrenal glands by ACTH, which leads to increased production of hormones in those areas where synthesis is not impaired, mainly in the reticular zone where androgens are formed. In the hypertensive form, a lot of 11-deoxycorticosterone and 11-deoxycortisol accumulate, which have a hypertensive effect.

The virile form is observed in both boys and girls. Girls experience virilization of the external genitalia varying degrees severity, during puberty the mammary glands do not develop, and menstruation does not appear. Boys experience penile hypertrophy, early pubertal hair growth, hyperpigmentation in the external genitalia, accelerated skeletal maturation and early closure of growth plates.

With the salt-wasting form, the first symptoms observed are disturbances in the input-electrolyte balance: increased excretion of sodium and chlorine, potassium retention. This leads to repeated vomiting, loose stools, dehydration, muscle hypotonia, cramps.

In the hypertensive form, in addition to virilization, persistent arterial hypertension.

Manifestation hypercortisolism there are Itsenko-Cushing's disease and syndrome: patients have severe weakness, increased fatigue, headache, leg and back pain, drowsiness, thirst. Characteristically moon-shaped face with bright blush on the cheeks, hypertrichosis, obesity with predominant fat deposition in the neck area in the form of a “moose scruff”, in the back and abdomen. Stretching stripes are formed on the skin of the abdomen, back, shoulders, hips, and mammary glands - crimson or purple stretch marks. Osteoporosis develops, arterial hypertension, steroid cardiomyopathy are noted, and glucose tolerance decreases. Lymphopenia, eosinopenia, erythrocytosis, and a tendency to increase blood coagulation are detected in the blood.

Primary hypercortisolism is observed in tumors of the adrenal glands; its manifestations are usually called Itsenko-Cushing syndrome.

Secondary hypercortisolism is caused by excess ACTH, which is produced by a tumor of the anterior pituitary gland, basophilic adenoma, leading to the development of Cushing's disease.

ACTH-like substances can be secreted in ectopic foci in tumors and metastases of bronchogenic cancer, cancer of the thyroid gland, pancreas, uterus, ovaries, etc.

Sometimes the cause of hypercortisolism may be excess production of corticoliberin in the hypothalamus, which leads to synthesis in the pituitary gland increased amount ACTH is accompanied by hyperplasia of the adrenal cortex and increased secretion of corticosteroids.

Hypoaldosteronism(insufficient production of aldosterone) is characterized by a number of symptoms: caused by hyperkalemia and hyponatremia and their effect on renal function, of cardio-vascular system and skeletal muscles. Patients experience fatigue, muscle weakness, arterial hypotension, periodic fainting, bradycardia, heart block.

Hypoaldosteronism - isolated deficiency of aldosterone production - occurs rarely - with an enzyme defect in the zona glomerulosa of the adrenal cortex, as well as after removal of the aldosteroma in one adrenal gland and atrophy of the zona glomerulosa in the other.

Pseudohypoaldosteronism occurs due to low sensitivity of the epithelium renal tubules to aldosterone.

Hyperaldosteronism(excess aldosterone production) leads to renal sodium retention and potassium loss. Patients have arterial hypertension and periodic cramps in various muscle groups. Initially, daily diuresis is reduced, then polyuria, polydipsia, nocturia, and resistance to antidiuretic drugs develop.

Hyperaldosteronism can be primary or secondary. Primary Hyperaldosteronism(Conn's syndrome) develops with a hormonally active tumor of the zona glomerulosa. Secondary hyperaldosteronism can be observed in a number of diseases accompanied by hypovolemia and renal ischemia, including after acute blood loss, for heart failure, for nephritis and other kidney diseases. Secondary hyperaldosteronism can occur in women during menstruation, pregnancy and lactation, as well as in persons of both sexes during severe physical stress, intense sweating, etc.

Hyperaldosteronism in liver diseases is associated with impaired aldosterone metabolism in liver failure.

At excess secretion of catecholamines Patients experience weakness, fatigue, sweating, loss of appetite, weight loss, headaches, blurred vision, tachycardia, peripheral vasospasm, arterial hypertension that cannot be treated, which can be crisis or non-crisis (permanent).

Excessive secretion of catecholamines occurs in pheochromocytosis and other tumors of chromaffin tissue. In addition, hypersecretion of catecholamines is observed with large physical activity, stress, pain syndrome.

Insufficient secretion of catecholamines endocrinopathy does not occur as an independent endocrinopathy.

RESEARCH METHODOLOGY

When examining a child, attention is paid to height, fat deposition, body proportions, muscle development, and hair growth. The severity of secondary sexual characteristics is assessed: in girls, the development of the mammary glands, pubic hair growth and development of hair in the armpit, the formation menstrual function; in boys, hair growth in the armpit, pubis and face, growth of thyroid cartilage, change in voice timbre, condition of the testicles, penis and scrotum. The stage of puberty is determined according to Tanner.

For girls:

· Stage I - the mammary glands are not developed, the nipple rises. There is no sexual hair growth;

· Stage II - stage of mammary gland swelling; The diameter of the areola increases. Growth of sparse, long, slightly pigmented hair; hair is straight, occasionally curly, located along the labia;

· Stage III - further enlargement of the mammary gland and areola without separating their contours. The hair darkens, becomes coarser, becomes more frizzy, and spreads beyond the pubic symphysis;

· Stage IV - protrusion of the areola and nipple with the formation of a secondary tubercle above the contour of the gland. Sexual hair growth female type, but does not cover the entire pubic area;

· Stage V - the mammary glands correspond to those of an adult woman; The areola fits into the overall contour of the mammary gland. Sexual hair growth occupies the entire suprapubic region.

For boys:

· Stage I - the penis, testicles and scrotum of children. There is no sexual hair growth;

· Stage II - enlargement of the testicles and scrotum; the penis usually does not enlarge, the skin of the scrotum turns red. Growth of sparse, long, slightly pigmented hair; hair is straight, occasionally curly, mainly at the base of the penis;

· Stage III - further enlargement of the testicles and scrotum and enlargement of the penis, mainly in length. Hair becomes darker, coarser, more frizzy; extend slightly beyond the pubic symphysis;

· Stage IV - further enlargement of the testicles and scrotum; the penis increases, mainly in diameter. Sexual hair growth male type, but does not occupy the entire pubic area;

· Stage V - the external genitalia in shape and size correspond to the organs of an adult male. Sexual hair growth occupies the entire suprapubic region.

When examining the genital organs, pay attention to the correctness of their structure. In boys, anomalies such as hypospadias (lower urethral cleft), epispadias (upper urethral cleft), penile hypoplasia (micropenis) can be identified. In girls, agenesis, hypoplasia or hypertrophy of the clitoris, fusion of the labia minora and majora, fusion of the hymen, cleft of the clitoris, aplasia of the labia and hymen are possible.

During palpation in boys, the presence of testicles in the scrotum is determined, their consistency and size are assessed, and then they are compared with the standards for each age.

If necessary, an ultrasound examination of the pelvic organs in girls and testicles in boys is performed.

To assess the function of the gonads, the level of sex hormones in the blood and urine is determined.

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" - chemical substances, 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. 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 a posterior - neurohypophysis and intermediate parts (lobes). The pituitary gland consists of an anterior - adenohypophysis and a 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 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 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, Intermediate part - intermedin hormone, 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 (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 ensured special cells, collected into 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, 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 fulfill 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 with gigantism or acromegaly, and underproduction can be observed with pituitary dwarfism, which we discussed in the lecture “Questioning, examining... 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 is impossible to interrupt this nonsense, It is impossible to interrupt this nonsense, You can’t protect yourself from it with earplugs... You can’t protect yourself from it 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. Targeted radiography of the “sella turcica” and especially nuclear magnetic resonance (NMR) studies and CT scan. 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 the presence of diabetes mellitus in a person (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 lesions endocrine glands of a different 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 accurate methods for studying gland function. 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 last years Ultrasound examination (US) is 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. 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 directly proportional relationship between the amount of aldosterone in the urine and the 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

• Complaints about fatigue, mood swings, sometimes tearfulness, emotional lability, palpitations that increase with physical activity -1-! these complaints are characteristic of thyrotoxicosis.
• Some patients note a feeling of heat and decreased chilliness (patients sleep under a thin blanket or sheet). There is an opinion that the pathophysiological basis this symptom is an increase in metabolism (due to increased activity of the thyroid gland).
• Complaints of drowsiness, chilliness, apathy, lethargy, poor memory, sometimes in combination with constipation, can be manifestations of hypothyroidism.
• Complaints of thirst (polydipsia), polyuria, dry mouth, increased appetite or, conversely, decreased appetite, and periodic itching of the skin are characteristic of diabetes mellitus. In most cases, the listed symptoms are observed during decompensation of the disease.
• Complaints about seizures causeless fear, accompanied by chills, headache, sometimes dizziness, nausea and vomiting, can be observed with pheochromocytoma, a hormonally active tumor of the adrenal glands.
• Complaints about darkening of the skin, pigmentation of certain areas of the body, especially in places of natural pigmentation, combined with complaints of weakness, weight loss, muscle fatigue and muscle pain are characteristic of chronic adrenal insufficiency. Synonyms for this term are: hypocortisolism, bronze disease, Addison's disease.
• Complaints of cramps, most often in the flexor muscles upper limbs, the appearance of periodic trismus - convulsive clenching of the jaws and other forms of spasms of striated muscles are a sign of hypoparathyroidism.
• Complaints of progressive weakness, severe fatigue, drowsiness, combined with rapid weight gain, make it necessary to exclude the presence of adiposogenital dystrophy in the patient.
• Complaints of severe thirst and corresponding polyuria, when daily diuresis reaches several liters, may be signs of diabetes insipidus.
• Complaints of severe weakness, poor appetite, weight loss, polyuria combined with complaints of pain in the bones, a tendency to loose teeth and frequent fractures bones that do not heal well may be signs of hyperthyroidism.

The borderline position between therapy (endocrinology) and gynecology is occupied by pathological course menopause. Women's complaints about the feeling of hot flashes - short-term sensations of heat combined with excessive sweating, irritability, and sometimes tearfulness require a detailed collection of gynecological history and gynecological examination to exclude of this disease. Male menopause occurs more smoothly, mainly with the development of symptoms of weakened sexual potency.
The examiner obtains a family and sexual history. The man is asked whether he is sexually active and at what age, and the number of children. The woman is asked if she has periods, their regularity and abundance (in particular, the number of days). In mature and elderly women, the time of onset of menopause and the characteristics of its course are clarified. menopause(presence of tides and their frequency). Next, you should find out the number of pregnancies and births; if there was no pregnancy, identify the cause.

Physical research methods

Examination of the patient

In some cases, examination of the patient is the initiating moment that makes one suspect endocrine pathology and direct the examination of the patient along this path.

First of all, the patient’s endocrine status is visually assessed. It is necessary to pay attention to the patient's weight and height. The average height of an adult man in Europe ranges from 170 to 190 cm, women - from 150 to 180 cm. In the second half of the 20th century. the height of the younger generation has increased by an average of 10-20 cm. Accordingly, the weight of a man should be in the range of 70-90 kg, and that of a woman - from 40 to 60 kg.
If these parameters are exceeded, they speak of a pathology that may be associated with endocrine status. Height above 2.5 m in men and more than 2.1 m in women is called gigantism, below 1 m - dwarfism, which is also associated with pathology endocrine system. When growth is very low, it is customary to talk about nanism (nanos - dwarf).

To calculate the ideal ratio of height and weight, it is recommended to use the formula. The simplest method is to use the Broca index:
Ideal body weight = (height in cm - 100) ± 10% correction according to constitutional type.
With a Broca's index in the range of 90-100%, the indicators are considered satisfactory; an index above 110% indicates excess weight.
There are four degrees of obesity:

• I degree: index 110-125%;
• II degree: index 125-150%;
• III degree: index 150-200%;
• IV degree: index above 200%.

If you are overweight or obese, you should pay attention to the distribution of adipose tissue. This is now given great importance, since obesity has become a worldwide problem, and with high weight, mortality increases by 4-6 times.

According to modern ideas, there are two types of obesity:

• android;
• gynoid.

With the android type of obesity, there is a predominant deposition of fat in the upper half of the body and on the abdomen. With the gynoid type of obesity, deposits are more noticeable on the hips and buttocks.

Thus, characteristic features endocrine pathology are the following external manifestations:

• acromegaly (Greek asgop - limb) - disproportionate enlargement of the limbs, face and other parts of the skeleton;
• gigantism - unusually high (more than 2.5 m) height of the patient;
• nanism - dwarfism, when the height of an adult patient is less than 140 cm;
• Itsenko-Cushing syndrome - morbid obesity with the presence of purple scars on the skin (striae, which are often located in the lower abdomen and thighs), often combined with pathological baldness. A sign of chronic elevated serum cortisol concentrations;
• morbid obesity;
• bronze coloration of the skin and mucous membranes due to adrenal insufficiency, Addison's disease;
• the type of hair growth may not correspond to the patient’s gender, which requires genetic analysis. When examining a patient, the presence of severe obesity of the female type with fat deposition on the hips, buttocks, and breasts in combination with hypoplasia of the genital organs requires the exclusion of adiposogenital dystrophy;

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, swollen eyelids and narrowing of the 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 male-type hair growth in women (appearance of a mustache, beard).

III. Skin examination:

1. Note the color, presence of scratches ( diabetes), 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 (with dry skin, its coarsening and thickening are noted; with increased 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(with subsequent loss of laundry weight)

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.

For slight swelling, palpation should be used:

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.

Most endocrine organs are inaccessible for direct examination, with the exception of the thyroid and gonads, so the state of the endocrine glands often has to be judged by clinical syndromes that are characteristic of hyper- or hypofunction of the affected gland, and homeostasis indicators.

Clinical examination of the endocrine system in children consists of studying complaints, medical history and life of the child, including genetic features family, conducting an objective examination of all organs and systems of the child, assessing data from additional research methods.

General examination of the patient

During an external examination of the child, attention is paid to the proportionality of the physique. Then an assessment is carried out physical development of the child, on the basis of which growth disorders can be identified. Grade physical development in children:

Considering the observed variation in various indicators of a child’s physical development, it is necessary to know the so-called normal, or Gaussian-Laplacian distribution. The characteristics of this distribution are the arithmetic mean value of the attribute or indicator (M) and the value of the standard deviation, or sigma (δ). Values ​​beyond the M ± 2δ standard for healthy children, as a rule, indicate pathology.

In practice, indicative estimates retain their significance, in which the following empirical rule should be used: random variation of a trait that changes with age usually does not extend beyond one age interval; the value of a sign may be pathological in nature if its value is in the interval + 1-2 age intervals. The age intervals in the tables of standards are usually chosen as follows: from birth to one year the interval is equal to a month, from 1 year to 3 years - 3 months, from 3 to 7 years - 6 months, from 7 to 12 years - one year.

To accurately determine indicators of physical development, the pediatrician must use tables (or curves) of the age centile distribution. The practical use of these tables (graphs) is extremely simple and convenient. Columns of centile tables or curves graphically show the quantitative boundaries of a trait in a certain proportion or percentage (centile) of children of a given age and gender. In this case, the values ​​characteristic of half of healthy children of a given age and gender - in the range from the 25th to the 75th centile - are taken as average or conditionally normal values.

Pituitary dwarfism is characterized by a slowdown in growth without changing body proportions. You can think about dwarfism if the child’s height lags behind what should be and goes beyond M-3δ (in the sigma series), below the boundaries of the 3rd centile (in centile tables) or SDS<-2. Рост взрослого мужчины-карлика не превышает 130 см, рост женщины - менее 120 см.

With hypothyroidism, there is a delay in growth with a violation of body proportions - short limbs. The face has a characteristic appearance: a wide flat bridge of the nose, widely spaced eyes (hypertelorism), a relative predominance of the facial skull, a large thick tongue, thick lips and other symptoms of hypothyroidism.

Acceleration of growth is typical for pituitary gigantism, in which growth exceeds the required height by more than 15% (above the 97th centile, SDS = +2), and thyrotoxicosis. Body proportions do not change with either disease.

If the hyperfunction of the pituitary gland manifests itself after the closure of the growth plates, acromegaly develops - an enlargement of the nose, hands and feet, a massive lower jaw, and the brow ridges protrude strongly.

Inspection, palpation and assessment of skin condition. Pale skin with an icteric tint, grayish marbling, and dryness is noted in hypothyroidism. Waxy pallor is characteristic of pituitary tumors.

Purple-bluish coloration of the facial skin is observed with hyperfunction of the adrenal cortex (Cushing's syndrome and disease).

Hyperpigmentation of the skin (bronze tint) is observed with adrenal insufficiency.

Stretch marks (striae) are characteristic of Cushing's syndrome and hypothalamic obesity.

Dry skin is observed in diabetes mellitus and diabetes insipidus; In diabetes mellitus, in addition, there may be skin itching and furunculosis.

Increased skin moisture is observed in thyrotoxicosis, hypoglycemic conditions, and hyperinsulinism.

Hair condition. Dry, coarse, brittle hair is characteristic of hypothyroidism. Hirsutism (excessive hair growth in the male pattern in androgen-dependent areas) and hypertrichosis (excessive hair growth in androgen-independent areas) are associated with hyperfunction of the adrenal cortex.

Virilization- changes in the external female genitalia according to the male type - observed with congenital dysfunction of the adrenal cortex, with tumors of the adrenal glands or ovaries.

Inspection, palpation and assessment of the distribution of subcutaneous fat. An excess amount of subcutaneous tissue with its uniform distribution is characteristic of constitutional-exogenous, nutritional, and diencephalic obesity.

Excessive deposition of subcutaneous fat in the area of ​​the shoulder girdle, 7th cervical vertebra, chest, and abdomen is observed in Itsenko-Cushing disease and syndrome.

Cerebral obesity is characterized by a bizarre distribution of subcutaneous tissue, for example, on the outer surface of the shoulder, inner thighs, etc.

There are 4 degrees of obesity:

I degree - excess body weight is 15-25% of the required amount,

II degree - -»- -»- from 25 to 50% -»-

III degree - -»- -»- 50-100% -»-

IV degree - -»- -»- more than 100%.

An important criterion for obesity is the body mass index (Quetelet) (BMI) - the ratio of weight in kg to height (in m 2). Obesity is defined as BMI exceeding the 95th centile for a given age and gender.

In the body, fat is located 1) in the subcutaneous fat (subcutaneous fat) and 2) around the internal organs (visceral fat). Excess subcutaneous fat in the abdominal area and visceral fat in the abdominal cavity form abdominal obesity. or "top" type. This type of fat distribution can be distinguished by measuring the circumferences of: the waist (WA) - under the lower edge of the ribs above the navel, the hips (HT) - at the level of the maximum protruding point of the buttocks, and calculating the WC/CV ratio. WC/BV values ​​of more than 0.9 in men and more than 0.8 in women indicate the presence of abdominal obesity. On the contrary, when WC/TB values ​​are equal to or less than 0.7, the “lower” or femorogluteal type of obesity is established.

A decrease in the development of subcutaneous fat is characteristic of Simmonds' disease (pituitary wasting), thyrotoxicosis, and diabetes mellitus before treatment.

Assessment of neuropsychic development and state of the nervous system

Hypothyroidism is characterized by a lag in mental development, while thyrotoxicosis is characterized by an acceleration of mental processes, short temper, irritability, tearfulness, fine tremor of the eyelids, fingers, instability of the autonomic nervous system.

With pituitary dwarfism and adipose-genital dystrophy, mental infantilism is observed; with hypoparathyroidism, increased neuromuscular excitability (positive Trousseau and Chvostek symptoms).

Then the endocrine glands accessible to objective examination are examined.

Methods for studying the thyroid gland:

Inspection. The thyroid gland is normally not visible to the eye and cannot be palpated. Upon examination, you can determine the degree of enlargement of the thyroid gland. Starting from the second (with an increase in degree I, it is not visible to the eye). In addition, upon examination, symptoms characteristic of a decrease or increase in the function of the gland are revealed: the condition of the skin, subcutaneous tissue, physical development, eye symptoms (exophthalmos-bulging eyes, Dalrymple's symptoms - widening of the palpebral fissure, Jellinek - pigmentation of the eyelids, Kraus - rare blinking, Graefe - lag of the upper eyelid when looking down, Möbius - violation of convergence - when an object approaches the eyes, they first converge, and then one eye involuntarily moves to the side).

Palpation The thyroid gland is performed with the thumbs of both hands, which are located on the front surface, and the remaining fingers are placed on the back of the neck. In infants, palpating can be done with the thumb and index finger of one hand. When palpating the gland in older children, they are asked to make a swallowing movement, while the gland moves upward, and its sliding at this time along the surface of the fingers facilitates palpation examination.

The isthmus of the thyroid gland is examined by sliding movements of the thumb of one hand along the midline of the neck in a direction from top to bottom. The isthmus is located on the anterior surface of the trachea below the thyroid cartilage and reaches the 3rd ring of the trachea. The lobes of the gland are located on both sides of the trachea and larynx, reaching the 5-6th tracheal ring.

When palpating the thyroid gland, it is necessary to note its size, surface features, the nature of the increase (diffuse, nodular, nodular), consistency (hard or soft elastic), pulsation, pain.

The term “goiter” is used when the thyroid gland is enlarged.

Currently in use WHO classification 2001, taking into account three clinical degrees of thyroid enlargement:

Grade 0 - the thyroid gland is not enlarged

1st degree - the thyroid gland is palpable

2nd degree - the goiter is palpable and visible to the eye

Auscultation examination of the thyroid gland is performed using a phonendoscope, which is applied to the gland. When the function of the gland increases, a vascular murmur is often heard over it. In older children, auscultation is performed while holding the breath.

Additional examination methods, used in the diagnosis of thyroid diseases in children:

Ultrasound examination – used to assess the size and structure of the gland;

Ultrasound examination with Dopplerography - blood flow in the gland is assessed;

Fine-needle puncture biopsy is a cytological examination of punctate, used in nodular forms of goiter to determine the cellular nature of the nodes;

Determination of the concentration of hormones in blood serum: thyroxine (T-4), triiodothyronine (T-3) and thyroid-stimulating hormone (TSH). T-4 and T-3 in the blood are in a free and protein-bound state. Hormonal activity is determined by the concentration of free fractions of thyroid hormones, therefore, to assess the functional state of the thyroid gland, it is necessary to examine the free fractions of T-3 and T-4;

5) Isotope scintigraphy - can be used to diagnose hormonally active and/or inactive formations, especially small ones in children over 12 years of age.

Enzyme immunoassay or radioimmunoassay

A) Antibodies to thyroid peroxidase (TPO) and microsomal antigen fractions (MAG) - used to diagnose the autoimmune process in chronic autoimmune thyroiditis;

B) Antibodies to TSH receptors - tested for suspected diffuse toxic goiter (Graves disease);

C) Antibodies to thyroglobulin are examined during observation of patients operated on for thyroid cancer (only in case of total resection).

7) X-ray method

Determination of bone age using radiographs of the hands.