The endocrine system, or internal secretion system, consists of glands internal secretion, 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 of chemical regulation in the body, establishing connections between its organs and systems and maintaining their functions at a certain level.

Hormones endocrine glands- substances with very high biological activity, i.e., acting 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 according to the mechanism “ feedback».

Since physical education 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 not yet included in widespread practice, is gradually beginning to occupy an increasing place in the complex athlete research.

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

Adaptation of the endocrine system to physical activity is characterized not simply by an increase in the activity of the endocrine glands, but mainly by a change in the relationships between individual glands. The development of fatigue during prolonged 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 the onset of voice loss, facial hair, etc. For older people, the time of the onset of 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, quick change mood, increased excitability, anxiety, usually accompanied by sweating, tachycardia, weight loss, low-grade fever, rapid fatigue, may indicate increased thyroid function. When reducing function thyroid gland apathy is noted, 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 the following signs: the proportionality of the development of individual parts of the body in tall people (is there a disproportionate increase in the nose, chin, hands and feet, which may indicate hyperfunction of the anterior lobe of the pituitary gland - acromegaly), the presence of bulging eyes, a pronounced shine in 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 deposition of fat 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 disease).

In addition, during examination, the hair on the body is determined, since hair growth depends to a large extent on the hormonal influences of the 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, direct palpation (as well as inspection) can be performed thyroid and male gonads; 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 than 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 the functional state of the 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 sports performance. Various sports appear to be associated with preferential increases in function different glands internal secretion, 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, an increase in the level of adrenaline in the blood is important.

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).

Manifestations of diseases of the endocrine glands are very diverse and can be detected already with traditional clinical examination sick. Only the thyroid gland and testicles are accessible to direct examination (examination, palpation). Laboratory research currently make it possible to determine the content of most hormonal substances in the blood, but the nature metabolic disorders associated with changes in the content of these hormones can also be determined using special methods. For example, in diabetes mellitus, determining blood glucose levels often more accurately reflects metabolic disorders than the level of insulin itself, which controls glucose metabolism.

In the diagnosis of endocrinopathies, it is important to focus primarily on the diverse symptoms of various organs and systems - skin, of cardio-vascular system, gastrointestinal tract, musculoskeletal and excretory systems, nervous system, eyes, comparing them with biochemical and other data additional research. It should be kept in mind that individual clinical manifestations diseases may be caused by differences and uneven distribution in tissues of receptors with which hormones interact.

History taking

When interviewing the patient, it is possible to identify a number of important data indicating dysfunctions of certain endocrine glands, the time and reasons for their occurrence, and the dynamics of development.

Already at the beginning of the conversation with the patient, one can clearly detect certain features: hasty, confused speech, some fussiness in movements, increased emotionality, characteristic of hyperfunction of the thyroid gland, and, conversely, lethargy, apathy, some lethargy with its hypofunction.

Complaints. Complaints from patients with endocrine disorders are often general character (bad dream, fatigue, easy excitability, weight loss), but may also be more characteristic of damage to the corresponding endocrine gland, including they may be associated with the involvement in the process (due to metabolic and hormonal disorders) of various organs and systems.

Patients may complain of itchy skin(diabetes mellitus, hyperthyroidism), hair loss (thyroiditis), pain in the joints (acromegaly) and bones (hyperparathyroidism), bone fractures (hyperparathyroidism, Cushing's syndrome), muscle weakness (Cushing's syndrome, hyperaldosteronism), pain in the area heart, palpitations with atrial fibrillation (hyperthyroidism, pheochromocytoma). There are often complaints about poor appetite, dyspeptic symptoms(hypothyroidism, adrenal insufficiency), sexual dysfunction - amenorrhea (hyperthyroidism, hypogonadism, Itsenko-Cushing syndrome), menorrhagia (hypothyroidism), impotence (diabetes mellitus, hypogonadism).

Physical methods endocrine system research

Inspection and palpation

As already noted, only the thyroid gland and testicles are accessible to inspection and palpation. However, it is very important both in these cases and in cases of damage to other endocrine glands (which cannot be examined and palpated) to focus on the results physical research various organs and systems (skin, subcutaneous fat, cardiovascular system, etc.).

Already during a general examination, a number of significant signs of pathology of the endocrine system can be identified: changes in growth (dwarf growth while maintaining the proportionality of the body of pituitary origin, giant growth with increased function of the pituitary gland), disproportionate sizes of individual parts of the body (acromegaly), features of the hairline, characteristic of many endocrinopathies , and a large number of other symptoms.

When examining the neck area, they get an approximate idea of ​​the size of the thyroid gland, symmetrical or asymmetrical enlargement of its various parts. When palpating the lobes and isthmus of the thyroid gland, the size, consistency, and nature (diffuse or nodular) of the increase are assessed. The mobility of the gland during swallowing, the presence or absence of pain and pulsation in its area are assessed. For palpation of nodes located behind upper section sternum, you need to immerse your fingers behind the sternum and try to determine the pole of the node.

When examining the skin, hirsutism (ovarian pathology, hypercortisolism), hyperhidrosis (hyperthyroidism), hyperpigmentation (hypercortisolism), ecchymosis (hypercortisolism), purplish-cyanotic striae are sometimes revealed - peculiar areas (stripes) of atrophy and stretching, usually on the lateral areas of the abdomen (hypercortisolism).

A study of subcutaneous fat tissue reveals both excessive development of subcutaneous fat tissue - obesity (diabetes mellitus) and significant weight loss (hyperthyroidism, diabetes mellitus, adrenal insufficiency). With hypercortisolism, excess fat deposition is observed on the face, which gives it a moon-shaped, rounded appearance (Cushing's syndrome). A kind of dense swelling of the legs, the so-called mucous swelling, observed in hypothyroidism (myxedema).

An examination of the eyes may reveal characteristic exophthalmos (hyperthyroidism), as well as periorbital edema(hypothyroidism). Possible development of diplopia (hyperthyroidism, diabetes mellitus).

Important data can be obtained from studying the cardiovascular system. With the long-term course of some endocrine diseases, heart failure develops typical signs edematous syndrome (hyperthyroidism). One of important reasons arterial hypertension are endocrine diseases (pheochromocytoma, Itsenko-Cushing syndrome, hyperaldosteronism, hypothyroidism). Less commonly observed orthostatic hypotension(adrenal insufficiency). It is important to know that in most endocrine diseases, changes in the electrocardiogram due to myocardial dystrophy are observed, such as rhythm disturbances, repolarization disorders - displacement of the ST segment, T wave. Echocardiography can occasionally reveal pericardial effusion (myxedema).

Sometimes develops full complex symptoms of malabsorption with typical diarrhea and associated laboratory changes such as anemia, electrolyte disturbances etc. (hyperthyroidism, adrenal insufficiency).

Urinary disorders with polyuria characteristic of diabetes mellitus against the background of polydipsia are often missed by both patients and doctors. Urolithiasis with symptoms renal colic occurs in hyperparathyroidism and Itsenko-Cushing syndrome.

When examining the nervous system, nervousness (thyrotoxicosis) and fatigue (adrenal insufficiency, hypoglycemia) are revealed. Possible disturbances of consciousness up to the development of coma (for example, hyperglycemic and hypoglycemic coma in diabetes mellitus). Tetany with convulsions is characteristic of hypocalcemia.

Additional methods for studying the endocrine system

Visualization of the endocrine glands is achieved by various methods. The usual is considered less informative X-ray examination. Modern ultrasonography more informative. The most accurate picture can be obtained by computed tomography, X-ray or magnetic resonance imaging. The latter study is especially valuable when studying the pituitary gland, thymus, adrenal glands, parathyroid glands, pancreas. These studies are primarily used to identify tumors of the corresponding endocrine glands.

Radioisotope research of various endocrine glands has become widespread, which primarily applies to the thyroid gland. It allows you to clarify the structural features (magnitude), as well as functional disorders. The most widely used are iodine-131 or pertechnetate labeled with technetium-99. Using a gamma camera, gamma radiation is recorded on photosensitive paper, and thus a scan is performed, which allows you to evaluate the size, shape, and areas of the gland that actively accumulate isotopes (the so-called hot nodes). Radioisotope scanning is used to study the adrenal glands.

Exist various methods determination of hormone levels in the blood. Among them most attention deserves radioimmunoassay (RIA-radioimmunoassay). Its principle is as follows: antibodies (antiserum) are first prepared for the test substance, which is an antigen, then a standard amount of the resulting antiserum is mixed with a standard amount of the original antigen labeled with radioactive iodine-125 or iodine-131 (up to 80% of the labeled antigen binds to antibodies, forming a radioactive precipitate with a certain radioactivity). Blood serum containing the test substance is added to this mixture: the added antigen competes with the labeled antigen, displacing it from complexes with antibodies. The more analyte (hormone) is contained in the test sample, the more radioactive tracers are displaced from the complex with the antibody. Next, the antigen-antibody complex is separated by precipitation or selective absorption from the free labeled hormone and its radioactivity (i.e., quantity) is measured on a gamma counter. The radioactivity of the precipitate decreases. The more antigen in the test sample, the less radioactivity of the remaining precipitate. Using this method, small amounts of insulin, pituitary tropic hormones, thyroglobulin and other hormones can be detected with great accuracy in the blood and urine. However, it should be borne in mind that an increase in the content of hormones in the blood can occur due to their fraction associated with proteins. In addition, the radioimmune method makes it possible to quantitatively evaluate substances that are chemically very close to hormones, lacking hormonal activity, but having a common antigenic structure with hormones. Determining hormone levels after special stress tests, which allow assessing the reserve function of the gland, is of some importance.

Among biochemical research blood highest value has a determination of glucose levels in blood and urine, which reflects the course of pathological process with diabetes mellitus. A decrease or increase in blood cholesterol levels is characteristic of thyroid dysfunction. Changes in calcium metabolism are detected in pathology of the parathyroid glands.

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 conducting computed tomography(CT) and magnetic resonance imaging (MRI).

To determine the functional state of the pituitary gland, radioimmunological methods are used 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.

During a clinical examination, one can 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, and 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 anterior surface of the neck, you can get an idea of ​​the size of the thyroid gland, which is not normally visualized (see degree of enlargement below).

At palpation The thyroid gland needs to pay attention to the following. a Size (normally the thyroid gland can be palpated, but the size of its lobe should not exceed the size of the nail plate of the patient’s thumb). 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, and 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 an 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. To more rare reasons include tumors (angiomas, ganglioneuromas), metastases, amyloidosis, infections (syphilis, fungal diseases), chronic intoxication, such as 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 have been identified clinical forms diseases:

· viril - 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. At 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 to varying degrees expressiveness, in puberty The mammary glands do not develop, and menstruation does not appear. In boys, there is hypertrophy of the penis, early pubertal hair growth, hyperpigmentation in the area of ​​the external genitalia, accelerated maturation skeleton 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 hypotension, and convulsions.

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. Characterized by a moon-shaped face with a bright blush on the cheeks, hypertrichosis, obesity with predominant deposition of fat in the neck in the form of a “moose scruff”, in the back and abdomen. On the skin of the abdomen, back, shoulders, hips, and mammary glands, stretch marks form - purple or purple stretch marks. purple. 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 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 the function of the kidneys, cardiovascular system and skeletal muscles. Patients experience fatigue, muscle weakness, arterial hypotension, periodic fainting, bradycardia, and 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 aldosteroma in one adrenal gland and atrophy zona glomerulosa in a different.

Pseudohypoaldosteronism occurs, due to the low sensitivity of the renal tubular epithelium 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, heart failure, 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 during heavy physical activity, stress, and pain.

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; hair growth in boys 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 dividing 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 is 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 is of the 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 ( superior cleft urethra), penile hypoplasia (micropenis). In girls, agenesis, hypoplasia or hypertrophy of the clitoris, fusion of the labia minora and majora, fusion of hymen, cleft clitoris, aplasia of the labia and hymen.

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.

Methods for studying endocrine glands

To study the endocrine function of organs, including the endocrine glands, the following methods are used:

Extirpation of endocrine glands.

Selective destruction or suppression of endocrine cells in the body.

Endocrine gland transplantation.

Administration of endocrine gland extracts to intact animals or after removal of the corresponding gland.

Administration of chemically pure hormones to intact animals or after removal of the corresponding gland (replacement “therapy”).

Chemical analysis of extracts and synthesis of hormonal drugs.

Methods of histological and histochemical examination of endocrine tissues

Method of parabiosis or creation of general blood circulation.

A method of introducing “labeled compounds” into the body (for example, radioactive nuclides, fluorescents).

Comparison of the physiological activity of blood flowing into and out of an organ. Allows you to detect the secretion of biologically active metabolites and hormones into the blood.

Study of hormone levels in blood and urine.

Study of the content of hormone synthesis precursors and metabolites in the blood and urine.

Study of patients with insufficient or excessive gland function.

Genetic engineering methods.

Extirpation method

Extirpation is a surgical procedure that involves removing a structural formation, such as a gland.

Extirpation (extirpatio) from Latin extirpo, extirpare - to eradicate.

A distinction is made between partial and complete extirpation.

After extirpation, the remaining body functions are studied using various methods.

Using this method, the endocrine function of the pancreas and its role in the development of diabetes mellitus, the role of the pituitary gland in regulating body growth, the importance of the adrenal cortex, etc. were discovered.

Availability assumption endocrine functions in the pancreas was confirmed in the experiments of I. Mering and O. Minkovsky (1889), which showed that its removal in dogs leads to severe hyperglycemia and glycosuria. The animals died within 2–3 weeks after surgery due to severe diabetes mellitus. It was subsequently found that these changes occur due to a lack of insulin, a hormone produced in the islet apparatus of the pancreas.

Extirpation of endocrine glands in humans is encountered in the clinic. Extirpation of the gland can be deliberate(for example, for thyroid cancer, the organ is completely removed) or random(for example, when the thyroid gland is removed, the parathyroid glands are removed).

A method of selectively destroying or suppressing endocrine cells in the body

If an organ that contains cells (tissues) that perform different functions, it is difficult, and sometimes not at all possible, to differentiate the physiological processes performed by these structures.

For example, when the pancreas is removed, the body loses not only the cells that produce insulin (  cells), but also cells that produce glucagon (  cells), somatostatin (  cells), gastrin (G cells), pancreatic polypeptide (PP cells). In addition, the body is deprived of an important exocrine organ that ensures digestion processes.

How to understand which cells are responsible for a particular function? In this case, you can try to selectively damage some cells and determine the missing function.

Thus, when alloxan (mesoxalic acid ureide) is administered, selective necrosis occurs  cells of the islets of Langerhans, which makes it possible to study the consequences of impaired insulin production without changing other functions of the pancreas. Hydroxyquinoline derivative - dithizone interferes with metabolism  cells forms a complex with zinc, which also disrupts their endocrine function.

The second example is selective damage to thyroid follicular cells ionizing radiation radioactive iodine (131I, 132I). When using this principle for therapeutic purposes, they talk about selective strumectomy, while surgical extirpation for the same purposes is called total, subtotal.

This type of methods also includes monitoring patients with cell damage as a result of immune aggression or autoaggression, and the use of chemical (medicine) agents that inhibit the synthesis of hormones. For example: antithyroid drugs - Mercazolil, popilthiouracil.

Endocrine gland transplant method

The gland can be transplanted into the same animal after its preliminary removal (autotransplantation) or into intact animals. In the latter case it applies homo- And heterotransplantation.

In 1849, the German physiologist Adolf Berthold established that transplanting a castrated rooster into abdominal cavity testes of another rooster leads to the restoration of the original properties of the castrato. This date is considered the birth date of endocrinology.

At the end of the 19th century, Steinach showed that transplanting gonads into guinea pigs and rats changed their behavior and life expectancy.

In the 20s of our century, transplantation of the gonads for the purpose of “rejuvenation” was used by Brown-Séquard and was widely used by the Russian scientist S. Vorontsov in Paris. These transplantation experiments provided rich factual material about the biological effects of gonadal hormones.

In an animal with an endocrine gland removed, it can be reimplanted in a well-vascularized area of ​​the body, such as under the kidney capsule or in the anterior chamber of the eye. This operation is called reimplantation.

Hormone administration method

Endocrine gland extract or chemically pure hormones may be administered. Hormones are administered to intact animals or after removal of the corresponding gland (replacement “therapy”).

In 1889, 72-year-old Brown Sequard reported experiments conducted on himself. Extracts from animal testes had a rejuvenating effect on the scientist’s body.

Thanks to the use of the method of introducing endocrine gland extracts, the presence of insulin and somatotropin, thyroid hormones and parathyroid hormone, corticosteroids, etc. was established.

A variation of the method is feeding animals with dry gland or preparations prepared from tissues.

Using clean hormonal drugs made it possible to establish their biological effects. Disorders that occur after surgical removal of an endocrine gland can be corrected by introducing into the body a sufficient amount of an extract of this gland or an individual hormone.

The use of these methods in intact animals led to the manifestation of feedback in the regulation endocrine organs, because the artificial excess of the hormone created caused suppression of the secretion of the endocrine organ and even atrophy of the gland.

Chemical analysis of extracts and synthesis of hormonal drugs

By performing a chemical structural analysis of extracts from endocrine tissue, it was possible to establish the chemical nature and identify the hormones of the endocrine organs, which subsequently led to the artificial production of effective hormonal preparations for research and therapeutic purposes.

Parabiosis method

Do not confuse with N.E. Vvedensky’s parabiosis. In this case we are talking about a phenomenon. We will talk about a method that uses cross circulation in two organisms. Parabionts are organisms (two or more) that are connected to each other through the circulatory and lymphatic systems. Such a connection can occur in nature, for example in conjoined twins, or it can be created artificially (in an experiment).

The method allows you to evaluate the role humoral factors in changing the functions of the intact organism of one individual when interfering with the endocrine system of another individual.

Particularly important are studies of conjoined twins, who share a common blood circulation but separate nervous systems. In one of the two conjoined sisters, a case of pregnancy and childbirth was described, after which lactation occurred in both sisters, and feeding was possible from four mammary glands.

Radionuclide methods

(method of labeled substances and compounds)

Note not radioactive isotopes, but substances or compounds labeled with radionuclides. Strictly speaking, radiopharmaceuticals (RP) = carrier + label (radionuclide) are introduced.

This method makes it possible to study the processes of hormone synthesis in endocrine tissue, the deposition and distribution of hormones in the body, and the routes of their elimination.

Radionuclide methods are usually divided into in vivo and in vitro studies. In in vivo studies, a distinction is made between in vivo and in vitro measurements.

First of all, all methods can be divided into in vitro - And in vivo -research (methods, diagnostics)

In vitro studies

Not to be confused in vitro - And in vivo -research (methods) with the concept in vitro - And in vivo -measurements .

With in vivo measurements there will always be in vivo studies. Those. It is impossible to measure in the body something that was not present (substance, parameter) or was not introduced as a testing agent during the study.

If a testing substance was introduced into the body, then a biosample was taken and in vitro measurements were carried out, the study should still be designated as an in vivo study.

If the test substance was not introduced into the body, but a biological sample was taken and carried out in vitro - measurements, with or without the introduction of a test substance (a reagent, for example), the study should be designated as an in vitro study.

In radionuclide in vivo diagnostics, the capture of radiopharmaceuticals from the blood by endocrine cells is more often used and is included in the resulting hormones in proportion to the intensity of their synthesis.

An example of the use of this method is the study of the thyroid gland using radioactive iodine (131I) or sodium pertechnetate (Na99mTcO4), the adrenal cortex using a labeled precursor of steroid hormones, most often cholesterol (131I cholesterol).

For in vivo radionuclide studies, radiometry or gamma topography (scintigraphy) is performed. Radionuclide scanning as a method is outdated.

Separate assessment of the inorganic and organic phases of the intrathyroidal stage of iodine metabolism.

When studying the circuits of self-government of hormonal regulation in in vivo studies, stimulation and suppression tests are used.

Let's solve two problems.

To determine the nature of the palpable formation in right lobe 131I scintigraphy was performed on the thyroid gland (Fig. 1) (Fig. 2).

Some time after the hormone was administered, scintigraphy was repeated (Fig. 3). The accumulation of 131I in the right lobe did not change, but in the left it appeared. What study was performed on the patient, with what hormone? Draw a conclusion based on the results of the study.

Second task.

To determine the nature of the palpable formation in the right lobe of the thyroid gland (Fig. 1), 131I scintigraphy was performed (Fig. 2). Some time after the hormone was administered, scintigraphy was repeated (Fig. 3). The accumulation of 131I in the right lobe did not change, in the left it disappeared. What study was performed on the patient, with what hormone? Draw a conclusion based on the results of the study.

To study the sites of binding, accumulation and metabolism of hormones, they are labeled with radioactive atoms, introduced into the body, and autoradiography is used. Sections of the tissue being studied are placed on radiosensitive photographic material, such as X-ray film, developed, and the dark spots are compared with photographs of histological sections.

Study of hormone content in biosamples

More often, blood (plasma, serum) and urine are used as bioassays.

This method is one of the most accurate for assessing the secretory activity of endocrine organs and tissues, but it does not characterize the biological activity and the degree of hormonal effects in tissues.

Various research techniques are used depending on the chemical nature of the hormones, including biochemical, chromatographic and biological testing techniques, and again radionuclide techniques.

Among radionuclide honeys there are

radioimmune (RIA)

immunoradiometric (IRMA)

radioreceptor (RRA)

In 1977, Rosalyn Yalow received the Nobel Prize for her improvements in radioimmunoassay (RIA) techniques for peptide hormones.

Radioimmunoassay, which is most widespread today due to its high sensitivity, accuracy and simplicity, is based on the use of hormones labeled with iodine (125I) or tritium (3H) isotopes and specific antibodies that bind them.

Why is it needed?

A lot of blood sugar In most patients with diabetes, insulin activity in the blood is rarely reduced, more often it is normal or even increased

The second example is hypocalcemia. Parathyrin is often elevated.

Radionuclide methods make it possible to determine fractions (free, protein-bound) of hormones.

In radioreceptor analysis, the sensitivity of which is lower and the information content is higher than radioimmune analysis, the binding of a hormone is assessed not with antibodies to it, but with specific hormonal receptors cell membranes or cytosol.

When studying the contours of self-government of hormonal regulation in in vitro studies, the determination of the complete “set” of hormones is used different levels regulation associated with the process under study (liberins and statins, tropins, effector hormones). For example, for the thyroid gland, thyrotropin-releasing hormone, thyrotropin, triiodotyrosine, thyroxine.

Primary hypothyroidism:

T3, T4, TSH, TL

Secondary hypothyroidism:

T3, T4, TSH, TL

Tertiary hypothyroidism:

T3, T4, TSH, TL

Relative specificity of regulation: the introduction of iodine and dioidtyrosine inhibits the production of thyrotropin.

Comparison of the physiological activity of blood flowing into and out of an organ allows us to identify the secretion of biologically active metabolites and hormones into the blood.

Study of the content of hormone synthesis precursors and metabolites in blood and urine

Often, the hormonal effect is largely determined by the active metabolites of the hormone. In other cases, precursors and metabolites whose concentrations are proportional to hormone levels are more readily available for study. The method allows not only to evaluate the hormone-producing activity of endocrine tissue, but also to identify the characteristics of hormone metabolism.

Monitoring of patients with impaired function of endocrine organs

This can provide valuable information about the physiological effects and roles of endocrine gland hormones.

Addison T. (Addison Thomas), English physician (1793-1860). He is called the father of endocrinology. Why? In 1855, he published a monograph containing, in particular, a classic description of chronic adrenal insufficiency. Soon it was proposed to call it Addison's disease. The cause of Addison's disease is most often a primary lesion of the adrenal cortex by an autoimmune process (idiopathic Addison's disease) and tuberculosis.

Methods of histological and histochemical examination of endocrine tissues

These methods make it possible to evaluate not only the structural, but also the functional characteristics of cells, in particular, the intensity of formation, accumulation and excretion of hormones. For example, the phenomena of neurosecretion of hypothalamic neurons and the endocrine function of atrial cardiomyocytes were discovered using histochemical methods.

Genetic engineering methods

These methods of reconstructing the genetic apparatus of the cell make it possible not only to study the mechanisms of hormone synthesis, but also to actively intervene in them. The mechanisms are especially promising for practical application in cases of persistent disruption of hormone synthesis, as happens in diabetes mellitus.

An example of the experimental use of the method is a study by French scientists who, in 1983, transplanted a gene that controls insulin synthesis into the liver of a rat. The introduction of this gene into the nuclei of rat liver cells led to the fact that the liver cells synthesized insulin within a month.

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Abstract on the topic:

“Methods for studying patients with diseases of the endocrine system”

Performed:

Student of group 33-L

Sirotkina Olga

Supervisor:

Chuprova N.K.

Kovrov, 2009

The procedure for studying patients with diseases of the endocrine system

The endocrine glands produce hormones that perform various functions, and when their activity is disrupted in the body, the most various disorders. Therefore, it is almost impossible to identify a small number of complaints that are typical only for endocrine pathology. Most often, complaints are identified due to malfunction of the following systems:

Central nervous system

Of cardio-vascular system

Genital area

Metabolism

CNS disorders are detected in all patients with VVS diseases. It appears as:

Irritability;

Increased nervous excitability;

Unreasonable anxiety;

Insomnia.

These complaints are characteristic of hyperthyroidism—increased thyroid function.

With hypothyroidism, a decrease in thyroid function, the following are observed:

Drowsiness;

Memory impairment;

Chilliness

Patients are also characterized by neurovegetative disorders:

Sweating;

Feeling hot;

Cardiovascular disorders occur in many types of endocrine pathologies, but are most typical for diseases of the thyroid gland, adrenal glands and pituitary gland.

Patients complain of:

Tingling in the region of the heart;

Heartbeat;

Shortness of breath on exertion.

Sexual disorders.

Decreased sexual function (cessation of menstruation, impotence, decreased libido) occurs primarily in diseases of the gonads, but is often observed in cases of dysfunction of the pituitary gland, adrenal glands, and thyroid gland.

Complaints related to changes in metabolism.

Appetite disturbances are possible both in the direction of increasing it (polyphagia, bulimia) and decreasing it up to the point of aversion to food (anorexia).

Changes in the patient's body weight are not always adequate to changes in appetite.

With hypothyroidism (myxedema), patients gain weight with decreased appetite.

People with hyperthyroidism and diabetes mellitus lose weight, despite a good appetite.

Polyuria, thirst, dry mouth are observed in diabetes mellitus and diabetes insipidus and are associated with impaired water and carbohydrate metabolism.

Pain in muscles, bones, and joints is constantly observed with dysfunction of the adrenal glands and pituitary gland and is explained by osteoporosis (loss of bone tissue), which sometimes leads to pathological bone fractures with minor injuries. These phenomena are a consequence of disturbances in mineral metabolism.

Other complaints.

Slow growth - with pathology of the hypothalamus, pituitary gland;

Changes in appearance - with Itsenko-Cushing's disease and syndrome, diseases of the thyroid gland, pituitary gland;

Changes in skin, hair, nails:

Dry skin - with hypothyroidism, diabetes mellitus and diabetes insipidus;

Swelling - with hypothyroidism;

Skin itching - with diabetes mellitus and diabetes insipidus;

Fragility, hair loss on the head, loss of eyebrows, eyelashes, brittle nails - with hypothyroidism;

Hair loss on the head, excess hair on the face and body - in case of Itsenko-Cushing's disease and syndrome;

Constipation - with hypothyroidism;

Diarrhea - with thyrotoxicosis;

Vomiting, abdominal pain - with untreated diabetes mellitus, adrenal insufficiency (Addison's disease).

Medical history

Determining the history of the development of the present disease is carried out according to the general scheme:

Risk factors;

Onset of the disease;

Development of the disease;

The treatment carried out, its duration, effectiveness.

Anamnesis of life

From the life history for the diagnosis of endocrine diseases, the following information is of particular importance:

Place of birth and residence of the patient.

Geographic location is essential for identifying possible endemic goiter caused by a lack of iodine in the soil and water of some areas.

Features of the individual development of the patient:

Birth injuries;

Growth pattern;

Data on sexual disorders.

Particular attention is paid to the onset of puberty and the appearance of secondary sexual characteristics.

Delay in sexual development may be a manifestation of a disorder of the gonads, adrenal glands, or thyroid gland;

Early development of sexual characteristics is a consequence increased function gonads.

Gynecological history in women.

Find out the time of appearance and nature of menstruation, as well as the appearance of signs of menopause. How did pregnancy and childbirth proceed?

Often endocrine diseases occur during puberty, after childbirth or during menopause.

Working and living conditions:

Conflict situations;

Occupational hazards and accidents.

The use of hormonal and antihormonal drugs (treatment with insulin, mercazolil, steroid hormones of the adrenal cortex, use anabolic steroids to build muscle mass).

Hereditary predisposition.

General inspection

Examination is a valuable method in diagnosing endocrine disorders. Often the diagnosis can be assumed at the first glance at the patient based on some characteristic signs.

In many diseases of the endocrine glands, the appearance and behavioral characteristics of patients attract attention:

Mobility, fussiness, animated gestures and a tense-frightened facial expression, which is caused by exophthalmos, rare blinking, increased shine of the eyes;

Slowness, low mobility, sleepy, swollen face, almost without facial expressions;

Closedness of patients, indifference to the environment;

"Moon Face";

Changing the shape of the neck.

The patient’s height, size and ratio of parts of his body:

Gigantic growth

Dwarf stature

Increase in the size of the limbs, big head with large facial features

Changes in body hair:

Hair thinning;

Accelerated hair growth in children;

Change in hair type.

Nutritional pattern and fat deposition characteristics:

Emaciation;

Increase in body weight;

Predominant fat deposition in the pelvic girdle;

Even distribution of fat throughout the body;

Excessive fat deposition on the face and torso.

Skin changes:

Tender, moist, with hyperemia, hot to the touch;

Rough, pale;

Thin, atrophic, flabby, with numerous fine wrinkles;

Rough, thickened, compacted;

Oily, acne-prone, with stretch marks;

Bronze color.

Palpation

Palpation as a method of studying endocrinological patients is used to evaluate the thyroid gland and male reproductive glands - the testicles.

Rules for palpation of the thyroid gland.

Four bent fingers both hands are placed on back surface neck behind the anterior edges of the sternocleidomastoid muscles, and thumb- on the front surface.

The patient is asked to make swallowing movements, during which the thyroid gland moves along with the larynx and moves between the fingers of the examiner.

The isthmus of the thyroid gland is examined by sliding fingers along its surface from top to bottom.

For ease of palpation, each of the lateral lobes of the gland is pressed on thyroid cartilage from the opposite side.

Percussion, auscultation

These methods occupy a secondary place in the diagnosis of endocrinological disorders:

Percussion above the manubrium of the sternum reveals a substernal goiter;

Auscultation allows you to listen to noise over the thyroid gland in cases of its hyperfunction, the appearance of which is explained by increased vascularization of the gland and is combined with its pulsation determined by palpation.

Additional research methods.

Determination of hormones in the blood;

Glucose tolerance test;

Scintigraphy;

Test with the absorption of radioactive I131 by the thyroid gland;

X-ray methods;

Thermography;

Thermometry.

Bibliography

1. Great medical encyclopedia.

2. Propaedeutics in therapy.

3. Fundamentals of nursing in therapy.

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