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SISTIM ENDOKRIN

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  • SISTIM ENDOKRINDr. Hj. RESMI KARTINI, MS

  • Homeostasis seluler diatur :Sistim saraf Sistim endokrin terutama hipotalamus ( pituitari )Dan sel neuroendokrin APUD

    HormonKelenjar endokrin target organinteraksi melalui reseptor

  • Reseptor - reseptorSurface membrane receptorsHormon polipeptide ( pituitary )KatekolaminCytoplasmic reseptorSteroidNukleusIntranuclear reseptorThyroid hormonSitoplasma

  • HIPOTALAMUS

    KONTROL

    KELENJAR ENDOKRIN PERIFERFEED BACK MECHANISMPITUITARY HORMON STIMULATORY INHIBITORY

  • Pituitary gland

    ANT:adenohipofisis Rathkes PouchPost : Neuro Hipofisis Floor Ventr IIIPost - Vasopresin ( ADH ) -OxytocinAnt -Asidofil somatrroph GH mammotroph PrL -Basofil Corticotroph Proopiomesamocortin acth,msh, endorfin,lipotropin Tirotrof TSH Glikoprotein Gonadotrop: FSH,LH -Khromofob

  • PATOLOGIPrimer : Lobus Ant PostAdenohipofisis Hiper / Hipopituit 1.Tropic hormon / Hipopituitary : 75 % destruksi -tumor non fungsional -Infeksi -Hipotal (jarang)

    2.Local effect - rare - Sela tursika besar --- Xray,CT,MRI Expansile lesion ( neoplasma )

  • - Defek Expanding dis.pit Chiasma opt / N. II Bitemporal hemianopsia visual impairment- Sangat jarang Tek intrakranial( Headache, nausea, vomitus Neoplasma )

  • HiperpituitariAdenomaKarsinoma (Hipotalamus Stimulasi >> Pituiti)----- jarangAdenoma MonoclonalSingle hormon Manifestasi klinikPlurihormonalPrimitif / Pluri potent cells

  • Morfologi

    Mikro adenoma ( < 10 mm )Mikro adenoma ( > 10 mm )Mikro adenoma : 40 % unselected autopsi. single ,multipel multiple foci hiperplMakro adenoma : Ekpansi dpt erosi tulangSella enkapsul poorly diliputi retikulin chiasma optikum syaraf kranialDasar otak,sinus cavernosus, tlg sfenoid

  • Mikroskopis :

    Uniform sel poligonal tersusun sheet,cord,nests.Stroma vascularisasi bertambahNecrosis ischemik,psammoma bodiesHemoragik pituit apoplexyMitosis /pleomorfik ? Malignancy metastasis

  • PITUITARY ADENOMA

  • PITUITARY ADENOMA

  • Somatotropic ADENOMASSomatotro. acidophilic macro adenoma GH Akromegali Gigantisme jarangHiperplasiaAkromegali Adult Megali :akral,Kepala, tgn, Kaki,jaw,lidah Soft tissue

  • Gigantisme : ChildrenSel matur uniform --- granulatedSebagian pleomorfik asidofil1/3 BSM Prl bimorfusPrl granul pada sel neoplastik tidak terdapat pada darah

  • ProlactinomasSparsely granulatedHiperplasia jarangHiperprolactinemi lesi hipotal drug impair dopaminergic trans mission (metildopa,reserpin) estrogen terapi Hipogonad laki 2 --- impoten,infertil peremp --- galactorrhea amenorrhea

  • 2/3 macro adenoma granulated acidophilic cells1/3 Micro adenomaKalsifikasiSel uniform sela tursika

  • Corticotroph tumors

    basophilik mikroadenoma ACTH ------ Hipersekresi kortisol adrenalHiperplasia / multiple micro adenoma cushings diseasePro opio melanocortincrookes hyaline changeskhromofobic less well defined cortisol excessSilent tumor besar induce local changes

  • Other functioning AdenomasGonadotroph tumor 6%Laki 2 FSH LH hipogonadPerempuan Gonadotropin sekresi - wl pun LH dapat dideteksi serum BesarMikros : Laki-laki Pleom, wanita :uniform small cell

  • CARCINOMA

    DiferensiasiDiagnosis Matastase : KGB Bone Hati dll

  • Disorders associated with HypopituitarismGerm cell TKraniofaringiomaGliomaKetiga diatas lesions of hypothal,ant hipofis hipopituitary 75 % destruksi klinikTumor klinik : Diab-insipidus Growth Acceleration Delayed puberty

  • 90% hipopituitproses destruksi adeno hipophisisTU: Nonsecretory adenomas Sheehans pit.necrosis Empty sella tursikaNeoplasma .metas.Pituit apopleksi chemorDisruption blood supply by sistemic arteritis / or trSinus venosus cavernosusDistruksi inflamasi lob ant by sarcoidosis / inf,surgical / radiation ablation metab.dis

  • NON SECRETORY CHROMOPHOBE PITUIT ADENOMA

    25 -30 %Klinik efek lokal - Kelainan lapangan pandangan - Sakit kepala - hipotensi --- one of target endoc organ UNDER pituit control ( HIPOTIROID HIPOGONADISM )

  • MORFOLOGIBesar silent bertahun-tahunNull cell adenomaOncocytoma sparsely granules lessionImunohistokimia FSH, / hormon, LH

  • SHEEHANS SYNDROME / NECROSIS PITUIT POST PARTUMHamil pituitary besar Hemorr vasospasmenekrosis.iskemik/ infark lobus anterior Shock

  • DICSickle cell anemiaTr. Sinus cavernosus arteritis temporal, traumatic injury pembuluh darah, DM (lama)

  • 95-99 % destruksi lobus anterior defisiensi gonadotropic laktasi menurun (puerperium)Defisiensi TSH atau hipotiroidACTH (insufisiensi adrenocortical)Infark : soft, pale fibrosis

  • EMPTY SELLA SYNDROMEHernia arachnoid deffect diafragma sellaTekanan CSF atropi pituitary empty sella

  • SINDROMA PITUITARY ANTERIORJarangTerutama lesi hipotalamus suprasellerDisfungsi ADH defisiensi diabets insipidusArginin vasopresin:oksitosin kontraksi uterus partus stim glandula lactating

    Neoplastik : tumor supraseller, metas Ca, abses, meningitis, TBC, sarcoidosis (inflamasi hipotalamus-hipofisial)Surgical radiasi hipotalamus-hipofisialSevere head injuryIdiopatik

  • Hypothalamik suprasellar tumors Neoplasma jrg GLIOMA / Craniopharyngioma

    Hipofungsipituitary anteriorHiperfungsiDiabetes insipidusCraniopharyngiomaDari sisa rathkes pouchPada sella, suprasellar Anak, dewasa mudabenign

  • MORFOLOGI3-4 cm, solid encapsule, kistik multilokuler, kalsifikasiMikroskopis :

  • ADENO HIPOFISIAL HIPOFUNGSILorain levi syndromeGH / hormon lain HipoglikemiagonadotropinKraniofaringiomaFrohlichs syndromeObesitasPerkembangan sex arrestMental sub normal,Growthtumor

  • Prepubertas--- growth pituitary dwarfism sexual retard

  • HIPOGONADISMAmenoreLoss of axilla and pubicSterillityOvarium atropi, genital atropiTestis atropi, sterillityLoss of axilla, pubicHipotiroid TSHHipoadrenal ACTHPanhipopituit Simmonds

  • TSHIodine in diet iodine+tirosin T3 sekresi abs stimulasi monoiodo oleh TSH oleh TSH andbowel diiodotirosinT4 blood

  • TIROIDTirotoksikosis (hipertiroidism)HipotiroidismDifus / fokal enlargement (Goiter) tidak ada hubungan antara lesi morfol dan klinik

  • TIROTOKSIKOSISHipertiroidism, Free T3 , T4 Hiperfungsi tiroid (Graves disease) hipertiroidismNon hiperaktif kelenjar tirotoksikosisSindrom :NervousnessBB (nafsu makan baik)PalpitasiHeat intoleranceRapid pulseWarm skinFatigabilityEmosi labilKelemahan ototPerubahan haidBMRTremor tanganPerubahan mataKelenjar tiroid membesar

  • MORFOLOGIVasodilatasi : Periferheat lossSirkulasi hiperdinamik general kulit : warm, moist, flushedhipertiroidperubahan mataGraves disease---proptosis perubahan imunologiInflamasi sekunder jaringan retroorbital jantung TakhikardiPalpitasiKardiomegaliAritmia, fibrilasi supraventrikuler

  • GRAVES DISEASE

  • THYROTOXIC CARDIOMIOPATHYFokus infiltrasi limfosit, eosinofil, interstisial, fibrosis ringan, fatty changesManifestasi lain: Otot skelet : atropi, fatty infiltrasi, infiltrasi limfosit fokal Hati : minimal fatty changes, fibrosis periportal, infiltrasi limfositOsteoporosis general lymphoid hyperplasia dg lymphadenopathy

  • Graves Disease< 40 th (85%)HipertiroidDiffuse toxic hyperplasiaHiperfungsi tiroid Pemberian iodine >> pada kelainan (T3 / T4)tiroid Jod basedows disease

  • HIPERFUNGSI TIROIDT3 T4 sirkulasi tirotoksikosisTerdiri dari :Graves diseaseToxic adenomaToxic noduler goiterKlinik :ExophtalmusProminent tiroidBMR Skin warm, sweaty : heat intoleranceWeakness,hiperkinesia, emotional instabilityBBGlucose tolerance, glukosuriaNadi , Cardial arrhythmia and failure ( orang tua )TSH

  • TIROIDITISTiroiditis interstitialPalpation tiroidSuperior / inferior tiroidjarang direct traumaticImunologi Staf, strep, salmonella, enterobacter, M tbc, jamur (candida, asper, mucor)

  • MorfologiKelenjar besarHasimotoSub acute granulomatous tiroiditisSub acute limfositic tiroiditisRiedel struma

  • HASHIMOTOS THYROIDITIS/ STRUMA LYMPHOMATOSA/ LYMPHADENOID GOITER : Goitrous hipotirNon endemic goter (children)Autoimun diseaseBerlangsung lama hipotiroid hipertiroidhashitoxicosisHashimoto Grave

  • ETIOLOGIAutoimunDefek fungsi tiroid spesifikSupressor T cellAntibodies tiroid peroksidase (antimicrosomal antibodies)AB Spesifik untuk tiroglobulinTSH reseptor

  • MorfologiKelenjar besar, diffuse, asimetris, kapsul intak, coklat noduler, Rubbery tissueMikroskopis :Perjalanan penyakit : usia pertengahanHipotiroidismAtropiStadium dini metabolisme normal, fungsi tiroid, TSH, T3 T4 Prognosa baik: 1-200 lymphomaGoitrous hipotirNon endemic goter (children)Autoimun disease lymphoma

  • HASHIMOTOS THYROIDITIS

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