Lecture 11

Theme

The Endocrine system.

Reading Materials:

Gray`s anatomy:4th ed. pages:1006-1011, 386-387, 470,

463,215-217, e69, 855,862, 332-335.

Gray`s anatomy:3rd ed. pages: 1017-1022, 386-387,

476, 470, 210-212, 333-336, 867, 874.
The Pituitary Gland

The pituitary gland, or hypophysis cerebri, is

a reddish-grey, ovoid body, about 12 mm in
transverse and 8 mm in anteroposterior
diameter, and with an average adult weight of
500 mg.
It is continuous with the infundibulum, a
hollow, conical, inferior process from the tuber
cinereum of the hypothalamus.
 The Pituitary Gland

The pituitary gland lies at the base of

the skull in a portion of the sphenoid bone
called sella turcica (Turkish saddle), which
consists of a deep central area -the
hypophyseal fossa.
The Pituitary Gland
The anterior portion of the sella turcica, the
tuberculum sellae, is flanked by posterior
projections of the sphenoid wings, the anterior
clinoid processes.
The dorsum sellae forms the posterior wall,
and its upper corners project into the posterior
clinoid processes.
The gland is surrounded by dura, and the roof
is formed by a reflection of the
dura attached to the clinoid processes, the
diaphragma sellae.
The arachnoid membrane and, therefore,
cerebrospinal fluid are prevented from entering
the sella turcica by the diaphragma sellae.
The pituitary stalk and its blood vessels pass
through an opening in this diaphragm. The lateral
walls of the gland are in direct
apposition to the cavernous sinuses and
separated from them by dural membranes. The
optic chiasm lies 5 to 10 mm above the
diaphragma sellae and anterior to the stalk.
The Pituitary Gland
The pituitary has two major parts, the
anterior pituitary or adenohypophysis and the
posterior pituitary also known as
neurohypophysis, which differ in their origin,
structure and function.
Between these portions is a small,
relatively avascular zone called the pars
intermedia, which is much less developed in
the human.
The neurohypophysis is a diencephalic
downgrowth connected with the
hypothalamus.
 The anterior pituitary, adenohypophysis,
originates from Rathke pouch, an ectodermal
evagination of the oropharynx, and migrates
to join the neurohypophysis.
Both include parts of the infundibulum.
The Pituitary Gland
The adenohypophysis is highly vascular.
 Most of the hormones synthesized
by the adenohypophysis are trophic.
Hormones synthesized by the
adenohypophysis are– Growth Hormone
(GH), Prolactin, Adrenocorticotropic
Hormone (ACTH), Thyroid-stimulating
hormone (TSH), Follicle-Stimulating
Hormone (FSH), Luteinizing Hormone (LH).
Neurones that secrete the peptides and
amines that control the anterior lobe are
widely distributed within the hypothalamus.
The Pituitary Gland
The axons arising from groups of
hypothalamic neurones (e.g. the
magnocellular neurones of the supraoptic
and paraventricular nuclei) terminate in the
neurohypophysis.
The long magnocellular axons pass to the
main mass of the neurohypophysis.
The neurohormones stored in the main
part of the neurohypophysis
are: vasopressin (antidiuretic hormone;
ADH), which controls reabsorption of water
by renal tubules, and oxytocin, which
promotes the contraction of uterine smooth
muscle in childbirth and the ejection of milk
from the breast during lactation.
The Pituitary Gland
The arteries of the pituitary arise from the
internal carotid arteries via
a single inferior and several superior
hypophysial arteries on each side.
The superior hypophysial arteries form a
capillary network in the median eminence of
the hypothalamus that recombines in long
portal veins draining down the pituitary stalk
to the anterior lobe, where they break up
into another capillary nerwork and re-form
into venous channels.
There are three possible routes for venous
drainage of the neurohypophysis: to the
adenohypophysis, via long and short portal
vessels; into the dural venous sinuses, via the
large inferior hypophysial veins; and to the
hypothalamus, via capillaries passing to the
median eminence.
The venous drainage carries hypophysial
hormones from the gland to their targets and
also facilitates feedback control of secretion.
The Pineal Gland
The pineal gland or epiphysis cerebri is a
small, reddish-grey organ, occupying a
depression between the superior colliculi.
It is inferior to the splenium of the corpus
callosum, from which it is separated by the
tela choroidea of the third ventricle and the
contained cerebral veins.
It is enveloped by the lower layer of the
tela, which is reflected from the gland to the
tectum.
The pineal is about 8 mm long.
 Its base, directed anteriorly, is attached by
a peduncle, which divides into inferior and
superior laminae, separated by the pineal
recess of the third ventricle, and containing
the posterior and habenular commissures
respectively.
The Pineal Gland
The pineal arteries are branches of the
medial posterior choroidal arteries, which are
themselves branches of the posterior
cerebral artery.
The capillaries drain into numerous pineal
veins, which open into the internal cerebral
veins and/or into the great cerebral vein.
The pineal gland contains cords and
clusters of pinealocytes, associated with
astrocyte-like neuroglia.
Melatonin, and its precursor 5-HT
(serotonin), are synthesized from tryptophan
by the pinealocytes, and secreted into the
surrounding network of fenestrated
capillaries.
The Thyroid gland
The thyroid gland is anterior in the neck
below and lateral to the thyroid cartilage.
It consists of:
 two lateral lobes - which cover the
anterolateral surfaces of the trachea, the
cricoid cartilage, and the lower part of the
thyroid cartilage,
and an isthmus that connects the lateral
lobes and crosses the anterior surfaces of the
second and third tracheal cartilages.
The thyroid gland arises as a median
outgrowth from the floor of the pharynx near
the base of the tongue.
The foramen cecum of the tongue indicates
the site of origin and the thyroglossal duct
marks the path of migration of the thyroid
gland to its final adult location. The
thyroglossal duct usually disappears early in
development.
The Thyroid gland
Lying deep to the sternohyoid,
sternothyroid, and omohyoid muscles, the
thyroid gland is in the visceral compartment
of the neck. This compartment also includes
the pharynx, trachea, and esophagus and is
surrounded by the pretracheal layers of
fascia.

There may also be functional thyroid gland:

associated with the tongue (a lingual
thyroid),
anywhere along the path of migration of the
thyroid gland, or
extending upward from the gland along the
path of the thyroglossal duct (a pyramidal
lobe).
 The Thyroid gland
Two major arteries supply the thyroid gland:
The superior thyroid artery and inferior thyroid
artery.
 Superior thyroid artery – the first branch of the
external carotid artery. When it reaches the
superior pole of the lateral lobe of the gland it
divides into anterior and posterior glandular
branches.

The anterior glandular branch passes

along the superior border of the thyroid
gland and anastomoses with its twin
from the opposite side.
The posterior glandular branch passes
to the posterior side of the gland and
may anastomose with the inferior thyroid
artery .
 The Thyroid gland
Inferior thyroid artery - a branch of the
thyrocervical trunk, which arises from
the first part of the subclavian artery.
Inferior thyroid artery - ascends along the
medial edge of the anterior scalene muscle,
passes posteriorly to the carotid sheath,
and reaches the inferior pole of the lateral
lobe of the thyroid gland. At the thyroid
gland it divides into an:
 inferior branch, which supplies the lower
part of the thyroid gland and anastomoses
with the posterior branch of the superior
thyroid artery, and
Occasionally, a small thyroid ima artery  an ascending branch, which supplies the
arises from the brachiocephalic trunk or the parathyroid glands.
arch of the aorta and ascends on the anterior
surface of the trachea to supply the
thyroid gland.
The Thyroid gland
Three veins drain the thyroid gland:
 The superior thyroid vein primarily drains
the area supplied by the superior thyroid
artery.
 The middle and inferior thyroid veins drain
the rest of the thyroid gland.

The superior and middle thyroid veins drain

into the internal jugular vein, and the inferior
thyroid veins empty into the right and left
brachiocephalic veins, respectively.

Lymphatic drainage of the thyroid gland is to

nodes beside the trachea - paratracheal nodes
and to deep cervical nodes inferior to the
omohyoid muscle along the internal jugular
vein.
The Thyroid gland
 The thyroid gland is closely related to the
recurrent laryngeal nerves.
After branching from the vagus nerve [X] and
looping around the subclavian artery on the
right and the arch of the aorta on the left, the
recurrent laryngeal nerves ascend in a groove
between the trachea and esophagus.
They pass deep to the posteromedial
surface of the lateral lobes of the thyroid gland
and enter the larynx by passing deep to the
lower margin of the inferior constrictor of the
pharynx.
Together with branches of the inferior
thyroid arteries, the recurrent laryngeal nerves
are clearly related to, and may pass through
ligaments, one on each side, that bind the
thyroid gland to the trachea and to the cricoid
cartilage of the larynx. These relationships
need to be considered when surgically
removing or manipulating the thyroid gland.
The Parathyroid Glands
 The parathyroid glands are two pairs of
small, ovoid, yellowish structures on the deep
surface of the lateral lobes of the thyroid
gland.
They are designated as the superior
and inferior parathyroid glands.
Derived from the third (the inferior
parathyroid glands) and fourth (the superior
parathyroid glands) pharyngeal pouches, these
paired structures migrate to their final
adult positions and are named accordingly.
The arteries supplying the parathyroid glands
are the inferior thyroid arteries, and venous
and lymphatic drainage follows that described
for the thyroid gland.
The Thymus
 The thymus is the most anterior component
of the superior mediastinum, lying
immediately posterior to the manubrium of
the sternum.
The left and right brachiocephalic veins are
located immediately posterior to the thymus
It is an asymmetrical, bilobed structure.
The upper extent of the thymus can reach
into the neck as high as the thyroid gland; a
lower portion typically extends into the
anterior mediastinum over the pericardial sac.
Involved in the early development of the
immune system, the thymus is a large structure
in the child, begins
to atrophy after puberty, and shows
considerable size variation in the adult.
In the elderly adult, it is barely identifiable
as an organ, consisting mostly of fatty tissue
that is sometimes arranged as two lobulated
fatty structures.
The Thymus
 Arteries to the thymus consist of small
branches originating from the internal thoracic
arteries.

Venous drainage is usually into the left

brachiocephalic vein and possibly
into the internal thoracic veins.

Lymphatic drainage returns to multiple

groups of nodes at one or more of the
following locations:
 along the internal thoracic arteries
(parasternal) ;
at the tracheal bifurcation (tracheobronchial);
 and in the root of the neck.
The Suprarenal glands
The suprarenal glands are associated with
the superior pole of each kidney.
They consist of an outer cortex and an inner
medulla.
The adrenal medulla, the central 20 percent
of the gland, secretes the hormones
epinephrine and norepinephrine in response
to sympathetic stimulation.
The adrenal cortex secretes an entirely
different group of hormones, called
corticosteroids.
The right gland is shaped like a pyramid,
whereas the left gland is semilunar in shape
and the larger of the two.
Anterior to the right suprarenal gland is part
of the right lobe of the liver and the inferior
vena cava, whereas anterior to the left
suprarenal gland is part of the stomach,
pancreas, and, on occasion, the spleen.
Parts of the diaphragm are posterior to both
glands.
The Suprarenal glands

The arterial supply to the suprarenal glands

is extensive and arises from three primary
sources:
As the bilateral inferior phrenic arteries pass
upward from the abdominal aorta to the
diaphragm, they give off multiple branches
(superior suprarenal arteries) to
the suprarenal glands.
A middle branch (middle suprarenal artery)
to the suprarenal glands usually arises directly
from the abdominal aorta.
 Inferior branches (inferior suprarenal
arteries) from the renal arteries pass upward
to the suprarenal glands.
The Suprarenal glands
The suprarenal glands are surrounded by the
perinephric fat and enclosed in the renal fascia,
though a thin septum separates each gland from
its associated kidney.

In contrast to this multiple arterial supply is the

venous drainage, which usually consists of a single
vein leaving the hilum of each gland.

On the right side, the right suprarenal vein is

short and almost immediately enters
the inferior vena cava, while on the left side, the
left suprrenal vein passes inferiorly to enter the
left renal vein.

The suprarenal gland is mainly innervated by

preganglionic sympathetic fibers from spinal levels
T8-L1 that pass through both the sympathetic
trunk and the prevertebral plexus without
synapsing. These preganglionic fibers directly
innervate cells of the adrenal medulla.
Pancreas
 The head of the pancreas lies within
the C-shaped concavity of the
duodenum.
 Projecting from the lower part of the
head is the uncinate process, which
passes posterior to the superior
mesenteric vessels.
 The neck of the pancreas is anterior
to the superior mesenteric vessels.
Posterior to the neck of the pancreas,
the superior mesenteric and splenic
veins join to form the portal vein.
 The body of the pancreas is elongate
and extends from the neck to the tail
of the pancreas.
 The tail of the pancreas passes
between layers of the splenorenal
ligament.
Pancreas

 The pancreas is composed of two

major types of tissues, as: (1) the acini,
which secrete digestive juices into the
duodenum, and (2) the islets of
Langerhans, which secrete hormones
directly into the blood.
 The human pancreas has 1 to 2 million
islets of Langerhans. Each islet is only
about 0.3 millimeter in diameter and is
organized around small capillaries, into
which its cells secrete their hormones.
Pancreas
 The islets contain three major types of cells
—alpha, beta, and delta cells.
 The beta cells, constituting about 60
percent of all the cells of the islets, lie
mainly in the middle of each islet and
secrete insulin and amylin.
 The alpha cells, about 25 percent of the
total, secrete glucagon.
 The delta cells, about 10 percent of the
total, secrete somatostatin.
 In addition, at least one other type of cell,
the PP cell, is present in small numbers
in the islets and secretes a hormone
pancreatic polypeptide.
 And the ε cells in the islet make ghrelin.
Pancreas
The arterial supply to the pancreas includes the:

 gastroduodenal artery from the common

hepatic artery (a branch of the celiac trunk),
 anterior superior pancreaticoduodenal artery
from the gastroduodenal artery,
 posterior superior pancreaticoduodenal artery
from the gastroduodenal artery,
 dorsal pancreatic artery from the inferior
pancreatic artery (a branch of the splenic artery),
 great pancreatic artery from the inferior
pancreatic artery (a branch of the splenic artery),
 anterior inferior pancreaticoduodenal artery
from the inferior pancreaticoduodenal artery (a
branch of the superior mesenteric artery), and
 posterior inferior pancreaticoduodenal artery
from the inferior pancreaticoduodenal artery (a
branch of the superior mesenteric artery)
Pancreas
the anterior superior pancreaticoduodenal vein
typically joins either the confluence of the right
gastroepiploic and right colic veins (the gastrocolic
trunk of Henle) or the right gastroepiploic vein
alone, to drain into the superior mesenteric vein at
the inferior border of the neck of the pancreas.
The posterior superior pancreaticoduodenal
vein drains cranially into the portal vein.
 Both anterior and posterior inferior
pancreaticoduodenal veins usually drain directly
into the superior mesenteric vein.
Veins from the body and tail of the gland drain
directly into the splenic vein.
A transverse (or inferior) pancreatic vein may be
present, running along the inferior border of the
pancreas to join the inferior mesenteric vein.
A few pancreatic veins communicate with
systemic veins in the retro-
peritoneum (veins of Retzius); these may form
retroperitoneal varices in portal hypertension.
Pancreas
Lymphatics from the tail and body
drain mostly into nodes along the
splenic artery and inferior border of
the gland, and from there to pre-
aortic nodes between the coeliac
trunk and superior mesenteric artery.
Lymphatics from the neck and head
drain more widely into nodes along
the pancreaticoduodenal, superior
mesenteric and hepatic arteries, and,
ultimately, into pre-aortic nodes.
The pancreas is innervated by the
vagus, celiac plexus and superior
mesenteric plexus.
The ovaries
The ovaries are the sites of egg
production (oogenesis).
The ovaries are not only the store for
germ cells-they also produce and secrete
hormones that are vital for reproduction
and thedevelopment of secondary sexual
characteristics.
The ovaries lie adjacent to the lateral
pelvic wall just inferior to the pelvic inlet.
Each of the two almond-shaped
ovaries is about 3 cm long and is
suspended by a mesentery -the
mesovarium, that is a posterior extension
of the broad ligament.
In the ovary, the major source of
hormone production is the
maturing follicle.
FSH stimulates growth and secretion of
oestrogens in ovarian follicles and LH,
induces progesterone secretion by the
corpus luteum.
The ovaries
From the abdominal aorta arise ovarian
arteries, descends along the posterior
abdominal wall, at the pelvic brim they
cross over the external iliac artery and
enter the suspensory ligament.
Branches from ovarian artery supply
lateral aspect of the ovaries and uterine
tubes.
From the internal iliac artery arise
uterine artery, gives off ascending
branches which reaches medial aspect of
the ovaries and uterine tubes.

Lymphatics from the ovaries and related

parts of the uterus and uterine tubes
leave the pelvic cavity superiorly and drain,
via vessels that accompany the ovarian
arteries, directly into lateral aortic or
lumbar nodes and, in some cases, into the
pre-aortic nodes on the anterior surface of
the aorta.
The ovaries
Veins draining the ovary form pampiniform
plexus of veins in the broad ligament.
The veins of the plexus usually merge to form a
singular ovarian vein, which leaves the lesser
pelvis with the ovarian artery.
The right ovarian vein ascends to enter inferior
vena cava, the left ovarian vein drains into the left
renal vein.

Innervation of Ovaries and Uterine Tubes:

• ovarian plexus
• uterine (pelvic) plexus.
The Testes

Each testis is composed of seminiferous

tubules and interstitial tissue surrounded by
a thick connective tissue capsule - the tunica
albuginea.The testes are located within the
scrotum.
 Spermatozoa are produced by the
seminiferous tubules.
 The 400 to 600 highly coiled seminiferous
tubules are modifiedat each end to become
straight tubules, which connect to a
collecting chamber - the rete testis, in a
thick, vertically oriented linear wedge of
connective tissue - the mediastinum testis,
projecting from the capsule into the posterior
aspect of the gonad.
Approximately 12 to 20 efferent ductules
originate from the upper end of the rete
testis, penetrate the capsule, and connect
with the epididymis.
The Testes

The approximately 200 million

androgen-producing Leydig cells, are
interspersed between the seminiferous
tubules.
The seminiferous tubules are
composed of Serroli cells and germinal
cells.
The Sertoli cells line the basement
membrane and form right junctions
with other Sertoli cells.
FSH stimulates spermatogenesis,
acting on testicular Sertoli cells.
LH induces testosterone
synthesis by Leydig cells in the testis.
Vasculature
 The arterial supply to the testis and
epididymis is derived from three
sources.
 These are:
 the testicular artery - arises from the
abdominal aorta, inferior to the origin of
the renal artery. It is supplying
approximately two-thirds of the testicular
blood supply,
 the vasal artery (artery to vas deferens,
artery to ductus defer-
ens, vasal artery, ductal artery) - is a branch
of the superior (and, occasionally, inferior)
vesical artery, which arises from the
internal iliac artery.
 and the cremasteric arteries (together
supplying approximately one-third of the
testicular blood supply) - is a branch of the
inferior epigastric artery.
Veins and lymphatics
 Testicular veins emerge posteriorly from
the testis, drain the epididymis,
and unite to form several highly
anastomotic channels surrounding the
testis, known as the pampiniform plexus,
a major component of the spermatic
cord.
 The pampiniform plexus ascends anterior
to the vas deferens, and is drained by 3–4
veins in the inguinal canal. The
veins enter the abdomen through the
deep inguinal ring and coalesce
into a single testicular vein that drains
into the inferior vena cava on
the right, and into the renal vein on the
left. The testicular veins contain valves.
 The lymph drainage of the testes is
to the lateral aortic or lumbar nodes and
pre aortic nodes in the abdomen, and
not to the inguinal or pelvic lymph nodes.
Innervation
 The testis is innervated either by nerve
fibres that arise from the tenth and
eleventh thoracic spinal segments, via the
renal and aortic plexuses, and
accompany the testicular vessels, or by
fibres that arise from the pelvic
plexus and accompany the vas deferens.
 Interestingly, some afferent and efferent
nerves have been shown to cross over
to the contralateral pelvic plexus, which
may be one reason why pathological
processes in one testis can affect the other.