ENDOCRINE SYSTEM

Endocrine System

Pituitary Pancreas Adrenal Gland

Gland

Thyroid Gland Parathyroid Gland

 Endocrine Glands

• Are ductless & secrete

hormones into
bloodstream.
 INTRODUCTION
Endocrine glands (Greek-”I separate within”) secrets
physiologically active substances called HORMONES directly to
blood stream.

Hormones – in Greek means “I excite or arouse”, was introduced by

Starling in 1905.

DEFINITION : Secretory product of Endocrine glands released directly

into the circulation in small amount in response to specific stimulus.On
delivery in circulation it produces response on the target cells or organs.
 Hormones

Hormones go to target
cells that contain
receptor proteins for it

• Neurohormones are
secreted into blood by
specialised neurons.

• Hormones affect
metabolism of targets
 Pituitary Gland

• Pituitary gland is located beneath hypothalamus at base of forebrain

 Pituitary Gland

• Is structurally &
functionally divided into
anterior & posterior lobes

• Hangs below hypothalamus

by infundibulum

• Anterior produces own

hormones
– Controlled by hypothalamus

• Posterior stores & releases

hormones made in
hypothalamus
 Anterior Pituitary

• Secretes 6 trophic
hormones that
maintain size of
targets
– High blood levels
cause target to
hypertrophy
• Low levels cause
atrophy
 Anterior Pituitary Hormones

• Growth hormone (GH) promotes growth, protein synthesis

• Thyroid stimulating hormone (TSH) stimulates thyroid to produce &

secrete T4 & T3

• Adrenocorticotrophic hormone (ACTH) stimulates adrenal

cortex to secrete cortisol, aldosterone

• Follicle stimulating hormone (FSH) stimulates growth of

ovarian follicles & sperm production
 Anterior Pituitary Hormones
• Luteinizing
hormone (LH)
causes ovulation &
secretion of
testosterone in
testes
Prolactin (PRL)
stimulates milk
production by
mammary glands.
 Anterior Pituitary
• Releasing & inhibiting
hormones from
hypothalamus are
released from axon
endings into capillary
bed in median eminence

– Carried by hypothalamo-
hypophyseal portal system
directly to another
capillary bed in Anterior
Pituitary
• Diffuse into A. Pit. &
regulate secretion of its
hormones
Releasing and inhibiting
hormones
Anterior pituitary hormones
 GROWTH HORMONE (GH)
 Protein hormone, secreted by acidophills
of anterior pitutary

Also called SOMATOTROPHIC hormone or

SOMATOTROPIN

 Secretion is more during strenuous

 exercises and deep sleep.

 No specific target organ

 .
 Anabolic hormone Ref: Guyton textbook
 . of physiology :924
 No direct action on bone but act thru
substance called STOMATOMADIN.
 No direct action on bone but act through
substance called STOMATOMADIN.

TWO TYPES:
1. Insulin like growth factor(IGF-1)
2. Insulin like growth factor(IGF-2)

GH carries almost all the metabolic activity with

IGF-1 .(somatomedin C)
 Growth Hormone (GH or
somatotropin)

• Stimulates uptake of amino acids; protein

synthesis; growth in most tissues.

• Stimulates breakdown of fats to be used as

an energy source but stimulates synthesis of
glycogen (diabetogenic)

• Promotes bone and cartilage growth

• Regulates blood levels of nutrients after a
meal and during periods of fasting

• Stimulates glucose synthesis by liver

 Normal concentration of GH ;
2 – 4 ng/ml in growing child

GH DEFICIENCY

Children with big skull with babyish face

Cephalometric studies :
Small size of ant. & post. Cranial base
Smaller mandibular dimensions
Small post. Facial height & mand.
height.

 Study done on 13 pts. with pitutary deficiency,

Cephalometric finding were low as compared to normal
HYPERSECRETION OF GH

1. GIGANTISM
2. ACROMEGALY

GIGANTISM

Occur during adolescence before

epiphysial closure.
Features:
 Tall stature
 Bilateral gynaecomastia
 Large hand and feet
 Associated features like:coarse hair,loss of libido,etc.
A CEPHALOMETRIC STUDY

Done on two female pt. suffering from Gigantism.

FINDINGS:

Ant. facial height +3.5D to +6.85D

Post. facial height +3.75D to +4.95D

Post. cranial base was long

Ant. cranial base was normal

Face was broad with pronounced zygomatic

arches but relatively normal occlusion
ACROMEGALY

Occur during adulthood after epiphyseal closure.

Usually a result of benign pitutary tumor.

Features :
Broad,thick nose
Thickening of the skin
Prominent brow
Coarsening of facial features
Prognathism : elongation and
widening of mandible (class 3 malocclution)
Serum level of IGF-1 was 10 times high.
Development of cross bite
ELONGATION AND WIDENING OF MANDIBLE IN
ACROMEGALY

Mandibular growth in Acromegaly results from

appositional growth and hypertrophic changes
in the condylar cartilage.
Chung – Juhwang and Jung- yul cha(AJODO 2004;126;118-26)

On orthodontic treatment with growth hormone

therapy in a 9 year old short stature child.

Conclusion at the end of the treatment :

1. High GH therapy affect growth of mandible more than the

growth of maxilla.

2. Amount and pattern of growth during high administration

are unpredictable
.
3. High therapy rarely affect the dental maturity.
 Growth Hormone & Body Growth
• Excess GH secretion in
adults, after epiphyseal
discs are ossified,
results in acromegaly
– There is no increase in
height
– However soft tissue still
grows
• Causing elongation of
jaw, deformities in hands,
feet, & bones of face
 Posterior Pituitary

• Stores & releases 2 hormones produced in

hypothalamus:
– Antidiuretic hormone (ADH/vasopressin) which
promotes H20 conservation by kidneys

– Oxytocin which stimulates contractions of uterus during

parturition
• & contractions of mammary gland alveoli for milk-ejection
reflex
Thyroid Gland
 Thyroid Gland

• Is located just
below the larynx
• Secretes T4 & T3
which set BMR &
are needed for
growth,
development
Effects of T3 and T4
1. Maintain normal rate of metabolism.

2. Increase the rate at which glucose, fat, and protein are meta-
bolized.

3. Increase the activity of Na+-K+ pump which increases body

temperature (“calorigenic effect”)

4. Can alter the number and activity of mitochondria resulting in

greater ATP synthesis and heat production.

5. Normal growth and maturation of bone, hair, teeth and

nervous tissue require thyroid hormone.

6. Both T3 and T4 play a permissive role for GH and GH does not

have its normal effect on tissues if T and T are lacking.
 Diseases of the Thyroid - Goiter

• In absence of sufficient
dietary iodide, T4 & T3
cannot be made & levels
are low
– Low T4 & T3 don’t provide
negative feedback & TSH
levels go up
• Because TSH is a trophic
hormone, thyroid gland
grows
• Resulting in a goiter
 Diseases of the Thyroid - Hypothyroidism
• People with inadequate T4 & T3 levels are
hypothyroid

– Have low BMR, weight gain, lethargy, cold intolerance

– & myxedema = puffy face, hands, feet

– During fetal development hypothyroidism can cause

cretenism (severe mental retardation)
 Diseases of the Thyroid - Hyperthyroidism
• Goiters are also produced by Grave's disease

– Autoimmune disease where antibodies act like TSH &

stimulate thyroid gland to grow & oversecrete =
hyperthyroidism

• Characterized by exopthalmos, weight loss, heat intolerance,

irritability, high BMR
 THYROXINE HORMONE (TH)

It has no specific target organ

Regulates the pace of metabolism through interactions
with mitochondrial , nuclear & extra mitochondrial
processes.
Prenatal hypothyroidism
Development of bone & teeth are retarded
Later enamel defects in prenatally developed teeth are seen.
Some degree of mental retardation is seen.
After birth
Growth of cranium is retarded – brachycephalic faces develop
Increased mental retardation.

TH important for synthesis of IGF-1

Reduced facial height seen in children hypothyroidism
of long duration.
Orthodontic consideration

TH administration leads to :

Increased bone remodelling

 Increased bone resorptive activity

Reduced bone density

This result in increased tooth

movement during ortho. treatment.

( Sherazi,Dehpour,Jafari J Clin
Pediatric Dent 23(3);259-64 1999)
Study by Luis and Rita TH treated animals have
less force induced
Root resorption.
 Calcitonin

• Secreted by C cells or parafollicular cells of thyroid

gland.

• Works with PTH & 1,25 Vit D3 to regulate blood

Ca2+ levels.

• Stimulated by increased plasma Ca2

• Physiological significance in adults is not

understood
 CALCITONIN

Peptide hormone, secreted by intra follicular cells

also called Thyrocalcitonin.

It flows in bloodstream and attracts Ca to bone, thus reducing

Serum calcium
.
It reduces bone resorption by reducing the no. of osteoclasts.

It is used in the treatment of Hypercalcemia and Osteoporosis.

Ortho consideration

It inhibit tooth movement and consequently delays

orthodontic treatment .
PARATHYROID GLAND
 Parathyroid Glands

• Are 4 glands
embedded in lateral
lobes of thyroid gland
• Secrete Parathyroid
hormone (PTH)
– Most important
hormone for control of
blood Ca2+ levels
 Parathyroid Hormone (PTH)

• Release is stimulated by low blood Ca2+ levels

• Stimulates osteoclasts to reabsorb bone

• Stimulates kidneys to reabsorb Ca2+ from filtrate, & inhibits

reabsorption of P043-

• Promotes formation of 1,25 Vit D3 that stimulates Ca2+

absorption by intestines
 Parathyroid Hormone

• Release stimulated by
decreased blood Ca2+

• Acts on bones, kidney,

& intestines to increase
blood Ca2+ levels
 PARATHORMONE(PTH)

Polypeptide hormone which mobilizes calcium and phosphorous

from bones
It increases serum calcium level, and decreases
serum phosphorous.

Anthony and Richard on rats: (AmJO vol-55 no3)

50U in 0.5cc solution injected in distal aspect of left central incisor
of 6 rats.
After 5th day- appliance fitted(1 ounce force)
6th day animal sacrificed and maxilla removed and examined.

Lat. Incisor treated with PTH moved more than the right lat. Incisor

Result ; PTH enhance ortho. Tooth movement if applied locally.

Effects of Parathyroid Hormone
 1,25 Vitamin D3
• Synthesis begins in skin when cholesterol derivative is converted to
Vit D3 by sunlight
 1,25 Vitamin D3

• Directly stimulates intestinal absorption of Ca2+ & P043-

• When Ca2+ intake is inadequate, directly stimulates bone reabsorption

• Stimulates kidney to reabsorb Ca2+ and P043

– Simultaneously raising Ca2+ & P043- results in increased tendency
of these to precipitate as hydroxyapatite

• Inadequate Vit D in diet & body causes osteomalacia & rickets (loss
of bone calcification)
 Vitamin - D3

Vit. D3 with parathyroid and cacitonin hormone

regulates the amount of Ca and phosphorous in human body.

It promotes interstitial Ca and phosphorous absorption

Vit.D3 increases the bone mass and thus reduces fractures

in osteoporosis .

It can be assumed that they can inhibit tooth movement.

Stimulated by PTH
Overview of Hormonal Control of Ca 2+
 SEX HORMONES

They are steroidal hormone.

At puberty, the increase in GH and IGF-1 production is

sex hormone dependent.

Promotes protein synthesis in the body.

They regulate normal bone metabolism

(after menopause- osteoporosis)
Role of sex hormone in dental & craniofacial development
( Ascraft,Southard and Tolley in AJODO 1992 102;310)

 Study by Spiegel & Sather in children with disorder of puberty:

in extreme early or late maturing children dental development
was slightly deviation to early and late development.

 Keller ,Satherand , Hayle reported delayed facial growth

in Hypogonadism .

 Estrogen directly stimulates the bone forming activity of osteoblasts.

 Androgens also inhibit bone resorption &also modulate

growth of muscle system.

 In Athletes excess use of drugs may effect the length

and the results of orthodontic treatment.
 CORTICOSTEROIDS
HYPERGLUCOCORTICOIDISM leads to short stature
and developed bone maturation.

Very small amount may decrease growth rate.

Increased bone resorption.

Cortisol has inhibitory effect on bone collagen synthesis

Cortisone accelerate the tooth eruption.

 PROSTAGLANDINS(PG)

They act by increasing number of osteoclasts and activating

already existing osteoclasts on application of mechanical stress.
Adrenal Gland
 Adrenal Glands

• Sit on top of
kidneys
• Each consists of
outer cortex &
inner medulla
– 2 arise differently
during
development
 Adrenal Glands

– Medulla synthesizes & secretes 80% Epi & 20% NE

• Controlled by sympathetic
– Cortex is controlled by ACTH & secretes:
• Cortisol which inhibits glucose utilization & stimulates
gluconeogenesis
• Aldosterone which stimulate kidneys to reabsorb Na+ and
secrete K+
• & some supplementary sex steroids
 Adrenal Medulla

• Hormonal effects of Epi last 10X longer than NE

• Innervated by preganglionic Symp fibers
• Activated during "fight or flight" response
– Causes:
• Increased respiratory rate
• Increased HR & cardiac output
• General vasoconstriction which increases venous return
• Glycogenolysis & lipolysis
Effects of Epinephrine Secretion from
Adrenal Medulla
 Hormones of Adrenal Cortex
• Mineralocorticoids: Zona glomerulosa
– Aldosterone produced in greatest amounts. Increases
rate of sodium reabsorption by kidneys increasing
sodium blood levels
• Glucocorticoids: Zona fasciculata
– Cortisol is major hormone. Increases fat and protein
breakdown, increases glucose synthesis, decreases
inflammatory response
• Androgens: Zona reticularis
– Weak androgens secreted then converted to testosterone
by peripheral tissues. Stimulate pubic and axillary hair
growth and sexual drive in females
 Glucocorticoids (Cortisol)

• Help the body resist stress by:

– Keeping blood sugar levels relatively constant
– Maintaining blood volume and preventing water shift into tissue
• Cortisol provokes:
– Gluconeogenesis (formation of glucose from noncarbohydrates)
– Rises in blood glucose, fatty acids, and amino acids
PANCREAS
Pancreas
• Located along small intestine and
stomach; retroperitoneal
• Exocrine gland
– Produces pancreatic digestive
juices
• Endocrine gland
– Consists of pancreatic islets
– Composed of
• Alpha cells; secrete glucagon
• Beta cells; secrete insulin
• Delta cells; secrete somatostatin
 Glucagon

• A 29-amino-acid polypeptide hormone that is a potent

hyperglycemic agent

• Its major target is the liver, where it promotes:

– Glycogenolysis – the breakdown of glycogen to glucose
– Gluconeogenesis – synthesis of glucose from lactic acid and
noncarbohydrates
– Release of glucose to the blood from liver cells
 Insulin
• Target tissue is the liver, adipose tissue, muscle, and
satiety center of hypothalamus
• A 51-amino-acid protein consisting of two amino acid
chains linked by disulfide bonds
• Synthesized as part of proinsulin and then excised by
enzymes, releasing functional insulin
• Insulin:
– Lowers blood glucose levels
– Enhances transport of glucose into body cells
– Counters metabolic activity that would enhance blood glucose
levels
 Islets of Langerhans

• Betas secrete insulin in

response to low blood
glucose
– Promotes entry of
glucose into cells
– & conversion of glucose
into glycogen & fat
– Decreases blood glucose
 Insulin & Glucagon Secretion

• Normal fasting
glucose level is 65–
105 mg/dl
– Insulin & glucagon
normally prevent
levels from rising
above 170mg/dl
after meals or falling
below 50mg/dl
between meals
 Diabetes Mellitus

• Characterized by chronic high blood glucose levels

(hyperglycemia)
• Type I (insulin dependent or IDDM) is due to
insufficient insulin secretion

• Type II (insulin independent or NIDDM) is due to

lack of effect of insulin

19-49
 Diabetes Mellitus (DM)

• Results from hyposecretion or hypoactivity of insulin

• The three cardinal signs of DM are:

– Polyuria – huge urine output
– Polydipsia – excessive thirst
– Polyphagia – excessive hunger and food consumption

• Hyperinsulinism – excessive insulin secretion, resulting in

hypoglycemia
Diabetes Mellitus (DM)
Effects of Uncontrolled Type I Diabetes
 Hypoglycemia
• Reactive hypoglycemia is oversecretion of insulin due to an
exaggerated response of  cells to a rise in glucose
– Occurs in people who are genetically predisposed to type II diabetes
– Symptoms include tremors, hunger, weakness, blurred vision, & confusion
Miscellaneous Glands &
Hormones

11-65
 Sex & Reproductive Hormones

• Gonads (testes & ovaries) secrete steroid hormones

testosterone, estrogen, & progesterone.

• Placenta secretes estrogen, progesterone, hCG, and

somatomammotropin

11-69
 Estrogen
• Causes epiphyseal discs (cartilaginous growth
plates) to seal (ossify) which stops growth

• Is necessary for proper bone mineralization &

prevention of osteoporosis

• Stimulates osteoblast activity & suppresses

formation of osteoclast

• Decreased rate of tooth movement.

19-73
 TESTOSTERONE
• Effect on Bone Growth and Calcium
Retention: Testosterone increases the total
quantity of bone matrix and causes calcium
retention. The increase in bone matrix is
believed to result from the general protein
anabolic functions of testosterone. Because of
the ability of testosterone to increase the size
and strength of bones, it is often used in old
aged men to treat osteoporosis.
• Decreased rate of tooth movement.
 REFERENCES
 Human physiology- A.k.Jain,2nd edition
 Text book of physiology – Guyton,10th edition
 Essentials of medical physiology – Sembulingum, 2nd edition
 Contemporary Orthodontics – Proffit
 Mc graw hills textbook of physiology
 Articles:
1. Endocrine regulation of craniofacial growth
2. Ortho. with GH – Chung jucha hwang jun yul
(Am J orthod dentofacial orthop.2004;126;118-26)
3. GH hormone receptors& IGF-1receptor – Angle orthod.2001
4. Effect of TH on ortho tooth movementin rats – Sharazi, Dehpour,
Jafari.- J clin Pediatr dent. 23(3);259-64,1999
5. Effects of corticosteroid on osteoporosis – Ashcraft, southard, tolley
( Am J ortho. Dentofac. Orthop.1992; 102:310)
Abstracts :
1. Am J orthod vol55 no. 3 – use of PTH to assist
ortho. tooth movement
THANK YOU