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1、2022/3/6,基础医学内分泌系统疾病,1,内分泌系统疾病Diseases of endocrine System,吴正蓉南方医科大学病理学系,2022/3/6,基础医学内分泌系统疾病,2,内分泌系统的组成Constitutes of endocrine system ：内分泌腺 glands、内分泌组织 tissue、内分泌细胞 cells,2022/3/6,基础医学内分泌系统疾病,3,二、糖尿病（自学）Diabetes,一、甲状腺疾病 Thyroid disease,2022/3/6,基础医学内分泌系统疾病,4,The butterfly-shaped thyroid,2022/3/6,
2、基础医学内分泌系统疾病,5,2022/3/6,基础医学内分泌系统疾病,6,This is the normal appearance of the thyroid gland on the anterior trachea of the neck. The thyroid gland has a right lobe and a left lobe connected by a narrow isthmus. The normal weight of the thyroid is 10 to 30 grams. It cannot easily be palpated on physical
3、examination.,2022/3/6,基础医学内分泌系统疾病,7,Normal thyroid seen microscopically consists of follicles lined by a an epithelium and filled with colloid. The follicles vary somewhat in size. The interstitium, which may contain C cells, is not prominent.,2022/3/6,基础医学内分泌系统疾病,8,2022/3/6,基础医学内分泌系统疾病,9,甲状腺上皮细胞可通过
4、泡膜上的“碘泵”主动摄取血浆中的I-。I-在甲状腺浓集，在过氧化酶催化下，氧化成活性碘。 活性碘使甲状腺上皮细胞核糖体上的甲状腺球蛋白中的酪氨酸残基碘化，生成一碘酪氨酸（MIT）或二碘酪氨酸（DIT）残基。 在过氧化酶催化下，一分子DIT与一分子MIT缩合成一分子T3，两分子DIT缩合成一分子T4。 含T3、T4的甲状腺球蛋白在滤泡腔贮存。,碘的摄取和活化,MIT与DIT的形成,T3与T4的形成,贮 存,利 用,甲状腺激素的合成与碘的代谢,2022/3/6,基础医学内分泌系统疾病,10,甲状腺肿Goiter,甲状腺肿瘤Thyroid neoplasm,甲状腺腺瘤Thyroid adenoma,
5、甲状腺癌Thyroid carcinoma,弥漫性非毒性Diffuse nontoxic,弥漫性毒性Diffuse toxic,甲状腺疾病Thyroid disease,甲状腺炎Thyroiditis,亚急性Subacute thyroiditis,慢性淋巴细胞性Chronic lymphocyticthyroiditis,2022/3/6,基础医学内分泌系统疾病,11,一般不伴甲亢，亦称单纯性甲状腺肿;分散发性和地方性两种。地方性与缺碘有关，又称地方性甲状腺肿。远离海岸的内陆山区和半山区多见，发病率达10%以上，是散发性的10倍以上;目前全世界约有10亿人生活在碘缺乏地区，我国病人超过3亿。
6、,弥漫性非毒性甲状腺肿 diffuse nontoxic goiter,Concept：,甲状腺素分泌不足，促甲状腺素（TSH）分泌增多，导致甲状腺滤泡上皮增生，胶质堆积而使甲状腺肿大。,2022/3/6,基础医学内分泌系统疾病,12,颈部甲状腺肿大，一般无临床症状少数可引起压迫、窒息、吞咽和呼吸困难可伴甲亢或甲低等症状,临床表现 Clinical manifestation： ：,2022/3/6,基础医学内分泌系统疾病,13,充满没有碘化的甲状腺球蛋白,病因与发病机制 Etiology & Pathogenesis:,缺碘 iodine deficiency,环境与食物缺碘,特殊期碘需求量
7、增加,甲状腺素合成减少，功能轻度低下,TSH分泌,反馈刺激垂体,甲状腺滤泡上皮增生,摄碘功能增强暂时缓解,持续缺碘,滤泡上皮不断增生,滤泡腔内充满胶质,甲状腺肿大,2022/3/6,基础医学内分泌系统疾病,14,外界因子作用,高碘,遗传与免疫,过氧化物酶、去卤化酶的缺陷及碘酪氨酸偶联缺陷等,过氧化物酶的功能过多的被占用，影响酪氨酸氧化，因而碘的有机化过程受阻，甲状腺代偿性肿大,主要是抑制碘的吸收、转运和浓缩和活化各个过程,2022/3/6,基础医学内分泌系统疾病,15,Diffuse nontoxic goiter,Pathogenesis:,Dietary iodine deficiency
8、 endemicNot apparent sporadic,Impaired synthesis of thyroid hormone,Rise TSH level in serum,Hypertrophy and hyperplasia of thyroid follicular cells,Gross enlargement of the thyroid gland,2022/3/6,基础医学内分泌系统疾病,16,增生期 Diffuse hyperplastic goiter 胶质贮积期 Diffuse colloid goiter 结节期 Nodular goiter,病理变化 Path
9、ological changes:,2022/3/6,基础医学内分泌系统疾病,17,1. 增生期 弥漫性增生性甲状腺肿 Diffuse hyperplastic goiter Gross：弥漫性对称性中度肿大 150g Diffuse，symmetric enlargement of the gland; 表面光滑 smooth & glossy surfaceMicroscope: 滤泡上皮增生肥大，呈立方或柱状，follicle are lined by hyperplastic columnar epithelium 伴小滤泡或小假乳头形成，formation of small foll
10、icle or pseudo-papilla 胶质较少 little colloid in the follice 间质充血 congestion of interstitium 甲状腺功能无明显改变,2022/3/6,基础医学内分泌系统疾病,18,The thyroid gland reveals hyperplasia. Most follicles are lined by hyperplastic epithelium which forms papillary structure. Colloid is decreased in most follicles.,2022/3/6,基础
11、医学内分泌系统疾病,19,Gross:弥漫性、对称性显著肿大,200-300g 表面光滑，切面棕褐色，半透明胶冻状 brown, glassy, translucent,2. 胶质贮积期 Diffuse colloid goiter,The gland is very enlarged and shows deep red-brown nodules on section.,2022/3/6,基础医学内分泌系统疾病,20,部分滤泡：上皮增生，小滤泡或假乳头形成 （增生期表现） 大部分滤泡：大量胶质贮积 Colloid is abundant in the follicles 上皮复旧、变扁平，
12、泡腔高度扩大 follicular epithelium are flattened or cuboidal or hyperplasia；dilatation of cavity,Microscope:,2022/3/6,基础医学内分泌系统疾病,21,2022/3/6,基础医学内分泌系统疾病,22,2022/3/6,基础医学内分泌系统疾病,23,Gross: 不对称结节状，大小不一， 境清（但无完整包膜） 切面：出血、坏死、囊性 变、钙化和疤痕asymmetrically enlarged glands with irregular nodules hemorrage,necrosis,cy
13、stic,calcification,scar,3. 结节期 Nodular goiter 滤泡上皮增生、复旧与萎缩不一致，分布不均,形成结节,showing nodularity with interspersed fibrous separation,2022/3/6,基础医学内分泌系统疾病,24,Gross specimen of a nodular goiter,2022/3/6,基础医学内分泌系统疾病,25,部分滤泡上皮：柱状或乳头状增生，小滤泡形成follicular epithelial hypertrophy and hyperplasia部分上皮：复旧或萎缩，胶质贮积regr
14、essive or atrophia, colloid storage间质：纤维组织增生，间隔包绕形成大小不一的结节病灶fibroplasia, irregular nodules,Microscope:,2022/3/6,基础医学内分泌系统疾病,26,Mixed large and small , micro follicles, typical of nodular, non-toxic (nodular),2022/3/6,基础医学内分泌系统疾病,27,The enlarged thyroid gland is multinodular- note fibrous septae. The
15、 follicles are variably distended and filled with colloid, and the epithelial lining is flattened.,2022/3/6,基础医学内分泌系统疾病,28,弥漫性毒性甲状腺肿 Diffuse toxic goiter,血中甲状腺素过多，作用于全身各组织所引起的临床综合征，临床上称为甲状腺功能亢进症，简称“甲亢” 20-40岁， 女性46倍于男性 原发性 为甲状腺自身病变,功能亢进,甲状腺素分泌增加; （90%） 继发性 甲状腺外器官病变,引起甲状腺功能亢进,如垂体 促甲状腺细胞腺瘤或下丘脑的促甲状腺释放激
16、 素的增多。（极少）,Concept: graves disease,2022/3/6,基础医学内分泌系统疾病,29,临床表现 clinical manifestation： 甲状腺肿大diffuse hyperplasia of the thyroid 基础代谢率和神经兴奋性升高 突眼性甲状腺肿（1/3） ophthalmopathy,2022/3/6,基础医学内分泌系统疾病,30,thyromegaly,2022/3/6,基础医学内分泌系统疾病,31,Bulgingeyes,2022/3/6,基础医学内分泌系统疾病,32,血中多种抗甲状腺的自身抗体增多，常与一些自身免 疫性疾病并存 血中存
17、在与TSH受体结合的抗体：TSI and TGI 遗传因素 精神因素 干扰免疫系统而促进自身免疫疾病的发生。,Pathogenesis: autoimmune disorder,2022/3/6,基础医学内分泌系统疾病,33,Gross: 弥漫对称增大（为正常的24倍）,光滑、质较软 diffusely symmetrically enlarged, gland is smooth and soft切面：灰红呈分叶状、胶质少，肌肉状,病理变化 pathological changes,showing symmetric, non-nodular enlargement of the thyro
18、id, which has a beefy red appearance because of hypervascularity.,2022/3/6,基础医学内分泌系统疾病,34,microscopically:,以滤泡上皮增生为主 呈高柱状或乳头状，有小滤泡形成follicular epithelial cells are tall,columnar ,crowed, formation of small papillae 滤泡腔内：胶质稀薄，吸收空泡colloid is pale with scalloped margins 间质：血管丰富、充血，淋巴组织增生vessel hyperaem
19、ia and lymphoplasia,2022/3/6,基础医学内分泌系统疾病,35,Thyroid hyperplasia in Graves disease,2022/3/6,基础医学内分泌系统疾病,36,A diffusely enlarged thyroid gland associated with hyperthyroidism is known as Graves disease. At low power here, note the prominent infoldings of the hyperplastic epithelium.,2022/3/6,基础医学内分泌系统
20、疾病,37,At high power, the tall columnar thyroid epithelium with Graves disease lines the hyperplastic infoldings into the colloid. Note the clear vacuoles in the colloid next to the epithelium.,2022/3/6,基础医学内分泌系统疾病,38,滤泡上皮细胞胞浆 内质网丰富、扩张 高尔基体肥大 核糖体增多，分泌活跃,Electron Microscope:,滤泡基底膜上有IgG沉着,Immunofluores
21、cent:,2022/3/6,基础医学内分泌系统疾病,39,This is an example of an immunofluorescence test positive for anti-microsomal antibody,Here is an example of immunofluorescence positivity for anti-thyroglobulin antibody,2022/3/6,基础医学内分泌系统疾病,40,甲亢手术前须经碘治疗治疗后甲状腺病变减轻：体积缩小、质实光镜下上皮细胞变矮、增生，胶质，吸收空泡。间质血管、充血，淋巴细胞 便于手术切除，减少术中出血
22、,2022/3/6,基础医学内分泌系统疾病,41,眼球突出 眼球外肌水肿和粘液水肿 球后纤维脂肪组织增生 淋巴细胞浸润 心肌和肝细胞可有变性、坏死及纤维化 全身淋巴组织增生 胸腺和脾增大 心脏肥大、扩大,全身变化 Pathological changes of other organs ：,2022/3/6,基础医学内分泌系统疾病,42,甲状腺炎 thyroiditis,1.亚急性甲状腺炎 Subacute thyroiditis 是一种与病毒感染有关的巨细胞性或肉芽肿性炎症；女男，中青年多见；起病急、病程短，发热、颈部压痛，可有短暂性甲状腺功能异常。,2022/3/6,基础医学内分泌系统疾病
23、,43,Gross: 结节状，轻-中度增大，质实，橡皮样，灰白或淡黄色，坏死或瘢痕，有粘连 Microscope: 灶状分布，类似结核结节的肉芽肿形成，多量炎细胞浸润，异物巨细胞反应，无干酪样坏死,Pathological changes:,2022/3/6,基础医学内分泌系统疾病,44,2022/3/6,基础医学内分泌系统疾病,45,2.慢性淋巴细胞性甲状腺炎Chronic lymphocytic thyroiditis,又称桥本甲状腺炎 Hashimotos thyroiditis 或自身免疫性甲状腺炎Autoimmune thyroiditis一种自身免疫性疾病中年女性多见甲状腺弥漫性肿
24、大，晚期有甲低表现,2022/3/6,基础医学内分泌系统疾病,46,Macroscope: 弥漫对称性肿大，质较韧，与周围组织无粘连，色灰白灰黄 Microscope: 实质组织广泛破坏、萎缩，大量淋巴C和嗜酸粒C浸润、淋巴滤泡形成、纤维组织增生,Pathological changes:,2022/3/6,基础医学内分泌系统疾病,47,This symmetrically small thyroid gland demonstrates atrophy. This is the end result of Hashimotos thyroiditis.,2022/3/6,基础医学内分泌系统疾
25、病,48,Here is a low power microscopic view of a thyroid with Hashimotos thyroiditis. Note the lymphoid follicle at the right center. This is an autoimmune disease and often antithyroglobulin and antimicrosomal antibodies can be detected.,2022/3/6,基础医学内分泌系统疾病,49,2022/3/6,基础医学内分泌系统疾病,50,甲状腺滤泡上皮发生的一种常见的
26、良性肿瘤 中青年女性多见 生长缓慢，随吞咽活动而移动,甲状腺腺瘤 Thyroid adenoma,2022/3/6,基础医学内分泌系统疾病,51,多为单发，球形，有完整包膜，35cmsolitary, spherical, encapsulated lesion切面多为实性，色暗红或棕黄并发出血、囊性变、钙化和纤维化cut surface: gray white to red brown; regressive change,Pathological changes:,Macroscope:,2022/3/6,基础医学内分泌系统疾病,52,Here is a surgical excision
27、 of a small mass from the thyroid gland that has been cut in half. A rim of slightly darker thyroid parenchyma is seen at the left. The mass is well-circumscribed. Grossly it felt firm.,2022/3/6,基础医学内分泌系统疾病,53,Thyroid adenoma,2022/3/6,基础医学内分泌系统疾病,54,单纯型腺瘤胶样型腺瘤胎儿型腺瘤胚胎型腺瘤嗜酸细胞性腺瘤,Histologic subtypes：,滤
28、泡性腺瘤,2022/3/6,基础医学内分泌系统疾病,55,单纯性腺瘤 （Simple-）包膜完整，大小较一致、拥挤、内含胶质的滤泡,B. 胎儿型腺瘤 （Fetal-）小而一致，仅含少量胶质或无胶质的小滤泡，间质水肿粘液样 microfollicular,2022/3/6,基础医学内分泌系统疾病,56,C. 胶样型腺瘤（Colloid-）大滤泡或大小不一、内含胶质的滤泡，间质少 macrofollicular,D. 胚胎型腺瘤（Embryonal-）瘤细胞小而一致，呈片状或条索状，无胶质，间质水肿,2022/3/6,基础医学内分泌系统疾病,57,2022/3/6,基础医学内分泌系统疾病,58,E
29、. 嗜酸性细胞腺瘤（Acidophilic cell-） 少见，瘤细胞大而多角，核小，胞浆内含嗜酸性颗粒，排列成索网或巢状,2022/3/6,基础医学内分泌系统疾病,59,Hurthle (oxyphile) cell tumor, lower power of photomicrograph, with well circumscribed margin established by an intact delicate fibrous capsule. This is a Hurthle cell tumor of low malignant potential (an adenoma).
30、,2022/3/6,基础医学内分泌系统疾病,60,包膜：前者常为多发结节、无完整包膜； 后者一般单发，有完整包膜； 滤泡：前者大小不一致，一般比正常大； 后者则相反； 周围：前者周围甲状腺组织无压迫现象，邻近 甲状腺内与结节内有相似病变； 后者周围甲状腺有压迫现象，周围和远 处甲状腺组织均正常,结节性甲状腺肿和甲状腺瘤的诊断及鉴别要点：,2022/3/6,基础医学内分泌系统疾病,61,2022/3/6,基础医学内分泌系统疾病,62,2022/3/6,基础医学内分泌系统疾病,63,甲状腺癌 thyroid Carcinoma,较为常见，约占所有恶性肿瘤的1.3，占癌症死亡病例的0.4与其它器官癌
31、相比，发展较缓慢 有的原发灶很小，临床上常首先发现转移灶 多数甲状腺癌患者甲状腺功能正常，仅少数引起内分泌紊乱,主要特点：,2022/3/6,基础医学内分泌系统疾病,64,Histologic types：,乳头状癌 Papillary carcinoma 滤泡癌 Follicular carcinoma 髓样癌 Medullary carcinoma 未分化癌 Undifferentiated carcinoma,2022/3/6,基础医学内分泌系统疾病,65,最常见类型(60%) 青少年、女性多见 肿瘤生长慢，恶性程度较低，预后较好 局部淋巴结转移较早,1乳头状癌 papillary ca
32、rcinoma,2022/3/6,基础医学内分泌系统疾病,66,圆形，直径约2-3cm，无包膜，质较硬切面：灰白，常伴有囊性变，出血、 坏死、纤维化和钙化,Gross:,2022/3/6,基础医学内分泌系统疾病,67,2022/3/6,基础医学内分泌系统疾病,68,The papillary carcinoma neoplasm can be multifocal because of the propensity to invade lymphatics within thyroid, and lymph node metastases are common. The larger mass
33、 is cystic and contains papillary excresences.,2022/3/6,基础医学内分泌系统疾病,69,乳头分枝多，中心有纤维血管间质间质内常见砂粒体（Psammona bodies） 呈同心圆状的钙化小体乳头上皮可单层或多层细胞核的改变：毛玻璃状核 核内假包涵体 核沟甲状腺微小癌：癌直径1cm,Microscope:,2022/3/6,基础医学内分泌系统疾病,70,Papillary carcinoma. Neoplasm forming glands and papillary structures destroying and replacing n
34、ormal thyroid follicles.,2022/3/6,基础医学内分泌系统疾病,71,This is the microscopic appearance of a papillary carcinoma of the thyroid. The fronds of tissue have thin fibrovascular cores. The fronds have an overal papillary pattern.,2022/3/6,基础医学内分泌系统疾病,72,Thyroid follicles are being replaced by a papillary ne
35、oplasm (epithelium covers fibrous stalk that branches). Note the fibrosis (pink) and the calcification (dark blue or black).,2022/3/6,基础医学内分泌系统疾病,73,This is another papillary carcinoma of thyroid. Note the small psammoma body in the center. The cells of the neoplasm have clear nuclei.,2022/3/6,基础医学内
36、分泌系统疾病,74,Psammoma bodies (spherical, concentrically laminated calcified mass).,2022/3/6,基础医学内分泌系统疾病,75,2022/3/6,基础医学内分泌系统疾病,76,2022/3/6,基础医学内分泌系统疾病,77,Notice the papillary formations within the cystic structure,2022/3/6,基础医学内分泌系统疾病,78,多发于40岁女性 比乳头状癌恶性程度高、预后差 早期血道转移 癌组织侵犯周围组织器官时，有相应的症状,2滤泡癌 follicul
37、ar carcinoma,2022/3/6,基础医学内分泌系统疾病,79,结节状，包膜不完整，界较清切面：灰白、质软,Gross:,Unlike papillary Ca, which can have a circumscribed appearance, follicular carcinoma can have a more diffuse, infiltrating pattern as shown in the image above,2022/3/6,基础医学内分泌系统疾病,80,可见不同分化程度的滤泡 分化好：类似于腺瘤，但有包膜和血管侵犯； 分化差：呈实性巢片状 瘤细胞异型性明
38、显 滤泡少而不完整嗜酸性细胞癌 (Acidophilic cell carcinoma) 少见，由嗜酸性癌细胞构成,Microscope:,2022/3/6,基础医学内分泌系统疾病,81,Tumor cells infiltrate the amicula,2022/3/6,基础医学内分泌系统疾病,82,Poorly differentiated follicular carcinoma with oxyphilic features,2022/3/6,基础医学内分泌系统疾病,83,2022/3/6,基础医学内分泌系统疾病,84,METATSTASIS TO BONE7 YEARS LATER
39、,2022/3/6,基础医学内分泌系统疾病,85,由滤泡旁细胞（即C细胞）发生的恶性肿瘤，占5%-10%高发期:40-60岁部分为家族性常染色体显性遗传90%的肿瘤分泌降钙素，产生严重腹泻和低血钙症,3髓样癌 medullary carcinoma,2022/3/6,基础医学内分泌系统疾病,86,瘤细胞圆形或多角，核仁不明显 实体片巢状、乳头状、滤泡状排列 间质内常有淀粉样物质沉着 IHC: 降钙素（calcitonin）+，甲状腺球蛋白（thyroglobulin）-,单发或多发，假包膜切面:灰白、黄褐色，质实而软,Gross:,Microscope:,2022/3/6,基础医学内分泌系统疾
40、病,87,At the center and to the right is a medullary carcinoma of thyroid. At the far right is pink hyaline material with the appearance of amyloid. These neoplasms are derived from the thyroid C cells and, therefore, have neuroendocrine features such as secretion of calcitonin.,2022/3/6,基础医学内分泌系统疾病,8
41、8,Medullary (C-cell) carcinoma of the thyroid with amyloid stroma,2022/3/6,基础医学内分泌系统疾病,89,Here the amyloid stroma of the medullary thyroid carcinoma has been stained with Congo red.,Immunohistochemical anti-calcitonin antibody stain of a medullary carcinoma showing strong positivity.,2022/3/6,基础医学内分
42、泌系统疾病,90,2022/3/6,基础医学内分泌系统疾病,91,少见，50岁女性多见 生长快，早期浸润和转移 恶性程度高，预后差,4未分化癌 undifferentiated carcinoma,2022/3/6,基础医学内分泌系统疾病,92,未分化癌：肿块较大，灰白，不规则，无包膜，广泛浸润、破坏，常有出血、坏死,2022/3/6,基础医学内分泌系统疾病,93,未分化癌：癌细胞大小、形态、染色深浅不一，核分裂像多,2022/3/6,基础医学内分泌系统疾病,94,2022/3/6,基础医学内分泌系统疾病,95,糖尿病 diabetes mellitus,胰岛素相对或绝对不足靶细胞对胰岛素敏感
43、性胰岛素结构上缺陷,碳水化合物、脂肪、蛋白代谢紊乱,高血糖、糖尿,诊断标准： 空腹血糖7.0mmol/L 餐后两小时血糖11.1mmol/L,2022/3/6,基础医学内分泌系统疾病,96,多饮、多食、多尿和体重,三多一少,并发症,酮症酸中毒、肢体坏疽、多发性神经炎、失明及肾功衰竭,2022/3/6,基础医学内分泌系统疾病,97,2022/3/6,基础医学内分泌系统疾病,98,Here is a normal pancreatic islet of Langerhans surrounded by normal exocrine pancreatic acinar tissue. The is
44、lets contain alpha cells secreting glucagon, beta cells secreting insulin, and delta cells secreting somatostatin.,2022/3/6,基础医学内分泌系统疾病,99,2022/3/6,基础医学内分泌系统疾病,100,Normal islets of Langerhans, on the right with immunoperoxidase staining for insulin to identify beta cells and on the left with immunop
45、eroxidase staining for glucagon to identify alpha cells,2022/3/6,基础医学内分泌系统疾病,101,糖尿病,原发性,继发性,胰岛素依赖型糖尿病(I型),非胰岛素依赖型糖尿病(II型),又称型或幼年型（10%）主要特点： 青少年，急，重，快，胰岛B细 胞明显，血中胰岛素，易 出现酮症，治疗依赖胰岛素,又称型或成年型（90%）主要特点：成年肥胖者，组织胰岛素受体减少 轻，发展较慢，胰岛数目正常或轻 度，不易出现酮症，一般可以不 依赖胰岛素治疗,Types of diabetes mellitus:,2022/3/6,基础医学内分泌系统疾
46、病,102,在遗传易感性的基础上，由病毒感染等诱发的针对胰岛B细胞的一种自身免疫性疾病。,患者体内可测到胰岛细胞抗体和细胞表面抗体 血清中抗病毒抗体滴度显著 证实与特殊的HLA有关，危险性高的有DR3、DR4、 DW3、DW4、B8、B15；中国人DR3和DR4分布频率高,胰岛素依赖型糖尿病,Etiology & Pathogenesis:,2022/3/6,基础医学内分泌系统疾病,103,不发生胰岛B细胞的自身免疫性破坏可能与肥胖有关： 组织胰岛素受体数量相对减少 （组织对胰岛素不敏感所致） 胰岛素相对不足等 目前认为II型的遗传易感性要强于I型，但 其机制更为复杂，不清。,非胰岛素依赖型,
47、病因、发病机制复杂，不清楚,2022/3/6,基础医学内分泌系统疾病,104,胰岛内分泌功能不足所致,继发性糖尿病,炎症、肿瘤、手术 胰岛广泛破坏或其他损伤内分泌疾病 影响胰岛素的分泌（如肢端肥大症、 Cushing综合征、甲亢、嗜铬细胞瘤、类癌综合征）,2022/3/6,基础医学内分泌系统疾病,105,早期：为非特异性胰岛炎继而：胰岛B细胞颗粒脱失、空泡变性、坏死、消失 A细胞相对增多晚期：胰岛变小、减少，纤维组织增生、玻变早期：病变不明显后期：B细胞减少，常见胰岛淀粉样变性（在B细胞周围及毛细胞血管间有淀粉样物质沉淀）,胰岛病变：不同类型、不同时期病变不同,型糖尿病：,型糖尿病：,Path
48、ological changes:,2022/3/6,基础医学内分泌系统疾病,106,An islet of Langerhans demonstrates insulitis with lymphocytic infiltrates in a patient developing type I diabetes mellitus. The destruction of the islets leads to an absolute lack of insulin that characterizes type I diabetes mellitus. This lesion precedes
49、 clinical onset of diabetes mellitus and is rarely observed.,2022/3/6,基础医学内分泌系统疾病,107,An islet of Langerhans demonstrates amorphous pink deposition of amyloid in a patient with type II diabetes mellitus,2022/3/6,基础医学内分泌系统疾病,108,动脉病变：细动脉玻变、动脉粥样硬化,Aortic atherosclerosis is demonstrated in three aortas
50、, from minimal at the bottom to severe at the top. Diabetics tend to have more advanced, extensive atherosclerosis,2022/3/6,基础医学内分泌系统疾病,109,肾脏体积增大 结节性肾小球硬化 弥漫性肾小球硬化 肾小管-间质损害 血管损害 肾乳头坏死,肾脏病变,High power to show the arteriosclerosis.,2022/3/6,基础医学内分泌系统疾病,110,Low power view showing sclerosis of para-glo