PAPER

ENDOCRINE SYSTEM
(Basic Biomedical Sciences Course)

Lecturer : Ni Nyoman Hartati, A.Per.Pend., S.Kep., Ners., M.Bio.Med.

Compiled by :
Group 9
Member Name :

1. I Wayan Yoga Candra Wibawa (P07120224028)

2. Ni Made Gita Maharani (P07120224041)
3. Ni Luh Putu Natasya Suci Maharani (P07120224047)
Class : Level 1 International Class

MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA

HEALTH POLYTECHNIC OF THE MINISTRY OF HEALTH DENPASAR
NURSING DEPARTMENT
YEAR 2024/2025

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 FOREWORD
We give thanks to God Almighty, because by His blessing and grace, we were able to
complete the paper entitled "The Endocrine System." This paper was prepared in order to
fulfill the assignment of the Basic Biomedical Sciences course of the Applied Undergraduate
Study Program, Department of Nursing, Ministry of Health, Denpasar.

We realize that the preparation of this paper is inseparable from the help and support
of various parties. Therefore, we would like to thank our supervisors, namely Mrs. Ni
Nyoman Hartati, A.Per.Pend., S.Kep., Ners., M.Bio.Med., colleagues, and all parties who
have provided input and support during the process of preparing this paper. We hope that this
paper can provide useful insights for readers about the endocrine system in the body and
know the glands contained in it. Hopefully this paper can be a useful reference for all parties
interested in the field of basic biomedicine.

Denpasar, November 19, 2024

Writer

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 TABLE OF CONTENTS
FOREWORD...........................................................................................................................i
TABLE OF CONTENTS.......................................................................................................Ii
CHAPTER I INTRODUCTION...........................................................................................1
1.1 Background................................................................................................................1
1.2 Problem Formulation.................................................................................................1
1.3 Purpose...................................................................................................................... 1
1.4 Benefit....................................................................................................................... 1
CHAPTER II DISCUSSION.................................................................................................3
2.1 Definition of Endocrine System.................................................................................3
2.2 Function of the Endocrine System.............................................................................3
2.3 Glands in the Endocrine System................................................................................4
2.3.1 Pineal gland (epiphysis of the celebria)...............................................................4
2.3.2 Hypothalamic gland............................................................................................5
2.3.3 Pituitary...............................................................................................................6
2.3.4 Thyroid gland (adenoid)......................................................................................9
2.3.5 Parathyroid gland..............................................................................................13
2.3.6 Thymus gland...................................................................................................18
2.3.7 Pancreatic gland................................................................................................21
2.3.8 Adrenal glands..................................................................................................25
2.3.9 Gonadal Glands................................................................................................27
CHAPTER III CLOSING................................................................................................... 32
3.1 Conclusion....................................................................................................................32
3.2 Advice...........................................................................................................................32
BIBLIOGRAPHY................................................................................................................ 33

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 CHAPTER I
INTRODUCTION
1.1 Background
Living things develop very complex structures and functions, The integration of
various components is essential to maintain their lives. This integration is controlled by 2
main systems, namely the Central Nervous System and the Endocrine System.
Emmatologically, anatomically and functionally, these two systems are interconnected.
For example, some endocrine glands originate from neuroectodermal, which is an
embryonal layer, which is also the origin of the central nervous system. There is also an
anatomical relationship between the central nervous system and the endocrine system that
has developed mainly through the hypothalamus. This condition causes stimuli that
interfere with the central nervous system, which will often also change the functional
activity of the endocrine system. The integrated activity between the endocrine and
central nervous system will help maximize the reaction to stimuli in the organism. If the
endocrine glands experience dysfunction, then the levels of hormones in the blood can be
high or low, thus interfering with body function. To control endocrine function, the
release of each hormone must be regulated within proper limits.
Therefore, a deep understanding of the endocrine system is essential for the
development of strategies for the prevention and treatment of hormone-related diseases as
well as for improving the quality of life of individuals through stress management and the
implementation of a healthy lifestyle.
1.2 Problem Formulation
1.2.1 What is the endocrine system?
1.2.2 What are the organs or glands that play a role in the endocrine system?
1.2.3 What is the role of hormones produced by these glands?
1.3 Purpose
1.3.1 To know and understand the definition of the endocrine system.
1.3.2 To know and understand the organs or glands in the endocrine system.
1.3.3 To know and understand the role of hormones produced.
1.4 Benefit
1.4.1 Theoretical
This paper is expected to add insight and understanding of the Endocrine System and
the glands that play a role in the system.

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1.4.2 Practitioners
This paper is expected to be useful when conducting an endocrine system assessment
in the field of nursing.

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 CHAPTER II
DISCUSSION
2.1 Definition of Endocrine System
Endocrine glands are glands that send their secretions directly into the blood
circulating in the tissues, these glands do not have ducts but secrete (secrete) hormones
directly into the blood so that they can reach every blood cell in the body. Hormones act
on specific tissue or organ targets and regulate their activity. Hormones regulate
processes such as the breakdown of chemical substances in metabolism, fluid balance
and urine production, body growth and development, and sexual reproduction. The
hormonal work of a gland can be influenced by several factors including the level of
substances in the blood and input from the nervous system, because hormones flow in
the blood, each hormone can reach every part of the body. However, the specific
molecular form of each hormone must be able to enter the receptors (recipients) of the
target tissue or organ only.

2.2 Function of the Endocrine System

Along with the nerves, the endocrine system functions to maintain hemostasis during
rest and exercise. The nerves and endocrine system also work together to initiate and
control movements, and all movements involve physiological processes. Where the
nervous system acts quickly to convey the message of nerve impulses, the endocrine
system has a slower but more durable response than the nerve impulses. Endocrine
organs are widely distributed throughout the body without anatomical continuity. In

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 addition to discrete endocrine organs, some organs are referred to as mixed organs,
having endocrine functions. Including thymus, stomach, duodenum, placenta, and heart.
The result of the secretion of endocrine glands is called hormones. Hormones are
chemical messengers that specialized cells release into the bloodstream. In general, there
are two types of hormones produced, namely single hormones and double hormones
(more than one). Overall, each gland in the body has a different function depending on
where the gland is produced. However, in general, the Endocrine System functions to:
1. Controls the activity of the body's glands.
2. Stimulates the activity of the body's glands.
3. Stimulates tissue growth.
4. Regulates metabolism, oxidation, and increases glucose absorption in the small
intestine.
5. Affects the metabolism of fat, protein, charcoal hydrate, vitamins, minerals, and
water.
2.3 Glands in the Endocrine System
The endocrine system glands in men and women are the same, but the difference is the
glands in the genitals. Men have testicular glands, and women have ovarian glands.
2.3.1 Pineal gland (epiphysis of the celebria)

The pineal gland (also called the pineal body, cerebri epiphysis, epiphysis, conarium
or "third eye") is an endocrine gland in the vertebrate brain. These glands produce
serotonin derived from melatonin, a hormone that affects the modulation of wake/sleep
patterns and seasonal function. It is similar in shape to the fruit of a tiny evergreen tree,
and it is located close to the center of the brain, between two lobes, tucked away in a
groove where two round thalamus bodies join.
The pineal gland is a small-shaped pine seed gland of the endocrine system. Melatonin
affects sexual development and the sleep/wake cycle. The pineal gland is made up of cells
called pinealocytes and cells of the nervous system called glial cells. The pineal gland

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connects the endocrine system with the nervous system in terms of converting nerve
signals from the sympathetic system and peripheral nervous system into hormonal signals.
2.3.1.1 Function of the Pineal Gland
The pineal gland is involved in several bodily functions including:
a. Secretion of the hormone melatonin.
b. Regulation of endocrine function.
c. Conversion of nervous system signals to endocrine signals.
d. Causes of drowsiness.
e. Influence of sexual development.
f. Influence on immune system function.
g. Antioxidant activity.
2.3.1.2 Dysfunction of the Pineal Gland
If the pineal gland is unable to produce sufficient amounts of melatonin, a person
can experience sleep disturbances, depression, cancer, degenerative diseases of the
brain, and fertility disorders. If the pineal gland produces too much melatonin, a
person can experience low blood pressure, abnormal function of the adrenal and
thyroid glands, or Seasonal Affective Disorder (SAD). SAD is a depressive disorder
that some individuals experience during the winter months when there is a decrease in
sunlight.
2.3.2 Hypothalamic gland

The hypothalamus is located in the forebrain (diensephalon). The hypothalamus and

the pituitary gland are located close together in the lower part of the brain. The
hypothalamus produces several hormones that can stimulate the pituitary gland to secrete a
hormone. For example: Thyrotropin-releasing hormone / Thyrotropin Releasing Hormone
(TRH), stimulates the anterior pituitary to produce Thyroid Stimulating Hormone (TSH).
The second hormone is called Gonadotropin Releasing Hormone (GnRH), stimulating the
anterior lobe of the pituitary to secrete the hormone Gonadotropin. The hormone

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somatostatin produced by the hypothalamus slows down the secretion of hormones carried
out by the pituitary gland. CRH (Cortocotropin Realeasing Hormone), stimulates the
anterior lobe of the pituitary to secrete Adrenocorticotropic Hormone (ACTH).
The hypothalamus produces several hormones that "tell" the pituitary gland to either
release or stop secreting the hormone. In this way, the hypothalamus provides a link
between the nervous system and the endocrine. The hypothalamus also produces
hormones that directly regulate the body's processes. These hormones travel to the
pituitary gland, which stores them until they are needed. Hormones include antidiuretic
hormones and oxytocin. Antidiuretic hormones stimulate the kidneys to conserve water by
producing more concentrated urine and Oxytocin is useful for stimulating labor
contractions.
2.3.3 Pituitary

The pituitary gland is an endocrine gland located at the base of the skull. The size is
approximately 10 x 13 x 6 mm. This gland is quite important, as it is a regulator of
hormonal activity and affects the work of other glands. The pituitary gland has three lobes,
namely the anterior lobe, the intermedia lobe, and the posterior lobe.
2.3.3.1 Anterior Lobe
The Anterior Lobe is the anterior pituitary that secretes several hormones, namely:

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1. Adrenocoticotrophic Hormone (ACTH): This hormone functions to stimulate
the adrenal cortex to secrete glucorticoids. An excess of this hormone can lead to
Cushing's Syndrome, a medical condition that occurs due to high levels of the
hormone cortisol in the body, also known as hypercortiolism. Cortisol is a
hormone produced by the adrenal glands and plays an important role in various
bodily functions, including regulating blood pressure, reducing inflammation, and
controlling blood sugar. When cortisol levels are too high, it can lead to a variety
of serious health problems.
2. Prolactin (PRL) or Luteotropin Hormone (LTH): Stimulates the secretion of
mammary/mammary glands. An excess of this hormone can lead to
Hyperprolactinemia which can result in menstrual disorders in women, galactorea
(milk production outside of breastfeeding), and infertility. In men, it can cause
erectile dysfunction and decreased libido.
3. Thyroid Stimulating Hormone (TSH): This hormone controls the growth and
development of the thyroid gland. If TSH is too high, it can lead to
Hyperthyroidism, a condition in which the thyroid gland produces too many
thyroid hormones (T3 and T4), resulting in symptoms such as anxiety, weight
loss, and increased heart rate.
4. Gonadotropic Hormone (FSH and LH): Gonadotropic hormone is a gonadal
that consists of follicle stimulating hormone (FSH) and luteinizing hormone (LH).
 In men, FSH functions to stimulate the growth and development of sperm,
while in women it functions to stimulate the growth of ovarian follicles
and produce estrogen.
 In men, LH functions to stimulate interstitial cells to produce testosterone,
while in women it functions for ovulation and progesterone secretion.

An excess of this hormone can cause:

 Polycystic Ovary Syndrome (PCOS) in women contributes to the

development of ovarian cysts and menstrual cycle disorders.
 Excess testosterone in men can stimulate excessive testosterone
production, which can contribute to health problems such as
aggressiveness and prostate problems.
5. Somatotropin Hormone (STH) or GH (Growth Hormone): Functions to
stimulate muscle growth and development. If there is a deficiency of STH

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 hormone during the growth period, it can cause Dwarfism, which is dwarfism. If
there is an excess of the STH hormone during the growth period, it can cause
Gigantism, which is a giant-like body. On the other hand, if hypersecretion occurs
when the growth period has expired, it can cause Acromegaly, which is
disproportionate bone growth.
2.3.3.2 Intermedia Lobe
The intermedia lobe is the central pituitary that secretes several hormones, namely:
1. Melanocyte stimulating hormone (MSH)
This hormone stimulates the formation of pigment and the spread of pigment-
producing cells (melanocytes) in the epidermis. If this hormone is produced a lot,
it causes the skin to turn black.
2. Endorphins
This hormone acts as a natural pain reliever, and responds to stress. An excess of
endorphins can lead to feelings of excessive euphoria, which may seem positive at
first. However, uncontrollable euphoria can make a person lose a sense of
proportionality in behavior and decisions.
2.3.3.3 Posterior Lobe
The Posterior lobe is the posterior pituitary that secretes several hormones, namely:
1. Antidiuretic Hormone (ADH) or Vasopressin: Functions to reabsorb water in
the renal tubules so as to reduce the volume of water lost.
2. Oxytocin: Functions to stimulate the contraction of smooth muscles during
childbirth, and the secretion of breast milk.

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2.3.4 Thyroid gland (adenoid)

2.3.4.1 Definition of Thyroid

The thyroid gland, located around the butterfly-shaped jaw, produces the
hormone thyroxine which functions to maintain an optimal tissue metabolic rate for
the normal function of cells and the body as a whole. The iodine-containing hormone
thyroxine stimulates the consumption of O2 by the body's cells, and regulates the
metabolism of fats and carbohydrates necessary for the body's normal growth and
development. The hormone thyroxine is relatively not essential for life, but its
absence will lead to deterioration and slowing down of mental and physical processes,
the individual becomes intolerant of cold, and in children causes mental retardation
and dwarfism. On the other hand, excess thyroxine secretion will cause the body to
become thin, often nervous, tachycardia, tremors, and excess heat production so that it
sweats frequently.

2.3.4.2 Structure of the thyroid gland

The thyroid gland is divided into two lobes, namely the left lobe and the right
lobe. The structure that connects the two
lobes is called the isthmus. Each lobe is
about 5 cm long, about 3 cm wide and has a
thickness of about 2 cm, while the isthmus
has a length and width of about 1.25 cm.
Microscopically, there are several structures
that make up the thyroid gland. The 3 main
constituent structures include:

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a. Thyroid follicles
Thyroid follicles are a collection of small cells that are between 0.02-0.9 mm in
diameter. Follicles
The thyroid is the main component for carrying out thyroid function. Thyroid
follicles
It has many blood vessels, nerve vessels and lymph vessels that surround its
nucleus. The thyroid follicle nucleus is a precursor protein of thyroid hormone
called thyroglobulin.
b. Follicular Cells
Follicular cells are the layers of cells that envelop the nucleus of the thyroid
follicle. When stimulated by Thyroid Stimulating Hormone (TSH), they secrete
thyroid hormones T3 and T4. The follicular shape of cells varies depending on
their activity, some are flat, cuboid, or columnar.
a. Parafollicular Cells
Parafollicular cells, also known as C cells, are minority cells that produce
calcitonin. This calcitonin plays a role in calcium homeostasis.

2.3.4.3 Function of the Thyroid Gland

The function of the thyroid gland is controlled by the tropic hormone TSH
(thyroid stimulating hormone or thyrotropin) secreted by the anterior pituitary gland.
On the other hand, trophic hormone (Y: trophic = feeding) is also partially controlled
by TRH (thyrotropin releasing hormone) secreted by the hypothalamus. It is also
partially controlled through a negative feedback mechanism by the free thyroxine
hormone circulating in the blood that inhibits the work of the anterior pituitary and
hypothalamus. Through this way, changes in the internal and external environment of
the body will cause adjustments in the secretion of thyroxine hormones in the form of
T4 (tetraiodotironin) and T3 (triiodotironin). In addition to producing thyroxine, the
thyroid gland also produces the hormone calcitonin, a hormone whose effect lowers
blood calcium levels.

2.3.4.4 Thyroid Hormones

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 In general, thyroid hormones function to
stimulate oxygen consumption, so the effect is
mainly secondary to an increase in oxygen
consumption. T3 and T4 enter the cell and bind
to receptors to thyroid hormone (TR). The
hormone-receptor complex then binds to DNA
through zinc finger bonds and increases or
sometimes decreases the expression of a wide variety of genes encoding enzymes that
regulate cell function. So the thyroid hormone receptors found in the cell nucleus are
members of the superfamily of nuclear transcription factors that are sensitive to
hormones.

There are two types of TR genes in humans, namely the  receptor gene on
chromosome 17 and the  receptor gene on chromosome 3. Each can form two
types of mRNA. So there are TR1 and TR2, as well as TR1 and TR2. TR2 is
found only in the brain, while others are widely spread throughout the body. TR2 is
different from other TRs because TR2 does not bind to T3 and its function is
unclear. TR binds DNA as monomers, homodimers and heterodimers to other
nuclear receptors, especially to retinoid X receptors.

T3 generally has an effect that is 3-4 times stronger and faster than T4. This is
because the bond between T3 and protein is less strong, on the contrary, the bond
with TR is stronger. RT3 is inert.

2.3.4.5 Thyroid gland dysfunction

Thyroid hormone dysfunction is a disorder that occurs when the thyroid gland
produces thyroid hormones in quantities that are not in accordance with the body's
needs, namely thyroxine (T4) and triiodotironin (T3). These hormones play a vital
role in the regulation of metabolism, growth, development, and organ function. This
dysfunction can be divided into two main conditions: hypothyroidism (low production
of thyroid hormones) and hyperthyroidism (excessive production of thyroid
hormones). Both of these conditions have complex pathological mechanisms and
various systemic implications. Although millions of men around the world have
problems with their thyroid, women are still more susceptible to thyroid disorders
than men. However, the disorder is often unnoticed. The risk of thyroid gland
dysfunction in women is 5-8 times greater than that of men. It is closely related to

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estrogen hormones in women. In addition, pregnant women are prone to thyroid
deficiency.

Women's life phases, such as menstrual cycles, pregnancy, childbirth, and

breastfeeding, make them need more iodine. This need is often unknowingly unmet so
that there is a thyroid deficiency in women. The main task of the thyroid gland is to
collect iodine from the blood to be produced into thyroid hormones.

The thyroid plays an important role, among others, in the metabolism of fats, proteins,
carbohydrates, and the regulation of body temperature. Symptoms of thyroid
deficiency (hypothyroidism), such as weakness, lethargy, difficulty thinking, and the
desire to sleep continuously, are often unnoticed by pregnant women. These
symptoms are often mistaken for part of pregnancy.

a. Hypothyroidism
Hypothyroidism occurs when the thyroid does not produce enough thyroid
hormones. The main causes include:
 Hashimoto's disease: An autoimmune disorder in which antibodies attack the
thyroid gland, causing chronic inflammation and decreased hormone
production.
 Iodine deficiency: Iodine deficiency can inhibit the synthesis of thyroid
hormones because iodine is an essential component of T3 and T4.
 Secondary hypothyroidism: Caused by a disorder of the pituitary or
hypothalamus, which reduces the secretion of TSH (thyroid-stimulating
hormone) or TRH (thyrotropin-releasing hormone).
Systemic Impact of Hypothyroidism:
 Cardiovascular system: Decreased cardiac output, bradycardia, and increased
peripheral vascular resistance.
 Nervous system: Cognitive impairment, depression, and peripheral
neuropathy.
 Metabolism: Decreased basal metabolic rate (BMR), weight gain, and
intolerance to cold.
 Other hormones: Disturbances in lipid metabolism, insulin resistance, and
hyperprolactinemia.
b. Hyperthyroidism

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 Hyperthyroidism is a condition in which the thyroid gland produces thyroid
hormones in excess. The main causes include:
 Graves' disease: An autoimmune disease in which autoantibodies stimulate
TSH receptors, causing hypersecretion of thyroid hormones.
 Toxic adenomas and multinodular goiters: Thyroid nodules that produce
thyroid hormones unregulated by TSH.
 Thyroiditis: An inflammation of the thyroid that can cause the release of large
amounts of thyroid hormones temporarily.
Systemic Impact of Hyperthyroidism:
 Cardiovascular system: Tachycardia, atrial fibrillation, hypertension, and
increased
risk of heart failure.
 Nervous system: Tremors, hyperreflexia, anxiety, and insomnia.
 Metabolism: Increased BMR, weight loss, and intolerance to heat.
 Muscle and bone: Thyrotoxic myopathy and an increased risk of osteoporosis
due to accelerated bone turnover.
c. Subclinical Thyroid Hormone Dysfunction
Subclinical dysfunction refers to a condition in which TSH levels are outside the
normal range, but T3 and T4 levels are still within the normal range. This
condition can indicate an early phase of hypothyroidism or hyperthyroidism and
has long-term implications for
cardiovascular and metabolic
function.

2.3.5 Parathyroid gland

Generally Humans have 4 parathyroid
glands located in the neck area, 2 in the superior
part and 2 more in the inferior part, the dorsal
part of the thyroid gland. The normal form of
the parathyroid gland is small, ovoid, flat and
brownish to slightly yellow. The size varies
between 5 – 7 mm (length) x 3 – 4 mm (width) x 0.5 – 2 mm (thickness) with the
weight of each gland ranging from 30 – 50 mg. Figure 1 shows the parathyroid

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gland located in the dorsal thyroid gland, 2 in the superior part and 2 in the inferior
part.

The parathyroid gland

originates from the endodermal
tissue of the pharyngeal pouch
wall (pharyngeal pouches wall).
The pharyngeal sac originates from
the pharyngeal arch. Further
development of the pharyngeal
arch into pharyngeal sacs occurs in
the fifth week of gestation shown
in Figure 2(A). Furthermore, the
pharyngeal pouch epithelium
undergoes differentiation into a
prospective organ as seen in Figure
2(B). Based on embryology, parathyroid glands are divided into superior groups
and inferior groups, there is a differentiation of parathyroid tissue originating from
the dorsal part of the endoderm of the third pharyngeal sac. The ventral part of the
pharyngeal pouch develops into the thymus gland. Initially, both the ventral and
dorsal parts are interconnected with the pharyngeal wall, but in the seventh week
of gestation there is a disconnection between the ventral and dorsal walls against
the pharyngeal wall. The thymus gland then moves towards the caudal and medial,
followed by the parathyroid gland, then there is a disconnection between the
parathyroid and the thymus. Furthermore, the inferior parathyroid gland settles on
the posterior surface of the thyroid gland, usually on the outside of the thyroid
gland fibrous capsule.
The superior parathyroid gland is also known as parathyroid fourths because it
originates from the lateral pharyngeal pouch of the fourth which differentiates at
the fifth and sixth weeks of gestation. In the seventh week of gestation,
parathyroid disconnection occurs with the pharyngeal wall. 8 Then, while moving
towards the caudal, the parathyroid attaches to the thyroid gland to reach its final
position on the posterior surface of the thyroid gland and settles as the superior

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 parathyroid gland. Figure 3 shows the location of displacement of the thyroid
gland, parathyroid and surrounding tissues as well as the approximate location of
the parathyroid gland after migration occurs.

2.3.5.1 Function of the Parathyroid Gland

The parathyroid gland is four small glands located behind the thyroid gland in the
neck. The primary function of the parathyroid gland is to regulate calcium levels in
the blood and body tissues to stay within the normal range, which is essential for the
function of nerves, muscles, and bones. Here is a complete explanation of the function
of the parathyroid gland:
1. Produces Parathyroid Hormone (PTH)
The parathyroid gland produces parathyroid hormone (PTH), which plays a
major role in regulating calcium, phosphorus, and magnesium levels in the
body. PTH works through several mechanisms:
2. Regulation of Blood Calcium Levels
 Increased Calcium Absorption in the Intestines PTH increases calcium
absorption in the intestines by stimulating the kidneys to produce
calcitriol (the active form of vitamin D), which helps increase calcium
absorption from food.
 Increases Calcium Release from Bones If blood calcium levels are low,
 PTH will stimulate the release of calcium from the bones by activating
osteoclasts, which are cells that break down bone tissue to release
calcium into the blood.
 Reduces Calcium Excretion in the Kidneys PTH reduces calcium
excretion through the urine by increasing calcium reabsorption in the
renal tubules.
3. Regulating Phosphate Levels
 PTH also regulates phosphate levels in the body: PTH increases
phosphate excretion by the kidneys to prevent too high phosphate
levels in the blood, as calcium and phosphate must be balanced for
bone health.
4. Maintaining Nerve and Muscle Function

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  Calcium plays an important role in the transmission of nerve impulses
and muscle contractions. By ensuring that calcium levels remain stable,
the parathyroid gland helps this function run normally.
5. Prevents Hypocalcemia and Hypercalcemia
 Hypocalcemia (low calcium levels): PTH works to increase calcium
levels.
 Hypercalcemia (high calcium levels): The activity of the parathyroid
gland decreases to reduce PTH levels, thereby lowering blood calcium.

2.3.5.2 Parathyroid Hormone

Parathyroid hormone is a peptide consisting of 84 amino acids with a
molecular weight of 9300. The gene is located on chromosome 11, encoding a
precursor called preproPTH, with 29 additional amino acids on the amino
terminus of the mature PTH peptide. The main function of PTH is to regulate
calcium ions by regulating their effects on the target organs, namely: bones,
mucosa of the intestine, and kidneys. The homestasis response to
hypocalcaemia is an increase in PTH, which stimulates the release of calcium
and phosphate from the bones, and the kidneys will retain calcium. The
phosphating effect of PTH allows the elimination of phosphate ressorbed from
the bone along with calcium. An increase in PTH, along with a decrease in
serum calcium and phosphate levels, activates the synthesis of 1,25(OH)2D in
the kidneys. Thus, the effect of PTH in the intestine on calcium absorption is
indirect, namely by increasing the production of vitamin D metabolites
1,25(OH)2D.
In normal individuals, the parathyroid gland can detect hypocalcemia and then
provide a response in the form of synthesis and secretion of PTH. PTH then
goes to the target organ and also stimulates the production of vitamin D3 in
order to mobilize calcium to reach normal serum calcium concentrations.
When serum calcium returns to normal, there is negative feedback to the
parathyroid gland to suppress the release of PTH. Vitamin D receptors are
expressed in parathyroid gland cells. Stimulation of these receptors reduces the
synthesis and secretion of PTH, increases the expression of calcium receptors
and prevents the proliferation of PTG cells. The working principle in our
healthy body is normal regulation/stimulation of Calcium levels with a

16
 negative feedback mechanism. When calcium levels decrease, vitamin D will
play a role in inducing PTH action and activating the inactive work of vitamin
D to become active.
2.3.5.3 Parathyroid Dysfunction
Parathyroid dysfunction occurs when the parathyroid gland does not function
normally, which can lead to a disturbance in the balance of calcium,
phosphate, and magnesium levels in the body. This condition is divided into
two main types: hyperparathyroidism (excessive production of parathyroid
hormone) and hypoparathyroidism (too low production of parathyroid
hormone).

A. Hyperparathyroidism
Hyperparathyroidism occurs when the parathyroid gland produces
excessive amounts of parathyroid hormone (PTH). These conditions are
divided into:
 Primary Hyperparathyroidism: Caused by direct disorders of the
parathyroid gland, such as benign tumors (adenomas), hyperplasia,
or rarely parathyroid cancer.
 Secondary Hyperparathyroidism: Occurs as a result of other
conditions, such as chronic kidney disease or vitamin D deficiency,
which causes low blood calcium levels and triggers the parathyroid
gland to work harder.
 Tertiary hyperparathyroidism: Occurs in patients with long-term
secondary hyperparathyroidism, in which the gland becomes
permanently overactive.
Symptoms of Hyperparathyroidism
 Hypercalcemia (high blood calcium levels), which can cause:
1) Fatigue
2) Bone pain
3) Kidney stone
4) Indigestion (nausea, vomiting, constipation)
5) Memory impairment or confusion
6) Weak muscles

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 7) Bone damage: Excessive PTH can cause bones to lose calcium,
increasing the risk
of osteoporosis or
fractures.
 Treatment of
Hyperparathyroidism
1) Surgery to remove
problematic parathyroid
glands (especially in
primary
hyperparathyroidism).
2) Medications such as calcimetics to reduce PTH production or vitamin
D and calcium supplements in secondary hyperparathyroidism.
3) Management of basic diseases, such as improving kidney function or
overcoming vitamin D deficiency.
2.3.6 Thymus gland

2.3.6.1 Definition of Thymus

Gland
The thymus gland is a
specialized organ that is part of
the lymphatic system and
endocrine system, serving as the
main site of maturation of T cells
(T lymphocytes), which is very important in the adaptive immune system. This organ
is triangular or lobular in shape and is located in the anterior mediastinum, just behind
the sternum and in front of the heart. The thymus has a vital role in the early stages of
human development, especially during childhood and adolescence, but it will shrink
in size and reduce in function with age in a process called thymus involution
2.3.6.2 Structure of the Thymus Gland

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 The thymus gland is a soft organ located above the heart just after the neck in
the upper chest cavity. The thymus gland can also be divided into 2 lobes surrounded
by fibrous capsules. At the time of human birth, this gland was about 5 mm long, 4
mm wide and 6 mm thick. Each of these lobules can be arranged by lobules that are
bounded by an areolar network. The thymus gland consists of 2 main parts, namely:
A. CortexThe thymus cortex is the outer part of the thymus gland which is
composed of lymphocytes and reticular epithelial cells that will be related to
the medulla. This cortex is the initial place where T cells are formed.
B. MedullaIn the medulla part of the reticular epithelial cells in the thymus
gland are coarser and there are fewer lymphocyte cells. Hassall's corpus is
also found in the medulla, which is a nest-like structure that is a gathering place
for reticular epithelial cells. The medulla is the site of the formation of advanced
T cells.

2.3.6.3 Mechanism of Action of the Thymus Gland

As is known, one of the activities of the thymus is lymphopoiesis or the growth
and maturation of lymphocytes which mainly occurs during the fetal period and the
beginning of the postnatal period, plasma cells and myelocytes are also formed in
small numbers. The thymus also produces a relationship with epithelial reticular cells
to detect foreign antigens and if the antigen is related to the glycoprotein membrane
on the cell surface marked in the MHC (Major Histocakompatibility Complex). The
MHC glycoprotein works as an antigen-binding receptor that activates the appropriate
response of T cells to specific foreign antigens and these T cells produce cells that
have immunological or immune capabilities. In the lymphoid organ, T cells occupy
the thymus dependent zone which includes the paracortical zone of the lymphoids.
In adults, the thymus is still an important source of small lymphocytes, especially
when a person experiences a reduction in lymphoid organs due to radiation. The
substance that has a humoral effect seems to penetrate through a cell-tight filter and
works as a substitute for thymus, thymusin. Thymosin is produced by epithelial
reticular cells and can be broken down into 2 glycoprotein fractions with low BM.
The substance that matures T cells is thymoprotein. The thymus is affected by the
genital gland, adrenal glands and also the thyroid gland. Sex hormones cause
involution and thyroidectomy accelerates involution.
2.3.6.4 Thymus gland dysfunction

19
 Dysfunction of the Thymus Gland refers to a disorder that affects the normal
function of the thymus in favor of the maturation and regulation of T cells (T
lymphocytes), which has an impact on the immune system. Because the thymus plays
an important role in immunology, dysfunction can lead to immune weakness,
autoimmune disorders, or even tumors.
A. Hypofunction of the Thymus (Low or Inactive Function)
This condition occurs when the thymus fails to perform its role normally, leading
to a deficiency of functional T cells.
1) Causes of Hypofunction of the Thymus:
 Premature Thymus Involution: The process of premature thymus
shrinkage
(before puberty), which is usually accelerated by chronic stress,
malnutrition, or severe infections.
2) Congenital Abnormalities:
 DiGeorge syndrome: Developmental defects of the thymus due to
abnormalities in chromosome 22q11.2, which lead to a deficiency or
absence of the thymus.
3) Side Effects of Treatment:
 Radiation therapy or chemotherapy can damage thymus tissue.
4) Severe Infection:
 Certain viral infections, such as HIV, can damage the thymus and
developing T cells.

B. Thymus Hyperfunction (Overactivity)

This condition occurs when the thymus produces too many hormones or its
activity causes a disruption to the immune system.
1) Causes of Thymus Hyperfunction:
 Thymus hyperplasia: An enlarged thymus that is often found in
patients with autoimmune disorders such as myasthenia gravis.
 Overstimulation: Stress or chronic infections can trigger
hyperactivation of thymus epithelial cells.
2) Impact of Thymus Hyperfunction:

20
  Autoimmune disorders: Abnormal or overproduced T cells, thus
attacking the body's own tissues (e.g. lupus, rheumatoid arthritis, or
myasthenia gravis).

C. Tumors in the thymus gland

The thymus can be the location of tumor growth, both benign and
malignant.
1) Types of thymus tumors:
 Thymus: A thymus epithelial tumor that is usually benign but can
cause autoimmune disorders. It is often associated with
myasthenia gravis (up to 30% of thymoma patients).
 Thymus carcinoma: A malignant tumor that is more aggressive
and can spread to surrounding tissues.
 Thymic lymphoma: A malignant tumor that involves
lymphocytes inside the thymus.
2) Symptoms of Thymus Tumors:
 Chest pain or pressure in the chest.
 Difficulty breathing (dyspnea).
 Chronic cough.
 Systemic symptoms such as fatigue, fever, or weight loss.
2.3.7 Pancreatic gland

2.3.7.1 Definition of Pancreatic Glands

21
 The pancreas is an important organ in the human body located behind the
stomach, in the upper abdominal cavity. This organ has two main roles,
namely:
 Exocrine function, which is related to the production of digestive enzymes
to break down food in the intestines.
 Endocrine function, which involves regulating blood sugar levels through
the secretion of hormones into the bloodstream.
As an endocrine gland, the pancreas plays a direct role in the endocrine
system, which is a network of glands that produce hormones to maintain the
body's balance (homeostasis).
2.3.7.2 Pancreatic Structure
The pancreas is made up of exocrine and endocrine tissue. In endocrine
function, the most important part is the islet of Langerhans, a small group of
endocrine cells scattered throughout the pancreas.
These islands are made up of different types of cells:
a. Alpha cells (α): Make up about 20% of the total islet cells of
Langerhans and produce glucagon.
b. Beta (β) cells: They are the most dominant cell type (60–70%) and are
responsible for insulin production.
c. Delta cells (δ): Make up about 10%, producing somatostatin which
inhibits the release of other hormones.
d. F cells (or PP): Produce pancreatic polypeptides, which help regulate
the function of pancreatic exocrines.
2.3.7.3 Pancreatic Hormones
The pancreas is a glandular organ in the digestive system that has endocrine
and exocrine functions. In endocrine function, the pancreas produces several
important hormones that regulate various metabolic processes in the body.
Pancreatic hormones play a vital role in maintaining blood sugar homeostasis,
energy metabolism, and other bodily functions. The balance between these
hormones is very important, and impaired secretion of pancreatic hormones
can lead to a variety of metabolic diseases, especially diabetes and indigestion:
a. InsulinInsulin is a hormone that lowers blood glucose levels by helping
the body's cells take glucose from the blood. This hormone plays an
important role in the metabolism of carbohydrates, fats, and proteins.

22
 After eating, blood glucose levels increase. The pancreas responds by
removing insulin from beta cells on the island of Langerhans. Insulin helps
glucose get into muscle cells, liver, and fat tissue to be used as energy or
stored as glycogen. Insulin deficiency causes type 1 diabetes, while
insulin resistance is associated with type 2 diabetes.
b. GlucagonGlucagon works as an insulin antagonist, i.e. increases blood
glucose levels. This hormone is released by alpha cells on the island of
Langerhans when blood glucose levels are low. Glucagon stimulates the
liver to break down glycogen into glucose (glycogenolysis) and produce
new glucose (gluconeogenesis). This is important to keep blood glucose
levels stable during fasting or between meals. Excess glucagon can occur
in some pancreatic tumors (glucagoomas), causing hyperglycemia.
c. Somatostatin
is a regulatory hormone that inhibits the release of other hormones,
including insulin, glucagon, digestive hormone, and growth hormone.
Produced by delta cells on the island of Langerhans, somatostatin helps
maintain metabolic balance by controlling the secretion of other hormones
and slowing the digestion of food. Tumors that produce excessive
somatostatin (somatostatinoma) can cause indigestion and low blood sugar.
d. Pancreatic Polypeptides (PP)
Pancreatic polypeptides regulate the function of pancreatic exocrine (such
as the secretion of digestive enzymes) and can affect appetite. Produced by
F cells on the island of Langerhans, this hormone is released after meals
and helps reduce pancreatic secretion as well as slow down intestinal
motility. Changes in PP levels can occur in conditions such as obesity or
anorexia.
e. Ghrelin (in small amounts)
Ghrelin, often called the "hunger hormone," increases appetite and
stimulates the release of growth hormone. Although more is produced by
the stomach, ghrelin is also produced in small amounts by the pancreas.
Ghrelin imbalances can affect weight and appetite, such as in obesity or
eating disorders.

2.3.7.4 Disorders of the Pancreatic Glands

23
 A malfunctioning pancreas can cause serious disorders, such as:
a. Diabetes Mellitus
This disease occurs when the pancreas is unable to produce enough insulin
or the body does not respond to insulin effectively.
 Types of Diabetes:
1) Type 1: Caused by autoimmune damage to pancreatic beta
cells, so the body cannot produce insulin.
2) Type 2: Caused by insulin resistance, where the body's cells do
not respond well to insulin.
3) Gestational: Occurs during pregnancy and is usually
temporary.
b. Hypoglycemia
This condition occurs when blood sugar levels are too low, often due to
excess insulin. Symptoms include cold sweats, dizziness, shaking, and
confusion.
c. Pancreatic Endocrine Tumors
1) Insulinoma: A tumor that causes excessive insulin production, so that
blood sugar is too low.
2) Glucagooma: A rare tumor that causes excessive production of
glucagon, resulting in increased blood sugar.
d. Pancreatitis
Inflammation of the pancreas, which can affect exocrine and endocrine
function, is often associated with alcohol abuse or gallstones.

2.3.7.5 The Role of the Pancreas in the Endocrine System and Body Balance
The pancreas not only regulates blood sugar levels, but also plays an
important role in the metabolism of carbohydrates, fats, and proteins. By
maintaining hormonal balance, the pancreas ensures the body has a stable
supply of energy and supports the normal functioning of all organs. If the
pancreas is disturbed, the body's metabolic balance can be disrupted, leading
to various chronic diseases and metabolic disorders.

2.3.8 Adrenal glands

24
2.3.8.1 Definition of Adrenal Glands
The adrenal glands, also known as the suprarenal glands, are two
small, triangular-shaped organs located above each kidney. These glands are
an important part of the endocrine system because they produce a variety of
hormones that help the body respond to stress, regulate metabolism, maintain
salt and water balance, and affect blood pressure. One type of human hormone
produced by the adrenal glands is the adrenaline hormone which indeed
originates from adrenaline itself. This hormone itself will be aroused and
released when in a "fight or flight" condition to prepare the body's reaction to
an emergency or frightening situation.
2.3.8.2 Structure of the Adrenal Glands
The adrenal glands have two main parts that differ structurally and
functionally:
a. Adrenal cortex (outer layer)
The adrenal cortex is made up of three layers (zones), each producing a
specific hormone:
1) Glomerulosa Zone
 Produces the hormone aldosterone (mineralocorticoid group).
 Function: Regulates the balance of electrolytes and body fluids
by controlling sodium absorption and potassium excretion by
the kidneys.
2) Fasikulata Zone
 Produces the hormone cortisol (glucocorticoid group).

25
  Function:
 Regulates the metabolism of carbohydrates, proteins,
and fats.
 Helps the body respond to stress.
 Controls inflammation and immune function.
3) Reticularis Zone
 Produces androgenic sex hormones (such as
dehydroepiandrosterone or DHEA).
 Function:
 Affects the development of secondary sexual
characteristics, especially during puberty.
b. Adrenal medulla (inner layer)
The adrenal medulla is the inner part of the adrenal gland that produces
the hormone catecholamine:
1) Adrenaline (Epinephrine)
o Function:
 Triggers a "fight or flight" response when stressed.
 Increases heart rate, blood pressure, and blood flow to
the muscles.
 Breaks down glycogen into glucose to provide instant
energy.
2) Noradrenaline (Norepinephrine)
o Function:
 Maintains blood pressure and increases blood flow to
vital organs during stressful situations.
2.3.8.3 Disorders of the Adrenal Glands
Disorders of the adrenal glands can lead to an excess or deficiency of
hormones, which has a serious impact on health.
a. Adrenal Hypofunction (Too few hormones)
1) Addison's Disease
It is caused by damage to the adrenal cortex so that the production of
cortisol and aldosterone decreases. Symptoms: Fatigue, weight loss,
low blood pressure, and hyperpigmentation of the skin.

26
 2) Adrenal Crisis is an acute life-threatening condition due to a sudden
lack of adrenal hormones.
b. Adrenal gland hyperfunction (Too many hormones)
1) Cushing's syndrome is caused by an excess of cortisol, usually due to a
tumor in the adrenal or pituitary gland. Symptoms: Weight gain in the
face and abdomen, high blood pressure, and muscle weakness.
2) Hyperaldosteronism (Conn Syndrome) is an excess of aldosterone that
causes high blood pressure and low potassium levels.
3) Pheochromocytoma Tumors of the adrenal medulla that cause excessive
adrenaline production. Symptoms: Attacks of hypertension, sweating,
and rapid heartbeat.

2.3.9 Gonadal Glands

2.3.9.1 Definition of Gonand Glands

The gonadal gland is a reproductive gland that functions as part of the
endocrine system and the reproductive system. These glands include the
testicles in men and the ovaries in women. In addition to producing

27
 reproductive
cells (sperm
in men and
eggs in
women),
gonads also
produce sex
hormones that
play an
important role
in sexual
development, reproductive function, and regulation of secondary sexual
characteristics. The gonads (gonads) form in the first weeks of gestation and
are evident in the fifth week. Differentiation was evident by measuring fetal
testosterone levels at the seventh and eighth weeks of gestation. Gonadal gland
activity occurs during prepuberty with increased gonadotropin secretion (FSH
and LH) due to a decrease in inhibisisteroids.
2.3.9.2 Structure of the Gonand Gland
The gonadal gland is a reproductive organ that plays an important role in
producing gametes (sex cells) and reproductive hormones. There are two types
of gonads in humans, namely the testicles in men and the ovaries in women.
Here is the structure of each:
a. Testicles (Male)
The male genital glands produce the hormone testosterone produced from the
testicles (male gonads) which function to stimulate the growth of secondary
sexual characteristics in men and sexual behavior.
Men have a pair of testicles that are found in the scrotum. The testicles (male
gonads) are elongated and hang at the top of the body cavity with the
mediation of the mesorcium. In Chonduricthyes, one testicle is larger than the
other. The testicles are made up of follicles where spermatozoa develop. The
size of the gonads can reach 12% or more of their body weight. Most of the
testicles are colored and smooth in cycloisia, the testicles are erect. The
testicles consist of thousands of sperm ducts (tubules). The body wall of the
spermatal tubule is lined by primitive gersmital cells that undergo specificity

28
called spermatogonium. The size of the testicles in adults is 4 x3 x 2.5 cm,
with a volume of 15 ± 25 ml in the shape of an avoid. Both testicles are
wrapped by tunica albuginea tissue attached to the testicles. Outside the tunica
albuginea there is a tunica vagainalis which consists of visceral and parietal
layers as well as tunica dortos.

The testicles have two functions, namely as an endocrine organ and a

reproductive organ. Produces testosterone and estradiol hormones under the
influence of LH. Testosterone is required to maintain spermatogenesis,
whereas FSH is required to initiate and maintain spermatogenesis. Estrogen
has the effect of lowering testosterone concentrations through negative
feedback on FSH while testosterone and estradiol levels are negatively
feedback on LH. The function of the testicles as a reproductive organ takes
place in the seminiferous tubules. The effect of testosterone on the fetus
stimulates the differentiation and development of the genitals towards the
male. During puberty, this hormone will stimulate the development of
secondary sex signs such as the development of body shape, the growth and
development of the genital organs, the distribution of body hair, the
enlargement of the larynx and the thickening of the vocal cords as well as the
development of aggressive traits. As an anabolic hormone, it stimulates the
growth and closure of the bone epifise.

Inside the testicles there are many tubules containing seminiferous cystes
surrounded by cretoli cells. Then, this cyste will differentiate into
spermatogonium which will then undergo the process of spermatogenesis into
permatozoa. According to Herper and Prugirin (1982) in Rustidja (1998) there
are two things related to sex differentiation, namely: Sex is formed at the end
of larval development, which is about 3 to 4 weeks after hatching. The sex of
the larvae after hatching is very labile so that it can be influenced by internal
and external factors.

b. Ovary (Female)
The female gonads or gonadal glands are as follows:
1. Estrogen is produced by the follicle graaf. Its function is to stimulate the
growth of secondary sexual characteristics in women.

29
2. Progesterone is produced by the corpus luteum, development, and growth
of the mammary glands.
The female gonadal glands are produced from the ovaries. The ovaries are
elongated, located under or next to gas bubbles, sometimes in pairs. The
ovaries depend on the upper part of the body cavity with cheovaria
intermediates. Its size and development in the human body varies according
to its level of maturity. The colors are also different. Most are whitish in color
when younger and turn yellowish when ripe. Like testes, the ovaries also
function as endocrine organs and reproductive organs.

As an endocrine organ, the

ovaries produce the hormones
estrogen and progesterone. As
a reproductive organ, the
ovaries produce ovums (eggs)
every month during ovulation
to be ready for fertilization by
sperm. Estrogen and
progesterone will affect the
development of secondary
sex, prepare the endometrium
to receive the results of
conception as well as maintain
the lactation process. Estrogen
is formed in the cells of the
follicle granulosa and the lutein cells of the corpus luteum. Progesterone is
also formed in the lutein cells of the corpus luteum.

The gonads in women (ovaries) are a kind of sac and have lamella that
contain fold cells that differentiate into the ougonium. Furthermore, the
ougonium will undergo an ovogenesis process into an ovum that is wrapped
in follicles and these follicles are located inside the lamella which affect the
ovarian space.
According to Rustidja (2000), the growth of oocytes in the ovaries can be
divided into two stages, namely:

30
  Primary growth stage (privitell ogenesis) which is characterized
by an increase in size.
 Secondary growth stage (oxogenenous vitellegenesis) which is
characterized by the formation of visicles in the parifer part of the
cytoplasm and expanding towards the cell nucleus. Oacetes
develop from the accumulation of egg yolk proteins from nature
(endogenous vitellogenesis) and regulate with egg yolk derivates
from the results of laxogenous vetellogenesis that are lower
through the bloodstream.
2.3.9.3 Disorders of the Gonadal Glands
Gonadal dysfunction can cause significant health problems, including:
a. Hypogonadism is a condition in which the gonadal glands produce
insufficient amounts of sex hormones. Cause: Genetic disorder, injury,
infection, or disorder of the HPG axis.
Symptom:
 In men: decreased libido, infertility, decreased muscle mass.
 In women: Irregular menstrual cycles, infertility, and hot flashes.
b. Polycystic Ovary Syndrome (PCOS) is an endocrine disorder in women
that causes excessive androgen production, irregular menstrual cycles, and
ovarian cysts.
c. Early or Late Puberty, which is an imbalance of gonadal hormones, can
cause puberty to occur too early or late.
d. Gonadal cancer for example, testicular cancer in men or ovarian cancer in
women.

CHAPTER III
CLOSING
3.1 Conclusion
The endocrine system is a glandular tissue that functions to produce and release
hormones into the bloodstream, playing an important role in regulating various body
functions. These hormones serve as chemical messengers that affect other organs and
tissues, contributing to metabolic regulation, growth, development, and response to stress.
Hormonal balance is crucial to maintain the body's homeostasis, which is a stable
condition necessary for optimal health. Imbalances in the endocrine system can lead to a

31
 variety of serious health problems, such as diabetes mellitus, hypothyroidism, Cushing's
syndrome, and growth disorders. Therefore, a deep understanding of the function and
impact of the endocrine system is essential for maintaining overall health and preventing
potential health problems that can arise as a result of hormonal dysfunction.

3.2 Advice
To maintain the health of the endocrine system, it is important to adopt a healthy
lifestyle. Consumption of a balanced nutritious diet rich in fiber, vitamins, and minerals, as
well as high in antioxidants from fruits and vegetables is highly recommended. In
addition, engage in regular physical activity to maintain weight and improve insulin
sensitivity. Stress management is also crucial; Relaxation techniques such as meditation
and yoga can help reduce stress that impacts hormonal balance. Don't forget to do regular
health checkups to monitor hormone levels and detect disorders early. With these
measures, individuals can support endocrine system health and improve overall quality of
life.

BIBLIOGRAPHY
Aryenti, A. S. (2019). Anatomy of Endocrin. Yarsi University, 1–7.
https://simdos.unud.ac.id/uploads/file_penelitian_1_dir/50ad33eccd269271ca585795f48
cf2b4.pdf

Perdana, I., & Eureka, S. (2020). PHYSIOLOGY OF THE ENDOCRINE SYSTEM. UNIQUE
Press.

Rahmah, J. (2023). Physiological Anatomy of the Human Body. PT MEDIA PUSTAKA

INDO.

32
Suparyanto and Rosad. (2020). Endocrine System Disorders. Suparyanto and Rosad, 5(3),
248–253.

Widjosono, G. (2017). Endocrine system. Textbook of Surgery, 925–952.

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