14. The Endocrine System…. The rest !

Question 1

The endocrine system

Answer 1

Multiple organs.

Highly integrated.

Secrete hormones to cause the effect

Question 2

Endocrine diseases

Answer 2

Underproduction

Overproduction

Mass lesions

Question 3

Areas to be covered

Answer 3

Hypothalamus
Pituitary
Thyroid
Parathyroid
Adrenals

Question 4

Hypothalamus

Answer 4

Located in the brain – above brain stem

Links the Central Nervous system to the Endocrine system

Question 5

Pituitary gland

Answer 5

Anterior

Posterior

Question 6

Anterior

Answer 6

Growth hormone
Thyroid Stimulating Hormone
Adreno-corticotrophic hormone
Follicle stimulating hormone
Lutenising hormone
Prolactin

Question 7

Posterior

Answer 7

Antidiuretic hormone

Oxytocin

Question 8

Pituitary Diseases

Answer 8

Hyperpituitarism-related effects
Adenomas
Hypopituitarism-related effectsInjury, surgery, radiation, inflammation
Local mass effectcompressing the optic chiasm

Question 9

Hyperpiuitarism

Answer 9

Most common cause is an adenoma in anterior lobe.

Other causes:CancerHyperplasia

Question 10

Pituitary Adenoma (1)

Answer 10

Functional- prolactinoma

Non Functional

Question 11

Pituitary Adenoma (2)

Answer 11

Macroadenomas ( > 1 cm in diameter )

Microadenomas (

Question 12

ACTH

Answer 12

Cushing’s disease

Question 13

Growth hormone

Answer 13

Gigantism (children)

Acromegaly (adults)

Question 14

Prolactin

Answer 14

Galactorrhea/ amenorrhea
sexual dysfunction
infertility

Question 15

TSH

Answer 15

Hyperthyroidism

Question 16

FSH, LH

Answer 16

Hypogonadism, mass effects/hypopituitarism

Question 17

Hypopituitarism

Answer 17

Occurs with loss of 75% or more of the anterior pituitary parenchyma.

Question 18

Hypopituitarism: causes

Answer 18

Ischemic necrosis of the pituitary: Sheehan’s syndrome

Non functioning adenomas

Surgery or irradiation

Inflammatory lesions

Question 19

Grave’s disease (Autoimmune)

Answer 19

Over treatment by thyroxine
Infective – De Quervain’s thyroiditis
Toxic multinodular goitre
Toxic adenoma

Question 20

Hyperthyroidism: Management

Answer 20

Testing: Clinical + thyroid function tests
Treat the cause
Carbimazole/propylthiouracil
Radioiodine
Thyroidectomy

Question 21

Hypothyroidism causes

Answer 21

Iodine deficiency
Autoimmune – Hashimoto’s thyroiditis
Iatrogenic: Surgery, radioiodine
Pituitary defects
Congenital

Question 22

Hashimoto’s thyroiditis

Answer 22

Autoimmune destruction of the thyroid gland.

Women > men

45 – 60 years old

Question 23

Hypothyroidism: Management

Answer 23

Thyroxine

Question 24

Hyperthyroidism symptoms

Answer 24

Intolerance to heat
Fine, straight hair
Bu;ging eyes
Facial flushing
enlarged thyroid
tachycardia
Increase systolic BP
Breast enlargement
weight loss
muscle wasting
finger clubbing
tremors
diahrrhea
menstrual changes (amenorrhea)
localised edema

Question 25

Hypothyroidism symptoms

Answer 25

``` Intolerance to cold receding hair line facial and eyelid edema dull blank expression extreme fatigue thick tongue - slow speech anorexia brittle nails and hair menstrual disturbances hair loss apathy lethargy dry skin muscle aches and weakness constipation ``` Late clinical manifestations: subnormal temp, bradycardia, weight gain, decrease LOC, thickened skin, cardiac complications

Question 26

Thyroid Cancer

Answer 26

Relatively uncommon Most common type is Papillary carcinoma. Papillary thyroid carcinoma is a non-functional tumour.

Question 27

Hypoparathyroidism: Causes

Answer 27

Removal by surgery (Thyroidectomy) Congenital Hereditary (autoimmune)

Question 28

Hypoparathyroidism: Symptoms

Answer 28

Due to low calcium;- Irritability- Tetany- Seizures

Question 29

Hyperparathyroidism

Answer 29

``` PRIMARY = Adenoma SECONDARY = Chronic renal failure TERTIARY = After renal transplant ```

Question 30

Hyperparathyroidism: Symptoms

Answer 30

Due to hypercalcemia:ConstipationDepressionSeizuresMuscle wastingPolyuriaBone fracturesKidney stones

Question 31

Hyperaldosteronism

Answer 31

Primary ( Conn’s Disease in > 50 %) Secondary (due to high renin)

Question 32

Conn’s Disease: Symptoms

Answer 32

Oedema Hypertension High Sodium Low Potassium

Question 33

Glucocorticoids: Cortisol

Answer 33

``` Essential to life Regulates blood sugar Inhibits inflammation Stress response Release is by circadian rhythm (normal) Stress Excess release ------ Cushing’s Syndrome ```

Question 34

Cushing’s Syndrome: Causes

Answer 34

ACTH releasing tumour (pituitary/lung) Steroids

Question 35

Addison’s disease (adrenal insufficiency)

Answer 35

Multiple causes: Autoimmune Infection Neoplasms

Question 36

Addison’s disease: Symptoms and signs

Answer 36

GI Symptoms (Anorexia, nausea, vomiting and diarrhoea) Weight loss Hyperpigmentation Low Sodium, High Potassium

Question 37

Gonadocorticoids (sex hormones)

Answer 37

Testosterone Oestrogen Both are also secreted from the gonads

Question 38

Phaeochromocytoma: Presentation

Answer 38

``` Hypertension Sweating Palpitations Nervousness Increased metabolic ratio Rapid heart rate ```

Question 39

Multiple Endocrine Neoplasia (MEN)

Answer 39

Group of inherited diseases resulting in proliferative lesions of multiple endocrine organs Different types