Endocrine disease L18

Question 1

What does the pineal gland control

Answer 1

Sleep wake cycle

Question 2

What does the pituitary gland control

Answer 2

Growth/lactation/Thyroid

Question 3

What does the thyroid gland do

Answer 3

Control metabolism

Question 4

What happens in the thymus

Answer 4

T cell maturation

Question 5

What is the adrenal gland responsible for

Answer 5

Stress response

Question 6

What does the pancreas control

Answer 6

Glucose metabolism

Question 7

What do the ovaries control

Answer 7

Ovulation

Question 8

What do the testes control

Answer 8

Spermatogenesis

Question 9

How does the pineal gland carry out its function

Answer 9

Secretes melatonin that regulates circadian rhythm or sleep wake cycles

Question 10

Effects of pineal glamd

Answer 10

Headache – due to hydrocephalus. Enlargement of pineal gland can block CSF flow
Insomnia/sleep disturbances – again from hydrocephalus
Nausea
Blurred vision
Upward Gaze palsy (Parinaud syndrome) – Enlargement of pineal can disturb superior colliculus, which regulates gaze movements
Staggering gait
Hearing loss

Question 11

Where is the pituitary gland located

Answer 11

Sits in the hypophysial fossa of the sphenoid bone

Surrounded by sella turcica. It lies near the optic nerves

Question 12

What do pituitary tumours do

Answer 12

Cause the absence or diminuition of hormone secretion by destruction of pituitary

Question 13

What does ischemia do

Answer 13

Prevent the blood flow so no oxygen reaches the cells, so cells go through necrosis and die off

Question 14

What cells do prolactinomas affect

Answer 14

Lactotrophs

Question 15

What cells do growth hormone secreting adenoma affect

Answer 15

Somatotrophs

Question 16

What cells do non secreting adenomas affect

Answer 16

All cells

Question 17

What cells do corticotroph adenoma affect

Answer 17

Corticotrophs

Question 18

When TSH, FSH and LH cells start secreting adenomas what cells are affected

Answer 18

Thyrotrophs and gonatrophs

Question 19

What is the differential diagnosis of prolactinomas

Answer 19

Loss of dopamine inhibition from hypothalamus quite often from trauma

Question 20

Side effects of prolactinoma in women

Answer 20

In women
Amenorrhea – unusual lack of menstruation
Oligomenorrhea – irregular menstruation
Galactorrhea - ‘Witchs milk’

Question 21

Side effects of prolactinoma in men

Answer 21

In men
Testicular atrophy
Gynecomastia = ‘man boobs’ 
Diminshed body hair
Impotence

Question 22

When is prolactin released

Answer 22

During pregnancy

Question 23

What effect do growth hormone secreting tumours have when a child is going through or before puberty

Answer 23

It amplifies puberty and stimulates IGF-1 and a child gets gigantism

Question 24

What effect do growth hormone secreting tumours have on a adult

Answer 24

Adults have acromegaly, this where you get clustering of chondrocytes, which are the cells which make cartilage, around the bones leaving the person with thickened fingers and feet

Question 25

What effect do corticotrophin secreting adenoma have on people

Answer 25

People get cushing syndrome, where you have truncal obesity. This is when you can have things such as moon faces, thin skin, abdominal striae(stretch marks), high blood pressure, glucose intolerance and fatigue

Question 26

What else can induce cushing syndrome

Answer 26

Long term steroid use to combat an autoimmune disease

Question 27

When TSH, FSH and LH cells start secreting adenomas, what effect do they have

Answer 27

Visual field loss, headache and diplopia and decrease in libido/energy in men

Question 28

What effects can non secreting adenomas have

Answer 28

Severe frontal headache

Question 29

What is papilloedema (extremely rare)

Answer 29

Optic disc swelling due to increased intracranial pressure

Question 30

Do nasal axons cross at the optic chiasm or temporal axons

Answer 30

Nasal axons and temporal axons remain uncrossed

Question 31

What type of retina detects your peripheral view

Answer 31

Nasal retina

Question 32

What type of retina detects your central view

Answer 32

Temporal retina

Question 33

What causes hyperthyroidism and happens in it

Answer 33

Increase in thyroxine production

1) Adenoma of thyroid - tumour
2) hyperfunctional - diffuse/multinodular goitre (large lump)
3) TSH secreting adenoma of pituitary
4) hyperplasia - graves disease

Question 34

What is the pathogenesis of graves disease

Answer 34

Activated B-cells produce antibodies which have a similar shape to TSH and so they bind to the the TSH receptors on the follicle cell on thyroid cells, causing over production of T3/T4

Question 35

How does graves disease affect TSH and affect does that have

Answer 35

In graves disease the production of TSH is inhibtited however this prevents the regulation of the autoantibodies produced by the B-cells, losing control of metabolism and causing rapid weight loss

Question 36

Why does a goitre occur

Answer 36

Follicular cells in the thyroid cant handle the stimulation by the antibodies so the cells divide and more form more cells, ending up with a goitre

Question 37

How does exophthalmos lead to keratoconjunctivitis sicca

Answer 37

The eyeball starts protruding out, and the eyelids dont stretch, so the eyes start drying out and you cant blink and replenish your tear film

Question 38

Exophthalmos affects which eye muscles and in what order

Answer 38

1) Elevation is usually first to go (inferior rectus restricts upgaze)
2) then abduction, which causes esodeviation due to tethered medial rectus

This causes diplopia (double vision)

Question 39

Does hyperthyroidism treatment have an effect on graves opthalmopathy

Answer 39

No, as you can get Graves’ opthalmopathy with no thyroid gland as both hyperthyroidism and Graves’ opthalmopathy have an underlying autoimmune aetiology

Question 40

What are the two main causes of hypothyroidism

Answer 40

1) Low dietary intake of iodine - essesntial for T4 production
2) Autoimmune disease of the thyroid - Hashimotos thyroiditis – T cells destroy thyroid