2. Pituitary and Thyroid Disease

Question 1

Endocrine disease can be (2)

Answer 1

Primary - gland failure

Secondary - control failure

Question 2

Types of multiple endocrine neoplasia (3)

Answer 2

MEN 1 - parathyroid, pancreatic islets
MEN 2a - parathyroid, phaeochromocytoma
MEN 2b - medullary thyroid, phaeochromocytoma

Question 3

Divisions of pituitary (2)

Answer 3

Anterior

Posterior

Question 4

Hormones secreted by anterior pituitary (6)

Answer 4

TSH
ACTH
GH
LH
FSH
Prolactin

Question 5

Hormones secreted by posterior pituitary (2)

Answer 5

ADH

Oxytocin

Question 6

Types of pituitary tumours (2)

Answer 6

Functional adenoma

Non-functional adenoma

Question 7

Features of functional adenoma (2)

Answer 7

Well-differentiated

Hormone-producing

Question 8

Functional adenoma associated with age (2) and diseases (2)

Answer 8

<40yrs old - Cushing’s disease

>40yrs old - Acromegaly

Question 9

Features of non-functional adenoma (2)

Answer 9

Space-occupying

Non-hormone producing

Question 10

Effects of non-functional adenoma (2)

Answer 10

Visual field defects

Other hormone deficiencies

Question 11

Pituitary tumour treatment

Answer 11

Surgery - trans-sphenoidal surgery

Question 12

Unregulated GH in children can lead to (2)

Answer 12

Excess - gigantism

Insufficient - growth failure

Question 13

Unregulated GH in adults can lead to (2)

Answer 13

Excess - acromegaly

Insufficient - metabolic changes (increased fat, reduced vitality)

Question 14

How do you measure GH

Answer 14

IGF-1

Question 15

Definition of acromegaly

Answer 15

Hormonal disorder caused by excess GH in adulthood

Question 16

Result of acromegaly

Answer 16

Appositional bone growth (hands, feet, face - mandible)

Question 17

Acromegaly presentation changes (9)

Answer 17

Coarse features
Enlarged supra-orbital ridges
Broad nose, thickened lips and soft tissues
Enlarged hands (Carpal tunnel syndrome)
Type 2 diabetes mellitus
CVD
Visual field defects (CN III, IV and VI nerve palsies)
Hyperprolactinaemia
Hypopituitarism

Question 18

Intra-oral acromegaly changes (4)

Answer 18

Enlarged tongue
Interdental spacing
Shrunk dentures
Reverse overbite

Question 19

Types of thyroid dysfunction (2)

Answer 19

Hyperthyroidism

Hypothyroidism

Question 20

Causes of hyperthyroidism (4)

Answer 20

Graves’ disease
Toxic multi-nodular goitre
Toxic adenoma
Pituitary tumour (rare)

Question 21

Symptoms and signs of hyperthyroidism ((17)

Answer 21

Hot and excess sweating
Weight loss
Diarrhoea
Palpitations
Muscle weakness
Irritable, manic and anxious
Warm moist skin
AF and tachycardia
Increased BP
HF
Tremor and hyperreflexia
Eyelid retraction and lid lag

Question 22

Cause of Graves’ disease

Answer 22

Auto-antibodies stimulating TSH receptors

Question 23

Symptoms and signs of Graves’ disease (2)

Answer 23

Ophthalmopathy (thyroid eye disease) - scleral injection, proptosis, periorbital oedema
Conjunctival oedema - chemosis

Question 24

Types of hypothyroidism (2)

Answer 24

Primary

Secondary

Question 25

Causes of primary hypothyroidism (6)

Answer 25

``` Autoimmune (Hashimoto's) thyroiditis Idiopathic atrophy Radioiodine treatment, thyroidectomy surgery Iodine deficiency Drugs Congenital ```

Question 26

Causes of secondary hypothyroidism

Answer 26

Hypothalamic/pituitary disease

Question 27

Outcome of hypothyroidism

Answer 27

Reduced metabolism

Question 28

Symptoms and signs of hypothyroidism (16)

Answer 28

``` Tired Cold intolerance Weight gain Constipation Hoarse voice Goitre Puffed face and extremities Angina Slow, poor memory Dry coarse skin Bradycardia, hyperlipidaemia Psychiatric confusion Hashimoto's goitre Delayed reflexes ```

Question 29

Population for Hashimoto's thyroiditis

Answer 29

Middle-aged to elderly women

Question 30

Presenting features of Hashimoto's thyroiditis (2)

Answer 30

Goitre | Hypothyroid features

Question 31

Hashimoto's thyroiditis is associated with (2)

Answer 31

FH of autoimmune disease (vitiligo, PA, type 1 DM, Addison's) Downs syndrome

Question 32

Causes of idiopathic atrophy (2)

Answer 32

Lymphocyte infiltration | Associated with organ specific autoimmune disease

Question 33

Thyroid disease investigations (3)

Answer 33

Blood tests - TSH, T3, T4 Imaging - ultrasound, radioisotope scan Tissue (fine needle aspirate/biopsy)

Question 34

Secondary hyperthyroidism investigation results (2)

Answer 34

Raised TSH | Raised T3

Question 35

Primary hyperthyroidism investigation results (2)

Answer 35

Low TSH | Raised T3

Question 36

Secondary hypothyroidism investigation results (2)

Answer 36

Low TSH | Low T4

Question 37

Primary hypothyroidism investigation results (2)

Answer 37

High TSH | Low T4

Question 38

Hyperthyroidism treatment (4)

Answer 38

Carbimazole B-blockers Radioiodine Surgery

Question 39

Hypothyroidism treatment

Answer 39

T4 (thyroxine) tablets

Question 40

Causes of thyroid enlargement (2)

Answer 40

Goitre | Solitary nodular enlargement