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Endo > Disorders of the thyroid gland > Flashcards

Disorders of the thyroid gland Flashcards

1
Q

How many lobes does the pituitary gland have?

A

two lobes

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2
Q

Where does the pituitary gland lie?

A

lies below the brain in the Sella Turcica

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3
Q

What is the anterior lobe of the pituitary gland derived from?

A

The anterior lobe (adenohypophysis) is derived from an invagination of the roof of the embryonic oropharynx
- Known as Rathke’s pouch.

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4
Q

What forms the pituitary stalk and what does it connect?

A

A notochordal projection forms the pituitary stalk
- Connects the gland to the brain and also the posterior lobe of the pituitary (neurohypophysis).

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5
Q

Describe the blood supply of the pituitary gland?

A

The pituitary gland has a dual blood supply.
- The first is via the long and short pituitary arteries
- The second is from the hypophyseal portal circulation.
This begins as a capillary plexus around the Arcuate nucleus of hypo to anterior

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6
Q

How were pituitary cell types orignally characterised?

A

classified by their staining characteristics with acidic (orange-G) and basic (aldehyde fuscin) dyes

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7
Q

Function of Prolactin

A

Breast milk production
- prolactin is an anterior pituitary hormone

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8
Q

Function of ADH

A

Water regulation

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9
Q

Function of oxytocin

A

Breast milk expansion

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10
Q

State the single word nomenclature for the following:

  • LH/FSH
  • GH
  • TSH
  • ACTH
A

Respectively:
Gonadotrophin

Somatotrophin

Thyrotrophin

Corticotrophin

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11
Q

Draw or describe the general feedback loop of the hypothalamic
- pituitary axis?

A

Hypo.= Tertiary
(Anterior) Pituitary = secondary
End organ = Primary

-ve feedback is induced by end organ hormones

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12
Q

State the 3 major clinical presentations of pituitary tumours?

A
  1. Hormone hypersecretion
  2. Space occupying lesion (tumours present in skull or cranial)
    - Headaches
    - Visual loss (field defect)
    - Cavernous Sinus Invasion
  3. Hormone deficiency states
    - Interference with surrounding normal pituitary
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13
Q

State the syndrome of excess GH

A

Acromegaly

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14
Q

State the syndrome of excess ACTH

A

Cushing’s disease

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15
Q

State the syndrome of excess TSH

A

Secondary thyrotoxicosis

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16
Q

State the syndrome of excess LH/FSH

A

Non-functioning pituitary tumour

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17
Q

State the syndrome of excess PROLACTIN

A

Prolactinoma

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18
Q

Draw or describe the GH feedback loop of the hypothalamic
- pituitary axis?

A

Blue is inhibitory effect (somatostatin)
red is stimulatory effect (GHRH)

IGF-1 stimulates chondrocytes for bone growth,
but also induces -ve feedback (GH also does this too)

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19
Q

State the systemic effects of GH/IGF-1 excess?

A
  1. Acral enlargement
    - spade like hands rings too small
    - Inc shoe size
    - macroglossia
    - carpal tunnel syndrome
  2. Increased skin thickness
  3. Increased sweating
  4. Skin tags and acanthosis nigricans
  5. Change appearance
  6. inter-dental spacing
  7. Visceral enlargement
  8. Metabolic Changes
  9. Impaired fasting glucose
  10. Impaired glucose tolerance
  11. Diabetes mellitus
  12. Insulin resistance
  13. Reduced total cholesterol
  14. Increased triglycerides
  15. Increased nitrogen retention
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20
Q

State 8 consequences of GH/IGF-1 excess?

A

Cardiomyopathy
Hypertension
Bowel Polyps
Colonic Cancer
Multinodular goiter
Hypogonadism
Arthropathy
OSA

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21
Q

State 6 major actions of cortisol?

A

Proteins are catabolised
- Releases Amino Acids
Na+ and H2O Retention
- Maintains BP
Anti inflammatory
Increased gastric acid production
Increases plasma glucose levels
Increases lipolysis
- Provides energy

22
Q

State how processes are affected by cortisol so it can increase plasma
glucose levels

A
  • Inc gluconeogenesis
  • Dec glucose utilisation
  • Increases glycogenesis
  • Inc glycogen storage
23
Q

State the 3 major changes that occur from cushing’s syndrome?

A

Changes in protein and fat metabolism
Changes in sex hormones
Salt and water retention

24
Q

Describe the effect as a result of change in protein and fat metabolism
from cushing’s syndrome?

A

Change in body shape
Central obesity
Moon face
Buffalo hump
Thin skin, easy bruising
Osteoporosis (brittle bones
Diabetes

25
Q

Describe the effect as a result of change in sex hormones
from cushing’s syndrome?

A

Excess hair growth
Irregular periods
Problems conceiving
Impotence

26
Q

Describe the effect as a result of salt and water retention
from cushing’s syndrome?

A

High blood pressure
Fluid retention

27
Q

Describe how prolactin has a different feedback to all the other anterior
pituitary hormones?

A

Tonic release of Dopamine inhibits PRL release
- Works via a positive feedback mechanism

28
Q

State the 3 drugs which can interfere with dopamine and prolactin
secretion?

A

Antiemetics
Antipsychotics
OCP/HRT

29
Q

State 6 features of PRL excess (prolactinomas)

A
  • Infertility
  • Oligoamenorrhoea
  • Amenorrhoea
  • Galactorrhoea
  • Reduced libido
  • Impotence
30
Q

How does excess PRL cause hypogonadism?

A

In hyperprolactinemia, which induces hypogonadism, the excess prolactin interferes with secretion of gonadotropin-releasing hormone
- Results in decreased testosterone/oestrogen

31
Q

State the treatment for prolactinomas?

A

Dopamine agonists:

  • bromocriptine,
  • cabergoline

(not surgery)

32
Q

Describe features of non-functioning pituitary tumour?

A

30% of all pituitary tumours
No syndrome of hormone excess produced
Cause symptoms due to space occupation

33
Q

State 5 symptoms of non-functioning pituitary tumours?

A
  • headache
  • visual field defects
  • nerve palsies
  • interfere with rest of pituitary function
  • deficiency of hormones
34
Q

State the treatment for non-functioning pituitary tumours

A

surgery (transsphenoidal approach) ± radiotherapy
no effective medical therapy

35
Q

State the effect of the loss of pituitary function with expanding tumour?
LH FSH

GH

TSH

ACTH

 Prolactin

A

Respectivrly:
Sex

Growth

Metabolism

Survival

Stalk compression

Further down is increasing in biological importance

36
Q

Describe the treatment for pituitary adenoma?

A

Surgery
Transsphenoidal
(Adrenalectomy - Nelson’s syndrome)

Radiotherapy
Slow

Drugs
Block hormone production
Stop Hormone Release

37
Q

State 5 causes of pituitary failure?

A

Tumour
- Benign
- (Malignant)
Trauma
Infection
Inflammation
- Sarcoidosis
- Histiocytosis
iatrogenic

38
Q

What is the effect of hypopituitarism on TH?

A

Bradycardia
Weight gain
Cold intolerance
Hypothermia
Constipation

39
Q

What is the effect of hypopituitarism on sex steroids?

A

Oligomenorrhoea
Reduced libido
Hot flushes
Reduced body hair

40
Q

What is the effect of hypopituitarism on reduced cortisol?

A

Tiredness
Weakness
Anorexia
Postural hypotension
Myalgia

41
Q

What is the effect of hypopituitarism on reduced GH?

A

Tired
Central weight gain

42
Q

State the treatment of hypopituitarism of:

  • Thyroid
  • Sex steroids
  • Reduced cortisol
  • Reduced GH
A

Thyroid
- Thyroxine
Sex Steroids
- Testosterone
- Oestrogen
Reduced Cortisol
- Hydrocortisone
Reduced GH
- Growth hormone

43
Q

State the control of vasopressin?

A

Increased plasma osmolality
Decreased blood pressure (Baroreceptors)
Decreased PaO2 and increased PaCO2
- cortisol
- sex steroids
- angiotensin II

44
Q

State the action of vasopressin?

A

Collecting ducts
increased permeability for H2O
reabsorbtion of free water
Vasoconstriction

45
Q

State effects for Syndrome of Inappropriate ADH (SIADH)

A

Too much ADH
Brain injury/infection
Lung cancer/infection asthma IPPV
Metabolic
- Hypothyroidism
- Addison’s

46
Q

State the diagnosis markers for SIADH?

A

 Plasma Na+
(<130mmol/l)
 Plasma osmolality
(>285mOsm/kg)
Urine osmolality
(>100mOsm/kg)
Urine Sodium
(>30mmol/l)

47
Q

State treatment for SIADH?

A 
Fluid restriction
Demeclocyline
ADH Antagonist (Tolvaptan)
48
Q

How is diabetes inspidus caused by?

A

Underproduction ADH

Cranial:
Lack of Production
Nephrogenic:
Receptor resistance

49
Q

State the diagnosis for diabetes inspidus?

A

Essentially too much urine being released

Polyuria (>3l)
OR
Polydipsia (excessive thirst)
 Plasma Na+
Dec. Plasma osmolality (> 295 mosmol/kg)
Inc. Urine osmolality (< 700 mosmol/kg)
Inc. Urine Na+

50
Q

What is the water deprivation test used for?

A 
Used to differentiate between primary polydipsia (excessive or anormal thirst) and
diabates insipidus (CDI/NDI) due to increased water output
C= Central
N= Nephrogenic

Endo (9 decks)

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