overview of anatomy of major endocrine glands Flashcards
A 33-year-old man presents complaining of visual disturbance. Examination reveals a bitemporal hemianopia with predominately the upper quadrants being affected. What is the most likely lesion? Craniopharyngioma Brainstem lesion Pituitary macroadenoma Frontal lobe lesion Right occipital lesion
disturbance to optic chasm - pituitary lies above this and so tumour could compress this
what attaches the hypothalamus to the pituitary gland
infundibulum
where is the antioer pituitary derived from
rathkes pouch
ectoderm
superior hypophyseal artery- internal carotid and hypophyseal portal system
rathkes cysts causing what
chronic headaches
67-year-old female goes to the GP for routine blood tests. The abnormality below is noted in the thyroid function test (TFT).
TSH is 7.8 normal is 0.5-5.5
Free T4 14 normal is 9-18
What condition does she have?
Hyperthyroidism Secondary hypothyroidism Subclinical hypothyroidism Hashimoto’s thyroiditis Graves’ disease
subclinical hypothyroidism
Tsh is higher than usual but T4 normal meaning patient has not gone to full blown hypo yet
thyroid what germ layer
thyroglossal bud from the endoderm
A 33-year-old woman presents with weight loss and excessive sweating. Her partner reports that she is ‘on edge’ all the time and during the consultation you notice a fine tremor. Her pulse rate is 96/min. A large, non-tender goitre is noted. Examination of her eyes is unremarkable with no evidence of exophthalmos. Her blood results are below. What is the most likely diagnosis?
TSH is less than 0.05 when normal is 0.5-5.5
T4 free is 26 normal is 9-18
anti-tsh is positive
Toxic multinodular goitre De Quervain’s thyroiditis Hashimoto’s thyroiditis Graves’ disease Iodine deficiency
graves
Can immediately rule out Hashimoto’s, De Quervain’s and Iodine deficiency as they all cause hypothyroidism
wight loss heat intolerance sweating oligomenohrha smooth painless goitre anxiety
Pretibial myxoedema is erythematous pitting oedema usually found around the tibia above the malleoli
treatment of graves
propanolol then carbimazole
hasimoto treatment and symptoms
weight gain cold intolerance dry skin non pitting oedema hair loss cosntipation menorrhagia brief thryotix period
levothyroxine
de quervains thyroiditis
symtpoms
treated with nsaids
mixed
painful goitre
raised ESR
iodine uptake is global reduced on scintigraphy
iodine deficiency cause hypothyroidism
symtpoms
same as hashimoto
dietary iodine replacement
60-year-old woman has presented to her GP with fatigue and constipation. She has a history of hypertension and depression and normally takes amlodipine, venlafaxine and over-the-counter vitamin D supplements. She has a 30-pack-year smoking history. Blood test results show the following: calcium high phosphate low sodium and potassium normal urea and creatinine normal PTH normal VIt D normal
What is causing her hypercalcaemia? Drug-induced Lung cancer Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism
primary hyperparathyroidism
PTH normal but calcium up and phosphate low
secondary is excess PTH due to low calcium
not tertiary as due to high PTH and enlarged glands and kidney derangement show in urea and elctrylotyes
embryology of parathryoid glands
Embryology:
Superior glands derived from 4th pharyngeal arch
Inferior glands derived from 3rd pharyngeal arch
embryology of the pancreas
ventral and dorsal pancreatic buds of the foregut
arterial supply of pancreas
splenic artery to body and to head is sup and inf pancreaticodudoednal arteries
venis is hepatic portal vein to body and splenic vein
All Autonomic Parasympathetic: CN X Induce secretion from acinar cells and Islets of Langerhans Sympathetic: Splanchnic nerves Limit exocrine secretion
A 47-year-old-female presents to her normal diabetic outpatient appointment as part of her regular check up. She is a type two diabetic with a body mass index of 24kg/m². She is currently on full dose metformin monotherapy. Her HbA1c is 59mmol/mol. She reports that she is compliant with her medications. After discussion the patient feels there is not much more she can do with lifestyle modification or diet and is willing to add extra therapeutics to her management as needed. Which of the following would be the most appropriate management options? Sitagliptin Gliclazide Pioglitazone Continue metformin only Insulin
Gliclazide is the preferred option when there is no concern about weight gain
If there was concern, sitagliptin (DPP-4 inhibitor) would be used as it does not cause weight gain
Insulin is not used until very far down the treatment pathway
56 year-old gentleman has a known pituitary adenoma causing excessive secretion of ACTH. Which part of his adrenal gland will be excessively stimulated? Zona glomerulosa Zona fasciculata Zona reticularis Adrenal medulla
cortisol release from the bona fasciculatata
the adrenal cortex comes from the mesoderm but where does the medulla come from
neural crest from the ectoderm
three layers GFR
Salt, sugar, sex – the deeper you go the sweeter it gets
Mineralocorticoids – aldosterone, production stimulated by angiotensin 2 as part of the RAAS
Glucocorticoids – cortisol
Androgens – dehydroepiandrosterone (DHEA) which is the precursor to testosterone (reticularis does synthesise a nominal amount of the others as well)
HPA axis
CRH - ACTH - glucocorticoids and catecholamines
You review a 52-year-old man who is being investigated for weight gain (particularly around his face), impotence and hypertension. On examination you record a blood pressure of 180/110 mmHg and notice purple striae around his abdomen. He also has some difficulty getting up from a chair and you observe generalised decreased muscle strength. What is the most likely diagnosis? Cushing’s syndrome Addison’s disease Conn’s syndrome Type 2 diabetes Depression
Cushing syndrome
striae of skin - moon face, obesity , weight Gain
easy brusing and diabetes
Addison’s is autoimmune normal
vitiligo , anorexia and weakness and hyper pigmentation in palms as excessive acth produces
bloods show low sodium and low glucose but high potassium
hydrocortisone and fludrocortisone to replace he aldosterone
criisis is when hypovolaemic , hyponatraemic and hyperkalaemic
what nerve lies infront of the parotid gland
facial nerve
A 75-year-old man presented with a 2-month history of dysphagia and regurgitation of undigested food. He also complains of halitosis and a chronic cough. Examination shows a small neck swelling which gurgles on palpation. Barium studies show a diverticulum or pouch forming at the junction of the pharynx and the oesophagus.
Based on the likely diagnosis, this diverticulum ( hidden canal or tube) commonly occurs between which of the following muscles?
Thyropharyngeus and cricopharyngeus muscles
what artery supplies the prostate gland
he arterial supply to the prostate gland is from the inferior vesical artery, it is a branch of the prostatovesical artery. The prostatovesical artery usually arises from the internal pudendal and inferior gluteal arterial branches of the internal iliac artery.
