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BDS2 - endocrinology > pituitary and thyroid disease > Flashcards

pituitary and thyroid disease Flashcards

1
Q

what is endocrine disease

A
  • all to do with hormones = dysfunction of hormone secreting glands
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2
Q

what are hormones controlled by

A
  • negative feedback regulation = the more is secreted the the less is allowed
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3
Q

what can endocrine disease either be

A
  • a CONTROL failure (secondary cause) = gland can make hormone but not asked to by the system
  • a GLAND failure (primary cause) = gland can’t produce - system broken
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4
Q

how do hormones work

A
  • is widespread
  • can have multi system effect
  • work anywhere = where it has an effect is where the receptor is, good if you want to influence the whole organism functions
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5
Q

what is multiple endocrine neoplasia (MEN)

A
  • hormone derives from embryonic tissue

- people who are prone to get cancer in one gland are also prone to another gland but will be a different type of cancer

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6
Q

what are the types of MEN

A
  • MEN 1, MEN2a and MEN2b
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7
Q

what is MEN 1

A
  • parathyroid, pancreatic islets, pituitary (anterior)

- associated tumours = adrenal cortex, carcinoid, lipoma

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8
Q

what is MEN2a

A

parathyroid, medullary thyroid, pheochromocytoma

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9
Q

what is MEN2b

A
  • medullary thyroid, pheochromocytoma
  • mucosal neuromas = lump on nerve
  • marfanoid appearance
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10
Q

what does the pituitary do

A
  • control of many gland activities
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11
Q

where is the pituitary located

A
  • within the sellatursica in the brain
  • means it is difficult to see
    with an MRI you can see what is going on
  • called the network router for other hormones
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12
Q

what type of control does pituitary have

A
  • hypothalamic control = releases hormones

- TRH, GnRH, CRH

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13
Q

what does the anterior pituitary do

A
  • releases these hormones
  • TSH = thyroid stimulating hormone which control the thyroid gland activity
  • ACTH = adrenocorticotrophic hormone
  • GH = growth hormone
  • LH, FSH prolactin = these 3 aren’t as important to know right now
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14
Q

what does the posterior pituitary do

A
  • releases ADH = antidiuretic hormone, which controls body fluids, diabetes insidious causes if you don’t have this, it stops you peeing a lot
  • oxytocin
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15
Q

what is the pituitary controlled by

A
  • mixture of endocrine and neurogenic stimuli
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16
Q

what does the hypothalamus allow messenger hormone to do

A
  • allow them to pass to trigger hormone release
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17
Q

what happens if you get a tumour in hypothalamus gland

A
  • its in an enclosed bony space (sellatursica) which will then squash the other parts of the pituitary gland
  • don’t see the problem of the tumour but will notice the problem of producing the other hormones - there will be too little or too much
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18
Q

what are pituitary tumours

A
  • usually dysfunction from adenomas = if ends in -oma then normally benign but will get bigger and bigger and start to cause problems
  • will take up space where pituitary gland sits
  • sometimes makes hormones
  • can get functional and non-functional tumours
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19
Q

what are functional pituitary tumours

A
  • 2 main issues = produces excess ACTH which is not switch off by the normal feedback so get more cortisol and produce growth hormones
  • in people under 40 get production of prolactin and ACTH = Cushing’s syndrome
  • in people over 40 get production of growth hormone = causes acromegaly
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20
Q

what are non-functional pituitary tumours

A
  • space occupying

- in people over 60

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21
Q

what are the main effects of non functional pituitary tumours

A
  • visual field defects, other hormone deficiencies
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22
Q

how does non functional tumours affect vision

A
  • if you have this tumour squashing the test of the pituitary it will push out of the sellatursica and push into the brain at the point of the optic chiasma which which will effect vision particularly peripheral so have tunnel vision
  • will squash the optic chiasma which is important as crosses over of nerves here
  • nasal fields taken out in both eyes so only get lateral fields in both eyes
  • visual field vision is now part of every eye exam
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23
Q

what is trans sphenoidal surgery

A
  • metal instrument goes up the nose through the sphenoid into the sellatursica
  • can’t go through the skull as this would tear the whole pituitary away
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24
Q

what happens if there is excess growth hormone

A
  • then very apparent
  • giantism in children = will be very tall but everything will be in proportion
  • acromegaly in adults = all growth plates are shut so won’t grow anymore in these areas but any areas where there isn’t growth plates will keep growing (hands, feet, mandible, skull and teeth become spaced out)
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25
Q

what happens there is insufficient growth hormone

A
  • growth failure in children

- metabolic changes in adults = increased fat, reduced vitality

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26
Q

how do you assess growth hormone

A
  • measure IGF-1

- insulin like growth factor 1

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27
Q

what is acromegaly

A
  • benign pituitary tumour = MEN1 possibility, functional adenoma produces growth hormone and too little of others
  • be suspicious = insidious onset
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28
Q

when is the peak incidence of acromegaly

A
  • 30-50 years old when it starts and it may take 10 years for it to show so patients often show 40-50 years
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29
Q

what are the features of acromegaly

A
  • coarse features
  • enlarged supra-orbital ridges
  • broad nose, thickened lips and soft tissues
  • enlarged hands = carpal tunnel syndrome, finger numbness
  • type 2 diabetes = insulin resistance from increased growth hormone
  • cardiovascular disease
  • change lipid balance in blood
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30
Q

what cardiovascular disease can be a feature of acromegaly

A
  • heart will change size
  • muscle will stop working properly as its changed size
  • a lot of acromegaly patients die of CV issues
  • reduced lifespan
31
Q

what are some intra oral changes from acromegaly

A
  • enlarged tongue = soft tissue is bigger and thicker - tongue gets in the way more and catches on teeth
  • interdental spacing
  • ‘shrunk’ dentures = won’t fit anymore
  • reverse overbite
32
Q

what are some other features of acromegaly

A
  • visual field defects = can squash other cranial nerves
  • hyperprolactinaemia = prolactin can be another tumour instead of GH
  • hypopituitarism = not making enough other hormones
33
Q

what is excess thyroid hormone called

A
  • hyperthyroidism

- control system is still working but its been overridden with TSH so isn’t doing as good a job

34
Q

what can hyperthyroidism be cause by

A
  • thyroid gland not working fine = which is primary cause
  • secondary cause is rare
  • thyrotoxicosis without hyperthyroidism
35
Q

what is deficiency in thyroid hormone called

A
  • hypothyroidism
  • also called myxoedema
  • primary is common
  • secondary is less common
36
Q

what is Grave’s disease

A
  • 70-80% of hyperthyroidism cases

- autoantibodies stimulating the TSH receptor = unsure how, it makes antibodies that fit the TSH receptor that shouldn’t

37
Q

what can primary causes of hyperthyroidism

A
  • toxic multi-nodular goitre = makes more hormone so increases in size
  • toxic adenoma
38
Q

how common is a pituitary tumour

A
  • rare

- it is a secondary cause

39
Q

what are the effects of hyperthyroidism

A
  • increased metabolism as thyroid hormone does metabolism

- if have too much through hormone then metabolism too fast

40
Q

what are the symptoms of hyperthyroidism

A
  • hot and excess sweating, weight loss, diarrhoea
  • palpitations, muscle weakness
  • irritable, manic, anxious
  • can happen all the time or in short bursts
41
Q

how can you get diarrhoea from hyperthyroidism

A
  • as water is passing through much quicker than it should
42
Q

what are the signs of hyperthyroidism

A
  • warm moist skin = sweat as burning so much energy
  • tachycardia and atrial fibrillation = as so excitable
  • increased blood pressure and heart failure
  • tremor and hyperrelfexia
  • eyelid retraction and lid lag = eyelid should sit above iris and move with is but with lid lag it is slow and you can see the white above the iris when you shouldn’t
43
Q

how can you get diarrhoea from hyperthyroidism

A
  • as water is passing through much quicker than it should
44
Q

what are the signs of hyperthyroidism

A
  • warm moist skin = sweat as burning so much energy

- tachycardia and atrial fibrillation = as so excitable

45
Q

what is Grave’s disease often associated with

A
  • family history of autoimmune disease = volition, PA, type 1 diabetes mellitus, coeliac, myasthenia gratis
  • people with Grave’s are likely to have other autoimmune diseases too as it is genetically coded
46
Q

what is difficult goitre

A
  • thyroid sits at the bottom of the neck

- increasing the size of the thyroid gland is known as goitre = get big lump at bottom of neck

47
Q

what is Grave’s called

A
  • an organ specific autoimmune disease
  • pernicious anaemia - intrinsic factor cells in stomach
  • vitiligo = melanocytes in skin affected
48
Q

what is the pathological reason for Grave’s disease

A
  • gland overworking so increases in size
49
Q

what is Grave’s called

A
  • an organ specific autoimmune disease
  • pernicious anaemia - intrinsic factor cells in stomach
  • vitiligo = melanocytes in skin affected
50
Q

what else can Grave’s disease affect other than thyroid hormone

A
  • cause ophthalmopathy = scleral injection, proptosis, periorybital oedema, get red hot swollen fat cells which can push eyeballs forward out of sockets
    = only way to stop is by stopping immune repose with steroids
  • cause conjunctival oedema = chemosis
51
Q

what are the primary causes of hypothyroidism

A
  • autoimmune thyroiditis (Hashimoto’s) (90% of cases)
  • idiopathic atrophy = gland is eaten away and gets smaller
  • radio iodine treatment/thyroidectomy surgery
  • iodine deficiency
  • drugs = lithium, carbimazole
  • congenital = if don’t fix, then can get birth defects
52
Q

how can you go from hyperthyroidism to hypothyroidism

A

if remove too much thyroid during thyroidectomy

53
Q

what are the secondary causes of hypothyroidism

A
  • don’t make enough TSH

- hypothalamic/pituitary disease

54
Q

what is the effect of hypothyroidism

A
  • reduced metabolism
55
Q

what are the symptoms of hypothyroidism

A
  • tired
  • cold intolerance, weight gain, constipation
  • hoarse voice, goitre, puffed face and extremities
  • angina
  • ‘slow’ or poor memory
  • hair loss = common presenting case
56
Q

signs of hypothyroidism

A
  • dry coarse skin
  • bradycardia, hyperlipidaemia
  • psychiatric confusion
  • goitre
  • delayed reflexes
  • can get swelling in tissues cause by hypothyroidism
57
Q

who is more likely to get Hashimoto’s thyroiditis

A
  • middle aged and elderly women
58
Q

who do autoimmune disease affect most

A
  • effect women more than men
59
Q

what are the presenting features of Hashimoto’s thyroiditis

A
  • goitre

- hypothyroid features

60
Q

how do you investigate thyroid diseases

A
  • blood = look at TSH, T3 and T4 levels
  • imaging = ultrasound scan, radioisotope scans - look at gland uptake
  • tissue = fine needle biopsy/aspirate (FNB/FNA)
61
Q

what is idiopathic atrophy

A
  • increased incidence with age
  • 10 times more in females = so possible autoimmune
  • don’t know why it happens = lymphocyte infiltrate, associated with organ specific autoimmune disease
62
Q

how do you investigate thyroid diseases

A

-

63
Q

if you are hyperthyroid and ti is a pituitary cause then what will show in your blood

A
  • raised TSH

- raised T3

64
Q

if you are hyperthyroid and it is an adenoma or Grave’s cause then what will show in blood

A
  • low TSH
  • raised T3
  • pituitary doesn’t want to make more so there is low TSH but high T3 as another antibody making it
65
Q

if you are hypothyroid and it is a pituitary cause then what will your blood show

A
  • low TSH
  • low T4
  • the pituitary is not asking for it
66
Q

if you are hypothyroid and it is a gland failure cause then what will blood show

A
  • high TSH

- low T4

67
Q

what is thyroid enlargement - goitre

A
  • diffuse enlargement of the thyroid gland
  • often iodine deficient = mountainous areas of developing countries
  • diffuse
  • drug related?
68
Q

what is thyroid enlargement - solitary nodule enlargement

A
  • adenoma, carcinoma, cyst formation possible

- low cancer risk - suspicious in children or elderly

69
Q

what is the treatment for thyroid enlargement - goitre

A
  • diffuse enlargement of the thyroid gland
  • often iodine deficient = mountainous areas of developing countries
  • diffuse
  • drug related?
70
Q

what is the treatment for thyroid enlargement - solitary nodule enlargement

A

-

71
Q

how does thyroid cancer show

A
  • usually with a thyroid swelling
  • in young and elderly = 80% papillary or follicular when younger, undifferentiated in elderly
  • ‘cold’ nodules on radioisotope scans
  • often TSH sensitive = give T4 post surgery
72
Q

what is the prognosis of thyroid cancer

A
  • generally a good prognosis in the young

- 5-10% year mortality in papillary but 80% 10 year mortality in follicular

73
Q

what are the dental aspects to consider in relation to pituitary and thyroid disease

A
  • goitre detectable to the dentist
  • hyperthyroid = avoid use of sedatives if severe
  • treated patients are to be treated as normal = if they are on treatment then treat as normal

BDS2 - endocrinology (3 decks)

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