Signs and Symptoms of Endocrine Disease

Q1. Label 1-8 on the above diagram.

1st Tracheal Ring

Right Lobe of Thyroid

Isthmus of Thyroid

Laryngeal Prominence

Cricoid Cartilage5

3

8

6

Hyoid bone 1

Lamina of thyroid cartilage 2

Cricothyroid membrane4

7

2nd & 3rd Tracheal Rings

Q2. What is the anatomical location of the isthmus to the tracheal rings?

anterior boundary:

posterior boundary:

apex:

roof:

floor:

Q3. Describe the borders of the anterior triangle of the neck.

median line of neckanterior border of SCM

suprasternal notchsubcutaneous tissue containing platysma

formed by pharynx, larynx & thyroid gland

Q4. Name the 8 lymph node groups numbered in the picture.

Q5. What areas are drained by these groups.

• 1 submental

• 2 submandibular

• 3 cervical (superficial & deep)

• 4 supra-clavicular

• 5 posterior triangle

• 6 post. Auricular

• 7 ant. Auricular

• 8 occipital

• 1 Lower central lip, lower canine teeth and lower anterior part of oral cavity

• 2 Lateral end of lower lip whole upper, upper and lower premolars, upper canines, hard palate, forehead, cheek and anterior face

• 3 Cheek & lateral face around angle of jaw and superficial nodes of head & neck

• 4 Lung & breast

• 5 Occipital & sub-occipital region of scalp

• 6 Lateral scalp area

• 7 Cheek & lateral face around angle of the jaw

• 8 Occipital & sub-occipital region of head and neck

The patient below presents complaining of bulging eyes and you notice she is fidgeting and restless throughout the consultation.

Q8. What complications of the above eye sign would you examine for?

Q6. What would you expect to find on examination of her hands? Warm sweaty palms, fine tremor, tachycardia (+ AF), (thyroid acropachy, palmar erythema etc.)

Q7. What eye signs are visible from the picture? Exophthalmos, thyroid stare

Chemosis, scleral injection, corneal ulceration, visual field loss, optic atrophy, ophthalmoplegia

Q9. Below are a number of eye signs associated with thyroid disease. Name the signs and state the endocrine condition where they would be found.

1

23

5

4

6

Chemosis Proptosis / Exophthalmos

Lid retraction

Ophthalmoplegia

Proptosis

Lid retraction

Below is a picture of a patient complaining of fatigue, weight gain and a preference for hot weather (Picture A).

Q12. What response are you likely to have from the examination illustrated in picture B?

A BQ10. What facial features are present in this patient? Peaches & cream complexion, loss of outer 1/3 of eyebrows, neck swelling

Q11. Taking the history with the facial signs, what is the most likely diagnosis?

Hypothyroidism

Slow relaxing reflexes

Q13. What hormones are secreted by FSH, lH, ICSH, GH, prolactin i. the anterior pituitary?

ii. The posterior pituitary? Oxytocin, ADH

Q14. Which structure is involved in the secretion of hormones controlling pituitary secretion of hormones

Hypothalamus

PITUITARY DISEASE

Disease of the pituitary gland usually manifests as a tumour and thus may present in two ways

i. symptoms relating to the local effects of the tumourHeadachesVisual problems

ii. symptoms relating to the endocrine function of the pituitary / growth hormone/ ACTH/ prolactin

Diseases / disorders of the pituitary gland may result in single hormonal abnormalities or a combination of hormonal abnormalities.

A tumour / SOL (space occupying lesion) of the pituitary may result in panyhpopituitarism - decrease in production of all pituitary hormones.

Growth hormone (GH) is usually the first to be affected followed in turn by prolactin, gonadotrophins, thyroid stimulating hormone (TSH) and finally adrenecorticotrophic hormone (ACTH).

• Increased growth hormone• Most likely due to an eosinophilic pituitary adenoma

growth hormone liver somatomedins

other tissues

GROWTH

GROWTH HORMONE

GIGANTISM

GH prior to puberty & epiphyseal fusion

ACROMEGALYGH post epiphyseal fusion

growth of soft tissue & flat bone enlargement

What are the clinical features of ACROMEGALY related to these anatomical regions?

• HANDS• spade-like shape• sweaty, warm palms• thickened skin• Tinel’s sign

• ARMS & AXILLA• prox. Myopathy• skin tags• acanthosis nigricans

• FACE• large supra-orbital

ridge/bossing• thickened lips• visual field defects• enlarged tongue• splayed teeth• prognathism (protruding

jaw)

• NECK• enlarged thyroid

(diffuse/multinodular)• hoarse voice

• CHEST• coarse body hair• Gynaecomastia• examine for:

cardiomegaly, arrhythmias,

• CCF, hypertension• BACK• Kyphosis

• ABDOMEN• organ enlargement –

liver, kidney, spleen• testicular atrophy• check for glucose in

urine• LOWER LIMBS• osteoarthritic changes hips/knees• footdrop (nerve entrapment)

Q15. What obvious clinical features are you able to recognise in the following

patients?

1 2

3

Frontal bossing, thickened lips

Spade-like hands

Splayed teeth,

Prognathism,

Spade-like hands,

Large supra-orbital ridge

ADRENAL DISEASE

Cushing’s disease: adrenal production secondary to excess pituitary ACTH

Cushing’s syndrome: excess circulating steroid hormone from any other source

• GENERAL

truncal obesity

bruising

++ pigmentation ext. surfaces

buffalo hump

tender vertebral bodies

• FACE and NECK

moon-shaped facies

acne

hirsutism

telangiectasia

plethoric cheeks

supra-clavicular fat pads

Signs and symptoms• ABDOMEN

striae – reddish/purplepalpate for adrenal massesenlarged liver

• LEGSbruisingoedema

• URINALYSIS & BPtest urine for glucosecheck for hypertension

Q16. What facial features of Cushing’s syndrome are present in this patient? Moon-shaped face, hirsutism, acne, hyperpigmentation

Q17. What obvious clinical features of Cushing’s syndrome are shown in these

pictures?

12

43

Moon-shaped face, acne, telangiectasia (chest)

Abdominal striae

Buffalo hump

Gynaecomastia