Signs and Symptoms of Endocrine Disease

1. Signs and Symptoms of Endocrine Disease

2. Hyoid bone 1 Lamina of thyroid cartilage 2 3 Laryngeal Prominence Cricothyroid membrane 4 6 Cricoid Cartilage Right Lobe of Thyroid 5 7 1st Tracheal Ring Isthmus of Thyroid 8 Q1. Label 1-8 on the above diagram. Q2. What is the anatomical location of the isthmus to the tracheal rings? 2nd & 3rd Tracheal Rings

3. Q3. Describe the borders of the anterior triangle of the neck. median line of neck anterior boundary: posterior boundary: apex: roof: floor: anterior border of SCM suprasternal notch subcutaneous tissue containing platysma formed by pharynx, larynx & thyroid gland

4. Q4. Name the 8 lymph node groups numbered in the picture. 1submental 2 submandibular 3 cervical (superficial & deep) 4supra-clavicular 5posterior triangle 6post. Auricular 7 ant. Auricular 8 occipital Q5. What areas are drained by these groups. • 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

5. The patient below presents complaining of bulging eyes and you notice she is fidgeting and restless throughout the consultation. 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 Q8. What complications of the above eye sign would you examine for? Chemosis, scleral injection, corneal ulceration, visual field loss, optic atrophy, ophthalmoplegia

6. 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. 3 2 1 Lid retraction 6 Proptosis / Exophthalmos Chemosis 4 5 Proptosis Lid retraction Ophthalmoplegia

7. Below is a picture of a patient complaining of fatigue, weight gain and a preference for hot weather (Picture A). A B Q10. 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 Q12. What response are you likely to have from the examination illustrated in picture B? Slow relaxing reflexes

8. Q13. What hormones are secreted by i. the anterior pituitary? FSH, lH, ICSH, GH, prolactin ii. The posterior pituitary? Oxytocin, ADH Q14. Which structure is involved in the secretion of hormones controlling pituitary secretion of hormones Hypothalamus

9. PITUITARY DISEASEDisease of the pituitary gland usually manifests as a tumour and thus may present in two waysi. symptoms relating to the local effects of the tumour Headaches Visual problems ii. symptoms relating to the endocrine function of the pituitary / growth hormone/ ACTH/prolactinDiseases / 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).

10. GROWTH HORMONE • Increased growth hormone • Most likely due to an eosinophilic pituitary adenoma growth hormone liver somatomedins other tissues GROWTH GIGANTISM  GH prior to puberty & epiphyseal fusion • ACROMEGALY • GH post epiphyseal fusion  growth of soft tissue & flat bone enlargement

11. What are the clinical features of ACROMEGALY related to these anatomical regions? • NECK • enlarged thyroid (diffuse/multinodular) • hoarse voice • HANDS • spade-like shape • sweaty, warm palms • thickened skin • Tinel’s sign • CHEST • coarse body hair • Gynaecomastia • examine for: cardiomegaly, arrhythmias, • CCF, hypertension • BACK • Kyphosis • ARMS & AXILLA • prox. Myopathy • skin tags • acanthosisnigricans • FACE • large supra-orbital ridge/bossing • thickened lips • visual field defects • enlarged tongue • splayed teeth • prognathism (protruding jaw) • ABDOMEN • organ enlargement – liver, kidney, spleen • testicular atrophy • check for glucose in urine • LOWER LIMBS • osteoarthritic changes hips/knees • footdrop (nerve entrapment)

12. Q15. What obvious clinical features are you able to recognise in the following patients? Spade-like hands 2 1 Splayed teeth, Prognathism, Spade-like hands, Large supra-orbital ridge 3 Frontal bossing, thickened lips

13. 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 ADRENAL DISEASECushing’s disease:  adrenal production secondary to excess pituitary ACTH Cushing’s syndrome: excess circulating steroid hormone from any other source Signs and symptoms • ABDOMEN • striae – reddish/purple • palpate for adrenal masses • enlarged liver • LEGS • bruising • oedema • URINALYSIS & BP • test urine for glucose • check for hypertension

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

15. Q17. What obvious clinical features of Cushing’s syndrome are shown in these pictures? 1 2 Abdominal striae Moon-shaped face, acne, telangiectasia (chest) 4 3 Buffalo hump Gynaecomastia