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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.

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Presentation on theme: "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."— Presentation transcript:

1 Signs and Symptoms of Endocrine Disease

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

3 anterior boundary: posterior boundary: apex: roof: floor: Q3. Describe the borders of the anterior triangle of the neck. median line of neck 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. 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

5 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

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

7 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 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 Slow relaxing reflexes

8 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

9 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 tumour Headaches Visual 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).

10 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 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? 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)

12 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

13 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/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 4 3 Moon-shaped face, acne, telangiectasia (chest) Abdominal striae Buffalo hump Gynaecomastia

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