Far Eastern University
Nicanor Reyes Medical Foundation
Gross HSB B
Pituitary, Pineal, Thyroid, Parathyroid Glands
Dr. Capulong (Nov. 3, 2014)
Endocrine System
consists of specialized structures that secrete hormones,
including:
o
discrete ductless endocrine glands
o
isolated and clustered cells of the gut and blood vessel
walls
o
specialized nerve endings
its influence is broadly distributed like the nervous system
hormones
o
organic molecules
o
carried by circulatory system to distant effector cells in
all parts of the body
o
influence metabolism and other processes (e.g.
menstrual cycle, pregnancy, parturition)
two most important
endocrine glands
o
pituitary gland
o
thyroid gland
mostly located in head
and neck area
o
pituitary gland
o
pineal gland
o
thyroid gland
o
parathyroid gland
glands are well
distributed
o
head, neck, torso,
abdominal and
even genital areas
Pituitary gland
also called the hypophysis cerebri
referred as the master endocrine gland due to its influence
on many other endocrine glands
vital to life
small, oval structure; 1 cm in size
x-ray: non-illuminating gland, however the shadow of the
sphenoid sinus and hypophysial fossa can be seen
attached to the undersurface of the brain by infundibulum
well protected due to its location
location:
o middle cranial fossa
o sella turcica (L. Turkish saddle)
bony formation on the upper surface of the
sphenoids body
composed of three parts:
tuberculum sellae (horn of saddle)
hypophysial fossa (pituitary fossa)
o
median seat of depression (seat of saddle)
o
accommodates pituitary gland
dorsum sellae (back of saddle)
parts:
anterior lobe or adenohypophysis
glandular in nature; synthesizes & secretes hormones
three parts:
pars distalis or pars anterior
o
largest
pars tuberalis
o
extends up along the anterior and lateral
surfaces of the pituitary stalk/infundibulum
o
mistaken as part of infundibulum
pars intermedia
o
bet. anterior & posterior pituitary lobes
o posterior lobe or neurohypophysis
neural in nature; stores & secretes hormones
direct communication to the base of the brain via the
infundibulum or the hypothalamo-hypophyseal tract
o
relations
o anterior:
sphenoid sinus
o posterior:
dorsum sellae
basilar artery
pons
o superior:
diaphragma sellae
smallest dural infolding
suspended bet. clinoid processes
partial roof over the hypophysial fossa in sphenoid
has aperture for passage of infundibulum and
hypophysial veins
separates anterior lobe from optic chiasma
optic chiasma
o inferior:
body of sphenoid and sphenoid air sinuses
o
laterally:
cavernous sinus and its contents (refer to plate below)
impt. structures: ICA, abducent nerve
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you sort of start thinking anythings possible if youve got enough nerve Ginny Weasley
Alyssa Willis L. Ng, 1A, A.Y. 2014-2015
blood supply (check plate 141, Netter)
anterior pituitary lobe has dual blood supply
superior hypophyseal artery
comes from internal carotid arteries
hypophyseal portal system
formed by a series of capillary network
releasing and inhibiting hormones pass through
here (hypothalamus pituitary)
o
posterior pituitary lobe
inferior hypophyseal artery
comes from internal carotid arteries
drainage
o
intercavernous sinuses (Snell, p. 654)
o
cavernous sinus (lec)
one of the larger draining sinuses in the cranial cavity
function
o
influences activities of many other endocrine glands
o
it is itself controlled by the hypothalamus
o
activities of the hypothalamus are modified by
information received along numerous nervous afferent
pathways from various parts of the CNS
plasma levels of circulating electrolytes and
hormoness
abnormalities
o
signs and symptoms
visual defects due to close proximity to the optic
chiasma
thrombosis due to impedance or decrease of blood
flow in cavernous sinus
increase in intracranial pressure due to pressure of the
pituitary gland to the cavernous sinus
hormones
o
anterior pituitary lobe
synthesizes and secretes its own hormones
o
Hormone
Abbrev.
Target
organs
Function
Growth
Hormone
Prolactin
GH
Bones and
muscles
Mammary
glands
Devt of bones
and muscles
Stimulate and
maintain milk
production
Folliclestimulating
hormone
FSH
Testes or
ovaries
Luteinizing
Hormone
LH
Testes or
ovaries
Thyrotropic
Hormone
TSH
Thyroid
Follicular
development
in ovaries;
Sperm
development
in testes
Triggers
ovulation;
Stimulates
testosterone
production
Influence
growth and
activity of the
thyroid gland
Adrenocorticotropic
Hormone
ACTH
PRL
Adrenal
cortex
Increase
secretion of
cortisol;
Increase skin
pigmentation
Notes
Reproductive
hormones;
Stimulated by
latching
Reproductive
hormones;
Very evident
during puberty
General
metabolic
hormone;
governed by (-)
feedback
Very evident
during
pregnancy
(dark coloured
necks and
armpits)
clinical correlation
Gigantism [growth hormone]
o
excessive growth hormonal production
before closure of epiphyseal plates
o
manifestations:
symmetrical/proportional enlargement
extremely tall
Acromegaly [growth hormone]
o
excessive growth hormonal production after
closure of epiphyseal plates
o
manifestations:
asymmetrical/disproportional
enlargement
abnormally large hands and feet
large embossed forehead
Cushings syndrome [ACTH]
o
suprarenal cortical hyperplasia most
common cause
o
adenoma or carcinoma of the cortex if
syndrome occurs in later life
o
manifestations:
moon-shaped or puffing face
truncal obesity
abnormal hairiness (hirsutism)
hypertension
edema-like features
humpback features
Simmonds disease (Panhypopituitarism)
o
excessive growth of chromophobes
microscopically, the pituitary gland has:
acidophils
basophils
chromophobes
o
decrease or absent hormonal production
o
all anterior pituitary hormones are affected
o
manifestations:
hypothyroidism
hypoadrenocorticalism
hypogonadism
dwarfism
o
treatment: supplement exogenous hormones
Pituitary gland enlargement/Pituitary tumor
o
manifestations: same as abnormalities
o
treatment: removal of pituitary gland done
by transsphenoidal surgery via the nasal
cavity
o
before: big incision/craniotomy elevate the
brain and gain access to base of the brain
o
posterior pituitary lobe
acts as storage/reservoir or extension of
hypothalamus
Hormone
Abbrev.
Oxytocin
Anti-Diuretic
Hormone/
Vasopressin
ADH
Target
organs
Function
Uterine
muscles;
Mammary
glands
Kidney
tubules
Stimulates contraction of uterus
during labor (augments labor);
Causes milk ejection during
latching
Can inhibit urine production;
In large amounts, can cause
vasoconstriction increased
blood pressure
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you sort of start thinking anythings possible if youve got enough nerve Ginny Weasley
Alyssa Willis L. Ng, 1A, A.Y. 2014-2015
clinical correlation
Oxytocin
o
during labour, commercially prepared
oxytocin may be given intravenously
o
naturally, it can also be increased through
nipple stimulation since during pregnancy,
there is heightened hormonal release
o
sex during pregnancy is allowed; however,
dont stimulate the nipple to avoid premature
uterine contraction
Pineal Gland
parts:
right lobe
pear shaped
apex: upward, as far as oblique line on lamina of
thyroid cartilage
base: lies below (level of fourth or fifth tracheal ring)
o
left lobe
characteristics same as right lobe
o
isthmus
narrow
connects right and left lobes over the trachea
extends across the midline in front of the second, third,
and fourth tracheal rings
o
pyramidal lobe
often present; 50% of individuals
projects upward from isthmus, usually to the left
usually connected to the hyoid bone by a fibrous or
muscular band
if muscular, it is called levator glandulae
thyroideae
o
opposite side of the pituitary gland
small cone-shaped body
consists of pinealocytes, supported by glial cells
location:
o
posterior end of the roof of the third ventricle of the brain
innervations:
o
postganglionic sympathethic nerve fibers
has a rich blood supply
function:
o
inhibitory effect on other endocrine glands
pituitary gland
pancreatic islets of Langerhans of the pancreas
thyroid gland
parathyroid gland
adrenal glands
gonads
o
before: thought to only have an effect in circadian
rhythm
pineal secretions
o
reach target organs via:
blood stream
cerebrospinal fluid
o
actions:
mainly inhibitory
directly inhibit production of hormones
indirectly inhibit secretion of releasing factors by
the hypothalamus
very evident during early childhood to teen years
o
CT scan or MRI: can see the glands outline
degenerates during adulthood (20s onwards)
o
CT scan or MRI: cannot see any trace of pineal gland,
except of calcifications on the area of the pineal gland
Thyroid Gland
vascular organ
usually described as a butterfly shape (lobes wings,
isthmus body)
bodys largest endocrine gland
surrounded by a sheath
o
derived from pretracheal layer of deep fascia
o
attaches the gland to the larynx and trachea
location:
o
deep to the sternothyroid and sternohyoid muscles
o
located anteriorly in the neck at the level of C5-T1
vertebrae
relations:
lobes
anterolaterally
sternothyroid
superior belly of omohyoid
sternohyoid
anterior border of sternocleidomastoid
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you sort of start thinking anythings possible if youve got enough nerve Ginny Weasley
Alyssa Willis L. Ng, 1A, A.Y. 2014-2015
posterolaterally
carotid sheath with:
o
common carotid artery
o
internal jugular vein
o
vagus nerve
medially
larynx
trachea
pharynx
esophagus
associated with the abovementioned structures
are:
o
cricothyroid muscle and its nerve supply
o
external laryngeal nerve assoc with superior
pole of the thyroid
o
recurrent laryngeal nerve assoc w/
paraverterbral, posterior part of the thyroid
*posterior border of each lobe is related posteriorly to the superior
and inferior parathyroid glands and anastomosis bet. superior and
inferior thyroid arteries
o
isthmus
anteriorly
sternothyroids
sternohyoids
anterior jugular veins
fascia
skin
posteriorly
second, third, and fourth rings of the trachea
**superior thyroid arteries branches anastomose along isthmus
upper border
functions:
affects all areas of the body except itself, spleen, testes,
and uterus
o
produces thyroid hormone
controls rate of metabolic activity of most cells in the
body
triiodothyronine (T3)
conversion of T4 at target tissues
active form of thyroid hormone
thyroxine (T4)
secreted by thyroid follicles
storage form of thyroid hormone
o
produces calcitonin or thyrocalcitonin
produced by C (parafollicular) cells
controls calcium metabolism
lowers the level of blood calcium by causing calcium
deposition on bone
antagonistic to parathyroid hormone
affected by menopause (decrease activity; promote
osteoporosis)
o
clinical correlation:
hypothyroidism
decrease in thyroid hormone concentration
causes cretinism (esp. if patient is child or pregnant
woman can be shared to the child)
signs and symptoms:
increase in weight
tendency to be sleepy
o
hyperthyroidism
increase in thyroid hormone concentration
signs and symptoms:
absence in weight gain
tremors and palpitations
causes Graves Disease
development:
o
thyroid starts at the base of the tongue
o
subsequently go down to the anterior neck area
o
has communication in the form of the foramen cecum
sometimes it does not close, even during adult years
if patent, can have formation of thyroglossal duct cyst
this is due to the constant filling up of saliva and
food particles through time
manifested as an anterior neck mass
o
to check if it is TDC:
when patient swallows, thyroid gland moves up and
down, because it is attached to tracheal rings
when patient sticks the tongue out and in, thyroglossal
duct cyst will move up and down because
communication is in the base of the tongue
blood supply:
o
superior thyroid artery*
first branch of external carotid artery
descends to the superior pole of each lobe
pierce the pretracheal layer of deep cervical fascia
divide into anterior and posterior branches
supply mainly anterosuperior aspect of the gland
accompanied by external laryngeal nerve
Page 4 of 6
you sort of start thinking anythings possible if youve got enough nerve Ginny Weasley
Alyssa Willis L. Ng, 1A, A.Y. 2014-2015
inferior thyroid artery*
largest branch of thyrocervical trunk from the
subclavian arteries
ascends behind the gland to the level of the cricoids
cartilage
turns medially and downward to reach posterior
border of the gland
divide into several branches that pierce pretracheal
layer of the deep cervical fascia
supply posteroinferior aspect including inferior poles of
the gland
recurrent laryngeal nerve crosses either in front of or
behind the artery or pass between its branches
nerve supply
nerves
superior cervical sympathetic ganglia
middle cervical sympathetic ganglia
inferior cervical sympathetic ganglia
o
nerves reach the gland through
cardiac plexuses
superior thyroid peri-arterial plexuses
inferior thyroid peri-arterial plexuses
o
vasomotor, not secremotor
o
endocrine secretion from thyroid gland is hormonally
regulated by pituitary gland
o
Parathyroid Gland
*right and left superior and inferior thyroid arteries anastomose
profusely over the surface of the gland to ensure supply and
provide potential collateral circulation bet. subclavian and
external carotid arteries
sometimes, thyroidea ima (12% of people [lec], ~10%
[Moore])
branch of the brachiocephalic artery or aortic arch
may also arise from the right common carotid,
subclavian, or internal thoracic arteries (Moore, p.1018)
ascends in front of trachea to the isthmus, where it
divides
blood drainage:
o
superior thyroid vein** internal jugular vein
accompany the superior thyroid arteries
drain superior poles of the thyroid gland
o
middle thyroid vein** internal jugular vein
do not accompany but run parallel courses with
inferior thyroid arteries
drain middle of the lobes
in doing thyroidectomy, one of the very important
steps is to ligate and cut it to prevent bleeding
o
inferior thyroid vein** brachiocephalic vein
usually independent
drain inferior poles
veins from two sides anastomose with one another as
they descend in front of the trachea
o
**three pairs of thyroid veins usually form a thyroid plexus of veins
lymph drainage
drains mainly laterally into the deep cervical lymph
nodes (Snell, p. 658)
o
a few lymph vessels descend to the paratracheal nodes
o
lymphatic vessels run in interlobular connective tissue,
usually near arteries and communicate with network of
lymphatic vessels (Moore, p. 1020)
vessels pass initially to prelaryngeal, pretracheal, and
paratracheal lymph nodes
prelaryngeal superior deep cervical lymph
nodes
pretracheal and paratracheal inferior deep
cervical lymph nodes
lymphatic vessels located along superior thyroid veins
pass directly to inferior deep cervical lymph nodes
some drain into brachiocephalic lymph nodes or the
thoracic duct
o
ovoid bodies
6 mm long greatest diameter
four in number
o
~5% of people have more
o
some have only two glands
location:
o
closely related to posterior border of the thyroid gland
o
lies within thyroid glands fascial capsule
o
two superior parathyroid glands
more constant in position
lie at the level of the midline of the posterior border of
the thyroid gland
usually lie slightly >1 cm superior to the pt. of entry of
the inferior thyroid arteries into the thyroid gland
usually at the level of the inferior border of the cricoid
cartilage
o
two inferior parathyroid glands
usually lie close to inferior poles of the thyroid gland
usually lie slightly >1 cm inferior to the arterial entry pt.
may lie:
within fascial sheath
embedded in the thyroid substance
outside the fascial sheath
sometimes:
found some distance caudal to the thyroid gland
in association with inferior thyroid veins
in superior mediastinum in the thorax (1-5% of
people)
function:
o
secrete parathyroid hormone
produced by chief cells
stimulates osteoclastic activity in bones
mobilizes bone calcium
increases calcium levels in blood
stimulates absorption of dietary calcium from small
intestine
stimulates reabsorbtion of calcium in proximal
convoluted tubules of the kidney
strongly diminishes reabsorption of phosphate in PCT
of kidney
o
secretion is controlled by calcium levels in the blood
o
low levels of calcium can cause muscle cramps or
tetany
Page 5 of 6
you sort of start thinking anythings possible if youve got enough nerve Ginny Weasley
Alyssa Willis L. Ng, 1A, A.Y. 2014-2015
blood supply:
superior thyroid arteries
inferior thyroid arteries
blood drainage
o
superior thyroid veins
o
middle thyroid veins
o
inferior thyroid veins
lymph drainage:
o
deep cervical lymph nodes
o
paratracheal lymph nodes
nerve supply:
o
superior cervical sympathetic ganglia
o
middle cervical sympathetic ganglia
clinical correlation
o
thyroidectomy
may inadvertently remove parathyroids because they
are hard to identify (look like fat tissues in normal
persons)
o
extracapsular thyroidectomy
to leave behind the posterior capsule of the thyroid
ensures that parathyroids are left behind
o
if removed:
can cause hypocalcemia
lifelong problem
signs and symptoms:
Chvostek sign
o
tapping cheek causes uncontrollable facial
movements
carpopedal spasm
o
fingers and toes are rigid
to correct:
implant parathyroids in a site with very good
blood supply
create a subcutaneous pocket for parathyroids
o
o
Quotes
Of course, there are instances wherein that [latching] is not
enough to stimulate milk production. You can either use the breast
pump or thats where the husband comes in. Di ko sinabing maglatch yung tatay. Just to stimulate the nipple.
If you want to have a sexual act, please do not touch the nipple.
Please do not touch the breast. Be creative.
Page 6 of 6
you sort of start thinking anythings possible if youve got enough nerve Ginny Weasley
Alyssa Willis L. Ng, 1A, A.Y. 2014-2015