1. Endocrine

2. - Pituitary gland- anterior & posterior
- anterior (adenohypophysis), posterior
(neurohypophysis)
- Anterior produce hormone and secrete into systemic
circ. It secretes follicular stimulating & luteinising
(gonadotropin), growth (somatotropins), prolactin,
thyroid stimulating (tyrotropin), adrenocorticotropic
(corticotropin)
- Posterior din produce. It release. Hypothalamus
produce oxytocin and vassopressin that secreted from
nerve axon into capillary bed, store in cells and
released by posterior pit gland into circ.

3. - Vasopressin (antidiuretic hormone) act on V2
R of distal tubules to reabsorp water, thus incr
total body water & decr urine vol
{if def of antidiuretic hormone, the v2 fail to
reabsorp water thus caue polyuria subsequently
polydipsia}
- Oxytocin cause contraction of uterine muscle
(labour) & initiate mechanism of breastfeeding

4. -hypopituitarism => low trophic hormone
(hormone from pituitary gland) > low target
hormone > subphysiological stimulate of
pituitary hormone (however it is suboptimal,
inappropriate or absent) > low target hormone
& normal or low trophic hormone

5. Hypopituitarism
• Reduced secretion of ant pituitary hormone, follow the seq growth hormone>
gonadotrophins (follicular-stimulating, luteinising hormone)> prolactin> thyroid
hormone> adrenocorticotrophic hormone, antidiuretic hormone GGPTAA
Causes
(according etiology)********
-tumour (pituitary tumour, craniopharyngioma)
-trauma
-iatrogenic – irridation, surgery
-infection –encephalitis
-infarction – seehan’s syndrome
(according anatomy)
-hypothalamus: Kallman’s syndrome, tumour, infection, infarction, inflammation
-pituitary stalk: mass lesion (craniopharyngioma), meningioma, trauma, surgery,
carotid artery aneurysm
- pituitary: infiltration (haemochromatosis, metastases, amyloid), tumour,
irridiation, inflammation, autoimmune, ischaemia (Sheehan’s syndromw, pituitary
apoplexy)

6. Signs & symptoms
1. GROWTH HORMONE
Sx:
-Hypoglycaemia (dizzy, hunger, weakness, trembling, numbness)
-dry wrinkly skin
-reduced balance strength exercise ability wellbeing
-osteoporosis
Signs:
-short stature
-central obesity
2. GONADOTROPHIN
Sx:
-Impotence/ reduced libido
-Irregular menses
-Infertility/ dyspareunia/ erectile dysfx
-Osteoporosis
Signs
-Hypogonadism- sparse axillary, pubic and facial hair
-Hypogonadism- Small breast, clitoris( female), small penis & testes (male)
-High- pitched voice
-Thin skin

7. 3. ADRENOCORTICOTROPHIC HORMONE
Sx
Non specific-nausea, fatigue
Hypoglycaemia
Signs
Pallor (skin, areola)
4. THYROID HORMONE
Sx
-Cold intolerance
-Fatigue
-Constipation
Signs
-bradycardia
-hypothermia
-slow relaxation of knee jerk

8. 5. PROLACTIN
Sx
Failure of lactation
6. ANTIDIURETIC HORMONE
Sx
Polyuria, polydipsia

9. Ix
1. Basal test
-follicular stimulating, luteinising hormone, testosterone,
estradiol
-insulin-liked growth factor
-prolactin
-thyroid function test-thyroid stimulating hormone, free t4
-cortisol
-U&E (Na+ decr)
-Hb (normochromic normocytic)

10. 2. Dynamic test
-short Synacthen test
-insulin tolerance test
-arginine + growth hormone releasing test
- Glucagon stimulation test (alternative for
insulin tolerance test if failed)

11. Thyroid gland enlargement
• Hyperthyroidism
– Graves disease
– Multinodular goiter
– Malignancy
• Hypothyroidm
– Iodine deficiency (esp in endemic area)
– Hashimoto’s thyroiditis
• Others
– Familial goiter

12. Hypothyroidism
• Causes
– Destruction
– Drugs
– Enzyme deficiency - dyshormonogenesis
– Autoimmune T
– H

13. • History taking
– Causes, symptoms, diagnosed (onser sx, test done,
medication, complication), family history, other
associated autoimmune disease
– Cold intolerance, lethargy, weight gain
– 手cold intolerance, dry scaly skin, Carpal tunnel syndrome
– numbness, pain, tingling (myxoedematous infiltration
causing compression on the median nerve), Muscle
weakness
– 头Alopecia, coarse brittle hair, lethargy, impaired memory
and cognition
– 脸Facial changes: loss of lateral 1/3 of eyebrow, periorbital
puffiness, hoarseness of voice
– GI- constipation, decr apetite, weight gain
– Sexual – menorrhagia

14. • PE (refer pg 55)
• Q & A
• Neurological manifestation and why
– Carpal tunnel synd (infiltration of myoedematous causing compression of median n)
– Myopathy (segmental demyelination in peripheral nerve> decr nerve conduction
velocity> polyneuropathy> weakness)
– Slow relaxation of ankle knee jerk
– Pseudodementia (impair hippocampal neurogenesis, maturation and differentiation in
development of brain> memory and cognition impairment)
– Cerebellar syndrome (antithyroid Ab mediated immune response> cerebellar
degeneration)
– Myoedema coma (ultimate hypothyroidism state before death may preceded by
surgery(thyroidectomy/radioiodine/pit surgery), infection, MI, stroke, trauma)
• Cvs manifestation and why
• Causes of aneamia
• Autoimmune disease associated
– DM
– Pernicious anaemia
– Rheumatoid arthritis
– Myasthenia gravis
– Hypoparathyroidism
– Addison’s disease