This document provides information on various endocrine-related topics including glucose tolerance testing, thyroid function testing, clinical examination of thyroid swellings, radiology of the pituitary, thyroid, and adrenal glands, and anti-thyroid drugs. It includes definitions, test types, results and interpretations, descriptions of clinical findings, imaging views and structures seen, and indications and side effects of drugs. The document aims to educate on evaluating and managing endocrine-related conditions through laboratory and imaging tests and pharmacological treatment.

1. Skill Lab
(Hormonal panel with different clinical problem & imaging)
(Biochemistry, Medicine, Radiology, Pharmacology)
By : Osama Al-Zahrani
@OSAMA_Z96

2. Biochemistry
(Glucose tolerance test
and Lab assessment of thyroid function)
Dr. Atif
Written By : Osama Al-Zahrani
@OSAMA_Z96

3. Glucose Tolerance Test (GTT)
• Definition :
Test to assess the ability of the body to utilize glucose.
• Types :
1- Oral glucose tolerance test (Standard).
2- Intravenous glucose tolerance test.
• Uses :
1- Prediabitic patient.
2- Gestational diabetes.
3- Diagnosis of abnormalities in the growth hormones production.

4. Glucose Tolerance Test (GTT)
(Result & Interpretation)
• Result :
• Interpretation :
Renal glycosuria.
This patient has renal problem.
• Result :
• Interpretation :
Normal blood glucose.
This patient isn’t diabetic.

5. Glucose Tolerance Test (GTT)
(Result & Interpretation)
• Result :
• Interpretation :
High blood glucose.
This patient has severe diabetes.
• Result :
• Interpretation :
Prediabetes.
This patient has mild diabetes.

6. Glucose Tolerance Test (GTT)
(Result & Interpretation)
• Result :
• Interpretation :
Constant blood glucose level.
This patient has reactive hypoglycemia.
• Result :
• Interpretation :
Sharp rise in blood glucose within 30m.
This patient has Lag storage disease.6

7. Lab assessment of Thyroid function
• Lab test used to assess thyroid function :
1- Serum TSH concentration.
2- Serum total T4 concentration.
3- Serum total T3 concentration.
• Technique :
By Enzyme linked immune sorbent assay (ELISA).
• Result & Interpretation :
AssessmentT4T3TSH
Primary HyperthyroidismHighHighLow
Secondary HyperthyroidismHighHighHigh
Primary HypothyroidismLowLowHigh
Secondary HypothyroidismLowLowLow

8. Medicine
(Clinical examination of thyroid goiter)
Dr. Ayman Elshikh
Written By : Osama Al-Zahrani
@OSAMA_Z96

10. • Diagnosis :
Diffuse goiter.
• Description :
Diffuse swelling at the anterior aspect of the neck with
smooth regular surface.
Physiological : Pregnancy & Puberty.
Clinical examination of Thyroid Swelling

11. • Diagnosis :
Solitary thyroid nodule.
• Description :
Single swelling at the lateral aspect
of the neck involving the left lobe of
the thyroid gland.
Clinical examination of Thyroid Swelling

12. • Diagnosis :
Solitary thyroid nodule.
• Description :
Single swelling at the midline aspect
of the neck (isthmus).
Clinical examination of Thyroid Swelling

13. • Diagnosis :
Multinodular goiter.
• Description :
Huge swelling at the anterior aspect of
the neck with irregular surface,
For example iodine deficiency.
Clinical examination of Thyroid Swelling

14. • Diagnosis :
Exophthalmos (Graves diseases).
• Description :
Protrusion of the eyeball with eyelid retraction and visible
upper part of the sclera, due to hyperthyroidism.
Clinical examination of Thyroid Swelling

15. • Diagnosis :
Malignant ulcerating goiter.
• Description :
Multinodular swelling at the anterior aspect of the neck
with ulceration and hyperpigmentation of the skin.
Clinical examination of Thyroid Swelling

16. Radiology
(Radiology of Pituitary, Thyroid, & Adrenal Glands)
Dr. Majed Shakhas
Written By : Osama Al-Zahrani
@OSAMA_Z96
‫مالحظة‬:‫األخطاء‬ ‫بعض‬ ‫تحتمل‬ ‫قد‬ ،‫الدكتور‬ ‫من‬ ‫مراجعتها‬ ‫تتم‬ ‫لم‬

17. • Radioactive iodine isotopes :
1- Iodine 131 : Therapeutic (T1/2 = 8 days)
2- Iodine 123 : Diagnostic (T1/2 = 13 hours)
• How to read Thyroid scan ?
(In the next slide !)
Thyroid scan

18. Thyroid uptake scans

19. • Type of imaging :
MRI scan of normal Pituitary gland.
• Orientation or View :
Sagittal view.
• Other structures seen :
1- Brain stem.
2- Spinal cord.
3- Nasal cavity.
4- Mouth cavity.
5- Blood vessels.
MRI scan of normal Pituitary gland (with contrast)
Visible blood vessels, due to the contrast
Pituitary gland

20. MRI scan of normal Pituitary gland (without contrast)
• Type of imaging :
MRI scan of normal Pituitary gland.
• Orientation or View :
Sagittal view.
• Other structures seen :
1- Brain stem.
2- Spinal cord.
3- Nasal cavity.
4- Mouth cavity.
Pituitary gland

21. • Type of imaging :
MRI scan of normal Pituitary gland.
• Orientation or View :
Sagittal view.
• Other structures seen :
1- Thalamus.
2- Midbrain.
3- Pons.
4- Medulla.
5- Sphenoid sinus.
MRI scan of normal Pituitary gland

22. MRI scan of normal Pituitary gland
• Type of imaging :
MRI scan of normal Pituitary gland.
• Orientation or View :
Coronal view.
• Structures seen :
1- Optic chiasm.
2- Pituitary gland.
3- Cavernous sinus.
4- Internal carotid artery.
5- Sphenoid sinus.
• Structure passing through the
cavernous sinus :
Internal carotid artery.

23. MRI scan of normal Pituitary gland
• Type of imaging :
MRI scan of normal Pituitary gland.
• Orientation or View :
Coronal view.
• Structures seen :
1- Optic chiasm.
2- Pituitary gland.
3- Cavernous sinus.
4- Internal carotid artery.
5- Sphenoid sinus.
• Structure passing through the
cavernous sinus :
Internal carotid artery.

24. CT scan of normal Adrenal gland
• Type of imaging :
CT scan of normal Adrenal gland.
• Orientation or View :
Axial view.
• Other structures seen :
1- Right crus of diaphragm.
2- Liver.
3- Kidneys.
4- Aorta.
5- Inferior vena cava.
* Hint :
The adrenal glands are not clearly visible in normal condition,
unless there is tumor.

25. CT scan of normal Adrenal gland
• Type of imaging :
CT scan of normal Adrenal gland.
• Orientation or View :
Coronal view.
• Other structures seen :
1- Right crus of diaphragm.
2- Liver.
3- Kidneys.
4- Aorta.
5- Inferior vena cava.
* Hint :
The adrenal glands are not clearly visible in
normal condition, unless there is tumor.

26. CT scan of Adrenal gland adenoma
• Type of imaging :
CT scan of Adrenal gland adenoma.
• Orientation or View :
Axial view.
• Diagnosis & Finding :
Enlargement of the adrenal gland due to the adenoma.
* Hint :
There are visible enlargement
of adrenal gland due to the tumor.

27. CT scan of Adrenal gland adenoma
• Type of imaging :
CT scan of Adrenal gland adenoma.
• Orientation or View :
Coronal view.
• Diagnosis & Finding :
Enlargement of the adrenal gland due to the adenoma.
* Hint :
There are visible enlargement
of adrenal gland due to the tumor.

28. Pharmacology
(Anti-thyroid drugs)
Dr. Salah Abdelhaque
Written By : Osama Al-Zahrani
@OSAMA_Z96
‫مالحظة‬:‫األخطاء‬ ‫بعض‬ ‫تحتمل‬ ‫قد‬ ،‫الدكتور‬ ‫من‬ ‫مراجعتها‬ ‫تتم‬ ‫لم‬

29. • Definition :
It is use of synthetic hormones in case the human body has no longer producing hormones.
• Examples :
1- Insulin replacement therapy.
2- Thyroxine replacement therapy.
3- Adrenaline replacement therapy.
4- Androgen replacement therapy.
Hormonal replacement therapy

30. Thyroid drugs
Liothyroxine (T3)Levothyroxine (T4)
Severe emergency hypothyroidism
Long-term management of
hypothyroidism other than
emergency
Indications
Pregnancy & lactationContraindications
Symptoms of hyperthyroidismSide effects

31. Anti-Thyroid drugs
PropylthiouracilCarbimazole
Interfere with the synthesis of thyroid hormonesMechanism of action
HyperthyroidismIndications
1- Sever hepatic impairment.
2- Pregnancy & Lactation.Contraindications
1- Hypothyroidism with over-treatment.
2- BM-suppression leading to neutropenia & Agranulocytosis.
3- Rash & pruritus (Treated with antihistamines).
Side effects

32. Anti-Thyroid drugs
Iodine {Radioactive Na-iodide (I131)}
Interfere with the synthesis of thyroid hormonesMechanism of action
1- Recurrence of hyperthyroidism after thyroidectomy.
2- Thyrotoxicosis.
3- Heart diseases.
Indications
1- Long-term treatment due to development of tolerance.
2- Pregnancy.Contraindications

33. • Propranolol & Nadolol
• Indications :
1- Thyrotoxic symptoms.
2- Adjunct to anti-thyroid drugs and iodine.
3- Neonatal thyrotoxicosis.
4- Supraventricular arrhythmias due to hyperthyroidism.
Anti-Thyroid drugs
33