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

Page 1 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 (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
Page 2 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

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
Page 3 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

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