Parathyroid and Adrenal Glands: Development, Anatomy, Physiology, and Surgery
Parathyroid and adrenal glands play crucial roles in the endocrine system. This content explores the development and anatomy of parathyroid glands, their physiology, function, and investigation methods. It also delves into the surgical aspects, management, risks, and complications associated with parathyroid surgery. Learn about the embryology related to these glands, the surgical anatomy, and physiology, including the variations in gland positions. The detailed histology of parathyroid glands is also discussed, covering the composition of stroma and secretory cells.
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Presentation Transcript
PARATHYROID AND PARATHYROID AND ADRENAL GLANDS ADRENAL GLANDS Dr. Zaeem dahla Consultant General & Laparoscopic Surgeon
Parathyroid glands Learning Objective A-To understand the development &anatomy of parathyroid. B-TO understand the physiology, function & investigation of PT. C-To describe management , risks & complications of parathyroid surgery.
EMBERIOLOGY EMBERIOLOGY THE foramen THE foramen caecum at the base of the tongue is a remnant of thyroglossal duct this hallow structure migrate caudally and pass in close continuity with, and some times through the developing hyoid cartilage. The PTGs The PTGs develop from the 3rid&4thpharyngeal pouch. The thymus The thymus gland also develop from 3rid pharyngeal pouch As it descend to superior mediastinum , in thorax it take with it the PTG which arise from 3rid pharyngeal pouch take the inferior site in regards to it upper pouch. THYROID GLAND THYROID GLAND ; usually arise from the 4th pharyngeal pouch.
Surgical anatomy & physiology The normal PTG weight up to 50mg with charterstic orange\brown colour . Most adult have 4 glands,2 superior,2 inferior , but may have more than 4 glands,. Superior PTG usually constant in its position , while the inferior PTG have non fixed position. Upper PTH glands found in a fat tissue above on the posterolateral border of the thyroid immediately above the point of entry of the inferior thyroid artery.
The lower pair of PTG , more variable in position , are usually found at the lower pole of thyroid ,but may be found anywhere along a line from this situation downwards to the upper pole of thymus . Approximately 5% of PTGs are found within the upper anterior mediastinum . each gland has small capsule and is supplied by a single leash of blood vessels , theses glands are usually lie outside thyroid gland capsule.
Histology; The stroma consists of rich sinusoidal capillary net work with islands of secretory cells , two type of cells . The chief cells or principle cells are small with vesicular nuclei and poorly staining cytoplasm. oxyphil cell are less numerous and larger , with granular cytoplasm and deeply staining .
FUNCTION. Chief cells give P.T.H also called parathormone, the hormone released directly into the blood.the circulating level of this hormone can be measured by radio- immuno-assay.it is sufficiently reliable to distinguish between high and low levels.
FUNCTION OF PARATHYROID HORMONE FUNCTION OF PARATHYROID HORMONE Stimulate osteoclast activity, thereby increase bone resorption by mobilizing calcium and phosphate. Increase the reabsorption of calcium by renal tubules; thus reducing urinary secretion of calcium Augment the absorption of calcium from the gut. Reduce renal tubular re absorption of phosphate , thus promoting phosphate urea.
Calcitonin hormone Calcitonin hormone Was once thought to be the second parathyroid hormone , but is now known to be secreted by thyroid from the parafolicular cells ( c cell) its action quite the opposite action of parathormone.
Disease of parathyroid glands Hypo Hyper parathyroidism parathyroidism
hypoparathyroidism Parathyroid titany is a rare complication of subtotal thyroidectomy (less than 1%) Symptoms usually appear on the 2ndor 3d post oprative day, and are temporary . Permanent hypoparathyroidism, most commonly encountered following radical thyroidectomy ,this require constant supervision and treatment . Titany in newborn may occur within the first few days of life in the child born of a mother with un diagnosed hypo parathyroidism.
Clinical feature The 1stsymptoms are tingling and numbness in the face ,fingers, toes. In extreme cases cramps in the hands and feet's are very painful ,the extended fingers are flexed metacarpi- phalangeal joints with thumb strongly adducted . This called ( capo pedal spasm)
Spasm of respiratory muscle. In infancy symptoms of titan may be mist taken for epilepsy , though there is no loss of consciousness. Latent titan maybe demonstrated by : # chvostek s sign # trousseau s sign
Treatment In acute cases the symptoms can be qiuckly and effectively relieved by slow iv injection 10-20 ml of 10% of calcium gluconate ,this can be repeated till the serum ca level has been established . Oral vitamen D (increase ca absorption from GIT) and calcium lactate . Initial dose 400000 units of calciferol may be followed by 100000 units ,daily till serum ca level become normal.
Hyperparathyroidism Symptoms of over activity of the para thyroid gland may result from single or multiple adenoma (85%) Hyperplasia of all 4 glands 13% Carcinoma more than 1% . That whole glands enlarged, darker in color. Firmer and more vascular .
Clinical feature Hyperparathyrodism rarely found in 1st decade of life's. More common in women than men . Most commonly between the age 20 -60 y The disease has been described as : bones ,stones , abdominal groans and psychic moans
Parathormone increase Psychic moans Bone disease Renal stone Abdominal groans Jonits, bones pain renal stone nausea ,vomiting, tiredness density of bones nephroclcinosis anorexia personality change Otitis fibrosa cystica renal colic peptic ulcer Bone cyst (jaw bones) pancreatitis
investigation serum calcium upper limit (10.9 mg/dl) serum phosphate lower limit (3 mg/dl) excretion of ca in urine . serum alkaline phosphatase . serum PTH .
Differential diagnosis Secondary cancer in bones ( breast, prostate, bronchus, kidney, thyroid) Carcinoma with endocrine secretion (bronchus , kidney, ovary) Multiple myeloma Vitamin d intoxication Sarcoidosis Thyrotoxicosis
treatment Surgery is the only curative treatment Pre operative treatment is not usually necessary. Occasionally patient with hypercalcemic crisis need emergency treatment by fluids infusion and biphosphate therapy .
