GROSS ANATOMY B

ENDOCRINE GLANDS I: Pituitary, Pineal, Thyroid and Parathyroid Glands

Dr. Capulong, Clinical Anatomy by Snell, Netter’s Atlas, Prev. Trans
- Major divisions:
OUTLINE ADENOHYPOPHYSIS (Anterior lobe)
I. PITUITARY GLAND - Bigger and main glandular portion
II. PINEAL GLAND - Hormones produced are innate to the anterior lobe
- Further subdivided into:
III. THYROID GLAND
o Pars anterior/distalis – biggest
IV. PRATHYROID GLANDS o Pars intermedia – narrow strip of tissue in between the anterior
and posterior lobe
ENDOCRINE SYSTEM ▪ Snell: separated by a cleft that is a remnant of an
- Controls most if not all of the basic embryonic pouch
metabolic processes of the body o Pars tuberalis – goes around the infundibular stalk acting like a
- Involves organs equally distributed in covering
the entire human body ▪ Snell: projection from the pars anterior which extends up
along the anterior and lateral surfaces of the pituitary
o Normally endocrine organs are stalk
along the central portion of the NEUROHYPOPHYSIS (Posterior lobe)
body - Smaller lobe and neural (nerve tissue) in nature
- HEAD & NECK AREA: location of the 2 - Made entirely of neural tissue: pars nervosa
most important endocrine glands - Does not produce hormones
o Pituitary and thyroid glands – control all metabolic processes in the body - Only stores hormones produced by the hypothalamus via the
- Glands produce and release special types of chemical substances to the blood hypothalamo-hypophyseal tract
- INFUNDIBULUM (pituitary hypophyseal stalk): direct communication with the
stream so as to reach the target organ or tissue
hypothalamus – hypothalamo-hypophyseal tract
- Exocrine vs endocrine
o Tubular structure that projects from the inferior aspect of the posterior lobe
EXOCRINE GLANDS ENDOCRINE GLANDS
Present in the GIT Chemical substances are released
Substances are released in a local via the blood stream and can reach
structure in a specific area even the most distal parts of the
body
- Governed by negative feedback mechanism
- Glands are closely associated with the hypothalamus responsible for limiting or
increasing the production of hormones via the release of releasing and inhibiting
hormones

I. PITUITARY GLAND (Hypophysis cerebri)

- Master Endocrine Gland: vital to life - Relations:
o Most important endocrine gland: hormones it produces influence the Anterior Sphenoid sinus
activities of many other endocrine glands Dorsum sellae
- Controlled by the hypothalamus Posterior Basilar artery
o Activities of the hypothalamus are modified by information received along Pons
Diaphragma sellae – infoldings of the dural covering
numerous nervous afferent pathways from different parts of the CNS and
- Has a central aperture allowing the passage of the
by the plasma levels of the circulating electrolytes and hormones Superior
infundibulum
- Small oval structure (average 1cm) attached to the undersurface of the brain by - Separates the anterior lobe from the optic chiasma
the infundibulum Inferior Body of sphenoid with its sphenoid air sinuses
- Well protected by virtue of its location in the sella turcica within the hypophyseal Cavernous sinus and its contents:
fossa superior portion of the sphenoid bone - Carotids
o Very difficult to access - Cranial nerves
o Old times: if there are problems with the pituitary gland, the only access is o III: Oculomotor Nerve
Lateral o IV: Trochlear Nerve
via removal of the temporal region through craniotomy → procedure o V: Trigeminal Nerve
entails more injury ▪ V1: Ophthalmic Nerve
o Present times: surgeries are done endoscopically via the nasal cavity which ▪ V2: Maxillary Nerve
has a more direct access to the pituitary gland - Optic chiasm (Optic nerves)
▪ From nasal cavity → turbinates → open up the nasal septum → *Abnormalities of the pituitary gland may cause compression to the associated nerves
sphenoid sinus → pituitary gland resulting to symptoms such as blurring of vision and headache

JUANMD Page 1 of 3
GROSS ANATOMY B
ENDOCRINE GLANDS I: Pituitary, Pineal, Thyroid and Parathyroid Glands
Dr. Capulong, Clinical Anatomy by Snell, Netter’s Atlas, Prev. Trans
BLOOD SUPPLY
- Has a very rich blood supply:
- Major blood supply is in the anterior lobe or the glandular portion of the
pituitary gland because it performs most of the activities of the glands
o Superior Hypophyseal Artery
o Inferior Hypophyseal Artery
o HYPOPHYSEAL PORTAL SYSTEM
▪ Intercommunication between the arteries and the veins
▪ Gives additional blood supply
▪ Mechanism is the same with the portal venous system
NOTE: The more activities an organ has, the bigger the demand for blood volume
HORMONES
- Regulated via negative feedback as mediated by the hypothalamus
- Main target are distal organs
POSTERIOR LOBE
OXYTOCIN – target organ: smooth muscles of the uterus
- Active during labor & causes milk ejection
- Helps in contraction of the uterus thereby augmenting labor
- Can be released the natural way by nipple stimulation
o Nipple stimulation must be prevented during 1st and 2nd trimesters of
pregnancy to prevent premature labor
During pregnancy, women are more sexually aggressive due to heightened
hormones. This can be manifested as having swollen nose, over-pigmented
armpits, etc.
ANTIDIURETIC HORMONE (Vasopressin) – target organ: kidney tubules
- Kicks of whenever there is an alteration to the normal circulating blood volume
in times of dehydration, trauma, exsanguination, or hemorrhage
- Stabilizes electrolytes and conserve water until such time wherein the effective
circulating blood volume is back to normal
ANTERIOR LOBE
GROWTH HORMONE – target organ: bone and skeletal muscles
- Surges during childhood years wherein there is rapid increase in muscle bulk
and bone elongation
- Excess production during childhood → GIGANTISM
o Clinical manifestation is symmetrical
o Equal elongation of long bones and equal development of skeletal
system
o Individual seems normal except for the very tall height
- Excess production during adulthood → ACROMEGALY
o Asymmetrical presentation
o Individual has normal length of body but has very big hands or feet or
frontal bone
o Conditions happen after epiphyseal plates have closed → no room for
the growth of long bones
PROLACTIN – target organ: breast tissue
- Occurs immediately before delivery (later stages of third trimester)
- Hormonal imbalance (increased prolactin): watery or milky secretions from
the breast even if not pregnant
FOLLICLE STIMULATING HORMONE & LUTEINIZING HORMONE
- Target organ: testes and ovaries
- For maturation and growth of reproductive organs
- Initiation of menstruation in females
THYROID STIMULATING HORMONE – target organ: thyroid gland
- For the production of T3, T4 and calcitonin
ADRENOCORTICOTROPIC HORMONE
- Target organ: adrenal glands particularly cortisol production
- Decrease or increase in steroid production can manifest as an
Addison’s or Simmond’s type of disease
CLINICAL CORRELATION
Presence of adenoma/carcinoma/cyst of the pituitary gland
- May affect all hormones and their target organs/cells
o Nonfunctioning pituitary gland – entire pituitary gland is laden with
chromophobes affecting the production of hormones
- Severely low or absent hormones: PANHYPOPITUITARISM (Simmond’s
Disease)
o Excessive growth of chromophobes
o All anterior pituitary hormones are affected
o Manifestation is all hypo (hypothyroidism, hypoadrenocorticalism
hypogonadism, dwarfism, etc.)
o Patient can be given exogenous or commercially prepared hormones for
intake
JUANMD
PITUITARY SURGERY
- Removes tumors transnasally and transsphenoidally
- Less invasive technique used to achieve safe and effective tumor removal while
promoting a more complete recovery
- Involves 2 surgeons: an ENT and a neurosurgeon
o Endoscope (small camera about 3-5mm) is inserted through the nose for
direct access with the pituitary gland
o Mucosal incisions are made at the back of the nasal cavity
▪ Aims to preserve the blood supply of the mucosa and the sense of
smell
o Mucosa is elevated from the back of the nasal septum and sphenoid bone
o Bone of the skull base over the tumor and pituitary gland is removed
o The dura is then lifted upward revealing the pituitary tumor and
compressed gland
o For large tumor: lower portion is removed first using microinstruments and
suction
▪ Remaining tumor is separated from the surrounding normal structures,
most importantly the compressed gland to help preserve and restore
its function
o The entire cavity including the walls of the cavernous sinus is then carefully
explored to make certain that all safely accessible tumor has been
removed
o Following removal, the tumor cavity, through the opening are typically
covered with harvested fat and bone which are held in position with
collagen matrix and tissue glue
▪ Most important step because it prevents CSF leak eliminating the
danger of direct access of infection from the nasal cavity, preventing
cavernous sinus thrombosis
- Endonasal approach could also be used for many midline skull base and brain
tumors such as meningiomas as long as the area of affectation is near the
sphenoid bone
II. PINEAL GLAND
- Small cone-shaped body that projects posteriorly from the posterior end of the
roof of the 3rd ventricle of the brain
- Consists essentially of groups of cells, the pinealocytes supported by glial cells
o Secretions reach their target organs via the bloodstream or through the
CSF
- Has a rich blood supply
- Innervated by postganglionic sympathetic nerve fibers
- Involved in diurnal rhythm (sleep cycle) of the body
- Influences the activities of the following endocrine glands:
▪ Pituitary gland
▪ Islets of Langerhans of the pancreas
▪ Parathyroid glands
▪ Adrenal glands
▪ Gonads
- Actions are mainly inhibitory and either directly inhibit the production of
hormones or indirectly inhibit the secretion of releasing factors by the
hypothalamus
- Can be seen and appreciated in a CT scan or MRI of a child
- Degenerates and calcifies in adults
III. THYROID GLAND
- Second most important endocrine gland
- Normally averages 20 grams
- Consists of right and left lobes connected by a narrow isthmus
- Protected by a true capsule
- Vascular organ surrounded by a sheath derived from the pretracheal layer of
the deep fascia
o Sheath attaches gland to the larynx and traches
o Fixed in the anterior of the neck via 2 attachments:
▪ Levator glandulae thyroideae - muscular
▪ Berry’s ligament - ligamental
- Each lobe is pear-shaped or butterfly-shaped
o Apex is directed upward as far as the oblique line on the lamina of the
thyroid cartilage
o Base lies below at the level of the 4th or 5th tracheal ring
- ISTHMUS: extends across the midline in front of the 2nd – 4th tracheal rings
Page 2 of 3
GROSS ANATOMY B
ENDOCRINE GLANDS I: Pituitary, Pineal, Thyroid and Parathyroid Glands
Dr. Capulong, Clinical Anatomy by Snell, Netter’s Atlas, Prev. Trans
- PYRAMIDAL LOBE (in 50% of the population): often present and projected SUPERIOR THYROID VEIN INFERIOR THYROID VEIN
upward from the isthmus, usually left to the midline - Drains into the internal jugular vein - Veins of both sides anastomose with
o Remnant of the tract where the thyroid gland follows as it descends to the one another as they descend in front
anterior neck area of the trachea
- Drains into the left brachiocephalic
o Embryologically, thyroid gland is at the base of the tongue and gradually
vein in the thorax
descends and settles at the anterior neck area MIDDLE THRYOID VEIN – no arterial counterpart
o Levator glandulae thyroideae – fibrous muscular band frequently connects - Drains also into the internal jugular vein
the pyramidal lobe to the hyoid bone - First step in dissection and thyroid surgery is identifying and ligating the middle
- Relations of the lobes: thyroid vein
Sternothyroid
Superior belly of the omohyoid
LYMPHATIC DRAINAGE
Anterolaterally Sternohyoid
(strap muscles) Anterior border of the SCM - Lymph drains mainly laterally into the deep cervical lymph nodes
**Neck incisions: skin → thin adipose tissue → platysma → - Few lymph vessels descend to the paratracheal nodes
strap muscles (pushed to the sides to see the thyroid gland)
Carotid sheath with the common carotid artery CLINICAL CORRELATIONS
Posterolaterally Internal jugular vein - Common tests done to rule out any thyroid pathology
Vagus nerve o Neck ultrasound
Larynx o Thyroid radionuclide iodine scan
Trachea
- Usual laboratory parameters in assessing thyroid function:
Pharynx
Medially Cricothyroid muscle and its nerve supply o Serum TSH (most important) – dictates if the patient is euthyroid (normal),
External laryngeal nerve hypothyroid or hypothyroid
Recurrent laryngeal nerve (in the tracheoesophageal o T3 & T4 levels
groove)
- Rounded posterior border of each lobe is related posteriorly to the: HYPOTHYROIDISM HYPERTHYROIDISM
o Superior and inferior parathyroid glands - Energy is not utilized by the body - All of the energy is utilized
o Anastomosis between the superior and inferior thyroid arteries - Increased basal metabolic rate due
- Relations of the isthmus to thyroid stimulation
Sternothyroids NODULAR GOITER – common in the Philippines
Sternohyoids - Presence of nodules in the thyroid gland
Anterior
Anterior jugular vein THYROGLOSSAL DUCT CYST
Fascia & skin - Common condition mistaken as a thyroid problem
Posterior 2nd – 4th rings of the trachea - Also present in the midline of the anterior neck
*Terminal branches of the superior thyroid arteries anastomose along its upper border - Thyroglossal duct: structure present during the developmental stages of the
thyroid gland
o Fragments as the thyroid descends from the back of the tongue to the
anterior of the neck
o Persistence usually appears in childhood, adolescence or in young adults
- Occurs most commonly in the region below the hyoid bone
- Cyst develops through time due to swallowed saliva and food particles
- Becomes prone to infection as it enlarges, thus should be surgically removed
Patient swallows Patient sticks tongue out
Thyroid gland (+) movement (-) movement
TDC (-) movement (+) movement

IV. PARATHYROID GLAND

- Ovoid bodies about 6mm long in their greatest diameter
- Four in number and closely related to the posterior border of the thyroid gland,
HORMONES lying within its fascial capsule
TRIIODOTHYRONINE (T3) – active hormone form o Superior parathyroid glands (2) – more constant in position
- Increases the metabolic activity of most cells of the body ▪ Lie at the level of the middle of the posterior border of the thyroid
gland
THYROXINE (T4) – storage hormone form o Inferior parathyroid glands (2) – lie close to the inferior poles of the
thyroid gland
CALCITONIN (Thyrocalcitonin) – secreted by the parafollicular cells (C cells) ▪ May lie within the fascial sheath, embedded in the thyroid substance
- Decreases serum calcium levels via deposition to the bones or outside the fascial sheath
- Snell: supplied by the superior and inferior thyroid arteries
BLOOD SUPPLY - Venous drainage and lymphatic drainage are same with the thyroid gland’s
SUPERIOR THYROID ARTERY INFERIOR THYROID ARTERY - PARATHYROID HORMONE: increases serum calcium levels by
- Origin: external carotid artery - Origin: thyrocervical tract o Stimulating osteoclastic activity of bones (bone resorption) and mobilizing
- Supplies the superior poles - Supplies the inferior poles and the
bone calcium to the bloodstream
- Accompanied by the external parathyroid glands
(superior) laryngeal nerve - Accompanied by the recurrent o Stimulating absorption of dietary calcium from the small intestine
- Injury to the SL nerve will cause tiring laryngeal nerve either on top of it of o Stimulating reabsorption of calcium in the PCT of the kidney
and abnormal pitch of the voice below - Hormone secretion is controlled by blood calcium levels
- Injury to the RL nerve, there is total - Removal of the parathyroid glands especially during thyroidectomy can result
loss of voice or even airway to permanent hypocalcemia
compromise

THYROIDEA IMA – present in 10-30% of patients

- Origin: brachiocephalic artery of directly from the arch of the aorta
- Supplies the isthmus

JUANMD Page 3 of 3