Lymph nodes and endocrine disorders

41 Lymph nodes and endocrine disorders





Questions



image What are the causes of hypercalcaemia?

image What tumours affect the adrenal gland?

image What are the causes of an enlarged lymph node in the head and neck?



Lymph nodes


The body has approximately 500 lymph nodes, around 200 of these are in the head and neck (Fig. 3.41.1). Causes of enlarged head and neck lymph nodes are important to remember as an OSCE might well include a node in the neck (remember LIST: lymphoma/leukaemia, infection, sarcoidosis, tumour); they include infections (e.g. tonsillitis, tuberculosis), malignancy (skin cancers, lymphoma, metastases) and sarcoidosis.


image

Fig. 3.41.1 Lymph nodes of the head and neck.


Lymph nodes of the head are examined by palpation from behind the patient, using gentle rotation movements of the fingertips (Ch. 42). If enlarged lymph nodes are found, then an examination should look for general lymphadenopathy (e.g. by palpation of the axilla and groin).



Cervical metastases from a distant tumour


Tumours metastasize to the cervical nodes from the lips, tongue, oral cavity, larynx, pharynx and nasopharynx. Tumours in these areas are linked to smoking and chewing carcinogens.



Parathyroid glands


There are four parathyroid glands, which lie behind the thyroid gland. They secrete parathyroid hormone, a substance that helps to maintain the correct balance of calcium and phosphorous in the body. In hyperparathyroidism, blood calcium rises and it is this hypercalcaemia that usually signals that something may be wrong with the parathyroid glands.


Hyperparathyroidism can be:


image primary: the parathyroid gland excretes excess parathyroid hormone, resulting in high calcium levels; adenomas cause 90% and treatment is with surgical excision of the adenoma

image secondary: hypocalcaemia (e.g. from renal failure, vitamin D deficiency) causes the parathyroid gland to increase production of parathyroid hormone

image tertiary: once the long-standing cause of calcium loss in secondary hyperparathyroidism has been stopped and calcium returns to normal, the parathyroids continue to secrete excess parathyroid hormone.
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Lymph nodes and endocrine disorders

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