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pathology cam304 > Non Thyroid Endocrine Pathology RM > Flashcards

Non Thyroid Endocrine Pathology RM Flashcards

1
Q

What are the functions of the parathyroid?

A

Release PTH in attempt to increase serum calcium
-> Bone : increased breakdown- release of Ca and phosphorus

-> Kidney (+inactive vitamin D) -> decreases excretion of calcium, increases calcitriol formation -> acts on SMALL intestine to increase absorption of calcium.

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2
Q

Main cells of parathyroid gland

A

Adipocytes
Chief Cells- release parathyroid
Oxypil Cells- potentially produce PTHrP and Calcitriol

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3
Q

What is primary hyperparathyroidism?

What are the causes?

A
  • hypercalcaemia (asymptomatic) AND Elevated PTH OR Normal PTH
  • PTH should be low if they are hypercalcemic.
  • also will have normal or elevated urine calcium
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4
Q

What are symptoms of hypercalcemia and what pathologies can be produced?

A

Stones- kidney

Bones: bone pain, fractures

Groans: pancreatitis, peptic ulcers

Moans (psychotic) fatgieu, poor concentration

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5
Q

What are the causes of primary hyperparathyroidism

A

PARATHYROID ADENOMA
parathyroid hyperplasia
carcinoma (rare

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6
Q

Histologically, what does a parathyroid adenoma look like?

A

loss of adipocytes
increased parenchymal cells
other glands depressed
well circumscribed

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7
Q

What are the causes of hypoparathyroidism?

what would someone present with?

A

Chvostek AND Trousseau Sign

usually caused by surgery

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8
Q

What is the most common tumour of the pituitary gland?

A 
Pituitary adenoma
35-50 yo
Clinical presentation demends on: 
size/pressure: microadenoma 10mm
Functional: hormonal effects (only 25% are non functioning)

will see hyperpituitarism

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9
Q

What are some of the size/pressure/invasive effects of pituitary adenomas?

A

Hypopituitarism
Headache
Visual field defects- bitemporal hemianopia
Stalk compression - decreases PIF leading to prolactin release

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10
Q

What effects can a large pituitary adenoma have on clinical symtoms

A

hypothalamus: abnormal temp regulation, diabetes insipidus, sleep disturbance
Temporal lobe: siezures, personality change
Posterior fossa: brainstem signs
Frontal lobe: altered mental state, frontal release signs, anosmia

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11
Q

what percentage of adenomas invade?

what can this cause?

A

25-30% invade locally (no metastatic capacity), causing compression and symptoms of CN3,4,5,6 issues such as
- > ptosis, diplopia, opthalmoplegia, pain and numbness along CNv1 of face

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12
Q

how would a pituitary surgery be performed?

A

Transnasally, through sphenoid sinus , then through floor of pituitary fossa.
-> aspiration

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13
Q

Adrenal gland:

WHAT IS THE NORMAL HISTOLOGICAL STRUCUTRE OF THE ADRENAL GLAND0 and what does each layer secrete

A

Glomerulosa: aldosterone
Fasciculata: cortisol
Reticularis: sex hormones (oestrogen and testosterone)
Medulla: adrenaline, noradrenaline

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14
Q

what are some common pathologies of the adrenal gland in an ADULT?

A
  • hyperplasia (due to excess ACTH or CRH)
  • Tumour: adenoma = cortex; phaeochromocytoma= medulla
    Carcinoma
    *destruction of adrenal cortex leading to adrenal insufficiency
    Cysts
    Myelolipomas
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15
Q

what are some common pathologies of the adrenal gland in an CHILDREN?

A

Neuroblastoma
Ganglioneuroblastoma
Ganglioneuroma
Carcinoma (more common than adenomas in children)

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16
Q

Adrenal gland hormones are in charge of stress response- -> what are short term and long term stress responses ?

A

ACTH from the anterior pituitary gland causes
short term:
- adrenaline release: glycogen broken down to glucose, increased BP, increased breathing

Long term:
cortisol release: protein and fats broken down and converted to glucose = more blood glucose
aldosterone release: rentention of sodium ions and water by the kidney, increased BV and BP

17
Q

Can have functioning and non functioning adenomas of the adrenal gland.
what are the two types of functioning adenoma,?

A

Classical adenoma: <5cm, no haemorrhage or necrosis, usually in Zf or ZG:

  • cushings syndrome with excess cortisol
  • cons syndrom with excess aldosterone
  • excess nandrogens

+
Black adenoma (rare)
pigmented

18
Q

What is Cushings Syndrome??

A

Cushing’s is increase in cortisol via exogenous cause. TWO TYPES
1- ACTH dependent:
- due to ACTH producing pituitary tumour (CUSHINGS DISEASE - 70%)
- ectopic ACTH non pituitary tumour (small cell lung cancer)
2- ACTH independent
- Cortisol secretion from adrenal adenoma

19
Q

Classical symptoms of cushings

A 
moon face
buffalo hump back
raised bp
striae on stomach
skinny arms
slow wound healing
red cheeks
moon face
20
Q

What is primary hyperaldosteronism?

A

hypersecretion of aldosterone
signs: HTN and hypokalaemia
Aetiology:
Bilateral, idiopathic hyperplasia (60-70%) in children and young adults
OR Conn’s Syndrome via adrenal adenoma (30-40%)

21
Q

Adrenogenital symptoms- virulisation and feminisation

A

Can be caused by adrenal pathologies or primary gonadal disorders

22
Q

What are the signs for adrenal carcinoma?

A

> 5cm
May or may not be functional, can be oestrogen secreting
Fatal tumour with mets.
Can cause Cushings and virilisation in a child and increased mitoses, fatal.

23
Q

What is Acute primary cortical Adrenal Insufficiency?

what are the causes

A

often insidious, cause severe shock:
weakness, vomiting, diarrhoea, CV collapse, abdo pain, hypoclycemia, electrolyte disturbance

Adrenal Crisis: chronic adrenal insufficiency in the setting of stress
Rapid withdrawal of steroids or failure to increase at times of stress
Massive adrenal haemorrhage (newborns after brithtrauma)

24
Q

Waterhouse Friderichsen Syndrome:
a form of adrenal insufficiency
what causes it

A

haemorrhage and infarction of the adrenals with a bacterial infection = hypotension -> shock + DIC

25
Q

DEFINE Addisons disease

A

Chronic Primary Adrenal (cortical) insufficiency

Causes:
Autoimmune adrenalitis
Tuberculosis
AIDS

26
Q

Signs of Addisons Disease

A

Tiredness, lethargy, weakness
Syncope, postural diziness
nausea, abdo pain,diarrhoea, constipation
general constitutional

CLinically
- anorexia
- hyperpigmentation
- hypotension
- thinning of pubic hair
vitiligo
27
Q

Treatment of Adrenal insufficiency=

A

Glucocorticoids, mineralocorticoids and IV fluids

● In chronic patients, must give steroid boost during infections, prior to surgery or during pregnancy

28
Q

What is a phaeochromocytoma?

A

Adrenal pathology- > to medulla
20-50 yrs
May be precipitated by stress, exercise, change in posture,
sudden onset, mins to hours, headache, tachycardia, palpitations, sweating, apprehension, pallor or flushing pain, vomiting. Severe HTN.
HTN: difficult to control
Hypotension: postural hypotension

29
Q

Neuroblastoma

A

40% arise in the adrenal medullary neuronal cells, the rest in various sympathetic ganglia
Important: MOST COMMON EXTRACRANIAL SOLID TUMOUR IN CHILDREN
18 months old

30
Q

What are the two types of neuroblastic tumours?

A

Ganglioneuroblastoma:

  • Ganglion cells invarious stages of maturation
  • Schwann cells and fibroblasts- > favourable

Ganglioneuroma:
Better differentiated lesions that resemble mature ganglion cells and few/nil neuroblasts
Organised fascicles

pathology cam304 (16 decks)

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