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Endocrine Pathology > Pathology of the Endocrine System > Flashcards

Pathology of the Endocrine System Flashcards

1
Q

How is balance of endocrine systems maintained?

A

By feedback inhibition

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2
Q

How are endocrine organs linked?

A

By feedback axis

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3
Q

3 things that can go wrong in endocrine pathology

A

Hyperfunction
Hypofunction
Effect of a mass lesion

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4
Q

Definition of hyperplasia

A

Increased number and secretory activity of cells

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5
Q

Definition of atrophy

A

Diminution of cells due to lack of stimulation

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6
Q

How would tissue damage of an endocrine organ be caused?

A 
Inflammation 
Autoimmune disease
Compression 
Trauma
Infarction
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7
Q

Two types of neoplasia of endocrine organs

A

Adenoma (benign)

Carcinoma (malignant)

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8
Q

Types of adenoma

A

Functioning

Non functioning

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9
Q

Types of carcinoma

A

Primary

Metastatic

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10
Q

What does the thyroid gland produce?

A

Thyroxine T4
Triiodothyronine T3
Calcitonin

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11
Q

What secretes calcitonin?

A

C cells

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12
Q

Causes of hyperthyroidism

A

Graves disease 70%
Toxic multinodular goitre 20%
Toxic adenoma

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13
Q

Who gets graves disease?

A

F > M

Peak 20-40 years

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14
Q

Is there a genetic predisposition to get graves disease?

A

Yes

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15
Q

Pathology of graves disease

A

Autoimmune production of anti TSH receptor antibodies

Stimulate activity, growth and inhibit TSH binding

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16
Q

Histology of graves disease

A

Increased cell activity

Increased cell numbers

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17
Q

Causes of hypothyroidism

A

Hashimotos thyroiditis
Iatrogenic - surgery, drugs
Iodine deficiency
Congenital hypothyroidism

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18
Q

Who gets Hashimotos thyroiditis?

A

F > M

45 - 65 y/o

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19
Q

Pathology of hashimotos thyroiditis

A

Autoimmune destruction of thyroid epithelial cells
Cytotoxic T cells, cytokine and antibody mediated destruction
Circulating antibodies to thyroglobulin and thyroid peroxidase

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20
Q

Size of the thyroid in hashimotos disease

A

Originally - the gland gets bigger even though it is being destroyed, as it is trying to compensate
This does result in destruction however and fails and therefore the gland then gets smaller

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21
Q

Histology of hashimotos

A

Hurthle cell change
- swollen
Intense infiltrate of lymphocytes and plasma cells

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22
Q

What is goitre?

A

An enlarged thyroid

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23
Q

Pathology of multinodular goitre

A

Iodine deifiency/goitrogens/other causes
Impaired synthesis of T3,T4
Increased TSH
Hypertrophy and hyperplasia of epithelium

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24
Q

What may develop in multinodular goitre?

A

Autonomous “toxic nodule”

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25
Q

Pathology of multinodular goitre

A

Area of the thyroid that is no longer responding to TSH stimulation and reduction
Pumps out thyroxin regardless

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26
Q

What may the dominant nodule in a multinodular goitre be?

A

Cyst
Follicular adenoma
Carcinoma

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27
Q

Investigations of a thyroid nodule

A

TFTs
USS
FNA

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28
Q

What do parathyroid glands produce?

A

PTH

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29
Q

How many parathyroid glands are there?

A

4

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30
Q

What does PTH do?

A

Regulates plasma Ca2+

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31
Q

Presentation of primary hyperparathyroidism

A

Usually asymptomatic hypercalcaemia

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32
Q

Causes of primary hyperparathyroidism

A

Sporadic or familial (MEN-1)

  • adenoma 85-95%
  • hyperplasia 5-10%
  • carcinoma - rare
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33
Q

Causes of secondary hyperparathyroidism

A

Physiological response to a decreased Ca2+ renal failure

34
Q

Functions of the hypothalamus

A

Maintains homeostasis
Governs emotional behaviour
Links nervous system to endocrine system via the pituitary gland

35
Q

Where is the pituitary gland found in?

A

Sella turcica

36
Q

How is the pituitary gland connected to the hypothalamus?

A

Via the pituitary stalk

37
Q

Another name for the anterior pituitary gland

A

Adenohypophysis

38
Q

Where does the anterior pituitary get its blood supply from?

A

Hypothalamus

39
Q

What does the anterior pituitary secrete?

A 
ACTH
TSH
GH
Prolactin 
FSH/LH
40
Q

Another name for the posterior pituitary

A

Neurohypophysis

41
Q

What does the posterior pituitary secrete?

A

ADH

Oxytocin

42
Q

3 major cell types of the anterior pituitary

A

Pink acidophils
Dark purple basophils
Pale chromophobes

43
Q

What do the pink acidophils secrete?

A

GH

PRL

44
Q

What do the dark purple basophils secrete?

A

ACTH
TSH
FSH
LH

45
Q

Most common cause of pituitary hyperfunction

A

Pituitary adenoma

46
Q

What age do people usually get pituitary adenomas?

A

35-60 y/o

47
Q

If a functioning pituitary adenoma was producing prolactin, what would this lead to and how common is this?

A

Prolactinoma

20-30%

48
Q

If a functioning pituitary adenoma was secreting GH, what would this lead to?

A

Gigantism

Acromegaly

49
Q

What would a functioning pituitary adenoma producing ACTH lead to?

A

Cushing’s disease

50
Q

How common is a pituitary carcinoma?

A

very rare

51
Q

Effects of a large pituitary adenoma giving a mass pressure effect

A

Radiographic abnormalities
Visual field abnormalities
Elevated Intracranial pressure
Compression damage - hypopituitary

52
Q

How much of the pituitary needs to be lost to give it hypofunction?

A

75%

53
Q

Causes of pituitary hypofunction

A 
Compression by tumours
- craniopharyngioma
- metastatic
Trauma 
Infection (rare)
- TB
- sarcoidosis
54
Q

Zones of the adrenal cortex

A

Zona glomerulosa
Zona fasiculata
Zona reticularis

55
Q

What does the zona glomerulosa secrete?

A

Mineralocorticoids

56
Q

What does the zona fasiculata secrete?

A

Glucocorticoids - cortisol

57
Q

What does the zona reticularis secrete?

A

Sex steroids
Oestrogen
Androgens

58
Q

What cells are found in the adrenal medulla?

A

Neuroendocrine (chromaffin) cells

59
Q

What does the adrenal medulla produce?

A

Adrenaline/noradrenaline

60
Q

What syndrome is related to hypercortisolsim?

A

Cushing’s syndrome

61
Q

What syndrome is related to hyperaldosteronism?

A

Conn’s syndrome

62
Q

Causes of cushing’s syndrome

A 
Iatrogenic steroids
Pituitary adenoma (cushings disease) - 70%
Ectopic ACTH
Functioning adrenal adenoma - 10% 
Independent adrenal adeoma
Dependent pituitary adenoma
63
Q

Pathology of conns syndrome

A

Hyperalsoteronism

Bilateral idiopathic hyperplasia

64
Q

Cause of conns syndrome

A

Functioning adrenal adenoma

65
Q

Cause of secondary hyperaldosteronim

A

Physiological due to decreased renal perfusion and increased renin-angiotensin

66
Q

Examples of adrenogenital syndromes

A

Functioning adrenal tumour
Pituitary tumour cushings disease
Congenital adrenal hyperplasia - steroid enzyme deficiency

67
Q

Causes of adrenal insufficiency

A

Meningococcal septicaemia
Addisons disease
Pituitary failure

68
Q

Causes of addisons disease

A

Autoimmune
Infections; TB, Fungus HIV-related infections
Replacement; metastatic carcinoma amyloidosis
Atrophy; prolonged steroid therapy
Congenital hypoplasia

69
Q

What are adrenocortical tumours?

A

Primary tumours of the adrenal cortex which are quite rare and are often benign

70
Q

Types of adrenocortical tumours

A

Adenoma

Carcinoma

71
Q

What tumour is found in the adrenal medulla?

A

Phaechromaocytoma

72
Q

Main feature of phaechromocytoma

A

Hypertension

73
Q

What % of phaechromocytoma is inherited?

A

up to 30%

74
Q

What are multiple endocrine neoplasias?

A

Hyperplasia/neoplasms of endocrine organs - younger age, multifocal. Inherited disorders with an underlying genetic mutation

75
Q

Distinct syndromes associated with endocrine neoplasms

A 
MEN 1 (Wermer syndrome)
MEN 2 (A, B and C)
76
Q

What does MEN 1 have a defect in?

A

Menin protein involved in regulating cell growth

77
Q

What endocrine neoplasias does MEN 1 result in?

A 
Parathyroid hyperplasia and adenomas
Pancreatic and duodenal endocrine tumours (hypoglycaemia and ulcers)
Pituitary adenomas (prolactinoma)
78
Q

What do MEN 2 result in with endocrine neoplasias?

A

Medullary carcinoma of the thyroid

Phaeochromocytoma

79
Q

In addition to the MEN 2 conditions, what else does MEN2A have?

A

Parathyroid hyperplasia

80
Q

In addition to the MEN2 conditions, what else does MEN 2 B have?

A

Neuromas of skin and mucous membranes
Skeletal abnormalities
Younger patients and aggressive

81
Q

Treatment of myxoedema coma

A

Hydrocortisone and levothyroxine

82
Q

Hormones that decrease during the stress response

A

Insulin
Testosterone
Oestrogen

Endocrine Pathology (11 decks)

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