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Endocrine Flashcards

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1
Q

What is the thyroid glands major role?

A

Regulation of the metabolic rate of the body

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2
Q

Where is the thyroid gland located?

A

Anterior neck spans C5 to T1 vertebrae

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3
Q

What is the anatomy of the thyroid gland?

A

Left and right lobe connected via central isthmus, anteriorly

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4
Q

What is the normal weight range of a thyroid?

A

10-20 g

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5
Q

What is the average size of a thyroid gland?

A

4 x 3 x 2 cm

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6
Q

Where is the thyroid gland situated within the body?

A

The lobes are wrapped around the cricoid cartilage

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7
Q

What is the appearance of the thyroid gland?

A

Posterior surface is concave or flat
Lobes taper superiorly
Isthmus is inferior

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8
Q

What is the microscopic appearance of a normal thyroid gland?

A

Thyroid epithelia form follicles filled with colloid
Epithelium is simple cuboidal or simple columnar
Cell types = follicular cells, C cells, lymphocytes, adipocytes

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9
Q

What is colloid?

A

A protein rich Reservoir of elements that make hormones

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10
Q

What are follicular cells function?

A

Produce T3 and T4
Act to control parts of the hypothalamatic-pituitary-thyroid axis

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11
Q

What is the hypothalmic pituitary thyroid axis?

A

Hypothalamus produces TRH which act on the pituitary
Pituitary acts on thyroid gland by producing TSH
Thyroid gland produces T3 and T4
T3 and T4 backwards inhibit the pituitary and the hypothalamus
TSH also backwards inhibits the hypothalamus

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12
Q

What is TSH?

A

Thyroid stimulating hormone

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13
Q

What is TRH?

A

Throtropin releasing hormone

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14
Q

What is the function of C cells?

A

C cells (paraphilicular cells) are found between the follicles
Secrete calcitonin which helps deposit calcium and phosphate in bones and tissues

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15
Q

What pathways does the thyroid gland regulate?

A

Basal metabolic rate
Gluconeogenesis
Glycgenlysis
Protein synthesis
Lipogenesis
Thermogenesis

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16
Q

What is the function of T3 and T4?

A

Active thyroid hormones
Act by a nuclear receptors to target tissues and activate the metabolic pathways
Fat soluble
Carried by plasma proteins

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17
Q

What tests can be used to invest thyroid pathology?

A

Blood tests - thyroid function (eg TSH serum levels, calcitonin, thyroglobulen
Ultrasound - single nodule versus multi nodular
CT/MRI - lymph node involvement
FNA - for enlargement especially in the case of single nodule, rapidly growing an airway obstructions
Assessment of vocal cords
Loss of function = equals sinister Needle biopsies
Thyroidectomy total or Lobectomy (partial)

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18
Q

What is the general dissection for a thyroid gland?

A

Orientate
Identify parathyroid glands, isthmus Describe external surface, capsule involvement
Measure in three dimensions
Weigh
Ink capsule one colour resection margins and isthmus another color
4 mm transverse slices in the coronal plane (superior to inferior)
Describe cut surface, lesion size, margins to capsule and isthmus

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19
Q

Give four examples of benign thyroid pathologies?

A

Follicular adenoma
Teratoma
Leiomyoma
Cysts

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20
Q

Give four examples of malignant thyroid pathologies?

A

Follicular carcinoma
Papillary carcinoma
Medullary thyroid carcinoma
Leiomyosarcoma

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21
Q

What does a result Thy1 mean?

A

Inadequate

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22
Q

What does a result Thy2 mean?

A

Non-neoplastic

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23
Q

What does a result Thy3 mean?

A

Indeterminate

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24
Q

What does a result Thy3a mean?

A

Mild atypia

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25
What does a result Thy3f mean?
Follicular cells, possible neoplastic adenoma/carcinoma
26
What does a result Thy4 mean?
Atypia, suspicious of malignancy
27
What does a result Thy5 mean?
Malignant
28
What should you do if you see a result of Thy3 or above?
Ask for advice Thy3f lesion = block lesion capsule looking for invasion all if >30 mm Papillary lesion can be multifocal so check for more than one lesion block background thyroid
29
What are MEN syndromes?
Multiple endocrine neoplasia syndromes
30
What does a result MEN type1 mean?
Autosomal dominant combined two or more tumors (parathyroid, pancreas, anterior pituitary)
31
What does a result MEN type2A mean?
Sipple syndrome - thyroid lesions often multiple or bilateral
32
What does a result MEN type2B mean?
Goorlin syndrome Wagenmann-Froboese syndrome Medullary thyroid carcinoma
33
What does a result FMTE mean?
Familial Medullary carcinoma
34
What is a thyroid follicular adenoma?
Benign, encapsulated tumour that shows thyroid follicular cell differentiation
35
Where are thyroid follicular adenomas most commonly found?
Thyroid lobe Isthmus Ectopic thyroid tissue
36
Who is most at risk of a Thyroid follicular adenoma?
3-5% incidence Adults all ages, usually 5th-6th decade F>M
37
What is the clinical presentation of a thyroid follicular adenoma?
Painless Solitary thyroid nodule Maybe incidental, palpable or on ultrasound Rare compression symptoms unless very large Can show hyperthyroidism Is a hyperfunctioning adonoma
38
What tests are there available for thyroid follicular adenoma?
Thyroid function test FNA
39
What is the treatment for a thyroid follicular adenoma?
Lobectomy
40
What is the macroscopic appearance of thyroid follicular adenoma?
Solitary Encapsulated nodule (multiple if hereditary) 1-10 cms Solid gray-white or tan-light brown +/- haemorrhage, cystic change, fibrosis, calcification
41
What is the microscopic appearance of thyroid follicular adenoma?
Cytologically different from background Compression sign on surrounding thyroid tissue Follicles can be normal, small or large
42
What additional tests can be carried out for thyroid follicular adenoma?
TTF1, PAX8 positive CK20, Calcitonin negative
43
What are the differential diagnoses for thyroid follicular adenoma?
Nodular hyperplasia Carcinoma
44
What is thyroid hyperplasia/goiter?
Diffuse or nodular enlargement with distorted outer surface Grossly visible Most common disease in the thyroid
45
Where can thyroid hyperplasia/goiter be found?
The entire thyroid gland
46
Who is most at risk of thyroid hyperplasia/goiter?
F>M Variable age Common during adolescence and pregnancy
47
What is the clinical presentation of thyroid hyperplasia/goiter?
Neck mass Generally asymptomatic Pressure signs due to compression of the trachea and oesophagus
48
What tests can be carried out for thyroid
TSH, T3, T4 function tests Ultrasound, CT scan, MRI FNA if rapid growth, pain, firm areas within nodule
49
What is the macroscopic appearance of thyroid hyperplasia/goiter?
Firm, amber cut surface (simple) Large 200 to 700 grams Increased size 8 to 15 centimeters Dominant nodules up to 10 centimeters Nodular outer surface Variegated cut surface Cystic Haemorrhage Brown gelatinous colloid nodules +/- calcification
50
What is the microscopic appearance of thyroid hyperplasia/goiter?
Vary in size Dilated follicles nodules Can be colloid/microfollicular/hypercellular Haemorrhage Rupture of follicle Fibrosis Cystic areas may have papillary structures Atypia in cells
51
What additional tests can help diagnose thyroid hyperplasia/goiter?
TTF1 positive
52
What is the differential diagnosis for thyroid hyperplasia/goiter?
Adenoma Carcinoma
53
What are thyroid cysts?
Usually part of a lesion Can be partially solid and fluid Generally represent degenerative follicular adenomas or colloid nodules Some carcinoma can have cystic components Test via ultrasound and fna Generally treat with Aspiration Excision is used if malignancy is suspected
54
What is hashimoto's thyroiditis?
Autoimmune disease that presents with goiter, elevated anti thyroid antibodies and hypothyroidism
55
Who is more at risk of hashimoto's thyroiditis?
30-50y M>F
56
What is the clinical presentation of hashimoto's thyroiditis?
Painless Coexist with other autoimmune diseases Difficulty swallowing Fatigue Sensitive to cold Sleepy Dry skin Constipation Muscle weakness Aches Joint pain and stiffness Depression Puffy face Hair loss Problems with memory
57
What tests are available for hashimotos thyroiditis?
TSH levels are high T3 and T4 levels are low in large thyroid on radiology
58
What is a typical treatment for hashimotos thyroiditis?
Hormone replacements Subtotal thyroidectomy for compression
59
What is the macroscopic appearance of hashimoto's thyroiditis?
Diffuse, symmetrical enlargement c Cut surface is pale yellow-tan Firm nodule, resembles lymph nodes maybe fibrotic or atrophied
60
What is the microscopic appearance of hashimoto's thyroiditis?
Small follicles Decrease colloid Lymphocytic and plasma cell infiltrate Hurtle cell change in widespread Fibrosis
61
What additional tests can can be carried out to diagnose hashimotos thyroiditis?
P63, galactin 3 positive
62
What is the differential diagnoses for hashimotos thyroiditis?
Chronic lymphocytic thyroiditis MALT lymphoma Papillary carcinoma
63
What is Graves disease?
Autoimmune disease characterized by hyperthyroidism, leading to increase secretion synthesis and size of thyroid
64
Who is most at risk of Graves disease?
F>M 20-40y
65
What is the clinical presentation of Graves disease?
Goiter Muscle weakness Tremors Sweating Heat intolerance Weight loss Tachycardia Anxiety Congestive heart failure Swelling of extremities Bulging eyes Fine hair Breast enlargement Diarrhea Amenorrhoea
66
What tests can be used to diagnose grave's disease?
T3 and T4 are increased Heart rate increased Blood pressure increased Increased sweating/body heat Enlarged thyroid
67
How is Graves disease treated?
Beta blockers (Rituximab) Excision (Subtotal)
68
What is the macroscopic appearance of grave's disease?
Diffuse and symmetrically enlarged thyroid Beefy red cut surface Weight 50-150 grams
69
What is the microscopic appearance of Graves disease?
Hyperplastic follicles with papillary in foldings d Diffuse hyperplasia and hypertrophy of follicular cells Colloid is decreased Patchy lymphoid infiltrate +/- papillary hyperplasia, pleomorphism, mitotic figures, psammoma bodies
70
What additional tests can help diagnose Graves disease?
P63 negative
71
What is the differential diagnosis of Graves disease?
Adenoma Papillary thyroid carcinoma
72
What is a thyroglossal duct?
In the embryo the thyroid gland begins by the base of the tongue by week seven is lies on the anterior neck as it descends it forms the thyroglossal duct The thyroglossal duct usually regresses by week 10 In some cases regression does not occur and cysts or fistulate and occur
73
How does a thyroglossal cyst occur?
Secretions within the thyroglossal duct can build up and form a thyroglossal cyst
74
What is the clinical appearance of a thyroglossal cyst?
Midline lump in the anterior neck
75
What are the clinical implications for an untreated thyroglossal cyst?
Infection and formation of a cutaneous fistula
76
How are thyroid glossil cysts or fistulae treated?
Excision
77
What are the adrenal glands?
Bilateral endocrine glands
78
Where are the adrenal glands located?
The medial aspect of the upper poles of each kidney
79
What are the functions of the adrenal glands?
Secrete steroids and catecholamine hormones direct into the blood
80
What are the adrenal glands surrounded by?
Perinephric fascia encloses the adrenal glands and the kidneys
81
What shape are the adrenal glands?
The right gland is pyramidal the left gland is semi lunar shape
82
What are the adrenal glands made of?
An outer connective tissue capsule Cortex Medulla
83
How does the adrenal gland Cortex appear?
Derived from mesoderm yellowish in colour Can be split into zona glomerulosa, zona fasciculata and zona reticularis
84
What is the function of the adrenal gland cortex?
To secrete corticosteroids and androgens
85
How does the zona glamourous of the adrenal glands appear microscopically?
Cells arranged in oval shaped clusters divided by trabeculae
86
What is the function of the zona glamorelosa within the adrenal glands?
Produces and secretes mineralcorticoids and hormones These maintain electrolyte and water balance eg Aldsterone
87
How does the zona fasciculata from the adrenal glands appear microscopically?
Parachymal cells known as spongiocytes arranged in columns with venous sinuses between them
88
What is the function of the zona vasicular within adrenal glands?
Produces and secretes glucocorticoids which regulate carbohydrate metabolism particularly during the stress response (e.g cortisol and corticosterone) and small amounts of androgens
89
How does the zona reticularis of the adrenal glands appear microscopically?
Cylindrical masses of epithelia arranged in a regular net-like pattern
90
What is the function of the zona reticularis of the adrenal glands?
Produces and secretes androgen precursors and a small amount of corticosteroids
91
How does the medulla of the adrenal glands appear?
The centre of the gland Dark brown in colour Contains chromaphin cells
92
What is the function of the medulla of the adrenal glands?
Secretes catecholominescsuch as adrenaline and hormones used in pain control
93
What are the normal sizes and weight of a adrenal gland?
5 x 3 x 1 cm 4 to 6 grams
94
What type of specimens can be received from the adrenal gland?
Unilateral adrenalectomy for non-functioning adenoma or a tumor Bilateral adrenalectomy for cushings disease
95
What is the general dissection for an adrenal gland?
Weigh Measure Ink margins if tumor present Consider removing fat Describe attached tissues Serially slice transversely Describe cut surface - cysts, haemorrhage Tumors process all if small + lymph nodes Two blocks plus one block for every 10 millimeters if large Include capsule, hemorrhage and necrosis
96
What tests can be carried out in the investigation of adrenal gland pathologies?
ACTH stimulation test - measures blood cortisol levels Blood and urine tests - levels of adrenal hormones Insulin induced hypoglycemia test - measures blood glucose and cortisol before and after insulin injection Serum cortisol levels Urea and electrolytes - sodium and potassium levels Blood glucose X-ray, ultrasound, MRI Biopsies Excision
97
How can acute stress affect the adrenal glands?
Atrophy due to loss of lipid vacuolation in the cortex cells
98
How can prolonged stress affected the adrenal glands?
Lead to enlargement of the adrenal glands due to hypertrophy and hyperplasia of the cortical cells
99
Give examples of pathologies that can lead to the removal of adrenal glands?
Functional or non-functional adenomous Hyperplasia
100
What is adrenal hyperplasia?
Non neoplastic increase in adrenal cortical cells diffuse is most common form followed by nodular
101
What is the macroscopic appearance of adrenal hyperplasia?
Nodular variant - at least one nodule Often diffusely nodular adrenal cortex which weighs >6 grams without fat Glands have rounded edges
102
What is the microscopic appearance of adrenal hyperplasia?
Increase thickness of zona reticularis and fasciculata Cells of the fasciculata appear lipid depleted, atypical, large hyperchromatic nuclei
103
What is the differential diagnosis of adrenal hyperplasia?
Adrenal adenoma
104
What is an adrenal gland adenoma?
Benign neoplasm arising from adrenal cortical cells Can be functional or non-functional
105
Where are adrenal adenomas found?
Adrenal Cortex all three layers
106
Who is most at risk for adrenal gland adenomas?
F>M 5th-7th decade left=right
107
What is the clinical presentation of an adrenal gland adenoma?
Varied can be due to hyperaldosteronism or hypercortisolism
108
In adrenal adenomous how does hyperaldosterism present clinically?
Also known as Cann's syndrome Hypertension Proximal muscle weakness Headache Polyurea Tachycardia
109
In adrenal gland adenomas how does hypercortisolism appear clinically?
Also known as Cushing syndrome Central obesity Moon face Plethora Thin skin Easy bruising Increased muscle mass Deepening voice Increased Pubic hair Increased penis/clitoris size Gynaecomastia Impotance if affecting the androgen precursors
110
What is the microscopic appearance of adrenal gland adenomas?
Weight less than 50 grams Size less than five centimeters Unilateral Solitary Golden yellow Focal haemorrhage Lipid depletion
111
What is the microscopic appearance of an adrenal gland adenoma?
Larger cells Different cytoplasm Increase nuclear size when compared to background cortical cells
112
What additional tests can be used in the diagnosis of adrenal gland adenomas?
Calretanin, Bcl2 positive EMA, CEA negative
113
What is the differential diagnosis of an adrenal gland adenoma?
Adrenal cortical carcinoma
114
What is Cushing syndrome?
Condition by having too much cortisol in your body
115
What causes Cushing syndrome?
Steroids (used for treating rheumatoid arthritis lupus and asthma) Excessive stress over prolonged period
116
What is the clinical presentation of Cushing syndrome?
Weight gain in the trunk Moon face Fatty lump between the shoulders Pink or purple stretch marks on stomach, hips, thighs, breasts and underarms Thin, frail skin Easy bruising Slow wound healing Acne Low sex drive Excessive hair Reduced fertility Tiredness Muscle weakness
117
What organ is involved in Cushing syndrome?
Adrenal glands
118
What organ is involved in Addison's disease?
Adrenal glands
119
What is Addison's disease?
Disorder that occurs when the adrenal glands are damaged results in a deficiency of cortisol and aldosterone
120
What causes Addison's disease?
Autoimmune Infections (tuberculosis, HIV) Haemorrhage Tumours
121
What is the clinical presentation of Addison's disease?
Muscle weakness Low mood Loss of appetite Weight loss Increase thirst Dizziness Fainting Exhaustion Darkened skin, lips or gums
122
What is the treatment for Addison's disease?
Hormone replacement
123
Where are the parathyroid glands located?
Anterior neck on the posterior aspect of the thyroid gland
124
Where exactly are the parathyroid glands positioned on the thyroid gland?
The Superior parathyroid glands - located at the middle of the posterior border of each thyroid lobe Inferior parathyroid glands - usually found near the inferior poles of each thyroid lobe although there is variation between individuals
125
What is the macroscopic appearance of parathyroid glands?
Flattened and oval in shape
126
What is the size and weight of a parathyroid gland?
4 to 6 mm maximum dimension 30 to 35 milligrams
127
What is the function of parathyroid glands?
Production of parathyroid hormone (PTH) this acts to increase the level of serum calcium
128
What is the process by which parathyroid glands control calcium levels within the blood?
Parathyroid hormone acts to increase the level of serum calcium Parathyroid respond to hypocalcemia (low blood calcium levels) Parathyroid hormone is produced and released leading to a release of calcium stored in bones, decreasing calcium excretion in urine and an increasing absorption of dietary calcium
129
What are the cell types found in paraphyroid glands?
Chief cells Oxyphil cells Adipose tissue
130
What is the role of chief cells within paraphyroid glands?
Abundant Produce and secrete PTH Prominent nucleus Relatively little cytoplasm Smaller than oxyphil cells
131
What do oxyphill cells of the paraphyroid glands look like?
Larger than chief cells Increase in number with age Unknown purpose
132
What is the general presentation of parathyroid pathologies?
Altered function Can be asymptomatic, so it incidental finding Hyperparathyroidism = altered metabolic state due to increase in secretion of paraphyroid hormone (e.g disordered calcium metabolism)
133
What tests are used when investigating parathyroid pathologies?
Combination of biochemistry clinical history and physical examination CT and MRI can demonstrate enlargement
134
What specimens can be received from the parathyroid glands?
Biopsies are very rare, maybe received as an interoperative frozen section Parathyroidectomy
135
What is a general microscopic description for parathyroid glands?
Measure in three dimensions Weigh to two decimal places Remove excess fat Ink margins slice in three millimeter intervals, transversely Process all if less than five millimeters Describe cut surface
136
What is hyperparathyroidism?
Spontaneous autonomous overproduction of PTH with no evidence of prior stimulation
137
What is pth?
Parathyroid hormone
138
What conditions can lead to hyperparathyroidism??
Adenoma Hyperplasia Carcinoma
139
What is the clinical presentation of hyperparathyroidism?
Often asymptomatic
140
How is hyperparathyroidism diagnosed?
Serum levels: Increased parathyroid hormone Increased calcium Decreased phosphatase
141
What are the clinical implications of high parathyroid hormone?
Bone disease (osteoporosis) Stones (renal stones) Groans (GI distress, nausea, ulcers, gallstones, pancreatitis) Moans (depression, fatigue)
142
How is hyperparathyroidism treated?
Excision of enlarged gland and one normal for comparison
143
What is the macroscopic appearance of hyperparathyroidism?
Solid and cystic areas brown due to haemosiderin
144
What is the microscopic appearance of hyperparathyroidism?
Osteoblastic and osteoclastic activity Cysts Haemosiderin laden macrophages Pale vaculated cells in a trabicular pattern
145
What additional tests can help in hyperparathyroidism diagnosis?
Cyclin D1 positive
146
What is the differential diagnoses of hyperparathyroidism?
Giant cell tumours Medullary carcinoma of the thyroid
147
What is Primary hyperparathyroidism?
Calcium feedback disturbed leads to increased parathyroid hormone (MEN1)
148
What is secondary hyperparathyroidism?
Defect in mineral homeostasis leads to increased parathyroid hormone (vitamin D deficiency)
149
What is tertiary hyperparathyroidism?
Prolonged stimulation leads to autonomous production
150
Where can parathyroid hyperplasia occur?
Chief cells = all four Water clear cell = usually all four but particularly the superior pair Secondary = SYMMETRICAL, all four Chief cells is symmetrical in 50% of cases
151
What is parathyroid hyperplasia?
Hyperplasia of the parathyroid glands Usually involves all four Can be chief cell hyperplasia (common), Water clear cell hyperplasia (rare) or secondary parathyroid hyperplasia
152
What is the clinical presentation of parathyroid hyperplasia?
Enlargement of glands Normally 1-3 grams combined weight in water clear self can be 100 grams combined weight
153
What are the risk factors of parathyroid hyperplasia?
Chief sale associated with MEN and water cell is not associated with MEN (Multiple endocrine neoplasias)
154
What is the treatment of parathyroid hyperplasia?
Excision of at least three of the four glands Frozen sections, touch preps or paraphyroid hormone essays can be performed intra-operatively to confirm removal
155
What is the macroscopic appearance of parathyroid hyperplasia?
Chief cells = all glands up to 10 grams Water clear cell = superior gland larger than inferior gland, soft, chocolate brown with cysts and haemorrhage
156
What is the microscopic appearance of parathyroid hyperplasia?
Usually no rim of compressed normal tissue May have mitotic activity Chief cell - sheets of chief cells, minimal fat, rare oxyphils Water clear cell - abundant optically clear cells with variable sizes, spherical clear vacuoles, surrounded by thin eosinophilic material, basal nuclei, compact or alveolar pattern
157
What is the differential diagnosis of parathyroid hyperplasia?
Adenoma
158
What is a parathyroid adenoma?
Benign Neoplasm derived from parathyroid parachymal cells Typically involves one gland (inferior more than superior) if two glands usually superior
159
Who is more at risk of paraphyroid adenoma?
Accounts for 85% of primary hyperparathyroidism F>M Broad age but commonly 30-60s
160
What is the clinical presentation of paraphyroid adenoma?
Can be asymptomatic if early on Kidney stone disease Bone loss Replacement of bones with fibrous tissue Weakness Fatigue Psychiatric disturbances Rare palpable masses
161
What tests can be used to investigate parathyroid adenoma?
Serum parathyroid hormone increased calcium increased FNA
162
What is the treatment for paraphyroid adenoma?
Excision
163
What is the macroscopic appearance of parathyroid adenoma?
Weight more than 40 grams Size 1 to 10 centimeters Solid yellow to tan, well circumscribed, ovoid nodule No invasion
164
What is the microscopic appearance of parathyroid adenoma?
Well circumscribed Thin fibrous capsule Decreased stromal adipocytes Compression of normal tissue at the edge Composed mainly of chief cells Mitosis Bizarre nuclei
165
What additional tests can help in the diagnosis of parathyroid adenoma?
Gata 3, parathyroid hormone positive TTF1, galactin 3 negative
166
What is the differential diagnosis of paraphyroid adenoma?
Hyperplasia Carcinoma Normal thyroid tissue
167
What is a parathyroid cyst?
Records of neck swelling contain high levels of paraphyroid hormone in the fluid
168
Who is most at risk of parathyroid cysts?
Present at any age
169
What is the clinical presentation of a parathyroid cyst?
Usually present with an asymptomatic mass
170
How are parathyroid cysts diagnosed?
FNA
171
How are parathyroid cysts treated?
Aspiration of contents Ablation in recurrent cases
172
What is the macroscopic appearance of a parathyroid cyst?
Large gland usually inferior more than superior 1-10 centimeters Uniloccular Thin walled Clear or turbid (cloudy/opaque/thick with suspended matter)
173
What is the microscopic appearance of a parathyroid cyst?
Lined by flattened parathyroid chief cells, oxyphills, clear cells No nodules Cyst wall has uniform thickness May contain granular material resembling colloid
174
What additional tests can help in the diagnosis of a parathyroid cyst?
Parathyroid hormone, chromagranin A positive Thyroglobulen negative
175
What is the differential diagnosis of a parathyroid cyst?
Cyst from thyroid Thyroglossal duct cyst Brachial cyst
176
What is hypoarthyroidism?
Endocrine abnormality that occurs when the paraphyroid glands are not functioning correctly
177
What are the clinical implications of hypotharafyroidism?
Leeds to a deficiency in parathyroid hormones Low levels of calcium in the blood High levels are phosphorus in the blood Increased irritability in the neuromuscular system
178
What are the causes of hypoparathyroidism?
Removal of parathyroid glands Autoimmune disorders Abnormal development of the gland Impaired parathyroid hormone action
179
What is the clinical presentation of a paraphyroid hormone deficiency?
Muscle weakness Tingling in fingertips Twitching of muscles
180
What is Primary hypotharathyroidism?
Congenital form of hypoparathyroidism
181
What is secondary hypoparathyroidism?
An acquired form of hypoparathyroidism
182
What is the pancreas?
An abdominal glandular organ with digestive (exocrine) and hormonal (endocrine) functions Oblong shaped With the exception of the tail it is a retroperitoneal organ located deep within the upper abdomen of the epigastrum and left hypochondrian regions
183
What are the anatomical relationships of the pancreas?
Stomach and pyloris lie anterior Duodenum curves around and outlines the head First part of the duodenum is anterior second part and the ampulla are lateral Transverse mesocolon attaches to the anterior surface of the pancreas Common bile duct descends behind and opens in the duodenum alongside the pancreatic duct Spleen is posterior and lateral
184
What are the five parts of the pancreas?
Head Uncinate process Neck Body Tail
185
What is the exocrine pancreas function?
Produces digestive enzymes
186
How does the exocrine pancreas produce digestive enzymes?
Lobulated serous gland composed of a proximately one million acini Drained by ducts into intralobular collecting ducts Drain to the main pancreatic duct which joins the common bile duct entering the duodenal at the sphincter of Oddi
187
How does the endocrine pancreas create hormones?
Clusters of cells known as is Islets of langerhans Contains cells that produce hormones relating to the endocrine functions Islets make up 5% of total pancreas
188
What sells are found in the eyelets of langerhans and what are their functions?
Alpha cells produce glucagon Beta cells produce insulin and amelyn Delta cells produce somata somatostatin Gamma cells produce pancreatic polypeptide Epsilon cells produce ghrelin
189
What are the pancreas endocrine functions?
Alpha cells - glucogen - increased blood glucose levels Beta cells - insulin - decrease blood glucose levels Beta cells - amelyn - slows gastric emptying to prevent spikes in blood glucose levels Delta cells - somatastatin - regulates islet cell secretion of other hormones Gamma cells - pancreatic polypeptide - GI function Epsilon cells - ghrelin - increases appetite Insulin also stimulates beta cells and inhibits alpha cells Glucagon stimulates alpha cells leading to activation of beta and delta cells Somatostatin inhibits alpha and beta cells
190
What tests can be used to investigate pancreatic pathologies?
Urea and electrolytes - imbalance in these occurs in acute pancreatitis and certain endocrine tumors Serum amylase - increased in acute pancreatitis Ultrasound - identifies gallstones and acute pancreatitis Peritoneal aspiration - catheter into peritoneal cavity aspirate blood/fluid or wash the cavity and obtain washings Precutaneous FNA - taken through the skin into a deep seated mass Endoscopic ultrasound guided aspiration Frozen section
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What is acute pancreatitis?
Sudden inflammation at the pancreas
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Who is most at risk of acute pancreatitis?
M=F but M has a higher mortality 50-60y for peak incidence
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What is the clinical presentation of acute pancreatitis?
Mild to severe epigastric pain Can radiate towards back Nausea Vomiting Diarrhea High white blood cell count Diffuse fat necrosis Peripheral vessel collapse Shock
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What are the causes of acute pancreatitis?
G. Gallstones E. Ethanol T. Trauma S. Steroids M. Mumps A. Autoimmune disorders S. Scorpion stings H. Hyper triglyceremia E. ERCP D. Drugs
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What are the clinical implications of acute pancreatitis?
Sepsis Shock Bowel perforation
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How is acute pancreatitis diagnosed?
Abdominal pain Serum amylase is high CT/MRI or TUS consistent with pancreatitis h High blood glucose levels
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How is acute pancreatitis treated?
Oxygen supplementation Fluids NSAIDs or opioids
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What is the microscopic appearance of acute pancreatitis?
Diffuse stippled necrosis of pancreatic parenchyma Peripancreatic fat Haemorrhage Black/brown necrosis
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What is the microscopic appearance of acute pancreatitis?
Oedema in interstitial fibrous tissue, adipose tissue and pancreatic parenchyma Acute inflammatory cells Limited fat necrosis +/- calcification
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What is the differential diagnoses of acute pancreatitis?
Acute choleocystitis Chronic pancreatitis Peptic ulcer disease
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What is chronic pancreatitis?
Fibrin inflammatory syndrome of the pancreas can follow repeated episodes of acute pancreatitis
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Where can chronic pancreatitis affect?
Pancreas and spread to surrounding organs
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Who is at most risk of chronic pancreatitis?
M=F Wide age range Can be hereditary
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What is the clinical presentation of chronic pancreatitis?
Severe abdominal pain often radiates to interscapular region Exocrine and endocrine dysfunction Weight loss Bloating Diabetes
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What are the causes of chronic pancreatitis?
Alcohol abuse Mass Stones in ducts Can be hereditary
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How is chronic pancreatitis diagnosed?
Histology plus radiology Calcification on CT Low plasma amylase
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What is the microscopic appearance of chronic pancreatitis?
Whiteish parenchyma (extensive fibrosis) Dilated ducts and calculi Calcification Pseudocysts in alcoholic pancreatitis
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What is the microscopic appearance of chronic pancreatitis?
Fibrosis Loss of acinar tissue and duct changes Fatty tissue in hereditary pancreatitis Acinar cells +/- atypia Lymphocytes Macrophages +/- multi-nucleated giant cells
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What additional tests can be used to help in the diagnosis of chronic pancreatitis?
CK7, CK19 positive P53 negative
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What is the differential diagnoses of chronic pancreatitis?
Pancreatic ductal adeno carcinoma Autoimmune pancreatitis
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What are the clinical implications of not treating chronic pancreatitis?
Abscess Systemic fat necrosis
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What can cause metaplasia to occur within the pancreas?
Information can cause squamous metaplasia in the pancreatic ducts
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If left untreated what are the implications of scream as metaplasia within the pancreatic ducks?
There is a risk of progression to pancreatic intra epithelial neoplasm
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What is PanIN?
Pancreatic inter-epithelial neoplasia
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What are pancreatic cystadonomas?
Benign Incidental finding Asymptomatic
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What is MCPNs?
Mucinus cystic pancreatic neoplasms Mucin producing lesions usually in the body or tail Asymptomatic Mostly benign but can be invasive
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What are SPNs?
Solid pseudopipillary neoplasms Benign or low grade malignant Have solid and pseudopillary architecture
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What are LECs?
Lymphoepithelial cysts Benign cystic lesion
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What are IPMSs?
Intraductal pancreatic mucious neoplasms Found in the head of the pancreas Produces symptoms of pancreatitis
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What is type 1 diabetes?
Disorder that occurs when the immune system destroys the pancreas' insulin producing cells Reduction in insulin production leads to hypoglycemia
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Who is at risk of type 1 diabetes?
Any age but usually before 40y
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What is the clinical presentation of type 1 diabetes?
Increase thirst Frequent urination Fatigue Blurred vision Weight loss Nausea Vomiting Stomach ache Mood changes
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What tests can be used to diagnose type 1 diabetes?
Urine test Blood test
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How is type 1 diabetes treated?
Insulin injections
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What is the macroscopic appearance of type 1 diabetes?
Maybe smaller than normal due to atrophy Impaired growth Loss of beta cells
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What is the microscopic appearance of type 1 diabetes?
Fewer acinar cell, same size Fibrosis Fewer Islets of langerhans but same size
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What are the clinical implications of leaving type 1 diabetes untreated?
If not managed can lead to major damage to the bodies organs
228
Name a benign, premalignant and malignant condition for the adrenal glands
Benign - Cushing syndrome Premalignant - adrenal medullary hyperplasia Malignant - carcinoma
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Name a benign and malignant condition for the parathyroid glands
Benign - hyperparathyroidism Malignant - carcinoma
230
Name a benign and malignant condition for the thyroid gland
Benign - multinodular goitre Malignant - carcinoma

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