Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Scientific Basis of Clinical Practice > Endocrine Pathology > Flashcards

Endocrine Pathology Flashcards

(85 cards)

Start Studying
1
Q

define diabetes mellitus

A

a chronic disorder of carbohydrates, fat and protein metabolism due to defective insulin secretory response, resulting in impaired carbohydrate, mainly glucose, use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the subtypes of primary diabetes?

A

type 1; insulin dependent diabetes mellitus

type 2; non-insulin dependent diabetes mellitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what genetic abnormalities is diabetes associated with?

A

genetic defects of B-cell function;
including maturity onset diabetes of the young (MODY)
chromosomal abnormalities; 2, 7, 12
some mitochondrial DNA abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is associated with secondary diabetes?

A

chronic pancreatitis
haemochromatosis
infectious; congenital rubella, cytomegalovirus
endocrinopathies; adrenal, pituitary tumours
congenital rubella
cytomegalovirus infection
drugs; corticosteroids, pentamidine, vacor
genetic disorders; downs syndrome
gestational diabetes mellitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the clinical features of type 1 diabetes?

A 
<20yrs onset
typically has normal weight
decreased blood insulin levels
anti-islet cell antibodies in the blood
ketoacidosis common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the clinical features of type 2 diabetes?

A 
onset later in life, >30yrs
typically obese
insulin levels normal or increased
ketoacidosis rare
90-100% concordance in twins
no HLA association
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the pathological features of type 1 diabetes?

A 
frequently HLA-D linked
autoimmune immunopathological mechanism
inflammation or insulitis in the islet cells early on in the disease
marked atrophy and fibrosis
severe beta cell depletion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the pathological features of type 2 diabetes?

A 
insulin resistance
relative deficiency of insulin
no inflammation in the islets of langerhans 
become focally atrophic
amyloid proteins may be deposited
only mild beta-cell depletion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe normal insulin production in normal islet cells

A

glucose results in stimulation of insulin production
increasing levels of glucose in the blood are transported across the cell boundary by the GLUT-2 transport mechanism
increasing production of preproinsulin and proinsulin
insulin is released into the bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the normal effects of insulin on cells?

A 
attaches to the insulin receptors
increased production of glucose transport units
increase in glucose uptake by the cell
increased protein synthesis
transfer of glucose into lipids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how does type 1 diabetes develop?

A 
genetic deposition; HLA-linked gene
environmental insult; viral infection
direct damage to beta cells
immune response develops against normal/altered beta cells
increased beta cell destruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the autoimmune factors that are associated with type 1 diabetes?

A 
pre-clinical phase of islet destruction; insulitis
presence of CD8 and CD9-positive macrophages
increase in class 1 major histocompatibility complex molecules
aberrant expression of class 2 MCH
70-80%; islet cell autoantibodies in their circulation
10-20%; other autoimmune diseases, SLE, RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how is obesity a risk factors for type 2 diabetes?

A

the peripheral tissues; muscle and fat, develop insulin resistance
unable to adequately utilise the glucose present in the blood
combined with deranged insulin secretion
= hyperglycaemia
the beta cells are unable to produce enough insulin to adequately lower the blood glucose and become exhausted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the features of deranged insulin secretion?

A

loss of the normal pulsatile oscillating secretion of insulin within the blood
abnormal response to hyperglycaemia
possibility of a genetic vulnerability to hyperglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the pathological complications of diabetes?

A

non-enzymatic glycolysation; glucose becomes linked with haemoglobin or becomes linked to collagen and form advanced glycosylation end products (AGE)
intracellular hyperglycaemia; disturbances of the polyol pathways
accumulation of sorbitol and fructose within the cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the clinical complication of diabetes?

A

brain; disease of small vessels
eyes; cataracts and glaucoma
MI
diseases of the small vessels of the peripheries; gangrene of the feet and toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

describe the complications of diabetes in the pancreas

A 
more common in type 1 diabetes
inflammatory cells/leucocytes  are present in the islets; insulitis
beta cell degranulation
reduction in the islet cell mass
amyloid deposition may occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

describe atherosclerosis in diabetes

A

occurs more rapidly in diabetes
atherosclerotic plaques are complicated by ulceration
marked fibrosis and calcification
origin of many of the vessels are occluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the causes of vascular complications in diabetes?

A

elevated blood lipid levels
low levels of HDL
increased thromboxane A2 activity; increased platelet stickiness
hyaline arteriosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

describe the complications of diabetes in the kidneys

A

renal artery narrowing; renal ischaemia and hypertension

diabetic microangiopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

describe diabetic microangiopathy

A

diffuse thickening of the basement membrane of small capillaries;
glomerular lesions
vascular lesions
pyelonephritis and necrotising papillitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

describe the glomerular lesions of diabetic microangiopathy

A

basement membrane thickening; the normal structures of an internal lamina densa, with outer laminar rara is lost
uniform thickening
increased deposition of glycjogenated collagen proteins

diffuse glomerulosclerosis; increase in mesangial matrix and narrowing of the capillary loops

nodular glomerulosclerosis; deposition of abnormal collagen fibres, result in a decrease in glomerular blood flow and development of renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

describe the vascular lesions of diabetic microangiopathy

A

hyaline arteriosclerosis; narrowing of the afferent and efferent arterioles due to deposition of hyaline material, replacing the muscle of the media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

describe pyelonephritis and necrotising papillitis associated with diabetic microangiopathy

A

acute pyelonephritis; mottled appearance, hyperaemia, inflammation and necrosis
tubules filled with polymorphs and inflammatory debris
necrotising papillitis; inflammation, associated ischaemia, necrosis of the papilla, passes into the ureter and may cause obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the neurological complications associated with diabetes mellitus?
peripheral symmetrical neuropathy may involve the sensory, motor or autonomic nervous system gangrene; inadequately supply of nerves with blood, resulting in nerve damage and cerebral haemorrhage cerebral haemorrhage; microangiopathy cerebral infarction; loss of blood supply, involvement of vessels within the brain, embolism from atherosclerotic neck vessels
26
what are the skin complications of diabetes?
recurrent infections; bacterial, fungal necrobiosis lipodica diabeticorum granuloma annulare
27
what are the pregnancy complications of diabetes?
increased chance of pre-elcamptic toxaemia large and immature babies risk of neonatal hypoglycaemia
28
describe the thyroid gland
develops embryologically from a down-growth of the pharyngeal epithelium descends lower in the neck during embryological development 15-20g very vascular organ nerve supply; cervical sympathetic nerves act on blood vessels to influence secretions
29
describe the histology of the thyroid gland
thyroid follicles lined by thyroid follicular epithelium | the follicles contain colloid; the store for thyroid hormone
30
describe the physiology of the thyroid gland
TSH released by the pituitary gland following the action of trophic factors from the hypothalamus in the base of the brain TSH acts on thyroid tissue to release T4/thyroxine and smaller amounts of T3/triiodothyronine T3 and T4 are released into the circulation; reversibly bound to thyroxine-binding globulin/TBG T3 and T4 have a negative effects on TSH and TRH
31
describe multi nodular goitre formation
a progressive cycle of hyperplasia, degeneration and fibrosis the gland becomes overall enlarged and nodular cystic change within the follicles surrounded by fibrosis
32
describe hyperthyroidism
a hyper metabolic state characterised by increased levels of thyroid hormones and gland hyperfunction ``` causes; diffuse hyperplasia thyroiditis hyper-functioning goitre over-ingestion of hormone ```
33
what conditions are associated with hyperthyroidism?
``` diffuse toxic hyperplasia (Grave's) toxic multi nodular goitre toxic adenoma acute.subacute thyroiditis thyroid stimulating hormone secreting pituitary hormone neonatal thyrotoxicosis in maternal struma ovarii; ovarian teratomatous thyroid iatrogenic (exogenous) hyperthyroidism ```
34
what are the clinical features of hyperthyroidism?
overactivity of the sympathetic nervous system cardiac; output increased, tachycardia, palpitations, arrhythmias, congestive heart failure neuromuscular; atrophy of musculoskeletal tissues, tremor, hyperactivity, emotional lability, anxiety osteoporosis skin; warm and moist, increased sweating GI; increased appetite, weight loss, increased bowel motility
35
how is hyperthyroidism diagnosed?
free T4 levels increased suppressed TSH radioactive iodine uptake by thyroid; increased activity
36
what are the causes of hypothyroidism?
insufficient thyroid parenchyma; developmental, radiation injury/surgical ablation, Hashimoto's thyroiditis interference with thyroid hormone synthesis; idiopathic primary hypothyroidism, iodine deficiency, drugs supra thyroidal; pituitary lesions, hypothalamic lesions
37
describe hypothyroidism in infancy
poor development of CNS and skeleton; severe mental retardation T3 T4 cross feto/maternal barrier before birth
38
what are the clinical features of hypothyroidism?
``` myxoedema decreased sweating constipation accumulation of matrix substances in subcutaneous tissue fatigue mental sluggishness slow speech cold intolerance weight gain reduced cardiac output; shortness of breath, reduced exercise tolerance ```
39
how is hypothyroidism diagnosed?
decreased thyroid hormone levels | TSH leve increased
40
describe the inflammatory conditions of the thyroid gland/thyroiditis
Hashimoto's and grave's; immune-related, associated with under activity and overactivity of thyroid hormone production granulomatous and subacute lymphocytic thyroiditis; diagnosed down the microscope riddle's thyroiditis; progressive fibrous replacement of the thyroid tissue palpation thyroiditis; histological changes after the preoperative handling or palpation of the thyroid tissue
41
describe the features Hashimoto's thyroiditis
gross; symmetrical atrophy of the normal bulk of thyroid tissue microscopy; normal follicles replaced by a lymphoid infiltrate epithelial cells; abundant eosinophilic/pink cytoplasm, oncocytic/Hurthle cell metaplasia
42
describe the pathology of Hashimoto's thyroiditis
the most common cause of thyroiditis autoimmune; caused by a T cell defect involves both cellular and humeral immunity blood; high titres of anti-thyroid antibodies, including anti-thyroid globulin antibody may have a genetic component associated with subtypes of HLA
43
what are the clinical features of Hashimoto's thyroiditis?
more common in females typically from 45-65yrs painless enlargement of the thyroid lobes rarely associated with an increase in B-cell lymphomas of the thyroid can be associated with other autoimmune diseases
44
describe grave's disease
hyper functional diffuse enlargement of the thyroid tissue infiltrative ophthalmology; exophthalmos immune mediated infiltration of the periocular muscles and soft tissue associated with pretibial myxoedema more common in females typically from 20-40yrs can be genetically linked
45
describe the pathology of grave's disease
autoimmune over-stimulation of the TSH receptor caused by auto-antibodies increased peripheral levels of thyroid hormone in the blood decrease in TSH histology; diffuse hyperplasia which involves both lobes
46
what clinical features suggest a thyroid neoplasm?
a solitary nodule; clinically palpable or discovered on imaging enlarged nodes in the neck a nodule in a younger patient
47
describe thyroid adenoma
a benign lesion of the thyroid gland presents as a direct solitary mass a lesion derived from the follicular epithelium of the thyroid gland share architectural and nuclear features with follicular carcinoma generally encapsulated defining feature; no evidence of capsular or vascular invasion range of histological subtypes; microfollicular, macrofollicular, oncocytic, hurthle cell
48
describe a follicular adenoma
``` composed of follicle of variable sizes many have a micro follicular pattern have a border of fibroconnective tissue must not show breach no vascular invasion ```
49
what are the risk factors for thyroid cancer?
mostly sporadic ionising radiation genetic susceptibility FAP familial papillary thyroid carcinoma syndrome medullary carcinoma; multiple endocrine neoplasia sydrnomes (MEN)
50
what are the main types of thyroid carcinoma?
papillary; most common follicular medullary anaplastic
51
describe papillary carcinomas
differentiated the tumour cells recapitulate the normal thyroid follicular epithelial cells metastasises to the lymph nodes typically 20-40yrs often presents as a thyroid nodule or mass
52
describe the diagnosis of a papillary carcinoma
based on a combination of a typically papillary-type architecture and characteristic nuclear features imaging fine needle aspiration
53
describe the histology of a papillary carcinoma
formation of well-formed fibrovascular papillae lined by neoplastic cells enlarged nuclei open/empty chromatin patterns often overlapping intranuclear pseudo inclusions; invaginations of the cytoplasm into the nucleus nuclear membranes are often irregular or wrinkled
54
describe the follicular carcinoma
10-15% differentiated characterised by capsular or vascular invasion, or both spreads via the blood-borne route minimally invasive; excellent long-term prognosis widely invasive; much poorer prognosis diagnosis requires full thickness breach through the capsule
55
describe the histology of a follicular carcinoma
full thickness capsular breach | or invasion into the blood vessels
56
describe medullary carcinoma
consists of neuroendocrine cells derived from the parafollicular C cells form tumours composed of sheets, trabecular or nests of small, darkly staining cells may secrete calcitonin deposition of pink amyloid associated with malignant cells can be associated with multiple endocrine neoplasia syndrome type 2 or familial medullary thyroid carcinoma syndrome up to 25% inherited
57
describe the diagnosis of medullary carcinoma
calcitonin serum levels; diagnostic parameter
58
describe the histology of medullary carcinoma
darkly staining closely-plaqued tumour cells | pink stromal amyloid
59
describe anaplastic carcinoma
rare; <5% all thyroid cancers undifferentiated consists of pleomorphic or spindled tumour cells which are obviously malignant high mortality; 90-100% local invasions; involves important structures of the neck mean age 65
60
describe the histology of anaplastic carcinoma
undifferentiated, obviously malignant cells high mitotic rate very pleomorphic nuclear features
61
describe poorly differentiated carcinoma
intermediate morphologically and behaviourally between differentiated and undifferentiated thyroid tumours composed of insular, solid or trabecular cells usually shows a widely invasive pattern within the thyroid tissue associated with necrosis obvious vascular invasion
62
describe thyroid lymphoma
rare may complicated thyroiditis usually a low-grade B-cell neoplasm can be high grade and aggressive; diffuse large B-cell
63
describe carcinoid tumours and the cells they originate from
arise from the cells which generate bioactive compounds present in various organs throughout the body derived from epithelial stem cells; islets, biliary tract, liver, C cells, adrenal most commonly seen in the GI tract phenotypically resemble endocrine cells
64
what are the features of carcinoid tumours?
occur at any age; peak between 50-60yrs | synthesise a wide range of bioactive products and hormones; insulin, 5-hydroxytryptamine, calcitonin
65
describe the behaviour of carcinoid tumours
potentially malignant variable behaviour; depending on site of tumour, depth of local penetration of tumour, and tumour size appendices and rectal carcinoids are less aggressive than gastric or small intestinal carcinoids
66
describe the anatomy of carcinoid tumours
gross; may be quite small, arise at the lower end of the small intestine histologically; often bland, with a monotonous cell population, shows little pleomorphism
67
describe carcinoid syndrome
due to elevated levels of 5-hydroxytryptamine and 5-hydroxyindoleacetic acid in the blood associated with carcinoid tumours GI carcinoids; frequently asymptomatic, small in size lung carcinoids; may produce a mass lesion gastric pancreatic carcinoids; may produce gastrin, results in Zollinger-Ellison syndrome or hyper secretion of stomach acid
68
what are the clinical features of carcinoid syndrome?
vasomotor disturbances; skin flushing and cyanosis intestinal hypertrophy; diarrhoea, abdominal cramps, nausea, vomiting asthmatic or bronchoconstrictive attacks; cough, wheezing, dyspnoea liver enlargement systemic fibrosis; heart (pulmonary and tricuspid valves), sub-endocardial fibrosis (RV) bronchial carcinoids; similar effects on the left side of the heart retroperitoneal and pelvic fibrosis collagenous pleural and intimal aortic plaques
69
what are the causes of increased cortisol levels?
anterior pituitary tumour; produces ACTH which acts on the adrenal gland adrenal gland adenoma adrenal gland hyperplasia a lung tumour (SCLC) produces ACTH; paraneoplastic Cushing's syndrome excessive steroids; iatrogenic Cushing's syndrome, atrophy fo the adrenal gland
70
what are the causes of Cushing's syndrome?
primary hyper secretion of ACTH; >50% primary adrenal neoplasm; 15-30% ectopic ACTH; SCLC, carcinoid tumour, medullary carcinoma of thyroid
71
what are the clinical features of Cushing's syndrome?
``` central obesity moon-like face weakness tiredness increased hair on the face and body high blood pressure high colour glucose intolerance; diabetes osteoporosis psychiatric symptoms ```
72
what are the causes of primary adrenal insufficiency?
``` loss of the cortex; antuommune infections; TB, fungal infection amyloid deposition in the adrenal glands metastatic carcinoma ```
73
what are the causes of secondary adrenal insufficiency?
hypo function of the pituitary gland; tumours inflammation
74
describe an adrenal adenoma
a tumour of the adrenal cortex large, well-defined, circumscribed nodules histology; encapsulated lesions proliferation of adrenal cortical cells
75
describe an adrenal carcinoma
a tumour of the adrenal cortex large tumour replacing the adrenal gland destroys surrounding tissue and invades into the surrounding structures histology; considerable mitotic activity and nuclear proliferation
76
describe pheochromocytomas
tumours which arise in the medulla derived from the sympathetic nervous system cells produce catecholamines may behave in a malignant fashion primarily benign associated with familial multiple endocrine neoplasia
77
what are the symptoms and signs of a pheochromocytoma?
``` sweating hypertension increased HR anxiety feeling of impending doom ```
78
describe the anatomy of a pheochromocytoma
gross; well circumscribed lesion does not involve the fat around the adrenal gland histology; considerable nuclear variability and mitotic activity malignant behaviour; invasion of adjacent tissue, presence of metastases
79
what are the consequences of pituitary adenomas?
secrete hormones; ACTH, GH, prolactin mass effect; press on adjacent structures can press on the optic nerve; bitemporal hemianopia
80
what are the clinical features of a pituitary adenoma?
endocrine abnormalitity mass effect of the lesion radiographic abnormality of the sella turcica pressure on the optic chiasm; bitemporal hemianopia increased intracranial pressure; headache, nausea, vomiting
81
describe the normal pituitary gland and how this changes in an adenoma
acidophil cells; produce GH, then produce excess basophil cells; produce ACTH, then produce excess chromophobe cells; produce no hormones normally, may produce prolactin in adenoma associated with MEN1
82
describe a microadenoma
``` a small pituitary tumour only identified on histology associated with excess prolactin production a caused of infertility no mechanical effect ```
83
what are the causes of hypopituitarism?
``` tumours mass lesions of the pituitary following pituitary surgery or radiation rathke's cleft cyst pituitary haemorrhage ischaemic necrosis/sheehan's syndrome; leads to empty sella syndrome genetic causes metastatic carcinoma ```
84
describe Sheehan's syndrome
hypotension inadequate blood supply necrosis of the pituitary gland
85
what syndromes are associated with the posterior pituitary?
diabetes insipidus | SIADH; leads to hyponatraemia

Scientific Basis of Clinical Practice (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions