Endocrine Pathology

Question 1

What do endocrine glands do?

Answer 1

secrete hormones directly in to the bloodstream

act systemically

Question 2

What do paracrine glands do?

Answer 2

secrete hormones

acts locally

Question 3

What do autocrine glands do?

Answer 3

secrete hormones

affects the cell secreting the protein

Question 4

What classification are most primary pituitary tumours?

Answer 4

adenomas

benign

Question 5

What are the 3 types of anterior pituitary adenomas?

Answer 5

Prolactinoma - commonest, galactorrhoea and menstral disturbances
Growth hormone secreting - gigantism in children, acromegaly in adults
ACTH secreting - Cushing’s syndrome

Question 6

What is a common side effect of a thyroidectomy?

Answer 6

horse voice - due to damage to recurrent laryngeal nerve

Question 7

What are ultimobranchial bodies?

Answer 7

Embryological structure

Gives rise to the parafollicular cells/C cells of the thyroid gland

Question 8

Where does ectopic thyroid tissue occur?

Answer 8

From foramen cecum (tongue) to supra-sternal notch

Question 9

What is a thyroglossal duct cyst?

Answer 9

Fluid filled tissue from when the thyroid was developing in the embryo

Question 10

What is acute thyroiditis?

Answer 10

acute inflammation of the thyroid due to infection

Question 11

What is palpation thyroiditis?

Answer 11

granulomas in thyroid follicles

almost always presents as thyroid nodules

Question 12

What is hashimoto’s?

Answer 12

Aka chronic lymphocytic thyroiditis
Autoimmune chronic inflammatory disorder
Thyroid antibodies - diagnostic

Question 13

What is the gland like in hashimotos macro and microscopically?

Answer 13

Diffuse enlarge non tender gland
No nodes/focal lesions
Follicules atrophied

Question 14

Does hashimotos cause hyper or hypothyroidism?

Answer 14

HYPOthyroidism

Question 15

Hashimotos increases the patients risks of developing which cancers?

Answer 15

Thyroid lymphoma

Papillary carcinoma

Question 16

What is Graves Disease?

Answer 16

Aka Diffuse Hyperplasia

autoimmune process causing HYPERthyroidism

Question 17

Thyroid pathology is more common in men or woman?

Answer 17

Women

Question 18

What are the signs and symptoms of graves disease? (5)

Answer 18

HYPERthyroidism
Pretibial myxoedema -  waxy discolored skin, peau d orange, non pitting oedema
Hair loss
Exophthalmos/proptosis
Tachycardia
Hyperactive reflexes

Question 19

What is the gland like in Graves disease macro and microscopically?

Answer 19

Diffusely enlarged goitre
Beefy red appearance
Hyperplastic infoldings

Question 20

What are the levels of T3, T4 and TSH in Graves disease?

Answer 20

T3 and T4 are elevated

TSH supressed

Question 21

What is a multinodular goitre?

Answer 21

It’s in the name! - many nodules and enlargement of the gland
Normal thyroid function

Question 22

How are benign and malignant tumours differentiated?

Answer 22

Colour: white = Malignant
Density: solid = Malignant
Location: In situ/encapsulated = Benign
Vascularity: High = Malignant

Question 23

What is the only benign tumour of the thryoid called? How does it present?

Answer 23

Follicular adenoma
Encapsulated 
Follicular cell differentiation 
Painless neck mass
One node in one lobe
'Cold' nodule on imaging

Question 24

What is the commonest malignant tumour of the thyroid?

Answer 24

Papillary carcinoma

Question 25

What 4 gene mutations cause papillary carcinoma?

Answer 25

RET NTRK1 BRAF V600E RAS

Question 26

What are psammoma bodies?

Answer 26

calcified structures in follicules

Question 27

What are the 3 differentiated malignant tumours of the thyroid?

Answer 27

Papillary carcinoma Follicular carcinoma Hurthle cell carcinoma

Question 28

What are the 3 undifferentiated malignant tumours of the thyroid?

Answer 28

Insular carcinoma Anaplastic carcinoma Medullary carcinoma - amyloid present

Question 29

What is primary hyperparathyroidism?

Answer 29

excessive section of parathyroid hormone from one or more glands

Question 30

What is secondary hyperparathyroidism?

Answer 30

Hyperplasia of glands with elevated PTH in response to hypocalcemia

Question 31

What is tertiary hyperparathyroidism?

Answer 31

Adenoma in association with longstanding secondary hyperparathyroidism

Question 32

What 3 things cause primary hyperparathyroidism?

Answer 32

Ageing Ionising radiation MEN 2a - subtype of endocrine tumours

Question 33

What 3 non neoplastic changes to the parathyroid gland causes hyperparathyroidism?

Answer 33

Primary chief cell hyperplasia Parathyroid adenoma - one gland Secondary and tertiary parathyroidism - all glands effected

Question 34

What are the clinical features of Cushings syndrome?

Answer 34

Slim arms and legs Fat deposits on the back of the neck and shoulders = "buffalo hump" Moon face

Question 35

What are the causes of Cushing's syndrome?

Answer 35

``` Steroids Pituitary adenoma Ectopic ACTH-secreting tumor primary adrenal gland disease Familial Cushings disease ```

Question 36

How does Cushing's syndrome develop?

Answer 36

Excess cortisol in the body

Question 37

What are the clinical features of Conns syndrome?

Answer 37

``` High blood pressure High level of calcium in the blood Fatigue Headache Muscle weakness Numbness ```

Question 38

What are the causes of Conns's syndrome?

Answer 38

Aldosterone-producing tumours

Question 39

How does Conns syndrome develop?

Answer 39

Excess aldosterone

Question 40

What are the clinical features of Addisons disease?

Answer 40

Hyperpigmentation Postural hypotension Hyponatraemia

Question 41

What are the causes of Addisons disease?

Answer 41

Autoimmune most common

Question 42

How does Addisons disease develop?

Answer 42

Primary adrenal cortical deficiency | Abnormal development of the gland cortex/adrenal cortex destruction

Question 43

What is the treatment for Addisons disease?

Answer 43

Long term steroid replacement

Question 44

What is phaeochromocytoma?

Answer 44

Catecholamine-secreting tumour | Arising from adrenal medulla