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Histopathology > Histopathology 4 - Endocrine disease > Flashcards

Histopathology 4 - Endocrine disease Flashcards

1
Q

What are the most common causes of hyper- and hypo-pituitarism?

A

Hyperpituitarism: functional adenoma
Hypopituitarism: nonsecretory adenomas/ ischaemic necrosis (Sheehan’s syndrome)/ surgery

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2
Q

What are the 3 symptoms of local mass effect of pituitary tumours?

A

Bitemporal hemianopia
Elevated ICP
Obstructive hydrocephalus

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3
Q

Recall 4 differentials for primary hyperthyroidism

A
  1. Grave’s
  2. Hyperfunctioning multinodular goitre
  3. Hyperfunctioning adenoma
  4. Thyroiditis
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4
Q

What is the cause of secondary hyperthyroidism?

A

TSH-secreting pituitary adenoma (rare)

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5
Q

How can struma ovarii cause thyroid disease?

A

Ovarian teratomas can secrete ectopic thyroxine

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6
Q

What autoimmune condition can cause hypothyroidism?

A

Hashimoto’s

most common cause of hypothyroidism in the UK

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7
Q

Differentiate the type of auto-antibodies involved in Grave’s vs Hashimoto’s

A

Grave’s: anti-TSH
Hashimoto’s: anti-TPO and anti-TG (thyroglobulin)

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8
Q

What is the histological appearance of a Hashimoto’s thyroid?

A

Lymphocyte aggregates and transformed follicular cells

Hurthle cells

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9
Q

What are the main symptoms of Hashimoto’s?

A

Clinically hypothyroid
Painless goitre

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10
Q

Recall 4 differentials for the cause of hypothyroidism

A
  1. Postablative
  2. Iodine deficiency - most common worldwide
  3. Congenital biosynthetic defect
  4. Autoimmune (Hashimoto’s) - most common in the UK
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11
Q

What is a thyroid adenoma?

A

Benign neoplasm of follicular thyroid epithelium

A small proportion causes thyrotoxicosis

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12
Q

How are thyroid adenomas diagnosed?

A

FNA and cytology

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13
Q

What are the 4 subtypes of thyroid carcinoma?

A

Papillary

Follicular

Medullary
Anaplastic

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14
Q

What is the most common type of thyroid carcinoma?

A

Papillary

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15
Q

What are the key histological features of papillary thyroid cancer?

A

Optically clear nuclei
Psammoma bodies

Orphan Annie eye: intranuclear inclusions

**this is the basis for diagnosis

NOT based on markers!

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16
Q

Which type of thyroid adenoma is associated with Multiple Endocrine Neoplasia?

A

Medullary

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17
Q

Which type of thyroid adenoma is most aggressive?

A

Aplastic

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18
Q

What is the most common cause of primary hyperparathyroidism?

A

Solitary adenoma

Followed by:

parathyroid hyperplasia

Carcinoma (very rare)

a before h; adenoma is more common than hyperplasia

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19
Q

What is the most common symptom of hyperparathyroidism?

A

Clinically silent hypercalcaemia (so not really a symptom)

If it is symptomatic:

bones- osteitis fibrosa cystica

stones - kidney stones

abdominal groans - constipation, nausea and ovmiting

psychic moans- depression

thrones - polyuria, polydipsia

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20
Q

What is secondary hyperparathyroidism almost always caused by?

A

Renal failure –> low calcium

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21
Q

Recall 3 possible causes of hypoparathyroidism

A

Surgical ablation
Congenital absence - di george syndrome
Auto-immune

22
Q

Recall 4 possible symptoms of hypoparathyroidism

A

Those of hypocalcaemia:
Muscle spasms/ tetany
Cardiac arrhythmias
Fits
Cataracts

CATS go numb

convulsions

arrythmia

tetany

spasms

numbness

23
Q

Recall the synthetic function of each zone of the adrenals

A

Medulla: Noradrenaline and adrenaline
Reticularis: androgens
Fasciculata: glucocorticoids
Glomerulosa: aldosterone

GFR - out to in

24
Q

What is Waterhouse-Friedrichson syndrome?

A

Adrenal insufficiency with sepsis and DIC

25
Q

Most common functional adenoma

A

Prolactinoma

26
Q

Size of amicroadenoma

A

<1cm

27
Q

Features of growth hormone excess

A
  • Diabetes
  • muscle weakness
  • hypertension
  • congestive cardiac failure
28
Q

Which anterior pituitary hormone deficiency manifests earliest?

A

Gonadotrophin deficiency

  • Amenorrhoea and infertility in women
  • Decreased libido and impotence in men
29
Q

Which type of cells make up anterior vs posterior pituitary?

A

Anterior: epithelial cells

Posterior: nerve cells

30
Q

Cells of the thyroid gland

A
  1. Follicular cells - epitehlial cells lining the follicles
    - these respond to TSH
    - convert Thyroglobulin –> T3 and T4
  2. Stromal cells
  3. Parafollicular cells - aka C cells
    - release calcitonin
31
Q

Causes of non-toxic thyroid goitre

A
  1. iodine deficiency
  2. cabbage
  3. enzyme defects
  4. puberty especially in girls
32
Q

What leads to multi-nodular goitre?

A
  • With time, simple thyroid enlargement may → multi-nodular pattern
  • This may reach a massive size which can → mechanical effects including:
    • dysphagia
    • and airway obstruction
  • A hyperfunctioning autonomic nodule may develop within multi-nodular goitre:
    • → hyperthyroidism
33
Q

Marker for follicular carcinoma

A

Thyroglobulin

34
Q

Causes of follicular carcinoma

A

80% are sporadic

20% are familial- associated with MEN- specifically in younger individuals

35
Q

Histology of medullary thyroid carcinoma

A
  • sheets of dark cells
  • apple green birefringence under polarised light
    • due to calcitonin being broken down into amyloid
36
Q

Which thyroid carcinoma is associated with amyloid?

A

Medullary

  • tumour of parafollicular C cells which produce calcitonin

calcitonin is broken down into amyloid

aMyloid- medullary

37
Q

Which cells are affected in medullary thyroid carcinoma?

A

Parafollicular c cells

38
Q

What type of nodule is more likely to be cancerous?

A
  • solitary
  • solid
  • younger patient
  • M>F
  • cold nodules more likely to be neoplastic compared to hot nodules
39
Q
A
40
Q
A
41
Q

Most common cause of cushing’s syndrome

A

exogenous steroids

  • atrophic adrenals
42
Q

Causes of endogenous cushing’s syndrome

A

Cushing’s disease (ACTH secreting tumour) –> solitary adrenal neoplasm (adenoma/carcinoma)–> bilateral adrenal hyperplasia (least common)

*contrast with adldosterone where bilateral adrenal hyperplasia is a more common cause than solitary adenoma/conn’s*

43
Q

Most common causes of primary hyperadlosteronism

A

60% bilateral adrenal hyperplasia

35% aldosterone secreting adenoma - Conn’s syndrome

44
Q

Causes of acute adrenal deficiency

A

–Sudden withdrawal of corticosteroid therapy

–Haemorrhage (neonates)

–Sepsis with DIC (Waterhouse-Friderichson syndrome)

45
Q

Causes of chronic adrenal insufficiency (Addison’s)

A

–Autoimmune (75-90%)

–TB

–HIV

–Metastatic tumour (lung and breast particularly)

–Rarely amyloid, fungal infections, haemochromatosis, sarcoidosis

46
Q

Rule of 10s for phaeochromocytoma

A

–10% arise in association with a familial syndrome inc. MEN 2A and 2B, von Hippel-Lindau disease and Sturge-Weber syndrome

–10% are bilateral

–10% are malignant

–In addition 10% of catecholamine-secreting tumours arise outside the adrenal (paragangliomas)

47
Q

Two tumours of adrenal medull

A
  1. Phaeochromocytoma
  2. neuroblastoma
48
Q

Inheritance pattern of MEN syndromes

A

autosomal dominant

49
Q

Features of MEN1

A

3Ps

pituitary adenoma

parathyroid adenoma

pancreatic tumour - insulinoma

50
Q

Features of Men2A

A

3Cs

Calcium (parathyroid adenoma)

Calcitonin (medullary thyroid carcinoma)

Catecholamines (phaeochromocytoma)

51
Q

Features of Men2B

A

Medullary thyroid carcinoma

Phaeochromocytoma

Marfanoid body habitus

Mucosal neoplasms/ ganlgioneuromas

52
Q

Which MEN syndromes cause hyperparathyroidism?

A

Men1 and Men2A

Histopathology (18 decks)

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