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REGUB > 20. Pituitary and Thyroid Pathology > Flashcards

20. Pituitary and Thyroid Pathology Flashcards

1
Q

What is the anterior lobe of the pituitary also known as?

A

Adenohypophysis

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2
Q

Where does the anterior lobe of the pituitary originate from?

A

Rathke’s pouch

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3
Q

What is the other name for the posterior lobe of the pituitary?

A

Neurohypophysis

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4
Q

Where does the posterior lobe originate from?

A

3rd ventricle

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5
Q

What is pseudohypofunction of an endocrine organ?

A

Target organ receptors not functioning

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6
Q

Which hormones increase the release of:

a. GH
b. TSH
c. FSH and LH
d. ACTH

A

a. GHRH
b. TRH
c. GnRH
d. CRH

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7
Q

Which hormones inhibit the release of:

a. Prolactin
b. GH

A

a. Dopamine

b. Somatostatin

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8
Q

What is the most common tumour of the pituitary?

A

Prolactinoma

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9
Q

What are the effects of the mass of a pituitary tumour?

A

Compress optic chiasm causing bitemporal hemianopia
Decrease in other hormones
Rarely symptoms of ICP

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10
Q

What are the symptoms of a prolactinoma in men?

A

Asymptomatic
Low libido
Impotence

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11
Q

What are the symptoms of a prolactinoma in women?

A

Amenorrhoea
Sterility
Galactorrhoea

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12
Q

Why does pituitary stalk compression cause increased prolactin release?

A

No inhibition by dopamine and PRL has no stimulatory hormone

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13
Q

What is the treatment for a prolactinoma?

A

Dopamine agonist

Surgery

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14
Q

What are the effects of high growth hormone on the structure of the adult body?

A 
Prognathism
Brow protrusion
Broad nose
Large hands and feet
Enlarged tongue
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15
Q

What are the non-structural effects of acromegaly?

A

Carpal tunnel syndrome
Diabetes
Joint pain
Deafness

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16
Q

What is the difference between Cushing’s syndrome and Cushing’s disease?

A

Syndrome is high cortisol due to any cause

Cushing’s disease is due to an ACTH releasing adenoma

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17
Q

What are the causes of hypopituitarism?

A

Adenoma compressing other segments
Trauma
Post surgery or radiation
Ischaemic necrosis

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18
Q

What is Sheehan’s syndrome?

A

Ischaemic necrosis of the pituitary due to blood loss in childbirth

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19
Q

What does SIADH result in?

A

Excessive water resorption and volume overload

Hyponatraemia

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20
Q

What is diabetes insipidus?

A

Reduced secretion of ADH so that the kidneys can’t resorb water

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21
Q

What is measured in a TFT?

A

T4, T3
TSH
Thyroid antibodies
Thyroglobulin

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22
Q

What does euthyroid mean?

A

Normal thyroid function

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23
Q

What is a struma ovarii?

A

Ovarian teratoma secreting thyroid hormones

24
Q

What are the primary causes of hyperthyroidism?

A

Grave’s disease
Multinodular goitre
Adenoma>carcinoma

25
Q

What causes secondary hyperthyroidism?

A

TSH releasing pituitary adenoma

26
Q

What is a ‘thyroid storm’?

A

Abrupt severe hyperthyroidism a/w underlying Grave’s

Can cause atrial fib

27
Q

What are the causes of primary hypothyroidism?

A

Hashimoto thyroiditis
Iatrogenic: surgery, radioactive iodine, drugs
Iodine deficiency
Dyshormogenic goitre: congenital

28
Q

What affect can hypothyroidism have on the heart?

A

Complete heart block

29
Q

What is Grave’s disease?

A

Familial autoimmune condition

IgG autoantibody to TSH receptor: stimulatory effects

30
Q

What are the microscopic signs of Grave’s disease?

A

Star shaped follicles
Little coloid
Lymphocytes

31
Q

What are the clinical signs of Grave’s disease?

A

Hyperthyroidism +/- swelling
Exophthalmos
Pretibial myxedema

32
Q

What is Hashimoto’s disease?

A

Autoimmune syndrome causing hypothyroidism

Follicular epithelial cells are attacked by killer T cells

33
Q

What can cause hyperthyroidism in Hashimoto’s disease?

A

Briefly due to inflammatory reaction causing release of all T3 and T4

34
Q

What is the macroscopic appearance of the thyroid in Hasmimoto’s disease?

A

Swollen gland at start, later atrophies

35
Q

What is the microscopic appearance in Hashimoto’s disease?

A

Dense infiltrate

Oxyphilic change of follicular epithelium

36
Q

What is De Quervain’s thyroiditis?

A

Subacute granulomatous thyroiditis

History of URTI before onset of sudden painful enlargement of the thyroid and fever

37
Q

How long does De Quervain’s thyroiditis last?

A

6-8 weeks, after which the patient returns to normal

38
Q

What is the microscopic appearance of De Quervain’s thyroiditis?

A

Focal acute inflammation

Granulomas

39
Q

What investigations should be done into a thyroid nodule?

A

Ultrasound
Radionuclide imaging (warm vs cold)
FNA biopsy

40
Q

What thyroid nodules are concerning?

A

Solitary
Young or male patient
Cold on radionuclide imaging

41
Q

What is a thy 1 stage on an FNA and what is the management?

A

Non diagnostic

Repeat FNA

42
Q

What is a thy 2 stage on an FNA and what is the management?

A

Non-neoplastic: hyperplastic or colloid nodule

No need to intervene

43
Q

What is a thy 3 stage on an FNA and what is the management?

A

Possible neoplasm:
3f: follicular lesion
3a: atypia
Taken out

44
Q

What is a thy 4 or 5 stage on an FNA and what is the management?

A

4: suspicious of malignancy
5: certain of malignancy
Remove

45
Q

What are the features of a follicular adenoma?

A

Euthyroid or sometimes hyperthyroid
Encapsulated, firm and small
NO INVASION

46
Q

What are the risks for malignant thyroid tumours?

A

Radiation
High iodine
Genetic
Nodules

47
Q

What is the most common malignant thyroid tumour?

A

Papillary carcinoma

48
Q

What patient group are papillary carcinomas most common in and what is the prognosis?

A

20-40 y/o females

Low grade tumour with very good prognosis

49
Q

What are the microscopic features of papillary carcinomas?

A

Pale, overlapping nuclei
Nuclear inclusions and grooves
Psammoma bodies

50
Q

Which malignant thyroid tumour is associated with a slowly enlarging, painless nodule?

A

Follicular carcinoma

51
Q

What is the treatment for a follicular carcinoma?

A

Total thyroidectomy

Radioactive iodine

52
Q

Which thyroid tumour is associated with MEN syndromes?

A

Medullary carcinoma

53
Q

What hormone is secreted by medullary carcinomas?

A

Calcitonin

54
Q

What is distinctive about the stroma of a medullary carcinoma?

A

Amyloid-like: stains with congo red

55
Q

Which thyroid tumour has the worst prognosis?

A

Anaplastic carcinoma

REGUB (31 decks)

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