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Clinical Pathology > 53 Endocrine diseases > Flashcards

53 Endocrine diseases Flashcards

1
Q

Where is the pituitary gland located?

A

Sella Turcica beneath the hypothalamus.

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2
Q

How do primary pituitary tumours cause effects? (2).

A

Secondary to hormone production.

Pressure on optic chiasma/adjacent pituitary.

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3
Q

What type of tumour is the most common in the thyroid?

A

Adenoma (benign).

Specifically - prolactinoma.

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4
Q

What are the types of adenoma in the pituitary? (3).

What do they cause?

A

Prolactinoma - galactorrhea, menstrual change.
GH secreting - gigantism, acromegaly.
ACTH secreting - Cushings.

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5
Q

Where does the thyroid gland migrate from?

A

Foregut.

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6
Q

Where is there a remnant of thyroid gland migration?

A

Foramen caecum.

Boundary between ant 2/3 and post 1/3 of tongue.

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7
Q

Where is the thyroid?

A

Anterior neck at level of 5th, 6th, 7th vertebrae.

Close proximity to the trachea.

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8
Q

Where may ectopic of the thyroid occur?

A

Between foramen caecum and suprasternal notch.

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9
Q

Where is the most common site for ectopic thyroid tissue?

What % are hypothyroid?

A

Lingual - base of tongue.

70%.

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10
Q

What is a thyroglossal duct cyst?
Who gets it?
Removal operation?

A

Persistent track representing embryological movement of thyroid.
Children and young adults.
Sistrunk procedure.

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11
Q

What is palpation thyroiditis?

Cause?

A

Microscopic granulomatous foci centered on thyroid follicles.
2o to rupture in surgery/palpation.

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12
Q

What is reidel thyroiditis?

Presentation? (4).

A

Fibrosing chronic thyroiditis.

Firm goitre, dysphagia, hoarseness, stridor.

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13
Q

Who gets Hashimoto’s thyroiditis?

A

Females&raquo_space; Males.

Aged 60.

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14
Q

What thyroid changes are seen in Hashimoto’s thyroiditis? (3).

A

Diffusely enlarged non tender gland.
Raised serum thyroid antibodies.
Lymphocytic infiltration + germinal centre formation.

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15
Q

What does Hashimoto’s thyroiditis raise the risk for? (2).

A

Thyroid lymphoma.

Papillary carcinoma of thyroid.

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16
Q

Who gets Grave’s disease?

A

Females&raquo_space; Males.

3/4th decade.

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17
Q

What does hashimoto’s thyroiditis cause?

A

Hypothyroidism.

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18
Q

What does Grave’s disease cause?

A

Hyperthyroidism.

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19
Q

What are the features of Grave’s disease? (7).

A 
Pretibial myxoedema.
Proptosis (exophthalmos).
Tachycardia.
Hyperactive reflexes.
Thyroid diffusely enlarged.
T3 and T4 elevated. TSH suppressed.
Thyroid autoantibodies
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20
Q

Describe a follicular adenoma of the thyroid gland. (4).

Histology. Who. Nodule. Hot vs cold?

A

Benign encapsulated tumour.
Females > males.
Painless and solitary nodule.
Usually cold on radio imaging.

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21
Q

What is the most common malignant tumour of the thyroid?

A

Differentiated thyroid carcinoma (papillary).

22
Q

What are the causes of a papillary thyroid carcinoma? (3).

A

FAP.
Cowden’s syndrome.
Radiation.

23
Q

Which type of cancer are these mutations associated with?

RET, NTRK1, PTC1/2, BRAF V600E, RAS.

A

Papillary thyroid carcinoma.

24
Q

What are the possible macroscopic appearances of a papillary thyroid carcinoma? (4).

A

Ill defined.
Encapsulated.
Cystic.
Granular.

25
Q

What are the four types of follicular neoplasms?

A

Adenoma.
Minimally invasive carcinoma.
Widely invasive carcinoma.
Hurthle cell neoplasm.

26
Q

Differentiate between a minimally invasive and a widely invasive follicular carcinoma.

A

Min: encapsulated, histological invasion only.
Wide: macroscopic invasion, or histological and >4 blood vessels invaded.

27
Q

What is a Hurthle cell carcinoma?

A

Thyroid carcinoma consisting mainly on Hurthle cells.

28
Q

How do Hurthle cell carcinomas behave?

A

Significant cervical lymph node mets.

Haematogenous: bone, liver, lung.

29
Q

Which thyroid carcinomas are unusually aggressive? (2).

A

Insular carcinoma.

Anaplastic carcinoma.

30
Q

Which cells are medullary carcinomas differentiated towards?

A

Parafollicular C cells.

31
Q

How does a primary thyroid lymphoma present? (4).

A

Mass which rapidly enlarges.
Pain and dysphagia.
Cervical lymphadenopathy.

32
Q

Which cancers commonly metastasise to the thyroid gland? (5).

A 
Renal cell carcinoma.
Melanoma.
Small cell lung cancer.
Neuroendocrine carcinoma.
Breast cancer.
33
Q

Which three factors are associated with 1o hyperparathyroidism pathogenesis?

A

Ageing.
Radiation.
MEN2A.

34
Q

What are the three causes of 1o hyperparathyroidism?

A

Adenoma (85%).
Diffuse chief/clear cell hyperplasia.
Carcinoma.

35
Q

Is primary chief cell hyperplasia neoplastic?

Site?

A

No.

All parathyroid tissue.

36
Q

What kind of enlargement does a parathyroid adenoma cause?

A

Single parathyroid gland enlargement.

Remaining glands are small + suppressed.

37
Q

Who is 2o and 3o hyperparathyroidism common in?

A

Renal failure.

38
Q

Name the zones in the adrenal gland, and the hormones they are responsible for producing: (4).

A

Medulla: catecholamines.
Reticularis: androgens.
Fasciculata: cortisol.
Glomerulosa: aldosterone.

39
Q

Adrenal congenital hypoplasia:
Genetic basis:
Treatment:

A

Rare. Small amount tissue, low hormones. Fatal unless Rx.
X-linked.
Glucocorticoid + mineralocorticoid replacement.

40
Q

Which enzyme deficiencies are seen in congenital adrenal hyperplasia?

A 
21 hydroxylase (90% of cases).
11-beta-hydroxylase.
41
Q

What does congenital adrenal hyperplasia lead to?

A

Female genital ambiguity.
Hyperandrogenism, virilisation.
Premature epiphyseal fusion - short.

42
Q

What is Addison’s disease?

Causes? (2).

A

Primary adrenal cortical insufficiency.

Autoimmune, TB.

43
Q

What are the triad of features in Addison’s disease?

A

Hyperpigmentation.
Postural hypotension.
Hyponatraemia.

44
Q

Who gets adrenal cortical nodules? (3).

A

Elderly.
Hypotensive.
Diabetic.

45
Q

What can adrenal cortical adenoma cause? (3).

A

Conn’s syndrome (if aldosterone).
Cushing’s (if cortisol).
Virilisation (rarely).

46
Q

Describe the pathology of an adrenal cortical adenoma: (2).

A

Unilateral solitary masses.

Lipid-filled adrenal cortical cells.

47
Q

5 year survival of an adrenal cortical carcinoma?

A

70%.

48
Q

What is a phaeochromocytoma?

A

Catecholamine secreting tumour arising from adrenal medulla.

49
Q

Which familial syndromes are associated with a pheochromocytoma? (3).

A

MEN2a and 2b.
von Recklinghausen’s disease.
von Hippel-Lindau disease.

50
Q

What are the symptoms of a pheochromocytoma? (4).

A

Hypertension.
Palpitations.
Headaches.
Anxiety.

51
Q

Which hormone levels are elevated from a pheochromocytoma? (3)

A

Catecholamines.
Adrenaline.
Noradrenaline.

Clinical Pathology (66 decks)

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