53 Endocrine diseases Flashcards
Where is the pituitary gland located?
Sella Turcica beneath the hypothalamus.
How do primary pituitary tumours cause effects? (2).
Secondary to hormone production.
Pressure on optic chiasma/adjacent pituitary.
What type of tumour is the most common in the thyroid?
Adenoma (benign).
Specifically - prolactinoma.
What are the types of adenoma in the pituitary? (3).
What do they cause?
Prolactinoma - galactorrhea, menstrual change.
GH secreting - gigantism, acromegaly.
ACTH secreting - Cushings.
Where does the thyroid gland migrate from?
Foregut.
Where is there a remnant of thyroid gland migration?
Foramen caecum.
Boundary between ant 2/3 and post 1/3 of tongue.
Where is the thyroid?
Anterior neck at level of 5th, 6th, 7th vertebrae.
Close proximity to the trachea.
Where may ectopic of the thyroid occur?
Between foramen caecum and suprasternal notch.
Where is the most common site for ectopic thyroid tissue?
What % are hypothyroid?
Lingual - base of tongue.
70%.
What is a thyroglossal duct cyst?
Who gets it?
Removal operation?
Persistent track representing embryological movement of thyroid.
Children and young adults.
Sistrunk procedure.
What is palpation thyroiditis?
Cause?
Microscopic granulomatous foci centered on thyroid follicles.
2o to rupture in surgery/palpation.
What is reidel thyroiditis?
Presentation? (4).
Fibrosing chronic thyroiditis.
Firm goitre, dysphagia, hoarseness, stridor.
Who gets Hashimoto’s thyroiditis?
Females»_space; Males.
Aged 60.
What thyroid changes are seen in Hashimoto’s thyroiditis? (3).
Diffusely enlarged non tender gland.
Raised serum thyroid antibodies.
Lymphocytic infiltration + germinal centre formation.
What does Hashimoto’s thyroiditis raise the risk for? (2).
Thyroid lymphoma.
Papillary carcinoma of thyroid.
Who gets Grave’s disease?
Females»_space; Males.
3/4th decade.
What does hashimoto’s thyroiditis cause?
Hypothyroidism.
What does Grave’s disease cause?
Hyperthyroidism.
What are the features of Grave’s disease? (7).
Pretibial myxoedema. Proptosis (exophthalmos). Tachycardia. Hyperactive reflexes. Thyroid diffusely enlarged. T3 and T4 elevated. TSH suppressed. Thyroid autoantibodies
Describe a follicular adenoma of the thyroid gland. (4).
Histology. Who. Nodule. Hot vs cold?
Benign encapsulated tumour.
Females > males.
Painless and solitary nodule.
Usually cold on radio imaging.
What is the most common malignant tumour of the thyroid?
Differentiated thyroid carcinoma (papillary).
What are the causes of a papillary thyroid carcinoma? (3).
FAP.
Cowden’s syndrome.
Radiation.
Which type of cancer are these mutations associated with?
RET, NTRK1, PTC1/2, BRAF V600E, RAS.
Papillary thyroid carcinoma.
What are the possible macroscopic appearances of a papillary thyroid carcinoma? (4).
Ill defined.
Encapsulated.
Cystic.
Granular.
What are the four types of follicular neoplasms?
Adenoma.
Minimally invasive carcinoma.
Widely invasive carcinoma.
Hurthle cell neoplasm.
Differentiate between a minimally invasive and a widely invasive follicular carcinoma.
Min: encapsulated, histological invasion only.
Wide: macroscopic invasion, or histological and >4 blood vessels invaded.
What is a Hurthle cell carcinoma?
Thyroid carcinoma consisting mainly on Hurthle cells.
How do Hurthle cell carcinomas behave?
Significant cervical lymph node mets.
Haematogenous: bone, liver, lung.
Which thyroid carcinomas are unusually aggressive? (2).
Insular carcinoma.
Anaplastic carcinoma.
Which cells are medullary carcinomas differentiated towards?
Parafollicular C cells.
How does a primary thyroid lymphoma present? (4).
Mass which rapidly enlarges.
Pain and dysphagia.
Cervical lymphadenopathy.
Which cancers commonly metastasise to the thyroid gland? (5).
Renal cell carcinoma. Melanoma. Small cell lung cancer. Neuroendocrine carcinoma. Breast cancer.
Which three factors are associated with 1o hyperparathyroidism pathogenesis?
Ageing.
Radiation.
MEN2A.
What are the three causes of 1o hyperparathyroidism?
Adenoma (85%).
Diffuse chief/clear cell hyperplasia.
Carcinoma.
Is primary chief cell hyperplasia neoplastic?
Site?
No.
All parathyroid tissue.
What kind of enlargement does a parathyroid adenoma cause?
Single parathyroid gland enlargement.
Remaining glands are small + suppressed.
Who is 2o and 3o hyperparathyroidism common in?
Renal failure.
Name the zones in the adrenal gland, and the hormones they are responsible for producing: (4).
Medulla: catecholamines.
Reticularis: androgens.
Fasciculata: cortisol.
Glomerulosa: aldosterone.
Adrenal congenital hypoplasia:
Genetic basis:
Treatment:
Rare. Small amount tissue, low hormones. Fatal unless Rx.
X-linked.
Glucocorticoid + mineralocorticoid replacement.
Which enzyme deficiencies are seen in congenital adrenal hyperplasia?
21 hydroxylase (90% of cases). 11-beta-hydroxylase.
What does congenital adrenal hyperplasia lead to?
Female genital ambiguity.
Hyperandrogenism, virilisation.
Premature epiphyseal fusion - short.
What is Addison’s disease?
Causes? (2).
Primary adrenal cortical insufficiency.
Autoimmune, TB.
What are the triad of features in Addison’s disease?
Hyperpigmentation.
Postural hypotension.
Hyponatraemia.
Who gets adrenal cortical nodules? (3).
Elderly.
Hypotensive.
Diabetic.
What can adrenal cortical adenoma cause? (3).
Conn’s syndrome (if aldosterone).
Cushing’s (if cortisol).
Virilisation (rarely).
Describe the pathology of an adrenal cortical adenoma: (2).
Unilateral solitary masses.
Lipid-filled adrenal cortical cells.
5 year survival of an adrenal cortical carcinoma?
70%.
What is a phaeochromocytoma?
Catecholamine secreting tumour arising from adrenal medulla.
Which familial syndromes are associated with a pheochromocytoma? (3).
MEN2a and 2b.
von Recklinghausen’s disease.
von Hippel-Lindau disease.
What are the symptoms of a pheochromocytoma? (4).
Hypertension.
Palpitations.
Headaches.
Anxiety.
Which hormone levels are elevated from a pheochromocytoma? (3)
Catecholamines.
Adrenaline.
Noradrenaline.
