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Clinical Pathology > CP9-1 diseases of the endocrine system > Flashcards

CP9-1 diseases of the endocrine system Flashcards

1
Q

What is meant by the term neurocrine?

A

Secretion of hormones into the bloodstream by neurones

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2
Q

What is meant by the term endocrine?

A

secretion of hormones into the bloodstream by endocrine glands

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3
Q

What is meant by the term paracrine?

A

Hormones molecules that are secreted by one cell affects an adjacent cell

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4
Q

What is meant by the term autocrine?

A

Hormone molecules secreted by a cell affect the secreting cell i.e. affect itself

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5
Q

What are some main glands in the body?

A

Pineal gland
Pituitary gland
Parathyroid gland
Thyroid gland
Adrenal gland
Pancreas
Ovary/testis

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6
Q

What are the most common tumours affecting the pineal gland?

A

Germline tumours -seminomas or teritomas

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7
Q

What is the role of the pituitary gland?

A

Control other endocrine glands

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8
Q

In which bone is the pituitary gland sat?

A

Sphenoid bone

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9
Q

What are the two lobes of the pituitary gland?

A

Neurohypophysis
Adenohypophysis

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10
Q

What hormones are secreted by posterior pituitary gland?

A

Oxytocin
ADH

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11
Q

What hormones are secreted by the anterior pituitary gland?

A

TSH
ACTH
FSH and LH
GH
Prolactin
Endorphin

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12
Q

What is the most common pituitary gland tumour?

A

Adenine (benign)

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13
Q

What determines how a pituitary tumour presents?

A

Depends on which hormone producing cell the tumour has developed from and clinical effects reflect the effects of excess hormone production

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14
Q

What are some local effects of pituitary tumours?

A

Bitemporal hemianopia or hypofunction of other pituitary gland cells

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15
Q

What is the most common adenoma of the pituitary gland?

A

Prolactinoma

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16
Q

When is a prolactinoma classes as a microprolactinoma?

A

<10 mm diabeter

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17
Q

When is a prolactinoma classed as a macroprolactinoma?

A

> 10 mm diameter

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18
Q

What symptom is common with a prolactinoma?

A

Bitemporal hemianopia

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19
Q

What are symptoms of prolactinoma?

A

Symptoms associated with increased prolactin production including:
Galactorrhea
Gynecomastia
Amenorrhea
Infertility

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20
Q

How is the pituitary gland related to acromegaly and gigantism?

A
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21
Q

What is the epidemiology of thyroid problems?

A

12%

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22
Q

at hormones are secreted by the thyroid gland?

A

Calcitonin
TRH
TSH
T3+T4

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23
Q

What thyroid hormone is involved in the negative feedback loop?

A

T4

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24
Q

What element (halogen) is important in thyroid function?

A

Iodine

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25
Q

What is hypothyroidism?

A

Insufficiency of circulating T3 and T4 hormones

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26
Q

What can cause hypothyroidism?

A

Congenitally = cretinism
Hashimoto’s thyroiditis (autoimmune disease)
Iodine deficiency
Drugs
Post-radioiodine therapy
Occurs secondary to pituitary gland pathology
Tertiary to hypothalamus pathology affecting pituitary gland and subsequently thyroid gland

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27
Q

What is the epidemiology of hypothyroidism?

A

2%
Women > men

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28
Q

How do patients with hypothyroidism present?

A

Painless, diffuse enlargement of gland
Elevated serum thyroid antibodies (especially in hashimoto’s)

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29
Q

What does hashimoto’s increases the risk of?

A

Thyroid lymphoma or papillary carcinoma

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30
Q

What are signs of hashimoto’s?

A

Hypothermia
Bradycardia
Periorbital oedema
Hair loss
Diastolic hypertension
Enlargement of tongue
Low basal metabolic rate
Pleural and pericardial effusion

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31
Q

What are symptoms of hashimoto’s?

A
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32
Q

What is hyperthyroidism?

A

Increased basal metabolic rate due to excess production of T3 and T4 hormones (very rarely due to excess TSH)

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33
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease (autoimmune condition)

34
Q

What can cause hyperthyroidism?

A

Grave’s disease
Diffuse goitre
Functional adenoma
Toxic modular goitre

35
Q

What is Grave’s disease?

A

An autoimmune disease where IgG auto-antibody binds to the thyroid epithelial cells causing a similar reaction to TSH and causes thyroid gland to enlarge

36
Q

What percentage of hyperthyroidism is caused by grave’s disease?

A

80%

37
Q

What is the epidemiology of grave’s disease?

A

1% worldwide
Women > men

38
Q

What are signs and symptoms of Graves’ disease?

A

pretibial myoxoedema
weight loss
tachycardia
heat intolerance + sweating
hair loss
wide eyed stare aka proptosis
hyperactive reflexes

39
Q

What is multinodular goitre (MNG)?

A

Enlargement of thyroid with varying degree nodularity that doesn’t cause hyper or hypothyroidism

40
Q

What can MNG be mistaken for?

A

Dominant nodule can be mistaken for thyroid carcinoma

41
Q

What are some complications of MNG?

A

Tracheal compression causes dysphagia

42
Q

When may multinodular goiter (MNG) present as hyperthyroidism?

A

If toxic MNG aka Plummer’s disease

43
Q

What is the epidemiology of MNG?

A
44
Q

What is a thyroid follicular adenoma?

A

A tumour with a defined fibrous tissue capsule developed from a solitary thyroid node.

45
Q

How does a thyroid follicular adenomas appear on radio-isotope scanning?

A
46
Q

What is thyroid follicular carcinoma?

A

A well differentiated malignant tumour in the thyroid, within a solitary module in 90% of cases, which invades the capsule and blood vessels

47
Q

What % of thyroid cancers are thyroid follicular carcinomas?

A

10-20%

48
Q

What % of patients with a thyroid follicular carcinoma have distant metastases?

A
49
Q

What is a papillary thyroid carcinoma?

A

A well differentiated carcinoma that invades lymphatics and spreads to local lymph nodes

50
Q

What is the most common thyroid malignant tumour?

A

Papillary thyroid carcinoma

51
Q

What % of thyroid carcinomas are papillary thyroid carcinomas?

A

60-70%

52
Q

Who is usually affected by papillary thyroid carcinomas?

A

<45 year olds
Women > men

53
Q

What is seen in histology in papillary thyroid carcinomas?

A

Annie eye nuclei
Round Calcification

54
Q

How many parathyroid glands does each person have?

A

4 in 90%
10% 3 or 5

55
Q

What is a role of the parathyroid gland?

A

Vitamin D, calcium and phosphate regulation

56
Q

What are causes or hyperparathyroidism?

A

Primary:
Parathyroid adenoma, hyperplasia or carcinoma
Familial hypocalciuric hypercalemia

Secondary to hyperthyroidsm:
Due to renal failure
Decreased calcium

Tertiary:
Autonomous hypersecretion of parathyroid hormone

57
Q

What is the epidemiology of primary hyperparathyroidism?

A

0.1% of population
Post menopausal women q

58
Q

What are symptoms of primary hyperparathyroidism?

A

Renal stones
Muscle weakness
Fatigue
Thirst and poluria
Anorexia
Constipation

59
Q

What are causes of hypercalcaemia?

A

Bone metastasise
Vit D intoxication
Sarcoidosis
Multiple myeloma
PTH producing tumours (rare)

60
Q

What are the 3 parts of the adrenal cortex?

A

Zona glomerulosa
Zona fasciculata
zona reticularis
(Outer —> inner )

61
Q

What cells are in the adrenal medulla?

A

Chromaffin cells

62
Q

What are the functions of the adrenal glands?

A

Salt regulation and BP
Blood sugar levels
Production of sex hormones
Production of stress hormones

63
Q

What is released by each layer of the adrenal cortex?

A
64
Q

What is secreted by chromaffin cells in adrenal medulla?

A
65
Q

What is Cushing’s syndrome?

A

A rare endocrine disorder due to excessive cortisol production

66
Q

What is the epidemiology of Cushing’s syndrome?

A

Men = women
25-40 year olds

67
Q

What are signs and symptoms of Cushing syndrome?

A

Central obesity with thinner arms and legs
Purple striae
Weight gain
High blood sugars
High BP
Fatigue
Sleep disorders
Emotional instability

68
Q

What is Conn’s syndrome?

A

Hyperaldosteronism causing renal retention of water and Na+ via the RAA system

69
Q

What causes Conn’s disease ?

A

Usually secondary to adrenal cortical hyperplasia, adenoma, carcinoma and familial hyperaldosteronism

70
Q

What is the epidemiology of Conn’s disease?

A

Women > men
30-50 year olds

71
Q

What are signs and symptoms of Conn’s disease?

A

mood disturbances, headaches and fatigue
polyuria and nocturia
muscle weakness, spasms and paresthesia
hypertension
cardiac arrythmias

72
Q

What is Waterhouse-Friderichsen syndrome?

A

Blood vessels in adrenal glands rupture due to severe bacterial infection. This causes acute adrenal insufficiency stopping the adrenal glands from producing hormones leading to adrenal crisis

73
Q

What is Addison’s disease?

A

Primary adrenocortical insufficiency secondary to failure of ACTH secretion - usually autoimmune cause.

74
Q

What is the epidemiology of Addison’s disease?

A
75
Q

What causes Addison’s disease?

A

autoimmunity

76
Q

What are signs and symptoms of Addison’s disease?

A
77
Q

What is pheochromocytoma?

A

Tumours of the adrenal medulla or autonomous nervous system which produce catecholamines like adrenaline and noradrenaline

78
Q

What are symptoms and signs of pheochromocytoma?

A

Racing heart beat e.g. palpitations
Headache
Pallor
Sweating
High BP

79
Q

What statistics surrounding pheochromocytoma are 10%?

A

10% are extraadrenal
10% affect children
10% are bilateral
10% are familial
10% are malignant
10% are incidental
10% are recurrent

80
Q

Most pituitary tumours are… malignant/bengin?

A

Benign

Clinical Pathology (65 decks)

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