Diseases of Endocrine System Flashcards by Imaani Goodier

where is the pituitary gland situated?

in the Sella Turcica

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how many parts of the pituitary gland are there and what percentage of the pituitary gland does it pertain?

Anterior and Posterior

75% = anterior lobe
25% = posterior lobe

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what is the function of the Adenohypophysis?

produces

prolactin
adenocorticotropic
growth hormone
thyroid stimulating
follicle-stimulating
luteinsing

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what is the function of the Neurohypophysis?

Produces

Oxytocin
antidiuretic peptide

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what are the causes of anterior pituitary hypo function?

VITAMIN D3

Vascular - Infarction
Inflammation - granulomatous
Trauma
Autoimmune - Pituitary autoimmune disease
Metabolic
Infection
Neoplasia - Non-secretory adenoma, metastatic carcinoma
D3 - Doctors

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what type of primary pituitary tumours is most common?

most = adenomas

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what are the types of Anterior Pituitary Adenomas?

Prolactinoma - commonest, galactorrhoea and menstrual disturbance
Growth Hormone Secreting - Gigantism in children, acromegaly in adults
ACTH secreting - Cushing’s syndrome

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where is the thyroid located?

located at the level of 5th - 7th vertebra

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how does the thyroid get to its position?

The main part migrates from foregut to anterior neck

- Ultimobranchial body forms in branchial arches and fuses with main gland laterally

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what is Chronic Lymphocytic Thyroiditis?

Autoimmune chronic inflammatory disorder that affect females more than males with a peak age at 59 years old

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what are the increased risks of Hashimoto’s?

80-fold increased risk of thyroid lymphoma

- Increased risk of papillary carcinoma of the thyroid

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what is Diffuse Hyperplasia (GRAVES DISEASE)

An autoimmune process, a diffuse hyperplasia of the follicular epithelium

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what is the cause of most cases of hyperthyroidism?

responsible for 80% of cases is diffuse hyperplasia (Graves’ Disease)

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what are the physical findings of GRAVES’ DISEASE?

Pretibial myxoedema, 
hair loss,
 wide-eyed stare or proptosis, 
tachycardia,
 hyperactive reflexes

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what are the clinical findings of Diffuse Hyperplasia?

Thyroid diffusely enlarged
T3 and T4 elevated.
TSH markedly suppressed
Thyroid autoantibodies - thyroid stimulating immunoglobin

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what is Multinodular Goitre?

Enlargement of thyroid +/- nodularity

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what is multinodular goitre often mistaken for?

Large ‘dominant’ nodules may be mistaken clinically for thyroid carcinoma

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what is follicular adenoma?

Benign encapsulated tumour with evidence of follicular cell differentiation

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what groups are more likely affected by follicular adenoma?

Females > Males

wide age range, usually fifth to sixth decade

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what are the % of malignant tumours of the thyroid?

1.1% of new cancers
0.32% of cancer deaths
85% are differentiated thyroid carcinoma
5-9% are medullary carcinoma
1-2% are anapaestic carcinoma
1-3% are malignant lymphoma

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what is the commonest type of thyroid carcinoma?

papillary carcinoma - 70%

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who is most at risk for papillary carcinoma?

Female predominance 2.5:1

wide age range mean 43 years

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what is papillary Carcinoma?

Familial, autosomal dominant non-medullary thyroid carcinoma

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what % of all thyroid cancer are follicular carcinomas?

10-20% of all thyroid cancers

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how do most follicular carcinoma present?

90% present with solitary nodule in thyroid

what are the groups most affected by Hurthle Cell Carcinomas?

Median age 53 (range 24-85 years) | Sex ratio of F:M 7:3

what is the main difference between follicular carcinoma?

Hurthle cell carcinomas have a significant incidence of cervical lymph node metastases compared to follicular carcinoma

what are the common haematogenous sites for hurthle cell carcinoma?

Bone, Liver and Lung

what is Primary Hyperparathyroidism?

excessive secretion of parathyroid hormone from one or more glands (PHPT)

what is secondary Hyperparathyroidism?

hyperplasia of glands with elevated PTH in response to hypocalcemia

what is tertiary hyperparathyroidism?

in association with longstanding secondary hyperparathyroidism

what is the incidence of primary hyperparathyroidism?

1. 25 - 28 cases per 100,000 population | 2. Caucasian women over 60 - 190/100,000

what is the pathogenesis of primary hyperparathyroidism?

1. Aging, tumorigenesis in general 2. Association with ionising irradiation 3. MEN 2a

what are the signs of Hypercalcemia/Hyperparathyroidism? Bones, Stones, Groans, Moans

1. Painful bones - painful bone condition 2. Renal Stones - Kidney Stones 3. Abdominal Groans - Gi symptoms: Nausea, Vomiting, Constipation, Indigestion 4. Psychiatric Moans - Effects on nervous system: lethargy, fatigue, memory loss, psychosis, depression

what is parathyroid Adenoma?

An encapsulated benign neoplasm of parathyroid cells

what is parathyroid adenoma associated with?

has an association with MEN1 and MEN2 syndrome and hyperparathyroidism and jaw tumour syndrome

what occurs during secondary and tertiary hyperparathyroidism

non-neoplastic increase in parathyroid parenchymal cell mass within all parathyroid tissue with a known stimulus

what is parathyroid carcinoma?

malignant tumour derived from parathyroid parenchymal cells

what is the survival rating for parathyroid carcinoma?

50% 10 year survival

what are the exogenous causes of Cushing's Syndrome?

excessive glucocorticoid medication

what are the endogenous causes of Cushing's Syndrome?

Adrenal Cortical tumours, adrenal cortical hyperplasia, ACTH secreting pituitary adenoma

what is cushing's syndrome due to?

due to prolonged exposure to cortisol

what are the signs and symptoms of cushing's syndrome?

``` Hypertension moon face central obesity buffalo hump weak muscles osteoporosis insomnia excess sweating mood swings headaches chronic fatigue women may have hirsutism and irregular menstruation ```

what is Conn's syndrome?

EXCESS PRODUCTION OF THE HORMONE ALDOSTERONE LEADING TO LOW RENIN LEVELS

What are the causes of primary Conn's syndrome?

adrenal cortical hyperplasia, adenoma familial hyperaldosteronism

what are the causes of secondary Conn's syndrome?

low circulating volume | poor renal circulation

who is most at risk of getting conns syndrome?

Women > Males | 30-50 year olds

what are the signs and symptoms of Conn's syndrome?

``` High BP Headache Muscular weakness Muscle spasms Cardiac ARRYTHMIAS Excessive urination ```

what is Addisons Disease?

Adrenal cortical insufficency

what are the causes of primary addisons disease?

Adrenal dysgensis, adrenal destruction. autoimmune adrenalitis TB

what are the causes of secondary addisons disease?

Failure of ACTH secretion

what are the triad of symptoms for addisons disease

1. Hyperpigmentation 2. Postural Hypotension 3. Hyponatraemia

how do you treat addisons disease?

treat with long term steroid replacement

what is adrenal cortical nodule?

Benign non-function nodules of adrenal cortex

what % of the population is affected by adrenal cortical nodules?

between 1.5% and 3% of the population

Which groups are affected by adrenal cortical nodules?

Elderly, hypotensive and diabetic patients

how was adrenal cortical nodules discovered?

it was incidentally discovered on radiographic studies

what is adrenal cortical adenoma?

A benign neoplastic proliferation of adrenal cortical tissue

what is the incidence of adrenal cortical adenomas in the population?

incidence from 1-5% of the population

what are the signs and symptoms of adrenal cortical adenoma?

symptoms are related to endocrine hyper function -aldosterone-producing tumours cause Conn's syndrome cortisol producing tumours cause cushing's syndrome - rare tumours cause virilisation

what is adrenal cortical carcinoma

its the malignant counterpart of adrenal cortical

What are the signs and symptoms of adrenal cortical carcinoma?

symptoms are related to hormone excess | abdominal mass is present

what is the survival rate for adrenal cortical carcinoma?

5 year survival about 70% | the prognosis is age and stage dependent

what is phaeochromcytoma?

Catecholamine-secreting tumour arising from adrenal medulla

what is the rate of pheochromocytoma is the population?

8/100000 are affected

what is the rule of 10's in relation to phaeochromocytoma?

``` it means 10% of tumours are: 10% bilateral 10% extra-adrenal 10% malignant 10% familial and q0% in children ```

what are some associations with pheochromocytoma?

MEN2A/2B Von Recklinghausen's disease von Hippel/indau disease

what are some symptoms of phaeochromocytoms?

hypertension palpitations headaches anxiety

what are some clinical features of pheochromocytoma?

elevated urine catecholamines, adrenaline and noradrenaline

what is the prognosis of benign pheochromocytoma?

excellent prognosis when its benign and properly managed surgically

what is the prognosis of malignant phaeochromocytoma?

not as good of a prognosis as tumour may pursue an aggressive course