Diseases of the endocrine system

Question 1

What do the following systems affect:

• Endocrine
• Autocrine
• Paracrine

Answer 1

• E= hormones directly into blood act systemically
• P= hormones act locally
• A= affects cell secreting the protein

Question 2

What are causes of anterior pituitary hypofunction?

Answer 2

-Tumours=non secretory adenoma, metastatic carcinoma
-Trauma
-Inflammation= autoimmune, infections, granulomatous
-Infarction
Iatrogenic

Question 3

Describe primary pituitary tumours

Answer 3

• Majority adenomas & benign
• Derived from any hormone producing cell
• Local effects due to pressure on optic chiasma/ adjacent pituitary

Question 4

What types of anterior pituitary adenomas are there?

Answer 4

• Prolactinoma- menstrual disturbance, galactorrhoea
• Growth hormone secreting= gigantism in children, acromegaly in adults
• ACTH secreting-Cushing’s syndrome

Question 5

Describe acute thyroiditis?

Answer 5

• Acute inflammation of thyroid parenchyma
• Local or sytemic infection
• Generalised sepsis
• Fever, chills, pain, malaise, swelling of anterior neck

Question 6

What is palpation thyroiditis?

Answer 6

• Microscopic Granulomatous foci centered on thyroid follicles
• Due to rupture of thyroid follicles
• Presents as thyroid nodule

Question 7

What is Riedel thyroiditis?

Answer 7

• Rare fibrosing form of chronic thyroiditis
• Firm goitre
• Stridor, hoarseness, dysphagia
• Benign

Question 8

Describe Hashimoto’s disease

Answer 8

-Autoimmune chronic inflammatory disorder
-Associated with diffuse enlargement of thyroid autoantibodies
-Chronic lymphocytic thyroiditis w/germinal centre formation
-Females most common
-Elevated serum thyroid antibodies
-Many become hypothyroid
-Inc risk of thyroid lymphoma & papillary carcinoma
-

Question 9

Describe Grave’s disease

Answer 9

• Diffuse hyperplasia
• May develop permanent hypothyroidism
• Autoimmune process & diffuse hyperplasia of follicular epithelium
• Females more common
• Pretibial myxoedema, hair loss, wide-eyes stare, tachycardia, hyperreflexia, proptosis

Question 10

Describe a multinodular goitre

Answer 10

• Enlargement of thyroid
• Most patients euthyroid
• Tracheal compression or dysphagia may develop

Question 11

Describe follicular adenoma

Answer 11

• Benign encapsulated tumour
• Follicular cell differentiation
• Females most common
• Painless neck mass
• Solitary nodule on one lobe
• Cold nodule on radioactive iodine imaging

Question 12

What is the most common type of thyroid cancer? Describe it

Answer 12

• Papillary carcinoma
• Familial, autosomalD non-medullary thyroid carcinoma
• Activation of RET or NTRK1
• Chromosomal translocations or inversions, RAS/BRAF mutations,
• Causes: Cowden’s syndrome, radiation exposure, therapeutic irradiation
• Granular, cystic, some encapsulated, infiltrative

Question 13

Describe follicular neoplasms

Answer 13

• Follicular adenoma
• Minimmaly invasive follicular carcinoma
• Hurthle cell neoplasms/ oncocytic carcinoma (acidophilic cells in canine thyroid), incidence of cervical lymph node mets
• Widely invasive follicular carcinoma

Question 14

Name the types of thyroid carcinoma

Answer 14

• Papillary carcinoma
• Insular carcinoma
• Anaplastic carcinoma (rapidly enlarging thyroid mass, inoperable)
• Medullary carcinoma (differentiation to parafollicular C cells, mutation in RET gene, autosomalD, MEN 2a&2b)

Question 15

Describe primary thyroid lymphoma

Answer 15

• Associated with lymphocytic thyroiditis
• Diffuse large B-cell
• Rapidly enlarging mass, pain, dysphagia, cervical lymphadenopathy

Question 16

What tumours are likely to metastasise to the thyroid?

Answer 16

• Renal cell carcinoma
• Melanoma
• Breast cancer
• Small cell lung cancer
• Neuroendocrince carcinoma

Question 17

What are the types of hyperparathyroidism?

Answer 17

• Primary= Excessive section of parathyroid hormone from one of more glands
• Secondary= Hyperplasia of glands with elevated PTH in response to hypocalcaemia
• Tertiary= Adenoma associated with longstanding secondary hyperparathyroidism

Question 18

What are causes of secondary hyperparathyroidism?

Answer 18

• Renal insufficiency
• Vit D deficiency
• Malabsorption

Question 19

What is the pathogenesis of primary hyperparathyroidism?

Answer 19

• Aging
• MEN 2a
• Association with ionizing irradiation
• Tumorigenesis
• Arterial hypertension, hypercalcaemia, dec renal function, psych problems, osteoporosis, urolithiasis
• Mostly single adenoma

Question 20

What is primary chief cell hyperplasia?

Answer 20

• Non neoplastic increase in parathyroid parenchymal tissue
• Abnormal calcium metabolism
• Fatigue, lethargy, anorexia, weakness, vomiting
• Bones, stones, abdo moans
• Elevated Ca, decrease in organic phosphorous, inc parahormone levels

Question 21

Describe parathyroid adenoma

Answer 21

• Encapsulated benign neoplasms of parathyroid cells
• symptoms of hypercalcaemia
• MEN1&2 syndrome, jaw tumour syndrome
• Single enlarged parathyroid gland remaining glands suppressed & small

Question 22

Describe secondary & tertiary parathyroidism

Answer 22

• non-neoplastic inc in parathyroid parenchymal cell mass within all parathyroid
• Common with renal failure & dialysis
• Identical path to primary hyperplasia associated with massive gland enlargement

Question 23

Describe parathyroid carcinoma

Answer 23

-Malignant tumour derived from parathyroid parenchymal cells

Question 24

Describe adrenal congenital hypoplasia

Answer 24

• Reduced vol of adrenocorticol tissue leading to adrenal cortical insufficiency
• High mortality
• Males, X-linked
• Hypoadrenalism
• Managed with mineralocorticoids & glucocorticoids

Question 25

Describe congenital adrenal hyperplasia

Answer 25

• Inherited
• Deficiency of enzymes required for synthesis of glucocorticoids & mineralocorticoids
• 21 hydroxylase deficiency most common
• Deficiencies of corticol & aldosterone secretion
• Genital ambiguity in F, normal M
• Advanced bone growth & premature epiphyseal maturation

Question 26

Describe Addison’s disease

Answer 26

• Primary adrenal cortical insufficiency
• Adrenal destruction
• Autoimmune form or TB
• Triad= hyperpigmentation, postural hypotension, hyponatraemia
• Long term steroid replacement

Question 27

Describe adrenal cortical carcinoma

Answer 27

• Malignant

- Abdominal mass

Question 28

Describe adrenal cortical nodule

Answer 28

-Benign non-functional nodules of adrenal cortex

Question 29

Describe an adrenal cortical adenoma

Answer 29

• Benign neoplastic proliferation of adrenal cortical tissue
• Endocrince hyperfunctioo
• Aldosterone producing tumours cause Conn’s syndrome
• Unilateral mass yellow/brown nodules
• Formed from lipid filled adrenal cortical cells

Question 30

What is Conn’s syndrome

Answer 30

• excess production of aldosterone by the adrenal glands resulting in low renin levels
• high blood pressure=poor vision or headaches

Question 31

Describe phaeochromocytoma

Answer 31

• Catecholamine secreting tumour from adrenal medulla
• Sporadic or familial MEN 2a/2b, von reckling, von hippel
• Elevated urine catecholamines, (nor)adrenaline
• Anxiety, headaches, palpitations, hypertensions