Diseases of the Endocrine System

Question 1

Location of the pituitary gland

Answer 1

Behind the optic chiasm in the Sella Turcica

Question 2

Anterior lobe

Answer 2

Adenohypophysis - 75% of pituitary and generally more important

Question 3

Causes of anterior pituitary hypofunction

Answer 3

Vascular e.g. infarction
Inflammation - granulomatous
Trauma
Autoimmune - pituitary autoimmune disease
Metabolic
Infection
Neoplasia - non-secretory adenoma, metastatic
Doctors - drugs affecting hormone status
VITAMIN D is the mnemonic

Question 4

Primary pituitary tumours

Answer 4

Mainly adenomas
May be secretory
Can cause local effects due to pressures on surrounding structures e.g. visual field defect

Question 5

Prolactinoma

Answer 5

Prolactin secreting hormone
Can cause menstrual dysfunction and galactorrhea in women
Can cause gynecomastia, loss of libido and erectile dysfunction in men

Question 6

ACTH tumour

Answer 6

Increases cortisol to excess

Causes Cushing’s syndrome

Question 7

Growth hormone secreting tumour

Answer 7

Causes gigantism inc. acromegaly

Question 8

Hashimoto’s disease

Answer 8

Also called chronic lymphocytic thyroiditis
Autoimmune chronic inflammatory disorder
More common in women
Peak age 59 years
Many patients develop hypothyroidism
Diffusely enlarged non-tender gland
80-fold increase of thyroid lymphoma if untreated
Increased risk of papillary thyroid cancer

Question 9

Test for Hashimoto’s

Answer 9

Serum thyroid antibodies (no one specific antibody)

Question 10

Graves’ disease

Answer 10

Diffuse hyperplasia
Autoimmune disease
Generally in younger people
Females over males
Pretibial myxoedema - rash on anterior surface of the legs
Thyroid eye disease

Question 11

Tests and examination for Graves’

Answer 11

Thyroid diffusely enlarged

T3 and T4 elevated, TSH markedly decreased due to negative feedback from T4

Question 12

Multinodular goitre

Answer 12

Enlargement of thyroid +/- nodularity
Most are euthyroid
Large 'dominant' nodules can be mistaken for thyroid carcinoma
Compressive symptoms
Can be caused by iodine deficiency
May appear calcified on an X-ray

Question 13

Follicular adenoma

Answer 13

Benign encapsulated tumour

Can cause similar symptoms to Hashimoto’s

Question 14

Most common kind of thyroid cancer

Answer 14

Differentiated thyroid carcinoma - papillary or follicular types

Question 15

Papillary carcinoma

Answer 15

Accounts for over 70% of thyroid carcinoma
Female predominance 2.5:1
Wide age range with a mean of 43 years
Familial, autosomal dominant
Related to radiation exposure
Frond-like structures macroscopically
Microscopically nuclei can look transparent

Question 16

Location of parathyroid glands

Answer 16

4, usually just posterior to thyroid but can be anywhere including inside the thyroid

Question 17

Role of parathyroid

Answer 17

Calcium control

Question 18

Primary hyperparathyroidism

Answer 18

Excessive secretion from one or more glands
Age related
Tumour genesis can cause
Radiation

Question 19

Secondary hyperparathyroidism

Answer 19

Hyperplasia of glands with elevated PTH due to another causes e.g. renal failure

Question 20

Tertiary hyperparathyroidism

Answer 20

Long-term hyperparathyroidism remaining after original cause of secondary has been corrected

Question 21

Symptoms of hyperparathyroidism

Answer 21

Hypercalcaemia
Renal stones
Painful bones
Abdominal/GI symptoms
Psychiatric symptoms including lethargy

Question 22

Parathyroid adenoma

Answer 22

One gland bigger than the others - need to check other too

Parathyroid tissue looks like hyperplasia

Question 23

Cushing’s Syndrome overview

Answer 23

Excess cortisol possibly related to increased secretion from zone fasticularis
Endogenous causes - tumours

Question 24

Signs and symptoms of Cushing’s

Answer 24

Hypertension
Moon face
Central obesity
Buffalo hump
Weak muscles
Osteoporosis
Easy bruising

Question 25

Conn's Syndrome overview

Answer 25

Hyperaldoseronism More women Excess aldosterone leading to reduced renin levels

Question 26

Symptoms and signs of Conn's Syndrome

Answer 26

``` High BP Headache Muscle weakness Muscle spasms Cardiac arrhythmias Excess urination ```

Question 27

Addison's disease

Answer 27

Adrenal cortical deficiency Primary - adrenal dysgenesis, adrenal destruction, often autoimmune, TB Secondary due to failure of ACTH secretion High mortality if not diagnosed

Question 28

Symptoms and signs of Addison's

Answer 28

Hypotension Hyperpigmentation Hyponatraemia

Question 29

Adrenal conical nodule

Answer 29

Benign neoplastic proliferation of adrenal comical tissue | Symptoms related to endocrine hyper function (including Cushing's, Conn's and rare tumours cause virilisation)

Question 30

Adrenal cortical carcinoma

Answer 30

Malignant tumour of the cortex Symptoms related to hormone excess Abdominal mass 5 year survival around 70%

Question 31

Phaeochromocytoma

Answer 31

More a pink-brown colour compared to a more yellowfins adrenal cortical carcinoma Catecholamine secreting tumour arising from adrenal medulla Rule of 10s - 10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial and 10% in children Can be extra-adrenal in similar tissues including base of skull, carotid bodies and other areas of retroperitoneum

Question 32

Symptoms and signs of pheochromocytoma

Answer 32

Excess adrenaline - hypertension, palpitations, headaches, anxiety Elevated urine catecholamines