Diseases of the Endocrine System (endocrine Pathology)

Question 1

What is the difference between Endocrine, Paracrine and autocrine/

Answer 1

ENDOCRINE: hormones in blood stream + act systemically.

PARACRINE: hormones act locally

AUTOCRINE: affects cell secreting the hormone.,

Question 2

Describe the location and location of the pituitary gland?

Answer 2

Location - Brain / Sella Turcica (depression in sphenoid bone), beneath hypothalamus.

Anatomy - 2 parts. Anterior forms 75% of gland. (outpouch of oral cavity)
25% posterior (down growth of hypothalamus)

Question 3

What are the main (broad) causes of anterior pituitary hypofuntion?

Answer 3

1) tumours
2) trauma
3) Infection
4) Inflammation
5) Iatrogenic

Question 4

Describe primary pituitary tumours?

• type
• effect

Answer 4

Primary Pituitary Tumour:

• most are adenomas and benign,
• Effects are caused secondary to the hormone produced
• can press on optic chiasma

Question 5

What are the types of anterior pituitary adenoma?

Answer 5

1) Prolactinoma
2) Growth hormone secreting
3) ACTH secreting

Question 6

What are the effects of Prolactinoma (an anterior pituitary adenoma)?

Answer 6

1) Galactorrhoea (excess milk production)

2) Menstrual disturbances

Question 7

What are the effects of Growth hormone secreting anterior pituitary adenoma?

Answer 7

1) Gigantism in children

2) Acromegaly in adults

Question 8

What is the affect of ACTH secreting anterior pituitary adenoma?

*ACTH = adrenocorticotropic hormone

Answer 8

1) Cuhing’s Syndrome

Question 9

Describe the anatomy of the thyroid?

Answer 9

1) Bilobed
2) located at 5th, 6th + 7th vertebra, anterior neck.
3) next to recurrent laryngeal nerve

Question 10

How does the thryoid develop during embryogenesis?

Answer 10

Develops as 2 parts.

• main part migrates from foregut to anterior neck.
• The ultimobranchial body forms in the branchial arches and fuses with main bit laterally

Question 11

What are the common sites for ectopic / heterotopic thyroid tissue?

Answer 11

*usually occurs anywhere from foramen cecum (base of tongue) to suprasternal notch.

1) Lingual thyroid - base of tongue.
2) aortic arch
3) esophagus

Question 12

What is a thyroglossal duct cyst?

Answer 12

A peristent track representing the embryological migration path of the thyroid gland in the neck.

It

Question 13

What is acute thyroiditis?

Answer 13

Inflammation of the thyroid usually caused by viral, bacterial or fungal infection.

Question 14

What is palpation thyroiditis?

Answer 14

Occurs secondary to the rupture of thyroid follicles caused by palpation / surgery.
Granuloma cells such as macrophages and also T cells act on the thyroid follicles.

Question 15

What is Riedel Thyroiditis?

Answer 15

• Riedel Thyroiditis is a rare fibrosing form of chronic thyroiditis.
• Presents with a firm goitre
• can cause dysphagia, hoarseness and stridor as the inflammation presses on the recurrent laryngeal nerver and trachea.

Question 16

What is Hashimoto’s disease?

Answer 16

Hashimoto’s disease is a chronic lymphoctytic thyroiditis caused by an autoimmune disease.

Thyroid is attacked by immune system causing hypothyroidism.

There is lymphocytic infiltration of the thyroid parenchyma, often with germinal centreal formation.

• diffuse enlargement of thyroid caused by fibrosis.
• Serum Thyroid antibodies elevated

*many patients become hypothyroid

Question 17

Give an autoimmune cause of Hypothyroidism?

Answer 17

Hashimoto’s disease

Question 18

What condition causes an 80 fold increased risk of thyroid lymphoma?

Answer 18

Hashimoto’s

Question 19

What is Grave’s Disease?

Answer 19

Graves’ Disease = Diffuse Hyperplasia of the thyroid

• Causes Hyperthyroidism
• IgG autoantibodies cause function and growth of thyroid follicular epithelium.

Question 20

What is a Goitre?

Answer 20

Goitre is enlargement of the whole thyroid gland without hyperthyroidism.

Question 21

what are the causes of thyroid nodules?

Answer 21

1) Iodine deficiency
2) Follicular adenoma (benign)
3) cysts caused by degenerating thyroid adenomas.
4) Thyroiditis
5) carcinoma / lymphoma (malignant)

Question 22

What are some common benign and malignant thyroid tumours?

Answer 22

Benign:
-Follicular adenoma (solid mass with fibroid capsule)

Malignant:
-Papillary adenocarcinoma (non-encapsulated inflitrative mass)

Question 23

What is hyperparathyroidism?

Answer 23

There are 2 types.
1) PRIMARY hyperparathyroidism - excessive secretion from 1 or more glands.

2) SECONDARY hyperparathyroidism - hyperplasia in response of glands with elevated PTH in response to Hypocalcaemia.
3) TERTIARY Hyperparathyroidism - adenoma associated with longstanding 2nd HPT.

Question 24

What are the clinical features of cushing’s syndrome?

Answer 24

1) Excess glucocorticoid
2) obesity, hypertension, diabetes
3) osteoporosis
4) Hirsutism (excess androgens in women)

Question 25

What are the causes of cushing’s syndrome?

Answer 25

• excess glucocorticoid administration
• excess ACTH secretion by adenohophysis
• adrenal cortex neoplasms
• ectopic ACTh secretion

Question 26

What are the clinical features of Conn’s Syndrome?

Answer 26

Conn’s syndrome aka primary hyperaldosteronism causing raised aldosterone and low renin.

• hypertension
• muscle weakness
• cardiac arrhythmias

Question 27

What is the cause Conn’s Syndrome?

Answer 27

Conn’s Syndrom is primary hyperaldosteronism.

It is caused by adenoma of te zona glomerulosa. Zona glomerulosa is the outermost layer of the adrenal cortex where aldosterone is secreted from.

Question 28

What are the clinical features of Addison’s Disease?

Answer 28

Addison’s Disease is the chronic insuffiency of adrenal cortical hormones causing:

1) weight loss
2) weakness
3) lethargy
4) Hypotension
5) Skin pigmentation
6) chronic dehydration

Question 29

What are the causes of Addison’s Disease?

Answer 29

Destruction of the Adrenal cortex causes chronic insufficiency of adrenal cortical hormones.

Question 30

What is Phaeochromocytoma?

Answer 30

catecholamine secreting tumour arising from the adrenal medulla.

Question 31

What are the different types of adrenal gland tumours?

Answer 31

• Congenital adrenal hyperplasia
• adrenal cortical nodule (benign)
• adrenal cortical adenoma (benign)
• Adrenal cortical adenoma
• Adrenal cortical carcinoma