Endo: Cushing's Syndrome, Adrenal Disease, Pituitary Disease

Question 1

What is Cushing’s syndrome?

Answer 1

Increased levels of cortisol in blood

Question 2

What is Cushing’s disease?

Answer 2

A cause of Cushing’s syndrome characterised by increased secretion of ACTH the anterior pituitary

Secondary hypercortisolism

Question 3

Causes of Cushing’s syndrome

Answer 3

Primary hypersecretion of ACTH (>50%)

Primary adrenal neoplasm (15-30%)

Paraneoplastic (from SCLC, carcinoid tumours, medullary carcinoma of thyroid)

Iatrogenic from excessive steriods

Question 4

Clinical features of Cushing’s syndrome

Answer 4

Hairy Buffalo Extol Purple Moon

• Hirtuism
• Central obesity (hump and trunk)
• Ecchymosis (bruising)
• Striae
• Moon face

Also:
Weakness, HTN, Diabeties, Neuropsychiatric issues, Osteoporosis, Menstrual issues

Question 5

Name the 3 areas of the cortex and the substances produced and secreted by each

Answer 5

GFR

ZONA GLOMERULOSA: Mineralocortocoids (aldosterone)

ZONA FASCICULATA: Corticosteroids (cortisol), small amount of androgens

ZONA RETICULARIS: Andorgens and small amount of corticosteroids

Question 6

What cells are contained in the medulla of the andrenal gland?

Answer 6

Chromaffin cells which secrete caecholamines

Question 7

What could cause primary insufficiency of the adrenal gland?

Answer 7

use surgical seive

Acute haemorrhagic necrosis
Infection
Amyloidosis
*Autoimmune (idiopathic/sarcoidosis/haemochromatosis)

Iatrogenic steroids
Metabolic failure of hormone production
Cancer
Congenital adrenal hypoplasia

Question 8

Causes of secondary adrenal insufficency?

Answer 8

Pituitary disease (neoplasm, inflammation)

Hypothalamic pituitary suppression (long term steroids, or steroid producing tumours)

Question 9

What are the most common adrenal tumours?

Answer 9

Cortex adenomas

Question 10

What tumours can occur in the medulla of the adrenal gland?

Answer 10

Phaechromocytomas

Or metastatic tumours

Question 11

Histology of adrenal adenoma: These lesions are encapsulated, and consist of a proliferation of adrenal ___ cells

Answer 11

Cortical

Question 12

Adrenal carcinoma histology: Cell nests resemble those of normal ____, however there is high mitotic activity, and the tumour invades the _____

Answer 12

Cortex

Capsule

Question 13

What cells do phaeochromocytomas arise from in the medulla? What do they secrete?

Answer 13

Derived form cells of SNS

Produce excess catecholamines

Question 14

Symptoms of phaeochromocytoma

Answer 14

Fight or flight symptoms (sweating, HTN, raised HR, anxiety, impending doom)

Question 15

Which genetic abnormality is linked to phaeochromocytomas?

Answer 15

Famililial multiple endocrine neoplasia

Question 16

Are phaeochromocytomas malignant or benign?

Answer 16

Primarily benign but can be malignant

Question 17

How much of the adrenal gland needs to be lost before chronic adrenal insufficiency presents?

Answer 17

90%

Question 18

Symptoms of adrenal infufficiency

Answer 18

Fatigue
Anorexia
Tan colour of skin
Dark patches on mucus membranes

Question 19

What 3 general effects can a pituitary adenoma have?

Answer 19

Mass effect (especially on optic nerve)

Produce hormones eg prolactin, ACTH, GHS, GnSH

May be non functional

Question 20

Age range affected by pituitary adenomas

Answer 20

30-50

Question 21

Are pituitary adenomas linked to MEN type 1 or 2?

Answer 21

1

Question 22

Symptoms of pituitary adenomas

Answer 22

Usually isolated and benign

Often incidental finding at autopsy

However, if functional the effects will follow the hormone produced

Question 23

Which cells does a normal pituitary gland have? (hint:ABC)

Answer 23

Acidophils
Basophils
Chromophome cells

Question 24

Acidophil adenoma produces which hormone in excess?

Answer 24

Growth hormone

Question 25

Basophil adenoma produces which hormone in excess?

Answer 25

ACTH

Question 26

Chromophobe adenoma produces which hormone in excess?

Answer 26

No hormone effect Some may produce prolactin

Question 27

Microadenoma produces which hormone in excess?

Answer 27

*Small adenoma identified only on histology PROLACTIN EXCESS AND INFERTILITY

Question 28

Which radiological abnormality is produced by a pituitary tumour?

Answer 28

Abnormality of the Sella Turcica

Question 29

How can pituitary tumours lead to hypopituitarism?

Answer 29

Can compromise the adjacent non neoplastic pituitary structures

Question 30

What is Sheehan's syndrome?

Answer 30

Ischaemic necrosis which leads to empty Sella syndome and hypopituitarism Can occur in pregnancy haemorrhages where hypotension leads to inadequate blood supple

Question 31

Examples of hypopituitarism causes

Answer 31

``` Tumour and mass lesions Pituitary surgery or radiation Rathke cleft cyst Haemorrhage Sheehan's syndrome (ischaemia) ``` Genetic

Question 32

Two types of posterior pituitary syndrome?

Answer 32

Diabetes insipidus (not enough ADH) Syndrome of inappropriate ADH secretion (SIADH) causing hyponatraemia

Question 33

Name electrolyte effects of Addison's disease

Answer 33

``` Hypercalcaemia Hypoglycaemia Hyperkalaemia Hyponatraemia --------- Hypotension ```

Question 34

Name electrolyte effects of Cushing's

Answer 34

``` Hypocalcaemia Hyperglycaemia Hypokalaemia Hypernatraemia ----------- Hypertension ```

Question 35

Which cells make up the posterior pituitary?

Answer 35

Pituicytes (modified glial cells with no scretory funciton)

Question 36

Symptoms of hyperprolactinaemia

Answer 36

Women: Loss of periods, galactorrhea, infertility Men: Decreased libido and impotence