Endo Pathology

Question 1

Pituitary adenoma

Answer 1

It is benign tumor of the anterior pituitary gland

Question 2

Classify pituitary adenomas based on function

Answer 2

1. Functional
2. Non-functional

Question 3

Functional pituitary adenomas include:

Answer 3

Prolactinoma
GH cell adenoma
ACTH cell adenoma

Question 4

Prolactinoma features

Answer 4

It’s features are associated with excess production of prolactin hormone

In females:
1. Galactorrhea
2. Amenorrhea due to inhibition of GnRH by prolactin therefore inhibiting the release of FSH and LH

In males:
1. Decreased libido and headaches

Question 5

What is the most common type of pituitary adenoma

Answer 5

Prolactinoma

Question 6

Treatment of prolactinoma

Answer 6

1. Dopamine agonists such as Bromocriptine, cabergoline help reduce tumor size
2. Surgery for larger lesions

Question 7

Cells that produce prolactin are called

Answer 7

Lactotrophs

Question 8

GH cell adenoma effects on Children and adults

Answer 8

In Children:
1. Gigantism: due to linear growth of bones

In Adults:
1. Acromegaly:
a) Increased size of hands, feet, jaw
b) Increased size of visceral organs such as the heart leading to cardiac failure
c) Enlarged tongue

2. Secondary diabetes mellitus

Question 9

How does GH cell adenoma cause secondary diabetes ?

Answer 9

Increased GH hormone induces gluconeogenesis from the liver also, it has an anti-insulin effect where it prevents uptake of glucose by cells.
All this helps to make glucose available for energy in promoting growth

Question 10

How is GH cell adenoma diagnosed

Answer 10

By testing for
1. Elevated GH levels and Insulin growth factor 1 levels ( IGF-1)

2. No decreasing effect on GH levels on administration of oral glucose

Question 11

Treatment of GH cell adenoma

Answer 11

1. Octreotide - somatostatin analogue
2. Surgery

Question 12

ACTH cell adenomas lead to?

Answer 12

Cushing’s syndrome

Question 13

Nonfunctional pituitary adenomas present as __ which leads to:

Answer 13

A mass
Which leads to
1. Bitemporal hemianopsia due to compression of optic chiasm
2. Hypopituitarism due to compression of normal pituitary tissue
3. Headaches

Question 14

Hypopituitarism

Answer 14

Decreased production of pituitary hormones by the anterior pituitary

Question 15

Symptoms of Hypopituitarism occur when how much percentage of pituitary parenchyma is lost?

Answer 15

More than 75%

Question 16

What are the causes of hypopituitarism?

Answer 16

1. Pituitary adenoma in adults
2. Craniopharyngioma in children
3. Sheehan syndrome
4. Empty sella syndrome

Question 17

How does pituitary adenoma and Craniopharyngioma cause hypopituitarism ?

Answer 17

Due to the following reasons including:
1. Mass effect therefore compressing normal pituitary
2. Pituitary apoplexy ( bleeding into pituitary adenoma) cause enalargement and compression

Question 18

How does sheehan syndrome cause hypopituitarism

Answer 18

In Pregnancy, there is increased hormones demand there leading to hypertrophy of pituitary gland but the blood supply remains the same
In case of bleeding during parturition, it may lead to infarction of pituitary gland

Question 19

What are the clinical presentations of sheehan syndrome

Answer 19

1. Poor lactation
2. Loss of pubic hair
3. Fatigue

Question 20

How does Empty sella syndrome cause hypopituitarism

Answer 20

Empty sella syndrome may be primary or secondary
In primary, there is herniation of arachnoid and csf into sella turcica therefore compressing and destroying the pituitary gland

In secondary there is destruction of pituitary gland either by surgery, trauma etc

Question 21

What is the clinical presentation of empty sella syndrome

Answer 21

Absent pituitary on imaging

Question 22

Pathologies of the posterior pituitary

Answer 22

1. Central diabetes insipidus
2. Nephrogenic diabetes insipidus
3. Syndrome of Inappropriate ADH secretions ( SIADH)

Question 23

Central diabetes insipidus

Answer 23

It is a disease caused by ADH insufficiency

Question 24

Causes of Central diabetes insipidus

Answer 24

Hypothalamus or posterior pituitary pathologies such as trauma, surgery, tumor, infections etc

Question 25

Clinical features of diabetes insipidus

Answer 25

1. Polyuria and polydipsia
2. Hypernatremia and high serum osmolality
3. Low urine osmolality and specific gravity

Question 26

How is it diagnosed?

Answer 26

Water deprivation test
Patient is deprived of water, this should increase ADH levels in normal patient leading to increased urine osmolality , if not then Central diabetes insipidus may be present

Question 27

Treatment of Central diabetes insipidus

Answer 27

Desmopresin ( Vasopresin/ ADH analogue)

Question 28

Nephrogenic diabetes insipidus

Answer 28

The nephrons do not respond to ADH

Question 29

Causes of nephrogenic diabetes insipidus

Answer 29

1. Genetic mutation
2. Drugs such as lithium and demeclocycline

Question 30

Clinical features of nephrogenic diabetic insipidus

Answer 30

Same as Central Diabetic insipidus but no response to Desmopresin

Question 31

Syndrome of Inappropriate ADH secretion

Answer 31

Excessive production of ADH

Question 32

Causes of SIADH secretion

Answer 32

1. Ectopic secretion example Small cell carcinoma in lungs
2. CNS Trauma
3. Pulmonary infections
4. Drugs such as cyclophosphamide

Question 33

Clinical features of SIADH secretion

Answer 33

1. Hyponatremia and low serum osmolality
2. Mental status changes and seizures due to swelling of neurons and cerebral edema
3. High urine osmolality and specific gravity

Question 34

Treatment of SIADH secretion

Answer 34

1. Free water restriction
2. Demeclocycline

Question 35

Thyroglossal duct cyst

Answer 35

It is a cystic dilation of the remnant of thyroglossal duct

Question 36

How does thyroglossal duct present clinically

Answer 36

Anterior midline neck mass

Question 37

Lingual thyroid

Answer 37

A condition where the thyroid persists at the base of the tongue

Question 38

How does lingual thyroid present ?

Answer 38

A mass at the base of the tongue