Endocrine disease (pathology) Flashcards
Endocrine gland
One whose secretions (hormones) pass directly into the blood stream
Hormones
Influence target organs by binding to receptors
Receptors may be on cell surface or intranuclear
Exocrine gland
One whose secretions pass into the gut, respiratory tract or exterior of the body
Normal adrenals
About 4g each at surgery
2-6g in sudden death autopsies
Cortex is about 90% of total weight
Hypocorticalism - causes (LOOK AT PICS)
Pituitary disease Primary adrenal failure -developmental -haemorrhagic necrosis -autoimmunity -destruction by TB or tumour Iatrogenic -suppression due to steroid therapy Addisonian atrophy Waterhouse-Friderichsen syndrome
Hypocorticalism - effects
Skin pigmentation Hypotension Muscle weakness Hypoglycaemia Hyponatraemia Hyperkalaemia Renal dysfunction
Hypercorticalism
Cushing's syndrome -adrenal tumours -iatrogenic Cushing's disease -pituitary microadenomas Conn's syndrome -excessive aldosterone Adreno-genital syndrome -androgen secreting adrenocortical carcinomas -congenital adrenal hyperplasia
Effects of Cushing’s syndrome
Obesity -trunkal obesity -buffalo hump Hypertension Osteoporosis Hyperglycaemia Myopathy Skin atrophy Polchythaemia Susceptibility to infection
Phaeochromocytoma
Tumour of catecholamine producing chromaffin cells
Paroxysmal hypertension
-fluctuating BP and symptoms
Phaeochromocytoma - associations
Familial - autosomal dominant Neurofibromatosis Von Hippel-Lindau disease Medullary carcinoma of thyroid Parathyroid adenomas
Phaeochromocytoma - behaviour
Most are benign
5-10% are malignant
Metastasise to lymph nodes, lungs, liver and bone
Phaeochromocytoma histology
Pinky blue hue
Ball cells?
Pleomorphic
Cells similar to that of medulla
Thyroid cytology
Safe
< need to excuse benign lesions
Thy 1-5 categories
Can establish diagnosis of some types of carcinoma
-papillary
-medullary
-anaplastic
Can’t distinguish between benign and malignant follicular lesions
Orange: colloid? Follicular and blood cells.
Thyroid disease
Masses -goitre Malfunction -hyperthyroidism -hypothyroidism -Hashimoto thyroiditis -Graves disease
Thyroid mass
Cyst
Dominant nodule in multinodular goitre
Benign neoplasms
Malignant neoplasms
Benign neoplasms
Follicular adenoma
-usually solitary
-encapsulated
Commoner than malignant neoplasms
Malignant neoplasms
Papillary adenocarcinoma Follicular adenocarcinoma Medullary carcinoma Anaplastic carcinoma Lymphoma
Papillary carcinoma
- epidemiology
- spread
- prognosis
- histology
60-70% of cases Children and young adults Lymphatic spread Excellent prognosis HISTOLOGY -true papillae -optically clear nuclei -nuclear grooves -nuclear inclusion -orphan Annie nuclei
Follicular carcinoma
- epidemiology
- spread
- prognosis
- histology
20-25% of cases Young-middle aged Blood stream spread Good prognosis Histology: -varying degrees of differentiation -poorly differentiated area -genuine capsular invasion -vascular invasion
Medullary carcinoma -epidemiology -spread -prognosis -
5-10% of cases Elderly, but familial cases earlier Lymphatic and blood stream spread Variable prognosis Histology: -variety of growth patterns -C cell hyperplasia
Anaplastic carcinoma
- epidemiology
- spread
- prognosis
- histology
10-15% of cases Elderly Aggressive local spread Very poor prognosis Cells present as sheets with lots of mitoses and necrosis
Lymphoma
Non-Hodgkin’s lymphoma
- may be in mucosa Associated Lymphoid Tissues
- better prognosis than most other lymphomas
- Hashimoto’s thyroiditis the commonest cause seen by pathologists
Feedback mechanism
The way that hormones are controlled
Demand and supply
Clinical symptoms due to endocrine disease
Underproduction/ non-functioning
Overproduction
Mass
Malignancy
Endocrine system
Hypothalamus Pituitary gland Thyroid gland Parathyroid gland Adrenal glands Pancreas (islets of Langerhans) Pineal gland Ovary/ testis
Hypothalamic - pituitary axis
Controls endocrine system
Senses hormone levels –> releases corticotropin releasing hormone –> stimulates anterior pituitary to release hormones –> adrenocorticotropic hormone is released (stimulating) –> thyroid/ adrenal receive hormones –> release cortisol –> negative feedback to anterior pituitary and hypothalamus
Adrenal cortex
Three layers: zona glomerulosa, zona fasciculator (produces cortisone), zona reticularis (produces ?)
Diagnostic tools
24hr urinary cortisol
Serum ACTH levels
Diurnal pattern of serum cortisol levels
Dexamathasone suppression test
Addisonian atrophy
Hypofunctioning adrenal
Thin cortex
Waterhouse-Friderichsen syndrome
Rare but fatal Young children Sepsis Body --> blue / black Cortex is filled with blood
Adrenal cortical adenoma
Small Benign Well circumscribed border Cells resemble normal cells No necrosis Small, regular nuclei
Adrenal cortical carcinoma
Large
Areas of haemmorhage and necrosis
Pleomorphic cells
Diagnostic tools - thyroid
Serum T3, T4, TSH, calcitonin Ultrasound Radioactive iodine uptake studies FNA Core biopsy Excision biopsy/ lobectomy Bone scan
Thyroid gland produces
Hormones - thyroxin
-T3, T4
TSH produced by pituitary
Thyroid disease - Hypothyroidism
Iodine deficiency Developmental Autoimmune Radiotherapy, radioiodine therapy Drugs
Thyroid disease - Hyperthyroidism
Autoimmune
Toxic adenomas
Autoimmune thyroid disorders
Hashimoto thyroiditis
Graves disease
Hashimoto thyroiditis
- epidemiology
- cause
- signs and symptoms
- risks
Middle aged, women
Auto-antibodies against thyroglobulin and thyroid peroxidase
Lymphocyte mediated destruction of thyroid follicles
Initial hyperthyroidism followed by hypothyroidism
Painless enlarged thyroid
Life long thyroxine
Risk of developing other autoimmune disease
Risk for thyroid malignancy
Graves disease
Production of Thyroid stimulating immunoglobulin
Anti-TSH receptor antibodies
Elevated T3 and T4. Low TSH
> uniform radio-iodine uptake
Treated with anti-thyroid medications, radio-iodine ablation and surgery
