Endocrine Disease Pathology

Question 1

Define endocrine gland

Answer 1

One whose secretions (hormones) pass directly into the blood stream

Question 2

What do hormones influence?

Answer 2

Target organs by binding to receptors - cell surface or intranuclear

Question 3

Define exocrine gland

Answer 3

Secretions pass into the gut, resp tract or exterior of the body

Question 4

How is the endocrine system controlled?

Answer 4

By a feedback mechanism - demand and supply are well balanced

Question 5

Clinical symptoms due to endocrine disease?

Answer 5

Underproduction/non-functioning e.g. diabetes
Overproduction
Mass
Malignancy

Question 6

Endocrine system examples?

Answer 6

Hypothalamus
Pit gland
Thyroid gland

Question 7

What is the hypothalamic-pituitary axis? Features?

Answer 7

Connection between hypothalamus and pit gland (releases hormones) - thyroid/adrenal stimulate hormones
Rich in blood supply as hypothalamus controls the endocrine system

Question 8

Structure of the adrenal gland?

Answer 8

Outer = cortex:  
Zona glomerulosa (outer) Zona fasciculata. Zona reticularis. 
Inner = medulla

Question 9

Diagnostic tools for the adrenal gland?

Answer 9

24hr urinary cortisol
Serum ACTH levels
Diurnal pattern of serum cortisol levels

Question 10

Causes of hypocorticalism?

Answer 10

Hypothalamic pituitary disease
Primary adrenal failure: Developmental, haemorrhagic necrosis, autoimmunity, destruction by TB or tumour
Iatrogenic: Suppression due to steroid therapy

Question 11

Effects of hypocorticalism?

Answer 11

• Skin pigmentation
• Hypotension
• Muscle weakness
• Hypoglycaemia
• Hyponatraemia
• Hyperkalaemia
• Renal dysfunction

Question 12

Types of hyperccorticalism?

Answer 12

Cushing’s syndrome - adrenal tumours, iatrogenic
Cushings disease - pit microadenomas
Conn’s syndrome - excessive aldosterone
Adreno-genital syndrome

Question 13

What is Pheochromocytoma?

Answer 13

Tumour of catecholamine producing
chromaffin cells
• Paroxysmal hypertension - pt likely to die so special anaesthetist needed

Question 14

Associations of Pheochromocytoma?

Answer 14

Familial – autosomal dominant
• Neurofibromatosis
• Von Hippel-Lindau disease
• Medullary carcinoma of thyroid
• Parathyroid adenomas

Question 15

Behaviour of Pheochromocytoma?

Answer 15

Most are benign
• 5 – 10% are malignant
• Metastasise to lymph nodes, lungs, liver
and bone

Question 16

How can pathology present?

Answer 16

Manifest as thyroid enlargement or increased/decreased amount of thyroid

Question 17

Thyroid pathology diagnostic tools?

Answer 17

Serum T3, T4, TSH, calcitonin
Ultrasound
Radioactive iodine uptake studies
FNA
Core biopsy

Question 18

Cytology of thryroid pathology?

Answer 18

Can establish diagnosis of some types of
carcinoma: papillary, medullary,
anaplastic
Can’t distinguish between benign and
malignant follicular lesions

Question 19

Thyroid disease classification?

Answer 19

Hypothyroidism:

• Iodine def
• Developmental
• Autoimmune
• Radiotherapy
• Drugs

Hyperthyroidism:

• Autoimmune
• Toxic adenomas

Masses

Question 20

What is goitre?

Answer 20

Enlarged thyroid

Question 21

Name the autoimmune thyroid diseases?

Answer 21

Hashimoto thyroiditis

Graves disease

Question 22

3:34 Hashimoto thyroiditis…

Answer 22

Autoimmune hypothyroidism
Middle aged women
Auto-antibodies against thyroglobulin…

Question 23

Thyroid mass can present as?

Answer 23

Cyst
Dominant nodule in mutlinodular goitre
Benign neoplasms
Malignant neoplasms

Question 24

Benign neoplasm

Answer 24

Follicular adenoma
usually solitary and encapsulated
Commoner than malignant neoplasms

Question 25

Malignant neoplasms

Answer 25

Papillary adenocarcinoma
Follicular adenocarcinoma
Medullary carcinoma
Anaplastic carcinoma
Lymphoma

Question 26

Papillary carcinoma features?

Answer 26

60-70% of cases
Children and young adults
Lymphatic spread
Excellent prognosis

Question 27

Histological features of papillary carcinoma?

Answer 27

True papillae

Optically clear nuclei

Question 28

Follicular carcinoma features?

Answer 28

20-25% of cases
Young-middle aged
Blood stream spread
Good prognosis

Question 29

Medullary carcinoma features?

Answer 29

5-10% cases
Elderly
Lymphatic and blood stream spread
Variable prognosis
C cell hyperplasia present

Question 30

Anaplastic carcinoma features?

Answer 30

10-15% cases
Elderly
Aggressive local spread
V poor prognosis
Pt struggles to breathe
Tumour of thyroid spread to soft tissues

Question 31

Lymphoma

Answer 31

Non-hodgkins
Mucosa associated lymphoid tissue

Better prognosis than most other lymphomas

Hashimotos thyroiditis…