Endocrine Pathology Flashcards
What do endocrine glands do?
secrete hormones directly in to the bloodstream
act systemically
What do paracrine glands do?
secrete hormones
acts locally
What do autocrine glands do?
secrete hormones
affects the cell secreting the protein
What classification are most primary pituitary tumours?
adenomas
benign
What are the 3 types of anterior pituitary adenomas?
Prolactinoma - commonest, galactorrhoea and menstral disturbances
Growth hormone secreting - gigantism in children, acromegaly in adults
ACTH secreting - Cushing’s syndrome
What is a common side effect of a thyroidectomy?
horse voice - due to damage to recurrent laryngeal nerve
What are ultimobranchial bodies?
Embryological structure
Gives rise to the parafollicular cells/C cells of the thyroid gland
Where does ectopic thyroid tissue occur?
From foramen cecum (tongue) to supra-sternal notch
What is a thyroglossal duct cyst?
Fluid filled tissue from when the thyroid was developing in the embryo
What is acute thyroiditis?
acute inflammation of the thyroid due to infection
What is palpation thyroiditis?
granulomas in thyroid follicles
almost always presents as thyroid nodules
What is hashimoto’s?
Aka chronic lymphocytic thyroiditis
Autoimmune chronic inflammatory disorder
Thyroid antibodies - diagnostic
What is the gland like in hashimotos macro and microscopically?
Diffuse enlarge non tender gland
No nodes/focal lesions
Follicules atrophied
Does hashimotos cause hyper or hypothyroidism?
HYPOthyroidism
Hashimotos increases the patients risks of developing which cancers?
Thyroid lymphoma
Papillary carcinoma
What is Graves Disease?
Aka Diffuse Hyperplasia
autoimmune process causing HYPERthyroidism
Thyroid pathology is more common in men or woman?
Women
What are the signs and symptoms of graves disease? (5)
HYPERthyroidism Pretibial myxoedema - waxy discolored skin, peau d orange, non pitting oedema Hair loss Exophthalmos/proptosis Tachycardia Hyperactive reflexes
What is the gland like in Graves disease macro and microscopically?
Diffusely enlarged goitre
Beefy red appearance
Hyperplastic infoldings
What are the levels of T3, T4 and TSH in Graves disease?
T3 and T4 are elevated
TSH supressed
What is a multinodular goitre?
It’s in the name! - many nodules and enlargement of the gland
Normal thyroid function
How are benign and malignant tumours differentiated?
Colour: white = Malignant
Density: solid = Malignant
Location: In situ/encapsulated = Benign
Vascularity: High = Malignant
What is the only benign tumour of the thryoid called? How does it present?
Follicular adenoma Encapsulated Follicular cell differentiation Painless neck mass One node in one lobe 'Cold' nodule on imaging
What is the commonest malignant tumour of the thyroid?
Papillary carcinoma
What 4 gene mutations cause papillary carcinoma?
RET
NTRK1
BRAF V600E
RAS
What are psammoma bodies?
calcified structures in follicules
What are the 3 differentiated malignant tumours of the thyroid?
Papillary carcinoma
Follicular carcinoma
Hurthle cell carcinoma
What are the 3 undifferentiated malignant tumours of the thyroid?
Insular carcinoma
Anaplastic carcinoma
Medullary carcinoma - amyloid present
What is primary hyperparathyroidism?
excessive section of parathyroid hormone from one or more glands
What is secondary hyperparathyroidism?
Hyperplasia of glands with elevated PTH in response to hypocalcemia
What is tertiary hyperparathyroidism?
Adenoma in association with longstanding secondary hyperparathyroidism
What 3 things cause primary hyperparathyroidism?
Ageing
Ionising radiation
MEN 2a - subtype of endocrine tumours
What 3 non neoplastic changes to the parathyroid gland causes hyperparathyroidism?
Primary chief cell hyperplasia
Parathyroid adenoma - one gland
Secondary and tertiary parathyroidism - all glands effected
What are the clinical features of Cushings syndrome?
Slim arms and legs
Fat deposits on the back of the neck and shoulders = “buffalo hump”
Moon face
What are the causes of Cushing’s syndrome?
Steroids Pituitary adenoma Ectopic ACTH-secreting tumor primary adrenal gland disease Familial Cushings disease
How does Cushing’s syndrome develop?
Excess cortisol in the body
What are the clinical features of Conns syndrome?
High blood pressure High level of calcium in the blood Fatigue Headache Muscle weakness Numbness
What are the causes of Conns’s syndrome?
Aldosterone-producing tumours
How does Conns syndrome develop?
Excess aldosterone
What are the clinical features of Addisons disease?
Hyperpigmentation
Postural hypotension
Hyponatraemia
What are the causes of Addisons disease?
Autoimmune most common
How does Addisons disease develop?
Primary adrenal cortical deficiency
Abnormal development of the gland cortex/adrenal cortex destruction
What is the treatment for Addisons disease?
Long term steroid replacement
What is phaeochromocytoma?
Catecholamine-secreting tumour
Arising from adrenal medulla
