Endocrine Pathology Flashcards by Rob Mackenzie

What are endocrine, paracrine and autocrine glands?

Endocrine - release hormones into blood and act systemically

Paracrine - hormones released that act locally

Autocrine - hormones secreted that act of cell itself

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What are the main causes for pituitary hypofunction?

Tumours - secretory adenoma or malignant

Trauma

Inflammation

Infarction

Iatrogenic

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What are the most common types of pituitary tumours? What are their effects?

Adenoma - can secrete any hormone originating from thyroid

Effects are secondary to hormone being produced (hyper functioning hormone)
Local effects due to pressure on optic chiasma/adjacent pituitary

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What is the effect of a PROLACTINOMA?

Galactorrhea (milk from breast)

Menstrual disturbances

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What is the effect of a growth hormone secreting adenoma?

Gigantism in children

Acromegaly in adults (excessive growth - massive facial features/hands)

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What is the effect of of a ACTH secreting adenoma?

Cushing’s syndrome

- moon face etc

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What is a potential complication of a thyroidectomy?

Damage to laryngeal nerve - hoarseness of voice

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Where is the thyroid located?

between C5-7, anterior neck

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What does ectopic mean?

Tissue somewhere where it shouldn’t

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What is heterotopia?

Displacement of tissue

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Where can ectopic/heterotopic thyroid glands occur?

Anywhere between foramen cecum (back of tongue to suprasternal notch

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Where is the most common place for ectopic/hetertopic thyroid glands to occur? Whats the effect?

Lingual thyroid - base of tongue

As this is only thyroid tissue, most patients present with hypothyroidism

Not neoplastic but can cause obstruction

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What is a thyroglossal duct cyst? What can it present?

Asymptomatic mass - cyst arising from embryological remnants

Dysphasia

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What is acute thyroiditis? What are the clinical symptoms?

Inflammation of thyroid - due to virus, bacteria or fungus (generalised sepsis0

Presents with fever, chills, malaise, pain in neck, NECK SWELLING

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What is palpable thyroiditis caused by? How does it present?

Excessive palpation/surgery

Presents with thyroid nodule (granulamtous foci replace follicles)

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What is Riedel thyroiditis? How does it present?

Rare, fibrosing form of chronic thyroiditis

Presents with firm goitre - dysphagia, stridor, hoarseness

mistaken for thyroid carcinoma

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What is Hashimoto’s thyroiditis? How does it present?

Autoimmune chronic inflammatory disorder of thyroid

diffuse enlargement of thyroid (non-tender)
high TSH/low T3 and T4 cells with thyroid antibodies

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What are the clinical signs of hashimoto’s?

Hypothyroidism -

Enlarged thyroid (non-tender)

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What are patients with Hashimoto’s at risk of developing?

Lymphoma

Papillary carcinoma of thyroid

What is Graves disease? How does it present?

Autoimmune chronic inflammatory condition of thyroid that causes HYPERTHYROIDISM

Elevated T3 and T4 with low TSH and high thyroid antibodies

What are the clinical features of Graves disease?

Exosphalmos
Tachycardia
Feeling hot
Hyperreflexia etc

What are the complications of Graves disease?

Can develop hypothyroidism

How does mutlinodular goitre present?

Can be functional i.e. normal

Multi nodular enlargement

However, symptoms are compression of trachea/dysphagia

How to differentiate between a benign nodule and malignant carcinoma?

Solitary nodule/Painless lump
silent cold nodule on radioactive iodine imaging
Invasive

What is the most common malignant cancer in the thyroid?

Papillary carcinoma

What are the three types of hyperparathyroidism? Why do they present?

Primary - excessive secretion of one/more glands (single adenoma, or diffuse chief cell) - MEN2a Secondary - hyperplasia of glands due to vit D deficiency, renal insufficiency and malnutrition

What is the complications of primary hyperparathyroidism?

Hypercalcaemia Osteoporosis reduced renal function

What is primary chief cell hyperplasia?

Increased in parathyroid cell mass (non-neoplastic) Hypercalcaemia - stones, bones, groans and abdominal moans

How does hyperparathyroidism present biochemically?

Increased calcium Reduced phosphate Increased PTH

What is parathyroid adenoma associated with?

MEN1 and MEN2a

How does parathyroid adenoma usually present?

One enlarged gland, remaining ones suppressed and small

How do parathyroid carcinomas present?

Hypercalcaemia

What does the adrenal cortex produce?

Aldosterone - mineralocorticoids Cortisol - glucocorticoids Androgens - testosterone and DHEA

What does the adrenal medulla produce?

Catecholamines (adrenaline/noradrenaline)

What is Cushings syndrome?

Excessive ACTH (pituitary adenoma) or excessive glucocorticoid secretion from adrenal cortex (cortisol) (adenoma)

What are the diagnostic features of Cushing's syndrome?

Elevated ACTH/cortisol in blood - moon face - central obesity - Striae - Hypertension - thinning hair - proximal muscle weakness

What is Conn's syndrome?

Excessive aldosterone release | adenoma

What are the clinical features of Conn's syndrome?

Hypertension (H2O and Na retention), potassium loss (muscle weakness/muscle arrythmias)

What is addison syndrome?

Underproduction of cortisol and aldosterone

What are the causes of addison syndrome

Primary adrenal cortical insufficiency or destruction Autoimmune or TB

How does addisons present clinically?

Postural hypotension Hyponatreamia hyper pigmentation

What is the treatment for addison's?

Steroid replacement therapy | fatal if undiagnosed

What is the name for a catecholamine releasing tumour arising from the adrenal gland?

PHAEOCHROMOCYTOMA

What are the symptoms of pheochromocytoma?

Symptoms related to excessive catecholamines ``` Hypertension pallor headaches, sweating nervousness. ```

How are pheochromocytoma diagnosed?

Raised urine catecholamines

What familial syndrome is pheochromocytoma potentially related to?

MEN2a/b