Endocrine Pathology

Question 1

where does the pituitary gland sit?

Answer 1

In the sella turcica of the sphenoid bone

Question 2

what hormones does the anterior pituitary produce?

Answer 2

growth hormone
prolactin
FSH
LH
TSH
ACTH

Question 3

what hormones does the pituitary hormone release?

Answer 3

ADH

oxytocin

Question 4

what is a pituitary adenoma?

Answer 4

tumours derived from the glandular tissue of the anterior pituitary

Question 5

what syndrome can pituitary adenoma’s be a part of?

Answer 5

MEN 1

Question 6

why can a pituitary adenoma cause bitemporal hemianopia?

Answer 6

The tumour can compres the optic chiasm ‘vision is missing in the outer half of both fields’

Question 7

what are the main mass effects caused by a pituitary adenoma?

Answer 7

bitemporal hemianopia

Diplopia

Question 8

what size do functional adenomas of the pituitary tend to be at presentation?

Answer 8

very small because they will have been producing symptoms related to the endocrine pathology

Question 9

what is a prolactinoma?

Answer 9

A pituitary adenoma causing excess production of prolactin

Question 10

What is the most common type of pituitary adenoma?

Answer 10

prolactinoma

Question 11

what is the presentation of prolactinomas in women of reproductive age?

Answer 11

Present with oligomenorrhoea or galactorrhoea

often present early so have small tumours

Question 12

how do prolactinomas present in men and post menopausal women?

Answer 12

mass effects such as headache/visual disturbance

larger at presentation

Question 13

what does an ACTH secreting adenoma present as?

Answer 13

Cushings syndrome

Question 14

what does a GH secreting adenoma present as?

Answer 14

acromegaly

Question 15

what causes the metabolic effects from having a GH pituitary aedenoma?

Answer 15

the increased IGF1

Question 16

what is there a higher mortality in acromegaly?

Answer 16

high incidence of left ventricular hypertrophy and hypertension

Question 17

what are the signs and symptoms of acromegaly?

Answer 17

• protruding supraorbital ridges
• enlarged nose
• coarse facial features
• headaches
• hypertension
• insulin resistance
• impotence
• degenerative joint disease
• peripheral neuropathy
• large hands and feet
• thicker skin

Question 18

what are the three biggest causes of thyrotoxicosis?

Answer 18

Graves Disease
toxic multinodular goitre
functional thyroid adenoma

Question 19

where is aldosterone secreted from?

Answer 19

aldosterone is a mineralocorticoid so comes from the zona glomerulosa

Question 20

where is cortisol secreted from?

Answer 20

zona fasciculata

Question 21

where are androgens secreted from?

Answer 21

zona reticularis

Question 22

what does the adrenal medulla secrete?

Answer 22

catecholamines

Question 23

what is cushings syndrome?

Answer 23

High levels of glucocorticoids

Question 24

what are the signs of cushings syndrome?

Answer 24

poor hair growth
moon face
buffalo hump
abdominal obesity
poor healing
bruising
proximal myopathy
hypertension 
striae
osteoporosis

Question 25

what is the common problem that presents in a patient with cushings?

Answer 25

weight gain | muscle weakness

Question 26

what are the most common causes of cushings syndrome?

Answer 26

exogenous steroid use

Question 27

why is important to bring patients off exogenous steroids slowly?

Answer 27

because the increased cortisol means the adrenal axis is downregulated meaning adrenal atrophy. coming off them slowly gives them a chance to increase production.

Question 28

what are four causes of cushings syndrome?

Answer 28

1. exogenous steroids 2. ACTH secreting pituitary adenoma 3. adrenal cortical adenoma 4. Paraneoplastic syndrome

Question 29

what is an ACTH secreting pituitary adenoma?

Answer 29

the adenoma secretes ACTH causing hyperplasia of the adrenal cortex as increased cortisol is made Causes cushings disease

Question 30

what is an adrenal cortical adenoma?

Answer 30

A tumour in the zona fasciculate which secretes cortisol causing cushings syndrome

Question 31

what is paraneoplastic syndrome?

Answer 31

tumour cells that secreted ACTH

Question 32

in paraneoplastic syndrome what is the most common tumour to secrete ACTH?

Answer 32

Small cell lung cancer

Question 33

In an adrenal cortical adenoma what colour is the tumour compared to the adrenal cortex?

Answer 33

the same as the adrenal cortex

Question 34

what is the equation for blood pressure?

Answer 34

Blood pressure = TPR x CO

Question 35

what is the main determinant of cardiac output?

Answer 35

circulatory volume mainly on renal sodium

Question 36

what are the causes of primary hyperaldosterism?

Answer 36

1. aldosterone producing cortical adenoma | 2. bilateral cortical hyperplasia

Question 37

what Is conns syndrome?

Answer 37

there is an aldosterone producing adrenal cortical adenoma

Question 38

what is the most common cause of primary hyperaldosteronism?

Answer 38

Conns syndrome

Question 39

what are the effects of angiotensin II?

Answer 39

- Stimulates aldosterone release - causes vasoconstriction - stimulates ADH release

Question 40

what is the effect of hyperaldosteronism?

Answer 40

- excess Na and water reabsorption - vasoconstriction of arterioles This things cause high blood pressure

Question 41

what is the effect of high aldosterone on sodium and potassium levels?

Answer 41

Low potassium | High sodium

Question 42

what is a phaeochromocytoma?

Answer 42

A neuroendocrine tumour of the adrenal medulla.

Question 43

what is the colour of the phaeochromocytoma?

Answer 43

The tumour is the same colour as the medulla with a small cortex around the edge.

Question 44

what is secreted from a phaeochromocytoma?

Answer 44

Catecholamines mainly aldosterone

Question 45

what is the presentation of a phaeochromocytoma?

Answer 45

Normally patients have no symptoms but can have a throbbing headache, sweating and palpations.

Question 46

why is it important to identify phaeochromocytomas?

Answer 46

they are a treatable form of hypertension

Question 47

what is the specific investigation done for measuring catecholamines and metanephrines?

Answer 47

a 24 hour urinary collection

Question 48

what percentage of phaeochromocytomas are familial and what syndromes?

Answer 48

10% | von hippel lindau, neurofibromatosis, MEN type 2

Question 49

what germline mutation is in phaeochromocytomas?

Answer 49

SDH

Question 50

what is the combination of low potassium and high aldosterone suggestive off?

Answer 50

high aldosterone levels

Question 51

what is the effect of hyperparathyroidism on calcium levels?

Answer 51

they will be high

Question 52

what type of genetic disorder are MEN 1 and 2?

Answer 52

autosomal dominant

Question 53

what is MEN 2 due to?

Answer 53

a germline mutation in RET proto-oncogenes