Endocrine Pathology

Question 1

What does the anterior pituitary gland secrete?

Answer 1

GH
prolactin
FSH
LH
TSH
ACTH

Question 2

What does the posterior pituitary secrete?

Answer 2

ADH

oxytocin

Question 3

Pituitary adenomas

Answer 3

Most common disease of the anterior pituitary
Derived from the glandular tissue of the anterior pituitary
Most cases are sporadic but may occur as part of the MEN 1 syndrome

Question 4

How do pituitary adenomas cause clinical effects?

Answer 4

MASS EFFECTS

• bitemporal hemianopia
• diplopia
• non-specific symptoms such as headaches

ENDOCRINE EFFECTS

• functional adenomas may produce symptoms related to excess hormone secretion
• non-functional adenomas do not produce hormones. larger at presentation as present due to mass effects rather than endocrine dysfunction

Question 5

Prolactinomas

Answer 5

Pituitary adenomas which produce excess prolactin
Most common type of functional adenoma

Women of reproductive age:
oligomenorrhoea
galactorrhea
often very small tumours and present early

Men and post-menopausal women:
mass effects e.g. headache and visual disturbance
typically larger at presentation

Question 6

ACTH secreting adenomas

Answer 6

present as Cushing’s syndrome

Question 7

GH secreting adenomas

Answer 7

present as acromegaly

Question 8

Cause fo acromegaly

Answer 8

excess GH

95% fot he time secondary to a pituitary adenoma

Question 9

signs and symptoms of acromegaly

Answer 9

board facies
spade like hands
large feet
large tongue
oily greasy skin

Question 10

complications of acromegaly

Answer 10

hypertension
diabetes mellitus (10%)
LVH
cardiomyopathy
colorectal cancer

Question 11

investigations of acromegaly

Answer 11

no suppression in OGTT

MRI may show pituitary adenoma

Question 12

treatment of acromegaly

Answer 12

dopamine antagonists (eg bromocriptine)
somatostatin analogue (eg octreotide)
pegvisomant (GH receptor antagonist)
external irradiation

Question 13

TSH secreting adenomas

Answer 13

rare

typically present as thyrotoxicosis (very rare cause of thyrotoxicosis though!)

Question 14

Adrenal Gland

Answer 14

cortex - composed of zone glomerulosa (mineralocorticoids), zone fasciculata (glucocorticoids), zone reticularis (androgens)

Question 15

Signs and symptoms of cushion’s syndrome

Answer 15

poor hair
hirsutism
poor healing
bruising
petechiae
poor nails
proximal myopathy
peripheral neuropathy
moon face
buffalo hump
abdominal obesity
striae
osteoporosis
diabetes mellitus
hypertension
immunocompromise

Question 16

causes of bushings syndrome

Answer 16

exogenous administration fo glucocorticoids to treat other diseases

secondment common cause is a pituitary adenoma secreting ACTH

adrenal cortical adenoma

paraneoplastic syndrome

Question 17

Conn’s syndrome

Answer 17

aldosterone producing adrenal cortical adenoma

Question 18

Function of aldosterone

Answer 18

key component of RAAS system

regulates fluid balance and blood pressure

increases sodium reabsorption in the kidney tubules which increases blood volume and raises blood pressure

stimulates release of ADH by posterior pituitary which stimulates reabsorption of water

Question 19

Phaeochromocytoma

Answer 19

neuroendocrine tumour of the adrenal medulla

secretes catecholamines (normally adrenaline) and causes HTN

usually asymptomatic but some may report symptoms such as headaches, sweating and palpitations

TREATABLE CAUSE OF HTN