endocrine pathology

Question 1

what are the microscopic and macroscopic histopathological features of:

The anterior pituitary

how they correlate to clinical features

Answer 1

made from epithelial cells derived from the developing oral cavity

Have follicles with stroma inbetween

Parafollicular cells are found in between the follicles

Question 2

pituitary adenomas most commonly affect which cells?

Answer 2

1. Prolactin cell: prolactinoma

next: null cell - make no hormones
then: acth & gh

Question 3

list the most common cause of hypopituitarism?

Answer 3

1.Nonsecretory pituitary adenomas

2. Ischaemic necrosis
   Most commonly post-partum (Sheehan’s syndrome)
   DIC, sickle cell anaemia, elevated intracranial pressure, shock
3. Ablation of pituitary by surgery or irradiation

Question 4

List the clinically important posterior pituitary syndromes

Answer 4

Diabetes insipidus
ADH excess eg SIADH

PP hormones:
Vassopressin / antidiuretic hormone (ADH) and oxytocin

Question 5

List 2 main functions of the thyroid gland?

Answer 5

Maintain basal metabolic rate - through t3,4 production

Make calcitonin - Parafollicular cells/C cells. promotes calcium absorption by skeleton

Question 6

what are non-pathological causes of goitres?

Answer 6

non-toxic goitres:

iodine deficiency;

• environmental eg derbyshire neck
• diet: cabbages/brassicas

Question 7

name some common, non-hormonal complications of thyroid goitres?

Answer 7

Multinodular goitre can lead to ->

dysphagia and airways obstruction

Question 8

how does a Multinodular goitre present?

Answer 8

non-toxic

can develop hyper functioning nodules -> these release thyroid hormones -> hyperthyroid

causes a hypothyroid state after a while due to negative feedback on TSH

Question 9

list the presenting triad in the Most common cause of endogenous hyperthyroidism

Answer 9

Graves:

1. Thyrotoxicosis
2. Infiltrative ophthalmopathy with exophthalmos in up to 40%
3. Infiltrative dermopathy (pretibibial myxoedema) in a minority of cases

Question 10

what is the pathogenesis of graves?

Answer 10

TSH receptor antibody - most important

Thyroglobulin antibody

Question 11

a painless goitre is indicative of?

Answer 11

Hashimoto’s thyroiditis

papillary carcinoma - just a mass rather than goitre

Question 12

Lymphoid cells with germinal centres
§ The epithelial cells become large with lots of eosinophilic cytoplasm (Hurthle cells)

the above is seen in which conditions?

Answer 12

Hashimoto’s thyroiditis - autoimmune hypothyroidism

Question 13

Usually solitary
Well circumscribed lesion that compresses the surrounding parenchyma
Well formed capsule
Small proportion cause thyrotoxicosis

is descriptive of?

Answer 13

Adenomas of the thyroid

Question 14

what is the most common origin of carcinomas of the thyroid in order?

Answer 14

Papillary (75-85%)
Follicular (10-20%)

Medullary (5%)
Anaplastic (<5%)

PFMA
Please find my answer

Question 15

how are papillary carcinoma’s diagnosed?

Answer 15

Based on nuclear features:

Optically clear nuclei
Intranuclear inclusions - orphan Annie
May be psammoma bodies - (little foci of calcification)

-> May present with cervical lymph node metastasis

Question 16

what are the characteristics of follicular carcinoma?

Answer 16

well demarcated

haematogenours spread -> lungs, bone, liver

Question 17

what is the pathogenensis of Medullary carcinoma?

epidemiology?

Answer 17

derived from parafollicular C cells

80% sporadic - adults 5-6th decade

20% familial - MEN - younger patients

Question 18

embryological orgiin of parathyroids?

Answer 18

Derive from developing pharyngeal pouches

Question 19

list causes of hyperparathyroid? which are most common?

Answer 19

80-90% - solitary adenoma

10-20% hyperplasia of all 4 glands
- Sporadic or component of MEN type 1

<1% carcinoma

Question 20

Neuromuscular irritability - tingling, muscle spasms, tetany
Cardiac arrhythmias
Fits
Cataracts

the above sx are assocaited with which condition? causes?

Answer 20

hypoparathyroidism:

Surgical ablation
Congenital absence
Autoimmune

Question 21

most common causes of cushings syndrome?

Answer 21

No 1. cause = Exogenous glucocorticoids

Top endogenous cause: Cushings disease (increased ACTH - pituitary adenoma)

others: ectopic acth - usually from lung cancer eg small cell

Question 22

what is seen on histology: cushings syndrome?

Answer 22

Exogenous glucocorticoids: Adrenal glands are atrophic

Cushings disease: Nodular adreno-cortical hyperplasia

Question 23

most common causes of Hyperaldosteronism?

Answer 23

60 % bilateral adrenal hyperplasia

35 % aldosterone secreting adenoma – Conn’s syndrome

Question 24

Clinical manifestations of which condition are hypertension and hypokalaemia?

Answer 24

primary Hyperaldosteronism

Question 25

what is the pathophysiology of CAH Congenital adrenal hyperplasias?

Answer 25

Group of autosomal recessive disorders
Hereditary defects in enzymes involved in cortisol biosynthesis

Decreased cortisol results in increased ACTH, adrenal stimulation and increased androgen synthesis
May present in childhood or less commonly in adults

Question 26

list some causes of adrenal insufficiency ?

Answer 26

1. Acute
   Haemorrhage (neonates)
   Sepsis with DIC (Waterhouse-Friderichson syndrome)
   Sudden withdrawal of corticosteroid therapy
2. Chronic (Addison’s disease)
   Autoimmune (75-90%)
   TB, HIV
   Metastatic tumour (lung and breast particularly)
   Rarely amyloid, fungal infections, haemochromatosis, sarcoidosis

Question 27

what is the difference in presentatoin of adenomas and carcinomas in the adrenals?

Answer 27

adenomas:
non-functional. conn’s, cushings

carcinomas:
congenital adrenal hyperplasia, large

Question 28

list some disease of the adrenal medulla?

Answer 28

Phaeochromocytoma

Neuroblastoma

Question 29

how are phaeo’s characterised?

Answer 29

10% associated with a familial syndrome inc. MEN 2A and 2B, vHL disease and Sturge-Weber syndrome

10% are bilateral
10% are malignant

10% arise outside the adrenal (paragangliomas)