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Cellular pathology > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Where is the pituitary gland located

A

sella turcica of the sphenoid bone, attached to the hypothalamus

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2
Q

What hormones are secreted from the anterior pituitary

A 
o Growth Hormone
o Prolactin
o FSH
o LH
o TSH
o ACTH
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3
Q

What is the difference of the hypothalamic involvement between hormones secreted from the anterior and posterior pituitary

A

ANT: these hormones are regulated by hormones from the hypothalamus

POS: these are synthesised in the hypothalamus - pass into the posterior pituitary to be secreted

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4
Q

What hormones are secreted from the posterior pituitary

A

o Oxytocin

o ADH

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5
Q

What is the most common disease of the anterior pituitary

A

Pituitary adenoma

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6
Q

What type of tissue is most commonly affected with a pituitary adenoma

A

Glandular tissue

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7
Q

What are the most common causes of pituitary adenoma

A

Most cases are sporadic, but they can occur as part of the MEN1 syndrome

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8
Q

What are the 2 main types of pituitary adenoma and how do they present

A

o Functional adenomas = Effects related to excess hormone secretion (very small at presentation - because the symptoms mean they are picked up earlier)
o Non-functional adenomas = don’t produce hormones - larger and therefore present with mass effects (however many are not detected - as they remain small)

” Mass effects
o Bitemporal hemianopia - due to compression of the optic chiasm, thereby affecting the optic nerves
o Diplopia - compression of CN III, IV, VI
o Non-specific symptoms of a intracranial mass ie headache

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9
Q

What is a prolactinoma

A

Pituitary adenomas that produce excess prolactin

They are the most common type of functional adenoma

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10
Q

How would a prolactinoma present in a woman of reproductive age

A

Oligomenorrhoea - infrequent/light menstruation (4-9 periods a year)
OR
Galactorrhoea - spontaneous flow of milk from the breast unassociated with pregnancy or breast feeding

(Note these patients generally have small tumours and present early)

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11
Q

How would a prolactinoma present in a man/post-menopausal woman

A

” Mass effects - headache / visual disturbance
OR
“ Galactorrhoea (occasionally)
These patients generally have larger tumours on presentation.

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12
Q

How do ACTH secreting adenomas present

A

Cushing’s syndrome

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13
Q

How do GH secreting tumours present

A

Acromegaly

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14
Q

List symptoms of acromegaly

A 
" Facial changes
o Protruding supraorbirtal ridges
o Enlarged nose
o Coarse facial features
o Prognathia
" Headaches
" Thickened calvaria
" LV hypertrophy
" HTN
" Insulin resistance
" Hepatomegaly
" Impotence and loss of libido / amenorrhoea in women
" Large hands
" Thickened skin
" Hyperostosis
" Degenerative joint disease
" Peripheral neuropathy (nerve compression)
" Large feet and heel pad
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15
Q

Mortality is doubled in patients with acromegaly- why

A

Mainly due to high incidence of CVD due to LV hypertrophy and HTN.
Also has another risk factor for CVD as it is a diabetogenic state (insulin resistance)

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16
Q

How do TSH secreting adenomas present

A

Thyrotoxicosis

not a very common cause of thyrotoxicosis though!

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17
Q

What are common causes of thyrotoxicosis

A 
" Graves (80%)
" Toxic multinodular goitre - secretes thyroid hormone independently of TSH
" A functional thyroid adenoma
" Drugs - amiodarone
" Thyroiditis (certain types)
18
Q

Where are the adrenal glands located

A

located in the retroperitoneum, superior to the kidneys

19
Q

What are the functional divisions of the adrenal glands

A

Cortex and medulla

20
Q

How is the adrenal cortex divided

A

o Zona glomerulosa = mineralocorticoids (ALDOSTERONE)
o Zona fasiculata = glucocorticoids (CORTISOL)
o Zona reticularis = ANDROGENS

21
Q

What does the medulla of the adrenal gland secrete

A

catecholamines - eg. adrenaline + noradrenaline

22
Q

How does the HPA axis regulate cortisol

A
  1. Hypothalamus secretes CORTICOTROPHIN RELEASING HORMONE - CRH
  2. Stimulates the anterior pituitary to secrete ACTH
  3. ACTH acts on the adrenal gland to stimulate the release of cortisol
  4. Cortisol has a negative feedback effect on both the hypothalamus and anterior pituitary - supressing CRH and ACTH
23
Q

What is Cushing’s syndrome

A

A metabolic disorder due to persistent excess circulating glucocorticoids

24
Q

List symptoms of Cushing’s syndrome

A
  • Weight gain - pattern of fat deposition = marked trunkal obesity and a moon face
  • Muscle weakness - proximal myopathy.
  • Gonadal dysfunction = menstrual irregularities in women and loss of libido in men
  • Hirsuitism in women
  • HTN - secondary
25
Q

What is the most common cause of Cushing’s syndrome

A

Exogenous administration of glucocorticoids

26
Q

List the main causes of Cushing’s syndrome

A
  1. Exogenous administration of glucocorticoids
  2. Pituitary adenoma which secretes ACTH
  3. An adrenal cortical adenoma which secretes cortisol
  4. Paraneoplastic syndrome
27
Q

A patient with cushing’s syndrome has adrenals that have atrophied. What is the most likely cause behind their symptoms?

A

Exogenous administration of glucocorticoids

28
Q

A patient with cushing’s syndrome has adrenals that have undergone hyperplasia. What is the most likely cause behind their symptoms?

A

Pituitary adenoma secreting ACTH

29
Q

What is Cushing’s disease

A

Pituitary adenoma which secretes ACTH

30
Q

A patient with Cushing’s syndrome is found to have an adrenal cortical adenoma. Which cells will this have arisen from? (not specific, just wants the location)

A

Cells in the zona fasciculata

31
Q

What is the equation for BP

A

BP= CO x TPR

32
Q

What are the 2 main factors affecting BP

A

Vasoconstriction - TPR

Increase in Na+ retention (+ H2O = + circulating volume = + CO)

33
Q

What is the equation for CO

A

CO= HR x SV

34
Q

What is the most common cause of primary hyperaldosteronism?

A

Conn’s syndrome (aldosterone producing adrenal cortical adenoma)

35
Q

What is the second most common cause of primary hyperaldosteronism

A

Bilateral adrenal cortical hyperplasia

36
Q

Briefly explain RAAS

A
  1. If BP falls there is reduced blood flow to the renal artery
  2. This hypoperfusion stimulates release of renin
  3. Results in the production of Ang II. Its effects include:
    a. Stimulates release of aldosterone from the adrenal cortex. Aldosterone increases Na+ (and water) reabsorption by the kidney tubules - increases blood volume and raises BP
    b. Vasoconstriction of arterioles (systemic) = raises BP
    c. Stimulates release of ADH by posterior pituitary - stimulates water reabsorption - increases blood volume = raises BP
  4. Restoration of blood flow = less renin released and so downregulates renin
37
Q

What are the effects of Ang II

A

a. Stimulates release of aldosterone from the adrenal cortex. Aldosterone increases Na+ (and water) reabsorption by the kidney tubules - increases blood volume and raises BP
b. Vasoconstriction of arterioles (systemic) = raises BP
c. Stimulates release of ADH by posterior pituitary - stimulates water reabsorption - increases blood volume = raises BP

38
Q

What are the main effects of hyperaldosteronism

A
  • Excess Na+ reabsorption = hypernatreamia
  • Excess K+ loss into urine = hypokalaemia
  • Excess Na+ retention = excess H2O reabsorption = + circulatory volume = + CO = + BP
39
Q

What is a phaeochromocytoma

A

Neuroendocrine tumour of the adrenal medulla, which secretes catecholamines

40
Q

What is the main effect of a phaeochromocytoma

A

Hypertension

41
Q

How do phaeochromocytomas present

A

Usually asymptomatic - may complain of episodes of throbbing headache/sweating/palpitation (due to episodic increases in circulating catecholamines).

42
Q

How do you investigate a suspected phaeochromocytoma

A

24h urine collection for catecholamine and metanephrine measurement

Cellular pathology (8 decks)

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