Histopathology 4 - Endocrine disease

Question 1

What are the most common causes of hyper- and hypo-pituitarism?

Answer 1

Hyperpituitarism: functional adenoma
Hypopituitarism: nonsecretory adenomas/ ischaemic necrosis/ surgery

Question 2

What are the 3 symptoms of local mass effect of pituitary tumours?

Answer 2

Bitemporal hemianopia
Elevated ICP
Obstructive hydrocephalus

Question 3

Recall 4 differentials for primary hyperthyroidism

Answer 3

1. Grave’s
2. Hyperfunctioning multinodular goitre
3. Hyperfunctioning adenoma
4. Thyroiditis

Question 4

What is the cause of secondary hyperthyroidism?

Answer 4

TSH-secreting pituitary adenoma (rare)

Question 5

How can struma ovarii cause thyroid disease?

Answer 5

Ovarian teratomas can secrete ectopic thyroxine

Question 6

What autoimmune condition can cause hypothyroidism?

Answer 6

Hashimoto’s

Question 7

Differentiate the type of auto-antibodies involved in Grave’s vs Hashimoto’s

Answer 7

Grave’s: anti-TSH receptor

Hashimoto’s: anti-TPO and anti-TG (thyroglobulin)

Question 8

What is the histological appearance of a Hashimoto’s thyroid?

Answer 8

Lymphocyte aggregates and transformed follicular cells

Question 9

What are the main symptoms of Hashimoto’s?

Answer 9

Clinically hypothyroid

Painless goitre

Question 10

Recall 4 differentials for the cause of hypothyroidism

Answer 10

1. Postablative
2. Iodine deficiency
3. Congenital biosynthetic defect
4. Autoimmune (Hashimoto’s)

Question 11

What is a thyroid adenoma?

Answer 11

Benign neoplasm of follicular thyroid epithelium

Question 12

How are thyroid adenomas diagnosed?

Answer 12

FNA and cytology

Question 13

What is the most common type of thyroid adenoma?

Answer 13

Papillary

Question 14

What are the key histological features of papillary thyroid cancer?

Answer 14

Optically clear nuclei
Psammoma bodies
Orphan Anne Nuclei

Question 15

Which type of thyroid adenocarcinoma is associated with Multiple Endocrine Neoplasia?

Answer 15

Medullary

Question 16

Which type of thyroid adenocarcinoma is most aggressive?

Answer 16

Aplastic

Question 17

What are the 4 subtypes of thyroid adenocarcinoma?

Answer 17

Follicular
Papillary (most common)
Medullary (associated with MEN, check CEA and calcitonin)
Anaplastic (most malignant)

Question 18

What is the most common cause of primary hyperparathyroidism?

Answer 18

Solitary adenoma

Question 19

What is the most common symptom of hyperparathyroidism?

Answer 19

Clinically silent hypercalcaemia (so not really a symptom)

Question 20

What is secondary hyperparathyroidism almost always caused by?

Answer 20

Renal failure

Question 21

Recall 3 possible causes of hypoparathyroidism

Answer 21

Surgical ablation
Congenital absence
Auto-immune

Question 22

Recall 4 possible symptoms of hypoparathyroidism

Answer 22

Those of hypocalcaemia:
Muscle spasms/ tetany
Cardiac arrhythmias
Fits
Cataracts

Question 23

Recall the synthetic function of each zone of the adrenals

Answer 23

Medulla: Noradrenaline and adrenaline
Reticularis: androgens
Fasciculata: glucocorticoids
Glomerulosa: aldosterone

Question 24

What is Waterhouse-Friedrichson syndrome?

Answer 24

Adrenal insufficiency with sepsis and DIC