Histopathology 4: Endocrine pathology Flashcards
Which 2 hormones are secreted from the posterior pituitary gland
ADH
Oxytocin
What is the most common pituitary adenoma ?
Prolactinoma
Which cells produce calcitonin ?
Parafollicular cells (C-cells)
What is the most common cause of non-toxic goitre world wide ?
Iodine deficiency
What is the most common cause of hyperthyroidism ?
Grave’s disease
List the triad of features seen in Grave’s disease ?
Hyperthyroidism
Exophthalmus
Pretibial myxoedema
Hypothyroidism with Hurthle cells on histology.
Most likely diagnosis ?
Hashimoto’s thyroiditis
Most common carcinoma of the thyroid ?
Pappilary carcinoma
Thyroid histology shows psamomma bodies, empty looking nuclei and intranuclear inclusions.
Most likely diagnosis ?
Pappilary carcinoma
Congo red staining of the thyroid shows apple green birefringence. The cancer is affecting the parafollicular cells. The patient is known to have MEN2a
Most likely diagnosis ?
Medullary thyroid carcinoma
Calcitonin is produced from the parafolicular cells and is broken down to form amyloid which deposits in the thyroid gland.
What is a common cause of secondary hyperparathyroidism ?
Renal failure
List 5 physical signs seen in hypoparathyroidism ?
CATS go numb
Convulsions
Arrhythmias
Tetany
Spasms
Numbness
Which paediatric tumour affects the adrenal medulla ?
Neuroblastoma
List 3 syndromes which feature phaeochromocytomas?
MEN
von Hippel Lindau
Sturge-Weber
what cells make up the anterior pituitary
epithelial
blood supply from pituitary portal system
qhat cells make up the posterior pituitary
nerve cells
supplied by nerves originating in the supraoptic nucleus and periventricular nucleus
list 3 main effects of functioning pituitary adenomas
prolactinomas - amenorrhoea…
GH adenomas - gigantism, acromegaly, DM, muscle weakness, hypertension, CCF
Corticotroph cell adenoma - CD
causes of hypopituitarism
non-secreting pituitary adenoma
ischaemic necrosis - esp post partum ( Sheehan syndrome), DIC, SCA, elevated ICP, shock
iatrogenic - ablation of pituitary by surgery or radiation
what 2 syndromes involve ADH
diabetes insipidus
SIADH
local mass effect of pituitary tumours
compression of optic chiasm - bitemporal hemianopia
larger - raised ICP
severe - obstructive hydrocephalus
4 primary causes of thyrotoxicosis
graves
hyperfunctioning multinodular goitre
hyperfunctioning adenoma
thyroiditis
causes of hypothyroidism
primary:
- post ablative
- AI (hashimotos)
- iodine deficiency
secondary:
- pit/hypothalamic failure
features of hashimotos thyroiditis
common
F>M
painless enlargement of thyroid gland
hist - epithelial cells become large with lots of eosinophilic cytoplasm (Hurthle cells)
what are thyroid adenomas
benign neoplasms of the follicular epithelium
usually solitary
well circumscribed
well formed capsule
small proportion functional and cause thyrotoxicosis
what features suggest thyroid carcinomas
solitary rather than multiple solid rather than cystic younger M nodules do not take up iodine
types of thyroid carcionoma
papillary (80%)
follicular
medullar
anaplastic
RF for thyroid carcinoma
genetics eg MEN
ionising radiation
diagnosis of papillary carcinoma
papillary architecture
nuclear features - optically clear nuclei, intranucleus inclusions
may have psammoma bodies (foci of calcifications)
may present with cervical LN calcifications
good prognosis
features of follicular carcinoma
peak middle age
follicular morphology
metastasise via blood to lungs, bone, liver
features of medullary carcinoma
neuroendocrine tumour derived from parafolicular C cells
mainly sporadic (80%)
20% familial - MEN
calcitonin produced by tumour cells broke down and deposited as amyloid within the thyroid
amyloid visualised using congo red under polarised light
features of anaplastic carcionoma
occurs in elderly
very aggressive
mets are common
local invasion - patients die within a year
key features of the parathyroid gland
derived from developing pharyngeal pouches
4 glands total
5 actions of PTH
activates osteoclasts increases renal absorption of calcium increases activation of vitamin D increases urinary phosphate excretion increases intestinal calcium absorption
causes of hyperparathyroidism
80-90% due to a solitary adenoma
10-20% due to hyperplasia of all 4 glands - MEN1
<1% due to carcinoma
almost no fat in adenomatous parathyroid
clinical features of hyperparathyroidism
hypercalcaemia…
stones, bones, groans, moans
bones - osteitis fibrosa cystica
causes of hypoparathyroidism
surgical ablation
congenital absence
AI
clinical features of hypoparathyroidism
CATS go numb Convulsions Arrhythmias Tetany Spasms
numbness
cell types in the adrenal gland
cortex = epithelial cells medulla = neural cells
which hormone is produced in each layer of the adrenal gland
G - aldosterone
F - glucocorticoids
R - glucocorticoids + androgens
M - adrenaline and noradrenaline
most common endogenous and exogenous cause of cushings
endogenous - DC - pituitary disease
exogenous - glucocorticoids
4 causes of cushings syndrome
pituitary - adrenal hyperplasia
adrenal - nodular hyperplasia
paraneoplastic - adrenal hyperplasia
iatrogenic - adrenal atrophy
causes of hyperaldosteronism
35% due to adenoma - Conns
60% bilateral adrenal hyperplasia
HYPERTENSION + HYPOKALAEMIA
virilising syndromes (excess androgens) may be associated with neoplasms
types of adrenal insufficiency
primary
secondary
acute - sudden withdrawal of steroid therapy, haemorrhage (neonates), sepsis with DIC (waterhouse-friederichson syndrome)
chronic - AI, TB, HIV, metastatic tumour (rare= amyloidosis, fungal, hemochromatosis, sarcoidosis)
two types of adrenocortical neoplasms
adenomas - mainly functional
carcinomas - rare, usually large, common with virilising syndromes
name 2 diseases of the adrenal medulla
phaeochromocytoma
neuroblastoma
rule of 10s with phaeos
10 % associatred iwth MEN, CHL, sturge-weber syndromes
10% bilateral
10% malignant
10% paragangliomas
what in MEN syndrome
group of inherited conditions causing proliferative lesions of endocrine glands
younger age
tumours preceded by hyperplasia
more aggressive and harder to treat
