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Year 5 path SW > Histopathology 4: Endocrine pathology > Flashcards

Histopathology 4: Endocrine pathology Flashcards

1
Q

Which 2 hormones are secreted from the posterior pituitary gland

A

ADH

Oxytocin

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2
Q

What is the most common pituitary adenoma ?

A

Prolactinoma

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3
Q

Which cells produce calcitonin ?

A

Parafollicular cells (C-cells)

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4
Q

What is the most common cause of non-toxic goitre world wide ?

A

Iodine deficiency

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5
Q

What is the most common cause of hyperthyroidism ?

A

Grave’s disease

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6
Q

List the triad of features seen in Grave’s disease ?

A

Hyperthyroidism
Exophthalmus
Pretibial myxoedema

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7
Q

Hypothyroidism with Hurthle cells on histology.

Most likely diagnosis ?

A

Hashimoto’s thyroiditis

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8
Q

Most common carcinoma of the thyroid ?

A

Pappilary carcinoma

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9
Q

Thyroid histology shows psamomma bodies, empty looking nuclei and intranuclear inclusions.

Most likely diagnosis ?

A

Pappilary carcinoma

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10
Q

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 ?

A

Medullary thyroid carcinoma

Calcitonin is produced from the parafolicular cells and is broken down to form amyloid which deposits in the thyroid gland.

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11
Q

What is a common cause of secondary hyperparathyroidism ?

A

Renal failure

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12
Q

List 5 physical signs seen in hypoparathyroidism ?

A

CATS go numb

Convulsions
Arrhythmias
Tetany
Spasms

Numbness

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13
Q

Which paediatric tumour affects the adrenal medulla ?

A

Neuroblastoma

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14
Q

List 3 syndromes which feature phaeochromocytomas?

A

MEN
von Hippel Lindau
Sturge-Weber

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15
Q

what cells make up the anterior pituitary

A

epithelial

blood supply from pituitary portal system

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16
Q

qhat cells make up the posterior pituitary

A

nerve cells

supplied by nerves originating in the supraoptic nucleus and periventricular nucleus

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17
Q

list 3 main effects of functioning pituitary adenomas

A

prolactinomas - amenorrhoea…
GH adenomas - gigantism, acromegaly, DM, muscle weakness, hypertension, CCF
Corticotroph cell adenoma - CD

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18
Q

causes of hypopituitarism

A

non-secreting pituitary adenoma
ischaemic necrosis - esp post partum ( Sheehan syndrome), DIC, SCA, elevated ICP, shock
iatrogenic - ablation of pituitary by surgery or radiation

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19
Q

what 2 syndromes involve ADH

A

diabetes insipidus

SIADH

20
Q

local mass effect of pituitary tumours

A

compression of optic chiasm - bitemporal hemianopia
larger - raised ICP
severe - obstructive hydrocephalus

21
Q

4 primary causes of thyrotoxicosis

A

graves
hyperfunctioning multinodular goitre
hyperfunctioning adenoma
thyroiditis

22
Q

causes of hypothyroidism

A

primary:

  • post ablative
  • AI (hashimotos)
  • iodine deficiency

secondary:
- pit/hypothalamic failure

23
Q

features of hashimotos thyroiditis

A

common
F>M
painless enlargement of thyroid gland
hist - epithelial cells become large with lots of eosinophilic cytoplasm (Hurthle cells)

24
Q

what are thyroid adenomas

A

benign neoplasms of the follicular epithelium
usually solitary
well circumscribed
well formed capsule
small proportion functional and cause thyrotoxicosis

25
Q

what features suggest thyroid carcinomas

A 
solitary rather than multiple
solid rather than cystic 
younger 
M 
nodules do not take up iodine
26
Q

types of thyroid carcionoma

A

papillary (80%)
follicular
medullar
anaplastic

27
Q

RF for thyroid carcinoma

A

genetics eg MEN

ionising radiation

28
Q

diagnosis of papillary carcinoma

A

papillary architecture
nuclear features - optically clear nuclei, intranucleus inclusions
may have psammoma bodies (foci of calcifications)
may present with cervical LN calcifications
good prognosis

29
Q

features of follicular carcinoma

A

peak middle age
follicular morphology
metastasise via blood to lungs, bone, liver

30
Q

features of medullary carcinoma

A

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

31
Q

features of anaplastic carcionoma

A

occurs in elderly
very aggressive
mets are common
local invasion - patients die within a year

32
Q

key features of the parathyroid gland

A

derived from developing pharyngeal pouches

4 glands total

33
Q

5 actions of PTH

A 
activates osteoclasts 
increases renal absorption of calcium 
increases activation of vitamin D 
increases urinary phosphate excretion 
increases intestinal calcium absorption
34
Q

causes of hyperparathyroidism

A

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

35
Q

clinical features of hyperparathyroidism

A

hypercalcaemia…
stones, bones, groans, moans

bones - osteitis fibrosa cystica

36
Q

causes of hypoparathyroidism

A

surgical ablation
congenital absence
AI

37
Q

clinical features of hypoparathyroidism

A 
CATS go numb
Convulsions 
Arrhythmias
Tetany 
Spasms

numbness

38
Q

cell types in the adrenal gland

A 
cortex = epithelial cells 
medulla = neural cells
39
Q

which hormone is produced in each layer of the adrenal gland

A

G - aldosterone
F - glucocorticoids
R - glucocorticoids + androgens

M - adrenaline and noradrenaline

40
Q

most common endogenous and exogenous cause of cushings

A

endogenous - DC - pituitary disease

exogenous - glucocorticoids

41
Q

4 causes of cushings syndrome

A

pituitary - adrenal hyperplasia
adrenal - nodular hyperplasia
paraneoplastic - adrenal hyperplasia
iatrogenic - adrenal atrophy

42
Q

causes of hyperaldosteronism

A

35% due to adenoma - Conns
60% bilateral adrenal hyperplasia

HYPERTENSION + HYPOKALAEMIA

virilising syndromes (excess androgens) may be associated with neoplasms

43
Q

types of adrenal insufficiency

A

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)

44
Q

two types of adrenocortical neoplasms

A

adenomas - mainly functional

carcinomas - rare, usually large, common with virilising syndromes

45
Q

name 2 diseases of the adrenal medulla

A

phaeochromocytoma

neuroblastoma

46
Q

rule of 10s with phaeos

A

10 % associatred iwth MEN, CHL, sturge-weber syndromes
10% bilateral
10% malignant
10% paragangliomas

47
Q

what in MEN syndrome

A

group of inherited conditions causing proliferative lesions of endocrine glands
younger age
tumours preceded by hyperplasia
more aggressive and harder to treat

Year 5 path SW (106 decks)

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