Histopathology - Endocrine disease Flashcards
What are the most common causes of hyper- and hypo-pituitarism?
Hyperpituitarism: functional adenoma
Hypopituitarism: nonsecretory adenomas/ ischaemic necrosis (post-partum)
What are the 3 symptoms of local mass effect of pituitary tumours?
Bitemporal hemianopia (compression of optic chiasm) Elevated ICP Obstructive hydrocephalus
Recall 4 differentials for primary hyperthyroidism
- Grave’s
- Hyperfunctioning multinodular goitre
- Hyperfunctioning adenoma
- de quervain’s thyroiditis
- post partum thyroiditis
What is the cause of secondary hyperthyroidism?
TSH-secreting pituitary adenoma (rare)
How can struma ovarii cause thyroid disease?
Ovarian teratomas can secrete ectopic thyroxine
What autoimmune condition can cause hypothyroidism?
Hashimoto’s
Differentiate the type of auto-antibodies involved in Grave’s vs Hashimoto’s
Grave’s: anti-TSH
Hashimoto’s: anti-TPO and anti-TG (thyroglobulin)
What is the histological appearance of a Hashimoto’s thyroid?
hurtle cell
lymphoid cells
What are the main symptoms of Hashimoto’s?
clinically hypothyroid
Painless goitre
Recall 4 differentials for the cause of hypothyroidism
- Atrophic
- Iodine deficiency
- Riedel’s thyroidits
- Autoimmune (Hashimoto’s)
What is a thyroid adenoma?
Benign neoplasm of follicular thyroid epithelium
How are thyroid adenomas diagnosed?
FNA and cytology
What is the most common type of thyroid cancer?
Papillary
What are the key histological features of papillary thyroid cancer?
Optically clear nuclei
Psammoma bodies
Which type of thyroid adenoma is associated with Multiple Endocrine Neoplasia?
Medullary
Which type of thyroid cancer is most aggressive?
Anaplastic
What are the 4 subtypes of thyroid cancer?
Follicular
Papillary
Medullary
Anaplastic
What is the most common cause of primary hyperparathyroidism?
parathyroid adenoma
What is secondary hyperparathyroidism almost always caused by?
Renal failure
Recall 3 possible causes of hypoparathyroidism
Surgical ablation
Congenital absence
Auto-immune
Recall 4 possible symptoms of hypoparathyroidism
Those of hypocalcaemia:
Muscle spasms/ tetany
Cardiac arrhythmias
Fits
Cataracts
Recall the synthetic function of each zone of the adrenals
GFR Medulla
GFR = adrenal cortex
Zona Glomerulosa =aldosterone [OUTER]
Fasciculata = glucocorticoids
Reticularis = androgens and glucocorticoids (cortex = epithelial cells)
Medulla = noradrenaline/adrenaline [INNER]
(medulla) = neural cells
What is Waterhouse-Friedrichson syndrome?
acute adrenal insufficiency with sepsis and DIC (bleeding into adrenal gland)
which thyroid cancer leads to amyloid deposits in thyroid?
medullary
calcitonin broken down and deposited as amyloid
visualised using Congo red stain
triad of graves disease
exomthalmos
thyrotoxicosis
pretibial myoedoma
phaechromo is a tumour of what part of adrenal gland
medulla = adrenaline/noradrenaline production
2 signs of conn’s
Hypertension –
Hypokalaemia
what’s cushings syndrome. give 6 features
excess glucocorticoids
HTN Weight gain Truncal obesity “Moon face”
“Buffalo hump” Cutaneous striae
give ACTH dependent and ACTH independent causes of cushings
ACTH dependent
Pituitary tumour
– “Cushing’s
disease” (85%)
Ectopic ACTH-producing tumour (5%) (small cell lung cancer, carcinoid tumour)
ACTH independent
drenal adenoma/cancer (10%), adrenal nodular hyperplasia, iatrogenic steroid use
what 2 tests for Addisons and cushings
Addisons - SynACTHen test
Cushings - 1st line: Overnight dexamethasone suppression test or 24h urinary free cortisol
most common virilising syndrome
CAH
21 hydroxylase deficiency
Autosomal recessive
