IOD endocrine pathology Flashcards
Pituitary hormones?
GH, prolactin, FSH, LH, TSH, ACTH, ADH and oxytocin
Pituitary adenomas?
Glandular tumours of anterior pituitary
mass effects?
bitemporal hemianopia
diplopia
intracranial symptoms
Endocrine effects?
functional-excess prolactin, GH and ACTH
can be small at presentation
non-functional-larger-mass effects
prolactinomas
most common functonal adenoma
repro age-oligomenorrhoea or galactorrhoea, present early
men/post-meno-mass effecrs can have galactorrhoea-larger
ACTH adenomas
Cushings syndrome
GH adenomas?
Acromegaly-GH
High IGF-1 secretion from liver
Features of acromegaly?
headaches, supraorbital ridges, enlarged nose, coarse face, prognathia, LV hypertrophy, HT, insulin resistance, hepatomegaly, large hands/feet, thick skin, impotence, joints, peripheral neuropathy,
TSH adenomas?
Hyperthyroidism/thyrotoxicosis- rare
Usually GD, multinodular goitre, functional thyroid adenoma
Adrenal gland?
cortex-z.glomerulosa (mc) ,z.fasiculata (gc), z.reticularis(androgens)
medulla-catecholamines
HPA axis?
HT, AP, AC,
CRH, ACTH, cortisol
Cushing’s syndrome features?
hair, hirsuitism, plethora, monnn face, buffalo hump, poor healing, bruising, abdominal obesity, petechiae, nails, striae,proximal myopathy, osteoporosis, DM,HT, peripheral neuropathy, immunocompromised, moon face, gonadal dysfunction
Causes of Cushings?
exogenous glucocorticoids causing atrophy of adrenal cotices
pituitary adenoma-hyperplasia due to more circulating ACTH
Adrenal cortical adenoma in ZF
paraneoplastic syndrome eg small cell lung cancer
Control of BP
VC-increases TPR so BP
Increasing sodium retention by kidneys increases water reabsorption and so BP
Primary hyperaldosteronism?
excess aldosterone
bilateral idiopathic adrenal hyperplasia-60-70%
aldosterone-producing adrenal cortical adenoma/Conns syndorme-30-40%
Aldosterone effects?
RAAS
renin-ang II
aldosterone-more sodium and water-increased blood vol and BP, VC ADH
NF
Hyperaldosteronism
no NF-excess aldosterone
excess sodium and water reabsorption and VC so higher BP
hypernatremia
hypokalaemia
phaeochromocytoma?
neuroendocrine tumour of adrenal medulla
brown tumour with orange rims more adrenaline-VC and HR-higher BP
headache, sweating and palpitations
treatable after surgery
i-24hr urine collection for catecholamines and metanephrine
rule of 10%s
10 extra adrenal
bilateral
malignant
not linked to hypertension
how many PCC cases are familial and genes?
25-30% RET-MEN2 NF1- VHL SDHB SDHC SDHD-succinate dehydrogenase SDH-mitochondrial electron transport and oxygen sensing
