IOD endocrine pathology

Question 1

Pituitary hormones?

Answer 1

GH, prolactin, FSH, LH, TSH, ACTH, ADH and oxytocin

Question 2

Pituitary adenomas?

Answer 2

Glandular tumours of anterior pituitary

Question 3

mass effects?

Answer 3

bitemporal hemianopia
diplopia
intracranial symptoms

Question 4

Endocrine effects?

Answer 4

functional-excess prolactin, GH and ACTH
can be small at presentation
non-functional-larger-mass effects

Question 5

prolactinomas

Answer 5

most common functonal adenoma
repro age-oligomenorrhoea or galactorrhoea, present early
men/post-meno-mass effecrs can have galactorrhoea-larger

Question 6

ACTH adenomas

Answer 6

Cushings syndrome

Question 7

GH adenomas?

Answer 7

Acromegaly-GH

High IGF-1 secretion from liver

Question 8

Features of acromegaly?

Answer 8

headaches, supraorbital ridges, enlarged nose, coarse face, prognathia, LV hypertrophy, HT, insulin resistance, hepatomegaly, large hands/feet, thick skin, impotence, joints, peripheral neuropathy,

Question 9

TSH adenomas?

Answer 9

Hyperthyroidism/thyrotoxicosis- rare

Usually GD, multinodular goitre, functional thyroid adenoma

Question 10

Adrenal gland?

Answer 10

cortex-z.glomerulosa (mc) ,z.fasiculata (gc), z.reticularis(androgens)
medulla-catecholamines

Question 11

HPA axis?

Answer 11

HT, AP, AC,

CRH, ACTH, cortisol

Question 12

Cushing’s syndrome features?

Answer 12

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

Question 13

Causes of Cushings?

Answer 13

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

Question 14

Control of BP

Answer 14

VC-increases TPR so BP

Increasing sodium retention by kidneys increases water reabsorption and so BP

Question 15

Primary hyperaldosteronism?

Answer 15

excess aldosterone
bilateral idiopathic adrenal hyperplasia-60-70%
aldosterone-producing adrenal cortical adenoma/Conns syndorme-30-40%

Question 16

Aldosterone effects?

Answer 16

RAAS
renin-ang II
aldosterone-more sodium and water-increased blood vol and BP, VC ADH
NF

Question 17

Hyperaldosteronism

Answer 17

no NF-excess aldosterone
excess sodium and water reabsorption and VC so higher BP
hypernatremia
hypokalaemia

Question 18

phaeochromocytoma?

Answer 18

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

Question 19

rule of 10%s

Answer 19

10 extra adrenal
bilateral
malignant
not linked to hypertension

Question 20

how many PCC cases are familial and genes?

Answer 20

25-30%
RET-MEN2
NF1-
VHL
SDHB SDHC SDHD-succinate dehydrogenase
SDH-mitochondrial electron transport and oxygen sensing