Non Thyroid Endocrine Pathology RM Flashcards
What are the functions of the parathyroid?
Release PTH in attempt to increase serum calcium
-> Bone : increased breakdown- release of Ca and phosphorus
-> Kidney (+inactive vitamin D) -> decreases excretion of calcium, increases calcitriol formation -> acts on SMALL intestine to increase absorption of calcium.
Main cells of parathyroid gland
Adipocytes
Chief Cells- release parathyroid
Oxypil Cells- potentially produce PTHrP and Calcitriol
What is primary hyperparathyroidism?
What are the causes?
- hypercalcaemia (asymptomatic) AND Elevated PTH OR Normal PTH
- PTH should be low if they are hypercalcemic.
- also will have normal or elevated urine calcium
What are symptoms of hypercalcemia and what pathologies can be produced?
Stones- kidney
Bones: bone pain, fractures
Groans: pancreatitis, peptic ulcers
Moans (psychotic) fatgieu, poor concentration
What are the causes of primary hyperparathyroidism
PARATHYROID ADENOMA
parathyroid hyperplasia
carcinoma (rare
Histologically, what does a parathyroid adenoma look like?
loss of adipocytes
increased parenchymal cells
other glands depressed
well circumscribed
What are the causes of hypoparathyroidism?
what would someone present with?
Chvostek AND Trousseau Sign
usually caused by surgery
What is the most common tumour of the pituitary gland?
Pituitary adenoma 35-50 yo Clinical presentation demends on: size/pressure: microadenoma 10mm Functional: hormonal effects (only 25% are non functioning)
will see hyperpituitarism
What are some of the size/pressure/invasive effects of pituitary adenomas?
Hypopituitarism
Headache
Visual field defects- bitemporal hemianopia
Stalk compression - decreases PIF leading to prolactin release
What effects can a large pituitary adenoma have on clinical symtoms
hypothalamus: abnormal temp regulation, diabetes insipidus, sleep disturbance
Temporal lobe: siezures, personality change
Posterior fossa: brainstem signs
Frontal lobe: altered mental state, frontal release signs, anosmia
what percentage of adenomas invade?
what can this cause?
25-30% invade locally (no metastatic capacity), causing compression and symptoms of CN3,4,5,6 issues such as
- > ptosis, diplopia, opthalmoplegia, pain and numbness along CNv1 of face
how would a pituitary surgery be performed?
Transnasally, through sphenoid sinus , then through floor of pituitary fossa.
-> aspiration
Adrenal gland:
WHAT IS THE NORMAL HISTOLOGICAL STRUCUTRE OF THE ADRENAL GLAND0 and what does each layer secrete
Glomerulosa: aldosterone
Fasciculata: cortisol
Reticularis: sex hormones (oestrogen and testosterone)
Medulla: adrenaline, noradrenaline
what are some common pathologies of the adrenal gland in an ADULT?
- hyperplasia (due to excess ACTH or CRH)
- Tumour: adenoma = cortex; phaeochromocytoma= medulla
Carcinoma
*destruction of adrenal cortex leading to adrenal insufficiency
Cysts
Myelolipomas
what are some common pathologies of the adrenal gland in an CHILDREN?
Neuroblastoma
Ganglioneuroblastoma
Ganglioneuroma
Carcinoma (more common than adenomas in children)
Adrenal gland hormones are in charge of stress response- -> what are short term and long term stress responses ?
ACTH from the anterior pituitary gland causes
short term:
- adrenaline release: glycogen broken down to glucose, increased BP, increased breathing
Long term:
cortisol release: protein and fats broken down and converted to glucose = more blood glucose
aldosterone release: rentention of sodium ions and water by the kidney, increased BV and BP
Can have functioning and non functioning adenomas of the adrenal gland.
what are the two types of functioning adenoma,?
Classical adenoma: <5cm, no haemorrhage or necrosis, usually in Zf or ZG:
- cushings syndrome with excess cortisol
- cons syndrom with excess aldosterone
- excess nandrogens
+
Black adenoma (rare)
pigmented
What is Cushings Syndrome??
Cushing’s is increase in cortisol via exogenous cause. TWO TYPES
1- ACTH dependent:
- due to ACTH producing pituitary tumour (CUSHINGS DISEASE - 70%)
- ectopic ACTH non pituitary tumour (small cell lung cancer)
2- ACTH independent
- Cortisol secretion from adrenal adenoma
Classical symptoms of cushings
moon face buffalo hump back raised bp striae on stomach skinny arms slow wound healing red cheeks moon face
What is primary hyperaldosteronism?
hypersecretion of aldosterone
signs: HTN and hypokalaemia
Aetiology:
Bilateral, idiopathic hyperplasia (60-70%) in children and young adults
OR Conn’s Syndrome via adrenal adenoma (30-40%)
Adrenogenital symptoms- virulisation and feminisation
Can be caused by adrenal pathologies or primary gonadal disorders
What are the signs for adrenal carcinoma?
> 5cm
May or may not be functional, can be oestrogen secreting
Fatal tumour with mets.
Can cause Cushings and virilisation in a child and increased mitoses, fatal.
What is Acute primary cortical Adrenal Insufficiency?
what are the causes
often insidious, cause severe shock:
weakness, vomiting, diarrhoea, CV collapse, abdo pain, hypoclycemia, electrolyte disturbance
Adrenal Crisis: chronic adrenal insufficiency in the setting of stress
Rapid withdrawal of steroids or failure to increase at times of stress
Massive adrenal haemorrhage (newborns after brithtrauma)
Waterhouse Friderichsen Syndrome:
a form of adrenal insufficiency
what causes it
haemorrhage and infarction of the adrenals with a bacterial infection = hypotension -> shock + DIC
DEFINE Addisons disease
Chronic Primary Adrenal (cortical) insufficiency
Causes:
Autoimmune adrenalitis
Tuberculosis
AIDS
Signs of Addisons Disease
Tiredness, lethargy, weakness
Syncope, postural diziness
nausea, abdo pain,diarrhoea, constipation
general constitutional
CLinically - anorexia - hyperpigmentation - hypotension - thinning of pubic hair vitiligo
Treatment of Adrenal insufficiency=
Glucocorticoids, mineralocorticoids and IV fluids
● In chronic patients, must give steroid boost during infections, prior to surgery or during pregnancy
What is a phaeochromocytoma?
Adrenal pathology- > to medulla
20-50 yrs
May be precipitated by stress, exercise, change in posture,
sudden onset, mins to hours, headache, tachycardia, palpitations, sweating, apprehension, pallor or flushing pain, vomiting. Severe HTN.
HTN: difficult to control
Hypotension: postural hypotension
Neuroblastoma
40% arise in the adrenal medullary neuronal cells, the rest in various sympathetic ganglia
Important: MOST COMMON EXTRACRANIAL SOLID TUMOUR IN CHILDREN
18 months old
What are the two types of neuroblastic tumours?
Ganglioneuroblastoma:
- Ganglion cells invarious stages of maturation
- Schwann cells and fibroblasts- > favourable
Ganglioneuroma:
Better differentiated lesions that resemble mature ganglion cells and few/nil neuroblasts
Organised fascicles
