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Pathology Flashcards

1
Q

What embryological structure forms the anterior pituitary?

A

Rathke’s Pouch

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2
Q

Differentiate the trophic and non-trophic hormones secreted by the anterior pituitary

A

Trophic: TSH, ACTH, FSH, LH

Non-trophic: GH and Prolactin

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3
Q

What type of cells make up the posterior pituitary gland?

A

modified glial cells and axonal processes

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4
Q

What hormones does the posterior pituitary gland secrete?

A 
Secretes ADH (vasopressin) 
and oxytocin
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5
Q

The hormone secreting cells in the anterior pituitary are either Acidophils or Basophils. Classify them into both groups.

A

ACIDOPHILS:
Somatotrophs – secrete GH
Mammotrophs – secrete PROLACTIN

BASOPHILS:
Corticotrophs – secrete ACTH
Thyrotrophs – secrete TSH
Gonadotrophs – secrete FSH / LH

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6
Q

What name is given to a cell which does not absorb acidic nor basic dye?

A

Chromophobe

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7
Q

What pathologies of the anterior pituitary usually result in HYPERfunction?

A

Adenoma

Carcinoma

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8
Q

What conditions of the anterior pituitary often cause HYPOfunction?

A
  • Surgery/radiation
  • Sudden Haemorrhage into gland
  • Ischaemic necrosis
  • Sheehan Syndrome (post-partum necrosis)
  • Tumours extending into sella turnica
  • Inflammatory conditions (e.g. Sarcoidosis)
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9
Q

How does the posterior pituitary cause Diabetes insipidus?

A
  • Lack of ADH secretion

- Can lead to life threatening dehydration

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10
Q

What condition is characterised by ectopic secretion of ADH by tumours?

A

Syndrome of Inappropriate ADH secretion (SIADH)

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11
Q

Pituitary adenomas are always sporadic. TRUE/FALSE?

A

FALSE

can also be associated with MEN1 gene mutation

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12
Q

Pituitary adenomas can secrete more than one hormone. TRUE/FALSE?

A

TRUE

although some tumours can be non-functioning also

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13
Q

What symptoms can large adenomas cause locally?

A
  • Atrophy of surrounding normal tissue due to pressure
  • Visual field defects
  • Infarction leading to panhypopituitarism
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14
Q

What is the most common FUNCTIONAL tumour found in the anterior pituitary?

A

Prolactinoma

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15
Q

How does a prolactinoma usually present?

A

Infertility
lack of libido
amenorrhea

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16
Q

A tumour secreting GH causes an increase in what peripheral hormone? And what can this cause?

A
  • Insulin Like Growth Factors (IGF)
  • Stimulates growth of bone, cartilage and CT
  • causes Gigantism (if bones yet to fuse) or acromegaly
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17
Q

What type of tumours usually secrete ACTH?

A

Microadenoma

OR Bilateral adrenocortical hyperplasia

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18
Q

What hormones do pituitary carcinomas usually secrete?

A

Prolactin or ACTH

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19
Q

Pituitary carcinomas tend to metastasise early. TRUE/FALSE?

A

FALSE

metastasise LATE after multiple recurrences

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20
Q

Craniopharyngiomas are slow growing. TRUE/FALSE

A

TRUE

Also often cystic and may calcify

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21
Q

Where do most Craniopharyngiomas arise?

A

Most are suprasellar

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22
Q

What symptoms are usually present in Craniopharyngiomas?

A
  • Headaches and visual disturbances

- Children may have growth retardation

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23
Q

Craniopharyngiomas have a good prognosis. TRUE/FALSE?

A

TRUE (If <5cm)

Risk of SCC after radiation

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24
Q

What is “Nephrogenic” Diabetes Insipidus?

A

Renal resistance to the effects of ADH

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25
How much does one adrenal gland roughly weigh?
4-5 grams
26
What are the two distinct anatomical regions of the adrenal gland?
Cortex and Medulla
27
What conditions can cause hyperfunction in the adrenal cortex?
Hyperplasia Adenoma Carcinoma
28
Adrenal cortex hypofunction can be acute or chronic. What are the causes of each?
Acute - Waterhouse-Friderichsen (septic infection) Chronic - Addison’s disease
29
Congential Adrenocortical Hyperplasia is Autosomal Dominant. TRUE/FALSE?
FALSE | Autosomal Recessive
30
Describe the pathogenesis of Congential Adrenocortical Hyperplasia
Enzyme deficiency => cant make aldosterone/ cortisol => all shunted to androgen production Reduced cortisol stimulates ACTH release and cortical hyperplasia
31
What does the androgen production in CAH lead to?
Virilisation | Precocious Puberty
32
Describe the pathogenesis of acquired Adrenocortical Hyperplasia
Endogenous ACTH production from: - Pituitary adenoma OR Ectopic ACTH from: - Paraneoplastic syndrome (small cell lung carcinoma) Causes Bilateral adrenal enlargement to meet Cortisol demands from all excess ACTH
33
Adrenocortical tumours are usually an incidental finding in adults. TRUE/FALSE
TRUE
34
Describe the appearance of an adrenocortical adenoma
- Well circumscribed - Usually small (2 to 3cm) - Yellow/brown surface (lipid) - Composed of cells resembling adrenocortical cells - Can be functional, but unlikely
35
Where do adrenocortical carcinomas usually spread to?
Local invasion – retroperitoneum, kidney Metastasis – vascular (liver, lung and bone) Peritoneum and pleura Regional lymph nodes
36
What is the 5 year survival for adrenocortical carcinomas?
20-35% | 50% are dead within the first 2 years
37
Adrenocortical Adenomas and Carcinomas look very similar. What can help to differentiate between them?
- Large size (often >20cm) - Haemorrhage and necrosis - Frequent mitoses, atypical mitoses - Lack of clear cells - Capsular or vascular invasion
38
What syndrome is related to an oversecretion of aldosterone from the adrenal cortex?
Conn's | = Primary Aldosteronism
39
What are the most common causes of Conn's syndrome?
``` 60% = diffuse or nodular hyperplasia of both adrenal glands 35% = Adenoma RARE = carcinoma ```
40
What hormone is secreted to excess in Cushing's syndrome?
Cortisol
41
What are the most common causes of Cushing's?
Exogenous Cause: Iatrogenic (steroid therapy) Endogenous Cause: - ACTH secreting pituitary adenoma - Ectopic ACTH (e.g. Small cell lung cancer) - Adrenal adenoma/carcinoma - Adrenal gland atrophy => no lesions
42
What can cause ACUTE adrenocortical insufficiency?
- Rapid withdrawal of steroid treatment - increasing dose of steroid treatment - Acute adrenal Crisis if pts have chronic disease - Massive adrenal haemorrhage - Newborn - Anticoagulant treatment - Septiceamic infection – Waterhouse Friderichsen
43
What are the most common causes of Addison's disease?
- Autoimmune adrenalitis - Infections (TB/fungal/HIV) - Metastatic malignancy (Lung, breast)
44
What are the more unusual causes of Addison's disease?
Amyloid Sarcoidosis Haemochromatosis
45
How much of the gland is already destroyed by the time Addison's disease presents?
90%
46
What vague symptom differentiates Addison's disease from hypopituitarism?
Raised Pigmentation | => patients often seem tanned (or even orange)
47
Biochemically, how do patients with Addison's Disease present?
Hyperkalaemia (High K+) hyponatraemia (Low Na+) Volume depletion => hypotension (Low BP) Hypoglycaemic
48
How do patients in Acute Addison's crisis present?
- Vomiting - abdominal pain - hypotension - shock and death
49
What innervates the Adrenal medulla?
Pre-synaptic fibres from sympathetic nervous system
50
What cells are found in the adrenal medulla and what do they secrete?
Neuroendocrine (chromaffin) cells | => secrete catecholamines
51
What two types of tumour are most commonly found in the adrenal medulla?
Phaechromocytoma | Neurblastoma
52
What do Phaechromocytomas secrete?
Secrete catecholamines
53
Phaechromocytomas can rarely cause secondary Hypertension. TRUE/FALSE?
TRUE
54
What complications can arise from the secondary hypertension of Phaechromocytoma?
Cardiac failure infarction arrhythmias
55
How should a Phaechromocytoma be investigated for in the lab?
Detection of urinary excretion of catecholamines and metabolites
56
Why is Phaechromocytoma known as the 10% tumour?
``` 10% are extra-adrenal 10% are bilateral 10% are malignant 10% are NOT associated with hypertension 25% are familial ```
57
How do Phaechromocytomas usually look?
Yellow, red/brown due to haemorrhagic and necrotic nature | Tumour turns dark brown due to oxidation of catecholamines in tumour cells
58
Where do Phaechromocytomas metastasise to?
skeletal metastasis regional lymph nodes liver lung
59
What subtypes of Multiple Endocrine Neoplasia does a Phaechromocytoma usually present in?
MEN2a | MEN2b
60
What are the 3 zones found in the adrenal cortex?
Zona Glomerulosa Zona Fasciculata Zona Reticularis
61
What hormones are secreted by the Zona Glomerulosa?
Mineralocorticoids | => Aldosterone
62
What hormones are secreted by the Zona Fasciculata?
Glucocorticoids | => Cortisol
63
What hormones are secreted by the Zona Reticularis?
Sex Steroids + Glucocorticoids

Endocrine (24 decks)

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