Pathology of Endocrine Disease

Question 1

RECAP- what are the four main glands of the endocrine system?

Answer 1

Thyroid gland
Parathyroid gland
Adrenal glands
Pancreas

Question 2

RECAP- what controls the four main glands of the endocrine system?

Answer 2

Pineal gland
Hypothalamus
Pituitary gland

-> hypothalamus is CEO, pituitary is general manager

Question 3

RECAP- what does the pineal gland produce?

Answer 3

Melatonin

Question 4

Hypertropy?

Answer 4

Increased number and secretory activity of cells

Question 5

Atrophy?

Answer 5

Reduction of cells due to lack of stimulation

Question 6

What can cause tissue damage?

Answer 6

Inflammation, autoimmune disease, compression, trauma, infarction

Question 7

Neoplasia?

Answer 7

Uncontrolled growth, either benign or malignant

Question 8

What is meant by a functioning adenoma compared to a non-functioning adenoma?

Answer 8

Functioning adenoma produces hormones, it is a secretory tumour

Question 9

Describe from a pathological POV what a benign neoplasm would look like down a microscope.

Answer 9

Often circumcised, localised, cannot invade and does not usually transform

Question 10

Describe from a pathological POV what a malignant neoplasm would look like down a microscope.

Answer 10

Synonymous with cancer
Invades, metastasises
If untreated, fatal

Question 11

All endocrine glands are regulated through the feedback mechanism.
Where do these always loop trhough?

Answer 11

The hypothalamus
Pituitary
Target organ

Question 12

Most endocrine organs have a high reserve capacity. What does this mean in terms of clinical presentation?

Answer 12

Often late to present, often organs are damaged by up to 70%

Question 13

Where is the pituitary gland located?

Answer 13

Sella turcica

Question 14

How is the pituitary gland connected to the hypothalamus?

Answer 14

Via pituitary stalk

Question 15

RECAP- the anterior pituitary is the biggest part of the pituitary gland.
Which hormones does it secrete?

Answer 15

ACTH- adrenal cortical trophic hormone
TSH- thyroid stimulating hormone
GH- growth hormone
LH/FSH
Prolactin

Question 16

RECAP- what hormones does the posterior pituitary gland produce?

Answer 16

ADH
Oxytocin

Question 17

What is the most common cause of pituitary hyperfunction?

Answer 17

Pituitary adenoma

Question 18

If a pituitary adenoma is-
1. functional
2. non-functional

what will happen?

Answer 18

1. Will secrete hormones
2. Will increase in size

Question 19

If a pituitary tumour is secreting GH, what could this cause as a result?

Answer 19

Acromegaly
Gigantism

Question 20

If a pituitary tumour is secreting ACTH, what could this cause as a result?

Answer 20

Cushing’s disease

Question 21

Prolctinoma?

Answer 21

Noncancerous tumour of the pituitary gland which secretes prolactin

Question 22

If a pituitary tumour is secreting prolactin, what could this cause as a result?

Answer 22

Galactorrhoea
Menstrual disorders

Question 23

Galactorrhoea?

Answer 23

Nipple discharge in someone who is not pregnant

Question 24

What can cause pituitary hypofunction?

Answer 24

Compression by a tumour
Trauma
Infection

Question 25

What is the function of the thyroid gland?

Answer 25

Synthesis, storage and release of thyroxine (T4) and triiodothyronine (T3) Regulates basal metabolic rate. Also synthesis, storage and release of calcitonin which regulates calcium homeostasis

Question 26

Which has a longer half life, T3 or T4?

Answer 26

T4

Question 27

Which more potent, T3 or T4?

Answer 27

T3

Question 28

What is the most common cause of hyperthyroidism?

Answer 28

Grave's disease

Question 29

Who tends to be affected more by Grave's disease?

Answer 29

Female > male Peak 20-4oyrs Genetic predisposition

Question 30

RECAP- what happens in Grave's disease?

Answer 30

Autoimmune production of anti-TSH receptor antibodies

Question 31

What is the most common cause of hypothyroidism?

Answer 31

Hashimoto's thyroiditis ->autoimmune destruction ->other causes = drugs, iodine deficiency

Question 32

What is Hashimoto's thyroiditis?

Answer 32

Autoimmune destruction of thyroid epithelial cells

Question 33

Who is more likely to get Hashimoto's thyroiditis?

Answer 33

Female> male 45-65yrs

Question 34

Describe follicular carcinomas.

Answer 34

Enlarged follicle epithelial cells, mirco-follciular architecture and they have a capsule. Localised and do not invade

Question 35

What is the most common differentiated thyroid carcinoma?

Answer 35

Papillary carcinoma (75-85%) Followed by follicular carcinoma (10%)

Question 36

How are thyroid nodules investigted?

Answer 36

TFT's Ultrasound FNA cytology ->hope you know FNA is fine needle aspiration x

Question 37

What are some of the risk factors for thyroid carcinoma?

Answer 37

FH Chronic inflammatory episodes Radiation exposure Obesity

Question 38

What is the only difference between a follicular adenoma and follicular carcinoma?

Answer 38

A follicular carcinoma has capsular breach and vascular invasion -> carcinoma is malignant

Question 39

How and where does a follicular carcinoma metastasise to?

Answer 39

Via blood to bone

Question 40

Typically, how old are patients with papillary carcinoma, the most common type of thyroid carcinoma?

Answer 40

<50yrs

Question 41

What is the associated mutation to papillary carcinoma?

Answer 41

BRAF mutation RET/PTC gene rearrangement

Question 42

What is papillary carcinoma associated with?

Answer 42

Exposure to ionising radiation

Question 43

How does a papillary carcinoma spread?

Answer 43

Via lymphatics

Question 44

What is the prognosis like for papillary carcinomas?

Answer 44

Very good

Question 45

What is a medullary carcinoma?

Answer 45

Malignant tumour of C-cells

Question 46

What does a medullary tumour produce and secrete?

Answer 46

Calcitonin -> +/- other polypeptides

Question 47

What has an opposing inhibitory mechanism on parathyroid hormone?

Answer 47

Calcitonin ->works the other way too, each inhibit each other

Question 48

If there is parathyroid hyperfunction caused by an adenoma, how much parathyroid glands are affected?

Answer 48

1

Question 49

If there is parathyroid hyperfunction caused by hyperplasia, how much parathyroid glands are affected?

Answer 49

4

Question 50

Parathyroid hyperfunction is usually sporadic. It can be familial in which syndrome?

Answer 50

MEN-1

Question 51

Secondary hyperparathyroidism can be as a result of what?

Answer 51

Renal failure -> decrease in calcium level because kidneys are not functioning. Feedback so not enough calcium = overproduction of PTH

Question 52

How would someone get multiple endocrine neoplasia (MEN)?

Answer 52

Inherited disorder with underlying genetic mutation

Question 53

What is MEN-1 also known as?

Answer 53

Wermer syndrome

Question 54

What is a MEN-1 tumour caused by?

Answer 54

Tumour suppressor gene mutation meaning there is a defect in the protein involved in cell growth

Question 55

What can this MEN1 tumour suppressor gene lead to?

Answer 55

Parathyroid hyperplasia and adenomas Pancreatic and duodenal endocrine tumours Pituitary adenoma -> three P's

Question 56

If a tumour is secreting insulin, what type of symptoms will the patient have?

Answer 56

Hypoglycaemic symptoms

Question 57

What causes MEN-2?

Answer 57

Mutation in the RET gene ->this mutation drives mutations and neoplasia

Question 58

What are two clinical manifestations of MEN-2?

Answer 58

Medullary carcinoma of the thyroid Pheochromocytoma

Question 59

MEN-2A has the same clinical manifestations (medullary carcinoma of the thyroid and pheochromocytoma) as well as one other. What is it?

Answer 59

Parathyroid hyperplasia

Question 60

MEN-2B has the same clinical manifestations as MEN2 (medullary carcinoma of the thyroid and pheochromocytoma) as well as two others. What are they?

Answer 60

Neuromas of skin and mucous membrane Skeletal abnormalities

Question 61

Who is more likely to be affected by MEN-2B?

Answer 61

Younger patients More aggressive