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2nd year- endocrine OC > Pathology of the Endocrine System 1 > Flashcards

Pathology of the Endocrine System 1 Flashcards

1
Q

what is the function of the endocrine system?

A

Integrated network of GLANDS - secrete chemical messengers – hormones - directly into bloodstream

HORMONES act on target cells distant from site of synthesis - bind to receptors – change cell activity

REGULATION of metabolism, growth and development, tissue function

maintain functional balance

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2
Q

what are the kind of hormones synthesised and stored in glands?

A

packets of cells with secretory granules
vascular
ductless

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3
Q

what are the contents of the classical endocrine system?

A 
pineal gland
hypothalamus
pituitary gland
thyroid gland
parathyroid gland
adrenal gland
pancreas
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4
Q

what is hyperplasia?

A

increased number and secretory activity of cells

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5
Q

what is atrophy

A

diminution of cells due to lack of stimulation

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6
Q

what is tissue damage?

A

inflammation, autoimmune disease, compression, trauma, infarction

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7
Q

what are the two types of neoplasia?

A

adenoma

carcinoma

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8
Q

whats the difference between adenoma and carcinoma

A

adenoma- functioning or non functioning

carcinoma- 1ry or metastatoc

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9
Q

how would you determine the cause of congenital abnormality?

A

morphologic findings

biochemical measurements of hormone levels, regulators and metabolites.

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10
Q

what is the function of synthesis, storage, release of thyroxine T4 and triiodothyronine T3?

A

regulated basal metabolic rate

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11
Q

whats the function of calcitonin?

A

regulates calcium homeostasis

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12
Q

what is the histology of thyroid gland?

A

Follicles

Colloid-contains thyroglobulin

Epithelial cells – TG synthesis, iodination, resorption & release of T4 and T3

C-cells – secrete calcitonin (not visible)

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13
Q

what is the manifestation of thyroid diseases?

A

Hyperthyroidism
Thyrotoxicosis*

Hypothyroidism
Myxoedema, Cretinism
Subclinical

Thyroid enlargement
Goitre
Isolated nodule/mass

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14
Q

what are the causes of thyroid diseases?

A

Thyroiditis
Autoimmune
Others

Gland destruction

Multinodular goitre
Tumours
Benign
Malignant

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15
Q

what are the causes of hyperthyroidism?

A

Diffuse toxic hyperplasia (Graves disease) – 70%

Toxic multinodular goitre – 20%

Toxic adenoma

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16
Q

whos more likely to get graves disease?

A

females
peak- 20-40 years
genetic predisposition

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17
Q

what happens to the histology in graves disease?

A

cell activity increases and cell numbers increase

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18
Q

what are the causes of hypothyroidism?

A

Hashimoto’s thyroiditis
(auto-immune destruction)

Iatrogenic – surgery drugs

Iodine deficiency

Congenital hypothyroidism

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19
Q

whos more likely to get hashimotos thyroiditis?

A

females

45-65 yrs

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20
Q

what is graves disease?

A

Autoimmune production of anti- TSH receptor antibodies
stimulate activity, growth, inhibit TSH binding
ophthalmopathy immune mediated – ocular fibroblasts have TSH receptor

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21
Q

what is hashimotos thyroiditis?

A

Autoimune destruction of thyroid epithelial cells
Cytotoxic T cells, cytokine and antibody mediated destruction
Circulating autoantibodies to
thyroglobulin ,
thyroid peroxidase

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22
Q

what happens to the thyroid in hashimotos thyroiditis?

A

Diffuse enlargement gradual failure

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23
Q

what is the histology of hashimotos thyroiditis?

A

hurthle cell change
intense infiltrate of plasma cells
lymphocytes

crowded follicles
distended colloid filled follicles
haemorrhage, fibrosis, cycstic change

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24
Q

what is goitre?

A

enlarged thyroid

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25
what is the pathway to multinodular goitre?
iodine deficiency, goitrogens --> impaired synthesis of T3 and T4 --> increase of TSH --> hypertrophy and hyperplasia of epithelium goes from simple to multi nodular
26
what is a thyroid nodule?
dominant nodule in multinodular goitre cysts follicular adenoma carcinoma
27
how would you investigate a thyroid nodule?
TFTs, ultrasound, FNA
28
name some thyroid tumours
Follicular adenoma ``` Carcinoma (5% of nodules) Differentiated thyroid carcinoma (DTC) Papillary carcinoma 75-85% Follicular carcinoma 10-20% Anaplastic carcinoma 5% Medullary carcinoma 5% (lymphoma) ```
29
what is the most non functioning thyroid neoplasm?
follicular adenoma
30
give some characteristics about follicular adenomas?
Most non-functioning Circumscribed, encapsulated tumour Histology often small microfollicles
31
how common are follicular carcinomas?
rare, usually solitary
32
where are follicular carcinomas most likely to metastasise?
blood, bones
33
what is the type of mutation in papillary carcinomas?
BRAF mutation or RET/PTC gene rearrangement
34
what is papillary carcinoma associated with?
exposure to ionizing radiation
35
where is papillary carcinoma most likely to spread?
lymphatics
36
what is the histology of papillary carcinoma?
Papillary projections Empty nuclei Psammoma bodies May be cystic
37
what are some characteristics of thyroid medullary carcinomas?
Malignant tumour of C – cells produces calcitonin (+/- other polypeptides) 70% sporadic
38
what are the type of genes in thyroid medullary carcinomas?
30% MEN 2A, 2B, familial FMTC – mutations in RET proto-oncogene – prophylactic thyroidectomy
39
how many glands are in the parathyroid gland?
4 small glands - 120mg
40
what do parathyroid glands produce?
PTH- regulates plasma Ca
41
what are the causes for parathyroid hyper function?
1ry hyperparathyroidism often assymptomatic hypercalcaemia Sporadic or familial (MEN-1) Adenoma (85-95% Hyperplasia (5-10%) Carcinoma (rare) 2ry hyperparathyroidism Physiological response to ↓ Ca2+ renal failure
42
what are the functions of the hypothalamus?
maintains homeostasis governs emotional behaviour links nervous system to endocrine system via the pituitary gland
43
what is the function of pituitary gland?
small gland, located in sella turcica connected to hypothalamus by pituitary stalk critical role in regulating other endocrine glands
44
what is the adenohypophysis
the anterior part of the pituitary gland that is derived from the embryonic pharynx and is primarily glandular in nature
45
where is the blood that supplies the anterior pituitary from?
hypothalamus
46
what does the anterior pituitary secrete?
ACTH, TSH, GH, PROLACTIN, FSH/LH
47
how is the anterior pituitary controlled?
release factors from hypothalamus
48
what is neurohypophysis?
that posterior part of the pituitary gland
49
what does the posterior pituitary secrete?
ADH, OXYTOCIN
50
what are the 3 major cell types of pituitary glands?
pink ACIDOPHILS secrete GH and PRL dark purple BASOPHILS secrete ACTH, TSH, FSH, LH pale CHROMOPHOBES
51
what is the most common cause of pituitary hyper function?
pituitary adenoma
52
what is the histology of pituitary adenoma?
cells of same appearance as normal gland | classified by hormone(s) produced by the neoplastic cells - detected by immunohistochemical stains
53
whos most likely to get pituitary adenomas?
usually adults, 35 to 60 yrs | most sporadic;
54
what are the effects of pituitary adenomas?
if functioning- hormone excess
55
what effect does prolactiinoma have on pituitary adenomas?
galactorrhoea, menstrual disorders
56
what effect does GH secreting have on pituitary adenoma?
acromegaly, gigantism
57
what effect does ACTH secreting have on pituitary adeomas?
Cushing’s disease
58
what effect does non-functioningn pituitary have on pituitary adenomas
immunohistochemical demonstration (mostly prolactin)
59
what is the result of a large pituitary adenoma?
radiographic abnormalities visual field abnormalities elevated intracranial pressure compression damage – hypopituitarism
60
what are the causes of pituitary hypofunction?
Compression by tumours – craniopharyngioma. metastatic Trauma Infection (rare) TB Sarcoidosis Post partum ischaemic necrosis Sheehan’s syndrome
61
what is the pathology of adrenal?
Hyperfunction clinical syndromes depend on which adrenal hormones stimulated Hypofunction Mass lesion - effect late Effect on adrenal gland –hyperplasia (diffuse or nodular), atrophy, mass lesion
62
what are the three syndromes of adrenal cortical hyper function?
Hypercortisolism– CUSHING’S SYNDROME Hyperaldosteronism (Conn’s syndrome) Adrenoginital syndormes
63
what are characteristics of hypercorticolism?
Exogenous -Iatrogenic steroids Endogenous ACTH dependent pituitary adenoma Cushings disease – 70% ectopic ACTH ACTH independent functioning adrenal adenoma 10%
64
what are some characteristics of hyperaldosteronism?
Bilateral idiopathic hyperplasia Functioning adrenal adenoma (2ry hyperaldosteronism – physiological due to ↓renal perfusion ↑renin-angiotensin)
65
what are characteristics of adrenogenital syndromes?
Functioning adrenal tumour Pituitary tumour Cushings disease Congenital adrenal hyperplasia – steroid enzyme deficiency
66
what are the acute causes of adrenal insufficiency destruction of glands?
meningococcal septicaemia | waterhouse friderichsen
67
what are the chronic causes of adrenal insufficiency destruction of glands?
1ry - Addison’s disease Autoimmune : autoimmune polyendocrine syndromes – spare medulla Infections: TB, fungus HIV-related infections Replacement: metastatic carcinoma amyloidosis, Atrophy: prolonged steroid therapy Congenital hypoplasia 2ry - Pituitary failure
68
what are the characteristics of adrenocortical tumours?
Functioning – hyperadrenal syndromes, atrophy of adjacent cortex Non functioning – often incidental – imaging/autopsy Yellow-brown circumscribed Most 2-3cm <30g
69
what are the characteristics of primary adrenocortical carcinoma?
rare, any age More likely functional – virilising Most large >20cm , haemorrhage and necrosis, cystic Metastasises by lymphatics and blood – invades adrenal vein
70
what are the characteristics of adrenal medullary tumour (phaeochromocytoma)
``` Adrenal medulla neuroendocrine cells secrete catecholamines → hypertension Usually benign behaviour, can be bilateral Up to 25% inherited – eg MEN 2 10% extra adrenal ```
71
what is the histology of adrenal medullary tumour?
Nests “Zellballen” of polygonal cells in vascular network | Granular cytoplasm containing catecholamines
72
what syndrome does MEN 1 cause?
wermer syndrome
73
what does the MEN 1 tumour supressor gene mutation cause?
defect in menin protein involved in regulating cell growth Parathyroid hyperplasia and adenomas Pancreatic and duodenal endocrine tumours (hypoglycaemia and ulcers) Pituitary adenoma (prolactinoma)
74
what does MEN 2 cause?
Medullary carcinoma of thyroid | Phaeochromocytoma
75
what does MEN2A cause?
sipple syndrome parathyroid hyperplasia
76
what does MEN 2B cause?
Neuromas of skin &mucous membrane, skeletal abnormalities + Younger patients, aggressive

2nd year- endocrine OC (27 decks)

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