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ZA - Endocrine System > Pathology of the Endocrine System > Flashcards

Pathology of the Endocrine System Flashcards

1
Q

What is hyperplasia?

A

An increased number and secretory activity of cells

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2
Q

What is atrophy?

A

Wasting of cells due to lack of stimulation

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3
Q

Causes of endocrine tissue damage?

A 
Inflammation
Autoimmune
Disease
Compression
Trauma
Infarction
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4
Q

What is a neoplasia?

A

The presence or formation of new, abnormal growth of tissue.

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5
Q

Types of neoplasia affecting endocrine glands?

A

Adenoma

Carcinoma

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6
Q

An adenoma can be…

A

Functioning or non-functioning

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7
Q

A carcinoma can be…

A

Primary or metastatic

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8
Q

What else can cause an endocrine disease?

A

A congenital abnormality?

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9
Q

How do we determine the cause of the pathology?

A

Morphological findings

Measinging hormone levels, hormone regulators and metabolites in blood

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10
Q

What are some general considerations when should remember in endocrine disease?

A

Disease in 1 gland may effect other glands, or have multi-organ effects

Feedback loops may be effected causing changes in glands

Endocrine organs have a high reserve capacity

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11
Q

What does the thyroid gland do?

A

Synthesizes, stores and releases triiodo-thyronine, thyroxine and calcitonin

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12
Q

Describe the histology of a thyroid gland?

A

Has circular follicles
Inside of circle called colloid and it contains thyroglobulin
C cells are not visable but secrete calcitonin

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13
Q

Describe the hypothalamus-pituitary-thyroid axis.

A

TRH from H to P
TSH from P to Thyroid
T3 and T4 released

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14
Q

Describe the feedback loops of the thyroid.

A

T3 and T4 have a short (acting on pit gland inhibiting TSH) and a long (inhibiting TRH at hypothalamus)

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15
Q

Causes of 1y thyroid disease?

A

Thyroiditis
Gland destruction
Multinodular goitre
Tumours

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16
Q

Causes of hyperthyroidism from most to least common?

A

Diffuse toxic hyperplasia - 70%

Toxic multinodular goitre - 20%

Toxic adenoma

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17
Q

Pathology behind graves?

A

Autoimmune production of anti-TSH receptor antibodies

These stimulate activity, growth and inhibit TSH binding

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18
Q

What is Graves opthalmopathy? Why does it happen?

A

Inflammation and other immune system events affect muscles and other tissues around your eyes

This is because ocular fibroblasts have TSH receptors

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19
Q

Why happens to the thyroid in graves?

A

Undergoes diffuse hyperplasia and hyperfunction

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20
Q

Causes of hypothyroidism?

A

Hashimoto’s
Iatrogenic - surgery or drugs
Iodine deficiency
Congenital hypothyroidism

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21
Q

What type of patients does hashimoto’s affect more?

A

45-65 yrs

Females over males

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22
Q

What type of patients does graves affect more?

A

20-40s
Female over male
Has a genetic predisposition

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23
Q

What is hashimotos?

A

Autoimmune destruction of thyroid epithelial cells by cytotoxic T cells, cytokines and antibody mediated destruction

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24
Q

What happens to the thyroid gland in hashimotos?

A

Diffuse enlargement with gradual failure

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25
Q

Causes of multinodular goitre?

A

Iodine deficiency

Goitrogens

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26
Q

Pathology of how a multinodular goitre affects the thyroid?

A

Impairs synthesis of T3 and T4

Leads to increases of TSH which causes hypertrophy and hyperplasia of the epithelium

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27
Q

What is the “thyroid nodule”

A 
Can be:
The dominant nodule in a multi-nodular goitre
A cyst
A follicular adenoma
A cacrinoma
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28
Q

Most common type of thyroid carcinoma? And types of this ?

A

Differentiated thyroid carcinoma - Papillary and follicular carcinomas

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29
Q

How to investigate a thyroid nodule?

A

TFTs
Ultrasounds
FNAs

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30
Q

Features of a follicular adenoma?

A

Is the most non-functioning neoplasm
Is a circumscribed, encapsulated tumour
Histology often shows small microfollicles

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31
Q

Features of the DTC - papillary carcinoma?

A

Usually <50yrs

Causes by a BRAF mutation or RET/PTC gene rearrangement

Associated with exposure to ionizing radiation - spread via lymphatics but has excellent prognosis

There is papillary projections with empty nuclei and psammonma bodies

May be cyctic

32
Q

Features of the DTC - Follicular carcinoma ?

A

Rare and usually solitary

Malignant cells breach the follicular capsules

Mets to blood and bones

33
Q

What mutation causes a follicular carcinoma?

A

RAS mutation

PAX8/PPARG translocation

34
Q

What is a thyroid medullary carcinoma? Effects?

A

A malignant tumour of the C-cells

Makes calctionin +/- other polypeptides

35
Q

How do thyroid medullary carcinomas arise?

A

70% are sporadic

30% - Genetic - can be treated with a prophylactic thyroidectomy

36
Q

What do parathyroid glands make?

A

PTH which regulates plasma calcium

37
Q

How does 1y hyperparathyroidism present?

A

Assymptomatic hypercalcaemia

38
Q

Causes of hyperparathyroidism?

A

Sporadic or familial Adenomas (85-95%), Hyperplasia’s or carcinomas (rare)

39
Q

What is 2y hyperparathyroidism in response to?

A

Reduced calcium due to renal failure

40
Q

What does the anterior pit gland secrete?

A 
ACTH
TSH
GH
FSH/LH
Prolactin
41
Q

What does the posterior pit gland release?

A

Vasopressin/ADH

Oxytocin

42
Q

Describe the histology of the pituitary gland?

A

3 major cells - acidophils, basophiles and chromophobes

Acidophils are pink and secrete GH and Prolactin

Basophils are dark purple and secerete ACTH, TSH, FSH and LH

Chormophobes are pale/white

43
Q

Most common cause of pituitary hyperfunction? Rarer causes?

A

A pituitary ademona

A carcinoma is very rare, some can be caused by hypothalmic disorders

44
Q

What age does a pituitary adenoma affect the most?

A

35-60 y/o

45
Q

Causes of the adenoma?

A

Most are sporadic with 5% being inherited

46
Q

Describe the lesion (in a pituitary adenoma)

A

Soft and well circumscribed macroscopic lesions

47
Q

Effects of the pituitary adenoma?

A

If functioning causes hormone excess

If large has a mass pressure effect

48
Q

What does excess Prolactin cause?

A

Galactorrhoea and menstrual disorders

49
Q

What does xs GH cause?

A

Acromegaly/Gigantism

50
Q

What does xs ACTH cause?

A

Cushings

51
Q

How are non-functioning adenomas caught?

A

Via immunohistochemical demonstration (?)

52
Q

Mass pressure effects of a adenoma in the pit gland is….

A

Radiographic abnormalities
Visual problems - bitemporal hemianopia
Elevated intracranial pressure
Compression damage leading to hypopituitarism

53
Q

How much function of the pituitary must be lost to cause pituitary hypofunction?

A

75%

54
Q

Causes of pituitary hypofunction?

A

Compression by tumours
Trauma
Infection by TB or sarcoid, which is rare

55
Q

What does the cortex in the adrenal glands secrete?

A

Steroid hormones - cortisol, aldosterone and sex steroids

56
Q

What does the medulla in the adrenal glands secrete?

A

Adrenaline/NA

57
Q

What is the effect of adrenal pathology (hypo/hyper function and mass lesions) of the adrenal gland?

A

Hyperplasia - diffuse or nodular
Atrophy
Mass lesion’s

58
Q

3 syndromes of adrenal hyperfunction?

A

Hypercortisolism - cushings
Hyperaldosteronism - conns
Adrenogenital syndromes

59
Q

What is the difference between cushing’s syndrome and disease?

A

Syndrome is ACTH independent and only affects the adrenal gland (1y)

Disease involves ACTH and is when there is a pituitary adenoma or ectopic ACTH lesions making excess ACTH

60
Q

Cause of exogenous cushings?

A

Iatrogenic steroids

61
Q

What causes an ACTH independent cushings?

A

A functioning adrenal adenoma

62
Q

Causes of 1y Conn’s syndrome?

A

Bilateral idiopathic hyperplasia

Functioning adrenal

63
Q

Causes of 2y conns?

A

Reduced renal perfusion causing increased RAAS

64
Q

What causes an adrenogenital syndrome?

A

Functioning adrenal tumour
Pit gland tumour - cushings disease
Congenital adrenal hyperplasia - steroid enzyme deficiency

65
Q

Acute causes of adrenal gland destruction = insufficiency.

A

Meningococcal septicaemia

66
Q

Chronic causes of 1y and 2y adrenal insufficiency.

A

1y - Addison’s disease

Autoimmune

Infection

Atrophy

Congenital hypoplasia
Replacements - metastatic carcinoma amyloidosis

2- Pit gland failure

67
Q

What type of tumours affect the adrenal gland?

A

Adenoma
Carcinoma
Medullary

68
Q

What does adenomas cause on adrenal gland?

A

Functioning = hyperadrenal syndromes and atrophy of cortex

Non- functioning = often found incidentally suggesting no effect?

69
Q

Appearance of an adrenal adenoma?

A

Yellow-brown circumscribed

70
Q

What does adenomas cause on adrenal gland?

A

Most likely functioning - causing “virilising” the abnormal development of male sexual characteristics in a female

71
Q

Appearance of adrenal carcinomas?

A

Large - over 20cm, haemorrhage and necrosing and cystic

72
Q

How does adrenal carcinoma metastasis and to where?

A

Via lymphatics and blood - invades the adrenal vein

Lung and breast

73
Q

What does an adrenal medullary tumour cause?

A

Phaeochroocytoma - xc secretions of catecholamines (adrenaline etc) leading to hypertension

74
Q

What is multiple endocrine neoplasia?

A

Inherited disorders due to mutations causing hyperplasia/ neoplasms

Aftects younger patients

75
Q

Distinct syndromes of multiple endocrine neoplasia?

A

MEN 1 - Wermer’s

MEN 2 - Split into 2A and 2B

76
Q

What causes MEN1 and waht is its effects

A

MEN 1 tumour suppressor gene mutated

Leads to parathyroid hyperplasia and adenomas

Pit. gland adenoma

Pancreatic and duodenal endocrine tumours

77
Q

What does MEN 2 cause?

A

Medullary carcinoma of thyroid

Phaeochromocytoma

ZA - Endocrine System (21 decks)

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