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Pathology of the Endocrine System Flashcards

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1
Q

How is balance of endocrine systems maintained?

A

By feedback inhibition

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2
Q

How are endocrine organs linked?

A

By feedback axis

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3
Q

3 things that can go wrong in endocrine pathology

A

Hyperfunction
Hypofunction
Effect of a mass lesion

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4
Q

Definition of hyperplasia

A

Increased number and secretory activity of cells

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5
Q

Definition of atrophy

A

Diminution of cells due to lack of stimulation

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6
Q

How would tissue damage of an endocrine organ be caused?

A 
Inflammation 
Autoimmune disease
Compression 
Trauma
Infarction
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7
Q

Two types of neoplasia of endocrine organs

A

Adenoma (benign)

Carcinoma (malignant)

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8
Q

Types of adenoma

A

Functioning

Non functioning

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9
Q

Types of carcinoma

A

Primary

Metastatic

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10
Q

What does the thyroid gland produce?

A

Thyroxine T4
Triiodothyronine T3
Calcitonin

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11
Q

What secretes calcitonin?

A

C cells

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12
Q

Causes of hyperthyroidism

A

Graves disease 70%
Toxic multinodular goitre 20%
Toxic adenoma

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13
Q

Who gets graves disease?

A

F > M

Peak 20-40 years

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14
Q

Is there a genetic predisposition to get graves disease?

A

Yes

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15
Q

Pathology of graves disease

A

Autoimmune production of anti TSH receptor antibodies

Stimulate activity, growth and inhibit TSH binding

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16
Q

Histology of graves disease

A

Increased cell activity

Increased cell numbers

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17
Q

Causes of hypothyroidism

A

Hashimotos thyroiditis
Iatrogenic - surgery, drugs
Iodine deficiency
Congenital hypothyroidism

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18
Q

Who gets Hashimotos thyroiditis?

A

F > M

45 - 65 y/o

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19
Q

Pathology of hashimotos thyroiditis

A

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

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20
Q

Size of the thyroid in hashimotos disease

A

Originally - the gland gets bigger even though it is being destroyed, as it is trying to compensate
This does result in destruction however and fails and therefore the gland then gets smaller

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21
Q

Histology of hashimotos

A

Hurthle cell change
- swollen
Intense infiltrate of lymphocytes and plasma cells

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22
Q

What is goitre?

A

An enlarged thyroid

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23
Q

Pathology of multinodular goitre

A

Iodine deifiency/goitrogens/other causes
Impaired synthesis of T3,T4
Increased TSH
Hypertrophy and hyperplasia of epithelium

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24
Q

What may develop in multinodular goitre?

A

Autonomous “toxic nodule”

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25
Pathology of multinodular goitre
Area of the thyroid that is no longer responding to TSH stimulation and reduction Pumps out thyroxin regardless
26
What may the dominant nodule in a multinodular goitre be?
Cyst Follicular adenoma Carcinoma
27
Investigations of a thyroid nodule
TFTs USS FNA
28
What do parathyroid glands produce?
PTH
29
How many parathyroid glands are there?
4
30
What does PTH do?
Regulates plasma Ca2+
31
Presentation of primary hyperparathyroidism
Usually asymptomatic hypercalcaemia
32
Causes of primary hyperparathyroidism
Sporadic or familial (MEN-1) - adenoma 85-95% - hyperplasia 5-10% - carcinoma - rare
33
Causes of secondary hyperparathyroidism
Physiological response to a decreased Ca2+ renal failure
34
Functions of the hypothalamus
Maintains homeostasis Governs emotional behaviour Links nervous system to endocrine system via the pituitary gland
35
Where is the pituitary gland found in?
Sella turcica
36
How is the pituitary gland connected to the hypothalamus?
Via the pituitary stalk
37
Another name for the anterior pituitary gland
Adenohypophysis
38
Where does the anterior pituitary get its blood supply from?
Hypothalamus
39
What does the anterior pituitary secrete?
``` ACTH TSH GH Prolactin FSH/LH ```
40
Another name for the posterior pituitary
Neurohypophysis
41
What does the posterior pituitary secrete?
ADH | Oxytocin
42
3 major cell types of the anterior pituitary
Pink acidophils Dark purple basophils Pale chromophobes
43
What do the pink acidophils secrete?
GH | PRL
44
What do the dark purple basophils secrete?
ACTH TSH FSH LH
45
Most common cause of pituitary hyperfunction
Pituitary adenoma
46
What age do people usually get pituitary adenomas?
35-60 y/o
47
If a functioning pituitary adenoma was producing prolactin, what would this lead to and how common is this?
Prolactinoma | 20-30%
48
If a functioning pituitary adenoma was secreting GH, what would this lead to?
Gigantism | Acromegaly
49
What would a functioning pituitary adenoma producing ACTH lead to?
Cushing's disease
50
How common is a pituitary carcinoma?
very rare
51
Effects of a large pituitary adenoma giving a mass pressure effect
Radiographic abnormalities Visual field abnormalities Elevated Intracranial pressure Compression damage - hypopituitary
52
How much of the pituitary needs to be lost to give it hypofunction?
75%
53
Causes of pituitary hypofunction
``` Compression by tumours - craniopharyngioma - metastatic Trauma Infection (rare) - TB - sarcoidosis ```
54
Zones of the adrenal cortex
Zona glomerulosa Zona fasiculata Zona reticularis
55
What does the zona glomerulosa secrete?
Mineralocorticoids
56
What does the zona fasiculata secrete?
Glucocorticoids - cortisol
57
What does the zona reticularis secrete?
Sex steroids Oestrogen Androgens
58
What cells are found in the adrenal medulla?
Neuroendocrine (chromaffin) cells
59
What does the adrenal medulla produce?
Adrenaline/noradrenaline
60
What syndrome is related to hypercortisolsim?
Cushing's syndrome
61
What syndrome is related to hyperaldosteronism?
Conn's syndrome
62
Causes of cushing's syndrome
``` Iatrogenic steroids Pituitary adenoma (cushings disease) - 70% Ectopic ACTH Functioning adrenal adenoma - 10% Independent adrenal adeoma Dependent pituitary adenoma ```
63
Pathology of conns syndrome
Hyperalsoteronism | Bilateral idiopathic hyperplasia
64
Cause of conns syndrome
Functioning adrenal adenoma
65
Cause of secondary hyperaldosteronim
Physiological due to decreased renal perfusion and increased renin-angiotensin
66
Examples of adrenogenital syndromes
Functioning adrenal tumour Pituitary tumour cushings disease Congenital adrenal hyperplasia - steroid enzyme deficiency
67
Causes of adrenal insufficiency
Meningococcal septicaemia Addisons disease Pituitary failure
68
Causes of addisons disease
Autoimmune Infections; TB, Fungus HIV-related infections Replacement; metastatic carcinoma amyloidosis Atrophy; prolonged steroid therapy Congenital hypoplasia
69
What are adrenocortical tumours?
Primary tumours of the adrenal cortex which are quite rare and are often benign
70
Types of adrenocortical tumours
Adenoma | Carcinoma
71
What tumour is found in the adrenal medulla?
Phaechromaocytoma
72
Main feature of phaechromocytoma
Hypertension
73
What % of phaechromocytoma is inherited?
up to 30%
74
What are multiple endocrine neoplasias?
Hyperplasia/neoplasms of endocrine organs - younger age, multifocal. Inherited disorders with an underlying genetic mutation
75
Distinct syndromes associated with endocrine neoplasms
``` MEN 1 (Wermer syndrome) MEN 2 (A, B and C) ```
76
What does MEN 1 have a defect in?
Menin protein involved in regulating cell growth
77
What endocrine neoplasias does MEN 1 result in?
``` Parathyroid hyperplasia and adenomas Pancreatic and duodenal endocrine tumours (hypoglycaemia and ulcers) Pituitary adenomas (prolactinoma) ```
78
What do MEN 2 result in with endocrine neoplasias?
Medullary carcinoma of the thyroid | Phaeochromocytoma
79
In addition to the MEN 2 conditions, what else does MEN2A have?
Parathyroid hyperplasia
80
In addition to the MEN2 conditions, what else does MEN 2 B have?
Neuromas of skin and mucous membranes Skeletal abnormalities Younger patients and aggressive
81
Treatment of myxoedema coma
Hydrocortisone and levothyroxine
82
Hormones that decrease during the stress response
Insulin Testosterone Oestrogen

Endocrine Pathology (11 decks)

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