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Clinical Pathology > Theme 5: Diseases of the endocrine system > Flashcards

Theme 5: Diseases of the endocrine system Flashcards

1
Q

What is the pineal gland?

A

a tiny organ above the 3rd ventricle in the brain responsible for the secretion of melatonin

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2
Q

What are the endocrine organs in our body

A
  • pineal gland
  • pituitary gland
  • parathyroid gland
  • thyroid gland
  • adrenal gland
  • pancreas
  • ovary
  • testis
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3
Q

What is an endocrine organ?

A

endocrine organ secretes hormones directly into the blood stream to reach a distant target organ

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4
Q

What is an exocrine organ?

A

secretes out material directly into the GI tract, respiratory tract or onto the skin surface

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5
Q

What are neurocrine hormones?

A

secretion of hormones into the bloodstream by neurones

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6
Q

What are endocrine hormones?

A

secretion of hormones into the bloodstream by endocrine glands

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7
Q

What are paracrine hormones?

A

hormone molecule secreted by one cell affects adjacent cells

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8
Q

What are autocrine hormones?

A

hormone molecule secreted by a cell affects the secreting cell

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9
Q

What is said to be the master of the endocrine system?

A

pituitary gland

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10
Q

Where is the pituitary gland?

A

in the sella turcica of sphenoid bone

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11
Q

What surrounds the pituitary gland?

A

posteriorly - mamillary bodies

anteriroly - optic chiasma

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12
Q

How is the pituitary gland divided?

A
  1. Anterior lobe
    - called the adenohypophysis
  2. Posterior lobe
    - called the neurohypophysis
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13
Q

What is the function of the anterior pituitary/adenohypophysis?

A

-produces and secretes the majority of the pituitary hormones

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14
Q

What is the function of the posterior pituitary/ neurohypophysis?

A

doesn’t produce any hormones, but it releases two hormones that are produced in the thalamus - oxytocin and ADH

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15
Q

What hormones are produced by the anterior lobe?

A

TSH, ACTh, FSH and LH, GH, PRL, endorphins

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16
Q

What is the most common type of pituitary tumour?

A

they are almost always benign adenomas

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17
Q

What might be some local effects of a pituitary tumour?

A

pressure on the optic chiasm (bitemporal hemianopia = ‘tunnel vision’)
or adjacent pituitary cells

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18
Q

How does a prolactinoma form?

A

a mutation in the lactotroph cells in the anterior pituitary - results in excess prolactin production

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19
Q

What are the symptoms of a prolactinoma?

A
  • galactorrea - increased secretion from breasts
  • gynecomastia - enlarged breast tissue in men
  • amenorrhea
  • infertility
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20
Q

If the anterior pituitary adenoma is a result of the cells responsible for producing growth hormone, what might be the symptoms?

A

gigantism and acromegaly (enlarged limbs, hands and feet)

acromegaly is excess GH after growth plates have closed

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21
Q

What is the best clinical test for confirmation of acromegaly?

A

oral glucose suppression test

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22
Q

What is gigantism

A

abnormally high linear growth due to the excessive action of IGF-1 before the closure of the epiphyseal growth plates in childhood

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23
Q

Which 3 hormones does the thyroid gland secrete?

A

T3
T4
Calcitonin

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24
Q

Explain how the hypothalamic-pituitary-thyroid axis works

A
  • Thyroid gland produces T3 and T4 which has a negative feedback effect back to the pituitary and hypothalamus, both of which have stimulatory effects
  • SO when the levels of T3 and T4 are increased, this tells the hypothalamus to produce less TRH and less TSH
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25
Q

What is hypothyroidism?

A
  • due to insufficiency of circulating T3 and T4 hormones
  • results in overall reduction in the basal metabolic rate and reduction in production of T3 and T4
  • more common in women
  • peak age 59 years
  • increased risk of carcinoma
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26
Q

What is the commonest cause of hypothyroidism?

A

hashimoto’s thyroiditis

27
Q

if a patients case of hypothyroidism is congenital, what main symptom will they have?

A

cretinism - physical growth deformity and mental impairment

28
Q

Other than hashimotos thyroiditis, what are some other causes of hypothyroidism?

A

iodine deficiencies, drugs, post surgery and post radioiodine therapy

29
Q

What are the signs and symptoms of hashimoto’s?

A

Signs:

  • hypothermia
  • bradycardia
  • periorbital edema
  • hair loss

Symptoms:

  • fatigue
  • weak ness
  • weight gain
  • constipation
  • cold intolerance
  • dry skin
  • hoarse voice
  • depression
30
Q

What is hyperthyroidism?

A
  • syndromes due to excess T3 and T4

- increased basal metabolic rate (bmr)

31
Q

What is the commenest cause of hyperthyroidism?

A

Grave’s disease
IgG auto-antibody that binds to the thyroid epithelial cells to produce more TSH
peaks in 30s/40s

32
Q

What are the signs and symptoms of Grave’s disease?

A 
Signs:
pretibial myoedema
hair loss
wide-eyed stare
proptosis
tachycardia
hyperactive reflexes
33
Q

What is the 2nd most common cause of hyperthyroidism?

A
  • multinodular goitre (MNG)

- enlargement of thyroid with varying degrees of nodularity

34
Q

What does euthyroid mean?

A

no symptoms of hyperthyroidism

35
Q

Name a common cause of a solitary thyroid nodule (other than MNG)?

A

thyroid follicular adenoma

  • solid mass with fibrous capsule
  • sometimes functional (producing excess thyroxine) but usually isnt
  • F>M
36
Q

Name 3 types of thyroid tumours

A
  1. Thyroid follicular adenoma
  2. Thyroid follicular carcinoma
    - well differentiated malignant tumour with good prognosis
    - presents with solitary nodule in thyroid gland
    - invades blood vessels
  3. Papillary thyroid carcinoma
    - well differentiated malignant tumour with good prognosis
    - most common thyroid carcinoma
    - younger, F>M
    - invades lymphatics
37
Q

Where are the parathyroid glands and how many do we have?

A
  • located in the posterior aspect of the thyroid

- 90% have 4 glands. rest have 3 or 5

38
Q

What are the functions of the parathyroid gland?

A

Calcium homeostasis:

  • produces parathyroid hormone (PTH) which stimulates calcium release from bones
  • calcitonin - reduces calcium levels in the blood
39
Q

What are the secondary causes of hyperparathyrodism? in response to hypocalcemia?

A
  • renal failure
  • decreased calcium e.g low oral intake, malabsorption, VitD
  • inhibition of bone resorption
40
Q

What are the signs and symptoms of primary hyperparathyroidism?

A 
renal stones
muscle weakess
tiredness
thirst and polyuria
anorexia
constipation
all a result of electrolye imbalances e.g hypercalcaemia
41
Q

How is the adrenal gland divided into two?

A

outer cortex

inner medulla

42
Q

What are the zones of the outer cortex?

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

43
Q

What does the zona glomerulosa secrete?

A

“salt”

mineralocorticoids e.g aldosterone

44
Q

What does the zona fasciculata secrete?

A

“sugar”

glucocorticoids e.g cortisol

45
Q

What does the zona reticularis secrete?

A

“sex”

androgens

46
Q

What do chromaffin cells in the medulla secrete?

A

“stress”

catecholamines e.g norepi, epi

47
Q

What is Cushing’s syndrome?

A
  • result of adrenal gland
  • rare endocrine disorder due to excessive cortisol
  • between ages 25-40
48
Q

What are some endogenous causes of cushings?

A
  • adrenal cortical tumours
  • adrenal cortical hyperplasia
  • ACTH secreting pituitary adenoma
49
Q

When is paraneoplastic cushings seen?

A

small cell lung carcinoma

50
Q

What is the exogenous cause of cushings?

A

patients on steroids

51
Q

What are the signs and symptoms of cushings

A
  • upper body obesity with thin arms and legs
  • red, round face
  • high blood sugar
  • high BP
  • vertigo
  • blurry vision
  • acne
  • purple striae
  • menstrual irregularities
  • hirsuitism
  • severe depression
  • cognitive difficulties
  • emotional instability
  • sleep disorders
  • fatigue
52
Q

Which organ secretes aldosterone?

A

adrenal gland

53
Q

What is Conn’s syndrome?

A
  • hyperaldosteronism
  • can be primary or secondary
  • increase release of aldosterone from zona glomerulosa
  • 30-50 years, W>M
54
Q

What are the signs and symptoms of Conn’s syndrome

A

high BP, headache, muscular weakness, muscle spasms, excessive urination and cardiac arrythmias

55
Q

What is Waterhouse-friderich syndrome?

A
  • acute adrenal insufficiency
  • generally secondary to septicaemia
  • adrenal gland failure (stops producing hormones) due to bleeding in adrenal glands
56
Q

What is Addison’s disease?

A
  • primary chronic adrenal cortical insufficiency
  • secondary due to failure of ACTH secretion
  • autoimmune form is most common
  • lack of mineralocorticoids and glucocorticoids
  • treatment with long term steroid replacement
57
Q

What is the triad of Addison’s disease?

A
  • hyperpigmentation
  • postural hypotension
  • hyponatraemia
  • GI disturbances
58
Q

What are the signs of an acute adrenal crisis?

A
  • fever
  • syncope
  • convulsions
  • hypoglycaemia
  • severe vomiting and diarrhea
59
Q

What is a pheochromocytoma?

A
  • catecholamine-secreting tumours of the adrenal medulla
  • produces adrenaline, noradrenaline
  • mostly sporadic but familial syndromes are von hippel-lindau disease etc
  • excellent prognosis when benign
  • malignant tumours may require aggressive treatment
60
Q

What are the symptoms of pheochromocytoma?

A 
racing heart beat
headaches
pallor
sweating
high BP
61
Q

What would we immediately treat thyrotoxicosis with and why?

A
  1. Beta blockers - to control the symptoms of hyperthyroidism e.g tachycardia and sweating
  2. Carbimazole - blocks production of thyroid hormone
62
Q

In primary hypothyroidism, why do we see a high TSH?

A

due to reduced negative feedback on the pituitary so it produces more TSH in attempt to stimulate the pituitary to secrete more T4

63
Q

What are the 2 first line screening tests for cushings?

A

24hr urine cortisol and overnight dex test

Clinical Pathology (57 decks)

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