diseases of the endocrine system

Which part of pituitary gland is larger?

Anterior lobe is larger 75%

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List causes of anterior pituitary hypofunction

tumours (non-secretory adenoma/metastatic carcinoma), trauma, infarction, inflammation, iatrogenic

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Describe primary pituitary tumours.

mainly adenomas and benign, effects due to hormone produced and local effects due to pressure on optic chiasma- or adjacent pituitary

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What are the types of anterior pituitary adenoma?

1) prolactinoma- commonest, galactorrhea and menstrual disturbance 2) Growth hormone secreting- gigantism in children/ acromegaly in adults 3) ACTH secreting- cushings syndrome

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Describe chronic lymphocytic thyroiditis (hashimotos)

autoimmune condition with chronic inflammation associated with diffuse enlargement (non-tender) and thyroid autoantibodies. serum thyroid antibodies elevated. lymphocytic infiltration of thyroid parenchyma with germinal centre formation.

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Describe diffuse hyperplasia (graves disease)

autoimmune resulting in clinical hyperthyroidism and diffuse hyperplasia of follicular epithelium- T3+4 elevated TSH markedly suppressed. thyroid antibodies to thyroid stimulating immunoglobulin.

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What physical findings do you see in graves disease?

Pretibial myxoedema, hair loss, wide-eyed stare or proptosis, tachycardia, hyperactive reflexes.

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describe multi nodular goitre

Enlargement of thyroid with varying degrees of nodularity- tracheal compression/ dysphagia may develop with large nodules

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Describe follicular adenoma

Benign encapsulated tumour with evidence of follicular cell differentiation. more common females. painless neck mass over years. solitary nodule involvement. cold nodule.

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What are the most common thyroid tumours?

Papillary carcinomas - mostly well differentiated and low grade- most common in females

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Describe papillary carcinoma

Familial, autosomal dominant non-medullary thyroid carcinoma- FAP -Cowden’s syndrome

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Whats the genetics involved in papillary carcinoma?

Activation of RET/NTRK1, Variety chromosomal translocations/inversions, Fusion of RET tyrosine kinase regions with constitutively expressed thyroid proteins eg PTC1 in inv(10)(q11;q21)/PTC2 t(10;17(q11.2;q21), BRAF V600E mutation, RAS mutations

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Describe the macroscopic appearance of a papillary carcinoma

1)ill defined, infiltrative 2) some encapsulated 3)may be cystic 4)granular 5) nuclear inclusions 6)psamoma bodies

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Describe follicular neoplasms

follicular adenoma, minimally invasive/widely invasive, hurthle cell neoplasms, was mutations

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What is the clinical behaviour of hurtle cell carcinoma?

significant incidence of cervical lymph node metastases Common haematogenous sites – Bone, Liver and Lung

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Define primary hyperparathyroidism

excessive secretion of parathyroid hormone from one or more glands (PHPT)

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Define secondary hyperparathyroidism

hyperplasia of glands with elevated PTH in response to hypocalcemia

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Define tertiary hyperparathyroidism

in association with longstanding secondary hyperparathyroidism

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What is MEN 2A?

Multiple endocrine neoplasia, type 2A is a hereditary syndrome characterized by medullary carcinoma of the thyroid, pheochromocytoma, parathyroid hyperplasia or adenomas (causing hyperparathyroidism), occasionally cutaneous lichen amyloidosis

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Describe parathyroid adenoma

encapsulated benign neoplasm of parathyroid cells.- symptoms of hypercalcaemia- Single enlarged parathyroid gland; remaining glands suppressed and small.

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What is parathyroid adenoma associated with?

MEN1 and MEN2 syndrome and hyperparathyroidism and jaw tumour syndrome.

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What is MEN1?

MEN1= pituitary adenoma+ parathyroid hyperplasia+ pancreatic tumour

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What is MEN2A?

MEN2A= parathyroid hyperplasia+ medullary thyroid carcinoma + phenocromocytoma

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What is MEN2B?

MEN2B= mucosal neuromas+ marfanois body habitus+ medullary thyroid carcinoma + phenocromocytoma

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Describe 2nd and 3rd hyperparathyroidism

Non-neoplastic increase in parathyroid parenchymal cell mass within all parathyroid tissue with a known stimulus.- common in real failure/dialysis patients

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Describe parathyroid carcinoma

Malignant tumour derived from parathyroid parenchymal cells.

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What are different causes of cushing syndrome?

1) prolonged exposure to cortisol 2) exogenous -excessive glucocorticoid medication 3)endogenous causes- adrenal cortical tumours, adrenal cortical hyperplasia and ACTH secreting pituitary adenoma 4) paraneoplastic cushing in small cell lung cancer

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What are the signs and symptoms of cushing syndrome?

hypertension, moon face, central obesity, buffalo hump, weak muscles, osteoporosis, insomnia, excess sweating, mood swings, headaches, chronic fatigue. Women may have increased hair growth (hirsuitism) and irregular menstruation.

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What is Conn's syndrome?

hyperaldosteronism, primary & secondary- excess production of the hormone aldosterone by the adrenal cortex leading to low renin levels. Controlled by renin-angiotensin system.

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What are the signs and symptoms of Conn's syndrome?

high BP, headache, muscular weakness, muscle spasms, excessive urination, cardiac arrhythmias.

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What are the aetiologies behind Conn's syndrome?adrenal cortical hyperplasia, adenoma and familial hyperaldosteronism

1)Adrenal cortical hyperplasia, 2)Adenoma 3)familial hyperaldosteronism

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Describe addisons disease

Primary adrenal cortical insufficiency caused by adrenal dysgenesis, adrenal destruction, autoimmune adrenalitis, TB. Secondary due to failure of ACTH secretion- autoimmune most common

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What is the triad in addisons disease?

1)hyperpigmentation 2)postural hypotension 3)hyponatraemia.

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Describe adrenal cortical nodule?

Benign non-functional nodules of adrenal cortex- no clinical symptoms

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Describe adrenal cortical adenoma

Benign neoplastic proliferation of adrenal cortical tissue.- Symptoms related to endocrine hyperfunction (hypertension, Cushing’s symptoms and virilisation)

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What hormone producing tumour causes Conns syndome?

Aldosterone- producing tumours

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What hormone producing tumour causes cushings syndrome?

Cortisol-producing tumours

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Describe phaeochromocytoma?

Catecholamine-secreting tumour arising from adrenal medulla-rule of 10-10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial and 10% in children.

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What are symptoms of phaeochromocytoma?

hypertension, palpitations, headaches, anxiety

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What is elevated in phaeochromocytoma?

urine catecholamines, adrenaline, noradrenaline

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diseases of the endocrine system

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