ENDOCRINE

SYSTEM

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PITUITARY GLAND
Pituitary adenomas and hyperpituitarism
Hypopituitarism
Posterior pituitary syndromes
Hypothalamic suprasellar tumors

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PITUITARY ADENOMA
Found in adults(35 to 60
years of age)
Genetic causes:
G-protein mutations
MEN1,CDKN1B,PRKAR1A,
AIP

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PITUITARY ADENOMA
Soft,well-circumscribed
lesion
Microadenoma(<1cm)
Macroadenoma(>1cm)
Composed of uniform,
polygonal cells in sheets
or cords

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PROLACTINOMA
Composed of weakly
acidophilic or
chromophobic cells

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOPITUITARISM
Decreased secretion of pituitary hormones
75% of parenchyma is lost or absent
Causes:
Tumors
Traumatic brain injury
Surgery or radiation
Pituitary apoplexy
Sheehan syndrome

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOPITUITARISM
Rathke cleft cyst
Empty sella syndrome
Genetic defects
Inflammation/infections

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

POSTERIOR PITUITARY SYNDROMES

Diabetes insipidus
Syndrome of inappropriate ADH secretion(SIADH)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOTHALAMIC SUPRASELLAR TUMORS

Gliomas
Craniopharyngiomas
Average 3 to 4 cm
Encapsulated and solid,cystic

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOTHALAMIC SUPRASELLAR TUMORS

Adamantinomatous
craniopharyngioma
Nests or cords of
stratified squamous
epithelium
Compact lamellar
keratin
formation(diagnostic)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOTHALAMIC SUPRASELLAR TUMORS

Papillary
craniopharyngiomas
Contain solid sheets
and papillae lined by
well-differentiated
squamous epithelium
Lack keratin,
calcification, and cysts

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

THYROID GLAND
Hyperthyroidism
Hypothyroidism
Thyroiditis
Graves disease
Diffuse and multinodular goiters
Neoplasms of the thyroid
Congenital anomalies

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOTHYROIDISM
Cretinism
Infancy or early childhood
Cretin-Christian Christ-like
Clinical features:
Severe mental retardation
Short stature
Coarse facial features
Protruding tongue
Umbilical hernia

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOTHYROIDISM
Myxedema
Older child or adult
Clinical features:
Slowing of physical and
mental activity
Generalized fatigue,apathy
Cold intolerant,overweight

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

THYROIDITIS
Inflammation of the thyroid gland
Types:
Hashimoto thyroiditis
Subacute(granulomatous) thyroiditis
Subacute lymphocytic thyroiditis

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HASHIMOTO THYROIDITIS
Gradual thyroid failure
due to autoimmune
destruction of thyroid
gland
45 to 65 years of age
More common in
women(10:1 to 20:1)
Breakdown in selftolerance to thyroid
auto-antigens

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HASHIMOTO THYROIDITIS
Diffusely enlarged
Intact capsule
Extensive infiltration of
parenchyma by
mononuclear infiltrates
Hurthle cells-follicular
epithelial cells with
abundant
eosinophilic, granular
cytoplasm

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

SUBACUTE (GRANULOMATOUS)
THYROIDITIS
De Quervain thyroiditis
Triggered by viral
infection
Causes thyroid pain
Chronic inflammatory
infiltrate with
multinucleated giant
cells

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

SUBACUTE LYMPHOCYTIC
THYROIDITIS
painless thyroiditis
Fibrosis and Hurthle
cells are not
prominent

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

GRAVES DISEASE
Triad:
Hyperthyroidism
Ophthalmopathy
Dermopathy

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

GRAVES DISEASE
Breakdown in self-tolerance to thyroid auto-antigens resulting
in autoantibodies production:
Thyroid-stimulating immunoglobulin
thyroid growth-stimulating immunoglobulins
TSH-binding inhibitor immunoglobulins

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

GRAVES DISEASE
Diffuse hypertrophy
and hyperplasia of
thyroid gland
Follicular epithelial cells
are tall and more
crowded than usual

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

DIFFUSE NONTOXIC GOITER

Enlargement of
entire gland
without nodules
Colloid goiter
Follicular epithelium
is flattened and
cuboidal
Abundant colloid
euthyroid

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

MULTINODULAR GOITER
Multilobulated
Asymmetrically enlarged
gland
Colloid-rich follicles
Follicular hyperplasia

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ADENOMAS
Solitary,spherical,
encapsulated lesion welldemarcated from
surrounding parenchyma
Uniform-appearing
follicles with colloid

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

CARCINOMAS
Papillary
Follicular
Anaplastic
Medullary

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PAPILLARY CARCINOMA
Most common form
of thyroid
cancer(85%)
Solitary or multifocal
lesion
Branching papillae
Orphan Annie eye
nucleus
Psammoma bodies

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

FOLLICULAR CARCINOMA
Single nodules,
well-circumscribed
or widely infiltrative
Fairly uniform cells
forming small
follicles containing
colloid

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ANAPLASTIC CARCINOMA
Undifferentiated tumors
Aggressive,65 years of
age
Pleomorphic giant cells
Sarcomatous spindle
cells

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

MEDULLARY CARCINOMA
Neuroendocrine
neoplasms from
parafollicular cells
Peak in 40s to 50s
Part of MEN syndrome
Polygonal to spindleshaped cells which
may form nests,
trabeculae, and
follicles

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

CONGENITAL ANOMALIES
Thyroglossal duct cyst
Midline neck mass from a
persistent thyroglossal duct
Fibrous cyst lined by
stratified squamous
epithelium or thyroid tissue

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PARATHYROID GLANDS
Hyperparathyroidism
Hypoparathyroidism
Pseudohypoparathyroidism

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PRIMARY HYPERPARATHYROIDISM
Causes:
Adenoma: 85% to 95%
Primary hyperplasia(diffuse or nodular): 5% to 10%
Parathyroid carcinoma: 1%

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

FAMILIAL PRIMARY
HYPERPARATHYROIDISM
Multiple endocrine neoplasia-1(MEN-1)
inactivation of MEN-1 gene

MEN-2
mutation of RET gene

Familial hypocalciuric hypercalcemia

decreased sensitivity to extracellular calcium

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PARATHYROID ADENOMA
Solitary,soft nodule,
with a capsule
Composed of fairly
uniform, polygonal
chief cells with small,
centrally placed
nuclei

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

SECONDARY
HYPERPARATHYROIDISM
Renal failure
Most common cause of secondary hyperparathyroidism
Hyperplastic parathyroid glands

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

HYPOPARATHYROIDISM
Surgically induced
Autoimmune
Mutations in autoimmune regulator(AIRE)gene

Familial
Autosomal dominant-PTH precursor peptide mutation
Autosomal recessive-glial cells missing 2(GCM2)

Congenital absence

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PSEUDOHYPOPARATHYROIDISM
End-organ resistance to PTH
PTH is normal or elevated
Hypocalcemia
hyperphosphatemia

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ENDOCRINE
PANCREAS
Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ENDOCRINE PANCREAS
Diabetes mellitus
Group of metabolic disorders sharing the common
underlying features of hyperglycemia
Diagnosis:
RBG >200mg/dL with classic s/s
FBG >126mg/dL on more than one occasion
OGTT >200mg/dL after 2 hrs

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

TYPE 1 DIABETES MELLITUS

Autoimmune disease
Islet cell destruction caused by immune effector cells
reacting against B-cell antigens

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

TYPE 2 DIABETES MELLITUS

Causes:
Decreased response
of peripheral tissues
to insulin
(insulin resistance)
B-cell dysfunctioninadequate insulin
secretion

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PANCREATIC ENDOCRINE NEOPLASMS

Insulinoma
Gastrinoma
Rare tumors
Glucagonoma
Somatostatinoma
VIPoma
Pancreatic carcinoid tumors

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

INSULINOMA
B-cell tumor
Most common
Small,solitary nodule
Monotonous
neoplastic cells
Abundant amyloid
deposition

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

GASTRINOMA
Part of Zollinger-Ellison
syndrome(pancreatic
islet cell lesions,
hypersecretion of
gastric acid, severe
peptic ulceration
Histologically bland

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

RARE PANCREATIC NEOPLASMS

Glucagonomas
A-cell tumors,increased glucagon
Somatostatinomas
D-cell tumors
VIPoma
Watery diarrhea,hypokalemia,achlorhydria, or WDHA syndrome
Carcinoid tumors
Produces serotonin

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ADRENAL GLANDS
Cushing syndrome
Elevated glucocorticoid levels
Diffuse hyperplasia
Vacuolated lipid-rich cells

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

PRIMARY ADRENOCORTICAL
ADENOMAS
May be malignant or benign
Common in women(30s to 50s)
Carcinomas tend to be larger

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ALDOSTERONE-PRODUCING
ADENOMAS
Solitary,small,wellcircumscribed lesions
Bright yellow with lipidladen cortical cells
Spironolactone bodieseosinophilic,laminated
cytoplasmic inclusions

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ADRENOCORTICAL INSUFFICIENCY
Hypofunction
Causes:
Primary adrenal disease(primary hypoadrenalism)
ACTH deficiency(secondary hypoadrenalism)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

WATERHOUSE-FRIDERICHSEN
SYNDROME
Overwhelming bacterial
infection
(Neisseria meningitides)
Rapidly progressive
hypotension leading to
shock
DIC
Massive bilateral adrenal
hemorrhage
Adrenals are converted
to sacs of clotted blood

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ADRENOCORTICAL NEOPLASMS
Adrenocortical adenoma
Well-circumscribed
nodular lesion
Yellow to brown color
Neoplastic cells are
vacuolated due to
intracytoplasmic lipid

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ADRENOCORTICAL CARCINOMAS
Large,invasive lesions
Composed of welldifferentiated cells to
bizarre,monstrous giant
cells

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

ADRENAL MEDULLA
Pheochromocytoma
Small,circumscribed
lesions to large
hemorrhagic masses
Polygonal to spindleshaped chromaffin
colored chief cells,
clustered with
sustentacular cells
into small nests or
alveoli(zellballen)

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

MULTIPLE ENDOCRINE NEOPLASIA

Type 1
Wermer syndrome
Involves parathyroid,pancreas,pituitary
Primary hyperparathyroidism-most common manifestation
Pancreas: endocrine tumors
Pituitary: prolactinoma

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)

MULTIPLE ENDOCRINE NEOPLASIA

Type 2
MEN-2A
Sipple syndrome
Pheochromocytoma,medullary carcinoma,parathyroid
hyperplasia
MEN-2B
Pheochromocytoma,medullary carcinoma,neuromas
Familial medullary thyroid cancer
Variant of MEN-2A

Print to PDF without this message by purchasing novaPDF (http://www.novapdf.com/)