Faculty of Medicine - Pathology of the Endocrine System

Topics Covered

• Tumors of the Pituitary Gland (Pages 750-754)

• Tumors of the Thyroid Gland (Pages 763-768)

• Tumors of the Adrenal Glands (Pages 792-795)

Pathology of the Pituitary Gland

Key Concepts

• Necrosis and Inflammation:

  • Necrosis: Can occur due to shock or post-delivery events (e.g., Sheehan's syndrome)

  • Inflammations: Include tuberculosis (TBC), sarcoidosis

Types of Tumors

• Adenomas:

  • Chromophobe (e.g., prolactinoma)

  • Eosinophilic (GH-secreting)

  • Basophilic (e.g., ACTH-, TSH-secreting)

Clinical Symptoms

1. Hyperpituitarism

   • Manifestations:

     • Growth Hormone (GH) → Gigantism/Acromegaly

     • ACTH → Cushing’s syndrome

     • TSH → Hyperthyroidism

     • FSH/LH → Hypogonadism

     • Prolactin → Galactorrhea, amenorrhea, infertility

2. Hypopituitarism

   • Causes: Tumors (destruction of the gland), congenital issues (e.g., dwarfism), effects of radiation, surgery, ischemia, and inflammation

Local Mass Effect of Adenomas

• Symptoms:

  • Visual field abnormalities (bitemporal hemianopsia)

  • Headache, nausea, vomiting (due to intracranial hypertension)

  • Seizures and obstructive hydrocephalus

  • Cranial nerve palsy

  • Pituitary apoplexy (bleeding)

Macroscopic Features

• Microadenomas: < 1 cm

• Macroadenomas: ≥ 1 cm

Pathology of the Thyroid Gland

Key Conditions

• Malformations: Aplasia, hypoplasia, ectopic thyroid gland, cysts

• Inflammations:

  • Acute thyroiditis

  • Subacute thyroiditis (de Quervain, giant cells)

  • Chronic thyroiditis

  • Hashimoto thyroiditis

  • Riedel’s fibrous thyroiditis

Hyperplasia and Goiter

• Goiter Types:

  • Diffuse and nodular

  • Can be normo-, hypo-, or hyperfunctional

  • Endemic Goiter: Linked to iodine deficiency and TSH hypersecretion

  • Clinical Effects:

  • Compression effects (dysphonia, dysphagia, superior vena cava syndrome)

Hyperthyroidism and Hypothyroidism

• Hyperthyroidism Causes:

  • Basedow-Graves disease: Autoimmune

  • Toxic adenoma

  • Nodular goitre

• Hypothyroidism Causes:

  • Congenital or acquired

Tumor Types

• Benign: Adenomas (with/without hyperfunction)

• Malignant:

  • Papillary carcinoma

  • Follicular carcinoma

  • Medullary carcinoma

  • Undifferentiated carcinoma

  • Lymphoma, angiosarcoma

Pathology of the Adrenal Glands

Adrenal Gland Disorders

• Hypofunction:

  • Causes include hemorrhages, tuberculosis, metastases

  • Waterhouse-Friderichsen syndrome

  • Addison disease

• Hyperfunction:

  • Causes include hyperplasia (primary/secondary-ACTH), adenomas

  • Syndromes:

  • Cushing syndrome: Glucocorticoid excess

  • Conn syndrome: Aldosterone excess

  • Adrenogenital syndrome: Sex steroid excess

Tumor Types

• Cortex: Adenomas, carcinoma

• Medulla:

  • Chromaffin cells (pheochromocytoma)

  • Neuroblastoma

Waterhouse-Friderichsen Syndrome

• Clinical Features:

  • Bilateral hemorrhagic necrosis of adrenal glands

Case Studies

• Example:

  • 41-year-old man with gynecomastia and advanced adrenal carcinoma

  • 49-year-old woman with multiple endocrine neoplasia (MEN1) exhibiting various symptoms

Important Definitions and Syndromes

• Cushing Syndrome: Results from excessive cortisol; symptoms include hyperglycemia and hypertension.

• Hyponatremia: Low sodium levels in the blood.

• Paraneoplastic Syndromes: Disorders associated with cancer due to substances produced by tumors.

Examples of Paraneoplastic Syndromes

• Cushing syndrome associated with small cell lung carcinoma.

• Hypercalcemia (parathyroid hormone-like substance) from renal cell carcinoma.

• Carcinoid syndrome (due to serotonin production).