endocrine pathology part i

8/18/2019 Endocrine Pathology Part i

http://slidepdf.com/reader/full/endocrine-pathology-part-i 1/13

ENDOCRINE PATHOLOGY PART IDyonesia Ary H.

TOPICS

Pathology of pituitary

Pathology of thyroid

Pathology of parathyroid

Pathology of adrenal

Pathology of pancreas

LEARNING OBJECTIVES

• Etiopathoenesis

• !orpho"oy #a$ros$opi$s % #i$ros$opi$s• C"ini$a" #ani&estations

PATHOLOGY O' PIT(ITARY GLANDBy i##)nohisto$he#istry

• *e $an +no, ,hat +in- o& hor#one is pro-)$e- in a $e"".

• A$i-ophie" $e""s $an pro-)$e STH or LTH. This $e""s are STH $e""s orLTH $e""s.

• Ana"oy &or asophie" $e""s / 'SH0 ICSH0 TSH0 ACTH0 !SH 1.

Clinical manifestations of pituitary disease

• Hyperpit)itaris#Ca)se- y2A-eno#a pit)itary2Hyperp"asia or $ar$ino#a o& the anterior pit)itary

• Hypopit)itaris#

Ca)se- y2-estr)$ti3e pro$esses /is$he#i$0 s)rery or ra-iation %in4a##ation12non&)n$tiona" pit)itary a-eno#as.

• Lo$a" #ass e5e$ts ra-ioraphi$ anor#aities o& the se""a t)r$i$a

• Disease o& the posterior pit)itary

PIT(ITARY HYPO'(NCTION2HYPOPIT(ITARIS!CAUSES

2 Hypotha"a#)s t)#o)r or $raniopharynio#a2 Chro#opho a-eno#a2 In&ar$tion2 Others / 3ery se"-o#1 e$ iatroeni$0 $yst0 t)er$)"osis0 sar$oi-osis0

iant $e"" ran)"o#a0 in6"tration0 i-iopathi$. The #ost &re7)ent $a)se

• Sheehan

• Chro#ophoo a-eno#a

• Craniopharynio#a

• ,ith SIGN2SY!PTO!

•A-)"t panhypopit)itaris# 2Sy##on-

•Chi"-ren -,ar6s# Lorain Le3i or 'roeh"i$h

SIGN2 SY!PTO!

Hipopit)itaris# -e$rease o& trophi$ hor#one0 espe$ia""y ACTH0 TSH0CH0 'SH

Sy#pto#s o& pri#ary $a)se8 sin o& t)#o)r or Sheehan -isease.

Da#ae o& ne)rohypophysis sta"+ ,ith sin o& asen$e o& 3asopressin e$ -i)rese0 po"y)ria0 )n$ontro""e- thirst

PANHIPOPIT(ITARIS! or Si##on- -isease

Ae 9: 2 ;: years

De6$ien$y o& a"" hor#ones espe$ia""y ona-e0 thyroi-0 a-rena".

Pit)itary -oes not $ontro"e a"-osteron 0 so a"an$e o& ,ater2e"e$tro"yt

not $hane-Atrophy $an e 3ery se3ere0 the en-o$rine is not &o)n-.

PATHOLOGY O' PIT(ITARY

CONGENITAL

•aenesis y $y$"ops.Taret "an-s 0 thyroi-0 s)prarena"is0 testis0

#y<e-e#a0 hypo"y$e#i$ $on3)"tion0 enita" atropohi$.

•hypop"asti$. By anen$epha"i. Se""a t)r$i$a 4at an- 6""e- ,ith 3as$)"artiss)e. A-rena" in3o"3e-0 )t thyroi-0 enita"0 ona-e notin3o"3e-.

BLEEDING.

•'o""o,in reat tra)#a or t)#o)r. Tra)#a $a)ses "ee-in0

"a$eration0 ne$rosis -iaetes in$ipi-)s. T)#o)r $a)se a"so intrahypophysea" "ee-in /pit)itary apop"e<ia 1.

•Sin $epha"ia0 optha"#op"eia0 #eninis#)s0 press)re on N. II. 'irst

sy#pto# o& T)#o)r.

IN'ARCT AND NECROSIS

•in&ar$t / 9= 1 o& a)topsy0 #ost"y in a-enohypophisis. No &)n$tiona"-e5e$t in >:= -a#ae o& hypophisis.

•Pathoenesis e#o"i0 tro#osis0 S$h,ar?#an pheno#ens 03as$)"arspas# or press)re on the "oo- 3esse".

• The #ost i#portant Sheehan -isease.

SHEEHAN@ S DISEASE.

!assi3e in&ar$t -)e ostetri$ sho$+.

Sho$+ -)e #assi& "ee-in or S$h,art#ann rea$tion aainst

p"a$enta" protein an- &or#e- s#a"" tro#osis.

Si#pto# "a$tation &ai")re0 a#enorrhoe0 a-reno$orti$a" ins)6siensian- hypothyroi-is#.

!i$ros$opi$s is$he#i$ or he#orrhai$ in&ar$t.In4a##ation o& pit)itary

A$)te or he#atoeni$ &ro# a septi$ &o$)se$ #eninitis0 sin)sitis an- otitis #e-ia0 ran)"o#ato)s in&e$tion

Chroni$2t$ / a part o& #)"tip"e "esion 12")es / $onenita" or a$7)isita" 12sar$oi-osis /non $aseatin t)er$"e12iant $e"" ran)"o#a0

Giant $e"" ran)"o#a

Sar$oi- "i+e "esion0 )t not syste#i$.

Espe$ia""y pars anterior

Ca)ses panhypopityitaris# ,ith hypothyroi-is#0 atrophy thyroi- an-

a-rena"

In &e#a"e

!i$ros non $aseatin t)er$"e

Ca)sa inota0 #ay e a)toi##)ne or in&e$tion

IN'ILTRATION or !ETABOLIC DISEASE

Amyloidosis, secondary can involved hypophysis ( arteryall !

"ans Schuller Christian deposition of cho lesterol containing

histiocytes in posterior lo#e, infundi#ulum stal$ ,retro#ul#air dia#etes incipidus ( due #loc$ing of A%"!&

'argoylism ( "urler syndrome ! deposition of mucopolysaccharide in sel of adenohypophysis foam cells

T(!O(R O' HYPOPHYSIS

Very rare / = o& $rania" t)#o)r1

Lo$a" sy#pto#0 -)e the press)re o& the t)#o)r to the s)rro)n-oran0 se""a t)r$i$a0 $hias#a N. opti$0 ne)rohyphysis0hypotha"a#)s0 $rania" ner3es.

En-o$rino"oi$ sy#pto#0 -)e hyperse$retion o& the hyphopysea"

hor#one oran- the trophi$ hor#one/thyroi-0 a-rena" et$.1

Another en-o$rino"oi$ sy#pto# is -e$re ase o& hor#one / e$eosinophi"i$ $e""s 1 -)e the press)re o& t)#or / $hro#ophoo $e""s 1

I& a-enohypophysis in3o"3e--e$rease o& trophi$ hor#one

I& ne)rohypophysis in3o"3e- -iaetes in$ipi-)s

Type o& t)#o)r a-eno#a eosinophie"0 a-eno#a asophie" 0 a-eno#a$hro#ophoo.

So#eti#es a-eno#a $hro#ophoo / in HE stainin 1 pro-)$es ,ith

hor#one / C)shin or a$ro#ea"y 1. *ith NON HE stainin 0 this$e"" in $hro#ophie".

!ORPHOLOGY

•Co)"- e s#a"" or i

•Co)"- e so"i- or $ysti$

•Bier t)#o)r in&ar$tion or he#orrhai$ /pit)itary apop"e<ia 1



• The $e"" is ,e"" -i5erentiate-0 in -i5)se0 sin)soi-a" or papi""air.

• ADENO!A CHRO!OPHOOB

•!ost t)#o)r in pit)itary. ! '0 9:2: years.

•Very i t)#o)r $ysti$. Press)re on se""a t)r$i$a0 N. II0 another $e""s/panhipopit)taris#1

•Press)re on hypotha"a#)s-estroy pro"a$tin inhiitin &a$tor no

inhiition o& pro"a$tin pro-)$tion a"a$torrhoa.

Classication of Pituitary Adenoma

•Pro"a$tino#a

•Gro,th hor#one /so#atotroph $e""1 a-eno#as

•Corti$otroph $e"" a-eno#a

•!i<e- ro,th hor#one2pro"a$tin $e"" a-eno#a

•Other p")rihor#ona" a-eno#a

•Hor#one2neati3e a-eno#as

Pituitary Adenoma

•!ost $o##on $a)se o& hyperpit)itaris#

•/anterior "oe1

•Base- on $"ini$a" #ani&estations

')n$tiona"Si"ent

•C"assi6e- on the asis o& hor#ones pro-)$e- y neop"asti$ $e""

-ete$te- y IHC stains.

•In$i-en$e := intra$rania" t)#or

•A-)"t ae 92: y.o.

•9= o& $ases asso$iate- ,ith !EN I

•!a$ros$opi$#a$roa-eno#a $##i$roa-eno#a F $#

!(LTIPLE ENDOCRINE ADENO!ATOSIS

• 'a#i"iar2here-itair -isease / a)toso#a" -o#inant1 $onsist o& $o#ination o& -i3erse en-o$rin a-eno#a.

• Type a-eno#a Lanerhans0 parathyroi-0 hypophysis.

• Type a-eno#a parathyroi-0 ne)ro6ro#a phaeo$hro#o$yto#a0 Ca#e-)""aiir thyroi-0

• Type 9 Ca papi""air thyroi-0 a-eno#a parathyroi-

CARCINO!A O' HYPOPHYSIS• VERY RARE

• NON '(NCTIONAL

• Ce"" atypi$ ,ith in6"tration an- #itosis.

CRANIOPHARYNGIO!A

• Ce"" o& Rath+e po)$h ,a"".

• In yo)n patient. !ost in se""a t)r$i$a.

• So"i- or $ysti$ / #ore &re7)ent 1.

• !)"ti"o$)"air $yst $ontain $ho$o"ate 4)i-0 $ho"estero". Ca"$i6$ation

&re7)ent. Dia#eter $an rea$h : $#.

• !i$ros$opi$s so"i- $e"" nest that anasto#osin. In one si-e $e""pa""isa-in/ a-a#antino#a 1.

• Press)re on N. II0 hypotha"a#)s0 hypophysis

PATHOLOGY O' THYROID

Clinical )anifestations

•Hyperthyroi-is#

•Hypothyroi-is#

•E5e$ts o& "o$a" t)#or #ass

'OITE*

!a$ros$opi$

2en"are#ent2-i5)se2si#etri$

"yperthyroidism

Thyroto<i$osis hyper#etao"i$ $on-ition e pri#ary orse$on-ary hyperthyroi-is#

Prin$ip"e $a)ses o& thyroto<i$osis / hyperthyroi-is#1

Gra3es -isease /=1 -i5)se hyperp"asia

Hyper&)n$tiona" /to<i$1 oiter #)"tino-)"ar

Hyper&)n$tiona" /to<i$1 thyroi- a-eno#a

C+IICA+ )AI-ESTATIOS O- ".PE*T".*OI%

•Basa" #etao"is#

•Car-ia$ syste# ta$hy$ar-ia0 pa"pitation

•Ne)ro#)s$)"ar

tre#or•O$)"ar e<optha"#os

•GIT #a"asorption0 -iarhea

•S$e"eta" osteoporosis

•(ter)s#enorrhaia0 in&erti"e

•CNS "ai"e0 &ati)e0 an<ietas

"ypothyroidism

De6$ien$y o& thyroi- hor#one pro-)$tion

C"ini$ #etao"is# ↓



• #enta" retar-e-0 &ati)e0 &a$e #y<e-e#a0 oiter0 ra-y$ar-i0

#yopathy0 $onstipation0 a#enorrhea0 oesity0 et$

• Etio"oy o3er2treat#ent0 -r)s /"ithi)#0 a#io-arone10 tiroi-itisHashi#oto0 Io-i)# -e6$ien$y0 $onenita"

Thyroiditis

• In4a##ation o& the thyroi- "an-

• A$)te % $hroni$• Pain in&e$tio)s thyroi-itis 0 s)a$)te ran)"o#ato)s thyroi-itis.

• Co##on % $"ini$a""y sini6$ant types

•Hashi#oto thyroi-itis

•S)a$)te ran)"o#ato)s thyroi-itis

•S)a$)te "y#pho$yti$ thyroi-itis.

Tiroiditis "ashimoto (struma lymphomatosa!

• Tiroi-itis +ronis "i#&ositi+

• Penyea )ta#a hipotiroi-is#

• Penya+it a)toi#)n -estr)+si +e" tiroi-

• (sia ;2 tah)n

• ♀♂K :8

"inis +e"enMar #e#esar0 -i&)s0 tida$ nyeri

• !enin+at+an risi+o0 D! tipe 0 #iastenia ra3is0 "i#&o#a se" B

Su#acute 'ranulomatous Thyroiditis

K Thyroi-itis De )er3ain

;:2: y. o.

♀ ♂K 9

Etio"oy $o<sa$+ie 3ir)s0 #)#ps0 #eas"es

C"ini$a" #ani&estations pain

Hyperthyroi-is# hypothyroi-is# e)thyroi-Thyroiditis %e /uervain

Su#acute +ymphocytic (Painless ! Thyroiditis

Pain"ess thyroi-itis or si"ent thyroi-itis

Hyperthyroi-is#

A-)"t ae0 pre-o#inant"y in postpart)# ,o#en

A)toi##)ne -isease /)n$"ear1

!orpho"oy en"are#ent o& the thyroi-

!i$ros$opi$s "y#pho$ytes in6"tration ,ith $entr)# er#inati3)#0

,itho)t Hrth"e $e""

'raves %isease

A)toi##)ne -isease /re$eptor TSH a)toantio-y10 HLA 2DR9 a""e"e0CTLA;

:2;: y. o.

♀♂K >

!orpho"oy si#etri$ -i5)se"y en"are#ent o& the thyroi- "an-

Chara$teristi$

Hyperthyroi-is#



• E<ophtha"#os

• Der#atopathy pretiia" #y<e-e#a

'oiter

• En"are#ent o& thyroi- "an-

• Io-i)# -e6$ien$y TSH hypertrophy % hyperp"asia o& &o""i$"e$e""s

• !orpho"oy• Si#p"e oiter /-i5)se non2to<i$1

• !)"tino-)"ar oiter

Simple 'oiter

• Di5)se0 a"" thyroi- "an-

• En-e#i$ /o&ten1 % spora-i$ /rare1

• En-e#i$ Io-i)# -e6$ien$y0 oitroen

• !orpho"oy phase e3o")si

• Hyperp"asia phase

• Co""oi- in3o")sion phase

$o""oi- -o#inan$e$o""oi- oiter

• C"ini$a" #ani&estations e)tiroi- % e5e$ts o& "o$a" thyroi- #ass

)ultinodular 'oiter

• Non2to<i$ or to<i$ oiter /thyroto<i$osis1

• Si#p"e #)"tino-)"ar oiter

• En-e#i$ % spora-i$

• !orpho"oy #)"tino-)"ar0 asi#etry0 Thyroi- ,eiht $o)"- e .:::

• C"ini$a" #ani&estations e5e$t o& "o$a" t)#or #ass e<pansion8e)thyroi-

eoplasm of the Thyroid 'land

Benin !a"inant K :

Neop"asti$ s)spi$ion

So"itary no-)"e

Yo)n ae

♂

ra-iation history$o"- no-)"e

-ollicular Adenoma of the Thyroid

Deri3e- &ro# &o""i$)"ar $e""s.

C"assi6$ations #a$ro&o""i$)"ar /-o#inan10 #i$ro&o""i$)"ar0 trae$)"arpattern.

C"ini$a" #ani&estations )ni"atera" #ass0 pain"ess0 $o##on"y

non&)nsiona"0 so#eti#es to<i$ a-eno#aQ

DD Hyperp"asia &o""i$)"ar no-)"e -o#inant % &o""i$)"ar $ar$ino#a

!a$ros$opi$ so"itary no-)"es0 en$aps)"ate-0 φ 9 $#

!i$ros$opi$ +aps)" inta+0 se"2se" +)oi-0 )ni&or# #e#ent)+ str)+t)r&o"i+e"



Carcinoma of the Thyroid 'land

• A-)"t 0 pre-o#inant in ♀

• A""#ost a"" -eri3e- &ro# &o""i$)"ar epithe"ia" $e""s0 e<$ept #e-)""ary

$ar$ino#a .

• S)types /;1

•Papi""ary />2=1

•'o""i$)"ar /:2:=1

•!e-)""ary /=1

•Anap"asti$ /F=1

Papillary Carcinoma of the Thyroid

• Co##on type #a"inan$y o& the thyroi-.

• A"" ae0 #ain"y 2;th -e$a-es

• Ris+ &a$tor ra-iation

• C"ini$a" #ani&estations asi#pto#ati$0 "y#pha-enopathy $o""i

• !a$ros so"itary or #)"ti&o$a" "ession0 en$aps)"ate- or not ,ithpapi""ary #ass

• !i$ros$opi$s papi""ary ro,in ,ith 6ro3as$)"ar sta"+0 ro)n-

"ass n)$"ei /Orphan Annie@s eye10 pse)-o2in$")sion % psa##o#ao-ies

• Pronosis is oo-0 e<$ept i& any -istan$e #etastasi?e- : ysr is

on"y :2=.

-ollicular Carcinoma of the Thyroid♀ 0 ;:2: y. o.

In$i-en$e Io-i)# -e6$ien$y areas

C"ini$a" #ani&estations s"o, ro,in no-)"es0 pain"ess0 $o"- no-)"e0

"y#pha-enopati /rare1

!a$ros$opi$ sin"e no-)"e ,ith inta$t $aps)" or not

!i$ros$opi$ t)#ors o& the the &o""i$)"ar $e""s /#a$ro&o""i$)"ar or

#i$ro&o""i$)"ar1 that #a-e in3asion into the $aps)" or "i#&o3as$)"ar.

Pronosis -epen-s on the sta-i)# o& the -isease.

)edullary Carcinoma of the ThyroidNe)roen-o$rine neop"asia0 -eri3e- &ro# C $e""s /$a"$itonin se$retion1

or para&o""i$)"ar $e""s.

C"ini$a" #ani&estations e5e$ts o& t)#or #ass e<pansion0

paraneop"asti$ $yn-ro#e $a)se- y po"ipepti-a hor#ones.

:= spora-i$0 := eneti$ /!EN A0 B or '!TC1

;:2: y. o.

!a$ros$opi$ so"itary0 )ni"oe /spora-i$10 i"atera" /eneti$10 so"i-

#ass.

!i$ros$opi$s po"yona" or spin-"e $e""s0 /nest0 trae$)"ar0 &o""i$)"ar1appearan$es0 a#y"oi- -eposit.



Anaplastic Carcinoma of the Thyroid• (n-i5erentiate- t)#or

• Aressi3e0 #orta"ity rate a"#ost ::=

• y.o.

• 'ro# -e-i5erentiate- t)#or o& the thyroi-

• C"ini$a" #ani&estations rapi- ro,in o& t)#or #ass0 "o$a" in3asionan- #etastati$ sprea-in.

• !i$ros$opi$ anap"asti$ $e""s /1 i?arre $e""s0 p"eo#orphi$ $e""s0 iant$e""sosteo$"ast2"i+e0 /1sar$o#ato)s appearan$e0 /91 #i<e- o& iant% spin-"e $e""s.

ENDOCRINE PATHOLOGY PART IIDyonesia Ary H.

PARATHYROID

Pro-)$e parathor#on0 a po"ypepti-0 the a$tion is in$rease ser)#

Ca"$i)# "e3e" an- -e$rease ser)# Phosphor "e3e".

In$rease resorsion o& one Ca"$i)#

A$t on nephron $e"" ,ith inhiition o& reasaortion o& P0 Ca0 % !.

In$rease Ca asortion &ro# -iesti3)s tra$t.

E#ryo"oi$ ran$hia"is po)$h III / "o,er "an-s 1 an- po)$h IV/ )pper "an-s 1

9 types o& $e""s $hie& 0 ,ater $"ear % o<yphi" $e""s

In3o"3e- in Ca #etao"is#

Vita#in D0 $a"$itonin0 $orti$osteroi-0 a-rena"in0 thy#)s0 estroen.

TOPICS

Hyperparathyroi-is#Pri#arySe$on-ary Tertiary

Hypoparathyroi-is#

PRI!ARY HYPERPARATHYROIDIS!

Co##on

A-)"t0 ♀ ♂ K 9 Parathyroi- hyper&)n$tion

Pathoenesis = spora-i$ a-eno#ahyperp"asia

Geneti$s !EN0 !EN0 'HH /&a#i"ia" hypo$a"$i)ri$ hyper$a"$e#ia1

CA(SES

a-eno#a /:=1 0 Ca /=10 hyperp"asia /= 1.

ADENO!Ain "an- / so"itair 1. Lo,er "an- is #ore &re7)ent. ::2 ::: #r /nor#a""y : #r 1. !ost"y $hie& $e""s.

CARCINO!Arare. 'i<e- to the aro)n-. Har- $onsisten$y. !itosis ,ith pa""isa-eo& the $e"" to the $api""aries. Dianosis in3asion or #etastasis.

HYPERPLASIA TYPES

Se$on-ary / -)e to the other -isease 10 e$

Chroni$ rena" &ai")re8 Ri$+ets8 Vit. D -e6$ien$y 8pse)-ohypoparathyroi-is#8 #e-)""ary thyroi- Ca8 #a"asortionsyn-ro#e

Pri#ary / not -)e to the other -isease 1 $a)sa inota.

Pri#ary hyperp"asia.

Less &re7)ent than the se$on-ary type 0 )t the #i$ros$opi$ pi$t)re isSA!E.

En"are#ent o& ALL "an-s

No 6<ation to the s)rro)n- tiss)e.



• No-)"ar s)r&a$e.

• No "ipi-.

• Oriin $hie& $e""s.

Parathyroid "yperplasia

Hyperparathyroi-is $"ini$a" pi$t)re

• BONE De#inera"isation $hane- in 6ro)s tiss)e. !i$ros$opi$s#any osteo$"asts.

• 'iro)s tiss)e retra$te- $ysts &or#ation. !a$ros$opi$ ro,n -)e

he#orrhae na#e BRO*N T(!O(R osteitis $hroni$a $ysti$a Re$+"inha)sen.

• Re#o3in the a-eno#ahyperp"asia #a+e the pi$t)re nor#a".Hyperparathyroi-is# +i-ney

• Nephro$a"$inosis % stone &or#ation +i-ney -estroye-. In the

einnin epithe"ia" $e""s is &ree $a"$i&i$ation % "o$+s the

nephron. Ca"$i6$ation o& interstiti)# &o""o,e- y 6rosis % $hroni$

in&e$tion.• En- sta-i)# !assi3e 6rosis ,ith $hroni$ in&e$tion. Atrophi$ t))"i,ith $yst &or#ation. = o& $a"$)"i -)e hyperparathyroi-is#

Hyperparathyroi-is# )"$)s pepti$)#

• Hyper$a"$e#ia sti#)"ates se$retion o& astri$ 4)i- easy to )"$)s

&or#in0 espe$ia""y in !EA.

• Hyper$a"$e#ia sti#)"ates stone &or#ation in -)$t)s pan$reati$)s. I&

the ")#en "o$+e- pan$reatitis a$)ta

Rena" ri$+ets in hyperparathyroi-is#

• / rena" osteo-ystrophia 1 an- se$on-ary hyperparathyroi-is#.

• Chroni$ rena" -iseases / hypop"asia0 po"y$ysti$0 ro,th -isease 1 $an$a)ses osteo-ystrophy / osteitis 6rosa0 osteo#a"a$ia0 osteoporosis1. In $hi"-ren #ore serio)s -,ar6s# e$a)se osteoenesisin$o#p"et an- epiphysis is not $"ose- yet1

• C"ini$a" Ca"$i6$ation o& artery ,a""0 heart0 +i-ney0 ")n0 s)$)tis0eyes0 et$.

• Epiphysea" $arti"ae -6st)ran$e the &or# is anor#a"0 en"are0$a"si6$ation. Crani)# thi$+ene-.

Pse)-o hyperparathyroi-is#

• Hyperparathyroi-is# -)e NON parathyroi- t)#o)r0

• T(!O(RS O' THE L(NG0 LIVER0 IDNEY $an pro-)$e parathor#on.

• Parathyroi- is nor#a".

HYPOPARATHYROIDIS!

• Hypo$a"$e#ia ,ith hyperphospate#ia. Ca)ses2 re#o3in o& parathyroi-2$o#p"i$ation o& thyroi- ra-iation2parathyroi- aenesisi-iopathi$

C"ini$a" tetany /C3oste+@s sin 10 $atara$t0 hair an- s+in ro,th

-ist)ran$e0 CNS sin0 s+e"et hyper-ensity0 3as$)"ar $a"$i6$ation.

Pse)-o hypoparathyroi-is#e A"riht@ -isease

Ca)se s+e"et an- t))"i rena"is not rea$t to parathor#on0 e3en in

hih $on$entration.

'a#i"ia" -iseases0 $"ini$a" pi$t)re an- "aoratori$ sa#e as

hypoparathyroi-is# / hypo$a"$e#ia0 hyperphosphate#ia 1.

Ca"$i6$ation an- ossi6$ation o& the so&t tiss)e. G"o#er)"ar &)n$tion isnor#a". Parathor#on "e3e" is nor#a".

Clinical )anifestations of Primary "yperparathyroid

Asy#pto#ati$

hyper$a"$e#iaSy#pto#ati$ PTH hyper$a"$e#ia

Bone -e&or#ity osteoporosis0 $ysti$ 6ro)s osteitis one &ra$t)renephro"itiasis0 $hroni$ rena" ins)6$ien$y po"y)ria0 po"y-ipsiGIT -ist)ran$es $onstipasi0 na)sea0 pepti$ )"$er 0 pan$reatitis0$ho"e"ithiasisCNS anor#a"ity -epression0 "ethary0 $on3)"sionCar-ia$ anor#a"ity $a"$i6$ation o& aorta #itra" 3a"3e

Etiology of "ypercalcemiaE"e3ate- o& PTH

Pri#ary hyperparathyroi-is# /a-eno#a hyperp"asia0 $ar$ino#a1'HH

De$rease- o& PTH

!a"inan$y

Vit. D into<i$ation

I##oi"i?ation

Thia?i-e -i)reti$

Gran)"o#ato)s -isease



Secondary "yperparathyroid• Chroni$ hypo$a"$e#ia $o#pensatoar #e$hanis# o3era$ti3ity o&

parathyroi- "an-

• Chroni$ rena" &ai")re

• Ina-e7)ate o& Ca inta+e0 steatorrhoea0 3it. D -e&i$ien$y )n$o##on

• !orpho"oy hyperp"asia o& parathyroi- "an-0 one -e&or#ity %

#etastati$ $a"$i6$ation

PATHOLOGY O' PANCREAS

Topics%)

Tumors

Insulinoma'astrinoma

)orfologi 0ompli$asi +an1ut %ia#etes

Pan+reas atro6 is"et0 ins)"itis0 -eposit a#i"oi-

!a+ro3as+)"ar a$$e"erate- atheros$"erosis /1 in&ar+ #io+ar- /1anren0 /91 arterio"os+"erosis hia"in HT

!i+roaniopati #e#rana asa"is #enea"0 -i&)s p- +api"er +)"it0retina0 "o#er)")s0 sara& peri&er

Penea"an a+.hia"in -pt pa-a non3as+)"ar t))")s0 +aps)"a Bo,#an0sara& peri&er0 p"asenta



%ia#etic ephropathy

• G"o#er)")s "essions

• Thi$+enin o& $api""ary asa" #e#rane

• Di5)se #esania" s$"erosis

• No-)"ar "o#er)"os$"erosis /=29:=1

• Arterio"os$"erosis

• Pye"onephritis



Endocrine eoplasm of the Pancreas

• In$i-en$e = pan$reas neop"as#.

• A-)"t

• Sin"e0 #)"tip"e0 enin or #a"inant

• Non&)n$tiona" % &)n$tiona"

• !a"inant/1 #etastasi?e-0 /1 3as$)"ar in3asion %

• /91 tiss)e in3asion• Ins)"ino#a := enin

"yperinsulinism (Insulinoma!

• Se" β t)#o)r

• !ost $o##on en-o$rine t)#o)r o& pan$reas

• Chara$teristi$s /1. B"oo- ")$ose "e3e" F : #-"0 /1 CNS/$on&)se0 st)por1 % /91 seranan -ipi$) o"eh p)asa"atihan %#e#ai+ -enan pe#erian ")+osa

• (s)a""y enin0 := #a"inant

• !orpho"oy so"itary0 F $#0 en$aps)"ate-0 t)#o)r $e""s arere"ati3e"y #onoton 0 trae$)"ar an- so"i- arrane.

Insulinoma

2ollinger3Ellison Syndrome('astrinoma!

• Gastrin hyperse$retion

• :2 = astrino#a o""iner2E""ison syn-ro#e hyperse$retion o&

astri$ a$i- % )"$)s pepti$)#

• Gastrino#a : = are #a"inant

• ± = astrino#a !EN #)"ti&o$a"

• C"ini$ := -iarrhea

PAT"O+O'. O- A%*EA+ '+A%Adrenal 'land %iseases

Corte< A-rena"

C)shin@s syn-ro#e

Conn@s syn-ro#e

A--ison@s -isease

!e-)"a A-rena"

Pheo$hro#o$yto#a



Cushing4s Syndrome• G")$o$orti$oi- /$ortiso"1

• Ee<oen /#ost $o##on1 % en-oen /91

• Pri#ary hypotha"a#)s2hypo6sis />:2:=1 C)shin@s -isease ACTH2

pro-)$in #i$roa-eno#a /F : ##10 pre-o#inan ♀

• Cortiso" hyperse$retion a-eno#a0 $ar$ino#a or hyperp"asia

• E$topi$ ACTH nonen-o$rine neop"as# /p)"#onary s#a"" $e"" $a 0

$ar$inoi- t)#o)r1

Clinical )anifestations of Cushing Syndrome

•S"o,"y

•Ear"y hypertension % ,eiht "oss

•'at -eposite /$entra" pattern1 #oon &a$e0 )5a"o h)#p.

•Se$on-ary D!

•Osteoporosis

Conn4s Syndrome 5 Primary "yperaldosteronismA"-osterone $a)se- y $orte< a-rena" t)#o)r /:= a-eno#a0

$ar$ino#a1

♀ ♂K 0 )sia 9:2;: tah)n

C"ini$ Hypertension /so-i)# retension10 hypo+a"e#ia ne)ro#)s$)"ar-ist)ran$e0 #)s$)"ar ,ea+ness0 paresthesia0 3is)a" anor#a"ity0tetany

!a$ros$opi$s so"itary0 φ $#

!i$ros$opi$s "a#e"ar eosinophy"i$ in$")sion in $ytop"as#

/spirono"a$tone o-y1.



Addison4s %isease 5 Chronic Insuciency PrimaryAdrenocortical

• A"-osterone % $ortiso" -e6$ien$y $a)se- y proressi3e -estr)$tion

in $orte< a-rena".

• E a)toi##)ne /:2>:=10 TBC0 AIDS0 #etastasi?e- $ar$ino#a /p)"#o

% #a##ae1.

• C"ini$ Ear"y proressi3e ne)ro#)s$)"ar -ist)ran$e0 &ati)e0 GITanore<ia0 na)sea0 3o#itin0 ,eiht "oss0 -iarrhea0 hyper+a"e#ia0hyponatre#ia0 hypotensi0 hypo"i$e#ia

• Stress a$)te a-rena" $risis -e"aye- therapy



Pheochromocytoma

• (n$o##on neop"as#a $o#pose- o& $hro#aUn $e""s that synthesi?e% re"ease $ate$o"a#ines % so#e pepti-e hor#ones.

• I#portant t)#or e$a)se o& si#i"ar a"-osterone se$retin a-eno#as8

i3e rise to s)ri$a""y $orre$ta"e &or# o& hypertension.

• o& these t)#ors pro-)$es C)shin syn-ro#e or so#e otheren-o$rinopathy.

Pheochromocytoma *ule of 67s

•:= arise in asso$iation ,ith se3era" &a#i"ia" syn-ro#es.

•: = are e<tra a-rena".•:= o& non &a#i"ia" a-rena" pheo$ho#o$yto#as are i"atera".

•:= o& a-rena" pheo$hro#o$yto#a are io"oi$a""y #a"inant.

•:= o& a-rena" pheo$hro#o$yto#a arise in $hi"-hoo-.

)orphology of Pheochromocytoma

•!a$ros$opi$s so"itary0 3ariations in si?e.

•!i$ros$opi$s /1 po"iona" % spin-"e $e""s0 /1 e""a""en nest $e""s /91

hiper3as$)"arity

•I##)nohisto$he#istry #ar+ers $hro#oranin % synaptophysin0 S::/1

•!a"inan$y i& any #etastasi?e-

)ultiple Endocrine eoplasia ()E! Syndromes

A ro)p o& eneti$a""y inherite- -iseases res)"tin in pro"i&erati3e"esions /hyperp"asia0 a-eno#as0 $ar$ino#as1 o& #)"tip"e en-o$rineorans8 ha3e $ertain -istin$t &eat)resat yo)ner ae than spora-i$ $an$ers.arise in #)"tip"e en-o$rine orans0 either syn$hrono)s"y

/at the sa#e ti#e1 or #eta$hrono)s"y /at -i5erent ti#es1.e3en in oran0 )t #)"ti&o$a")s)a""y asy#pto#ati$ stae o& en-o$rine hyperp"asia)s)a""y #ore aressi3e % re$)r

)E Syndromes

•)E36 K *er#er syn-ro#e0 in3o"3in parathyroi-0 pan$reas %pit)itary "an-s.

•)E38A K Sipp"e syn-ro#e0 $hara$teristi$ y pheo$hro#o$yto#a0#e-)"ary $ar$ino#a % parathyroi- hyperp"asia.

•)E389 $"ini$a" o3er"ap ,ith !EN2A0 )s)a""y #)"ti&o$a" % #ore

aresi33e than !EN2A8 is a$$o#panie- y ne)ro#as oran"ione)ro#as

•-amilial medullary thyroid cancer is a 3ariant o& !EN2A8 a stronpre-isposition to #e-)"ary thyroi- $an$er )t not the other$"ini$a" #ani&estations o& !EN2.

endocrine pathology part i

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