1 / 43

Endocrine Tutorial

Endocrine Tutorial. Hyperthyroidism. Clinical features. Hyperthyroidism. Clinical features CVS: tachycardia, palpitations, atrial fib CNS: tremor, anxiety, lability, insomnia Heat intolerance; warm, moist, flushed skin Weight loss with increased appetite. Hyperthyroidism.

brock-meyer
Download Presentation

Endocrine Tutorial

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Endocrine Tutorial

  2. Hyperthyroidism • Clinical features

  3. Hyperthyroidism • Clinical features • CVS: tachycardia, palpitations, atrial fib • CNS: tremor, anxiety, lability, insomnia • Heat intolerance; warm, moist, flushed skin • Weight loss with increased appetite

  4. Hyperthyroidism • Clinical features • CVS: tachycardia, palpitations, atrial fib • CNS: tremor, anxiety, lability, insomnia • Heat intolerance; warm, moist, flushed skin • Weight loss with increased appetite • Causes

  5. Hyperthyroidism • Clinical features • CVS: tachycardia, palpitations, atrial fib • CNS: tremor, anxiety, lability, insomnia • Heat intolerance; warm, moist, flushed skin • Weight loss with increased appetite • Causes • Graves disease • Exogenous thyroid hormone • Functioning multinodular goitre/thyroid adenoma • Thyroiditis • Secondary (hypothal/pituitary dysfunction)

  6. Hypothyroidism • Clinical features

  7. Hypothyroidism • Clinical features • CVS: bradycardia, cardiomegaly, pericardial effusion • CNS: slowed mental activity, apathy, fatigue, cretinism • Cold intolerance; cool skin; myxedema; hair loss • Weight gain with decreased appetite • Coarsening of features

  8. Hypothyroidism • Clinical features • CVS: bradycardia, cardiomegaly, pericardial effusion • CNS: slowed mental activity, apathy, fatigue, cretinism • Cold intolerance; cool skin; myxedema; hair loss • Weight gain with decreased appetite • Coarsening of features • Causes

  9. Hypothyroidism • Clinical features • CVS: bradycardia, cardiomegaly, pericardial effusion • CNS: slowed mental activity, apathy, fatigue, cretinism • Cold intolerance; cool skin; myxedema; hair loss • Weight gain with decreased appetite • Coarsening of features • Causes • Hashimoto thyroiditis • Surgery / Radiation / Drug-induced • Infiltration by tumour • Secondary (hypothal/pituitary dysfunction)

  10. Graves disease • Epidemiology • What type of people get Graves disease?

  11. Graves disease • Epidemiology • Women, 20-40 yrs, (M:F = 1:7)

  12. Graves disease • Epidemiology • Women, 20-40 yrs, (M:F = 1:7) • Pathogenesis

  13. Graves disease • Epidemiology • Women, 20-40 yrs, (M:F = 1:7) • Pathogenesis • Autoimmune disorder • Activation of thyroid by thyroid autoantibodies • Anti-TSH R, anti-thyroglobulin, anti-T3/T4 • Associated with certain HLA types • Associated with other AI disorders • Hashimoto thyroiditis, pernicious anaemia, rheumatoid arthritis

  14. Graves disease • Gross findings • Mild symmetrical thyroid enlargement • Eyes: exophthalmos, lid retraction, lid lag • Skin: pretibial myxedema

  15. Graves disease • Microscopic findings Graves disease Normal thyroid

  16. Graves disease • Microscopic findings

  17. Hashimoto Thyroiditis • Epidemiology

  18. Hashimoto Thyroiditis • Epidemiology • Women, 45-65 yrs, (M:F = 1:10 to 20)

  19. Hashimoto Thyroiditis • Epidemiology • Women, 45-65 yrs, (M:F = 1:10 to 20) • Pathogenesis

  20. Hashimoto Thyroiditis • Epidemiology • Women, 45-65 yrs, (M:F = 1:10 to 20) • Pathogenesis • Autoimmune disorder • Destruction of thyroid by thyroid autoantibodies • Anti-TSH R, anti-thyroglobulin • Associated with certain HLA types • Associated with other AI disorders • SLE, pernicious anaemia, rh. Arthritis, Sjogrens, IDDM, Graves • May cause transient hyperthyroidism in early stages • Gradual destruction and fibrosis  hypothyroidism

  21. Hashimoto Thyroiditis • Gross findings • Enlarged pale thyroid initially • Atrophic thyroid eventually

  22. Hashimoto Thyroiditis • Microscopic findings

  23. Hashimoto Thyroiditis • Microscopic findings

  24. Thyroiditis • Painful • Infectious • Adjacent sinusitis, mycobacteria, fungi • Subacute (granulomatous) • Post viral • Painless • Hashimoto’s • Fibrous • Fibrosis, atrophy, hypothyroidism

  25. Goitre • What is it?

  26. Goitre • What is it? • Enlarged thyroid • Due to impaired thyroid hormone synthesis

  27. Goitre • What is it? • Enlarged thyroid • Due to impaired thyroid hormone synthesis • Causes

  28. Goitre • What is it? • Enlarged thyroid • Due to impaired thyroid hormone synthesis • Causes • Iodine deficiency • Goitrogens • Inherited disorders

  29. Goitre • Pathogenesis • Hyperplasia of follicular epithelium • Increased thyroid hormone release (decreased colloid) • Involution of follicles when enough thyroid hormone released • Accumulation of colloid • Two forms: • Diffuse • Multinodular

  30. Goitre • Gross findings • Diffuse: Diffuse enlargement without nodules • Multinodular:

  31. Goitre • Microscopic findings • Diffuse (initial hyperplastic stage): • Hyperplastic and hypertrophied follicles • Decreased colloid • Diffuse (involution stage) • Dilated follicles, atrophic epithelium • Abundant colloid

  32. Goitre • Microscopic findings • Multinodular goitre: • Recurrent episodes of stimulation and involution • Hyperplastic and hypertrophied follicles with decreased colloid • Dilated follicles with atrophic epithelium and abundant colloid • Haemorrhage, fibrosis, calcification, cyst formation

  33. Thyroid neoplasms • Risk factors • M:F = 1:4 • Radiation therapy • Hashimoto’s • Multinodular goitre • Types • Follicular adenoma • Carcinoma • Papillary • Follicular • Anaplastic • Medullary

  34. Follicular adenoma • Morphology:

  35. Follicular carcinoma • Morphology: • Same as follicular adenoma! BUT • Vascular / capsular invasion • Haematogenous mets

  36. Papillary carcinoma • Morphology:

  37. Papillary carcinoma • Morphology:

  38. Causes of hyperparathyroidism Parathyroid hyperplasia Parathyroid adenoma

  39. Hyperadrenalism • Presentation • Cushing’s syndrome • Conn’s syndrome • Causes • Primary • Hyperplasia, adenoma, carcinoma • Secondary • Hypothalamic/pituitary disorders • Ectopic ACTH secretion • Activation of renin-angiotensin system

  40. Causes of hyperadrenalism hyperplasia carcinoma adenoma

  41. haemorrhage metastases infection (TB) Causes of hypoadrenalism

  42. Pancreatic islet cell tumour + Pituitary adenoma + Parathyroid hyperplasia = MEN I

  43. Phaeochromocytoma + Medullary carcinoma of thyroid + Parathyroid hyperplasia = MEN II

More Related