Endocrine – Pathology · FCPS Part 1

Complete Adrenal Table

Disease	Main hormone abnormality	ACTH	Renin	K⁺	BP	Key clinical findings
Cushing disease	↑ Cortisol	↑	—	↓/normal	↑	Central obesity, moon face, buffalo hump, purple striae, proximal muscle weakness
Adrenal Cushing syndrome	↑ Cortisol	↓	—	↓/normal	↑	Same Cushing features; ACTH suppressed
Ectopic ACTH	↑↑ Cortisol	↑↑	—	↓↓	↑↑	Severe HTN, marked hypokalemia, metabolic alkalosis, hyperpigmentation
Primary adrenal insufficiency (Addison)	↓ Cortisol + ↓ Aldosterone	↑	↑	↑	↓	Hyperpigmentation, hypotension, hyponatremia, hyperkalemia
Secondary adrenal insufficiency	↓ Cortisol; aldosterone relatively preserved	↓	Usually normal	Normal	↓/normal	Weakness, hypotension, hyponatremia; no hyperpigmentation
Primary hyperaldosteronism (Conn)	↑ Aldosterone	↓/normal	↓	↓	↑	Hypertension, hypokalemia, metabolic alkalosis
Secondary hyperaldosteronism	↑ Aldosterone	—	↑	↓	Usually ↑	Hypertension or volume depletion depending on cause
Pheochromocytoma	↑ Catecholamines	—	—	Normal	↑	Episodic HTN, headache, sweating, palpitations

MEN 1 (Multiple Endocrine Neoplasia Type 1)

The Classic Triad of MEN 1 ("3 Ps"):

Parathyroid: Primary hyperparathyroidism (causing hypercalcemia).
Pancreas: Pancreatic neuroendocrine tumors, most notably Gastrinomas (which secrete excess gastrin, leading to Zollinger-Ellison Syndrome and severe gastric ulcers).
Pituitary: Pituitary adenomas (e.g., prolactinoma).

Pituitary necrosis (Sheehan syndrome)

1. Pathophysiology

Sheehan syndrome is post-partum hypopituitarism caused by ischemic necrosis of the anterior pituitary gland.
◦ During pregnancy, the anterior pituitary expands significantly in size without a proportional increase in its blood supply. Severe post-partum hemorrhage or hypovolemic shock during delivery leads to infarction and ischemic injury of the gland.
2. Clinical Manifestations:
◦ Failure of lactation / Agalactorrhea: Loss of prolactin.
◦ Secondary Amenorrhea: Loss of gonadotropins (FSH) and {LH}.
◦ Loss of Axillary and Pubic Hair: Loss of adrenal androgen stimulation due to deficient {ACTH}
◦ Fatigue and Weakness: Secondary adrenal insufficiency {ACTH} deficiency) and hypothyroidism {TSH} deficiency).