Endocrine pathology is the subspecialty of diagnostic pathology which deals with the diagnosis and characterisation of neoplastic and non-neoplastic diseases of the endocrine system. This relatively young subspecialty was initially focused mainly on thyroid and parathyroid pathology, with some participants also involved in studies of the pituitary, the endocrine pancreas, and the adrenal glands. However, the endocrine system involves much more than these traditional endocrine organs and the discipline has grown to encompass lesions of the dispersed neuroendocrine cells, including neuroendocrine tumours (NETs) of the lungs, gastrointestinal tract, thymus, breast and prostate, as well as paraganglia throughout the body, not just in the adrenals. Indeed, the production of hormones is the hallmark of the endocrine system, and some aspects of gynecological/testicular, bone and liver pathology also fall into the realm of this specialty. Many of the lesions that are the focus of this discipline are increasing in incidence and their pathology is becoming more complex with increased understanding of molecular pathology and a high incidence of familial disease. The future of endocrine pathology will demand a depth of understanding of structure, function, prognosis and prediction as pathologists play a key role in the multidisciplinary care team of patients with endocrine diseases. It is anticipated that new technologies will allow increased subspecialisation in pathology and growth of this important area of expertise.

INTRODUCTION

The history of surgical pathology, like many other disciplines in medicine, is one of evolution based on demand for expertise. Pathology as a science originated in the investigations of clinicians whose curiosity drove them to better understand the diseases they saw and tried to treat. In endocrinology, biochemistry was the basis for measuring changes in the hormonal environment. As surgical pathology grew in importance, the structural changes that reflected functional alterations started to emerge. Advances in surgery and increasing experience with structure-function correlations have allowed this field to blossom into a significant area of pathology subspecialisation. This review will provide some historical perspectives, describe the scope of endocrine pathology in the 21st century and offer a vision of the challenges and opportunities that face the discipline.