Endocrine Patho I

Question 1

3 classifications of hormones

Answer 1

Peptide (pituitary, insulin, glucagon)

Amino acid derivative (catecholamines, thyroid hormone, serotonin/melatonin)

Lipid (cholesterol derived; gondatropin, estrogen, progesterone etc)

Question 2

4 types of cell surface receptors

Answer 2

Tyrosine Kinase Receptors
G Protein S receptors (increase lvl of cyclic AMP)
G Protein I receptors (decrease lvl of cyclic AMP)
G Protein Q receptors (IP,DAG processes)`

Question 3

2 types of steroid hormone receptors

Answer 3

1. Cytoplasmic (glucocorticoid, mineral corticoid, androgen)

2. Nuclear (Estrogen, thyroid hormone receptors, vit D receptors, retinoid acid receptors)

Question 4

general s/s of hormone excess/deficiency

Answer 4

excess- endocrine gland hyperplasia caused by increased tropic stimulus to secretion

Def- Endocrine gland atrophy due to loss of tropic stim to secretion

Question 5

what are the 3 possible scenarios of hormonal cell secretion

Answer 5

Autocrine- cell has hormonal production and releases signal onto itself

Paracrin- Cell releases hormone that travels a short distance to reach target

Endocrine- Cell releases hormone that travels far to reach target

Question 6

tumors that can affect hypothalamus fundtion

Answer 6

Pituitary (mc)
Craniopharyngioa
midline hamartoma
langerhans histiocytosis

Question 7

Inflammatory disorders altering hypothalamic functoon

Answer 7

Sacroidosis (produces granulomatous inflammation in the hypothalmus

Mengitis

Question 8

Clinical findings of hypothalamic dysfunction

Answer 8

Secondary hypopituitarism

Central diabetes insipidus

Question 9

What is hyperprolactinemia

Answer 9

Loss of dopamine inhibition of prolactin causes an increase in prolactin leading to milk prod in females

Question 10

What causes precocious puberty

Answer 10

Midline hamartoma

Question 11

What usually causes a bitemporal hemianopia

Answer 11

due to compression of the optic chasm by a suprasellar mass

Question 12

what is the site for melatonin prod

Answer 12

Pineal gland

Superior cervical sympathetic ganglia stims receptors on pinealoctes to cause release

Question 13

What are the majority of pineal gland tumors

Answer 13

Majority are germ cell tuors

Question 14

2 major clinical findings/disorders of pineal gland disorders

Answer 14

Visual disturbances- Paralysis uff upward gaze (parinaud syndrome)

Obstructive hydrocephalus- due to compression of the aqueduct of Sylvius

Question 15

What is a crainiopharyngioma, age, and types (2)

Answer 15

rare type of benign tumor that begin just above the pituitary gland
5-15 + 60+

Adamantimatous (can cacify)
Papillary (rarely calcify)

Question 16

symptoms of a craniopharyngioma

Answer 16

depends on loc

-Growth failure, delayed puberty, loss of mentrual function, loss of sex drive, increased sensitivity to cold, fatigue

Question 17

mc benign tumor classification of pituitary + clinical manifistation

Answer 17

pituitary adenoma

clinical manifestation

• single hormone overlord
• destruction of surrounding normal pituitary function

Question 18

5 of the pituitary adenomas (and mc)

Answer 18

Prolactinoma (mc)

GH secreting (acromegaly if adult, giantism if child)

ACTH secreting (bushings)

Plurihormonal

Null cell

Question 19

What is the stalk effect in a pituitary adenoma

Answer 19

mass pressing on the stalk will prevent dopamine from reaching the pituitary gland, causing increased levels of prolactin without actually producing prolactin

Question 20

clinical pres and dx of prolactinoma

Answer 20

Prolactinomas are dx earlier in females than males
-pts present w symptoms of galactorrhea, infertility, amenorrhea

Basal prolactin lvl of 200ng/ml

Question 21

what can primary hypothyroidism(destruction of thyroid gland itself) cause

Answer 21

Both TSH and TRH are elevated

-stims release of TSH, TRH causes release of prolactin

Question 22

what is the mutation in GH secreting adenomas and clinical presentation in children/adults

Answer 22

40% have mutation in the GNAS1 gene on chromosome 20q13

In children= gigantism

In adults= Acromegaly

Question 23

classic signs of acromegaly

Answer 23

Growth of skin, soft tissues, organs

• mc finding is sacral enlargement or widening of the hands/feet and coarsening of facial features
• persistent levels of GH

Question 24

How to diagnos Acromegaly

Answer 24

Failure to suppress GH levels with an oral load of glucose

Question 25

ACTH secreting adenoma causes what

Answer 25

Elevated levels of plasma ACTH and plasma cortisol

–Cushing disease is clinical pres

Question 26

What is hypopituitarism and some causes

Answer 26

underpaid of pituitary gland hormones (loss of 75% or more of gland)

• Null cell pituitary adenoma
• Ischemic injury
• pituitary apoplexy
• empty sella syndrome

Question 27

clinical presentation of hypopituitarism

Answer 27

Gh deficiency 
TSH def (hypothyroidism)
ACTH def (hypoadrenalism)
ADH def (diabetes insipidus)

Question 28

What are the two pathologies of the post pituitary gland

Answer 28

• syndrome of inappropriate antidiuretic hormone

- diabetes insipidus

Question 29

What is syndrome of inappropriate antidiuretic hormone

Answer 29

• hyperfunctioning of the post pituitary gland

- increased levels of antidiuretic hormone (ADH_

Question 30

What i diabetes insipidus

Answer 30

-syndrome causes by hypo functioning of the post pituitary gland resulting in decreased levels of ADH

Question 31

2 types of diabetes insipudis

Answer 31

Central- due to decreased prod of ADH

Nephyrogenic- due to decreased renal responsiveness to ADH

Question 32

clinical pres of Diabetes inspidus

Answer 32

-polyuria/poly dispia

urine osmolarity is 200mOsm/kg

Question 33

How to differentiate diabetes insipidus from primary polydispia

Answer 33

• in diabetes insipidus, urine osmolarity is less then plasma osmolarity
• in primary polydipsia both are dilute
• decreased urine output and increased osmolarity in primary polydispia
• high urine output and dilute urne in diabetes insipidus