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My Pathoma Notes > 15 Endocrine > Flashcards

15 Endocrine Flashcards

1
Q

Pituitary Adenoma

A

Benign anterior pituitary tumor
(Functional or non-functional)

Non-Functional Tumors & Mass Effect
-Bitemporal hemianopsia (Lose peripheral vision)
-Hypopituitarism
-Headache

Functional Tumors & Hormone Effects
Ex. Prolactinoma
-Galactorrhea & amenorrhea in F
-Decreased libido & headache in M
-Tx. Dopamine agonist (to inhibit prolactin secretion & shrink tumor) or surgery

Ex. Growth Hormone Adenoma
-Gigantism in kids
-Acromegaly in adults
-Associated with DM2
-Elevated GH & IGF-1 & lack of GH suppression by oral glucose
-Tx. Octreotide (Blocks signal to release GH)
GH receptor antagonist
Surgery

Other
-ACTH Producing Adenomas ~ Cushing’s
-TSH Producing Adenoma
-LH Producing Adenoma
-FSH Producing Adenoma

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2
Q

Hypopituitarism

A

Insufficient production of anterior pituitary hormones

Due to Pituitary Adenoma in adults
-Compresses normal gland/fxn
-Craniopharyngioma in kids

OR due to Sheehan syndrome
-Gland doubles in size during pregnancy
-Susceptible to infarction
-Notable for loss of pubic hair

OR due to Empty Sella Syndrome
-***

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3
Q

Posterior Pituitary

A

Releases ADH & oxytocin (But these are produced in the hypothalamus)

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4
Q

Central Diabetes Insipidus

A

ADH deficiency due to hypothalamic or posterior pituitary pathology

Polyuria & compensatory polydipsia
Hypernatremia, high serum osmolality
Low urine osmolality, low specific gravity

Diagnose: Water deprivation fails to increase urine osmolality (Even if they’re not drinking water, they/ll lose too much water)

Tx. Desmopression (ADH analog)

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5
Q

Nephrogenic Diabetes Insipidus

A

Impaired renal response to ADH (Effective ADH deficiency) with no response to desmopressin

Due to inherited mutations or drugs like lithium

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6
Q

Syndrome of Inappropriate ADH Secretion (SIADH)

A

Excess ADH secretion

Hyponatremia (by dilution), low serum osmolality
AMS, seizures

Due to…
-Ectopic production (ie Small Cell Carcinoma)
-CNS trauma
-Pulmonary infection
-Drugs (ie Cyclophosphamide)

Tx. Free water restriction, Demeclocycline

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7
Q

Thyroglossal Duct Cyst

A

Cystic dilation of thyroglossal duct remnant, presents as anterior neck mass

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8
Q

Lingual Thyroid

A

Persistent thyroid tissue at base of tongue, presents as base of tongue mass

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9
Q

Hyperthyroidism

A

Increased level of circulating TH
+++BMR (by increasing synthesis of Na/K ATPase)
+++SNS activity (by increasing exp of Beta-1 rec)

Weight loss despite increased appetite
Heat intolerance, sweating
Tachycardia, arrhythmia, tremor
Anxiety, insomnia, heightened emotions
Staring gaze with lid lag
Diarrhea with malabsorption
Oligomenorrhea
Bone resorption with hypercalcemia
Decreased muscle mass with weakness
Hypocholesterolemia
Hyperglycemia (Gluconeo & Glycogenolysis)

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10
Q

Graves Disease

A

Autoimmune hyperthyroidism, IgG that stimulates TSH receptor!

F of reproductive age
Hyperthyroid symptoms
“Diffuse” goiter
Exopthalmos
Pretibial myxedema

Histo: Hyperplasia of follicles with “scalloping of colloid”

Labs
+++Total & free T4
—TSH
Hypocholesteremia
Hyperglycemia

Tx. Beta-blockers for SNS
Thioamide to block peroxidase
Radioiodide ablation

Complication: Thyroid Storm
-Excess catecholamines & hormones
-Due to stress like surgery or childbirth
-Arrhythmia, hyperthermia, vomiting, hypovolemic shock
-Tx. PTU to block peroxidase
Beta-blockers
Steroids

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11
Q

Multinodular Goiter

A

Enlarged thyroid gland with nodules

Due to relative iodine deficiency

Usually non-toxic (“Euthyroid”)
Rarely, “toxic-goiter” that is TSH-independent

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12
Q

Cretinism

A

Hypothyroidism in neonates, infants

Due to maternal hypothyroidism in pregnancy
Thyroid agenesis
Dyshormonogenetic goiter (No peroxidase)
Iodine deficiency

Intellectual disability
Coarse facial features
Enlarged tongue
Short stature, skeletal abnormalities
Umbilical hernia

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13
Q

Myxedema

A

Hypothyroidism in older children or adults

Myxedema (Dough-like tissue) especially of larynx with deepened voice & tongue

Due to Hashimoto Thyroiditis
Iodine deficiency
Drugs like lithium
Thyroidectomy/ Radioablation

(—BMR, —SNS)
Weight gain despite normal appetite
Slowed mental activity
Muscle weakness
Cold intolerance with decreased sweating
Bradycardia, reduced CO
Constipation
Oligomenorrhea
Hypercholesterolemia

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14
Q

Hashimoto Thyroiditis

A

Autoimmune destruction of thyroid gland
-HLA-DR5***
-Anti-thyroglobulin ab’s
-Anti-microsomal ab’s

Initially presents as hypERthyroidism
Then as hypOthyroidism (Dec T4, Inc TSH)

Histo: Chronic inflammation + Germinal centers + Hurthle cells +/- Marginal zone (Risk for B-Cell Lymphoma)

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15
Q

Subacute (deQuervain) Granulomatous Thyroiditis

A

Granulomatous thyroiditis following viral infection, self-limited

Tender*** thyroid
Transient hyPERthyroidism

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16
Q

Reidel Fibrosing Thyroiditis

A

Chronic inflammation with fibrosis of thyroid, seen in young F

“Hard as wood” NON-tender thyroid
HypOthyroidism
Fibrosis may extend to airway

Ddx: Anaplastic Carcinoma (Seen in older pt’s)

17
Q

Thyroid Neoplasia

A

Benign > malignant
Distinct, solitary nodule

(131)-I-Radioactive Uptake Study
-Inc uptake in Graves or Nodular Goiter
-Dec uptake in Adenoma or Carcinoma, FNA Bx!

(FNA = Fine needle aspiration)

18
Q

Follicular Adenoma

A

Benign follicular gland tumor, surrounded by fibrous capsule

Usually non-functional
May secrete TH

Histo: Tumor with follicles surrounded by capsule

19
Q

Papillary Carcinoma

A

80% of thyroid carcinoma

Risk: Exposure to ionizing radiation in childhood, used to be tx for acne

Histo: “Orphan Annie-Eyed Smiling” nucleus (White clearing in center nucleus with groove)
+/- Calcification, with Psammoma bodies

Can spread to cervical lymph nodes
Still excellent prognosis

20
Q

Follicular Carcinoma

A

Malignant follicular tumor, surrounded by capsule but with invasion THROUGH capsule

NOTE: FNA biopsy cannot distinguish between follicular adenoma VS. carcinoma

Spreads hematogenously (NOT thru lymph nodes) causing metastasis

21
Q

Medullary Carcinoma

A

Malignant tumor of parafollicular C cells

+++Calcitonin
-HypOcalcemia thru renal excretion
-Deposits within tumor as amyloid

Histo: Tumor cells within amyloid stroma (pink)
(Diagnose by FNA Bx)

Familial Cases
-MEN 2A & 2B
-Mutated RET oncogene (Prophylactic thyroidectomy)

22
Q

Anaplastic Carcinoma

A

Malignant tumor of thyroid, undifferentiated

Seen in older pt’s

23
Q

Anaplastic Carcinoma

A

Malignant tumor of thyroid, undifferentiated
Invades local structures
-Resp compromise
-Dysphagia

Seen in older pt’s
Poor prognosis

Histo: Highly malignant cells that don’t resemble anything you’d see in the thyroid

Ddx: Reidel Fibrosing Thyroiditis (Fibrotic thyroid seen in young F)

24
Q

Parathyroid Gland

A

Chief cells secrete PTH to raise amount of serum/free/ionized Ca++
++Blasts to activate clasts (To resorb bone)
++Activate Vit D to +Absorption of Ca++ & phos
++Reabsorption of Ca++ & Excrete phos

25
Q

Primary Hyperparathyroidism

A

Excess PTH because problem with gland itself
-Parathyroid adenoma (>80%)
-Sporadic hyperplasia
-Carcinoma

26
Q

Parathyroid Adenoma

A

Benign tumor of gland, produces PTH which increases serum Ca++ (Usually asymptomatic but…)

Inc PTH & Hypercalcemia
+Kidney stones & nephrocalcinosis*
+CNS disturbances
+PUD, acute pancreatitis, constipation
+Osteitis fibrosa cystica (Massive resorption)

Labs:
-High serum PTH & Ca++ & ALP
-Low serum phos
-High urinary cAMP

Tx: Remove gland

27
Q

Secondary Hyperparathyroidism

A

Excess PTH due to other disease

Chronic renal failure
-Dec phos excretion, accumulates in blood
-Binds free Ca++
-PTH gland detects low serum Ca++
-Inc PTH to +Bone resorption

Labs:
-High serum phos, PTH, ALP
-Low serum Ca++

28
Q

Hypoparathyroidism

A

Low PTH due to autoimmune destruction of gland, surgical excision, DiGeorge syndrome

Low PTH -> Low serum Ca++
-Numbness, tingling, muscle spasms

29
Q

Pseudohypoparathyroidism

A

Low serum Ca++ but with normal PTH levels
Due to organ resistance to PTH

(Organ resistance due to defective Gs protein, autosomal dominant form associated with short stature & short 4/5 digits)

30
Q

Adrenal Cortex

A

Glomerulosa = Mineralocorticoids (Aldosterone)
Fasciculata = Glucocorticoids (Cortisol)
Reticularis = Sex steroids (Andro, Estro, Progestin)

-All made from cholesterol

31
Q

Cushing Syndrome

A

Excess of glucocorticoids (cortisol)

HTN
–Upregulates alpha-1 receptors on arteries

Immune suppression
–Inhibits phospholipase A2 (No AA metabolites)
–Inhibits IL-2 (T cell growth factor)
–Inhibits release of histamine

Dx: +++24hr

Causes:
1. Exogenous corticosteroids
-Adrenal glands become atrophic

  1. Primary Adrenal Adenoma/ Hyperplasia/ Carcinoma
  2. ACTH-Secreting Adenoma
  3. Paraneoplastic ACTH Secretion
    -Tumor secretes ACTH, hits both adrenal glands
32
Q

High Dose Dexamethasone Test

A

If ACTH production suppressed…
-> Pituitary adenoma

If ACTH production NOT suppressed…
-> Ectopic, Small Cell Carcinoma

33
Q

Hyperaldosteronism

A

HyPER-Natremia (Keep Na+ & h2o) -> HTN
HypO-Kalemia (Dump K+)
Metabolic alkalosis (Dump H+)

Primary (HIGH Aldosterone, Low renin)
-Adrenal adenoma
-Sporadic hyperplasia
-Carcinoma

Secondary (HIGH Aldosterone, HIGH renin)
-Activation of RAAS
a. Fibromuscular dysplasia in young F
b. Renal a stenosis

34
Q

Congenital Adrenal Hyperplasia

A

Steroidogenesis shunted towards sex steroid production

Most commonly due to 21-hydroxylase deficiency

Clitoral enlargement in F
Precocious puberty in M
Lack of cortisol -> Life-threat htn!
Lack of aldosterone -> HypO-Na+, hypO-vol, HyPER-K+

(Look out for 11-hydroxylase deficiency, would have same symptoms as 21 but no salt wasting)

(Look out for 17-hydroxylase deficiency, would only make mineralocorticoids)

35
Q

Adrenal Insufficiency

A

No adrenal hormones

Acute: Waterhouse-Friderichsen Syndrome
-Child with N. meningitidis
-NOTE
***

Chronic: Autoimmune, M. tb, Metastatic carcinoma
-HypOtn, weakness, vomiting, diarrhea
-HypONa+, HypOvol, HyPERK+
-Hyperpigmentation

36
Q

Adrenal Medulla

A

Neural-crest derived chromaffin cells, produce catecholamines (epi & norepi)

37
Q

Pheochromocytoma

A

Chromaffin cell tumor, associated with…
-MEN2A & 2B
-VHL Disease
-NF Type 1

HTN, Tachycardia, palpitations, HA, sweating
Gross: Brown tumor

Dx: High serum metanephrines
High 24hr urine metanephrines & VMA

Tx: Surgical excision

My Pathoma Notes (10 decks)

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