Chapter 14 Endocrine disorders

Question 1

What is the Endocrine System?

Answer 1

○ maintains metabolic equilibrium by continuously adjusting mutually opposing forces, a process known as homeostasis
○ It does this by secreting hormones that stimulate a target organ, which in turn secretes its own hormone(s) to achieve the desired end effect

Question 2

The normal endocrine system

Answer 2

○ pituitary secretes multiple hormones.
○ The thyroid gland regulates metabolic rate.
○ The adrenal cortex secretes corticosteroids.
○ The adrenal medulla is anatomically and
○ functionally distinct from the cortex.
○ The parathyroid glands regulate calcium metabolism.

Question 3

Pituitary adenomas usually cause what?

Answer 3

Hyperpituitarism

Question 4

Hyperpituitarism

Answer 4

○ excretion of excess trophic hormones and can be caused by hyperplasia, adenoma, or carcinoma of any of the cell types of the anterior pituitary
○ more common than hypopituitarism

Question 5

Hypopituitarism

Answer 5

○ decreased secretion of pituitary hormones
○ failure of the anterior pituitary and do not involve the posterior pituitary

Question 6

Prolactinoma

Answer 6

○ most common functioning pituitary tumor
○ accounting for about 30% of adenomas
○ causes galactorrhea

Question 7

galactorrhea

Answer 7

milk secretions from the breast of a male or nonpregnant female

Question 8

Null Cell Adenoma

Answer 8

○ do not secrete hormones and come to attention because of mass effect
○ originate from any of the cell types in the anterior pituitary

Question 9

ACTH Adenoma

Answer 9

○ account for about 15% of pituitary adenomas
○ associated with excessive secretion of cortisol and related hormones from the adrenal cortex
○ produce a combination of clinical findings known as Cushing syndrome

Question 10

• Growth Hormone Adenoma

Answer 10

○ secrete GH and also prolactin
○ Often the early clinical manifestations are subtle

Question 11

GH adenoma causes which two syndromes?

Answer 11

○ Acromegaly
○ Gigantism

Question 12

Acromegaly

Answer 12

○ conspicuous growth of bones in the hands, feet, face, skull, and jaw
○ growth of liver, heart, thyroid, adrenals, and other viscera
○ and expansion of the skin and soft tissue.
○ Patients have prominent brows and chin, gapped teeth, and huge feet and hands with thick fingers.

Question 13

Gigantism

Answer 13

○ general increase in body size, with especially long arms and legs
○ occurs when a child or teenager develops an adenoma that secretes GH before growth plates close at the ends of long bones

Question 14

TSH Adenoma

Answer 14

secrete TSH and are rare stimulates thyroid release of T3 and T4, which causes hyperthyroidism

Question 15

TSG adenoma treatments

Answer 15

○ surgical or radiotherapeutic ablation of the lesion
○ drug treatment to counteract the effects of increased T3 and T4

Question 16

Hyperthyroidism

Answer 16

increased blood TSH and radiographic imaging of the Sella turcica

Question 17

What is a sign of posterior pituitary failure?

Answer 17

evidence of failure of the posterior pituitary in the form of diabetes insipidus (DI) due to secretion of too little or too much ADH

Question 18

Diabetes Insipidus

Answer 18

○ a syndrome of ADH deficiency and features excessive production of dilute urine
○ Patients are frequently dehydrated and have high blood sodium and osmolarity and low urine specific gravity

Question 19

inappropriate ADH secretion (SIADH)

Answer 19

○ associated with excessive ADH production, usually from a nonpituitary neoplasm
○ Symptoms are essentially due to water intoxication
○ low serum sodium, while having concentrated urine with high urine sodium

Question 20

pituitary apoplexy

Answer 20

○ Sudden pituitary hemorrhage
○ usually as a consequence of some other pathologic process in the pituitary

Question 21

Sheehan syndrome

Answer 21

○ Ischemic infarction of pregnancy
○ physiologic demands of pregnancy cause pituitary hyperplasia

Question 22

Thyrotoxicosis

Answer 22

○ a hypermetabolic state caused by excess thyroid hormone
○ caused by increased levels of blood T3 and/or T4, no matter the source

Question 23

Graves disease

Answer 23

○ the most common cause of hyperthyroidism
○ an autoimmune disease caused by the production of multiple antithyroid antibodies
○ thyroid-stimulating immunoglobulin (TSI)

Question 24

When does Graves disease occur?

Answer 24

○ between ages 20 and 40
○ Women are affected about 10 times more often than men

Question 25

Cretinism

Answer 25

congenital hypothyroidism

Question 26

Myxedema

Answer 26

○ hypothyroidism that develops in an older child or an adult
○ thyroid is usually not enlarged
○ accumulations of thick (myxomatous) fluid in various organs
○ The skin is cool and pale

Question 27

Hashimoto Thyroiditis

Answer 27

○ a chronic autoimmune disease
○ the most common type of thyroiditis
○ occurs as a nontoxic goiter and almost exclusively in middle aged women

Question 28

Hypothyroidism

Answer 28

thyroid hormone underproduction by the thyroid gland

Question 29

Thyroiditis

Answer 29

inflammation of the thyroid gland

Question 30

Nontoxic goiters

Answer 30

impaired synthesis of thyroid hormone

Question 31

Neoplasms of the thyroid are?

Answer 31

common and usually not aggressive

Question 32

Euthyroid Sick Syndrome

Answer 32

Patients with severe nonthyroidal illness may have abnormally low thyroid function tests but are clinically euthyroid

Question 33

goiter

Answer 33

○ an enlarged thyroid gland

Question 34

The three most common types of thyrotoxicosis are

Answer 34

○ glandular hyperplasia
○ Multinodular goiter
○ Adenoma of the thyroid with overproduction of hormones

Question 35

Thyroid follicular adenomas

Answer 35

○ are benign neoplasms of the epithelial cells that line thyroid follicles
○ reveal themselves as a solitary, painless mass in an otherwise healthy woman with no evidence of thyroid hormone excess or thyroid failure

Question 36

Thyroid Carcinomas

Answer 36

○ arise from the epithelium that lines the thyroid follicles
○ Most occur in adults; females are more affected than males

Question 37

Thyroid Carcinomas types

Answer 37

○ Papillary carcinomas: are the most common
○ Follicular carcinomas: malignant neoplasms of follicular epithelium arranged into follicles
○ Anaplastic carcinoma: a highly aggressive, almost uniformly fatal malignancy of follicular epithelium
○ Medullary carcinomas:

Question 38

Adrenocortical hyperfunction

Answer 38

excess cortical hormones.

Question 39

Adrenocortical failure

Answer 39

causes cortisol insufficiency

Question 40

Cushing syndrome

Answer 40

exogenous—glucocorticoid medical therapy
○ suppress pituitary production of ACTH and the cortex becomes thin and atrophic

Question 41

Cushing syndrome: Signs and Symptoms

Answer 41

hypertension, obesity, round (moon) facial features, diabetes, skin marks (striae), excess body and facial hair (hirsutism), and menstrual and mental abnormalities

Question 42

Adrenocortical insufficiency

Answer 42

results in concurrent deficiency of all three corticosteroids

Question 43

Primary acute cortical failure

Answer 43

○ occurs in three clinical settings and is invariably fatal without quick diagnosis and cortisol replacement
○ withdrawal of corticosteroid therapy. This is perhaps the most common cause of acute cortical failure

Question 44

(Waterhouse-Friderichsen syndrome

Answer 44

Bilateral acute hemorrhagic destruction of the adrenal glands

Question 45

Addison Disease

Answer 45

○ Primary chronic cortical failure
○ attributable to one of four conditions: autoimmune adrenalitis, TB, AIDS, or metastatic carcinoma

Question 46

Hyperparathyroidism

Answer 46

overactivity of the parathyroid glands

Question 47

Hypoparathyroidism

Answer 47

underactivity of the parathyroid glands

Question 48

MEN-1 syndrome (Wermer)

Answer 48

Abnormal function of parathyroid, pancreas, pituitary, and duodenal gastrin-secreting cells

Question 49

MEN-2 syndrome

Answer 49

Several subvarieties according to the glands involved