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Pathology > Chapter 15 ( Endocrine ) > Flashcards

Chapter 15 ( Endocrine ) Flashcards

1
Q

Presentation of non functional tumors of anterior pituitary ?

A

Mass effect :
Bitemporal hemianopia
Hypopituitarism
Headache

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2
Q

Dopamine agonists ?

A

Bromocriptine

Cabergoline

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3
Q

When does hypopituitarism symptoms arise ?

A

When > 75% of the pituitary parenchyma is lost

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4
Q

Causes of hypopituitarism ?

A

1- pituitary adenoma in adults or Craniopharyngioma in children due to mass effect
2- Pituitary apoplexy
3- Sheehan syndrome
4- Empty sella syndrome

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5
Q

Presentation of Sheehan syndrome ?

A

Poor lactation
Loss of pubic hair
Fatigue

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6
Q

Causes of Empty sella syndrome ?

A

1- secondary to trauma which damages the pituitary

2- herniation of the arachnoid and CSF into the sella compresses and destroys the pituitary gland

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7
Q

Causes of Nephrogenic diabetes insipidus ?

A

Inherited mutations

Drugs that blocks the effect of ADH on renal distal tubules as Lithium and Demeclocycline

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8
Q

Causes of SIADH ? Clinical features ? Ttt ?

A

1- Ectopic production ( ex: small cell carcinoma of the lung )
2- CNS trauma
3- Pulmonary infection
4- Drugs as Cyclophosphamide

Presents with :
Hyponatremia and low serum osmolality
Mental status changes and seizures ( as hyponatremia leads to neuronal swelling and cerebral edema )

Ttt :
Free water restriction
Demeclocycline

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9
Q

Increased BMR in hyperthyroidism is due to ?

A

Increased synthesis of Na-K ATPase

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10
Q

Mechanism of Graves disease ?

A

Autoantibody IgG that stimulates TSH receptor ( Type ll hypersensitivity )

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11
Q

Mechanism of Exophthalmos and pretibial myxedema in Graves disease ?

A

Fibroblasts behind the orbit and overlying the chin express the TSH receptor
TSH activation results in Glycosaminoglycans ( chondroitin sulfate and hyaluronic acid ) build up , inflammation , fibrosis and edema leading to exophthalmos and pretibial myxedema

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12
Q

Histology of Graves disease ?

A

Irregular follicles with scalloped colloid and chronic inflammation

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13
Q

Causes of cretinism ?

A

Maternal hypothyroidism during early pregnancy
Thyroid agenesis
Dyshormonogemetic goiter
Iodine deficiency

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14
Q

Most common causes of myxedema ?

A

Iodine deficiency
Hashimoto thyroiditis
Drugs as Lithium
Surgical removal or radiablation of the thyroid

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15
Q

Most common cause of hypothyroidism in regions where iodine levels are adequate ?

A

Hashimoto thyroiditis

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16
Q

Hashimoto thyroiditis is associated with ?

A

HLA-DR5

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17
Q

Antibodies present in Hashimoto thyroiditis ?

A

Antithyroglobulin antibody
Anti thyroid peroxidase antibodies
Antimicrosomal antibody

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18
Q

Histology of Hashimoto thyroiditis ?

A

Chronic inflammation with germinal centers and Hurthle cells ( eosinophilic metaplasia of cells that line follicles )

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19
Q

Hashimoto thyroiditis increases risk for ? Presentation ?

A 
B cell ( marginal zone ) lymphoma 
Presents as enlarging thyroid gland late in disease course
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20
Q

De Quervain thyroiditis mechanism ? Presentation ? Fate ?

A

Granulomatous thyroiditis that follows a viral infection

Presents as a tender thyroid with transient hyperthyroidism

Self limited by 15% progress to hypothyroidism

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21
Q

Presentation of Reidel thyroiditis ?

A

Hypothyroidism

Hard as wood , non tender thyroid gland

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22
Q

Follicular adenoma histology ?

A

Benign proliferation of follicles surrounded by fibrous capsule

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23
Q

Papillary thyroid carcinoma risk factor ? Histology ? Spread ?

A

Exposure to ionizing radiation in childhood

Comprised of papillae lined by cells with clear Orphan Annie eye nuclei and nuclear grooves , papillae are often associated with psammoma bodies

Spread to cervical LNs

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24
Q

Follicular carcinoma spread ?

A

Hematogenously

25
Q

Multiple endocrine neoplasia ( MEN ) are associated with mutations in ?

A

RET oncogen

26
Q

MEN 2A ?

A

Medullary carcinoma
Pheochromocytoma
Parathyroid adenoma

27
Q

MEN 2B ?

A

Medullary carcinoma
Pheochromocytoma
Ganglioneuromas of the oral mucosa

28
Q

Action taken when RET mutation is detected in a patient ?

A

Prophylactic Thyroidectomy

29
Q

Medullary carcinoma of the thyroid histology ?

A

Sheets of malignant cells in an amyloid stroma

30
Q

Causes of primary hyperparathyroidism ?

A

Parathyroid adenoma
Sporadic parathyroid hyperplasia
Parathyroid carcinoma

31
Q

Most common cause of secondary hyperparathyroidism ?

A

Chronic renal failure

32
Q

Causes of hypoparathyroidism ?

A

Autoimmune damage to the parathyroid
Surgical excision
DiGeorge syndrome

33
Q

Autosomal dominant form of pseudohyperparathyroidism is associated with ?

A

Short stature

Short 4th and 5th digits

34
Q

Type l DM mechanism ? Associated with ?

A

Type lV hypersensitivity : autoimmune destruction of beta cells by T lymphocytes

Associated with : HLA-DR3 and HLA-DR4

35
Q

Mechanism of DKA in stress ?

A

In stress epinephrine is secreted which in turn stimulated glucagon secretion

36
Q

Mechanism of obesity causing type ll DM ?

A

Obesity leads to decrease numbers of insulin receptors

37
Q

Histology of pancreas in type ll DM ?

A

Amyloid deposition in the islets

38
Q

The leading cause of death among diabetics ?

A

Cardiovascular disease

39
Q

Gross of kidneys in case of glomerulosclerosis due to DM ?

A

Small scarred kidneys with a granular surface

40
Q

Glucose freely enters to ?

A

Schwann cells
Pericytes of retinal blood vessels
The Lens

41
Q

The leading cause of blindness in the developed world ?

A

DM

42
Q

MEN 1 ?

A

Parathyroid hyperplasia
Pituitary adenomas
Pancreatic endocrine neoplasms

43
Q

Presentation of insulinomas ?

A

Episodic hypoglycemia with mental status changes that are relieved by administration of glucose

44
Q

Presentation of Gastrinomas ?

A

Treatment resistant peptic ulcers which may be multiple and can extend to the jejunum ( Zollinger - Ellison syndrome )

45
Q

Presentation of somatostatinomas ?

A

Achlorhydria ( due to inhibition of gastrin )

Cholelithiasis with steatorrhea ( due to inhibition of cholecystokinin )

46
Q

Presentation of VIPomas ?

A

Watery diarrhea
Hypokalemia
Achlorhydria

47
Q

Mechanism of moon face , buffalo hump and truncal obesity on Cushing syndrome ?

A

High glucose associated with Cushing syndrome —> high insulin —> increases storage of fat

48
Q

Mechanism of hypertension in Cushing syndrome ?

A

Cortisone upregulates alpha-1 receptors on the blood vessels causing vasoconstriction

49
Q

Primary hyperaldosteronism is most commonly due to ?

A

Sporadic adrenal hyperplasia

50
Q

Causes of secondary hyperaldosteronism ?

A

Seen with activation of renin angiotensin system as in :
Renovascular hypertension
CHF

51
Q

Most common cause of congenital adrenal hyperplasia ?

A

Inherited 21 hydroxylase deficiency

52
Q

Waterhouse-Friderichsen syndrome ?

A

Acute adrenal insufficiency
Characterized by hemorrhagic necrosis of the adrenal glands
Classically due to DIC in young children with Neisseria meningitidis infection

53
Q

Most common causes of Adisson disease ?

A 
Autoimmune destruction ( most common cause in West )
TB ( most common cause in developing countries )
Metastatic carcinomas ( arising from the lung )
54
Q

Adrenal medulla is composed of ?

A

Neural crest-derived Chromaffin cells

55
Q

Diagnosis of pheochromocytoma ?

A

Increased serum metanephrins

Increased 24 hours urine metanephrins and vanillylmandelic acid

56
Q

Drug administered before surgical excision of pheochromocytoma to avoid hypertensive crisis ?

A

Phenoxybenzamine ( irreversible alpha blocker )

57
Q

Sites of pheochromocytoma ?

A

Adrenal medulla ( 90% )
Bladder wall
Organ of Zuckerkandl at the inferior mesentric artery root

58
Q

Pheochromocytoma is associated with ?

A

MEN 2A
MEN 2B
Von Hippel-Lindau disease
Neurofibromatosis Type l

Pathology (18 decks)

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