Chapter 21: endocrine Flashcards
1
Q
Pituitary gland structure
- suspended by ______ from ______ at base of ______
- ______ lobe
- ______ lobe
- ______ lobe
A
stalk hypothalamus brain anterior intermediate posterior
2
Q
Pituitary Diseases: Tumors
- ______: higher levels of hormones
- ______: lower levels of hormones, may be due to the compression of ______
- localized mass lesion causing compression of the ______ or the ______ of the brain (Macro > __cm & Micro < __ cm Adenoma). clinical symptoms: ______ and ______
- may be functional (______) or nonfunctional (______)
A
pituitary hyper function pituitary hypo function pituitary tumors optic chiasm basal portion 1 1 headache vision loss hormone-producing silent
3
Q
- ______: increased prolactin, ______ and ______ (females) or as decreased ______ and ______ (males), most common type of pituitary adenoma
- treatment by ______ to suppress the ______ production or ______ for larger lesions
A
pituitary tumors prolactinoma galactorrhea amenorrhea libido headache dopamine agonists prolactin surgery
4
Q
- ______ refers to deficient secretion of one or more of the pituitary hormones. it has many causes and various clinical presentations. most commonly, only one or a few pituitary hormones are ______. occasionally, total failure of pituitary function known as ______. causes include:
- ______: more than half of all hypopituitarism in adults is caused by ______, usually ______. the tumor itself may be functional, but symptoms of ______ often result from ______ of ______ by the mass.
A
anterior pituitary hypo function hypopituitarism deficient panhypopituitarism tumors pituitary tumors adenomas hypopituitarism compression adjacent tissue
5
Q
- ______: most commonly caused by ectopic production of ADH by various tumors, especially ______ of the lung. SIADH results in ______ of ______ with consequent ______ (low blood sodium), reduced ______, and inability to dilute the ______. treatment: ______
- ______: results in diabetes insipidus. characterized by ______ (3Ps), with consequent ______ and ______. causes may include tumors, trauma, ______, and damage to the ______ or ______.
- treatment: ______
A
posterior pituitary diseases syndrome of inappropriate ADH (SIADH) secretion small cell carcinoma retention water dilutional hyponatremia serum osmolality urine water restriction deficiency of ADH polyuria dehydration insatiable thirst inflammatory processes posterior pituitary hypothalamus ADH analog
6
Q
- ______: enlargement of the thyroid
- ______ (nontoxic goiter) is goiter without ______
- ______ is goiter associated with hyperthyroidism; if the patient is ______ or ______, the term nontoxic goiter is applied
- ______ is goiter occurring with high frequency in iodine-deficient geographic areas; the term ______ is used for goiter in non-iodine-deficient areas
- ______ is irregular enlargement of the thyroid resulting in ______ formation
- ______ refers to the late stage of simple goiter in which goiter looks ______; nodules may be ______ or ______ (multi nodular goiter)
A
goiter simple goiter thyroid hormone dysfunction. Toxic goiter euthyroid hypothyroid endemic goiter sporadic goiter nodular goiter nodule nodular colloid goiter nodular single multiple
7
Q
- decreased serum free T4, increased ______
- ______ (hypothyroidism in neonates and infants) due to ______ deficiency, deficiency of _____ necessary for the synthesis of thyroid hormones, mal development of the thyroid, failure of the fetal thyroid to descend from its origin at the base of the ______, transplacental transfer of ______ from a mother with autoimmune thyroid disease
- clinical symptoms: severe ______, impairment of ______ with ______ and ______, large ______, big ______
A
hypothyroidism TSH cretinism iodine enzymes tongue anti-thyroid antibodies mental retardation physical growth retarded bone development dwarfism tongue abdomen
8
Q
- autoimmune destruction of the thyroid gland; associated with HLA-______
- most common cause of ______ in regions where ______ levels are adequate
- ______ and ______ antibodies are often present (sign of thyroid damage
- chronic ______
A
hashimoto's syndrome or thyroiditis DR5 hypothyroidism iodine anti-thyroglobulin anti-microsomal inflammatory process
9
Q
- ______ (diffuse toxic goiter): Autoantibody (______) that stimulates TSH receptor (type __ hypersensitivity). frequently in women the in men. (3) the incidence is increased in ______ and ______ positive individuals. ______ (TSI) an ______ antibody reacts with ______ receptors and stimulates ______. a similar reaction with thyroid growth immunoglobulin (TGI) stimulates ______ and ______. in addition to TSI and TGI, ______ and other autoantibodies are characteristic.
- ______ (protrusion of the eyes), possibly due to autoimmune mechanisms and independent of thyroid hyper function
- manifestations include the signs and symptoms of ______
- treatment: ______ drugs, ______, large does of ______
A
hyperthyroidism grave's disease IgG II HLA-DR3 HLA-B8 thyroid-stimulating immunoglobulin IgG thyroid follicle TSH thyroid hormone production glandular hyperplasia enlargement antimicrosomal striking exophthalmos hyperthyroidism antithyroid thyroidectomy radioactive iodine
10
Q
thyroid neoplasms -benign tumors: \_\_\_\_\_\_ -malignant tumors: \_\_\_\_\_\_ carcinoma \_\_\_\_\_\_ carcinoma \_\_\_\_\_\_ carcinoma \_\_\_\_\_\_ carcinoma
A
adenoma papillary follicular medullary anaplastic
11
Q
-______: pleomorphic cells arranged in ______. highly malignant tumor exhibating rapid ______ and ______. most patients die within ______ year. incidence: 1%
A
anaplastic carcinoma solid sheets growth metastasis 1
12
Q
- _________: Ca++ concentration increases-______
- ______: Ca++ concentration decreases-______
A
diseases of the parathyroid gland hyperparathyroidism Hypercalcimia hypoparathyroidism Hypocalcimia
13
Q
- Excess PTH due to a disorder of the parathyroid gland itself. Most common cause is ______ (>80% of cases).
- Lab findings: ______ and ______, Decreased ______ phosporus, and increased ______ phosphorus, Increased serum ______ and serum ______.
- Clinical symptoms: ______, cystic changes in bone due to osteoclastic resorption; it is also known as ______; fibrous replacement of resorbed bone may lead to the formation of non-neoplastic tumor-like masses (______). Metastatic calcification on tissues. Kidney problems with ______.
- treatment: ______
A
primary hyperparathyroidism parathyroid adenoma Hypercalcemia hypercalciuria serum urinary alkaline phosphatase PTH Osteitis fibrosa cystica von Recklinghausen disease of bone “brown tumor” stones surgery
14
Q
Compensatory parathyroid hyperplasia occurs in response to decreased concentration of serum ______. Most common cause is ______ of ______. Characteristics include decreased serum ______, increased serum ______, and increased serum ______; diffuse osteoclastic bone disease; and metastatic calcification. ______ is increased.
A
secondary hyperparathyroidism ionized calcium hypocalcemia chronic renal disease calcium phosphorus alkaline phosphatase PTH
15
Q
- the most common cause is accidental surgical excision during thyroidectomy. In rare instances, this disorder is associated with congenital thymic hypoplasia (DiGeorge syndrome). Severe ______.
- leads to ______ and ______
- treated with ______ and supplementary ______
A
hypoparathyroidism hypocalcemia neuromuscular excitability tetany high calcium diet vitamin D
16
Q
- ______ is similar to hypoparathyroidism, with decreased calcium, increased phosphate, and increased parathyroid hormone.
- this disorder is characterized by multi hormone resistance involving ______ and the pituitary hormones ______, ______ hormone, and ______ hormone.
A
Pseudohypoparathyroidism PTH TSH luteinizing follicle- stimulating
17
Q
adrenal cortex: hyper function
-______ (hyper corticism): From increased circulating glucocorticoids, primarily cortisol.
-Causes: exogenous______ medication (most common), Hyperproduction of _____ by corticotrophs of the pituitary, ______ adenoma or adrenal carcinoma (less common than adenoma), Ectopic production of ______ by non-pituitary carcinomas, especially small cell carcinoma of the lung.
-diagnosis: by increased 24 hour ______ levels
Clinical symptoms: ______, ______ face, buffalo hump, truncal ______, abdominal ______ and immune suppression
-treatment: high dose______ (Cortisol analog) suppresses ACTH production by a
pituitary adenoma (Cortisol levels decrease), but fails to suppress ______ production by a small cell lung carcinoma (Cortisol levels remain ______).
A
Cushing syndrome corticosteroid ACTH Adrenal cortical ACTH urine cortisol muscle weakness moon obesity strech marks dexamethasone ectopic ACTH high
18
Q
- ______: Aldosterone secreting adenoma. Clinical characteristics include ______, ______ and ______ retention, and ______, often with hypokalemic alkalosis. Overproduction of ______ hormones
- ______: Excess sex steroids with hyperplasia of both adrenal glands.
- ______ enlargement (females) or ______puberty (males) due to excess ______ or genital phenotypic problems,
A
Overproduction of aldosterone (Conn’s syndrome) hypertension sodium water hypokalemia adrenal sex Congenital adrenal hyperplasia Clitoral precocious androgens
19
Q
- it is an adrenal cortical hypofunction due to idiopathic adrenal atrophy
- ______ caused by increased ACTH
- ______ (most common)
- tuberculosis
- characteristics include ______; ______ pigmentation of skin, vomiting, diarrhea, decreased serum ______, ______, ______, and ______; and increased serum ______
- treated by administration of ______
A
Addison's disease Hyperpigmentation autoimmune disorder hypotension increased sodium, chloride, glucose, and bicarbonate potassium. corticosteroids
20
Q
-Produces catecholamines which stimulate the symphathetic nervous system -\_\_\_\_\_\_ (noradrenaline) -\_\_\_\_\_\_ (adrenaline) -any emotional stress causes release of these hormones
A
adrenal medulla
norepinephrine
epinephrine
21
Q
- ______: adults, mostly benign, but in 10% of cases, malignant. This uncommon but important cause of surgically correctable hypertension results from hyper-production of ______ (epinephrine and norepinephrine) by the tumor; the ______ is usually episodic, but may be persistent.
- Increased ______ of catecholamines and their metabolites (______, ______, and ______) is present.
- this tumor can also cause ______
- treatment: ______ or alpha or beta or ______ to control hyoertension
A
tumors of the adrenal medulla Pheochromocytoma catecholamines hypertension urinary excretion metanephrine, normetanephrine, and vanillylmandelic acid hyperglycemia Surgery calcium channel blockers
22
Q
- ______: highly malignant catecholamine- producing tumor occurs in early childhood. It is comprised of ______ cells which form characteristic rosette-like structures (______ pseudorosettes)
- Urinary catecholamines and catecholamine metabolites are the same as in _________.
- this tumor rarely causes ______
- it usually originates in the ______ with a _____ abdominal mass
- treatment: ______ and ______. sometimes ______
A
tumors of the adrenal medulla Neuroblastoma small round blue “Homer Wright” pheochromocytoma hypertension adrenal medulla large surgery chemo radiation
23
Q
- ______: increased growth hormone
- ______ results if adenoma develops before _____
-______ results if adenoma develops after epiphyseal closure
characterized by overgrowth of the ______, ______, ______, ______, and general enlargement of ______, along with ______, ______, and hypertension.
-treatment: by ______, ______ or surgery
A
pituitary tumors growth hormone cell adenoma gigantism epiphyseal closure acromegaly jaws, face, hands, feet viscera hyperglycemia osteoporosis GH receptor antagonist GHIH
24
Q
- ______ adenomas secrete ACTH leading to ______
- rare adenomas include ______, ______, and ______ producing adenomas
A
pituitary tumors
ACTH
cushing syndrome
TSH, LH, FSH
25
Q
- ______: pregnancy related ______ of the pituitary gland. gland ______ in size during pregnancy, but ______ does not increase significantly; blood loss and ______ during ______ (child birth) causes ______.
- clinical symptoms are due at first to loss of ______, then to subsequent loss of ______ and ______
A
anterior pituitary hypo function sheehan syndrome infarction doubles blood supply shock parturition infarction gonadotropins thyroid-stimulating hormone (TSH) and ACTH
26
Q
- ______: this is primarily a radiologic term that describes an enlarged sella containing a ______, ______ pituitary at the base. it is secondary to a congenitally defective or absent diaphragma sella, which permits transmission of ______ into the sella
- ______ disturbances are generally minor but may include ______, ______, frank hypopituitarism, ______, diabetes insipidus, and ______
A
anterior pituitary hypo function empty sella syndrome thin flattened cerebrospinal fluid pressure endocrine hyperprolactinemia amenorrhea acromegaly cushing syndrome
27
Q
- ______: common in women than men (adults)
- clinical symptoms: ______, tendency to ______ because of a low metabolic rate, ______ pitch of voice, mental and physical slowness, ______
- abnormal physical findings: puffiness of ______, ______, and ______. ______ skin, ____ loss, ______ and ______ hair, scant axillary and pubic hair, thinning of the ______, ______ in relaxation place of deep tendon reflexes
A
hypothyroidism myxedema cold intolerance gain weight lowered constipation face, eyelids, hands dry hair coarse brittle eyebrows increase
28
Q
- ______: patients with this disease usually have less severe symptoms of hyperthyroidism than those with graves disease and never develop ______
- because patients with toxic goiter tend to be older, ______ complications, including ______ and ______, may dominate the clinical presentation. Serum ______ and ______ levels are frequently only minimally elevated, and the uptake of ______ may be normal or only slightly elevated. ______ following a course of ______ is the most common treatment.
A
hyperthyroidism toxic multi nodular goiter (plummer disease) exophthalmos cardiac atrial fibrillation congestive heart failure T4 and T3 radio labeled iodine radio labeled iodine anti thyroid therapy
29
Q
-______: papillae are lined by ______ cells with ____nuclei (“______” nuclei). Low-grade malignancy; survival rate is ______ at 20 years, despite tendency for early metastasis, to ______ lymph nodes. incidence 70%
A
papillary carcinoma cuboidal clear Orphan Annie 85% ipsilateral cervical
30
Q
-______: composed of follicular cells of _____. aggressive; the prognosis depends of the _____ of differentiation and the ______. common in ______. incidence 20%
A
follicular carcinoma thyroid cellular degree tumor stage women
31
Q
-______: ______deposits in the tumor and elevated serum levels of _______ . Aggressive; survival rate is __% at 5 year. incidence: 5%
A
medullary carcinoma
amyloid
calcitonin
50%
