chapter 24- endocrine pathology Flashcards
what is the most common pituitary adenoma
prolactinoma
what is the proper treatment for prolactinoma
dopamine agonists or surgery
what hormonal effect does prolactinoma have on Males and females
males= decreased libido and headache; females= galactorrhea and amenorrhea
how do you diagnose (lab results) GH adenoma
increased GH and IFG-1; lack of GH suppression by oral glucose
what is the common tumor causing hypopituitarism in adults
pituitary adenoma
what is the common tumor causing hypopituitarism in kids
craniopharyngioma
how do people with sheehan syndrome present
poor lactation and loss of pubic hair
how do you diagnose central diabetes insipidus
H2O deprivation fails to increase urine osmolality
what is the treatment for central diabetes insipidus
desmopressin (ADH analogue)
what is the term for cystic dilation of thyroglossal duct remnant
thyroglossal duct cyst
if you see the term “scalloping of calloid” what disease should you think of
graves disease
describe TSH and T4 levels in graves disease
total and free T4 increased; decreased TSH
what is a major complication of graves disease
thyroid storm
what is multi nodular goiter due to
relative iodine deficiency
what is the term for hypothyroid in neonates and infants
cretinism
what are the clinical presentations of cretinism
mental retardation, short stature with skeletal abnormalities, coarse facial features, enlarged tongue
what HLA is hashimoto thyroiditis associated with
HLA-DR5
what antibodies are often present with hashimoto thyroiditis
antithyroglobin and antimicrosomal
what lymphoma are people with hashimoto more common to get
B-cell lymphoma
when you hear increased number of pink cells or herthel cells what disorder should you think
hashimoto thyroiditis
what typically precedes subacute/de quiervain granulomatous thyroiditis
viral infection
describe the thyroid gland in redial fibrosing thyroiditis
hard as wood, nontender
who does redial fibrosing thyroiditis classically occur in
young females
what conditions cause increased uptake of radioactive iodine
graves or nodular goiter
what conditions cause decrease uptake of radioactive iodine
adenoma and carcinoma
describe follicular adenoma
benign; usually non-functional; follicles surrounded by fibrous capsule
what is the major risk factor for papillary carcinoma
exposure to ionizing radiation in childhood
if you see orphan-anide nuclei and simmoma body what should you think
papillary carcinoma
what cells are malignantly proliferating in medullar carcinoma
parafollicular cells
what carcinoma presents similarly to rediel, except that rediel is in young and this carcinoma is in old
anapestic carcinoma
what is the most common cause of secondary hyperparathyroidism
chronic renal failure
what is likely occurring if there is numbness and tingling, especially around lips; tetany; decreased PTH and decreased serum calcium
hypoparathyroidism
what is the issue in pseudohypoparathyroidism
end organ resistance to PTH due to issue with Gs protein
describe the presentation of someone with pseudohypoparathyroidism
autosomal dominant; associated with short stature and short 4th and 5th digits
what is the likely genetic basis of pancreatic endocrine tumors (of islet cells)
component of MEN1
how do you diagnose CUshings syndrome
increased 24 hour urine cortisol levels
how do you distinguish between ACTH secreting pituitary adenoma and paraneoplastic ACTH secretion
high-dose dexamethasone
what is the most common deficit in congenital adrenal hyperplasia
21 hydroxylase deficiency
if you have a young child that previously had neisseria infection that is not presenting with adrenal insufficiency, what is the likely diagnosis
waterhouse-friderichsen syndrome
what is the term for a tumor of chromatin cells in the adrenal medulla
pheochromocytoma
how do you diagnose pheochromocytoma
increased serum metanephrines and increase 24 hour urine metanephrines and UMA
What do the stem cells that somatotrophs, mammosomatotrophs, and lactotrophs derive from express
PIT-1
What factors are expressed for gonadotroph differentiation
SF-1 and GATA-2
What is the mechanism of alteration of GNAS
Activating mutation
What gene is involved as an activating mutation in pituitary carcinomas
HRAS
What gain of function gene is associated with GH adenomas
GNAS
What type of adenomas are associated with MEN1
GH, prolactin, and ACTH adenomas
What is the most common alteration in hyperpituitarism
G protein mutations
What distinguishes pituitary adenomas from non-neoplasticism anterior pituitary parenchyma
Cellular monomorphism and absence of significant reticulum network
What is the most common hyperfunctioning adenomas of the pituitary gland
Prolactinoma
What adenoma is commonly associated with Psammoma bodies and/or pituitary stone
Prolactinoma
Describe the morphology findings of somatotropin adenoma
Sparsely granulated subtypes are composed of chromophobe cells with considerable nuclear and cytologic pleomorphism and focal, weak staining for GH
What syndrome can occur after removal of adrenal glands for treatment of Cushing syndrome
Nelson syndrome
What are the clinical presentations with SIADH
Hyponatremia, cerebral edema, resultant neurologic dysfunction
What is the diagnostic feature of adamantinomatous type of craniopharygiomas (occuring in kids
Wet keratin (lamellar keratin formation); dystrophic calcification (machine oil like)
When you see the term hurthle cell what disease should you think of
Hash improvement
What polymorphisms increase susceptibility to hashimoto
CTLA4 and PTPN22
Describe the cut section of Graves’ disease
Parenchyma has soft, meaty apperance resembling muscle
What are the 2 phases of diffuse nontoxic (simple) goiter
Hyperplastic and colloid involution
What is the usual presentation of thyroid gland adenomas
Unilateral painless mass
What is the hallmark finding with thyroid gland adenomas
Presence of intact, well formed capsule encircling tumor
What are most cases of papillary thyroid gland carcinomas assoaciated with
Prior radiation, orphan Annie eyes nuclei, papillae, psammomma bodies
What is the common phrase used to describe hyperparathyroidism
Painful bones, renal stones, abdominal groans, psychic moans
What does symptomatic untreated hyperparathyroidism lead to (interrelated skeletal abnormalities)
Osteoporosis, brown tumors and osteitis fibrosa cystica
What is the most common cause of secondary hyperparathyroidism
Renal failure
What are the autoimmune causes of hypoparathyroidism
APS1 and mutations in AIRE
How does hypoparatyroidism present in childhood
Candidiasis
What are the classic findings on physical exam with hypoparathyroidism
Chvostek sign and trousseau sign
What is the classic triad with DM
Polyuria, polydipisia, polyphagia
Is ketoacidosis more common with DM1 or 2
DM1
What do alpha cell tumors increase and then cause due to this
Increases glucagon; characteristic skin rash
What does the pituitary show with Cushing syndrome in its hyaline
Crooks hyaline change
What is the most common clinical consequence of hyperadrenalism
HTN
What side are aldosterone producing adenomas more common on
Left
What adrenal cortex issue is associated with spironlactone bodies
Aldosterone-producing adenomas
Who should congenital adrenal hyperplasia always be suspected in
Neonate with ambiguous genitalia
What disease should you think of when the nuclei are usually round to oval with salt and pepper chromatin
Pheochromocytoma
What is sipple syndrome associated with (alteration)
MEN-2A
What is associated with MEN-2B
Neuro as, marfanoid habitus
What mutations are common in familial medullary thyroid cancer
RET mutations
