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Pathology > Chapter 24 - The Endocrine System > Flashcards

Chapter 24 - The Endocrine System Flashcards

1
Q

most common cause of hyperpituitarism

A

adenoma

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2
Q

types of pituitary adenomas

A

functioning - associated with hormones or nonfunctioning - without clinical symptoms of hormone excess

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3
Q

difference between micro and macro pituitary adenomas

A

micros is less than 1 cm and macro is greater than 1 cm

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4
Q

clinical symptoms of pituitary adenomas

A

endocrine abnormalities and mass effects –> abnormalities of the sella turcica, visual field abnormalities, signs + symptoms of increased intracranial pressure, sometimes hypopituitarism

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5
Q

most frequent type of hyperfunctioning pituitary adenoma

A

prolactinoma

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6
Q

symptoms of prolactinoma

A

amerorrhea, galactorrhea, loss of libido

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7
Q

other than a prolactinoma, how can you get hyperprolactinemia

A

from lactotroph hyperplasia where there is an interference with normal dopamine inhibiition of prolactin, like from drugs

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8
Q

second most common type of functioning pituitary adenoma

A

growth hormone cell (somatotroph) adenomas

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9
Q

a somatoroph adenoma causes _____ in a child; why?

A

gigantism if it appears before the epiphyses have closed

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10
Q

what if a somatotroph adenoma appears after the the epiphyses lates close?

A

results in acromegaly

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11
Q

symptoms of acromegalyy

A

growth in skin and soft tissues, viscera, bones of face hands and feet, enlarged jaw, broadening of lower face, enlarged hand and feet with broad, sausage like fingers

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12
Q

what other diseases/symptoms can be seen alongside a growth hormone excess

A

diabetes mellitus, generalized muscle weakness, hypertension, CHF

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13
Q

how do you diagnose a growth hormone excess

A

elevated serum GH and IGF-1 levels; failure to suppress growth hormone production in response to an oral load of glucose

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14
Q

what are hormone levels like with corticotroph adenoma

A

excess production of ACTH which leads to an adrenal hypersecretion of cortisol

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15
Q

hypofunction of the anterior pituitary happens when: ___% of the parenchyma is lost

A

75%

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16
Q

what happens in pituitary apoplexy

A

sudden hemorrhage into the pituitary gland, often into a pituitary adenoma

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17
Q

symptoms of pituitary apoplexy (3)

A

headache, diplopia, hypopituitarism

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18
Q

what is sheehan syndrome

A

postpartum necrosis of the anterior pituitary; during pregnancy, the ant. pituitary enlarges to 2x its size, but this physiologic increase in not accompanied by an increase in blood supply so there is relative anoxia and may cause infarction

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19
Q

what happens in primary empty sella syndrome

A

defect in the diaphragma sella that allows the arachnoid mater and CSF to herniate into the sella resulting in expansion of the sella and complression of the pituitary

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20
Q

classic patient presentation of primary empty sella syndrome

A

obese women with a history of multiple pregancies

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21
Q

what causes secondary empty sella syndrome

A

a mass like an adenoma enlarges the sella but then it is surgically removed or undergoes necrosis causing a loss of pituitary function

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22
Q

children with growth hormone deficiency develop _____

A

pituitary dwarfism

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23
Q

what symptoms do gonadotropin (LH and FSH) deficiency cause in men and women

A

women: amenorrhea and infertility; men: decreased libido, impotence, and loss of pubic and axillary hair

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24
Q

prolactin deficiency results in what symptom?

A

failure of postpartum lactation

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25
syndromes involving ADH secretion
diabetes insipidus and syndrome of inappropriate ADH secreation
26
diabetes insipidus characteristics and causes
ADH deficiency, excessive dilute urination with inappropriateloy low specific gravity, can results from trauma, tumors, inflammatory disorders of the hypothalamus and pituitary
27
what are electrolyte levels like in the blood of a patient with diabetes insipidus
serum sodium and osmolality are increased because of the excessive renal loss of free water --> causes thirst and polydipsia
28
electrolyte levels in SIADH
excess resoption of excessive amounts of free water results in hyponatremia
29
frequent causes of SIADH
secretion of ectopic ADH by malignant neoplasms (particularly small-cell carcinomas of the lung), drugs, infections
30
clinical manifestation of SIADH (3)
hyponatremia, cerebral edema, resultant neurologic dysfunction
31
where is a craniopharyngioma derived from
vestigial remnants of rathke pouch
32
most craniopharyngiomas are located:
suprasellarly
33
ages associated with craniopharyngiomas
5-15 years and 65 years or older
34
2 forms of craniopharyngiomas
adamantinomatous craniopharyngiomas (mostly kids) and papillary craniopharyngioma (mostly adults)
35
some morphological characteristics of craniopharyngiomas
dystrophic calcification (kid-type much more commonly calcifies) and cyst formation
36
clinical features of hyperthyroidism (7)
hypermetabolic state with overactivity of the sympathetic nervous system (beta-adrenergic tone), heat intolerance, sweating, weight loss depsite increased appetite, cardiac manifestations (like tachycardia and arrythmias, LVH, low output heart failure), neuromuscular overactivity (tremor, emotional lability, insomnia, proximal muscle weakness), ocular changes (wide staring gaze and lid lag - tru thyroid opthalmopathy associated with proptosis is seen only with Graves), bone resorption
37
what is thyroid storm
abrupt onset of sever hyperthyroidism
38
what causes a thyroid storm
commonly in patients with underlying graves disease and results from an acute elevation in catecholamine levels that could be encountered during infection surgery, cessation of antithyoid medication, and stress
39
many patients with thyroid storm die of:
cardiac arrythmias
40
what is cardiomyopathy
thyrotoxicosis with left ventricular dysfunction and "low-output" failure
41
congenital hypothyroidism is a result of
endemic iodine deficiency in the diet (common) or inborn errors of thyroid metabolism (mutations in thyroid peroxidase), thyroid agenesis or hypoplasia
42
what is myxedema
hypothyroidism developing in the older child or adult
43
clinical features of myxedema
generalized fatigue, apathy, mental sluggishness, patients are listless, cold intolerant, and frequently overwieght
44
histology and pathophysiology of myxedema
accumulation of matrix substances like GAGs and hyaluronic acid in the skin, subQ, and viscera --> non-pitting edema, broadening and coarsening of facial features, enlargement of tongue, deepening of voice
45
when should you suspect myxedema in a patient (what would they present with?)
unexplained increase in body weight or hypercholesterolemia
46
autoimmune destruction of the thyroid gland
hashimoto thyroiditis
47
HLA associated with Hashimotos
HLA DR5
48
how does hashimotos contribute to thyroid cell death
CD8+ cytotoxic T-cell mediated cell death, cytokin-mediated cell death
49
antibodies associated with hashimotos
anti-thyroid antibodies (anti-thyroglobulin, anti-thyroid peroxidase antibodies)
50
what does the thyroid look like in hashimotos thyroiditis (histology, what kind of infiltrate)
enlarged, mononuclear inflammatory infiltrate with germinal centers, abundant eosinophilic cytoplasm --> Hurthle cells
51
what may present before clinical hypothyroidism in Hashimotos
transient thyrotoxicosis by disruption of the thyroid follicles with secondary release of thyroid hormones --> hyperthyroid state --> T4/3 fall with compensatory increase in TSH
52
increased risk of ____ in hashimotos
B-cell non-hodgkins lymphomas
53
40-50 year old woman with thyroiditis after a viral infection is what disease
subacute (granulomatous) thyroiditis/ De Quervain thyroiditis - giant cells
54
most common cause of thyroid pain
Granulomatous (de quervain) thyroiditis
55
painless thyroiditis during the postpartum period
subacute lymphocytic thyroiditis, lymphocytic infiltration with hyperplastic germinal centers
56
Riedel thyroiditis is identified by what?
extensive fibrosis involving the thyroid and contiguous neck structures
57
what may riedel thyroiditis be present similar to?
anaplastic carcinoma of the thyroid (but in this case it would be a 70-80 year old woman)
58
most common cause of endogenous hyperthyroidism
graves disease
59
triad of graves disease
hyperthyroidism, infiltrative opthalmology and exopthalmos, pretibial myxedema
60
age of patients with graves
20-40 year old women
61
pathogenesis of graves disease
IgG self tolerance to the TSH receptor which releases an increase of thyroid hormones
62
morphology of thyroid gland in graves disease
diffuse hypertrophy and hyperplasia
63
what sound can you hear with auscultation in graves disease
bruit
64
lab findings in graves disease
elevated free T4 and T3 with decreased TSH, increased radioactive iodine uptake
65
endemic goiter is the result of
iodine deficiency
66
sporadic goiter usually occurs at what age
puberty or in a young adult that may result from enzymatic defects
67
irregular enlargement of the thyroid
multinodular goiter, uneven iodine uptake
68
clinical symtpoms of a multinodular goiter
airway obstruction, dysphagia, SVC syndrome
69
what is plummer syndrome
long standing gooiter producing hyperthyroidism (because goiters are usually subclinical)
70
which types of nodules are benign and do they take up more or less iodine
hot nodules that take up radioactive iodine
71
are most follicular adenomas of the thyroid functional or non-functional?
nonfunctional

Pathology (9 decks)

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