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Systemic Pathology > Endocrine 1 and 2 > Flashcards

Endocrine 1 and 2 Flashcards

1
Q

What are the 2 ways hormones can be transported?

A
  1. Bound to plasma proteins

2. Free in the blood

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2
Q

Which hormones are biologically active?

A

Those that are free in the blood

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3
Q

What are 3 general characteristics of hormones?

A
  1. They have a specific rate of secretion
  2. Feedback systems, either positive or negative feedback
  3. Affect only cells with the appropriate receptors
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4
Q

What are the 5 functions of the endocrine system?

A
  1. Homeostasis
  2. Energy metabolism
  3. Reproduction
  4. Growth and development
  5. Response to stress and injury
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5
Q

What are the 3 types of endocrine disease?

A
  1. Oversecretion or hyper function
  2. Undersecretion or hypo function
  3. Mass effect or tumors
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6
Q

What is mass effect?

A

A tumor presses on another organ altering its function

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7
Q

Where is the parathyroid gland located? How many are there usually? What is the range of how many there can be?

A

Located on the posterior part of the thyroid gland. Normally there are 4 of them but can be 1-12

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8
Q

The parathyroid glands are derivatives of?

A

The third and fourth branchial pouches

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9
Q

What are 3 possible ectopic locations of the parathyroid?

A

Intrathyroid, intrathymic, anterior mediastinum

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10
Q

Is the parathyroid gland encapsulated? What three things make up the gland?

A

Yes

Oxyphil cells, chief cells, stromal fat

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11
Q

Describe the appearance of a chief cell?

A

Polygonal cells with clear cytoplasm (glycogen), central uniform nuclei

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12
Q

Describe an oxyphil cell

A

Has acidophilic cytoplasm with abundant mitochondria

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13
Q

Stromal fat makes up what percentage of the gland?

A

30%

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14
Q

What controls the release of PTH?

A

Free or ionized calcium

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15
Q

How does PTH regulate calcium?

A
  1. Causes release of calcium from bone
  2. Decreases reabsorption of phosphate and increases calcium absorption in the kidney
  3. Vitamin D3 is hydroxyl and this causes reabsorption of calcium in the intestine
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16
Q

What is the range for serum calcium and free calcium?

A

Serum is 8-10 mg/dl

Free is 4-5.6 mg/dl

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17
Q

What is the normal range for PTH?

A

10-65 nanomoles/L

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18
Q

What are the 2 general causes of hypercalcemia?

A

Raised PTH or lowered PTH

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19
Q

Raised PTH is due to hyperparathyroidism, what are the usual causes of PRIMARY hyperparathyroidism?

A

Almost always an adenoma but can also be from hyperplasia, (carcinoma 1% of the time)

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20
Q

Does increased PTH always lead to hypercalcemia?

A

No calcium can be high, low, or normal depending on RENAL FUNCTION

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21
Q

What causes SECONDARY hyperparathyroidism?

A

Increase in PTH secondary to HYPOcalcemia and HYPERphosphatemia of chronic renal failure

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22
Q

What is TERTIARY hyperparathyroidism?

A

Autonomous parathyroid hyper function in those with secondary hyperparathyroidism

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23
Q

What can cause decreased PTH?

A 
Malignancy (anywhere like small cell carcinoma of the lung)
Vitamin D toxicity
Immobilization
Thiazide diuretics
Granulomatous disease like sarcoidosis
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24
Q

Most cases of hyperparathyroidism are?

A

Asympomatic (see chart for possible symptoms)

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25
Q

What two effects does excess PTH have on bone?

A

Osteoporosis and ostelitis fibrosa cystica (brown tumor)

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26
Q

In ostelitis fibrosa cystic what cells are present in marrow?

A

Multinucleated giant cells, inflammatory cells, also fibrosis

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27
Q

What can ostelitis fibrosa cystica present as?

A

Cystic lesion in small bones

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28
Q

How can you detect how many parathyroid glands are enlarged?

A

Sestamibi scanning

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29
Q

Parathyroid adenomas occur more in men or women?

A

3x more often in women

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30
Q

How do you distinguish an adenoma from hyperplasia?

A

An adenoma will be sharply demarcated from the gland

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31
Q

Parathyroid hyperplasia typically occurs in how many glands? Does this differ from adenoma?

A

Typically in all four glands, adenoma is usually just in one

32
Q

Why does parathyroid hyperplasia occur?

A

Either a sporadic thing most of the time or as part of MEN (multiple endocrine neoplasia) 2A

33
Q

Parathyroid hyperplasia usually exhibits hyperplasia of which cell? What other cells are present?

A

Chief cells, variable oncocytes

34
Q

What is the most common sign of parathyroid carcinoma?

A

A palpable neck mass

35
Q

Carcinoma leads to?

A

Excessive PTH, even more than adenoma or hyperplasia, usually > 14 mg/dl serum calcium, normal is 8-10

36
Q

Histologically how do you identify parathyroid carcinoma?

A

Should see capsular invasion and hyper plastic chief cells

37
Q

What are the ABSOLUTE criteria for parathyroid carcinoma?

A

Vascular invasion and metastasis

38
Q

What is associated with aggressive parathyroid carcinoma?

A

Macronuclei, more than five mitoses per 50 high power fields, and necrosis

39
Q

What are the 3 types of MEN?

A

MEN 1 or Wermer syndrome
MEN 2A or Sipple’s syndrome
Men 2B

40
Q

In wermers neoplasia will occur where?

A

Pituitary, parathyroid, pancreas, and carcinoids

41
Q

MEN 2A or simple’s will lead to what cancer?

A

Medullary thyroid or c cell and pheochromocytomas

42
Q

MEN 2B will lead to neuromas in…

What other cancers?

A

Eye, buccal, and GI mucosa
Medullar thyroid or c cell carcinoma
Pheochromocytomas

43
Q

Which MEN syndromes lead to parathyroid hyperplasia?

A

Type 1 or wermer’s and type 2a or sipple’s

44
Q

What is similar about MEN 2a and 2b?

A

Both can lead to pheochromocytomas and medullary thyroid or c cell carcinoma

45
Q

What is the largest endocrine organs?

A

The thyroid

46
Q

What is located in the lumen of the thyroid?

A

Colloid

47
Q

What 2 cells are present in the thyroid?

A

C cells and epithelial follicular cells

48
Q

What hormones are produced in the thyroid and by which cells>

A

T3 and T4 are produced by the epithelial follicular cells

Calcitonin is produced by the c cells

49
Q

What causes the thyroid to release T3 and T4?

A

Thyroid stimulating hormone

50
Q

What causes the release of TSH from the pituitary?

A

Thyroid releasing hormone from the hypothalamus

51
Q

Where does thyroid tissue begin forming embryologically?

A

Foramen cecum

52
Q

Where is the thyroid normally located?

A

In front of the larynx

53
Q

Ectopic locations of the thyroid include?

A

Lingual, mediastinal, heart, anterior tongue

54
Q

What is a thyroglossal duct cyst?

A

Persistence and dilatation of the thyroglossal duct in the midline of the neck, only a problem if infected

55
Q

What lines the thyroglossal duct cyst?

A

Either squamous or respiratory epithelium

56
Q

What is the most common cause of hypothyroidism in the US? Worldwide?

A

Hashimoto’s thyroiditis

Iodine deficiency

57
Q

What are causes of secondary hypoparathyroidism?

A

Pituitary or hypothalamic failure

58
Q

Levels of which hormone will be high in hypothyroidism?

A

TSH

59
Q

What effects does hypothyroidism have on infants? Adults?

A

Cretinism

Myxedema or edema of the eye area

60
Q

What is the most common cause of goiter in the US? The origin of this disease is?

A

Hashimoto thyroiditis, immune origin

61
Q

What is the histologic “triad” of hashimoto thyroiditis?

A
  1. Lymphocytic infiltrate
  2. Lymphoid follicles with germinal centers
  3. Hurthle cell metaplasia of follicular epithelium
62
Q

Those with hashimoto thyroiditis are at risk of?

A

B cell lymphoma, papillary carcinoma, Hurthle cell neoplasm

63
Q

What are the 2 other names for subacute thyroiditis?

A

Granulomatous and De Quervain

64
Q

What is the cause of subacute thyroiditis? Describe the clinical course

A

Viral infection

Triphasic clinical course of hyper, hypo, then normal thyroid function

65
Q

Subacute thyroiditis is the most common cause of?

A

Painful thyroid

66
Q

What cell is present in subacute thyroiditis?

A

Multinucleated giant cells since its an infection

67
Q

In Riedel’s thyroiditis what is the most important thing you will see histologically?

A

Obliterating phlebitis

68
Q

Why is thyrotoxicosis?

A

Hypermetabolic state caused by increased T3 and T4

69
Q

What is the primary cause of thyrotoxicosis? Secondary?

A

Grave’s disease

TSH secreting pituitary adenoma

70
Q

What type of thyroid nodule is more likely to be malignant?

A

A cold one

71
Q

What is the most definitive way to diagnose thyroid cancer?

A

Fine needle aspiration

72
Q

What is the most common malignant thyroid tumor?

A

Papillary carcinoma

73
Q

A papillary carcinoma will be lined with?

A

Fibrovascular core with cuboidal, columnar cells and psammoma bodies

74
Q

What is the most common thyroid neoplasm?

A

Follicular adenoma

75
Q

How do you differentiate adenoma from well differentiated carcinoma?

A

Integrity of the capsule

Systemic Pathology (11 decks)

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