Endocrine Flashcards
1
Q
communicate with each other and with cells of sensory and effector tissues by means of neurons
A
neural cells
2
Q
serves as an interface between the brain and endocrine system
A
neuroendocrine system
3
Q
hormones that trigger biochemical signals when interacting with cell surface receptors
A
peptide hormones, small neurotransmitters (E/NE)
4
Q
hormones that diffuse across the plasma membrane and interact with intracellular receptors
A
lipid soluble hormones (steroids, thyronine, retinoids)
5
Q
adenohypophysis arises from what germ cell layer
A
oral ectoderm / Rathke’s pouch
6
Q
neurohypophysis arises from what germ cell layer
A
neural ectoderm
7
Q
acidophilic cells that secrete prolactin
A
lactotrophs
8
Q
acidophilic cells that secrete growth hormone or somatotrophin
A
somatotrophs
9
Q
basophilic cells that produce POMC
A
corticotrophs
10
Q
basophilic cells that produce thyroid stimulating hormone
A
thyrotrophs
11
Q
basophilic cells that produce gonadotropins
A
gonadotrophs
12
Q
what commonly causes hyperpituitarism
A
anterior pituitary adenoma
13
Q
5 clinical manifestations of local mass effect
A
- visual field abnormalities
- increased intercranial pressure
- cranial nerve palsy
- obstructive hydrocephalus
- acute hemorrhage
14
Q
classification of pituitary adenomas (5)
A
hormone production, functional vs nonfunctional, cell type, sporadic vs inherited, size
15
Q
pituitary adenoma smaller than 1 cm
A
microadenoma
16
Q
pituitary adenoma bigger than 1 cm
A
macroadenoma
17
Q
functional tumors are usually this size
A
microadenoma
18
Q
characteristics of atypical adenomas (2)
A
Tp53 mutation and brisk mitotic activity
19
Q
acidophilic components stain what color
A
pink (cytoplasm)
20
Q
basophilic components stain what color
A
purple
21
Q
chromophobic components stain what color
A
clear
22
Q
most common hyperfunction forming pituitary adenoma
A
prolactinoma/lactotroph adenoma
23
Q
causes of prolactinomas (7)
A
pregnancy, high estrogen, renal failure, hypothyroid, hypothalamic lesions, dopamine inhibiting drugs, or mass in the sella turcica
24
Q
clinical presentation of prolactinomas (4)
A
amenorrhea, galactorrhea, loss of libido, infertillity
25
second most common functional adenoma
growth hormone producing adenoma /somatotroph adenoma
26
what does growth hormone producing adenomas result in (3)
gigantism, acromegaly, glucose intolerance abnormality
27
what does the growth hormone producing adenoma stimulate
insulin-like factor 1 in the liver
28
agressive variant of corticotroph adenoma
Crooke's cell adenoma
29
pituitary adenoma that is PAS positive
adrenocorticotrophic hormone producing adenoma (chromophobe)
30
what two conditions does an ACTH producing adenoma present with
cushing syndrome and hyperpigmentation
31
these develop in crooke's cell adenoma
hyaline, cytokeratin-rich perinuclear rings
32
rare pituitary adenoma (1%) that causes hyperthyroidism
thyrotroph adenoma
33
these pituitary adenomas typically get large before detection
gonadotroph adenoma
34
gonadotroph adenomas are often associated with these
neurologic defects
35
pituitary adenoma that causes hypopituitarism, makes up 25% of all adenomas and associated with mass effect
non-functional pituitary adenomas
36
the only true criterion of a malignant pituitary gland
systemic metastasis
37
pituitary carcinomas are commonly producing these two hormones
ACTH and prolactin
38
most pituitary carcinomas are these types of adenomas
functional
39
ischemic necrosis associated with pregnancy
Sheehan syndrome
40
75% loss or absence of anterior pituitary
hypopituitarism
41
terminal end of the axons from the hypothalamus into posterior pituitary gland
herring body
42
modified glial cells in the posterior pituitary
pituicytes
43
excess release of ADH is associated with (4)
plasma pressure, left atrial distension, exercise, certain emotional states
44
what malignant neoplasm ectopically secretes ADH
small cell lung cancer (neuroendocrine)
45
ADH deficiency
diabetes insipidus
46
three causes of ADH deficiency
-head trauma
-hypothalamic / pituitary surgery
- idiopathic
47
mass arising from the remnants of the Rathke's pouch and infundibulum
craniopharyngioma
48
presentation of craniopharyngioma (2)
intercranial pressure and visual disturbances
49
craniopharyngioma in children is called
adamantinomatous craniopharyngioma
50
this type of staining is diagnostic of adamantinomatous craniopharyngioma
wet keratin staining
51
desquamated cells that form large, pale, eosinophilic masses that may contain calcium
wet keratin
52
another subtype of craniopharyngioma
papillary craniopharyngioma
53
key dianostic features of adamantinomatous craniopharyngioma (3)
- sheets of squamous cells with peripheral palisading
-stellate reticulum
- ghost cells with wet keratin
54
rare condition of enlargement or malformation of stella turcica
empty sella syndrome
55
flattened pituitary gland in that a defect in the diaphragm of the sella lets arachnoid mater and csf to herniate
primary empty sella syndrome
56
mass enlarges the sella turcica, and is removed or spontaneously necrosed leading to loss of pituitary function
secondary empty sella syndrome
57
increased production of this hormone is common in empty sella syndrome
prolactin
58
another term for pituitary cachexia
Simmonds disease
59
destruction or physiological exhaustion of the anterior pituitary
pituitary cachexia
60
what three organs does pituitary cachexia affect
thyroid, adrenal glands, gonads
61
adiposogenital dystrophy
Froehlich syndrome
62
Froehlich syndrome can be caused by
damage to the hypothalamus or acquire due to a tumor or surgical treatments
63
the most common tumor to metastasize to the pituitary gland
breast
64
average weight of the thyroid
18-25 grams
65
secrete thyroid hormones
follicular cells
66
secrete calcitonin
parafollicular cells
67
reduces blood calcium levels and promotes born formation by inhibiting osteoclasts
calcitonin
68
contains thyroglobulin
colloid
69
what percent of T3 is released
5%
70
what percent of T4 is released
95%
71
hypermetabolic state due to elevated T3 and T4 or decreased TSH
thyrotoxicosis
72
most common cause of endogenous hyperthyroidism in the US
Graves disease
73
type of goiter in Graves disease
diffuse toxic goiter
74
this antibody acts like regulatory pituitary hormone TSH causing an over production of thyroid hormones in Graves disease
thyrotropin receptor antibody (TRab)
75
weight and appearance of graves disease
50-100 grams and beefy appearance
76
microscopic of Graves disease (3)
-papillary infoldings
-peripheral scalloping
-variable patchy lymphoid infiltrate in the stroma
77
most often caused by dietary iodine deficiency
goiter
78
hyperfunctioning nodules develop with longstanding goiter resulting in hyperthyroidism
toxic multinodular goiter
79
rare disease characterized by difficulty swallowing, iron deficiency anemia, glossitis, cheilosis, and esophageal webs
Plummer-Vinson syndrome
80
severely advanced hypothyroidism due to the lack of thyroid hormone production
myxedema
81
acute inflammation of the thyroid causing hypothyroidism, associated with severe thyroid pain
thyroiditis
82
chronic lymphocytic thyroiditis
Hashimoto's thyroiditis
83
most common cause of hypothyroidism with sufficient iodine
hashimoto thyroiditis
84
epithelial cells with abundant eosinophilic granular cytoplasm
Hurthle/oxyphil cells
85
thyroiditis that presents as a silent or painless thyroid enlargement, 5-10% of postpartum women
subacute lymphocytic thyroiditis
86
hot nodules are more likely to be (take up radioactive iodine-functioning)
benign
87
cold nodules are more likely to be
malignant
88
solitary nodules are more likely to be this than multiple nodules
malignant
89
toxic adenoma
produces thyroid hormone
90
non functioning adenomas in the thyroid have this characteristic
higher risk of cancer
91
critical feature of a hyperfunctioning toxic adenoma
intact capsule
92
most common form of thyroid cancer
papillary
93
most papillary carcinomas are associated with
previous ionizing radiation
94
most common variant of papillary carcinoma
follicular variant
95
how is papillary carcinoma diagnosis usually made
FNA (fine needle aspiration)
96
metastasis of papillary carcinoma typically goes to the
lung
97
diagnosis of papillary carcinoma is determined by nuclear features where densely granular chromatin is with clear ground glass appearance
orphan annie eye
98
concentric lamellated dystrophic calcifications
psammoma bodies
99
often unencapsulated and infiltrative variant of papillary carcinoma
tall cell variant
100
dense fibrosing variant of papillary carcinoma
sclerosing variant
101
what variant of papillary carcinoma is common in children
sclerosing variant
102
follicular carcinoma is more common in which sex
women
103
type of thyroiditis thought to be triggered by viral infection or inflammatory process
subacute granulomatous thyroiditis (de Quervain)
104
shifting pain presents in this type of thyroiditis
subacute granulomatous (de Quervain)
105
history of this increases incidence of thyroid malignancy
radiation to head and neck
106
sex predominance of thyroid carcinomas in early and mid adult life
female
107
sex predominance of thyroid carcinomas in childhood and late adult life
male
108
carcinoma that arises from parafollicular cells
medullary carcinoma
109
genetic alterations that activate MAP kinase pathway in this cancer
papillary carcinoma
110
genetic alterations that activate P1-3K/AKT signaling pathway in this cancer
1/3 of follicular carcinoma
111
RET proto-oncogene mutations in this cancer
30% of sporadic medullary carcinoma
112
psammoma bodies are often present in this carcinoma
papillary carcinoma
113
lymphatic invasion is common in this carcinoma
papillary carcinoma
114
cut surface of a papillary carcinoma
granular, friable, well circumscribed, encapsulated
115
solitary cold nodule (malignant) indicates what type of thyroid carcinoma
follicular carcinoma
116
follicular carcinoma tends to metastasize how?
hematogenous spread
117
follicular carcinoma is more frequent in areas where there is a deficiency of this
dietary iodine
118
these two structures are usually invaded in a follicular carcinoma
capsule and vascular
119
are psammoma bodies present in follicular carcinoma
no
120
this carcinoma requires extensive submission of the capsule to rule out invasion
follicular carcinoma
121
hurthle/oncocytic variant of follicular carcinoma cells
large cells with pink cytoplasm
122
undifferentiated, aggressive tumors of follicular epithelium
anaplastic carcinoma
123
anaplastic cells in anaplastic carcinoma (3)
- large giant cells
-spindle cells
-mixed cell
124
worst prognosis thyroid carcinoma, nearly 100% mortality
anaplastic carcinoma
125
this carcinoma replaces an entire lobe
anaplastic carcinoma
126
this carcinoma has distant metastasis
anaplastic carcinoma
127
muscle and vascular invasion may occur in this cancer
anaplastic carcinoma
128
neuroendocrine neoplasm derived from parafollicular cells that secrete calcitonin
medullary carcinoma
129
what other polypeptide hormones can medullary carcinoma secrete (3)
somatostatin, serotonin, vasoactive intestinal polypeptide
130
medullary carcinoma in children may have activation of this mutation
RET mutation, leads to overactive protein that triggers uncontrollable growth
131
medullary carcinoma in adults
sporadic - 70%
132
medullary carcinoma in younger patients
familial (MEN syndrome 2A/2B) - 30%
133
prophylactic thyroidectomies offered to pts with medullary carcinoma
pts with RET mutations
134
these deposits may occur from altered calcitonin molecules in medullary carcinoma
amyloid deposit
135
precursor lesion for medullary carcinoma
parafollicular cell hyperplasia
136
prognosis of thyroid cancer depends on (4)
age of patient
metastasis
extrathyroid extension
SIZE of tumor
137
does thyroid cancer have an in situ stage
no
138
extremely rare thyroid cancer
thyroid lymphoma
139
most common congenital anomaly of the thyroid
thyroglossal duct cyst
140
thyroglossal duct cyst typically has this inside
mucin, myxoid appearance
141
epithelium in thyroglossal duct cyst
cilated columnar/metaplastic stratified squamous epithelium
142
chief cells of the parathyroid secrete this
parathyroid hormone
143
oxyphil cells of the parathyroid characteristic
larger cells that dont produce hormone
144
regulates serum calcium concentration via neg feedback to increase calcium levels, affecting bone, kidney, intestines
parathyroid hormone
145
how PTH increases blood calcium (4)
- promoting calcium release from bone by increasing osteoclasts
- increasing phosphate excretion in urine
-promoting kidney calcium reabsorption
- increasing conversion of vitamin D to absorb calcium
146
most common cause of asymptomatic hypercalcemia
hyperparathyroidism
147
hyperparathyroidism is more common in which sex
women
148
autonomous, spontaneous overproduction of PTH resulting in hypercalcemia
primary hyperparathyroidism
149
most common cause of primary hyperparathyroidism
parathyroid adenoma
150
results from a chronic depression of serum calcium
secondary hyperparathyroidism
151
two most common causes of secondary hyperparathyroidism
chronic renal insufficiency, decreased activation of vitamin D
152
persistent or excess secretion of PTH even after hypocalcemia has been corrected
tertiary hyperparathyroidism
153
two ways tertiary hyperparathyroidism can occur
after a renal transplant or chronic renal failure
154
typically isolated to one parathyroid gland
parathyroid adenoma
155
MEN syndromes can cause these that cause hyperparathyroidism
tumors
156
parathyroid hyperplasia in hyperparathyroidism are only in one gland?
no, multiglandular, often all 4 glands
157
PTH level, calcium level, and phosphorus level in primary hyperparathyroidism
high, high, low
158
PTH level, calcium level, and phosphorus level in secondary hyperparathyroidism
high, low, high
159
PTH level, calcium level, and phosphorus level in tertiary hyperparathyroidism
very high, high, high
160
stones in the kidney
nephrolithiasis associated with hyperparathyroidism
161
calcium salts in renal parenchyma (cortex/medulla)
nephrocalcinosis associated with hyperparathyroidism
162
accelerated bone reabsorption causing osteoporosis and bone-loss dz
bone resorption associated with hyperparathyroidism
163
release of calcium in the blood, reabsorbed by the kidney
osteitis fibrosa cystica
164
result from excess osteoclast activity, formed in osteitis fibrosa cystica
brown tumors
165
where are brown tumors most common to arise (2)
mandible and maxilla
166
is resection curative in osteitis fibrosa cystica
yes
167
normal parathyroid weight
less than 50 mg
168
abnormalities in parathyroid adenoma
painful bones, renal stones, abdominal groans and psychic moans
169
chief cell hyperplasia pattern
diffuse/multinodular
170
parathyroid carcinoma on all glands?
no, usually one
171
typical weight of parathyroid carcinoma
more than 10 grams
172
parathyroid gland in primary hyperplasia weight
usually 1 gram or less
173
parathyroid adenoma weight
0.5 to 5 grams
174
the only definitive features of parathyroid carcinoma (2)
invasion and metastasis
175
4 major causes of hypoparathyroidism
-surgical removal/damage of parathyroid
-congenital
-autoimmune
-pseudo hypoparathyroidism (resistance)
176
surgical removal resulting in hypoparathyroidism occurs commonly due to what
thyroidectomy
177
congenital hypoparathyroidism can be caused by this syndrome
DiGeorge syndrome
178
these patterns are seen in parathyroid carcinoma
nodular or trabecular patterns
179
abnormalities in hypoparathyroidism (3)
neuromuscular irritability(needs calcium), renal abnormalities, arrythmias
180
secrete glucagon
alpha cells
181
secrete insulin and amyloid
beta cells
182
secrete somatostatin
delta cells
183
secretes pancreatic proteins
PP/F cells
184
synthesize serotonin
enterochromaffin cells
185
secrete VIP
D1 cells
186
diabetic nephropathy can cause
end stage renal disease
187
diabetic retinopathy can cause
adult onset blindness
188
diabetes mellitus can cause (3)
-vascular disease
-tooth decay
-increase susceptibility to infection
189
diabetic neuropathy can cause
peripheral damage (feet, hands)
190
absolute deficiency of insulin secretion caused by beta cell destruction
type 1 diabetes
191
combination of peripheral resistance to insulin action and inadequate compensatory response of insulin secretion by beta cells
type 2 diabetes
192
failure of target tissue to respond normally to insulin
insulin resistance
193
complications of insulin resistance (4)
-direct uptake of glucose into muscle
-reduced glycolysis
-fatty oxidation in the liver
-inability to suppress gluconeogenesis in the liver
194
triad of diabetes mellitus
polydipsia, polyuria, polyphagia
195
body breaks down fat at a higher rate bc it can't use glucose, the liver breaks fat down into ketones which makes blood acidic
diabetic ketoacidosis
196
islets can become replaced with this in long standing type 2 diabetes
amyloid
197
there is infiltration of this in islets in diabetes
lymphocytic infiltrate
198
nodular glomerulosclerosis seen in diabetic nephropathy
Kimmelstiel-Wilson lesion
199
first clinical feature of pancreatic cancer
new onset diabetes
200
diabetic morphology
reduction in number and size of islet cells
201
most pancreatic NET have malignant potential except this
insulinomas
202
pancreatic cancer most commonly metastasizes to this organ
liver
203
beta cell tumor that causes overproduction of insulin resulting in hypoglycemic attacks
insulinomas
204
most common pancreatic endocrine neoplasm
insulinoma
205
most pancreatic neuroendocrine tumors are functional?
yes
206
gastrinomas form in the pancreas/duodenum to secrete large amounts of gastrin which causes the stomach to produce too much acid
Zollinger-Ellison syndrome
207
triad of ZE syndrome
pancreatic/duodenal tumor, gastric hypersecretion, peptic ulcers
208
alpha cell tumor of the pancreas that has uncontrolled glucagon synthesis
glucagonoma
209
what percent of glucagonomas are malignant
75%
210
very rare delta cell tumor in the pancreas or duodenum that produces somatostatin
somatostatinoma
211
somatostatinoma malignant potential
high
212
VIPoma that produces VIP, mostly affecting females and have high malignant potential
Verner-Morrison syndrome
213
where do VIPomas tend to occur
tail of pancreas
214
nests and cord of cells with salt and pepper chromatin are seen in what neuroendocrine tumor
VIPomas
215
NET that is usually an incidental finding
pancreatic carcinoid
216
this is important in staging pancreatic tumors
size
217
right adrenal gland shape
pyramidal
218
left adrenal gland shape
semilunar
219
the layer of the adrenal cortex that takes up most of the space
zona fasciculata
220
what is responsible for the yellow color of the cortex (gross)
lipid content of fasciculata cells
221
this layer of the adrenal cortex has anastomosing cords and acidophilic granular cytoplasm
zona reticularis
222
hypercortisolism
Cushing syndrome
223
ACTH producing pituitary adenoma
Cushing disease
224
paraneoplastic ACTH production (ectopic) can also cause what
Cushing syndrome
225
ACTH independent causes of cushing syndrome (4)
adrenal adenoma, adrenal carcinomas, hyperplasia, exogenous glucocorticoids
226
small cell lung cancer can also produce what
ACTH
226
clinical signs of cushing disease (4)
moon face, buffalo hump, striae, menstrual irregularities
226
adrenal cortical hyperplasia occurs in both glands?
yes, bilateral
227
forms of adrenal gland hyperplasia (4)
adrenal cortical hyperplasia, adrenal medullary hyperplasia, ACTH-independent macronodular adrenal hyperplasia, primary cortical micronodular form
228
hyperplastic lesion that is considered a precursor of pheochromocytoma
adrenal medullary hyperplasia
229
normal weight of adrenal gland
5 grams
230
adrenal hyperplasia weight
greater than 30 grams
231
this bilateral hyperplasia of the adrenal cortex is 10-15 times normal weight
congenital adrenal hyperplasia
232
conn syndrome
primary hyperaldosteronism
233
overproduction of aldosterone resulting in suppression of RAAS and decreased plasma renin activity
primary hyperaldosteronism
234
primary hyperaldosteronism is mostly caused by
bilateral adrenal hyperplasia (resembling zona glomerulosa)
235
second leading cause of primary hyperaldosteronism
adrenocortical neoplasm
236
activation of the RAAS system due to extra-adrenal cause of increased plasma renin (kidney)
secondary hyperaldosteronism
237
3 causes of secondary hyperaldosteronism
- decreased renal perfusion
-hypovolemia/edema
-pregnancy
238
adrenal gland failure due to massive bleeding into the adrenal glands, commonly caused by Neisseria meningitidis
Waterhouse-Friderichsen syndrome
239
causes of ACUTE primary adrenocortical insufficiency (3)
Waterhouse-Friderichsen syndrome, withdrawal of long term steroids, stress in people with an underlying chronic adrenal insufficiency
240
causes of CHRONIC primary adrenocortical insufficiency (Addison's disease) (3)
- autoimmune adrenalitis*
- metastasis
- AIDS
241
adrenocortical insufficiency resulting from hypothalamus or pituitary dysfunction
secondary adrenocortical insufficiency
242
benign adrenocortical tumor
adenoma
243
malignant adrenocortical tumor
adrenocortical carcinoma
244
benign adrenomedullary tumor
pheochromocytoma
245
malignant adrenomedullary tumor
neuroblastoma
246
how large are the lesions in an adrenocortical carcinoma + weight?
>5cm, 200-300g
247
these will be present in aldosterone secreting adenomas (within cortex)
spironolactone bodies
248
which gland is an aldosterone secreting adenoma more common in
the left adrenal gland
249
after patients are treated for HTN with spironolactone, what can be found?
aldosterone secreting adenoma
250
aldosterone secreting carcinomas often present in pts with this syndrome
Conn syndrome (primary hyperaldosteronism)
251
medulla cells that originate from the neural crest
chromaffin cells
252
paraganglioma in the adrenal gland made of chromaffin cells that is mostly benign
pheochromocytoma
253
90% of pts with pheochromocytomas have this condition
hypertension
254
nest of cells pattern seen in pheochromocytomas
Zellballen pattern
255
chromatin appearance in pheochromocytomas
salt and pepper
256
most common extracranial solid tumor of children
neuroblastoma
257
embryonal tumors that develop from neural crest cells
neuroblastoma
258
how is neuroblastoma staged
based on age and prognosis
259
benign, mature, fat and hematopoietic cell adrenal benign neoplasm
adrenomyelolipoma
260
benign, rare, hormonally silent neural crest tumor that is more common in children and YA, "incidentaloma"
ganglioneuroma
261
extra adrenal paraganglia along the aorta
Organs of zuckerkandl
262
autosomal recessive disorder with complete or partial enzyme deficiency in the cortex that leads to altered levels of cortical hormones
congenital adrenal hyperplasia / adrenogenital syndrome
263
clinical presentation of congenital adrenal hyperplasia
-female masculinization
-male genitalia enlargement and oligospermia
264
this is commonly associated with carcinomas than adenomas in CAH
adrenal virilization
265
most common MEN1 pituitary tumor
prolactinoma
266
MEN1 syndrome term
Wermer's syndrome
267
most common manifestation of MEN1 syndrome
primary hyperparathyroidism
268
epitheliod cells of the pineal gland
pinealocytes
269
brain sand of the pineal gland
corpora arenacea
270
blocks the secretions of gonadotropins
melatonin
271
produces melatonin
pinealocytes
272
benign and asymptomatic, may cause vision/eye movement problems
pineal cysts
273
rare tumor of pineal gland that presents as a solid mass, may have cystic spaces on imaging
pineocytoma
274
inability to move eyes up and down (in pineocytomas)
sunset sign
275
these eosinophilic cells arranged in a circular pattern are present in pineocytomas
neurocytic rosettes
276
dorsal midbrain syndrome in pineocytoma
Parinaud syndrome
277
most aggressive tumor of the pineal gland that usually presents in childhood
pineoblastoma
278
high N:C ratio in this tumor of the pineal gland
pineoblastoma
279
50% of the tumors in the pineal gland are this
germ cell
280
pineal germinomas resemble germinomas of this organ
testicles
281
what does the histology of pineal germinomas look like
lobules of polygonal tumor cells with fibrous septae and lymphocytes
282
arise from sequestered embryonic germ cells
pineal germinoma
283
tumor suppressor gene on chromosome 11 is inactivated producing this MEN syndrome
MEN1
284
3 clinical manifestations of MEN1
-parathyroid hyperplasia/adenomas
-pituitary tumor
-islet cell tumor
285
3 clinical manifestations of MEN2a
-parathyroid hyperplasia
-pheochromocytoma
-medullary thyroid cancer
286
3 clinical manifestations of MEN2b
-mucosal neuroma
-pheochromocytoma
-medullary thyroid cancer
287
activating mutations in the tyrosine kinase receptor on chromosome 10 produce this MEN syndrome
MEN2
