Endocrine 2

Question 1

Pituitary hypofunction:

Endocrine insufficiency of the pituitary causes hypofunction of secondary organs, which depends upon ______ stimuli.

Answer 1

trophic

Question 2

Pituitary hypofunction is a rare condition that may occur in _____ age group

Answer 2

Any age group

Question 3

What is panhypopitiutarism?

Answer 3

When pituitary hypofunction involves all of the pituitary cells

Question 4

Pituitary hypofunction can involve all of the pituitary cells (including all of the acidophils, which normally produce Prolactin and growth hormone; or the basophils, which produce gonadotropins, TSH and ACTH) or it may be _________

Answer 4

selective

Question 5

When pituitary hypofunction is selective, this means it can be limited to one set of ______ or _____ pituitary cells

Answer 5

anterior or posterior

Question 6

What is an example of selective pituitary hypofunction limited to one set of anterior pituitary cells?

Answer 6

hypogonadism secondary to deficiency of gonadotropic cells

Question 7

What is an example of selective pituitary hypofunction limited to one set of posterior pituitary cells?

Answer 7

Diabetes Insipidus

Question 8

What are the 3 causes of pituitary hypofunction and give an example of each

Answer 8

1. Congenital defects (ex: pituitary dwarfism)
2. Tumors that destroy the pituitary or hypothalamus (ex: gliomas or Craniopharyngiomas)
3. Ischemia (ex- post partum necrosis of the pituitary AKA Sheehans Syndrome)

Question 9

The diagnosis of pituitary hypofunction may be suspected clinically, but how must it be confirmed?

Answer 9

by appropriate biochemical tests of pituitary function to show the hormone deficiency.

Question 10

What is the name of the disease?

Panhypopituitarism of adults- is marked by general weakness, cold intolerance, poor appetite, weight loss, and hypotension.

Answer 10

Simmonds disease

Question 11

In Simmonds disease what specifically occurs in women and in men?

note: Simmonds disease is panhypopituitarism of adults that is marked by general weakness, cold intolerance, poor appetite, weight loss and hypotension

Answer 11

Women- ammenorrhea (do not menstruate)

Men- impotence

Question 12

Pituitary insufficiency of childhood results in what?

Answer 12

dwarfism

Question 13

Are neoplasms in the location of the pituitary usually benign or malignant and what type of symptoms do they cause (hypo or hyperfunctioning)?

Answer 13

• Usually are benign
• may induce hypo- or hyperfunctioning symptoms, related to the extension of the tumor into the adjacent intracranial structures.

Question 14

Tumors of the pituitary:

_____% are active and _____% are hormonally inactive and are usually not recognized unless they cause compression of adjacent structures

Answer 14

75% are active

25% are hormonally inactive

Question 15

Tumors of the pituitary:

Compression of what adjacent structure causes sxs of hypopituitarism or Diabetes Insipidus

Answer 15

The pituitary stalk

Question 16

Diseases of the ______ presents as functional disturbances (hyperfunctioning or hypofunctioning) or can present as mass lesions, such as from goiters or neoplasms

Answer 16

Thyroid Gland

Question 17

What are the top 3 causes of hyperfunctioning of the thyroid gland and which one is most common?

Answer 17

1. 85% is due to Graves Disease
2. Nodular Goiter
3. Thyroid adenoma

Question 18

What is Graves Disease caused by?

Answer 18

an autoimmune disease caused by antibodies to the TSH receptors on the surface of the thyroid follicular cells

Question 19

Is Graves Disease more common in Men or Women and by how much?

Answer 19

F > M (10:1)

Question 20

True or false, Graves Disease is often associated with other autoimmune disorders

Answer 20

True

Question 21

How does Graves Disease result in hypersecretion of thyroid hormones T3 and T4?

Answer 21

1. Circulating IgG antibodies bind to TSH receptors on the surface of the thyroid cells, exerting a stimulus similar to the effects of TSH itself
2. The antibodies bound to the TSH receptors stimulate hypersecretion of thyroid hormones T3 and T4

Question 23

Which disease?

Histologically, the enlarged thyroid is composed of hyperplastic follicles lined by hyperactive, tall cuboidal cells.

The thyroid also contains lymphoid follicles (sign of autoimmune disease)

Answer 23

Graves Disease

Question 24

What would thyroid labs for Graves Disease look like in regards to TSH, T3 and T4?

Answer 24

Elevated T3/T4

Low TSH

Question 25

What are sxs of Graves Disease?

Answer 25

Looks like pt has been running a race:

HTN, tachycardia, diaphoresis, metabolic muscle breakdown

Question 26

Which thyroid tumor?

• May occasionally be hyperactive
• appear as solitary nodules that concentrate radioactive iodine.

Answer 26

Thyroid Adenoma

Question 27

What is the difference between a toxic thyroid goiter/adenoma vs a non- toxic thyroid adenoma/goiter?

Answer 27

Toxic= hyperfunction

Non-toxic= no hyperfunction

Question 28

What is this a picture of?

Answer 28

Thyroid Adenoma

Question 29

All result from an excess of thyroid hormones and includes:

• restlessness
• nervousness
• emotional liability
• sweating
• tachycardia.

Answer 29

Hyperthyroidism

Question 30

Hyper or hypothyroidism?

Cardiac palpitations, muscular tremor and diarrhea are common.

Weight loss is seen, even though the patient has an increased appetite.

Answer 30

Hyperthyroidism

Question 31

Most patients with Graves disease have what physical exam finding that is not seen in goiters or thyroid adenomas? What is this due to?

Answer 31

Exophthalmos

-due to collagen deposition in swollen orbital muscles

Question 32

Tx of hyperthyroidism depends on the underlying process.

The best results are achieved when?

Answer 32

The best results are achieved in patients with solitary hyperfunctioning nodules that can be surgically removed

Question 33

How is Graves Disease and nodular goiters treated?

Answer 33

treated with antithyroid drugs

if these are ineffective, a subtotal thyroidectomy is recommended.