endocrine Flashcards
pituitary adenoma may produce symptoms by _______ or _______
hormone production or by local mass effect
local mass effect of pituitary adenoma
- compression of optic nerve leading to visual disturbances
* increased intracranial pressure (headache, nausea, vomiting)
Hypofunction (hypopituitarism)
• may manifest as a deficiency of one hormone or multiple hormones
anterior pituitary lobe derived from the
primitive oral cavity (Rathke’s Pouch)
posterior pituitary lobe derived from
neuroectoderm
thyroid gland develops from an invagination of _______
which arises at the , in the region of the foramen cecum
endoderm,
base of the tongue
thyroid gland then migrates _______to its location anterior to the thyroid cartilage
caudually
histology of thyroid gland
follicles filled with colloid and lined by cuboidal follicular cell
small nests of C-cells scattered between the follicle
most common cause of hyperthyroidism
o Graves disease (#1)
o ingestion of excessive exogenous thyroid hormone (TH)
o hyperfunctional multinodular goiter
o hyperfunctional thyroid adenoma
clinical manifestations of hyperthyroidism
Hypermetabolic state, Overactivity of the sympathetic nervous system
thyroid storm
- Abrupt onset of hyperthyroidism
* Patients can die of cardiac arrhythmia
diagnosis of hyperthyroidism
elevated levles of TH, decreased levels of TSH
common causes of hypothyroidism
o Ablation by surgery or radiation therapy
o Hashimoto thyroiditis
o Iodine deficiency
Cretinism
hypothyroidism.
children
Impaired development of skeleton and CNS
Coarse facial features
Myxedema
- Develops in adults
- Generalized apathy and mental sluggishness (mimics depression)
- Cold-intolerance, obese
- Coarse facial features, enlargement of tongue, deepening of voice, constipation, late cardiac effects
- Accumulation of mucopolysaccharide-rich edema
hypothyroidism can be ____ or _____
primary or secondary
TSH levels are ______ in primary
increased
graves disease is a ______ disease
hyperthyroid
Hashimoto Thyroiditis is a _______ disease
hypothyroid
Most common cause of hypothyroidism where dietary iodine is sufficient
Hashimoto Thyroiditis
• Most common manifestation of thyroid disease
goiters
• Diffuse and multinodular goiters reflect impaired synthesis of _______
thyroid hormone
goiters are most often caused by
dietary deficiencies
Impairment of TH synthesis leads to……
- increased serum TSH
- hypertrophy and hyperplasia of thyroid follicular cells
- gross enlargement of gland
most thyroid nodules are
non-neoplastic
which nodules are more likely to be neoplastic
in younger people
in males
Follicular Adenoma
o solitary nodules, 3-5 cm in diameter
o grossly separated from the normal thyroid by a thin, discrete capsule
accounts for 70-80% of thyroid cancers
Papillary Thyroid Carcinoma
Follicular Carcinoma
o accounts for 10-20% of thyroid cancers
o Older age than papillary; areas with dietary iodine deficiency
o grossly may resemble an adenoma with a discrete capsule
o Must see invasion through the capsule or into the blood vessels
this condition has lots of different nuclei affects
Papillary Thyroid Carcinoma
which have mutations in the RET proto-oncogene
Papillary Thyroid Carcinoma
Medullary Thyroid Carcinoma
Medullary Thyroid Carcinoma
derived from the parafollicular (C) cells
which has Increased serum calcitonin
medullary thyroid carcinoma
Medullary Thyroid Carcinoma
derived from the parafollicular (C) cells
uncommon
parathyroid embryology
Derived from the third and fourth pharyngeal pouches
parathyroid gland is composed of mostly
o composed mostly of chief cells (principal cells, clear cells), also oxyphil cells
chief cells secrete
PTH
function of PTH
increase serum calcium
Hyperparathyroidism causes
hypercalcemia
difference between primary and secondary hyperparathyroidism
primary- an autonomous spontaneous overproduction of PTH
secondary- associated with chronic renal failure
primary hyperparathyroidism
Caused by parathyroid adenomas or hyperplasia
Deposition of calcium in throughout body, including blood vessels
T/F secondary hyperparathyroidism doesnt have incrase Ca levels
TRUE
DiGeorge’s syndrome is a _______ disease. and associated with that
autoimmune.
Hypoparathyroidism
DiGeorge’s syndrome is
Hypoparathyroidism. dont have one
type 1 diabetes
Symptoms appear once 90% of beta cells have been destroyed
o Ketoacidosis
o Ketoacidosis
Since these people are using fat as their primary energy source, excess ketones in blood, decrease in blood pH
Ketoacidosis
Since these people are using fat as their primary energy source, excess ketones in blood, decrease in blood pH
• Normal glucose is ______
70-120mg/dL
total lack of insulin is associated with which type
type 1
insulin resistance is associated with which type of diabetes
type 2
o Responsible for 80% of DM-related deaths
vasculopathy
Responsible for 80% of DM-related deaths
vasculopathy
vasular disease then _____ disease are main problems with diabetes
kidneys. (diabetic nephropathy)
diabetic nephropathy
- Diffuse glomerulosclerosis
- 90% of diabetics within 10 years; not specific to diabetics
- Microangiopathy around glomerular capillaries and deposition of matrix
- Proteinuria, total renal failure
Nodular glomerulosclerosis resuls from
diabetes
Insulinoma
Insulin Secreting Islet Cell Tumor
• Beta cell tumor, hyperinsulinism, most are adenomas
• Hypoglycemia quickly occurs from fasting or exercise
Zollinger-Ellison Syndrome
- Pancreatic islet cell tumor, hypersecretion of gastric acid, severe peptic ulcers
- Most are malignant (60%), surgical resection
adrenal medulla is the source of
epinephrine
adrenal cortex 3 levels
o zona glomerulosa – mineralcorticoids (aldosterone)
o zone fasciculata – glucocorticoids (cortisol)
o zona reticularis – sex hormones (estrogen/androgen)
Cushing Syndrome
hypercortisolism
Primary adrenal hyperplasia or neoplasm (e.g. adrenal adenoma)
Hyperaldosteronism causes….
hypertension, hypokalemia
Primary Chronic Adrenocortical Insufficiency (Addison’s Disease)
progressive destruction of adrenal cortex
Serum ACTH may be elevated → skin and mucosal pigmentation
Primary Chronic Adrenocortical Insufficiency (Addison’s Disease)
progressive destruction of adrenal cortex
Serum ACTH may be elevated → skin and mucosal pigmentation
Potassium retention, sodium loss, hyperkalemia, hyponatremia, volume depletion, and hypotension
Secondary Adrenocortical Insufficiency
Any disorder of hypothalamus of pituitary that reduces output of ACTH
Symptoms similar to Addison’s disease
But no skin/mucosa pigmentation
Pheochromocytoma
neoplasm of chromaffin cells
in adrenal glands
