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Org Path Exam 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the main way the endocrine system maintains homeostasis?

A

feedback inhibition

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2
Q

What looks more like brain tissue? The anterior or posterior gland

A

the posterior gland does

but the anterior releases way more hormones

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3
Q

What causes hyperpituitarism?

A

adenoma in anterior lobe

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4
Q

What causes hypopituitarism?

A

Injury: ischemia, radiation, inflammation, nonfunctioning neoplasms causing compression

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5
Q

What are the other effects of a mass in the pituitary gland?

A

Visual field abnormalities
Increased intracranial pressure
Headaches, nausea, vomiting

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6
Q

What is Bitemporal Hemianopsia and what causes it?

A

It is tunnel vision

  • due to the proximity of the optic nerves/chiasm to the sella, expanding pituitary lesions often compress the optic chiasm
  • causes visual field abnormalities, classically in the form of defects in the lateral (temporal) visual fields, so-called bitemporal hemianopsia or tunnel vision.
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7
Q

What’s the difference between a functional/non-functional adenoma?

A

Functional: composed of a single cell type and produce a single predominant hormone
Nonfunctional adenomas: likely to be detected at a later stage, thus grow bigger (don’t typically secrete hormones which is why they are detected later?)

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8
Q

What is a pituitary apoplexy?

A

Adenoma with hemorrhage causing rapid enlargement

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9
Q

what are symptoms of prolactinomas? (pituitary)

A

Amenorrhea, galactorrhea, infertility

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10
Q

What are symptoms of GH secreting adenomas? (pituitary)?

A

Gigantism in children

Acromegaly in adults (Enlargement of jaw, hands, feet, viscera)

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11
Q

What are the symptoms of corticotroph cell adenoma?

A

hypercortisolism

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12
Q

What are the causes of hypopituitarism?

A

1) Sheehan syndrome
- enlargement of pituitary during pregnancy (increase in prolactin-secreting cells)
- Blood supply does not increase
- Vulnerable to ischemia in peripartum period
2) Empty sella syndrome
- Any condition that destroys all or part of the pituitary

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13
Q

What are the clinical symptoms of hypopituitarism?

A
  • develop slowly

- Hypofunction of thyroid, adrenal glands, and gonads

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14
Q

If the posterior pituitary has issues, what syndromes might be related to ADH?

A
  • ADH deficiency causes diabetes insipidus and dehydration (too much water coming out)
  • inappropriate ADH (SIADH) causes excessive resorption of water
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15
Q

If the posterior pituitary has issues, what syndromes might be related to oxytocin?

A

Stimulates contraction of uterus and breast ducts

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16
Q

What types of hormones does the Thyroid secrete and what cells secrete each of the hormones?

A

Thyroid follicular cells: hormones to regulate metabolism

1) Thyroxine (T4)
2) Tri-iodothyronine (T3)

Parafollicular cells (“C cells”): calcitonin- regulates calcium

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17
Q

What causes the thyroid to secrete its hormones?

A
  • The hypothalamus secretes thyrotropin releasing hormone and the anterior pituitary releases thyroid stimulating hormone
  • all done via feedback mechanism
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18
Q

What are the causes of hyperthyroidism? (thyrotoxicosis)

A

Common causes:

  • Graves Disease –autoimmune disease
  • Excess exogenous(from outside) thyroid hormone
  • Multinodular goiter (hyperfunctional)
  • Thyroid adenoma (hyperfunctional)

Less common causes:
Pituitary adenoma (excess TSH)
Thyroiditis

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19
Q

What is Graves disease and what does it cause?

A 
Autoimmune disease (hyperthyroidism(
Antibodies to TSH receptor
Women > men 
Younger adults (20-40 years)
Exophthalmos (when eyes bulge)
Pretibial myxedema (edema or fluid in shins)
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20
Q

What are dental implications of hyperthyroidism?

A

catecholamine susceptibility (e.g. epinephrine)

Mild hyperthyroidism:
-exaggerated response to narcotic analgesics, sedatives in routine doses

Severe hyperthyroidism:

  • life threatening arrhythmias & cardiac failure
  • exacerbation of underlying cardiovascular symptoms
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21
Q

What causes a multinodal goiter and what effect does it have on the thyroid?

A
  • Impaired synthesis of thyroid hormone -> increased TSH -> enlargement of thyroid
  • Compression of airway, esophagus, and large vessels in the neck
  • Hyperthyroid, euthyroid, hypothyroid
  • could be caused by Low Iodine and then TSH keeps signaling the thyroid to produce T3/T4
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22
Q

What is thyroiditis?

A

Inflammation causing injury to thyroid follicles and release of thyroid hormone

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23
Q

What are the clinical features of hyperthyroid?

A

-Hyper metabolic state/over-reactive sympathetic nervous system
-Stimulation of the gut, hypermotility, malabsorption, diarrhea
-Weight loss despite increased appetite
-Nervousness tremor, palpitations, irritability
-Excessive sweating and heat intolerance
-Thyroid storm = medical emergency
Abrupt onset of severe hyperthyroidism –> cardiac arrhythmias and death

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24
Q

How do we determine hyperthyroidism with lab tests?

A
  • Measure TSH concentration in serum, in conjunction with unbound (“free”) T4
  • High T4 would suppress TSH in primary hyperthyroidism
  • TSH may be elevated in pituitary disease
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25
Q

What causes hypothyroidism?

A
  • Ablation of thyroid by surgery or radiation
  • Hashimoto’s thyroiditis (autoimmune disease)
  • Primary idiopathic hypothyroidism
  • Pituitary disease
  • Dietary iodine deficiency
26
Q

What do both Graves disease and Hashimoto’s thyroiditis have in common?

A
  • both are autoimmune thyroid disease
  • for both, increased frequency of other autoimmune disorders:
  • Systemic lupus erythematosus
  • Type 1 diabetes mellitus
  • Addison disease
27
Q

What do lab tests reveal for hypothyroidism?

A

T4 level is decreased and TSH level is increased due to loss of feedback inhibition

28
Q

What are the dental implications of hypothyroidism?

A

-Exaggerated response to CNS depressants (narcotic analgesics, sedatives)

Mild hypothyroidism:
-exaggerated response to narcotic analgesics, sedatives in routine doses

Severe hypothyroidism:
-respiratory / cardiovascular depression

29
Q

What are the differences between adenomas and carcinomas in regard to thyroid nodules?

A

Adenomas = benign neoplasms-clonal expansion of one cell that does not really travel anywhere else

  • Multiple nodules
  • “Hot” nodules

Carcinomas = malignant (possibility of metastasis)

  • Solitary nodule
  • “Cold” nodules
30
Q

What are the types of thyroid cancer and which is the main type?

A

Papillary carcinoma (75-85% of cases)
Follicular carcinoma
Medullary carcinoma
Anaplastic carcinoma (worst case scenario)

31
Q

What are the causes of thyroid cancer?

A

exposure to radiation:
Treatment of tonsils, acne
Atomic bomb survivors in Japan
Chernobyl nuclear plant disaster

32
Q

What are the microscopic features of the four types of thyroid cancer?

A

Papillary carcinoma:

  • Clear nuclei “Orphan Annie”
  • Papillary architecture

Follicular carcinoma:
Numerous small follicles resembling normal thyroid

Medullary carcinoma:

  • Derived from parafollicular cells or “C cells” (calcitonin)
  • Follow calcitonin levels
  • Extracellular amyloid (“pink fluff” in picture)

Anaplastic carcinoma (

33
Q

Is the parathyroid gland affected by the pituitary and hypothalamus?

A

No! Unlike the other endocrine glands, the parathyroid glands are controlled by the level of FREE CALCIUM IN THE BLOOD, rather than hormones secreted by the pituitary and hypothalamus

34
Q

What is the different between hyperplasia, adenoma, and carcinoma?

A

Hyperplasia-variable enlargement of all glands
Adenoma-Enlargement of one gland with atrophy of others
Carcinoma-Metastasis or invasion

35
Q

What are the clinical features of hyperparathyroid?

A
  • High calcium levels—worrisome for cancer
  • PTH may be inappropriately elevated for calcium level
  • PTH should be low to undetectable in non parathyroid disease

“Painful bones, renal stones, abdominal groans, and psychic moans”

36
Q

What causes hyperparathyroidism for primary vs. secondary?

A

Primary hyperparathyroidism: overproduction of PTH by the parathyroid

  • Hyperplasia
  • Adenoma
  • Carcinoma

OR Secondary hyperparathyroidism (due to a secondary problem)

  • chronic renal insufficiency
  • Dietary calcium and/or vitamin D deficiency
37
Q

What causes hypoparathyroidism?

A
  • Surgical ablation of thyroid
  • Primary (idiopathic) atrophy of parathyroid glands
  • Thymic aplasia (DiGeorge’s syndrome)
  • Autoimmune disorders
38
Q

What are clinical symptoms of hyperparathyroidism?

A
  • Tingling, neuromuscular irritability, seizures

- Calcification of basal ganglia, dental abnormalities, osteosclerosis, osteomalacia

39
Q

How is the adrenal gland stimulus?

A

the hypothalamus secretes cortisol releasing hormone which stims the ant. pituitary to release ACTH which causes the adrenal glands to release cortisol, aldosterone, & dehydroepiandrosterone

40
Q

What are the three zones of the adrenal cortex and what do they produce?

A

Zona glomerulosa: aldosterone (salt)
Zona fasciculata: steroids
Zona reticularis: androgenic hormones

41
Q

What does the adrenal medulla produce?

A

Norepinephrine & epinephrine (catecholamines)

42
Q

What does hyperadrenals cause?

A

Glucocorticoids –> Cushing syndrome
-Cortisol

Mineralocorticoids–>hyperaldosteronism
-Aldosterone

Adrenocortical androgens –> virilizing syndromes

43
Q

Describe Cushing Syndrome

A
  • Most caused by having of exogenous glucocorticoids
  • Hypothalamic or pituitary hypersecretion of ACTH
    - –Pituitary adenoma
    - –Pituitary hyperplasia
  • Adrenocortical hyperplasia, adenoma, carcinoma
  • Secretion of ectopic ACTH by a neoplasm
  • overall excess cortisol!
44
Q

What are the clinical signs of Cushing’s syndrome?

A

trunk weight gain, buffalo hump, moon face, thinning of skin

45
Q

What are lab tests for Cushing’s syndrome?

A
  • 24-hour urinary free cortisol level
    - always increased
  • Loss of normal diurnal pattern of cortisol secretion
46
Q

What is hyperaldosteronism and what are the causes?

A
  • basically causes more fluid in your vascular system
  • Excess aldosterone causes sodium retention and potassium excretion, with resultant hypertension and hypokalemia

Causes:

  • Adrenocortical neoplasm (usually adenoma–most common)
  • Adrenocortical hyperplasia
47
Q

What are the Adrenogenital syndromes?

A

Virilization:

  • Primary gonadal disorders
  • Adrenocortical neoplasms (usually carcinomas)
  • Congenital adrenal hyperplasia
    - 21-hydroxylase deficiency
48
Q

What happens if you get a deficiency in one of the pathways that make a adrenal cortex hormone?

A

It gets shunted over

it goes from mineralocorticoids, glucorticoids, and then sex hormones

49
Q

Treatment of Cushing’s syndrome

A

Treatment: exogenous glucocorticoids to suppress ACTH levels and provide adequate levels of glucocorticoids

50
Q

what causes adrenal cortex insufficiency?

A

Primary adrenal disease:

  • Chronic primary adrenal insufficiency (Addison disease)
  • Acute primary adrenal insufficiency

Decreased stimulation due to deficiency of ACTH

51
Q

What is Addison’s disease?

A

“General languor and debility, remarkable feebleness of the heart’s action… and a peculiar change in the color of the skin”

Causes:
Autoimmune (60-70%)
Infections
Metastasis

52
Q

What causes acute adrenocortical insufficiency?

A

Any stress:

  • Rapid withdrawal of steroids on patient with chronic adrenal insufficiency
  • Failure to increase steroids during time of stress
  • Massive hemorrhage (childbirth, postoperative)
  • Infection
  • basically anything that destroys adrenal tissue including addison’s etc.
53
Q

What is the adrenal medulla generally?

A
  • from neural crest !!! It might have a different embryologically origin than cortex
  • Nests of large cells with sympathetic nerve innervation
  • Secretes epinephrine and norepinephrine (catecholamines)
54
Q

What does Pheochromocytoma cause?

A
  • It is a neoplasm secretes excess catecholamines –> hypertension
  • Abrupt increase in blood pressure, palpitations, tachycardia, headache, sweating, tremor, anxiety –> sudden death
55
Q

What do the lab tests for pheochromocytoma look for?

A

Increased urinary excretion of free catecholamines and their metabolites, such as vanillylmandelic acid (VMA) and metanephrines

56
Q

What is a neuroblastoma?

A

a malignant adrenal medulla tumor

Young children

57
Q

What is multiple endocrine neoplasia?

A

Neoplasia and/or hyperplasia of multiple endocrine glands (familial diseases)

58
Q

What is MEN 1?

A

Pituitary, parathyroids, and pancreas (“3 Ps”) and Chrom. 11
Parathyroid:
-Hyperplasia
-Adenomas

Pancreatic islets:

  • Carcinoma
  • Adenomas
  • Hyperplasia

Pituitary:
-Adenomas

59
Q

What is MENII or IIa?

A

Thyroid, parathyroid, adrenal
Thyroid:
Medullary carcinoma (100%)

Adrenal:
Pheochromocytoma

Parathyroid:
Hyperplasia

Chromosome 10

60
Q

What is MEN IIb or III?

A

Thyroid, adrenal, mucocutaneous ganglioneuromas

Thyroid:
-Medullary carcinoma (100%)

Adrenal:
-Pheochromocytoma

Extra endocrine changes: skin, oral mucosa, eyes, respiratory tract, gut
-ganglioneuromas

Chromosome 10

Org Path Exam 2 (8 decks)

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