Endocrine 4 Flashcards
Are benign or malignant thyroid neoplasms more common?
benign tumors are more common
Only 3-4 cases of ___________ are diagnosed yearly per 100,000 people, and less than 1000 people die each year in U.S
Thyroid cancer
What condition?
Presents as a nodule, which may vary in size, most being small, well encapsulated with fibrous tissue, and composed of thyroid follicles
follicular adenomas (a type of thyroid adenoma)
how is the final diagnosis of a thyroid adenoma made?
only by microscopic examination of biopsy material
Are thyroid adenomas premalignant? Do they require tx?
No
so small nodules dont require any tx
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Thyroid carcinomas occur in several histologic forms, including what 4 types?
In order of most common:
- Papillary (by far MC)
- Follicular
- Medullary
- Anaplastic
“Pappi Forgot Meds Again”
All thyroid carcinomas originate from ______ cells, except for which one?
Follicular cells
Except Medullary Carcinoma
T/F: no definite risk factors for developing thyroid cancers are known
true
Are thyroid cancers more common in males or females?
Females
Which cancer accounts for 80% of all thyroid cancers?
Papillary Carcinoma
Which thyroid cancer?
It is a low-grade malignant lesion that is hormonally inactive
Papillary Carcinoma
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When do papillary carcinomas occur and when is the peak incidence?
Occurs early in life
peak incidence: 3rd to 5th decades
Where does the papillary carcinoma tend to metastasize to?
local lymph nodes
distant mets are not found until late in the disease
What is the prognosis of papillary carcinomas?
very favorable prognosis with 80% of patients still alive 10 yrs. after diagnosis.
Which thyroid cancer differs from the other types of thyroid carcinomas in that it is derived from Parafollicular C-Cells
Medullary carcinomas
Medullary Carcinoma-
What do the parafollicular C-cells (what medullary carcinomas are derived from) produce?
Like normal C-Cells, it produces Calcitonin, the hormone involved in regulating the homeostasis of Calcium
Which thyroid cancer?
Histologically, it is composed of round neuroendocrine cells arranged in groups or nests.
The stroma contains Amyloid which is derived from the Calcitonin.
Medullary Carcinoma
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Which thyroid tumor?
A rare tumor with an extremely poor prognosis with most patients dying within one year of diagnosis.
Anaplastic Carcinoma
Histologically, which tumors are composed of undifferentiated, large or small tumor cells that bear no resemblance to normal thyroid cells.
Anaplastic Carcinoma
Adrenal hyperfunctioning results in which 3 partially overlapping syndromes?
- Cushings Syndrome or hypercortisolism
- Conn’s syndrome or hyperaldosteronism
- Adrenogenital syndrome
What is Cushing’s Syndrome caused by?
hypersecretion of glucocorticoids
What is Conn’s Syndrome caused by?
hypersecretion of mineralcorticoids
What is Adrenogenital Ayndrome caused by?
hypersecretion of the adrenal sex hormones
Of these, which is addisons and which is cushings?
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top is Addisons, bottom is Cushings
Which layer of the adrenal cortex relates to Cushing’s Syndrome?
Zona fasciculata (produces glucocorticoids)
Which of the 3 diseases of the adrenal cortex (Cushing’s syndrome, Conn’s syndrome or Adrenogenital syndrome) is most common?
Cushing’s syndrome
Cushing’s Syndrome is caused by adrenal ______ or ______
Hyperplasia or neoplasia
Cushing’s syndrome or Disease
In 70% of cases, hypercortisolism occurs as a result of hypersecretion of ACTH from pituitary adenomas
Cushing’s DISEASE
T/F: The same symptoms can also occur as a result of hypersecretion of corticosteroids from adrenocortical tumors (Cushing’s Syndrome).
True
Cushings Disease or Cushings syndrome?
_____= hypercortisolism occurs as a result of hypersecretion of ACTH from pituitary adenomas
________= same sxs as above but as a result of hypersecretion of corticosteroids from adrenocortical tumors
Cushing’s Disease= hypercortisolism occurs as a result of hypersecretion of ACTH from pituitary adenomas
Cushing’s Syndrome= same sxs as above but as a result of hypersecretion of corticosteroids from adrenocortical tumors
70% of cases of hypercortisolism are from Cushing’s Disease
What accounts for ~20% of the cases of hypercortisolism?
What about the remaining 10% of cases?
20%= Cushing’s Syndrome
10%= extrapituitary tumors (ex: small cell carcinoma of the lungs)
What is the most common source of ectopically secreted ACTH.
Extrapituitary tumors, like small cell carcinoma of the lungs
Pathology of which condition?
- Hyperplasia of the adrenals leads to bilateral thickening of the cortex.
- The tumor appears as discrete nodules or marked irregular enlargement of the entire gland.
- The tumors may be benign adenomas or malignant carcinomas.
Cushing’s Syndrome
Why are adrenocortical tumors yellow?
b/c of their high lipid content
_______ are usually well circumscribed whereas ________ tend to extend into the adjacent tissues
Adenomas, carcinomas
Symptoms of which condition?
- truncal or central obesity- most prominent on the face and trunk (moon face and buffalo hump)
- red in the face b/c of engorgement of blood
- HTN
- Thinning of the skin
- Fatigue
- Weakness
- Mental instability
- Glucose intolerance/DM
Cushing’s Syndrome
What are the most common biochemical disturbances in Cushing’s Syndrome
Glucose intolerance and Diabetes
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The following are common features of which condition?
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Cushing’s Syndrome
In clinical practice, what is the most common cause of Cushing’s Syndrome?
Exogenous Steroid hormones
(commonly used for tx of various immune disorders, renal disease, and many skin disorders)
Exogenously induced Cushing’s Syndrome responds well to what?
gradual tapering off and cessation of steroid treatment
***NO ABRUPT CESSATION B/C PT NOT PRODUCING ACTH–> COULD KILL THEM****