Endocrine 4

Question 1

Are benign or malignant thyroid neoplasms more common?

Answer 1

benign tumors are more common

Question 2

Only 3-4 cases of ___________ are diagnosed yearly per 100,000 people, and less than 1000 people die each year in U.S

Answer 2

Thyroid cancer

Question 3

What condition?

Presents as a nodule, which may vary in size, most being small, well encapsulated with fibrous tissue, and composed of thyroid follicles

Answer 3

follicular adenomas (a type of thyroid adenoma)

Question 4

how is the final diagnosis of a thyroid adenoma made?

Answer 4

only by microscopic examination of biopsy material

Question 5

Are thyroid adenomas premalignant? Do they require tx?

Answer 5

No

so small nodules dont require any tx

Question 6

Thyroid carcinomas occur in several histologic forms, including what 4 types?

Answer 6

In order of most common:

1. Papillary (by far MC)
2. Follicular
3. Medullary
4. Anaplastic

“Pappi Forgot Meds Again”

Question 7

All thyroid carcinomas originate from ______ cells, except for which one?

Answer 7

Follicular cells

Except Medullary Carcinoma

Question 8

T/F: no definite risk factors for developing thyroid cancers are known

Answer 8

true

Question 9

Are thyroid cancers more common in males or females?

Answer 9

Females

Question 10

Which cancer accounts for 80% of all thyroid cancers?

Answer 10

Papillary Carcinoma

Question 11

Which thyroid cancer?

It is a low-grade malignant lesion that is hormonally inactive

Answer 11

Papillary Carcinoma

Question 12

When do papillary carcinomas occur and when is the peak incidence?

Answer 12

Occurs early in life

peak incidence: 3rd to 5th decades

Question 13

Where does the papillary carcinoma tend to metastasize to?

Answer 13

local lymph nodes

distant mets are not found until late in the disease

Question 14

What is the prognosis of papillary carcinomas?

Answer 14

very favorable prognosis with 80% of patients still alive 10 yrs. after diagnosis.

Question 15

Which thyroid cancer differs from the other types of thyroid carcinomas in that it is derived from Parafollicular C-Cells

Answer 15

Medullary carcinomas

Question 16

Medullary Carcinoma-

What do the parafollicular C-cells (what medullary carcinomas are derived from) produce?

Answer 16

Like normal C-Cells, it produces Calcitonin, the hormone involved in regulating the homeostasis of Calcium

Question 17

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.

Answer 17

Medullary Carcinoma

Question 18

Which thyroid tumor?

A rare tumor with an extremely poor prognosis with most patients dying within one year of diagnosis.

Answer 18

Anaplastic Carcinoma

Question 19

Histologically, which tumors are composed of undifferentiated, large or small tumor cells that bear no resemblance to normal thyroid cells.

Answer 19

Anaplastic Carcinoma

Question 20

Adrenal hyperfunctioning results in which 3 partially overlapping syndromes?

Answer 20

1. Cushings Syndrome or hypercortisolism
2. Conn’s syndrome or hyperaldosteronism
3. Adrenogenital syndrome

Question 21

What is Cushing’s Syndrome caused by?

Answer 21

hypersecretion of glucocorticoids

Question 22

What is Conn’s Syndrome caused by?

Answer 22

hypersecretion of mineralcorticoids

Question 23

What is Adrenogenital Ayndrome caused by?

Answer 23

hypersecretion of the adrenal sex hormones

Question 24

Of these, which is addisons and which is cushings?

Answer 24

top is Addisons, bottom is Cushings

Question 25

Which layer of the adrenal cortex relates to Cushing’s Syndrome?

Answer 25

Zona fasciculata (produces glucocorticoids)

Question 26

Which of the 3 diseases of the adrenal cortex (Cushing’s syndrome, Conn’s syndrome or Adrenogenital syndrome) is most common?

Answer 26

Cushing’s syndrome

Question 27

Cushing’s Syndrome is caused by adrenal ______ or ______

Answer 27

Hyperplasia or neoplasia

Question 28

Cushing’s syndrome or Disease

In 70% of cases, hypercortisolism occurs as a result of hypersecretion of ACTH from pituitary adenomas

Answer 28

Cushing’s DISEASE

Question 29

T/F: The same symptoms can also occur as a result of hypersecretion of corticosteroids from adrenocortical tumors (Cushing’s Syndrome).

Answer 29

True

Question 30

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

Answer 30

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

Question 31

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?

Answer 31

20%= Cushing’s Syndrome

10%= extrapituitary tumors (ex: small cell carcinoma of the lungs)

Question 32

What is the most common source of ectopically secreted ACTH.

Answer 32

Extrapituitary tumors, like small cell carcinoma of the lungs

Question 33

Pathology of which condition?

1. Hyperplasia of the adrenals leads to bilateral thickening of the cortex.
2. The tumor appears as discrete nodules or marked irregular enlargement of the entire gland.
3. The tumors may be benign adenomas or malignant carcinomas.

Answer 33

Cushing’s Syndrome

Question 34

Why are adrenocortical tumors yellow?

Answer 34

b/c of their high lipid content

Question 35

_______ are usually well circumscribed whereas ________ tend to extend into the adjacent tissues

Answer 35

Adenomas, carcinomas

Question 36

Symptoms of which condition?

1. truncal or central obesity- most prominent on the face and trunk (moon face and buffalo hump)
2. red in the face b/c of engorgement of blood
3. HTN
4. Thinning of the skin
5. Fatigue
6. Weakness
7. Mental instability
8. Glucose intolerance/DM

Answer 36

Cushing’s Syndrome

Question 37

What are the most common biochemical disturbances in Cushing’s Syndrome

Answer 37

Glucose intolerance and Diabetes

Question 38

The following are common features of which condition?

Answer 38

Cushing’s Syndrome

Question 39

In clinical practice, what is the most common cause of Cushing’s Syndrome?

Answer 39

Exogenous Steroid hormones

(commonly used for tx of various immune disorders, renal disease, and many skin disorders)

Question 40

Exogenously induced Cushing’s Syndrome responds well to what?

Answer 40

gradual tapering off and cessation of steroid treatment

***NO ABRUPT CESSATION B/C PT NOT PRODUCING ACTH–> COULD KILL THEM****