Describe what the following cell of the adenohypophysis produces: 1. somatotrophs 2. lactotrophs 3. corticotrophs 4. thyrotrophs 5. gonadotrophs

1. growth hormone (GH) 2. prolactin 3. adrenocorticotrophic hormone (ACTH) 4. thyroid stimulating hormone (TSH) 5. Follicle stimulating hormone (FSH) & Lutenizing hormone (LH)

Endocrine Pathology Flashcards by Annabella Moody

Functions of the endocrine system include: (4)

maintain metabolic equilibrium (homeostasis)
secrete chemical messengers (hormones)
regulate activities of various organs
process of feedback inhibition

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Maintaining metabolic equilibrium:

Homeostasis

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chemical messengers:

hormones

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In the process of feedback inhibition, increased activity of target tissue, typically ______ the activity of the gland secreting the stimulating hormone

down regulates

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diseases of under/overproduction of hormones

endocrine diseases

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Endocrine disease are associated with the development of:

mass lesions

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What are the three classification of endocrine diseases?

too little
toot much
others: tumors

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Tumors of endocrine glands, whether benign or malignant, may secrete the hormone native to the gland, these tumors are said to be:

functional tumors

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With functional tumors of endocrine glands, it may be the _____ of the tumor or the _____ that calls attention to the tumor

mass effect; metabolic effect of the excessive hormone

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List the endocrine organs: (6)

(excluding testicles, ovaries, thymus, pineal gland, hypothalamus)

anterior pituitary
posterior pituitary
thyroid
parathyroid
pancreas
adrenal glands

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Where is the pituitary gland located?

base of brain sella-turcica

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The pituitary gland is connected to the:

hypothalamus

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The pituitary gland is connected to the hypothalamus by:

-stalk composed of axons
-venous plexus

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What is the function of the pituitary gland?

Central role in regulation of other endocrine glands

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What are the two components of the pituitary gland?

anterior lobe (adenohypophysis)
posterior lobe (neurohypophysis)

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What part of the pituitary gland is the adenohypophysis?

anterior lobe

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What part of the pituitary gland is the neurohypophysis?

posterior lobe

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Disease of the pituitary gland are categorized base on:

the lobe they are mainly effecting

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Label the following image:

a) pons
b) midbrain
c) hypothalamus
d) pituitary gland

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What can be seen in the following image?

Pituitary gland

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Label the following image:

a) hypothalamus
b) anterior pituitary (adenohypophysis)
c) posterior pituitary (neurohypophysis)

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What are the different types of cells in the anterior pituitary?

somatotrophs
lactotrophs
corticotrophs
thyrotrophs
gonadotrophs

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Describe what the following cell of the adenohypophysis produces:

somatotrophs
lactotrophs
corticotrophs
thyrotrophs
gonadotrophs

growth hormone (GH)
prolactin
adrenocorticotrophic hormone (ACTH)
thyroid stimulating hormone (TSH)
Follicle stimulating hormone (FSH) & Lutenizing hormone (LH)

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growth hormone (GH)
prolactin
adrenocorticotrophic hormone (ACTH)
thyroid stimulating hormone (TSH)
Follicle stimulating hormone (FSH) & Lutenizing hormone (LH)

The following hormones are produced in the:

Anterior pituitary gland (adenohypophyisis)

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What hormones are produced in the posterior pituitary?

1. antidiuretic hormone (ADH, Vasopressin) 2. Oxytocin

1. antidiuretic hormone (ADH, Vasopressin) 2. Oxytocin The following hormones are produced in the:

posterior pituitary (neurohypophysis)

What is the function of the following hormone: Growth hormone (GH)

Tissue growth

What is the function of the following hormone: TSH

Stimulates thyroid to produce thyroid hormones

What is the function of the following hormone: ACTH

Acts on the adrenal gland to produce cortical hormones

What is the function of the following hormones: FSH & LH

Act on the testes to produce testosterone & sperm Act on the ovaries to produce the ova, estrogen & progesterone

What is the function of the following hormone: Prolactin (PRL)

Acts on breast glandular tissue

What is the function of the following hormone: Oxytocin

Acts on uterus for uterine contraction Functions in lactation

What is the function of the following hormone: ADH

Acts on kidney to stimulate water reabsorption

Diseases of the anterior pituitary include: (2)

1. hypopituitarism (decreased secretion of trophic hormones) 2. hypoerpituitarism (increased secretion of trophic hormones)

Disease of the anterior pituitary in which there is a decreased secretion of trophic hormones:

hypopituitarism

Disease of the anterior pituitary in which there is an increased secretion of trophic hormones:

hyperpituitarism

What are the characteristics of hypopituitarism:

destructive lesions/processes

give some examples of what might cause hypopituitarism:

-ischemia -radiation -inflammation -neoplasms

What are the characteristics of hyperpituitarism:

functional adenoma within the anterior lobe with local mass effects

What are some of the local mass effects involved in hyperpituitarism?

-enlargement of the sella turcica -visual field abnormalities -increased intracranial pressure

-Pituitary adenomas -radiation treatment -neurosurgery -sheehan syndrome These are all potential causes of:

hypopituitarism

Ischemic necrosis of the pituitary gland:

Sheehan syndrome (may cause hypopituitarism)

What are the clinical manifestations of hypopituitarism? (6)

1. pituitary dwarfism 2. amenorrhea & infertility 3. low libido & impotence 4. postpartum lactation failure 5. hypothyroidism 6. hypoadrenalism

1. pituitary dwarfism 2. amenorrhea & infertility 3. low libido & impotence 4. postpartum lactation failure 5. hypothyroidism 6. hypoadrenalism These are the clinical manifestations associated with:

hypopituitarism

-pituitary adenomas -pituitary hyperplasia -pituitary carcinomas -hypothalamic disorders These are all potential causes of:

Hyperpituitarism

What are the clinical manifestations of hyperpituitarism? (3)

1. gigantism 2. acromegaly 3. cushing disease

-condition of hyperpituitarism -excess growth hormone

gigantism

Gigantism is caused by ______ which produces excess growth hormone

primary tumor

The primary tumor of gigantism is an:

adenoma of the AP

What is the second most common anterior pituitary syndrome?

gigantism

What type of tissues are affected in gigantism?

all growing tissues

Gigantism occurs:

before growth plate closure

List the symptoms associated with gigantism: (7)

1. generalized overgrowth (3 standard deviations) 2. headaches 3. chronic fatigue 4. arthritis & osteoporosis 5. muscle weakness 6. hypertension 7. CHF

-condition of the anterior pituitary with excess GH -late diagnosis -poor vision (photophobia) -enlarged skull, hands, feet, ribs -soft tissues, viscera -enlarged maxilla, mandible, nasal & frontal bones, & maxillary sinus -intraoral manifestations

acromegaly

Describe the intraoral manifestations of acromegaly: (5)

1. diastemas 2. malocclusion 3. macroglossia 4. enlarged lips 5. sleep apnea

Diabetes insipidus (central) is a disease involving the:

posterior pituitary

What are two symptoms associated with diabetes insidipidus (central)?

1. polyuria (also dilute urine) 2. polydipsia

Diabetes insipidus (central) is due to irregularities of what hormone?

Secretions of inappropriately high levels of ADH (SIADH)

The secretion of inappropriately high levels of ADH (SIADH) seen in diabetes insipidus (central) may cause:

1. hyponatremia 2. cerebral edema 3. neurologic dysfunction 4. increased total body water

Describe the increased total body water seen in diabetes insipidus (central): (2)

1. blood volume normal 2. no peripheral edema

Iodide from a normal diet is stores in the _______ (bound to _____) and used for production of ____ & _____

thyroid gland; thyroglobulin; T3 & T4

T3 & T4 have identical chemical compositions except for:

addition of one iodide (in T4)

____ is produced exclusively by the thyroid while majority of _____ is the result of ____ conversion

T4; T3; T4

_____ is the activator for synthesis of TSH

TRH (Thyrotropin releasing hormone)

TRH is the activator for synthesis of:

TSH

____ is the activator for T3 & T4 production

TSH (Thyroid stimulating hormone)

-T3/T4 levels are low -elevation in ____ levels -increase in T3/T4 production

TSH

TRH controls _____ production

TSH

TSH controls _____ production

T3 & T4

The three glands responsible for thyroid function include:

1. hypothalamus 2. pituitary 3. thyroid

A very small amount of T3 & T4 is not bound to ______ and remains _____

thyroxine binding proteins; free in circulation

What form of T3 & T4 are metabolically active?

The small percentage of each that are free in circulation (not bound)

What is the affect on basal metabolic rate with: 1. decreased T3 & T4 2. increased T3 & T4

1. Decreased BMR 2. Increased BMR

Low levels of T3 & T4 have what effect on gluconeogenesis & glycogenolysis?

Decreased gluconeogenesis & decreased glycogenolysis

High levels of T3 & T4 have what effect on gluconeogenesis & glyconeogenesis?

increased gluconeogenesis & increased glycogenolysis

Low levels of T3 & T4 have what effect on protein metabolism?

Decreased protein synthesis & decreased proteolysis

High levels of T3 & T4 have what effect on protein metabolism?

Increased protein synthesis & increased proteolysis & muscle wasting

Low levels of T3 & T4 have what effect on lipid metabolism?

Decreased lipogenesis & decreased lipolysis Increased serum cholesterol

High levels of T3 & T4 have what effect on lipid metabolism?

Increased lipogenesis & increased lipolysis Decreased serum cholesterol

Low levels of T3 & T4 have what effect on thermogenesis?

Decreased thermogenesis

High levels of T3 & T4 have what effect on thermogenesis?

Increased thermogenesis

Low levels of T3 & T4 have what effect on the autonomic nervous system?

Normal levels of serum catecholamines

High levels of T3 & T4 have what effect on the autonomic nervous system?

Increased expression of Beta-adrenoreceptors (increased sensitivity to catecholamines, which remain at normal levels)

Discuss the causes of primary hypothyroidism:

1. intrinsic abnormality in the thyroid 2. surgery 3. radiotherapy 4. autoimmune

Discuss the causes of secondary hypothyroidism:

Pituitary failure

-Hypothyroidism -adult -generalized fatigue -apathy -mental sluggishness -listless -cold intolerance -overweight This describes:

myxedema

-Hypothyroidism -childhood -impaired skeletal development -severe mental retardation -short stature -course facial features -delayed tooth eruption This describes:

Cretinism

The adult form of hypothyroidism:

myxedema

The childhood form of hypothyroidism:

cretinism

Symptoms of hypothyroidism include: (5)

1. cold intolerance 2. fatigue, lethargy 3. weight gain 4. constipation 5. bradycardia

Despite elevated TSH levels, in the condition of ______ the thyroid continues to produce reduced levels of T3/T4. This malfunction is permanent.

Hypothyroidism

How is hypothyroidism treated? What is the outcome?

Treated with replacement therapy, TSH values return to normal

In hypothyroidism if TSH is increased, this is considered ________ hypothyroidism

primary

In hypothyroidism if TSH is decreased, this is considered ______ hypothyroidism

secondary

In both primary & secondary hypothyroidism _____ is low

What is the treatment of both primary & secondary hypothyroidism?

supplement

Hashimoto thyroiditis is a ______ disease

autoimmune

Describe the thyroid in Hashimoto thyroiditis:

painless enlargement, symmetric & diffuse

What is a risk associated with Hashimoto thyroiditis?

Risk of B-cell non-Hodgkins lymphomas

Clinical signs and symptoms of hyperthyroidism include: (7)

1. goiter (small) 2. exopthalmous (frequent) 3. heat intolerance 4. weightloss, muscle wasting 5. malabsorption & diarrhea 6. tachycarida 7. irritability & anxiety

The most common cause of hyperthyroidism is:

autoimmune- grave's disease

Discuss the following laboratory levels associated with hyperthyroidism: 1. T4 & Free T4 2. T3 & Free T3 3. TSH 4. TRH

1. Elevated 2. Elevated 3. Suppressed 4. Suppressed

In hyperthyroidism despite low _____ levels, the thyroid continues producing elevated _____ levels

TSH; T3/T4

In hyperthyroidism despite low TSH levels, the thyroid continues producing elevated T3/T4 levels. This is possible because of _______ which stimulate the thyroid hormone production. This thyroid hyperfunction is permanent.

autoantibodies (TSI= thyroid stimulating immunoglobulins)

In hypethyroidism, because of feedback from thyroid hormones T3 & T4, TSH production & release is:

reduced

What is seen in this image? What is this characteristic of?

Exopthalmos; hyperthyroidism

Describe some symptoms associated with Grave's disease: (5)

(hyperthyroidism) -tachycardia -increased appetite -weightloss -exopthalmos -heat intolerance

In grave's disease autoantibodies are created against:

TSH receptors

In primary grave's disease, TSH levels are:

low

In secondary grave's disease, TSH levels are:

normal to high

In both primary & secondary grave's disease, describe the levels of T3 & T4:

Increased

What is the treatment for grave's disease?

ablation

What is one major concern with Grave's disease?

Occurrence of thyroid storm

In grave's disease, thyroid storms may be caused by:

1. infection 2. stress 3. trauma

Describe what may occur with a thyroid storm:

-elevated body temp -tachycardia -20-40% mortality

Diffuse & multinodular goiter can be described by:

1. thyroid enlargement 2. impaired synthesis of thyroid hormone 3. euthyroid (maintenance of minimal function)

In diffuse & multinodular goiter impaired synthesis of thyroid hormone is due to:

1. iodine deficiency (endemic) 2. hyperplasia of follicles (pituitary stimulation)

In diffuse & multinodular goite, the maintenance of minimal function of the thyroid is called:

euthyroid

List the sequence of events in endemic goiter:

1. diet deficient in iodine 2. decreased output of T3 & T4 by thyroid 3. Pituitary response by secreting TSH 4. Thyroid hyperplasia

What can be seen in the following images?

Endemic goiter

What type of thyroid neoplasm is being described below: -solitary -males -younger -warm/cold nodules

adenoma

What type of thyroid neoplasm is being described below: -75-85% -all ages -radiation -10yr survival = 95% -worse outcome in elderly

Papillary carcinoma

What type of thyroid neoplasm is being described below: -10-20% -older -iodine deficiency -cold nodules

follicular carcinoma

What type of thyroid neoplasm is being described below: -5% -neuroendocrine -calcitonin (C cells) -amyloid -MEN 2 A/B (20%)

Medullary carcinoma

Usually presents as solitary, non-functioning nodule:

Papillary carcinoma

The parathyroid glands are derived from:

developing pharyngeal pouches

Lie in close proximity to upper and lower poles of each thyroid lobe:

Parathyroid glands

May be found on a path of descent of pharyngeal pouches- carotid sheath, thymus, anterior mediastinum:

Parathyroid glands

What do the parathyroid glands secrete?

PTH

The parathyroid glands secrete PTH, which with ______ regulates ____

calcitonin, calcium homeostasis

The parathyroid glands secrete PTH, which with calcitonin regulates calcium homeostasis- controlled by the level of:

free (ionized) calcium

PTH: 1. activates ____ activity 2. increases______ resorption 3. increases ______ into the active ____ form in the kidneys 4. increases urinary excretion of ____ 5. increases ____ absorption by the GI tract

1. osteoclast 2. Ca renal tubular 3. conversion of Vitamin D; dihydroxy form 4. phosphates 5. Ca

What is an iatrogenic cause of hypoPARAthyroidism?

Surgically induced

The congenital absence of the parathyroid glands resulting hypoPARAthyroidism:

DiGeorge syndrome

What is an autoimmune cause of hypoPARAthyroidism?

APECED

What are the three characteristic signs of hypoPARAthyroidism?

1. hypocalcemia 2. Chvostek sign 3. Trosseau sign

Hypocalcemia from hypoPARAthyroidism may result in:

tetany

Describe Chvostek sign associated with hypoPARAthyroidism:

When tapping cranial nerve VII muscle contraction of the eye, mouth & nose

Describe the Trosseau sign associated with hypoPARAthyroidism:

Occluding circulation of forearm resulting in carpalspasm

What can be seen in the following image? What is this caused by? What condition is this characteristic of?

Trosseau sign caused by tetany in patient with hypoPARAthyroidism

What condition is associated with the following images?

HypoPARAthyroidism

Primary hyperPARAthyroidism is caused by: (include percentages)

1. adenoma (75-80%) 2. hyperplasia (10-15%) 3. carcinoma (<5%)

Secondary hyperPARAthyroidism is caused by:

Renal failure

Primary hyperPARAthyroidism caused by adenoma is associated with:

one gland

Primary hyperPARAthyroidism caused by hyperplasia is associated with: (2)

1. multiglandular 2. MEN 1& 2a,b

Adenoma (one gland), hyperplasia (multiglandular) & MEN 1, 2a,b, & carcinoma are all causes of:

primary hyperPARAthyroidism

What are some outcomes of renal failure that are responsible for contributing to secondary hyperPARAthyroidism?

1. hyperphosphatemia 2. chronic hypocalcemia 3. vitamin D deficiency

Adenoma, hyperplasia, and carnoma are all responsible for:

primary hyperPARAthyroidism

What morphologic changes are associated with primary hyperPARAthyroidism?

1. Skeletal changes 2. serum calcium level changes

What are the skeletal changes seen in primary hyperPARAthyroidism?

1. bone resorption 2. formation of bone cysts & hemorrhages (osteitis fibrosa- cystic) 3. brown tumors 4. urinary tract stones (nephrolithiasis) 5. metastatic calcification

1. bone resorption 2. formation of bone cysts & hemorrhages (osteitis fibrosa- cystic) 3. brown tumors 4. urinary tract stones (nephrolithiasis 5. metastatic calcification These are all skeletal changes seen in:

Primary & secondary hyperPARAthyroidism

in primary hyperPARAthyroidism, serum calcium levels are high, especially:

ionized calcium levels

-Hypercalcemia -Hypophosphatemia -Increased urinary excretion of both calcium & phosphate These all accompany:

Primary hyperPARAthyroidism

In this condition, calcium is chronically depressed and low serum calcium levels lead to compensatory hyperactivity of the parathyroids. Serum phosphate levels are elevated.

Secondary hyperPARAthyroidism

Describe the serum calcium levels and serum phosphate levels associated with secondary hyperPARAthyroidism:

Low serum calcium levels High serum phosphate levels

Describe the serum calcium levels and serum phosphate levels associated with primary hyperPARAthyroidism:

High serum calcium levels (especially ionized Ca) Low serum phosphate levels

What are the causes of secondary hyperPARAthyroidism? (4)

1. chronic renal failure 2. vitamin D deficiency 3. inadequate dietary calcium 4. steatorrhea

Describe the morphologic changes associated with secondary hyperPARAthyroidism: (3)

1. hyperplastic parathyroid glands 2. bone changes 3. metastatic calcification

What has more severe clinical features, primary or secondary hyperPARAthyroidism?

Primary

The clinical features of secondary hyperPARAthyroidism are related to symptoms secondary to:

chronic renal failure

Describe the bone abnormalities associated with secondary hyperPARAthyroidism:

renal osteodystrophy

Seen with secondary hyperPARAthyroidism, elevated calcium & phosphate products; causes blood clots & painful skin ulcers:

Calciphylaxis

Occurs when excess parathyroid hormone is secreted by the parathyroid glands, usually after long-standing secondary hyperPARAthyroidism:

Tertiary hyperPARAthyroidism

-Osteomalacia & loss of lamina dura -brown tumor -nephrolithiasis -peptic/duodenal ulcers -mental changes These are all related to:

hyperPARAthyroidism

What saying is used to described the symptoms of hyperPARAthyroidism:

Stones, bones, moans, & groans

PTH functions to: 1. ____ serum calcium 2. ____ osteoclats 3. ____ renal tubular reabsorption of calcium 4. ___ renal conversion of vitamin D 5. _____ urinary excretion of phosphate 6. _____ gastric absorption of calcium

1. increases 2. activates 3. increases 4. increases 5. increases 6. increases

What are shown in the following images?

Adrenal glands

Little beanies on top of the kidneys:

Adrenal glands

From outermost to innermost layer in a transverse section of the adrenal glands the layers include:

Capsule, cortex, medulla

Label the following image:

a) capsule b) zona glomerulosa c) zona fasiculata d) zona reticularis e) medulla

The outermost layer of the adrenal gland cortex is the _____

zona glomerulosa

The zona glomerulosa produces _____ which is regulated by _____

aldosterone; angiotensin II

The middle layer of the adrenal gland cortex is the _____

zona fasciculata

The zona fasciculata produces _____ which is regulated by _____

glucocorticoids (cortisol); ACTH (biofeedback)

The innermost layer of the adrenal gland cortex (right outside the medulla):

Zona reticularis

The zona reticularis produces ______ and has no feedback with _____

androgens; ACTH

What is produced by the medulla of the adrenal gland?

Epinephrine & norepinephrine

Adrenal cortex pathology associated with too little:

adrenal insufficiency

acute adrenal insufficiency:

Waterhouse-friderichsen

Primary chronic adrenal insufficiency:

Addison's disease

Adrenal cortex pathology associated with too much: (3)

1. Hyperaldosteronism 2. Hypercorticolism 3. Adrenogenital syndrome

Destruction of the adrenal cortex resulting in decreased production of adrenal corticosteroid hormones:

Addison's disease

Addison's disease is categorized as a ____ disease

autoimmune

What type of cancer is associated with Addison;s disease?

Metastatic caricnoma

What infections are associated with Addison's disease?

1. deep final infections 2. TB (both involved with AIDs)

Addison's disease is a ______ hypoadrenocorticism, involving destruction of the adrenal cortex Secondary hypoadrenocorticism is a disorder of the ____ or ______

primary hypothalamus or pituitary