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Pathology > Endocrine Pathology- Exam II > Flashcards

Endocrine Pathology- Exam II Flashcards

1
Q

Functions of the endocrine system include: (4)

A
  1. maintain metabolic equilibrium (homestasis)
  2. secrete chemical messengers (hormones)
  3. regulate activities of various organs
  4. process of feedback inhibition
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2
Q

Maintaining metabolic equilibrium:

A

homeostasis

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3
Q

Chemical messengers:

A

hormones

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4
Q

In the process of feedback inhibition, increased activity of target tissue, typically ____ the activate of the gland secreted the stimulating hormone

A

down regulates

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5
Q

Diseases of under/over production of hormones:

A

endocrine diseases

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6
Q

Endocrine diseases are associated with development of:

A

mass lesions

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7
Q

What are the 3 classifications of endocrine diseases?

A
  1. too little
  2. too much
  3. others: tumors
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8
Q

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

A

functional tumors

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9
Q

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

A

mass effect; or metabolic effect of the excessive hormone

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10
Q

List the endocrine organs: (6) -
excluding testicles, ovaries, pineal gland, hypothalamus

A
  1. anterior pituitary
  2. posterior pituitary
  3. thyroid
  4. parathyroid
  5. pancreas
  6. adrenal gland
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11
Q

Where is the pituitary gland located?

A

base of brain- sella turcica

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12
Q

The pituitary gland is connected to the:

A

hypothalamus

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13
Q

The pituitary gland is connected to the hypothalamus by:

A
  • stalk composed of axons
  • venous plexus
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14
Q

What is the function of the pituitary gland:

A

central role in regulation of other endocrine glands

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15
Q

What are the two components of the pituitary gland?

A
  1. anterior lobe (adenohypophysis)
  2. posterior lobe (neurohypophysis)
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16
Q

What part of the pituitary gland is the adenohypophysis?

A

anterior lobe

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17
Q

What part of the pituitary gland is the neurohypophysis?

A

posterior lobe

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18
Q

How are the diseases of the pituitary gland categorized?

A

based on what lobe is mainly affected

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19
Q

Label the following image:

A

A: pons
B: midbrain
C: hypothalamus
D: pituitary gland

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20
Q

What can be seen in the following image?

A

pituitary gland

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21
Q

Label the following image:

A

A: hypothalamus
B: anterior pituitary (adenohypophysis)
C: posterior pituitary (neurohypophysis)

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22
Q

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

A
  1. somatotrophs
  2. lactotrophs
  3. corticotrophs
  4. thyrotrophs
  5. gonadotrophs
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23
Q

Describe what the following cell of the adenohypophysis produces:

  1. somatotrophs
  2. lactotrophs
  3. corticotrophins
  4. thyrotrophs
  5. gonadotrophs
A
  1. growth hormone (GH)
  2. prolactin
  3. adrenocorticotrophic hormone (ACTH)
  4. thyroid stimulating hormone (TSH)
  5. follicle stimulating hormone (FSH) and luteinizing hormone (LH)
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24
Q

The following hormones are produced in the:

  1. growth hormone (GH)
  2. prolactin
  3. adrenocorticotrophic hormone (ACTH)
  4. thyroid stimulating hormone (TSH)
  5. follicle stimulating hormone (FSH) and luteinizing hormone (LH)
A

anterior pituitary (adenohypophysis)

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25
Q

What hormones are produced in the posterior pituitary? (2)

A
  1. Antidiuretic Hormone (ADH/Vasopressin)
  2. Oxytocin
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26
Q

The following hormones are produced in the:

  1. Antidiuretic Hormone (AHD/Vasopressin)
  2. Oxytocin
A

posterior pituitary (neurohypophysis)

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27
Q

What is the function of the following hormone?

Growth hormone (GH)

A

tissue growth

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28
Q

What is the function of the following hormone?

TSH

A

Stimules thyroid to produce thyroid hormones

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29
Q

What is the function of the following hormone?

ACTH

A

Acts on the adrenal gland to produce cortical hormones

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30
Q

What is the function of the following hormones?

FSH and LH

A

Act on the testes to produce testorone and sperm

Act on the ovaries to produce the ova, estrogen, and progesterone

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31
Q

What is the function of the following hormone?

Prolactin (PRL)

A

Acts on breast glandular tissue

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32
Q

What is the function of the following hormone?

Oxytocin

A

Acts on uterus for uterine contraction; functions in lactation

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33
Q

What is the function of the following hormone?

ADH

A

Acts on kidney to stimulate water reabsorption

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34
Q

Diseases of the anterior pituitary include:

A
  1. Hypopituitarism (decrease secretion of trophic hormones)
  2. Hyperpituitarism (increased secretion of trophic hormones)
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35
Q

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

A

hypopituitarism

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36
Q

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

A

hyperpituitarism

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37
Q

What are the characteristics of hypopituitarism?

A

destructive lesions/processes

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38
Q

Give some examples of what might cause hypopituitarism:

A
  • ischemia
  • radiation
  • inflammation
  • neoplasms
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39
Q

What are the characteristics of hyperpituitarism?

A

functional adenoma within the anterior lobe with local mass effects

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40
Q

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

A
  • enlargement of sella turcica
  • visual field abnormalites
  • increased intracranial pressure
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41
Q
  • pituitary adenomas
  • radiation treatment
  • neurosurgery
  • Sheehan syndrome

These are all potential causes of:

A

hypopituitarism

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42
Q

Ischemic necrosis of the pituitary gland:

A

Sheehan syndrome (may cause hypopituitarism)

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43
Q

What are the clinical manifestations of hypopituitarism? (6)

A
  1. pituitary dwarfism
  2. amenorrhea & infertility
  3. low libido & impotence
  4. postpartum lactation failure
  5. hypothyroidism
  6. hypoadrenalism
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44
Q
  1. pituitary dwarfism
  2. amenorrhea & infertility
  3. low libido & impotence
  4. postpartum lactation failure
  5. hypothyroidism
  6. hypoadrenalism

These are all clinical manifestations of:

A

hypopituitarism

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45
Q
  • pituitary adenomas
  • pituitary hyperplasia
  • pituitary carcinomas
  • hypothalamic disorders

These are all potential causes of:

A

hyperpituitarism

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46
Q

What are the clinical manifestations of hyperpituitarism?

A
  1. gigantism
  2. acromegaly
  3. Cushing disease
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47
Q
  • condition of hyperpituitarism
  • excess growth hormone (GH)
A

gigantism

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48
Q

Gigantism is caused by ____ which produces excess growth hormone

A

primary tumor

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49
Q

The primary tumor in gigantism is an:

A

adenoma of the AP

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50
Q

what is the second most common anterior pituitary syndrome?

A

gigantism

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51
Q

What type of tissues are affected in gigantism?

A

all growing tissues

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52
Q

Gigantism occurs:

A

before growth plate closure

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53
Q

List the symptoms associated with gigantism: (7)

A
  1. generalized overgrowth (3 standard deviations)
  2. headaches
  3. chronic fatigue
  4. arthritis & osteoporosis
  5. muscler weakness
  6. hypertension
  7. CHF
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54
Q
  • condition of anterior pituitary with excess growth hormone
  • late diagnosis
  • poor vision
  • enlarged skull, hands, feet, & ribs
  • soft tissue, viscera
  • enlarged maxilla, mandible, nasal & frontal bones, & maxillary sinus
  • intraoral manifestations
A

acromegaly

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55
Q

Describe the intraoral manifestations of acromegaly: (5)

A
  1. diastemas
  2. malocclusion
  3. macroglossia
  4. enlarged lips
  5. sleep apnea
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56
Q

Diabetes insipidus (central) is a condition involving the:

A

posterior pituitary

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57
Q

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

A
  1. polyuria (dilute urine)
  2. polydipsia
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58
Q

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

A

Secretion of innapropriotely high levels of ADH (SIADH) from the posterior pituitary

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59
Q

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

A
  1. hyponatremia
  2. cerebral edema
  3. neurologic dysfunction
  4. increased total body water
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60
Q

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

A
  • blood volume normal
  • no peripheral edema
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61
Q

Iodide from a normal diet is stored in the ____ (bound to ____) and used for production of ___ and ___

A

thyroid gland (bound to thyroglobulin); T3 and T4

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62
Q

T3 and T4 have identical chemical compositions except for:

A

addition of one iodide (in T4)

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63
Q

___ is produced exclusively by the thyroid while majority of ___ is the result of ___ conversion

A

T4; T3; T4

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64
Q

____ is the activator for synthesis of TSH

A

TRH (thyrotropin releasing hormone)

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65
Q

TRH is the activator for synthesis of:

A

TSH

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66
Q

____ is the activator for T3 and T4 production

A

TSH (Thyroid Stimulating hormone)

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67
Q
  • T3/T4 levels are low
  • Elevation in ____ levels
  • Increase in T3/T4 production
A

TSH

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68
Q

TRH controls ___ production

A

TSH

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69
Q

TSH controls ___ production

A

T3/T4

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70
Q

The 3 glands that are responsible for thyroid function include:

A
  1. hypothalamus
  2. pituitary
  3. thyroid
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71
Q

A very small percentage of T3 and T4 is not bound to ____ and remains ___

A

thyroxine binding proteins; free in circulation

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72
Q

What form of T3 and T4 are metabolically active?

A

the small percentages of each that are free in circulation

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73
Q

What is the effect on basal metabolic rate with:

  1. decreased T3 and T4
  2. increased T3 and T4
A
  1. decreased BMR
  2. increased BMR
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74
Q

Low levels on T3 and T4 have what effect on gluconeogenesis and glycogenolysis?

A

decreased gluconeogenesis & decreased glycogenolysis

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75
Q

High levels of T3 and Tr have what effect on gluconeogeneis and glycogenolysis

A

increased gluconeogenesis & increased glycogenolysis

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76
Q

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

A

decreased protein synthesis & decreased proteolysis

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77
Q

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

A

increased protein synthesis, increased proteolysis and muscle wasting

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78
Q

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

A

decreased lipogenesis & decreased lipolysis & increased serum cholesterol

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79
Q

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

A

increased lipogenesis & increased lipolysis & decreased serum cholesterol

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80
Q

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

A

Decreased thermogenesis

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81
Q

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

A

increased thermogenesis

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82
Q

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

A

normal levels of serum catecholamines

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83
Q

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

A

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

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84
Q

Discuss causes of primary hypothyroidism:

A
  1. intrinsic abnormality in the thyroid
  2. surgery
  3. radiotherapy
  4. autoimmune
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85
Q

Discuss the causes of secondary hypothyroidism:

A

pituitary failure

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86
Q

If hypothyroidism is caused by pituitary failure, this results in:

A

secondary hypothyroidism

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87
Q
  • Hypothyroidism
  • Adult
  • Generalized fatigue
  • Apathy
  • Mental sluggishness
  • Listless
  • Cold intolerance
  • Overweight

This describes:

88
Q
  • Hypothyroidism
  • Childhood
  • Impaired skeletal development
  • Severe mental retardation
  • Short stature
  • Course facial features
  • Delayed tooth eruption

These describe:

89
Q

The adult form of hypothyroidism:

90
Q

The childhood form of hypothyroidism:

91
Q

Symptoms of hypothyroidism include: (5)

A
  1. cold intolerance
  2. fatigue/lethargy
  3. weight gain
  4. constipation
  5. bradycardia
92
Q

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

A

hypothyroidism

93
Q

How is hypothyroidism treated? What is the outcome?

A

treated with replacement therapy, TSH values return to normal

94
Q

In hypothyroidism, if TSH is increased this is describing what form?

A

primary hypothyroidism

95
Q

In hypothyroidism, if TSH is decreased, this is describing what form?

A

secondary hypothyroidism

96
Q

In both primary and secondary hypothyroidism, ____ hormone is low

97
Q

What is the treatment of both primary and secondary hypothyroidism?

A

supplement

98
Q

Hashimoto Thyroiditis is a ____ disease

A

autoimmune

99
Q

Describe the thyroid in Hashimoto thyroiditis

A

painless enlargement; symmetric & diffuse

100
Q

What is a risk associated with Hashimoto thyroiditis?

A

Risk of B-cell non-hodgkins lymphomas

101
Q

Clinical signs and symptoms of hyperthyroidism include: (7)

A
  1. goiter (small)
  2. exophthalmus (frequent)
  3. heat intolerance
  4. weight loss & muscle waisting
  5. malabsorption and diarrhea
  6. tachycardia
  7. irritability and anxiety
102
Q

The most common cause of hyperthyroidism is:

A

autoimmune - graves disease

103
Q

Discuss the following laboratory levels associated with hyperthyroidism:

  1. T4 & free T4=
  2. T3 & free T3
  3. TSH =
  4. TRH =
A
  1. elevated
  2. elevated
  3. suppressed
  4. suppressed
104
Q

In hyperthyroidism despite low ____ levels, the thyroid continues producing elevated ____ levels.

A

TSH; T3&T4

105
Q

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 hyper function is permanent.

A

autoantibodies (TSI= thyroid stimulating immunoglobulins)

106
Q

In hyperthyroidism, because of feedback from thyroid hormones T3 and T4 , TSH production and release is:

107
Q

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

A

exopthalmos; hyperthyroidism

108
Q

Describe some symptoms associated with graves disease: (5)

A

(Hyperthyroidism)
- tachycardia
- increased appetite
- weight loss
- exopthalmos
- heat intolerance

109
Q

In graves disease, autoantibodies are created against the:

A

TSH receptors

110
Q

In primary graves disease, TSH levels are:

111
Q

In secondary graves disease, TSH levels are:

A

normal to high

112
Q

In both primary and secondary graves disease, describe the levels of T3 and T4:

113
Q

What is the treatment for graves disease?

114
Q

What is one major concern with graves disease?

A

thyroid storm

115
Q

In graves disease, thyroid storm may be caused by:

A
  1. infection
  2. stress
  3. trauma
116
Q

Describe what may occur with a thyroid storm?

A
  • elevated body temp
  • tachycardia
  • 20-40% mortality
117
Q

Diffuse and multi-nodular goiter can be described by:

A
  1. thyroid enlargement
  2. impaired synthesis of thyroid hormone
  3. euthyroid
118
Q

In diffuse and multi nodular goiter, impaired synthesis of thyroid hormone is due to:

A
  1. iodine deficiency (endemic)
  2. hyperplasia of follicles (pituitary stimulation)
119
Q

In diffuse and multi nodular goiter, the maintenance of minimal function of the thyroid is called:

120
Q

List the sequence of events in endemic goiter:

A
  1. diet deficient in iodine
  2. decreased output of T3 and T4 by thyroid
  3. pituitary responds by secreting TSH
  4. thyroid hyperplasia
121
Q

What can be seen in these images?

A

endemic goiter

122
Q

What type of thyroid neoplasm is being described?

  • solitary
  • males
  • younger
  • warm/cold nodules
123
Q

What type of thyroid neoplasm is being described?

  • 75-85%
  • all ages
  • radiation
  • 10 year survival = 95%
  • worse outcome in elderly
A

papillary carcinoma

124
Q

What type of thyroid neoplasm is being described?

  • 10-20%
  • older
  • iodine deficiency
  • cold nodules
A

follicular carcinoma

125
Q

What type of thyroid neoplasm is being described?

  • 5%
  • neuroendocrine
  • calcitonin (C cells)
  • amyloid
  • MEN 2 A/B (20%
A

medullary carcinoma

126
Q

Usually presents as solitary, non-functioning nodule:

A

papillary carcinoma

127
Q

The parathyroid glands are derived from:

A

developing pharyngeal pouches

128
Q

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

A

parathyroid glands

129
Q

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

A

parathyroid glands

130
Q

What do the parathyroid glands secrete?

131
Q

The parathyroid glands secrete PTH which, with ___ regulates ____

A

calcitonin; calcium homeostasis

132
Q

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

A

free (ionized) calcium

133
Q

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
A
  1. osteoclast
  2. Ca renal tubular
  3. conversion of vitamin D; dihydroxy
  4. phosphates
  5. calcium
134
Q

What is an iatrogenic cause of hypoPARAthyroidism?

A

surgically induced

135
Q

The congenital abscence of the parathyroid glands resulting in hypoPARAthyroidism:

A

DiGeorge syndrome

136
Q

What is an autoimmune cause of hypoPARAthyroidism?

137
Q

What are the three characteristic signs of hypoparathyroidism?

A
  1. hypocalcemia
  2. Chvostek sign
  3. Trousseau sign
138
Q

Hypocalcemia from hypoPARAthyroidism may result in:

139
Q

Describe Chvostek sign associated with hypoPARAthyroidism:

A

When tapping CN 7, muscle contraction of the eye, mouth, and nose

140
Q

Describe Trousseau sign associated with hypoPARAthyroidism:

A

when occluding circulation of forearm, carpal spasms occurs

141
Q

What can be seen in the following image?

A

trousseau’s sign caused by tetany in patient with hypoPARAthyroidism

142
Q

What condition is associated with the following images?

A

hypoparathyroidism

143
Q

Primary hyperPARAthyroidism is caused by: (include percentages)

A
  1. Adenoma (75-80%)
  2. Hyperplasia (10-15%)
  3. Carcinoma (<5%)
144
Q

Secondary hyperPARAthyroidism is caused by:

A

renal failure

145
Q

Primary hyperPARAthyroidism caused by adenoma is associated with:

146
Q

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

A
  1. multiglandular
  2. MEN 1 & 2a,b
147
Q

Adenoma (one gland), Hyperplasia (multi glandular and MEN 1,& 2a, b) and Carcinoma are all causes of:

A

primary hyperPARAthyroidism

148
Q

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

A
  1. hyperphosphatemia
  2. chronic hypocalcemia
  3. vitamin D deficiency
149
Q
  • adenoma, hyperplasia, and carcinoma are all responsible for:
A

primary hyperPARAthyroidism

150
Q

What morphologic changes are associated with primary hyperPARAthyroidism?

A
  1. skeletal changes
  2. serum calcium level changes
151
Q

What are the skeletal changes seen in primary hyperPARAthyroidism?

A
  1. bone resorption
  2. formation of bone cysts & hemorrhages (osteitis fibrosa- cystic)
  3. brown tumors
  4. urinary tract stones (nephrolithiasis)
  5. metastatic calcification
152
Q
  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:

A

primary and secondary hyperPARAthyroidism

153
Q

In primary hyperPARAthyroidism serum calcium levels are high, especially:

A

ionized calcium levels

154
Q
  • Hypercalcemia
  • Hypophosphateima
  • Increased urinary excretion of both calcium and phosphate

These all accompany:

A

primary hyperPARAthyroidism

155
Q

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

Serum phosphate levels are elevated

A

secondary hyperPARAthyroidism

156
Q

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

A

LOW serum calcium
HIGH serum phosphate

157
Q

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

A

HIGH serum calcium (especially ionized)
LOW serum phosphate

158
Q

What are the causes of secondary hyperPARAthyroidism? (4)

A
  1. Chronic renal failure
  2. Vitamin D deficinecy
  3. Inadequate dietary calcium
  4. Steatorreha
159
Q

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

A
  1. hyperplastic parathyroid glands
  2. bone changes
  3. metastatic calcification
160
Q

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

161
Q

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

A

chronic renal failure

162
Q

Describe the bone abnormalities associated with secondary hyperPARAthyroidism:

A

renal osteodystrophy

163
Q

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

A

calciphylaxis

164
Q

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

A

tertiary hyperparathryoidism

165
Q
  • osteomalacia & loss of lamina dura
  • brown tumor
  • nephrolithiasis
  • peptic/duodenal ulcers
  • mental changes

These are all related to:

A

hyperparathryoidism

166
Q

What saying is used to describe the symptoms of hyperPARAthyroidism?

A

stones, bones, moans, & groans

167
Q

PTH functions to:

  1. ____ serum calcium
  2. ____ osteoclasts
  3. ____ renal tubular absorption of calcium
  4. ____ renal conversion of vitamin D
  5. ____ urinary excretion of phosphate
  6. ____ gastric absorption of calcium
A
  1. increases
  2. activates
  3. increases
  4. increases
  5. increases
  6. increases
168
Q

What are shown in the following images?

A

adrenal glands

169
Q

Little beanies on top of the kidneys:

A

adrenal glands

170
Q

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

A

capsule, cortex, medulla

171
Q

Label the following image of the adrenal gland:

A

A: Capsule
B: Zona glomerulosa
C: Zona fasiculata
D: Zona reticularis
E: medulla

172
Q

The outermost layer of the adrenal cortex is the ____.

A

zona glomerulosa

173
Q

The zona glomerulosa produces ____ which is regulated by ____.

A

aldosterone; angiotensin II

174
Q

The middle layer of the adrenal cortex is the ____.

A

zona fasiculata

175
Q

The zona fasiculata produces ____ which is regulated by _____.

A

glucocorticoids (cortisol); ACTH (biofeedback)

176
Q

The innermost layer of the adrenal cortex (right outside the medulla) is the ___

A

zona reticularis

177
Q

The zona reticularis produces ____ and has no feedback with ____.

A

androgens; ACTH

178
Q

What is produced by the medulla of the adrenal gland?

A

epinephrine and norepinephrine (catecholamines)

179
Q

Adrenal cortex pathology associated with too little:

A

adrenal insufficiency

180
Q

Acute adrenal insufficiency:

A

waterhouse-friderichsen

181
Q

Primary chronic adrenal insufficiency:

A

Addisons disease

182
Q

Adrenal cortex pathology associated with too much: (3)

A
  1. hyperaldosterism
  2. hypercorticolism (Cushing syndrome)
  3. Adrenogenital syndrome
183
Q

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

A

Addisons disease

184
Q

Addisons disease is categorized as a ____ disease:

A

autoimmune

185
Q

What type of cancer is associated with Addisons disease?

A

metastatic carcinoma

186
Q

What infections are associated with Addisons disease?

A
  1. deep fungal infections
  2. TB

(both are involved with AIDS)

187
Q

Addisons disease is a ____ hypoadrenocorticism involving destruction of the adrenal cortex.

Secondary hypoadrenocorticism is a disorder of the ____ or ____.

A

primary

hypothalamus or pituitary

188
Q

In Addisons disease (primary hypoadrenocorticism involving destruction in the adrenal cortex) the clinical symptoms appear:

189
Q

Describe some symptoms with Addisons disease (primary hypoadrenocorticism involving destruction of the adrenal cortex): (5)

A
  1. weakness & fatigue
  2. postural hypotension
  3. GI disturbances
  4. hyperpigmentations (bronzing)
  5. adrenal crisis
190
Q

Describe the GI disturbances that may occur with Addisons disease (primary hypoadrenocorticism involving destruction of the adrenal cortex): (5)

A
  • nausea and vomiting (N/V)
  • anorexia
  • diarrhea
  • weight loss
  • salt cravings ( increased K+ and decreased Na+)
191
Q

Describe the hyperpigmentation (bronzing) involved in Addison’s disease (primary hypoadrenocorticism involving destruction of the adrenal cortex):

A
  • ACTH precursor stimulates melanocytes
  • frictional areas
192
Q

Describe the acute adrenal crisis that occurs with Addisons disease (primary hypoadrenocorticism involving destruction of the adrenal cortex): (3)

A
  • abdominal pain
  • hypotension
  • vascular collapse
193
Q

Primary hypercortisolism is considered:

A

endogenous

194
Q

Secondary hypercortisolism is considered:

195
Q

Is primary (endogenous) or secondary (exogenous) hypercortisolism more common?

A

secondary (exogenous)

196
Q

What is the cause of primary (endogenous) hypercortisolism?

A

too much endogenous steroid

197
Q

Primary (endogenous) hypercortisolism occurs in females at ___x more common rate as well as in the ___ decade of life

A

5x; 3rd decade

198
Q

Too much endogenous steroid is the cause of primary hypercortisolism. The large amount of the endogenous steroid may be due to: (include percentages)

A
  1. pituitary adenomas (that produce ACTH) 50%- involved in Cushing disease
  2. Adrenal hyperplasia & neoplasm (10-20%)
  3. Neuroendocrine tumors (that produce ACTH) -involved in small cell lung carcinoma
199
Q

What rule applies to secondary hypercortisolism?

A

rule of 2s

200
Q

Secondary hypercortisolism can become:

A

hypocortisol without taper

201
Q

What disease is being described?

Tumor in the anterior pituitary that releases excess ACTH causing adrenal hyperplasia. The adrenal hyperplasia produces excess amounts of cortisol:

A

Pituitary chasing syndrome

202
Q

What disease is being described?

Tumor in the adrenal gland producing excess cortisol.

OR

Nodular hyperplasia of the adrenal gland producing excess cortisol .

A

adrenal cushing syndrome

203
Q

What disease is being described?

Lung cancer or other non-endocrine cancer causing an increased production of ACTH. The increased ACTH acts on the adrenal gland to produce excess cortisol

A

paraneoplastic Cushing syndrome

204
Q

What disease is being described?

Patient takes an increased amount of steroids which causes adrenal atrophy

A

Cushing syndrome?? this one is weird I know

205
Q

What disease is being described?

  • Central obesity
  • Peripheral wasting
  • Buffalo hump
  • Moon facies
  • Abdominal striae
  • Hirsutism
  • Poor wound healing
  • Diabetes
  • Hyperglycemia
  • Osteoporosis
  • Hypertension
A

Hypercortisolism (Cushing syndrome)

206
Q

What disease does this man have? What are some key features in this image that leads you to the diagnosis?

A

Cushing syndrome (hypercortisolism)

  • red cheeks
  • moon face
207
Q

What disease can be seen in this image?
What are some key features in this image that leads you to the diagnosis?

A

Cushing syndrome (hypercortisolism)

  • pendulous abdomen
  • abdominal striae
  • moon face
  • red cheeks
208
Q

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

A

buffalo hump; Cushing syndrome (hypercortisolism)

209
Q

Adrenal neoplasms can occur in the:

A

cortex or medulla

210
Q

Adrenal neoplasms that occur in the cortex include:

A

adenomas & carcinomas

211
Q

Adrenal neoplasms that occur in the medulla include:

A

pheochromocytoma & neuroblastoma

212
Q
  • Cushing disease
  • hyperaldosteronism
  • “incidentalomas”

These area all due to:

A

adenomas of the adrenal cortex

213
Q

Carcinomas of the adrenal cortex are considered:

214
Q
  • Viralizing adenoma
  • Li-Fraumeni & Beckwith-Wiedemann

These are both results of:

A

adrenal cortex carcinoma

215
Q

Pheochromocytoma and neuroblastoma are both:

A

adrenal neoplasms of the medulla

Pathology (24 decks)

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