Endocrine System Pathology Flashcards
sudden onset of neurologic impairment due to a rapidly enlarging adenoma
pituitary apoplexy
cut off value to determine micro and macroadenomas
1cm
most common cause of hyperpituitarism
prolactin cell adenoma
second most common cause of hyperpituitarism
somatotroph adenoma
[diagnosis: pituitary cell type]
galactorhea, amenorrhea (in females), seuxal dysfunction, infertility
lactotroph
Hormone: prolactin
[diagnosis: pituitary cell type]
gigantism (children), acromegaly (adults)
Somatotroph
hormone: GH
[diagnosis: pituitary cell type]
cushing syndrome, presence of large, nelson syndrome
Corticotroph
hormone: ACTH
___ syndrome
destructive adenoma after adrenalectomy for treatment of cushing syyndrome
Nelson syndrome
[diagnosis: pituitary cell type]
Hyperthyroidism
Thyrotroph
Hormone: TSH
[diagnosis: pituitary cell type]
Hypogonadism, mass effect, hypopituitarism
Gonadotroph
Hormone: FSH, LH
[diagnosis: pituitary]
uniform, polygonal cells in sheets and cords, sparse reticulin network, invasion and increased mitosis: atypical adenomas
pituitary adenoma
[diagnosis: pituitary]
atypical adenomas + metastasis (CSF/systemic)
pituitary CA
hormone that is lost first following hypopituitarism
FSH and LH
hormone that is lost last following hypopituitarism
prolactin
[diagnosis: pituitary hormone deficiency]
amenorrhea, infertility, decreased libidi, impotence, loss of pubic and axillary hair
FSH, LH
[diagnosis: pituitary hormone deficiency]
pallor
MSH
[diagnosis: pituitary syndromes]
Serum Na: increased
Plasma Osm: increased
Urine Na: decreased
Urine Osm: Decreased
UO increased
CVP decreased
ADH is low
Central DI
[diagnosis: pituitary syndromes]
Serum Na: increased
Plasma Osm: increased
Urine Na: decreased
Urine Osm: Decreased
UO increased
CVP decreased
ADH is high
nephrogenic DI
due to unresponsiveness of renal tubules to ADH
[diagnosis: pituitary syndromes]
Serum Na: low
Plasma Osm: low
Urine Na: high
Urine Osm: high
UO low
CVP high
ADH is high
SIADH
[diagnosis]
vestifgial remnant of rathke pouch, mass effect, compress pituitary parenchyma
craniopharyngioma
[diagnosis: pituitary]
nest of squamous cells with peripheral palisading around a spongy reticulum
tumor nests float on wet keratin
cranipharyngioma
most common cause of congenital hypothyroidism world wide
iodine deficiency
most common cause of hypothyroidism in iodine-sufficient areas
Hashimoto Thyroiditis
[diagnosis]
infancy to early childhood, impaired CNS development, short stature, coarse facial features, protruding tongue, umbilical hernia
cretinism
[diagnosis]
late adulthood to adult, slowing of physical activity, overweight, hypercholesterolemia, non-pitting edema, coarse facial features, macroglossia, deepening of voice
myxedema
[diagnosis]
fibrosis of the thyroid gland + contiguous neck structures
Reidel Thyroiditis
[diagnosis]
hyperplastic follicles forming pseudopapillary structures, moth eaten colloid
graves ophthalmopathy
[diagnosis]
painless goiter, transient hyperthyroidism then hypothyroidism
autoantibodies against TG and TPO
hashimoto thyroiditis
[diagnosis]
painless goiter, transient hyperthyroidism then hypothyroidism
autoantibodies against TPO; usually associated with a history of autoimmune disease
Subacute Lymphocytic or postpartum
[Diagnosis]
painful, variable thyroid enlargement, transient hyperthyroidism then hypothyroidism then normal
antigen-mediated immune damage to follicular cells (by cytotoxic T cells)
notable history of URTI
Granulomatous
[diagnosis]
hurthle cell change present, present fibrosis, absent granulomas
present: lymphocyte, monocyte, plasma cell, and germinal center
Hashimoto
[diagnosis]
hurthle cell change absent, absent fibrosis, absent granulomas
present: lymphocyte, monocyte, plasma cell, and germinal center
Subacute Lymphocytic/postpartum
[diagnosis]
hurthle cell change absent, absent fibrosis, present granulomas with multinucleated giant cell
Acute phase: PMNs
Granulomatous
[diagnosis]
Hyperthyroidism
Ophthalmopathy
Dermopathy
Graves disease
Type of hypersensitivity of graves disease
Type II hypersensitivity
Autoantibodies against TSH receptor
[diagnosis]
low TSH
high FT3/FT4
Graves
[diagnosis: phase of goiter]
Trophic effects of TSH on gland, diffuse, symmetrical enlargement, colloid is less abundant
hyperplastic phase
[diagnosis: phase of goiter]
sufficient iodine intake/ decrease thyroid demand
brown, glassy, translucent cut surface
flattened and cuboidal follicular epithelium
abundant colloid
colloid or involution phase
cassava causes goiter since it contains
thiocyanate
____ syndrome
autonomous nodule in a long-standing TMNG, but no ophthalmopathy, no pretibial myxedema
Plummer Syndrome
[diagnosis]
non-functional thyroid nodule, enclosed by and intact, well-formed capsule
thyroid adenoma
[diagnosis]
non-functional thyroid nodule, no capsule noted
adenomatous nodule
[diagnosis]
non-functional thyroid nodule, capsular and vascular invasion noted
follicular CA
most common thyroid CA
papillary
second most common thyroid CA
follicular
thyroid CA arising from the parafollicular C cells
medullary
thyroid CA that is warm on scintiscan
follicular thyroid CA
Medullary Thyroid CA is associated with what MEN
MEN 2
[diagnosis]
high VIP, High ACTH, high calcitonin, hypocalcemia, MEN2
Medullary thyroid CA
[diagnosis: thyroid CA]
orphan annie nuclei, psammoma bodies, lymphatic invasion
papillary
[diagnosis: thyroid CA]
small, polygonal to spindle shape, acellular amyloid deposit, parafollicular C cell hyperplasia
medullary thyroid CA
[diagnosis: thyroid CA]
osteoclast-like multinucleated giant cells, spindle-shaped cells, Cytokeratin (+), Thyroglobulin (-)
Anaplastic thyroud CA
most common cause of secondary hyperparathyroidism
renal failure
most common cause of primary hyperparathyroidism
parathyroid adenoma
Stones, Thrones, Bones, Graons, psych overtones are clinical manifestations of?
hyperparathyroidism
___ disease of bone
increased osteoclast activity, peritrabecular fibrosis, cystic brown tumor
Von Recklinghausen disease
reliable criteria for parathyroid malignancy
metastasis and local invasion
[diagnosis]
calcifications of basal ganglia, frank psychosis, emotional instability, parkinsonian-like movement disorders
calcification of lens, QT prolongation
hypoparathyroidsm
cut off FBS value for impaired glucose tolerance
100-125 mg/dL
cut off FBS value for diabetes
> /126 mg/dL
cut off RBS value for diabetes
> / 200 mg/dL + 3 Ps
Cut off HBA1c value for diabetes
> / 6.5%
cut off value for 2hour 75g OGTT
> /200 mg/dL
Diabetic coma are due to
ketoacidosis, volume depletion
Type I DM is classified as ___ hypersensitivity reaction
Type IV
most important susceptibility gene in Type I DM is located in what chromosome
Chromosome 6
Triad of T2DM
genetic, environmental, proinflammatory state
most important environmental factor in T2DM pathogenesis
central or visceral obesity
[diagnosis]
hyperglycemia + ketoacidosis
DKA
[diagnosis]
hyperglycemia without ketoacidosis
Hyperosmotic hyperglycemic state
most common acute complication of DM
hypoglycemia
Microvascular changes in the kidneys due to T2DM
diffuse thickening of BM and leaky capillarues
[diagnosis]
nodular glomerulosclerosis or intercapillary glomerulosclerosis
(+) PAS
positive acellular nodules in glomerulus
Kimmelstiel-Wilson Disease
most common pancreatic neuroendocrine tumor
insulinomas
___ triad
Hypoglycemia (<50mg/dL)
Neuroglycopenic symptoms
Relief upon administration of parenteral glucose
Whipple triad
[diagnose]
hyperinsulinsm, whipple triad
usually benign
Histo: recapitulate normal pancreatic islet, amyloid deposition
insulinoma
___ syndrome
- Pancreatic islet tumor
- Hypersecretion of gastric acid
- severe peptic ulceration
Zollinger-Ellison syndrome
[diagnose]
Hypergastrinemia
Zollinger-Ellison Syndrome
usually malignant
Histo: recapitulate normal pancreatic islet
Gastrinoma
[diagnose]
DM, necrolytic migratory erythema, anema
alpha cell tumor
Glucagon
Glucagonomas
[diagnose]
DM, cholelithiasis, steatorrhea, hypochlorydia
gamma cell tumor
Somatostatin
Somatostatinomas
[diagnose]
watery diarrhea, hypokalemia, achlorydia
VIPoma
___ syndrome
VIPoma
Verner-Morrison Syndrome
[diagnose]
facial flushing, diarrhea, bronchoconstriction
Pancreatic Carcinoid
Serotonin
Most common cause of cushing syndrome (overall)
iatrogenic (exogenous steroids)
most common endogenous cause of Cushing syndrome
ACTH-secreting pituitary adenoma
[diagnose]
abdomina striae, obesity, buffalo hump, moon facies
cushing syndrome
[diagnose]
crooke-hyaline change (homogenous, paler cytoplasm of ACTH-secreting cells), increased 24 hour urine free cortisol, decreased plasma ACTH
ACTH-independent
[diagnose]
crooke-hyaline change (homogenous, paler cytoplasm of ACTH-secreting cells),
increased 24 hour urine free cortisol,
increased plasma ACTH
ACTH-dependent
[diagnose]
increased plasma aldosterone,
decreased plasma renin activity
primary hyperaldosteronism
[diagnose]
increased plasma aldosterone,
increased plasma renin activity
secondary hyperaldosteronism
most common cause of primary hyperaldosteronism
bilateral idiopathic hyperaldosteronism
most common cause of congenital adrenal hyperplasi
21-hydroxylase deficiency
waterhouse-friedrichsen syndrome can be complication of a disseminated bacterial infection. The causative agent is usually
N. meningitides
most common cause of primary chronic adrenocortical insufficiency
autoimmune adrenalitis
[diagnose]
irregularly shrunken adrenals with lymphoid infiltrates, hyperpigmentation is present
ACTH stimulation test: negative
addison disease
[diagnose]
adrenal has a variable size, hyperpigmentation is absent
ACTH stimulation test: positive
secondary adrenocortical insufficiency
[diagnose: adrenocortical neoplasm]
hypercortisolism and hyperaldosteronism
grossly: yellow, lipid-rich mass
minimal atypia, no necrosis,
adenoma
[diagnose]
virilization
gross:hemorrhage and cystic change
anaplastic, marked mitosis, marked necrosis,
adrenal carcinoma
____ originates from chromaffin cells of medulla
pheochromocytoma
[diagnose]
nests of cell surrounded by sustentacular cells, salpt and paper chromatin, rich vascular network
pheochromocytoma
the only criteria for malignancy of pheochromocytoma
metastasis
[diagnose]
- Prolactinoma
- Primary hyperparathyroidism
- Insulinoma or gastrinoma
MEN 1
Wermer Syndrome
[diagnose]
- Pheochromocytoma
- parathyroid hyperplasia
MEN 2A
Sipple syndrome
[diagnose]
1, pheochromocytoma
- Neuroma
- Ganglioneuromas
- Marfanoid habitus
MEN 2B
