Exam 3 - Chapter 9: Endocrine Flashcards
2
The endocrine system consists of highly integrated and widely distributed groups of organs called _____.
glands
2
Glands create a state of _____ among the various organs of the body.
2
Signaling by secreted molecules can be classified into what three types?
3
Hormones act on target cells that are _____ from their ________.
3
Endocrine hormone is frequently carried by ___ from its site of release to its ______.
5
Production of several hormones from endocrine glands is stimulated by ________ released from the _______.
5
The endocrine hormone inhibits production of the _____, a process known as _____.
7
What are the 7 major endocrine glands?
9
Endocrine diseases can be classified as diseases of ___________ and their resulting biochemical and clinical consequences. Or, they can be classified as diseases associated with the development of _______ that may be _____ or may be associated with _________.
11
The pituitary gland is a ____ shaped structure at the base of the brain, within the ________.
11
The pituitary gland function is controlled by the ______.
11
The pituitary gland is connected to the hypothalamus by a _____ containing _____ extending from the hypothalamus and a __________.
11
Along with the hypothalamus, the pituitary gland has a central role in regulating what?
12
What is the name of the attachment between the hypothalamus and the pituitary?
13
What are the 6 hormones associated with the anterior pituitary?
13
What is the chemical class and effect of growth hormone?
13
What is the chemical class and effect of prolactin?
13
What is the chemical class and effect of thyroid stimulating hormone (TSH)?
13
What is the chemical class and effect of adenocroticotropic hormone (ACTH)?
13
What is the chemical class and effect of follicle-stimulating hormone (FSH)?
13
What is the chemical class and effect of luteinizing hormone?
14
What are the 2 hormones associated with the posterior pituitary lobe?
14
What is the chemical class and effect of antidiuretic hormone?
14
What is the chemical class and effect of oxytocin?
15
What is the hormone associated with the intermediate zone of the pituitary?
14
What is the chemical class and effect of melanocyte stimulating hormone?
14
The posterior pituitary does not produce hormones, but rather it ________.
15
______ cells in the hypothalamus release ______ or ______ into the posterior lobe of the pituitary gland. These hormones are stored or released into the blood via the _______.
17
Are pituitary adenomas benign or malignant?
17
What age group are pituitary adenomas most common in?
17
What is the most common cause of hyperpituitarism?
Pituitary adenomas are classified on the basis of _______ by the tumor cells.
17
Large pituitary adenomas, particularly _____ ones, may cause _______.
18
What is the seconnd most common functioning pituitary adenoma?
18
What hormone is associated with somatotroph adenoma?
18
What are the two disorders associated with somatotroph adenoma? When does each occur in relation to epiphyseal plate closure?
18
What is the most common pituitary adenoma?
18
What age and gender are most commonly affected by lactotroph adenomas?
18
What hormone is involved in lactotroph adenoma?
18
What are three disorders associated with lactotroph adenoma? Which genders are affected by each?
18
What hormone is associated with thyrotroph adenoma?
18
What is the associated disorder with thyrotroph adenoma?
18
What is the hormone associated with cotricotrph adenoma?
18
What disease is associated with corticotroph adenoma?
18
What two hormones are associated with gonadotroph adenoma?
18
What are the effects associated with gonadotroph adenoma?
20
When does gigantism occur?
20
At what ages do the epiphyseal growth plates close in boys vs. girls?
20
In gigantism, the growth is usually _____ with long arms and long legs.
20
What is superimposed with gigantism if increased GH levels persist beyond epiphyseal closure?
20
In gigantism, failure of enlarged organs, especially the _____, may occur.
21
With acromegaly, there is growth noted in ____, ____, _____ and ______ of the face, hands, and feet.
21
What are the three oral manifestations of acromegaly?
21
What are the two treatment options for acromegaly?
24
What is there excess production of in corticotroph adenoma?
24
Corticotroph adenoma leads to _________ and the development of _________.
25
Cushing disease is due to the excess production of _____ by __________ or _________.
25
Cushing Syndrome is excess levels of _____ due to ______, ________, or ________.
26
What are 8 signs and symptoms of Cushing Disease/Syndrome?
28
The anterior pituitary gland receives arterial supply from the ________, which is a branch of the ______. This vessels first forms a capillary network around the _______. Blood from this network is then transported to a secondary capillary plexus surrounding the anterior pituitary. Known as the ______. this structure allows the hypothalamys to communicate with the anterior pituitary via the release of ______ into the blood.
28
The infundibulum and posterior pituitary gland receive a rich blood supply from ______. The three major vessels are the _______.
29
What percent of the anterior pituitary is destroyed in anterior pituitary gland hormone disorders?
29
What is decreased in anterior pituitary gland hormone disorders?
29
What is the associated disorder of anterior pituitary gland hormone disorders?
29
What is decreased in posterior pituitary gland hormone disorders?
29
What is the associated disorder of posterior pituitary gland hormone disorders?
30
What is another name for Sheehan Syndrome?
30
What is Sheehan Syndrome due to?
30
During pregnancy, the anterior pituitary enlarges to _____. This physiologic expansion of the gland is not accompanied by _________. Hence, there is relative ______. Any further loss of blood supply caused by _______ or _____ may precipitate infarction of the anterior lobe.
31
What are four symptoms of Sheehan syndrome?
31
When may the Diagnosis for Sheehan syndrome be made?
31
What is the treatment for Sheehan Syndrome?
33
Diabetes insipidus is characterized by ________ due to the inability of the ______ to ________.
33
What are 5 conditions that diabetes insipidus can be seen in?
34
What are four symptoms associated with diabetes insipidus?
34
What is the treatment for Diabetes Insipidus?
36
The thyroid gland consists of _____ connected by a _____.
36
Where is the thyroid gland located relative to the larynx?
37
From what two main structures does the thyroid gland originate from?
37
Early in gestation, the thyroid gland begins its descent anterior to the pharynx as a _______. It then continues to descend anterior of the hyoid bone and the cartilages of the larynx. By the _____ week, it reaches its destination ______to the upper trachea
38
Where does the thyroid gland begin formation?
39
The thyroid gland is divided by thin fibrous septae into _____ composed of _____ follicles.
39
The follicles that compose the thyroid gland lobules are lined by ___ or _______ epithelium and filled with _______.
40
In response to hypothalamic factors, TSH is released from the ______ into the ______.
40
TSH binds to its receptors on thyroid ________.
40
Thyroid follicular epithelial cells convert ______ into ______ and ________.
43
What is the disease that is an autoimmune disorder of the thyroid gland?
43
What is there excess of in Graves disease?
43
What is the name for a hyperfunctioning benign tumor of the thyroid gland?
44-
What are six hyperthyroidism clinical features?
- increase in basal metabolic rate
- cardiac manifestations
- overactivity of the sympathetic NS
- ocular changes
- skeletal system effects
- thyroid storm
44
What are 4 things seen with the increase in basal metabolic rate in hyperthyroidism?
44
What is the earliest and most consistent sign of hyperthyroidism?
44
What are 4 examples of the cardiac manifestations associated with hyperthyroidism?
45
What are four examples of overactivity of the sympathetic nervous system seen in hyperthyroidism?
45
What are two ocular changes seen with hyperthyroidism?
45
True thryoid opthalmia associated with ____ occurs only in _______.
46
In hyperthyroidism, affects on the skeletal system stimulates _____, increased _______ and reducing _________ causing osteoporisis and increased risk of fractures.
46
Thyroid storm is a _______. It is an abrupt onset of _________ that occurs most commonly in patients with Graves disease.
50
Graves disease is an _____ disorder.
50
Graves disease has a peak incidence in people between _____ years of age.
50
What is the ratio of women to men affected with Graves disease?
50
Graves disease is chaaracterized by the production of _____ against _______, most importantly the _______.
50
Graves disease is the most common cause of __________.
51
What is localized, infiltrative dermopathy, aka pretibial myxedema?
51
What is the triad of clinical findings seen in Graves disease?
54
What lab values are elevated in Graves disease?
54
What lab values are decreased in Graves disease?
57
What is hypothyroidism in children called?
55
What are three sources of treatment for Graves Disease?
57
What is hypothyroidism in adults called?
57
What is Hashimoto thyroiditis?
58
Hypothyroidism is a condition caused by a ______ that interferes with the production of thyroid hormone.
58
Hypothyroidism prevlance ____ with age.
58
What is the ration of women to men affected by hypothyroidism?
59
What are 5 clinical features of creatinism?
61
Early symptoms of myxedema include _______, ____, and ______ which mimics depression.
61
In myxedema, _____ and _______ are slowed.
61
Myxedema patients are _____, _____ intolerant, and frequently ______.
61
Do patients have an increased or decreased cardiac output in myxedema?
63
Lab values play a vital role in the diagnosis of suspected hypothyroidism because of the _________ of symptoms.
63
TSH levels are _____ in primary hypothyroidism.
63
TSH levels are not increased if hypothyroidism takes place at the ________ or _________ levels.
63
What is the most sensitive screening test for hypothyroidism?
68
Hashimoto Thyroiditis is caused by what?
68
Hashimoto Thyroiditis predisposition has a strong ______ component.
69
Hashimoto Thyroiditis is ______ enlargement of the thyroid gland associated with some degree of hypothyroidism.
69
What group has a higher prevalence of hashimoto thyroiditis?
69
The enlargement of the thyroid seen in Hashimoto Thyroiditis is ____ and _____.
69
People with Hashimoto thyroiditis are at an increased risk of _______ and ______.
70
What lab values are decreased in Hashimoto thyroiditis?
70
What lab values are increased in Hashimoto thyroiditis?
72
What is a goiter?
72
Goiter may be associated with ______ in thyroid function or with _________ or __________.
73
What are the two types of goiter?
75
What are the two neoplasms of the thyroid?
75
Is thyroid adenoma benign or cancerous?
75
Is thyroid carcinoma benign or cancerous?
76
The major concern in persons presenting with thyroid nodules is the possibility of ________.
76
Benign thyroid neoplasms outnumber malignant neoplasms by a ratio of ______.
76
Most of the thyroid malignancies are ___, meaning they mostly do not ______.
76
A history of _______ to the head and neck region is associated with an increased incidence of thyroid malignancy.
78
Thyroid adenomas are typically ____, ____ masses derived from ________.
78
With thyroid adenomas are there more functional or nonfunctional adenomas?
78
Are thyroid adenomas painful or painless masses?
78
Larger thyroid adenomas may produce difficulty in ______.
81
What is the 5 year survival rate for thyroid carcinoma?
78
What is the treatment for thyroid adenomas?
81
What sex is thyroid carcinoma more common in?
81
After what age is thyroid carcinoma more common in?
81
Thyroid carcinoma frequently presents ________.
81
What is the sign associated with thyroid carcinoma?
81
What symptom is associated with thyroid carcinoma?
82
What are the four subtypes of thyroid carcinoma?
82
What percent of the time is papillary thyroid carcinoma seen?
82
What percent of the time is follicular carcinoma seen?
82
What percent of the time is poorly differentiated and anaplastic carcinoma seen?
82
What percent of the time is medullary carcinoma seen?
82
From what cells does medullary carcinoma arise from?
83
Lymphoma of thyroid may occur in the setting of _______.
83
Is lymphoma of the thyroid curable?
85
Parathyroid glands are derived from the ________.
85
Parathyroid glands are located on the _______ and _______ of each thyroid lobes.
85
How many parathyroid glands are there?
85
What are the 2 cell types in parathyroid glands?
85
Oxyphil cells have _______ containing ________.
87
What is the number 1 function of parathyroid glands?
87
The activity of the parathyroid gland is controlled by the levels of ________.
87
Decreased levels of free calcium stimulates the ____ and ____ of the ____ hormone.
89
What are three associated disorders of primary hyperparathyroidism?
89
What percent of the time is hyperplasia seen in primary hyperparathyroidism?
89
What percent of the time is adenoma seen in primary hyperparathyroidism?
89
What percent of the time is carcinoma seen in primary hyperparathyroidism?
89
What disorder is associated with secondary hyperparathyroidism?
89
What disorder is associated with tertiary hyperparathyroidism?
90
Primary hyperparathyroidism has elevated levels of ____.
90
What is one of the most common endocrine disorders?
90
Is primary hyperparathyroidism more common in adults or children?
90
Is primary hyperparathyroidism more common in women or men?
90
Primary hyperparathyroidism can be ____ or _____.
90
What are the four clinical manifestations of primary hyperparathyroidism if it is symptomatic?
91
In what percent of primary hyperparathyroidism patients are renal stones seen?
91
What are three issues associated with the bones of patients with primary hyperparathyroidism?
91
What are two abdominal issues with with patients with primary hyperparathyroidism?
91
Peptic ulcers in patients with primary hyperparathyroidism are associated with _____ that ____ after surgical excision.
91
What causes the moans of primary hyperparathyrodism?
92
Detection via screenings of what two things would indicate primary hyperparathyroidism?
92
What is a treatment for primary hyperparathyroidism?
93
Brown tumors are _______ that may appear in severely affected primary hyperparathyroidism patients.
93
Brown tumors of primary hyperparathyroidism have excessive _____ activity.
93
What gives the brown appearance of brown tumors?
93
Brown tumors appear identical to what?
93
What is the most severe skeletal manifestation of primary hyperparathyroidism?
93
Osteitis fibrosa cystica develops from _______ and _____ of long-standing brown tumors.
95
The endocrine pancreas consists of ____ clusters of cells known as ________.
95
Iselts of Langerhans contain ___ major and ___ minor types of cells.
95
What are the four major types of cells of the endocrine pancreas?
95
What are the two minor cell types of the endocrine pancreas?
96
Beta cells of the endocrine pancrease produce ____, which regulates _______ in tissues and reduced _____ levels.
96
Alpha cells of the endocrine pancreas secrete _____, which stimulates _____ in the liver and thus _____ blood sugar.
96
Delta cells of the endocrine pancreas secrete _____, which suppresses ________ release.
96
PP cells of the endocrine pancreas secrete ______, which exert several ___ effects, such as stimulation of secretion of _______ and inhibition of _____.
98
D1 cells of the endocrine pancrease secrete _________, a hormone that induces _____ and ______.
98
Enterochromaffin cells of the endocrine pancreas synthesize _______.
99
Diabetes mellitus is a group of ______ sharing the common feature of _______.
99
Diabetes mellitus is caused by defects in _______, ______, or most commonly, _____.
100
What are five consequences of diabetes mellitus?
101
In hyaline arteriolosclerosis, there is deposition of _______ and ________ in vascular walls, making them ______.
101
Hyaline arteriolosclerosis is most evident in the ____, ______, ____, and _______.
102
Atherosclerosis occurs in most diabetes within ________ years of onset of Diabetes Mellitus, regardless of _____.
102
5% of nondiabetics _____ years old have ________ atherosclersoso vs. ___ of diabetics.
102
What is the most common cause of death in diabetics?
104
What is the most severely damaged organ in diabetics?
104
What are three conditions seen in people with diabetic nephropathy?
104
What is the name of the lesion seen in the kidneys of people with poorly controlled diabetes mellitus?
105
Diabetic retinopathy includes retinal _____. ______, and ______.
105
Diabetic retinopathy involves retinal damage due to ______, which is the ________.
105
What are two consequences of diabetic retinopathy that contribute to visual impairment.
105
_____% of patients develop some form of diabetic retinopathy _____ years after diagnosis.
106
Diabetic neuropathy is _____ neuropathy involving both the _____ and _______ nerves of legs.
106
Diabetic neuropathy may affect _________ nervous system leading to ____ and _____ dysfunction and impotence.
107
What are two oral manifestations of diabetes?
109
The adrenal gland is a ____ endocrine gland consisting of a ___ and a ____, which differ in their development, structure, and function.
109
What are the three zones of the adrenal cortex?
109
What does the zona glomerulosa synthesize?
109
What two things does the zona reticularis synthesize?
109
What does the zona fasciculata synthesize?
109
The adrenal medulla is composed of ______ cells that synthesize _____, mainly ______.
110
What are the two mineralocorticoids produced by the zona glomerulosa?
110
What are the two glucocorticoids produced by the zona fasciculata?
110
What are the two androgens produced by the zona reticularis?
110
What are the two catecholamines and the two peptides produced by the medulla of the adrenal gland?
112
What is the disorder associated with hyper cortisol?
112
What is the disorder associated with hyper aldosterone?
112
What is the disorder associated with hyper androgens?
114
Cushing syndrome is a disorder caused by conditions that produce _________.
114
What is the ration of women to men affected by Cushing Syndrome?
115
What is the sequence of four common symptoms seen in people with Cushing Syndrome?
116
What are 7 common findings of Cushing Syndrome?
118
What disorder is associated with Hypoadrenocorticism?
120
Clinical features of Addison disease do not begin to appear until at least ____% of the glandular tissue has been destroyed.
120
In Addison disease, with gradual destruction of the adrenal cortex, there is insidious onset of what 5 symptoms?
121
What is bronzing in Addison disease?
121
In Addison disease, bronzing is more prominent in ____ skin and over ________.
121
In Addison disease, bronzing is caused by elevated levels of __________, derived from the _________ and is a precursor of both ______ and _________.
123
What are the oral manifestations seen in Addison disease?
123
What is the first manifestation of Addison disease?
125
What are the levels of ACTH in primary hypoadrenocorticism?
125
What are the ACTH in secondary hypoadrenocorticism?
126
What is the treatment for Addison Disease?
126
The physiologic dose of glucocorticoids for Addison disease treatment is approximately ______ mg of hydrocortisone or its equivalent per day in divided doses.
126
Under stressful conditions, someone with Addison disease may need additional hormone above the physiologic dose. However, this adjustment is not required for dental procedures performed using ____ and lasting ______.
129
In normal situations, cortisol is critical for function of the body, particularly in dealing with _____.
129
As cortisol is metabolized and serum levels drop, feedback to the _____ signals it to produce _____, which stimulates the adrenal gland to produce _______.
130
In Addison disease, therapeutic corticosteroids have what effect? What may be precipitated as a result of this?
132
To avoid Addisonian crisis, the clinician must be aware of the potential side effects of _________ and must be able to adapt the treatment of the patient accordingly.
132
For stressful dental and surgical procedures it is often necessary to increase the ______ because of the greater need of cortisol. Consultation with the physician who is managing the corticosteroid therapy is advised.
133
How are cortisol, aldosterone, ACTH, and CRH levels affected in primary adrenal insufficiency when there is negative feedback?
133
How are cortisol, aldosterone, ACTH, and CRH levels affected in secondary adrenal insufficiency when there is negative feedback?
133
How are cortisol, aldosterone, ACTH, and CRH levels affected in tertiary adrenal insufficiency when there is negative feedback?
134
What is the most common cause of hypoadrenocorticism in Western countries?
134
What are three examples of infections that can cause hypoadrenocorticism?
134
What are 4 things that rarely cause hypoadrenocorticism?
137
The adrenal medulla is composed of ____ cells and their supporting cells known as ______ cells.
137
The adrenal medulla is a major source of _____ in the body.
137
_______ cells like chromaffin cells are widely dispersed in an _______ system of clusters and nodules that together with the adrenal medulla make up the ________ system.
138
What is pheochromocytoma?
138
What are neuroblastic tumors?
139
What do pheochromocytomas synthesize and release?
139
It is important to recognize pheochromocytomas because they are a rare cause of _______.
141
Traditionally, the features of pheochromocytomas have been summarized by the _______.
141
The rule of 10s for pheochromocytomas:
- 10% of pheochromocytomas are _____.
- 10% of sporadic adrenal pheochromocytomas are ______.
- 10% of adrenal pheochromocytomas are biologically ______.
- 10% of adrenal pheochromocytomas are not associated with _____.
141
The traditional 10% rule that has now been modified for pheochromocytomas pertains to _______. ___% of individuals with pheochromocytomas and paragangliomas harbor a _______.
143
What is the dominant feature of pheochromocytoma and in what percent of cases is it seen?
143
What are two treatment options for pheochromocytomas?
144
Neuroblastoma is a cancer composed of ________.
144
Neuroblastomas most commonly arise in and around _____ which have similar origin to ______.
144
Neuroblastomas are a common malignant tumor in _____. The median age at presentation is _____, with peak ages _____.
144
Neuroblastomas are slightly more common in what sex?
146
What are the three types of multiple endocrine neuroplasia syndromes?
146
Which multiple endocrine neuroplasia syndrome has oral manifestations?
147
What is another name for MEN1 syndrome?
147
What is the inheritance pattern for MEN1?
147
MEN1 is a syndrome characterized by mutations in the _______.
147
MEN1 Syndrome involves the development of _______.
147
What are the 3 P’s of MEN1 syndrome?
150
What is another name for MEN-2A syndrome?
150
What three things characterize MEN-2A syndrome?
151
What 5 things do patients with MEN-2B Syndrome develop?
151
How does medullary carcinoma of the thyroid in MEN-2B compare to that of MEN-2A?
152
What are the oral manifestations seen in MEN-2B?
