Exam 4 - Chapter 21 Flashcards
Prolactinoma
Most common type of pituitary adenoma (tumor)
Causes: Pituitary lactotroph adenoma
Pathology: Multiple chromophobic cells containing prolactin
Symptoms: Females - Amenorrhea, glactorrhea, increased prolactin. Males - Decreased libido and headaches. Decreased LH and FSH levels
Treatment: Dopamine agonists to suppress prolactin production
Gigantism
Pituitary adenoma resulting in being tall
Causes: Pituitary somatotropic adenoma appears before epiphyseal closure
Pathology: Multiple acidophilic cells containing GH
Symptoms: Tall stature
Treatment: Octreotide
Acromegaly
Pituitary adenoma resulting in being huge
Causes: Pituitary somatotropic adenoma appears after epiphyseal closure
Pathology: Multiple acidophilic cells containing GH
Symptoms: enlargement of hands, feet, skull, and jaw. Insulin resistance (hyperglycemia). Cardiomegaly
Treatment: GH receptor agonist
Marfan’s Syndrome
Disorder that affects connective tissue
Causes: Mutation in fibrillin gene, usually hereditary
Pathology: Cystic medial necrosis of aorta (leads to dilation), mitral valve prolapse. Dislocation of lens. Spinal deformities
Symptoms: Tall stature with long extremities, hyperextensible joints, arachonodactyly, ectopia lentis (dislocation of lenses), scoliosis
Treatment: Treating the individual symptoms
Pituitary Cachexia
Necrosis of anterior pituitary
Causes: Pituitary adenomas, Sheehan syndrome
Pathology: Circumscribed lesion
Symptoms: Generalized panhypothyroidism, decreased TSH, infertility (decreased LH and FSH), bitemporal hemianopsia (loss of lateral vision)
Treatment: Hormone replacement
Hypopituitarism
Deficient secretion of one or more pituitary hormones, usually caused by adenomas/tumors
Panhypopituitarism
Total failure of pituitary function, usually caused by adenomas/tumors
Sheehan Syndrome
Pregnancy-related pituitary infarction
Causes: Glands double in size during pregnancy, but blood flow doesn’t compensate. Child birth results in life-threatening blood loss and hypopituitarism
Pathology: Loss of gonadotropins, then TSH and ACTH
Empty Sella Syndrome
Enlarged sella containing a thin, flattened pituitary at the base
Causes: Congenital defect or absent sella
Symptoms: Usually minor but hyperprolactinemia, amenorrhea, acromegaly, diabetes insidipus, Cushing syndrome
SIADH (Syndrome of Inappropriate ADH)
Posterior pituitary disease
Causes: Ectopic ADH production by small-cell carcinoma
Pathology: Water retention in nephrons, resulting in low blood sodium and decreased serum osmolality
Symptoms: Fatigue and confusion
Treatment: Fluid restriction
Diabetes Insipidus
Deficiency of ADH
Causes: Tumors, hypothalamus damage, pituitary damage, trauma
Symptoms: 3 p’s: Polydipsia (Increased thirst), Polyuria (Increased urination), and Polyphagia (Increased appetite)
Treatment: ADH analog
Cretinism
Hypothyroidism occurring in neonates and infants
Causes: Iodine deficiency, congenital deformity of thyroid, deficiency of enzymes that synthesize TH
Pathology: Hypothyroidism
Symptoms: Severe mental retardation, impaired physical growth, dwarfism, goiter, edematous face, large tongue, big abdomen
Treatment: Synthetic levothryoxine
Myxedema
Hypothyroidism in adults, most common in middle-aged women
Causes: Idiopathic, iodine deficiency, destruction of thyroid
Pathology: Hypothyroidism
Symptoms: Cold intolerance, low metabolic rate, lowered pitch, constipation, mental/physical slowness, periorbital edema, thickening of face and hands, pale dry skin, hair loss, goiter, hypotension, hypothermia, bradychardia
Treatment: Synthetic levothyroxine
Goiter
Enlargement of thyroid
Simple Goiter (nontoxic goiter): Goiter without thyroid
hormone dysfunction. Includes euthyroid and hypothyroid
Toxic Goiter: Goiter associated with hyperthyroidism
Endemic Goiter: Goiter occurring with high frequency in
iodine-deficient geographic areas
Sporadic Goiter: Goiter in non-iodine-deficient areas
Nodular Goiter: Irregular enlargement of the thyroid,
resulting in nodule formation
Nodular Colloid Goiter: Late stage of simple goiter in which goiter looks nodular; nodules may be single
or multiple
Multinodular Goiter
Causes: Long-standing simple goiter
Pathology: Asymmetrical, nodular enlargement, with possible colloid-rich follicles
Symptoms: Euthyroid, hyperthyroid, dysphagia or hoarseness
Treatment: Synthetic levothyroxine
Hashimoto Thyroiditis
Destruction of thyroid
Causes: Autoimmune, HLA-DR5, more common in middle-aged women
Pathology: Anti-thyoglobulin, anti-microsomal antibodies, lymphocytic and plasma cell infiltrate
Symptoms: Weight gain, brittle hair, pallor, puffy face, cold intolerance, fatigue, muscle weakness
Treatment: Synthetic levothyroxine
Grave’s Disease
Hyperthyroidism caused by toxic goiter, most common in middle-aged women and patients who are HLA-DR3 and HLA-B8 positive
Causes: Autoimmune
Pathology: Thyroid-stimulating immunoglobulin (TSI) and thyroid growth immunoglobulin (TGI) react with receptors which stimulate TH production and glandular growth
Symptoms: Weight loss, sweating, rapid heartbeat, irritability, exopthalmos, low TSH
Treatment: Antithyroid drugs, thyroidectomy, radioactive iodine
Plummer Disease
Toxic multi-nodular goiter
Less severe symptoms of hyperthyroidism than Grave’s disease, and no exopthalmos
Thyroid Carcinomas
Thyroid tumors and cancers. Painless masses in neck
Papillary: Cuboidal cells with clear nuclei (Orphan Annie Nuclei), 75-80% of cases, can metastasize to local lymph nodes
Follicular: Small, uniform follicles filled with colloid. Incidence is 20% but aggressive. Metastasizes to lung and bone via hematogenous spread
Medullary: Amyloid deposits in tumor and increased serum calcitonin. Incidence is 5% but aggressive. Secretes calcitonin
Anaplastic: Pleomorphic giant cells arranged in solid sheets, small anaplastic cells. Incidence is 1%, highly malignant, poor prognosis
Primary Hyperparathyroidism
Parathyroid glands produces excess calcium which results in hypercalcemia
Causes: PTH adenoma or other PTH disorders
Pathology: Hypercalcemia, hypercalcuria, increased PTH levels, increased serum alkaline phosphate, decreased serum phosphate, increased urinary phosphorous
Symptoms: Osteitis fibrosa cystica (cystic spaces in bone filled with fibrous tissue i.e. brown tumors, due to increased osteoclast activity) and bone pain, nephrocalcinosis, peptic ulcers, constipation, weakness, polyuria, altered mental status
Treatment: Surgical removal of glands
Secondary Hyperparathyroidism
Parathyroid hyperplasia in response to decreased concentration of serum ionized calcium
Causes: Hypocalcemia due to chronic renal failure
Pathology: Increased PTH, increased serum alkaline phosphate, increased serum phosphate, decreased serum calcium
Symptoms: Diffues osteoclastic bone disease, metastatic calcification
Treatment: Surgical removal of glands
Hypoparathyroidism
Shrinkage of parathyroid glands due to decreased PTH
Causes: Surgical removal of parathyroid glands, congenital absence of parathyroid glands, radioactive iodine therapy
Pathology: Hypocalcemia, decreased PTH levels, increased serum phosphate levels
Symptoms: Tetany, neuromuscular irritability, Trousseau sign, Chvostek sign
Treatment: Calcium and vitamin D
Pseudohypoparathyroidism
Similar to hypoparathyroidism, but instead of not making enough PTH, the body doesn’t respond well to the PTH
Similar symptoms
Cushing Syndrome
High cortisol levels from hyper function of adrenal cortex
Causes: Hypercotisolism, exogenous corticosteroid medication, increased ACTH production, adrenal corticol adenoma/carcinoma, ectopic ACTH-secreting tumors such as small cell carcinoma
Pathology: Iatrogenic - adrenocorticol atrophy, ACTH Overproduction - bilateral nodular hyperplasia of cells in zona fasciculata, Adrenal Adenoma - small encapsulated lesion of zona fasciculata cells, Pituitary Hyperplasia/Adenoma - collection of basophilic cells
Symptoms: Truncal besity, hypertension, moon facies, buffalo hump, muscle wasting, hyperglycemia, skin changes, osteoporosis, hirsutism, immune suppression
Treatment: Surgical resection of pituitary/adrenal adenoma, ectopic ACTH-secreting tumors
Conn Syndrome (Primary Hyperaldosteronism)
Overproduction of aldosterone
Causes: Aldosterone-secreting adrenocortical adenoma
Pathology: Adenoma and hyperplasia of adrenal cortex
Symptoms: Hypertension, headache, polyuria, polydipsia, sodium and water retention, hypokalemia and hypokalemic alkalosis, overproduction of adrenal sex hormones, decreased serum potassium, decreased renin levels
Treatment: Adrenalectomy
Congenital Adrenal Hyperplasias
Excess sex steroids with hyperplasia of both adrenal glands
Causes: Autosomal recessive deficiency in enzymes involved in biosynthesis of cortical steroids
Pathology: Hydroxylase deficiencies which interfere with aldosterone, cortisol, and sex hormone production
Symptoms: Clitoral enlargement (females), precocious puberty (males), masculinization, hypotension, hypertension, no salt wasting
Treatment: Replacement of decificient hormones
Addison Disease (Primary Adrenocortical Insufficiency)
Adrenal atrophy resulting in cortical hypofunction
Causes: Idiopathic, autoimmune
Pathology: Few cortical cells
Symptoms: Hyperpigmentation due to increased ACTH levels, weakness/fatigue, nauseau and vomiting, hypotension, hypoglycemia, hyponatremia, hyperkalemia
Treatment: Corticosteroids
Adrenal Medulla Functions
Produce catecholamines which stimulate sympathetic nervous system (such as norepinephrine and epinephrine
Pheochromocytoma
Adrenal medulla tumor containing lesions
Causes: 90% benign and sporadic, 10% malignant
Pathology: Nests of polygonal chromaffin cells, increased urinary excretion of catecholamines and metanephrine levels
Symptoms: Bouts of hypertension, headache, palpitations, diaphoresis, hyperglycemia
Treatment: Alpha or beta calcium channel blockers to control hypertension
Neuroblastoma
Highly malignant adrenal medulla tumor that occurs early in childhood and produces catecholamines
Pathology: Small, round, blue cells which form rosette-like structures, increased urinary excretion of catecholamines and metanephrine levels, large abdominal mass in adrenal medulla
Symptoms: No hypertension
Treatment: Surgery, chemo, radiation
