Exam 4 - Chapter 21

Question 1

Prolactinoma

Answer 1

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

Question 2

Gigantism

Answer 2

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

Question 3

Acromegaly

Answer 3

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

Question 4

Marfan’s Syndrome

Answer 4

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

Question 5

Pituitary Cachexia

Answer 5

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

Question 6

Hypopituitarism

Answer 6

Deficient secretion of one or more pituitary hormones, usually caused by adenomas/tumors

Question 7

Panhypopituitarism

Answer 7

Total failure of pituitary function, usually caused by adenomas/tumors

Question 8

Sheehan Syndrome

Answer 8

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

Question 9

Empty Sella Syndrome

Answer 9

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

Question 10

SIADH (Syndrome of Inappropriate ADH)

Answer 10

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

Question 11

Diabetes Insipidus

Answer 11

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

Question 12

Cretinism

Answer 12

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

Question 13

Myxedema

Answer 13

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

Question 14

Goiter

Answer 14

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

Question 15

Multinodular Goiter

Answer 15

Causes: Long-standing simple goiter
Pathology: Asymmetrical, nodular enlargement, with possible colloid-rich follicles
Symptoms: Euthyroid, hyperthyroid, dysphagia or hoarseness
Treatment: Synthetic levothyroxine

Question 16

Hashimoto Thyroiditis

Answer 16

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

Question 17

Grave’s Disease

Answer 17

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

Question 18

Plummer Disease

Answer 18

Toxic multi-nodular goiter

Less severe symptoms of hyperthyroidism than Grave’s disease, and no exopthalmos

Question 19

Thyroid Carcinomas

Answer 19

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

Question 20

Primary Hyperparathyroidism

Answer 20

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

Question 21

Secondary Hyperparathyroidism

Answer 21

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

Question 22

Hypoparathyroidism

Answer 22

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

Question 23

Pseudohypoparathyroidism

Answer 23

Similar to hypoparathyroidism, but instead of not making enough PTH, the body doesn’t respond well to the PTH

Similar symptoms

Question 24

Cushing Syndrome

Answer 24

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

Question 25

Conn Syndrome (Primary Hyperaldosteronism)

Answer 25

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

Question 26

Congenital Adrenal Hyperplasias

Answer 26

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

Question 27

Addison Disease (Primary Adrenocortical Insufficiency)

Answer 27

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

Question 28

Adrenal Medulla Functions

Answer 28

Produce catecholamines which stimulate sympathetic nervous system (such as norepinephrine and epinephrine

Question 29

Pheochromocytoma

Answer 29

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

Question 30

Neuroblastoma

Answer 30

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